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ELC-15-1796 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,Fl- Phone: LPhone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239351 Permit Number: ELC-7-15-1796 Scheduled Inspection Date:January 06,2016 Permit Type: Electrical-Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Addition/Alteration Job Address:11300 NE 2 Avenue Thompson Hall Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-02 Project: BARRY UNIVERSITY Contractor: ACRES ELECTRIC CORPORATION INC Phone: (954)327-7227 Building Department Comments DISCONNECT SINGLE CELL COOLING TOWER WIRE IN Infractio Passed comments NEW 2 CELL TOWER WITH VFD FOR MOTORS INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid January 05,2016 For Inspections please call: (305)762-4949 Page 10 of 35 Miami Shores Village �tCl _ n1ti8r ( 10050 N.E.2nd Avenue NE A, , r;O ,O �s �A Z Miami Shores,FL 33138-0000 �t Sys APPROVED ��•. g Phone: (305)795-2204 :.. Expiration: 01/23/2016 I ue tate:7/2712016 Project Address Parcel Number Applicant 11300 NE 2 Avenue Number: Thompson Hal 1121360010160-02 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: $ 12,000.00 ACRES ELECTRIC CORPORATION IM (954)327-7227 . .. _... _,. :, Total Sq Feet: 0 Type of Work:DISCONNECT SINGLE CELL COOLING TOWE Available Inspections: Additional Info: Inspection Type: Classification:Commercial Final Scanning: 1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.20 DBPR Fee $5.40 Invoice# ELC-7-15-56383 DCA Fee $5.40 07/27/2015 Check*27567 $393.00 $0.00 Education Surcharge $2.40 Permit Fee $360.00 Scanning Fee $3.00 Technology Fee $9.60 Total: $393.00 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,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: Ice �at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and W I authorize the above-named contractor to do the work stated. July 27, 2015 Authorize ignatu :Owner / Applicant / Contractor / Agent Date Building Department Copy July 27,2015 1 ' a Miami Shores Village - Building Department JUL 172015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 0— Tel:(305)795-2204 Fax:(305) 756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20LO BUILDING Master Permit No. al C,I -2,> PERMIT APPLI TION Sub Permit.No. LL—C'( �y-nG ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1:3 00 2p4> M6 6 ` T1 40M PSdN R*L L- Cit : Miami Shores County: Miami Dade zip: 3/3 Folio/Parcel#: 112, 150b 1 (7) (e f7 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:Q OWNER:Name(Fee Simple Titleholder): hW4 (miUt�ZSi-rY Phone#: U5 ! rT Address: l 3Uy K!C E= City: M (get s I fp 1-2-Lf State: r zip: Tenant/Lessee Name: Phone#: Email: /� CONTRACTOR:Company Name: 1 P JL-f-3 Phone#: `may �22 i-2. -Z Address://4/fjrCJ /V lip"Al—1 City: a'!t:Aa=aT i -b-'i State: Zip: 3 2 S Qualifier Name:_ _I4-a-V"t N 13R-S Ar"Le,/__'J Phone#: 1104-1325% State Certification or Registration#:,2&/3m'�a f Ao Certificate of Competency#: DESIGNER:Architect/Engineer: TLC &-X61A)&--2;A1A)6- Phone#: 3aS 26(0-65-53 Address: _67.57 &-yc Gfl oo�oAt bk .sufm- 1/co city: 6f AM 1 State:)'c zip: 3 7-Co Value of Work for this Permit:$ 67(_7 L9_ C7° Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New t Repair/Replace ❑ Demolition Description of Work: ,Dt5M,AI ALT aJ6L457 CE2�("DDLi.c1�JDuJC� . J,(/IILE /N 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$ , (Revised 02/24/2014) , 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 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. 'l�',&—­­ Signature -loovm Signature OWNER or AGENT tl CONTRACTOR The f7ring instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of V UF7 20 � ,by day of u rQ 020 S/ by .►/Cl6CI� ✓Qo�'7 �'=_ who is personally known to ev 1 y-% f3NCor-,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: 0g111NNttll/// NOTARY PUBLIC: �Iilssr . S .•aG "��o�to� S Sign: --- . y rint: ` <� �' �•� E Print: r • MFy • r • �,� / • •tP V �i Seal: �N SOAMMA10:9% yrla+► •:�ZZ Seal: :�! e' :`.�•. .. Nomyho•8aaat�oeU /Is't'AiE, MY comm.E NW Z1,2018 tltill •,,,el Commisslml 0 FF 184787 APPROVED BYr J 444 Plans Examiner Zoning Structural Review Clerk (Revised 02/24/2014) Jun.04 .2015 22 :04 ACRES ELECTRIC CORP 9543277200 PAGE. 15/ 17 STATE OF FLORIDA DEPARTMENT OF WSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LIMSMG 130ARID s "r,-01300212MO The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provislons of Chapter 489 FS. � ✓+�a Expiration date: AUG 31,201+ BESANCON,KEVIN DOUGLAS ACRES ELECTRIC C0RPtbRA110N, INC 5460 SW 18TH COURT • PLANTATIoN FL 33317 MUED, OGII W14 DISPLAY AS REQUIRED BY LAW SEQ 0 L°4a91940�31104 Jun.04 .2015 22 :05 ACRES ELECTRIC CORP 9543277200 PAGE. 17/ 17 jjjt(WApD COUNIry LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm.A-100,, Ft. Lauderdale, FL 33301-1895—954-831.4000 VA UD OCTOBER 1w2014 THROUGH SEPTEMBER 30,2®i5 13usinessHOMO. cRas Ecx'tzZc CORP X>vvc OSa�sln®ssType:1ELEcTRicxL conTR cToro QWnorNarne:JMVX.3 DOUGLAS AESANCON Buefne"Opened,o2 2s/2009 BusjnM Locadon1.5480 SW 16 CT SutWC*ut'l CerVReq:EC1300222'C PLA'�-TAT-Log Exemption Cods: Buel"We Prone: ROOM S"tm Employe" f+Aschlnes proTssslonaris 1 For 1Ae fto kumbsr of Vending Type: Tax Asnaunt Transfer Fee NSF Foe pe<aalty Prior Years Co!ledion Cost I Tote1 Fsid 27,00 3.00 G.OQ O.CG 4.00 4'_8+J 30.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for fits privilege of doing busss within Broward County and is non-regulatory in nature.You must meet aN CouMy and/or MuniclpsitY planning WHEN VALIDATED the zoning mquirements, This Business Tax Reooeipt must be trsnsfarred when the business is sold, business name has changed or you he" moved the business location.This rewlpt do"not indicate that the business is level or that it►s in comptlarce with State or local laws and regulations. Mallfng Address: 7477 REV'IN DOLS LAS SESD�NCON Race 09 9/2013-00-00 5480 SW 16 CT ps3� o9jag,r�01e 30.80 PLANTATION, FL 33317 2014 - 2015 `l CERTIFICATE OF LIABILITY INSURANCE 6%2%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 terns 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 Jon Rock NAME: The Contractors Choice Agency PHONE (800)918-3584 FAX Noio(877)684-9951 PO Box 13645 E n� :Jon@ nginsuranceonline.com INSURERS AFFORDING COVERAGE NAIC q Chandler AZ 85248 INSURERA:PCIC Ins Co RRG 12497 INSURED INSURER B Acres Electric Corporation Inc. INSURER C: 11480 N Mt. Vernon Drive INSURERD: INSURER E: Plantation FL 33325 INSURER F: COVERAGES CERTIFICATE NUMBER-CL122615420 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 TYPE OF INSURANCE A SUB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 50,000 PREMISES Ea occurrence $ A CLAIMS-MADE Fx_1 OCCUR CIC5009-PCAS4081-04 /6/2015 /6/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMEBINED SINGLE LIMIT •i n ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER ANY PROPRIETORIPARTNEWEXECUTIVE I E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If mora space is required) License # EC13002120 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Robert Rock/JON ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(2ntnnFl n1 Tha ArnRrt nama anrl Innn ara ranicfararl marlre of OrnRn AC" CERTIFICATE OF LIABILITY INSURANCE DATE(MMNDIYYYY) 06/18/2015 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(iss)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 NAME: David Carothers PHE FAX (AlcON c/o Praxiom Risk Management,LLC EAILo 888 350-7729 (A/C,No -M 123 West Bloomingdale Avenue#300 ADDRESS: Brandon,FL 33511 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A:American Zurich Insurance Company 40142 INSURED INSURERB: Resource Management,Inc.Alt.Emp:ACRES ELECTRIC CORPORATION, INSURER C: INC 281 Main St.Suite 5 INSURER D: Fitchburg,MA 01420-4371 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:15MA005880622 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 ADDL TYPE OF INSURANCE UER POLICY EFF POLICY EXPLTR POLICY NUMBER MM D M D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 7 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F7 ❑ PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMB $ Ea acc deM ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY �,I N X STATUTE ER A OFFICER/MEMBERANY OPRIETRIPARTNER/E ECUTIVE ❑ NIA WC94-60-464-00 01/01/2015 01/01/2016 E.LEACH ACCIDENT $ 1,000,000 EXCLUDE (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCYLIMIT $ 1,000,000 Location Coverage Period: 01/01/2015 01/01/2016 Client# 302061-FL DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Coverage is provided for ACRES ELECTRIC CORPORATION,INC State Certified Electrical Contractor EC13002120 only thoseco-employees 4052 SW 7TH STREET of,but not subcontractors PLANTATION,FL 33317 to: CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Jan. 04 .2016 03:59 ACRES ELECTRIC CORP 9543277200 PAGE. 3/ 3 ��k4�i2 �r✓ t S -�?�-� ACORLJ DATE(UWDDIYYYY} CERTIFICATE OF LIABILITY INSURANCE 01/04/2016 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 do"not conflar rights to the certificate holder In lieu of such endorsemen a, PRODUCER David Carothers PHONE rte); (888)$50-7729 [AIAXC.Not: cto Praxiom Risk Management,LLC -MAIL 123 West Bloomingdale Avenue#300 __.,... . .._._ Brandon,FL 33611 INSUREtiL31 AFFORDING COVERAGE NAIC/.,_ INSUAM A: American.Zurip Insurance Company 40142 INSURED INSURER 91 — Resource Management,Inc.Aft.Emp;ACRES ELECTRIC CORPORATION, INSURER C: INC -........... 281 Main St,Suite 5 INSURER D i Fitchburg,MA 01420.4371 INSURERS:__ tNBURER P• •�._ COVERAGE$ CERTIFICATE NUMBER:16MAGO5880622 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, L R TYPE OF INSURANCE P LILY NUMBER Mw �i♦`.. POLICY EXP OMITS W COMMERCIAL GEN11PAL LIABILITY EACH OCCURRENCE $ l9Al')! '61�E a S CLAIMS-MADE occuR MED EXP A one enoyl $ PERSONAL&ADV INJURY $ O_E_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY U JECT LOC PRODUCTS-COMP/OP AGO $ — OTHER: $ AUTOMOBILE LIABILITY g ANY AUTO BODILY INJURY(Per PonOn) $ _ AUTO1SfYP1ED SCHEDULED BODILY INJURY(Per accident) S HIRED AUTOS AtyroeWED PROPERTY D ` _ $ $ UMBRELLA LIAROCCUR EACH OCCPIRR£NCE $ EXCESS LIAR ..w - CLAIMS-MADE AGGREGATE $ DED RETENTION I WORKERS COMPENB)ATION X TA TE A► AND 19MPLOYLW LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE YIN E.L.EACH ACCIDENT $ 1 10W.000 OF'PICENMEMBEREXCLUDED? NIA WC 94.60-464-01 01/01/2016 01/01/2017 (MaIf YYae�dssoribmMary In Nn EL DISEASE-EA E t�IPIAY£ $ 11000,000 DESt:A0PTI OF OPERATIONS below 111.DISEASE,POLICY LIMIT I$ 11000,000 Location COveraga Period: 01/01/2016 01/01/2017 ClIentR 302061-FL DESCRIPTION Oil OPERATM8I LOCATIONS I VEHICLES(ACORD 101,Addltrenal Remit Sotredule,may be attached It more epee le mquin" Coverage le provided for ACMES ELECTRIC CORPORATION,INC only those cu-smPioyees 4052 SW 7TH STREET of,but not subcont(wom PLANTATION,FL 33317 to: CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores village,FL 33138 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Jan. 04 .2016 03:59 ACRES ELECTRIC CORP 9543277200 PAGE. 2/ 3 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-1 00, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 11,2015 THROUGH SEPTEMBER 3p,2016 DBA:ACnS ELECTRIC CORP INC Receipt#:IMNI& MAt/ALARMS/CONTRACT Businm Name: Business Type:(ELECTRYCAL CONTRACTOR) s Owner Name:KEVIN DOUGLAS BESANCON Business Opened:02/23/2009 Business Location:9715 N BROWARD BLVD #232 State/County/Cort/Rog:EC13002120 PLANTATION Exemption Code: r business phone: Rooms assts Employees Machines Professionals 1 For v¢ ins suslmss only Number of Machines: Vending T Tau Amount Transfer Fee NSF Fee Penalty Prior Years C0110dOn Coat Totai Paid 27.00 3.00 0.00 0..00 0.00 0.46 30.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS 01100MES A TAX RECEIPT This tax Is levied for the privIlege of doing business within Broward County and Is non-regulatory In nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements, This Business Tax Receipt must be transferred when the business Is sold, business name has changed or you have moved the business location.This recelpt does not Indicate that the business Is legal or that it Is In c:ompilance Wth State or local taws and regulations. Meiling Addr+ease: KEVIN DOUGLAS BESANCON Receipt #04A^14-00003600 9715 W BROWARD BLVD 11232 Paid 09/25/2018 30.00 PLANTATION, TL 33324 2015 - 2016 City of Plantation Certificate# 154177 LOCAL BUSINESS on TAX CERTIFICATE Account#OC15-0784 Valid from 10/5/2015 to 09130/2016 THIS CERTIFICATE MUST BE CONSPICUOUSLY DISPLAYED Classification:(4)d.13 Electrical Contrector Business Name A Address: Besancon, Kevin Douglas Acres Electric Corporation, Inc. t 9715 W.Broward Blvd #232 CITY CLEFRK SIGUMW Plantation FL 33324 NOTICE: N Business is sold this Certificate must be transferred within 10 days or It becomes null and void.