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DS-16-412 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2201 Fax: (305)756-8972 inspection Number: INSP-252890 Permit Number. DS-2-16412 Scheduled Inspection Date: May 27,2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Mesa,Michel Inspection Type: Final Owvner. THOMAS,LOUIS DE Work Classification: Addition/Alteration Job Address:1235 NE 100 Street Miami Shores,FL 33138-2603 Phone Number .(30$)786-4922 Parcel Number 1132050080040 Project: <NONE> Contractor: MIAMICRETE INC Phone: (305)790.4850 Building Department Comments PLAIN CONCRETE DRIVEWAY infractio Passed meats INSPECTOR COMMENTS False Inspector Comments Passed eJ To Failed Correction Needed Re-Inspection Fee No Additional insimctions can be scheduled until n3-inspection fee Is pail. 4� Mav 26.2016 For Inspections please call:(305)782.4949 Paae 3 of 26 "SUPERIOR MIX CORP. .89445 NW TERR UPAN Mi . Z MIAMI, Fl.. 33186 �,� l ;PHQNE: 305 887 0030 . "4 41" FP►)C�rS 887 OOg1: Make Checks,F�a �®T0.SUPERIOR MIX , '�Iln>I w. itperiormix.not ' 4 ,.e • • MIAhIIPRETE b 7�*►/1y+�Zqq►7yoW 16 ST IIIa . I235 'NE 100 ST • ti Rif J. .er reef '433K� OSCAR • • o 11#0■ �;;. .�iZpm 3 +0+0 F!ump. MIX X + EhfV T EI.lt�>'FEE-,tFU CH 5. 0 f4F IS) mW,, AMOUNT SLUMP THIS DELIVERY TOTAL CU.YDS. , TAX ' TOTAL:` 8 �6 OF YOUR ORDER FOCU.YDS. i '!7{.j 3P.■i Cj�STOMEft OR HIS AGENT ASSUMES PULL RESPONSIBILITY FOR STRENGTH AND/OR PERFORMANCE OF ANY CONCRETE PLACED ' ABOVE DpSIGN SLUMP OR WHEN WATER IS ADDED. � WATER ADDED, YES ❑ NO GLS. NYER,OR HIS AGENT,,AGRELS TO ASSUME RESPONSA86TY FOR CONCRETE,AND ANY PROPERTY'DAMAGE'RESULTING FR0141 TRUCK MAKING DELIVERY BEYOND CURB Li111E.ALL'CLAIM$MUST / TIME 00-DELIVERY. F- I,E IT BECOME EQLSSARY T�BRIN ANY z; f r. 5 N ACTION TO COLLECTAMOUNTS DUE THIS INVOICE PUFtCHASERSHi "61=7tES ' F��$"1?��EASONAB�CEATTORNBXS FEES AND COURT.COSTS INCURID BY VENDOR IN SECURING COLLEC,�TIONS.INTEREST SHALLACCRUE AT 2°E'ER MO Tli SONAN NG BALANCES.,' ■ ■UNLOA.M�j LEAVING THE JOB UNLOADING ■ G, ACC>REX CERTIFICATE OF LIABILITY INSURANCED 2;1"x'YM 16 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()es)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 CONTACT ACCURATE GROUP LLC NAME: E I FAX 8300 W FLAGLER ST SUITE 114 AIC,No,F4: AIC,No: E-MAIL MIAMI FL 33144 ADDRESS: 76G4B INSURERS AFFORDING COVERAGE NAIC# INSURERA:FLORIDA W.C. JUA INSURED INSURER B: MIAMICRETE, INC. INSURER C: 7910 SW 16TH ST MIAMI FL 33155 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. INSR ADOL SUSR POLICY EFF POLIO LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYY MWDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES a occurrence $ CLAIMS-MADE EJOCCUR MED EXP(Any oneperson) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMPIOP AGG POLICY PROJECT f I LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me accident S ANY AUTOOFULED BODILY INJURY Per personl S ANEO AUTOS NON-OWNED BODILY INJURYPer accident $ AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED1 IRETENTION S A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY (GFR 13UB-7D77031-1-15) 09-29-15 09-29-16 X TORY LIMITS ER ANY PROPRIEfORIPARTNERIEXECUTIVE MINIMUM PREMIUM POLICY OFFICERIMEMBER EXCLUDED? YIN EL.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) Y NIA EL.DISEASE—EA EMPLOYEE S 1-000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—PO-IJCY LIMIT IS 11,000.000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,d more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MIAMI SHORES VILLAGE EXPIRATION DATE THEREFO.NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT AUTHORIZEOREPRESENTATIVE 10050 NE 2 AVE MIAMI SHORES VILLAGE FL 33138 131988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD EMW V Miami Shores Village 4. 10050 N.E.2nd Avenue NE , Miami ShoresFL 33138-0000 2 "' tae Phone: (305)795-2204 ; M Expiration: 08/23/2016 affim Project Address Parcel Number Applicant 1236 NE 100 Street 1132050080040 LOUIS DE THOMAS Miami Shores, FL 33138-2603 Block: Lot: Owner Information Address Phone Cell LOUIS DE THOMAS 1235 NE 100 Street (305)796-4922 MIAMI SHORES FL 33138-2603 Contractor(s) Phone Cell Phone $ 10,000.00 Valuation: MIAMICRETE INC (305)790-4850 -------� �----- Total Sq Feet: 1200 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:PLAIN CONCRETE DRIVEWAY Additional Info: Review Planning Bond Retum: Classification:Residential Review Building Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# DS-2-16-58690 CCF $6.00 0225/2016 Credit Card $629.50 $50.00 DBPR Fee $2.25 DCA Fee $2.25 02/162016 Credit Card $50.00 $0.00 Education Surcharge $2.00 Bond#:2995 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $8.00 Total: $679.50 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 AFFIDAVI . I ify'that al the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni Fu ami authorize the above-named contractor to do the work stated. February 25,2016 Authorized Signatu :Owner / Applicant / Contractor / Agent Date Building Department Copy February 25,2016 1 Miami Shores Village 7Y ; Zofo Building Department Q-2t'- 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(WS)762-4949 FBC 1t2014 BUILDING Master Permit No. d�'1 10 " Li 12— PERMIT APPLICATION Sub Permit No. XBUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL []PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑SHOP �1CONTRACTOR DRAWINGS JOB ADDRESS: K-7-- . City: Miami Shores County: Miami Dade Zin: / Folio/Parcel#: js the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): AOL., T S 4,' ne#: G Address: 7*i ;S-3 a t� City:S State: 06 Zip: Tenant/Lessee Name: /Q� Phone#: Email: !� �� o r� /4 5 %� e%Q . CONTRACTOR:Company Name: (µ for .1- C Phone#: Address: ��(0 7� �70 1 City: yk l State: 1 Zip: l Qualifier Name: 1)NW, Phone#: State Certification or Registration#: Certificate of Competency#: 02) ' W DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Va $ /0 o 01c>--b !sem 7 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: TU�ZA Specify color of color thru tile: Submittal Fee$5U' Permit Fee$ ! CCF$ CO/CC$ or Scanning Fee$ ' _ Radon Fee$ DBPR$ ' �� Notary$ Technology Fee$ CJ cr�, Training/Education Fee$ C) Double Fee$ Structural Reviews$--(2-> Bond$ = ' TOTAL FEE NOW DUE$ c � • ® (Revised02/24/2014) p ' go 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 grthe Job site for the first Inspection which occurs seven (7) days after the building permit isIs In the ab ce of such p ed notice, the Inspection will not be app r nspection fee will be charged. to Signature Signature "Wr �/ i� OWNE or AGENT CONTRACTOR Th foregoing Instrument was acknowledged before me this The foregoing instrument was acknowld ed before me this day of � 20 by _day of ,20ZZe by 1 619 uho is personally known to gf- �� C/4&/ who is personally known to 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: NOTARY PUBLIC: Sign: Sign: ". RODRIGO ALVAREZ ?"YP"e4= ROOK ' MY COMMISSION#EE884004 Print: P Print: E*PIAES Moch 110.2617 Seal: -A EXPIRES Iviarch 14.2017 Seal: 71 » F+-WmIetags—icecom .�4 �J (gp7i39"IS3 FlordaNcitarySPNIoB.Com APPROVED BY a'u' Plans Examiner L Zoning Structural Review Clerk (Revised02/24/2014) 1111111111111130 CFN 2s�1tSFa•OO9'4 306 OR EK 29963 Pss 1420-1021 QPss) RECORDED 02/16/2016 12:36:35 HARVEY RUVINY CLERK OF COURT DOCUN IENT COVER PAGE r�I€�r�I-c�A E cour�TYP FLORIDA For those documents not providing the mquired.3 x 3 inch space on the first page,this cover page must be attached. It must describe the document in sufficient detail to prohibit its transference to another document. An additional recording fee for this page must be remitted. ------------------------------------- (Space ---------------------- ---- -- (Space above this line reserved for recording office use) Document Title: (91;�_ (Mortgage,Deed,Construction Lien,Etc.). Executing Party: Legal Description: (If Applicable) As more fully described in above described document. Return Document To/Prepared By: (Relevant excerpts) Rule 2.520(d)On all..documents prepared...:..which are to be recorded in the public records of any county...a3-inch by 3-inch space atthe top right-hand comero�thefirstpage and al-inchby3- inchspaceatthetopright-handcomeroneachsubsequentpageshallbeleftblankandreservedfor use by the clerk of court R.S.695.26 Requirements forrecordinginshunents affectingrealproperty— (1)No instrument by which the title to real property or any interest therein is conveyed,assigned, noo encumbered,or otherwise disposed of shall be recorded by the clerk oithe circuit court unless: . w (e)A 3-inch by 3-inch space at the top right-hand corner on the first page and a 1-inch by 3-inch son space at the top right-hand comer on each subsequent page are reserved for use by the clerk of the court... 2 N K/rT 1 rV;Rcsv nAll A -t%.,.i.i..n-•....... .: ..:.t .t .t. .. OR BK 29963 PG 1021 UAST PAGE a Miami Shores Village Building Department 10050 N.E.2nd Avenue toad► Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner).Z d> 0 1 S _e a 3hereinafter referred to as the �3 j owner of the followirT g described property(address): c 7, �o � Legal Description V9 VS'-. Lot _Block Subdivision-'�ekj J�cS Folio# 'fA Reque is per ission to install (describe work): A/e- ,�.J /� ✓L-f W.A Within the public right of way of(address) IN CONSIDERATION of the approval of this permit by the Village,the owner agrees as follows: I. To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the Rem(s)to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an a ' !ed in the Public Records of Dade County, Florida by the Village Man er of tmi Sh es Village(or his fully authorized representative). Signature �' OCP �error Agent T e o' instrument was acknowledged before me this day of , 20&, by who !&- sonally known to me or who has produced asldenb kation io D IGO� 'AREZ �4 NOTARY PUB1• MY Miss[ E884004 Sign: . +, March 14,2017 (40n aes-o� Print: t STATE c �r , y�i+r J��'�pERKNP'C+c My Commission Expires �: wi rw ltd'M this oo an �V 0o 1 6 VWN5SS my hand an ficial Seal. ►RVEY R IN,C ,of Circuit and County Courts em U.O. oqp f� F TMASHIAARNOLD#201144 CTOB Construction Trades Qualifyinq Board BUSINESS CERTIFICATE OF COMPETENC 03BS00653 MIAMICRETE INC D.B.A. STUN Z ENRIQUE certified under the provisions of Chapter 10 of Miami-Dade CountN U - r CONTRACTING U" ML 091'3u/ u 100*1 sl �1' MOM ©ate Coity, State 16 T1 a F M ISS FTQ �841 t — !0 NOT MV J Y n 1 Y F14,7 NAt147lOCATi0111 RECEIPT NO. ri +` ' MKMICRM INC RENEWAL SEPTEMBER, .� 6— 9LQSW l fi>: 8378688 Must bedisplayg# W1 H'—1 . 3 5 Pvrsusm-# Sorg 4384[ 875.13 Ct� 2 ,4 � i �Td7cRa riQtonh!. r peyt►�rtlufi6alaaalB aassTax Tie Ott � �r,lt'tl OIt�iWldar aqt alifi6atlQnS,t0 d0(Itt8111e8e.ltaldar amst cmapiy tH rrylDtas etai'ratlnirematNs wrhich aQQtyto tfie t11i8in8a6. . -�� �E N0.61Db�mr>at ba dtsQleyed oa ali nommeroia!rehiclea-ABTemi—Ueda Cc>Ee Sec> � i �>� ��� z _�, _ ' Ear ire information,visit s�.,r o�... _ r � w AOI-^1"T'�FJ PAi. �, V. tl tt t(1iB$8111A fiii #girl t G>$tPT.n/0.ft 0E ? # THIS 74,734" S 4 T Pumuarst t4 otal#y � r z�} OWNER TYPE OF BUSINESS PAYMENT RECEIVEq ;et NpA1VlfCRETE INC SPECIALTY BUILDING CONTRACTOR BY TAX COLL13cTOR 225.00 10/02/201 CREDITCAPD-16-00041" i sipt to notvW in the folWmft tMmdaiQalides Aveature,Dorsi,Niaiea6,K"Blsaay�9 IYNainl gardens,A PAW takes.Palmetto Bay.Pinecteat.Suncor fates Be"Tom of Cutler Bay; MIA fwmate informatloo,visit wwwjdamide 5 '4 CERTIFICATE OF LIABILITY INSURANCE DA0211612016 YY) 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 how Is an ADDITIONAL INSURED,the polk y(les)must be endorsed. If SUBROGATION IS WAIVED,wNect to the terms and conditions of the policy,certain policies may require an endorselnertt A statement on this certificate does not confer rights to the certlficato holder in lieu of such andorsemerrt(e). PRODUCER Lucia Estreilt Accurate &M (305)226.8727 Nl (306)226-8767 8300 West Flagler Suite 114 ludeesael net Miami,FL 33144 RNSU AFFORDING COVERAGE NAC 0 Phone (305)226-8727 Fax 305)226-3767 INSURER A: Covington Spa Ciel Insurance Co. INSURED -INSURER 13: Progressive Insurance Com n Miamicxete Inc. INSURER C 7910 SW 16 5treO INSURER D: INSURER E Miami FL 33155- SURER 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. I TYPE OF INSURANCEWON POLICY NUMBER F Y Lem ® COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1#000,000.00 DAMAGE RENTED ❑ CLAIM"ADE ® OCCUR PREMISEST $ 100,000.00 ❑ MED EXP one person $ 5,000.00 A ❑ Y VBA354846-00 01/14/2016 01/14/2017 PERSONAL&AM INJURY $ 1,000,000.00 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ® POLICY ❑ j2CQT ❑ LOC PRODUCTS-COMPIOPAGG $ 1,000,000.00 ❑ OTHER $ AUTOMOBILELIABILITYN D 1 LIMIT 1,000,x.00 ® ANY AUTO SWILY NAM(Per person) $ B ❑ ABUT OWNED ® � Y 03339995-2 10/23!2015 04123!20EDULED 16 BODILY INJURY(Par aod�ttl S ® HIRED AUTOS El AUTO OAST $ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EWEN LIAS ❑CLAIMS-MADE AGGREGATE $ ❑ om ❑ RETENTION$ $ VIORKERSCOMPENSATION ®PER AND R�IPL.OYER$'LIABILITY YIN ANTUTE Y PROPRIETOR(PARTNERJEXECUTIVri---iN/A EL.EACH ACCIDENT $ OFFICERIMEMIER EXCLUDED? U � �attuy M NH) E.L.DISEASE-EA EMPLOYER$ DESCRIPTION OF OPERATIONS below EL DISEASE-FOI)CY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addhimal Rafuuits Sehodul%B mere eP�M►alutrod) License Number.03BS00653 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES IJE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICIKW NERED IN Building Department ACCORDANCE WITH THE POLICY PRO{ 10050 NE 2nd Ave AUTHORIZED REPRESMAWYE Miami Shores Village,FL 33138 j Lucia Estrella ®1986-2014 ACORD CO RATION. All rights reserved. ACORD 25(2014101)OF The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE °A��''010D2' o2/1I/2o16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THM 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(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 oqL—ate holder in lieu of such endorsements. PRODUC NTA ACCURATE GROUP LLC NAME` PHONE FAX 8300 W FLAGLER ST SUITE 114 'vc.No.Exc): E MAIL MIAMI ADDRESS: FL 33144 76G4B INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:FLORIDA W.C. JUA INSURER B: MIAMICRETE, INC. INSURER C: 7910 SW i6TH ST MIAMI FL 33155 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. INSR ADDLISUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDtYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED " PREMISES Ea occurrence S CLAIMS-MADE FDOCCUR MED EXP(Any oneperson) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMPJOP AGG POLICY PROJECT M LOC S AUTOMOBILE LIABILITY MBINED SING LIMIT Ea ac idem S ANY AUTO gRULED BODILY INJURY Per a of S ALL OWNED NON OWNED AUTOS AUTOS BODILY INJURY Per accident S HIREDAUTOS PROPERTY DAMAGE (Per accident) S S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS I" CLAIM&MADE AGGREGATE $ DEDI IRETENTION S WORKERS COMPENSATION OTH- A AND EMPLOYERS*LIABILITY (GFRI3UB-7D77031-1-15) /9-29-15 09-29-1G x O rTLlMirs ER ANY PROPRIETORIPARTNERIEXECUTIVE MINIMUM PREMIUM POLICY " OFFICERIMEMBER EXCLUDED? YM (Mandatory In NH) Y WA LEACH ACCIDENT 5 1.000.000 E LDISEASE—EA EMPLOYEES 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT IS 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) LICENSE NUMBER 03BS00653 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MIAMI SHORES VILLAGE EXPIRATION DATE THEREFO.NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE ` MIAMI NE 2 AVE MIAMI SHORES VILLAGE FL 33138 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SKETCH OF SURVEY Miami Shores Village d ?pfd ps, PROVED DATE rt Z NTNG DEPT 4. DDG DEPT Sl IBJECT TO COMPLIANCE WITH ALL FEDERAL. I n rF ANn MINTY Rlfl.ES AND 11MILII.ATIONR 100.00' M i All01 atj t 100.00' - - .. N. E. 1 00 ST RE ET T •• •�� --sus z —- -- --- -- -— — . ... .. . . . .. .. . . .. . . . . . • • • • • • • • • — .. .--'1.•: a --.M`)• - .. ••• • • • ••• • • •• UND Acis CERTIFICATE OF LIABILITY INSURANCE D°'5`"05t1a/201201 6 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:N the certificate holler Is an ADDITIONAL.INSURED,the polky(tes)must be endorsed.If SUSROGATION IS'WANED,subJect to the terms and conditions of Ho policy, certain pok*s may require an endorsement.A statement on this carlt6cate does not confer rights to the .certificate holder in lieu of such and s. Mmm ACCURATE GROUP LLC 8300 W FLAGLER ST SUITE 119 woo ADDR8S8: MIAMI FL 33199 AFFOiSl S CONPAGE MAIC 0 76G9B trEAA:FLORIDA N.C. JUA nt 6: MIAMICw=' INC. wsufumG: 1910 SW 16TH ST � MIAMI FIS 33155 ORKSM E: 91S 1M P COVERAGES CERTIFICATE NUMBER: REV110"NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ENSURED 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'FRMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .UABRAY CC EE DAMMETORMW COMMERMALGENEIMUASOM PR-04M we 0=01axe g MAaas aerAM ❑tKxAflt S j_nAGQAArATfUMrrAPPJMPM Uffosomw UAatUTY ANY AUTO WAMY Ift gEM)_ -•••.••••.. Y HIRED AUTOS jig= $ 16AUABH OCCUR UA#b Rs WORKERSCOMPORKIM A AM SMOVEW UAMM (6Ml3UB-7077031-1-15) 09-29-15 09-29-16x A MINIMUM PREMIUM POLICYOFFICOWMEMBERECUMM `HAG 1,000,000 �vho�l y WA � _ �. �„1,000,000 Wyo.descrft r' 1,000,000 am top"*OF OPIUMN&MMORIAMN MrAM • MM ts mqzq LOUIS DE TOMAS 1238 NE 100 ST,MIA SHOIL>tS ACAWMWS03BB0083 CERTIFICATE HOLDER CANCELLATION SNODU)AHOY Of THE AWN DESCRM POUMS 66 CAHCEU.eo 8514M THE MIAMI SHORES VILLAGE P �°ATE Tt�EF0,NOTICE WLL BE aE�M[ACCORD E ennt THE BUILDING DEPARTMENT ,aREPrNrATn+E 10080 SH 2 AVE MIAMI SHORES FL 33138 01988-2010 ACORD CORPORATION.AN righty reserved. ACORD 25(201&” The ACORD name and logo are registered marks of ACORD