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WS-15-1616 'Vow 119 Miami Shores Village cEr�� Building Department JUN 2i9 205 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY• . 12�� =&�' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 I® BUILDING Master Permit Nom-! PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP �o� m CONTRACTOR DRAWINGS JOB ADDRESS: 'yY& 1 1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 O 1 I -b® Is the Building Historically Designated:Yes NO V _ Occupancy Type: S ,Load: Construction Type: C Q) Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): G 2oy 5�— S�- 'C�\ MFr- Phone#: �O 7S�• 1503 Address: N1� 0\ City: \"Vl\ ► Finn I-e `'-00 V�y State: 711— Zip: t) Tenant/Lessee Name: 1 Phone#: Email:. CONTRACTOR:Company Name: �, C- �Y ones#•. 34 S. Address: �►.; City: 'If%^ \ State: VL— Zip: 33 121 Qualifier Name: Phone#:f 0 5. Q 601 . 7m 5' State Certification or Registration#: iS C) Certificate of Competency#: v v DESIGNER:Architect/Engineer: c. o•w 5 kZ �. " Phone#:3� Address: eb I 'S'W 1 ` City: ; ti*h; State: V L' Zip: Value of Work for this PermR:$ �, ( 9 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ` Repair/Replace ❑ Demolition Description of Work: M C\llz� %t--4. `� ; �c •••/ era �_ f �y Y O_y_ �� • h�� 44"V\ a ���% V-5 Specify color of color thru tile: Mf Submittal Fee$ 4- nQ jQ Permit Fee$—E Pj U - QQ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ?�✓�- •�1 IRevised02/24/20141 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N I N 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..... F 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$25W, 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 approved a s ion fee will be charged. Signatu '�'�'" Signature`.' OWNER or AGENT CONT OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of JL)W .20 IJ- ,by day of -'�i b.. ,20 B C ,by r� r A10-0 .who Is personally known to .:. ,� � e ,who ersonally known me or who has produced .It -� i�LiC@hs 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• P�J�rXI/L Print: Print: ' Seal: Seal: AoV P% Notary Public State of Florida ' Brenda Bello My Commission EE 199414 KBY1;;@7l13 lorida �or a� Expires 06/272016 4,1'. 8414#ii##i APPROVE ,J Plans Examiner Zoning Structural Review Clerk 4 (Revised02/24/2014) 'Vow 119 Miami Shores Village cEr�� Building Department JUN 2i9 205 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY• . 12�� =&�' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 I® BUILDING Master Permit Nom-! PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP �o� m CONTRACTOR DRAWINGS JOB ADDRESS: 'yY& 1 1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 O 1 I -b® Is the Building Historically Designated:Yes NO V _ Occupancy Type: S ,Load: Construction Type: C Q) Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): G 2oy 5�— S�- 'C�\ MFr- Phone#: �O 7S�• 1503 Address: N1� 0\ City: \"Vl\ ► Finn I-e `'-00 V�y State: 711— Zip: t) Tenant/Lessee Name: 1 Phone#: Email:. CONTRACTOR:Company Name: �, C- �Y ones#•. 34 S. Address: �►.; City: 'If%^ \ State: VL— Zip: 33 121 Qualifier Name: Phone#:f 0 5. Q 601 . 7m 5' State Certification or Registration#: iS C) Certificate of Competency#: v v DESIGNER:Architect/Engineer: c. o•w 5 kZ �. " Phone#:3� Address: eb I 'S'W 1 ` City: ; ti*h; State: V L' Zip: Value of Work for this PermR:$ �, ( 9 Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ` Repair/Replace ❑ Demolition Description of Work: M C\llz� %t--4. `� ; �c •••/ era �_ f �y Y O_y_ �� • h�� 44"V\ a ���% V-5 Specify color of color thru tile: Mf Submittal Fee$ 4- nQ jQ Permit Fee$—E Pj U - QQ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ?�✓�- •�1 IRevised02/24/20141 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N I N 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..... F 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$25W, 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 approved a s ion fee will be charged. Signatu '�'�'" Signature`.' OWNER or AGENT CONT OR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of JL)W .20 IJ- ,by day of -'�i b.. ,20 B C ,by r� r A10-0 .who Is personally known to .:. ,� � e ,who ersonally known me or who has produced .It -� i�LiC@hs 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• P�J�rXI/L Print: Print: ' Seal: Seal: AoV P% Notary Public State of Florida ' Brenda Bello My Commission EE 199414 KBY1;;@7l13 lorida �or a� Expires 06/272016 4,1'. 8414#ii##i APPROVE ,J Plans Examiner Zoning Structural Review Clerk 4 (Revised02/24/2014) ' 1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 •`'�� +�'`` 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HARDER, DAVID WAYNE ADANAC DEVELOPEMENT AND CONSTRUCTION SERVICES INC 100 NE 84 STREET, SUITE 200 MIAMI FL 33138 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of 8usiness.and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTM N QF.OUSINESS AND and they keep Florida's economy strong. PROFE `5$1t^aULATION Every day we work to improve the way we do business in order to CGC 1506482. IStI 05/29/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED GEADONTRAGT( t about our divisions and the regulations that impact you,subscribe HARDER,DAA YID to department newsletters and loam more about the Department's ADANAC DEVIL 4! OISTRUCTI initiatives. n : Our mission at the Department is:License Efficiently,Regulate Fairly. �_<> r; F We constant) strive to serve you better so that you can serve your . customers. lank you for doing business in Florida, Ex CERTIFIED under the provi8fons of Ch0529 020 and congratulations on your new license! 'ate:nuGa1,2018 L1405290002074 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD z . CGC15OM2 The GENERAL CONTRACTOR ' Named.below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 HARDER, DAVID WAYNE ADANAC.DEVELOP1EM �GQRGtQI+ IV1ESg Y 100 NE 84'STREE7,BL00Y � ;' 33 MIAMI - '1 p .N K�, : w Y R , ■ I=L ' .. "� mP+ •ar<..wa,'�, "'ce, "-=yt � ,`�` �'�y,, `•� A 1 tk -, ' ISSUED: 0529/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405290002074 ' 1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 •`'�� +�'`` 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HARDER, DAVID WAYNE ADANAC DEVELOPEMENT AND CONSTRUCTION SERVICES INC 100 NE 84 STREET, SUITE 200 MIAMI FL 33138 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of 8usiness.and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTM N QF.OUSINESS AND and they keep Florida's economy strong. PROFE `5$1t^aULATION Every day we work to improve the way we do business in order to CGC 1506482. IStI 05/29/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED GEADONTRAGT( t about our divisions and the regulations that impact you,subscribe HARDER,DAA YID to department newsletters and loam more about the Department's ADANAC DEVIL 4! OISTRUCTI initiatives. n : Our mission at the Department is:License Efficiently,Regulate Fairly. �_<> r; F We constant) strive to serve you better so that you can serve your . customers. lank you for doing business in Florida, Ex CERTIFIED under the provi8fons of Ch0529 020 and congratulations on your new license! 'ate:nuGa1,2018 L1405290002074 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD z . CGC15OM2 The GENERAL CONTRACTOR ' Named.below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 HARDER, DAVID WAYNE ADANAC.DEVELOP1EM �GQRGtQI+ IV1ESg Y 100 NE 84'STREE7,BL00Y � ;' 33 MIAMI - '1 p .N K�, : w Y R , ■ I=L ' .. "� mP+ •ar<..wa,'�, "'ce, "-=yt � ,`�` �'�y,, `•� A 1 tk -, ' ISSUED: 0529/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405290002074 L66 -ax* eceip luliarni-Dade County,Stki:o Ioerda =-641316 kbT A BILL ADO N0'f PAY 5315718 Q BUSINESS NAMEtLOCA'TION RECEIPT NO. EXPIRES; aDaNac DEVELOPMENT& = REivEvvAL , SEPTEMBER 30,,20' 5 CONSTRUCTION SERC (NC Must be displayed at piece of business 100 NE 84 ST 200 Pursuant to County Code MIAMI FL 33138 Chapter 8A�=eat.9&10 . . OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ADANAC DEVELOPMENT WONSTR 196 „GENERAL BUILDING BY TAX COLUCTOR. ;:SVCS CONTRACTOR 45,00 09/17/2014 Workers) 1 CGC1508482 CHECK21-14069883 'Pie I.ra1"Bssiposs Tax t pteely p"md of the fecal 8asiaesa Taw Tke'Reoeipt is a Ikeiree, permit,or a oertiRoaBoo otiM bd&es qualglestioas,to do bask m Holder nuaa comply v"aar gareramesiai = or nongovorlatte pal regulalwy laws and re4wmmeats wbkb apply to the business The RECEIPT No.abou8 Gait be dbipb W, ,00 aH commercial reMoles-Ailiemk-Dade Code Sec 8a-278 For more iafamutimb Nsit , A� CERTIFICATE OF LIABILITY INSURANCE °A'E`M'M°°""""' 6/26/2015 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. H 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 Bunny Gruntler Casualty Systems, Inc. PHONE (305)551-0590 FAX (305)551-0857 3331 SN 107 Ave Admin@casusitysystems.com INSURER(S)AFFORDING COVERAGE NAIL 0 Miami FL 33165 nnuRm A Arch Specialty Insurnace Co. INSURED INSURER B: ADANAC Development 6 Construction Services, INSURER 0: 100 N F. 84th .Street INSURER D: INSURER BE: Miami FL. 33138 INSURER COVERAGES CERTIFICATE NUMBER;CL1512904000 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. am ADDL LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF Y LIMRB GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B coMMmm&GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 A I CLAIMS-MADE ®OCCUR MMOOOP75001 /28/2015 /28/2016 MED EXP oneperaon $ 10,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000 S POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE L[Mrr(ER acckWM ANY AUTO BODILY INJURY(Per person) $ � OOWNED CHHEDNON-OWNED BODILY INJURY(Per accident) $ . HIRED AUTOS AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS•MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION STATU OTH AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTNE a N/A EL EACH ACCIDENT $ OFFICERAAEMBER EXCLUDED? PMondahory M NH) E.L.DISEASE-EA EMPLOYEE $ I u O OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) GC Lic # 1506482 CERTIFICATE HOLDER CANCELLATION 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 REPREBENTATNE Miami Shores, FL 33138 Ethel Gruntler/BUNNY ACORD 25(2010108) ©1988-2010 ACORD CORPORATION. All rights reserved. INA025 minri 1 M Thra Armon narrw anri Innn arm nania#arsaA mar4a of Ad nA11 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DMSION OF WORKERS'COMPENSATION *"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 3/14/2014 EXPIRATION DATE: 3/13/2016 PERSON: HARDER DAVID FEIN: 200270724 BUSINESS NAME AND ADDRESS: ADANAC.DEVELOPMENT AND 100 NE 84 ST,SUITE 200 MIAMI FL 33138 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the Issuance of the certificate,the person named on the notice or certificate no longer mets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to met the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850}413-1609 ADANAC DEVELOPMENT AND CONSTRUCTION SERVICES, INC. June 29, 2015 State of Florida County of Miami Dade Before me this Day personally appeared David Harder who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 103 NE 99 Street, Miami Shores, FL 33138. Sworn to (or affirmed) and subscribed before me this 30th day of June, 2015, by David Harde Personally known:4/Z� "_ I Print, Type or stamp name of Notary !. OK Notary Public State of Florida Brenda Bello woe My Commission EE 199414 aypei" Expires 06/27/2018 100 NE 84th Sb'eet PHONE 305.759.8912 Suite 200 CEL. 305.987.2995 r<i. n<c li lniu tip.itu! Mlaml,FL 33138 EMAIL. daVidC�adanaCdeVfttBPd1t00n1 WEBSITE wwmadanacdevelopmenu m Miami shores Village mail null" Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption -7- 7 R- 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 SIGNING LOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature a / —Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this. 6?7 day of 20 Ir By who is personally known to me or has produced as identification. Notary: SEAL: pr. Notary Public State of FlOrid8 EE 19" Brenda Bello14 14 My commission EE 199414 01 6 Excires 06/27/201