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EL-16-765 Inspection Worksheet v Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-258936 Permit Number: EL-3-16-765 Scheduled Inspection Date: May 27,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: ROSSETTI,JOHN Work Classification: Pool- Private Job Address:549 NE 95 Street Miami Shores, FL Phone Number Parcel Number 1132060140740 Project: <NONE> Contractor: R GOOD ELECTRIC INC Phone: (954)432-2232 Building Department Comments POOL ELECTRIC Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-255373. Not ready pool not compleat. Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 26,2016 For Inspections please call: (305)762-4949 Page 17 of 26 Miami Shores Village ) ^ 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 ` Phone: (305)795-2204 �`` �` �`�� Expiration: 0912412016 Project Address Parcel Number Applicant 549 NE 95 Street 1132060140740 Miami Shores, FL Block: Lot: JOHN ROSSETTI Owner Information Address Phone Cell JOHN ROSSETTI 549 NE 95 ST MIAMI FL 33138-2731 Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 R GOOD ELECTRIC INC (954)432-2232 Total Sq Feet: 0 Type of Work:POOL ELECTRIC Available inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:1 Light Niche Bonding Review Electrical Alarms Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.Y0 DBPR Fee Invoice# EL-3-16-59119 x.50 03/28/2016 Check#:2240 $615.20 $0.00 DCA Fee $4.50 Education Surcharge $0.40 Permit Fee-Additions/Alterations $300.00 Scanning Fee $3.00 Technology Fee $1,60 Work without Permit Fee $300.00 Total: $616.20 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 certify at all the forgoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo ut rm I authorize the above-named contractor to do the work stated. March 28,2016 Autho gnature:Owner / Applicant / Contractor Date Building Department Copy March 28,2016 1 Miami Shores Village R Building Department MAR 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 [BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 5{ti1 FBC 2014 BUILDING Master Permit No. bQ 16 020Q, PERMIT APPLICATION Sub Permit No. EL, fir ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP +� q CONTRACTOR DRAWINGS JOB ADDRESS: `� 1 A.) 9 5 7&-r City: Miami Shores County: Miami Dade Zip: .3310 Folio/Parcel#: l k 3Q10(0 0 1 4 `o-7gy Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type�:}- Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): R��S��lla Phone#: 3/ S?G- "7155 Address: 5V R)e QS City: VL-A''L Z S" State: i=L Zip: 33) 3? Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Elec;bi/i, Phone#: q5q-o24-S%C1q Address: 1'730 ISI+�� -q8 � City: Porribmn >1&.A State: fit.. Zip: 330e7�' Qualifier Name: LASCal ZDmt Phone#: State Certification or Registration#: (,3cc�L?�?O Certificate of Competency#: DESIGNER:Architect/Engineer: AJA '•Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Z;nnn. — Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration JA New ❑ Repair/Replace ❑ Demolition Description of Work: ?pot GIG 4y i c. Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ 'r,��® CO/CC$ Scanning Fee$ 'CJO Radon Fee$ ''� DBP�R$ 50 Notary$ Technology Fee$ t GO Training/Education Fee$ ® C ' o Double Fee$ 3 0z). Structural Reviews$ Bond$ /0 TOTAL FEE NOW DUE$ Z® (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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Sig Signature z,, _11Q „11,n OWNER or AGENT CONTRACTOR The foreg g instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 j(0 by AS day of 20 16 ,by who is personally known to who is personally known to r me or who has produced df i" I«w&#, as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign,• Sign: Print: Print: Seal: HERYL MORGAN Seal: CHERYL MORGAN *I *_ MY COMMISSION#FF008874 A9 ,oQ MY COMMISSION mFF008874 o•,• EXPIRES June 28,2017 -•',,oF ,, EXPIRES June 28 2"7* e*�•�s��x e(A�6Y7� Rt1¢���,raF� *s�**�sa*��+><** l` f�"�`+►a*e�F�forfide�NotaryB®rv�eae �*� sa�a��s�ea��aa�xa�x�x APPROVED BY8$/�//�j`�L//// Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 10/27/2014 07:04AM 9544322232 R GOOD ELCT PAGE 02/05 STATE OF FL ORIOA. DEPARTMENT OF BUSINESS AND PROFESSIONAL.REGULATION ELECTRICAL CONTRACTORS.LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GOOD,RUSSELL R GOOD ELECTRIC INC 1730 N W 88TH WAY PEMBROKE PINES Fl_33024 e E CiOna��O��YYaua'�J'i1$���yy��u u�iaa/1116•�tebl tl►=s t�{t,1'�..—_«•.�•�.�r�, �)••,'1a!'w'_7rY'T•j':.f•L'S�•.tN.'�.:,i�sry :s•;..�5»'�iani.=Ira t :t.fs;4:,e,:.:•=::"'4„i•:=•• 4• _ one rnMon Floridians Eckmad by ilia Department of t3 _ Business end Professional K . • . ,, •.'• ,. .::., ;,,. .. .. ._»' fro at+chute�ts drt bJvlc r professionals and businesses range '".• '"'STATE UF'F.1�ORIDA'.. ro ya ars.from boxers to barbeque restaurants, s '" `Dg. , �c and they keep Florida's e=orgy strong. :;r ; , ::: TME '��•,• ;BU IN AN :> Pf20.F i OO.ULA`ilOD�f" Every day wework to Im rove the way we do business In order o ":_'; t„ pp t E 1 002270 r '` 3�/Q�l2014; c: serve you better. For information about our services.please tog onto t ,:• • r1.�:rar,: :,;is Kass:;"� • : www.rnyflaridalicertseco!r. Thane you can rind more informagon `>` drY.. i't =•:�b) » :; ut that thou'subali� _ TitiD EL"� C 'r =' ..... to ottlgerlt news etre'One and s and uleam more a Dep megYsRrxRt{SS y :• �; %:'.• •F -GOOD I- Our mission at the Department Is:L.108r"Efterdly Regulate Fair�rly. We rJstanfly StiilrB t0 � N'7- S- -r' :j{r•':���;r:i •,7• a°� . ....»..» 's.r ... s wsiomers. -thank you for od Ing business Florid BeNe your �'".'-'«�^..';.', ` :`^:�,- .ri_, :�"".•:: ,•- ;:: '' and congratulator ort your new Qoensel a. 9, dB,CERTIFIt:p:atldLJ;tl1&jtroytsJon8pg7,�11.989•FB,.:,.; ,4 • fi ;'.l�h�pn eiato;,pI16�fa 201$. «, ,,.r'•• .{d40'i'�OGD1t74• .p;,. • `-^i"'::'rs•��w:Si:;=�.xs !:rt�:i:i:.^ :•r'sa,Wjs::�•=i�6•':4:r a`.v:r•••u�• r•..':"�-a a •:.f i:i..:ist..S{. 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Y • ..zw_.r':'.z.•..»•.=...s .• « �..:V et�tS:R iv k�Y--- yj: �,:" •'�•y�7�!� �•:' d•"}"•.:�» �'t�' •a;���i'• ""i.:' f qw t+ i " . ......... sP::r w'.5•es-i���.�3'.�..:"«'• ..};,aiz-':' k'�' ^�•': '`'••`• "'•.;fir r..l1v."^•"a''�,•.: '• :z's i e •I u.".t.z•.a ,x�'»..h ..':7�.t,�:i tr',1L 1•,f...i:�,..sr.««R,,.•.fs•. .=:r.:«..:t .-rte:i••''•..i�.i.'.t•..... .3 ,..i MUM— rfFilA.Ol9 U rlt_�1 OV AC D=e%i nD=n C2V t AIAI naafi. .....e7..aa.......>. 09!$9/2015 06:35AM 9544322232 R GOOD ELCT PAGE 04/05 ?$�..'L�'i1:P A7!"��iar,_7:s�,:l;{::$• r•L..a.T7• lra::'.": ?:.o-.i+ .°'."''� t• r. •. � :i.:.7:..: '"%i« .,7:o:n.•:. :irki::l'�.�,t '�a.«:�l•'�7'aA' ryi83+..?iC.�w� 1, 1*0WARD COUNTY LOCAL BUSINESS TAX RECEIPT E f4� 115 S.Andrews Ave.,Rm.X 100.Ft Lauderdale,FL 33301-1895—954-831-40'00 VALID OCTOBER 1.2015 THROUCaH ; TENI ER 3b,2016 � � 1 i6�! O13�.R GOOD BUIL'WRIC INC ReceiptM-181-88776 TgE,/I itb19/Cp�� Business barns: Business Type:taracnim•Camfmst) Y; Owner teams:xussar,L coon SLtSineSS OPMC(1:07/16/1994 {' cki BUSfRtS L at1Dn:1730 NW 88 WAY StmelCOuntlji/C@itlft:EM3002210 �i It PEMROR$ PINES Exompfion Code: L. Busing Phone:954-432=2232 Room 9a�Ra - Employabs Pfonab g l i Q FW VwdkV eas1"nOnly i?} ;;4 tfunibet of Usehtnes: Va mang Type: i f Tax Amount Transfer Fee'i NSF t' :—.—Penalty. ''Arfgr•Yodr's '. Cogedon Cast 'rota!Paid , — ,t 37.00 0.00 `0.66-1 0.001 27.00 r`f THIS RECEIPT MUST BE POSTED CONOPICUOUSLY IN YOUR PLACE OF ISWINESS THIS BECOMES A TAX RECEW This tax b levied forthe paddy of doing business vAh1n Bmward Courttyy and is '$ nmmegufatory in nature.Yate mint meet aq County mWor Mun*aiify planning . VVgtt�1 VA1L1f3A'rF.® and Xoilhtg teWremenlL This Business Taos ReeaW must he bwolbued when � the budnm is sold, bushes name has 41ianged or you have moved the t+ bu*mss focaUm Mit receipt dam not indicate that the �zs legal or that f�` if b in=Oar=whit Stag of focal bws and regulations. `i '•�'� � ingAddress: � ��s i. , Rt7SSHM GOOD Receipt #1'CP 14" 00031199 :i 7730 Ntf 88 NfpiY paid 08/13/2015 27.Q0 �•.$j: PFMRORE PngEs, FL 33024 4 •fit ; , 2015 - 2016 i t ; ''..' 7 -rT: °S>1'77 •.W=h•...LVY�dL'i4 .'«a�E'�. hTTfi.�Y.l: 1� .ati'4yi:r..".s. s t Y .!•a +'i4fi:'+T '.':'7n .1. &`«:•+R •sL . ab • t1 1! i t 4� 06/95/2015 10:02AM 9549505093 CIAG PAGE 01/01 CERT'IFICAT'E OF LIABILITY INSURANCE MOMS MA CERTIFICATE It ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RMHTS UPON THE CERTIFICATE HOWER,THIS 0"FICATB DOES{NOT AFFU M MMY OR NEGATIVELY AMEND, EXTEND OR ALTER INE COVERAGE AFFORDED QY THE POuWEs MOW. TM CER LATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURM.S), AUTHORIZED REPRESENTATIVE 04 PRODUCER,AND THE CERTIFICATE HOLDER. IMPORT -.It ho ar Is an ADDITIONAL RED, pvlicy(I")ntus !et endorsed. n SUBROGAT! N IS the Nrms and of the o! t eitain c4dw ,subject p �►• p ntaj►t�uirm an endotsen>snt.dt,s�tatetn®nt on this Cet�Ic8t0 flees not s'ottter rlgMta•�the cegtbate holder In of andt endorsomeB Lany Karavastle Gamp�etB Insurance Qroup 657.8887 125 E Md ft RdPam eft AFFOROM enw"Amm a Pam Doom ' FL 330111 we=A: LLOYDS OF LONDON stauRge r s� R.Good Medrie,Inc. 9730 N.W.180 Way o uRERE: Pemto—M 022FL 33024 ' CO GES i CERTIFICATE NUMBER: REVISION NUMBER- THiS M TO CERTIFY T THE POLICIES OF INSURANCE USTF_D BELOW HAVE BF-EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POtM PERIOD MGATED.NO ANDINQ ANY RBQUIRBMENT.TERM OR CONUMON OF My CONTRACT OR OTHER DOCUMM WTH RESPECT TO WHICH THIS WIM CERTIMATE MAY BE LIED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POIACIl:$NSCRISED HEREIN 13 SUBJECT TO All THE TERMS, EXCUMMS AND CON OF$"POUWS&l.MITS SHOWN MAY HAVE Bwx REDUCED BY PAID CLAIM& lYP@ LMM aOWA¢RCLU GOWAL tVMM FAWOCCURREMEa 1 000 tXAd�M1A�iQX a� � a 100,000 A iaeoaxP as a� 5000 N N CWFL0=72T 04N412Q't5 04-1402016 PERB mL&ADVUV.w s 1 QWoo0 QPLAQWAM''Mt l'APPpL=P w m Ep$ t._J Loc oPNERALaOCiREaATe ?&Saw -00MMOPAW.i Doo LELMI cuummr a AWA M YaLN9ir(Fbrpora _ �. AUMS 8mYSlmyowsc s HMOAUrOS $ a . ur�Rsu.Ataas amara M=33 UA6s °AMMMAN Ace►zE ' ReT 9 8 ANp►E►dFE tA1Rs•w►aukir § Ut�T Y/8 NIA 61 A BE f sU t LL OWAN-EA smom eAse•P4acv a ossct� �oi�eAv 10aA7ioRs��eles to tat.Ae RameKso sem,a�rassaasasslr a�epomal Ekcical Contractor }''ATE HOLDER • LATI N MI-Z ai"CMA ANY OF THE AROW wasc uo PoWES W CANOSLt M BEFORE Miami Shares Village 791 WMAWN DATE TilMtWP, NOTICE,WILL 8E MUVMM W 10060 N E i2nd Avenue CE VVITH TNB PoLM PRONISMS. PAMml Shores,FL 33938 AMOMD seMwfim ^wM ti 0 ISH-2014 ACORD CORPORATION.AI fti9ts rasovic ACORO 28(2014/09] The ACORD name and logo are registered Mo is of ACORD 4 0.9/09/2015 06:35AM 9544322232 R GOOD ELCT PAGE 02/05 • t .REF ATWATM CtuBF�L olrcErt STATE QF FLORIDA i DEPARTEW OF FINMCIAL SERVICES i DIMION OF WOM(gRW COMPEMATION "CERTIFICATE OF EMOMN TO BE ExeWT FROM FLORIDA WORmRW COWUSAnoN LAW-' R CONSTRUCTION INDUSTRY EXEMPTION This oeMes tet the tndWual l0ad below has ek& g berekempt from Fbma vj0ftW Compenntan ww. EFF e%i1VE DATE: W31MIS MO'IRA`I'LON DATE: W3=17 PERSON: GOOD RUSSELL FEM 591065734 BUSINESS HAM AND ADDRESS: '. R GOOD ELECTRIC INC t�1730 N W SM WAY PEMBROKE PINES FL 9=4 SCOPES OF BUSINESS OR TRADE: ' ' � i FLECTRICAL WPJNQ V MIN BUIL toC440C5(14�F.St.e�ol6oazafaoo�paa�grAooi6�i�oa�mt9wgl�cimyEerh41�1ffia0�wd9oteledlenewdaTtlda areyapere�rbene�sor 'o�tu�W�'�odmp0ar pa<mm�db►t�c�xggpp5�?�,F.9i«CCt�ke�aeptt0.ba�,,, t�fj► _ rd 9�eempaoftha cry¢988�000illhelEO�I09oEe19c�onLotq=mVLA4w=dtepgp(44ft0gl*F4.NAM ofobaBo bbw malmpt®edoleta:Boalnhae�pptnp�chsllbesub�sdl�revom<Tal�atanytiaoeal�rq�e4�gci9�snotTeaagteil�losottha , dsapdCson,�nd M�vtiolku acaWTwdaao 1a�aa�111eceads ddds se�ttaame'iss�itoot a O.Thad '�1lrevolaea i M-F2-0m4-42 COznFIGATE OF ELEC110N To se XPi'REvmw as-13 QtlI:5ROAlS7(8S0)415.1M i } f ii Miami shores Village 3511 umv" Building Department �,tpRTpA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if. 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY i SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er Stat of Florida 77— O" County of Miami-Dade The foregoing was acknowledge before me this Aday of SGnuutj By ���n ��Se�G who is personally known to me or has produced as.identification. Notary: CWTHYA, COPLIN CO�dNIiSStON#FF246967 SEEM..: .'•, EXPIRES duty 20,2019 I RN GLOOM ELEC"' "FRICL, INCE . 1730 NW 38th Way Pembroke Pines, FL 33024 March 1,2016 Before me this day personally appeared Russell Good,who being duly sworn,deposes and says: That she will be the only person working on the project located at 549 NE 95 St Miami Shores,FL 33158. RUSELL GOOD EC13002270 Sworn to and subscribed before me this 1st day of March,2016 by, Russell G<dwhEoispersonally known to be or produce Identification ... "W{A. CINTHYA COPLIN 'A :•> My COMMISSION#FF245967 (407139"163 ftorWsNote NOTARY ATE OF FLORIDA AT LARGE EXPIRES July 20,2019 8erviee.cow 1730 NW 88th Way Pembroke Pines,FL 33024 Phone:954-214-5899 04/15/2016 11:32AM 9549605093 CIAG � PAGE 01/01 C0-� l 6 5" AcoRa® CERTIFICATE OF LIABILITY INSURANCE DATE(ArM/DOJW" 04/162018 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 13Y 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 CWWICM 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.A statement on this eartificate does not confer rrghte to the COMEle holder In Rau of such endorsement{s�, PRODUCER Larry Complete Insurance Authority Group,Inc Kal57-89is 54 s57-8867c NO. 954)860-5093 126 E McNab Rd EMAIL Awppw 1217*2ravasifis ole inc com INSURERS)AFFORDING COVERAGE NAIL� Pompano Beach FL 33090 INSUMAt LLOYD'S OF LONDON INSURED INSURER 9 R.Good 8eotria,Inc III,SURERC I 1730 NW 88th Way INSURE!D: INSURER E- PenUroke Pines FL 33024 1NSVR@RFa 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 CONDinoN OF ANY CONTRACT OR OTHER DOCUMENT MATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS pF SUCH POLICIES,LIMITS SHOWN MAY HAW BEEN REDUCED BY PAID CLAIM$. I N MrR TYFM OF INSURANCE ADDL OURN L1CY EF L1CY POLICY NUMBER LIM= COMAAERCIIu GENERAL LVIBILITY EACH OCCUNWNCE $ 1,000,000 CLAIMS.MADE ❑X OCCUR P g 100,000 AMED ECP(Arty one pumm) $ 5,000 N N CIBFL,0000727 CW14/2018 04/142017 PERSONAL&ADV INJURY $ 1,000,000 GENLAGGREGATE LpwTAFPLIE8FER GENERALAGGREGATE S 2,000,000 X p0l=El APER& El LOC PRODUCTS.COMp1Op AGG I$ 2,000.000 OTHER: 3 AUTQAAOOU,L'LIAN ILIYY OAA IN LIMIT $ ANY AI)T p ALL OYJNED BoO'LY wjURY(Pw PwMM) 8 "CN6pULEp AUTOS A1�F08 BODILY MURY(Pm a $ HIRED AUT08 q� D PPROP 3 S UM6RELu1W1BHoLrAcuR,,.-,, Ewfl OCCURRENCE $ ED p$ AGGREGATE $ AND EAI PLOYERS'lJAB1USY Y/N - ER ANY OFFIL:EWM8unEER WWAAME T1� NIA g (mangy In M"1 E L E�GH AGGn EN•r g y EL DISEASE-EA EMPL $ UES NOF ERA r EL DISEASE-POLICY LIMIT I$ Wa7tON OF OPiRATIONS I LOCAY CNB I VMQL W(ACORD lot AamffonW RW Aft ftbW %my lw sMoctw rMWV EpM is MgUWSM F1@CtriOldfl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shotes ACCORDANCE WITH THE POLICY PROVISIONS. 10500 NE 2nd Avenue AUTHO?dzft mwmwmTATIVE Miaml Shores FL 33138 --e - ACORD 25 2014!01 ®1988 2014 ACORD CORPORATION.All rights rasorvod. ( ) The ACORD name and 1090 are registered marks of ACORD