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MC-15-1501 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-237142 Permit Number: MC-6-15-1501 Scheduled Inspection Date: June 08,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: WICHMANN,ANGELA KELSEY Work Classification: Addition/Alteration Job Address:1399 NE 104 Street Miami Shores, FL Phone Number (954)444-2156 Parcel Number 1122320320040 Project: <NONE> Contractor: MASTER MECHANICAL SERVICES, INC. Phone: 305-825-3004 Building Department Comments KITCHEN AND BATH RENOVATION AND ADDITION OF infractio Passed Comments 1/2 BATH WITHIN SQUARE FOOTAGE INSPECTOR COMMENTS False J Inspector Comments Passed Im Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 07,2016 For Inspections please call: (305)762-4949 Page 1 of 36 Miami Shores Village ' j � Fto e1 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 2E�1 :m� Expiration: 06/06/2016 Project Address Parcel Number Applicant 1399 NE 104 Street 1122320320040 Miami Shores, FL Block: Lot: ANGELA KELSEY WICHMANN Owner Information Address Phone Cell ANGELA KELSEY WICHMANN 1399 N.E. 104 ST. (954)444-2156 MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone MASTER MECHANICAL SERVICES, IN 305-825-3004 Valuation: $ 11,303.00 _._.....__ _.,, .. .. Total Sq Feet: 00 Tons: Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work:KITCHEN AND BATH RENOVATION P Underground Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7,20 DBPR Fee Invoice# MC-6-15-56021 $5.93 12/08/2015 Check#:3052 $435.66 $0.00 DCA Fee $5.93 Education Surcharge $2.40 Permit Fee $395.60 Scanning Fee $9.00 Technology Fee $9.60 Total: $435.66 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 AFFI VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an g. Futhermore,I authorize the above-named contractor to do the work stated. December 08, 2015 Authoriz ignature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 08,2015 1 r , V �ID 9 Miami Shores Village U14 015 3UN �� 2 Building Department 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 20 JO BUILDING Master Permit No. % /��� PERMIT APPLICATION Sub Permit No�/„® ` W. ❑BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL .UMBING MECHANICAL [PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION [] SHOP 1 9 CONTRACTOR DRAWINGS JOB ADDRESS: 13 p t 1 l 2a City: Miami Shores County: Miami Dae Z712: Folio/Parcel#: l l - dQqa s the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Floc!Zone: BFE: FFE: T P191A /�NvIQ OWNER:Name(Fee Simple Titleholder): A NCS� � L P one#: 9- Y. Y 21S Address City: t� l!�V►�, !SOP je2fStState: Zip: C� Tenant/Lessee Name: Phone#: Email: cJ@1�✓i c� CONTRACTOR:Company Name: MfCj,\4 RJ I r-AL- Phone#: 3Y,19 2 Address:_1`5 (S-1 t'�Dj I3 PL City: ✓K i AM L State: —Zip: R Qualifier Name: Wi l Our—•• C.V--S Phone#: State Certification or Registration M 0 NMG 0 S'A z oa Certificate of Competency#: DESIGNER:Architect/Engineer.-AA® n�����'� d1 r��'��. r Ppho\ne#: Address 100 1J�V �2 �a Q � )b City: yState: �- Zip: (Value of •o Square/Linear Footage of Work: Type of Work: ❑ Addition C&Alteration ❑ New ❑ Repair/Replace Demolition Description of Work: 10.E ?Sy AIrN ® CIJ1• o1� Y Specify color of color thru tile: Submittal Fee$ Permit Fee$ ` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Educatlon Fee$ Double Fee$ Structural Reviews$ Bond$ _ TOTAL FEE NOW DUE$ (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. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -3 day of -OM 020 15 .by 1- day of 20 !'S ,by who is personally known to who is personally knnwn 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: Print: c , Print: r e e ••• eNIS Seal: a .�yEtiiflgi Seal: * * f�YCOI�MI8SION0EE842213 W #EE2M80 ,, F EXPIRES:October 10,2018 Yf EXPIt3ES:June 2S,2016 f''�oa %"Ttq 0 WMy%*ft b ft"Thio ti p Pfe Ink s *s*********************s******** *s** *****s***************s**s**sss******s*****s**s******s******s****ss**s APPROVED BY L Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ones allot" Miami shores Village Building Department RIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: ftwf��rr;z,2 V 11�Jl BUSINESS ADDRESS: G VJ S3 fL.- CITY 01AM I C TATE 4�-L ZIP 3.30!-:SL1/ BUSINESS PHONE: (. l �- �C�`-t' FAX NUMBER( CELL PHONE( ) QUALIFIER'S NAME: W I LU NA .7—t ®c a—' QUALIFIER'S LIC NUMBER: C G dJ c� 10 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION .� CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 V 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 FLOWERS,WILLIAM SHAWN MASTER MECHANICAL SERVICES INC 15181 NW 33 PLACE MIAMI FL 33054 Congratulationsl With this license you become one of the nearly ................. one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. Ow' PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CMC057200 ISSUED: 06/15/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more Information CERTIFIED MECHANICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe FLOWERS,WILLIAM SHAWN to department newsletters and learn more about the Department's MASTER MECHANICAL SERVICES INC initiatives. 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 CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new licensel Expiration date:AUG 31,2016 L1406150001601 DETACH HERE _ . ............... ... ... ..........._.._ ..... -...._ _.............._................ .. ... _....__....__................._._. _.......... _.. .....__........... ...__...._._.... .._...._._ RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONr� CONSTRUCTION INDUSTRY LICENSING BOARD ' CMC057200 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 FLOWERS, WILLIAM SHAWN __ MASTER MECHANICAL SERVICES INC 15181 NW 33 PLACE .; MIAMI FL 33054 ■ ISRIIFn• M/115/91114 niSPl AY AS REQUIRED BY LAW SEQ# L1406150001601 ADO . 004226 • I Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOTPAY I 4549821 \11LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES 4 MASTER MECHANICAL SERVICES INC RENEWAL SEPTEMBER 30, 2015 15181 NW 33 PL 4749843 Must be displayed at place of business MIAMI GARDENS FL 33054 Pursuant to County Code Chapter 8A—Art 9&10 r SEC.TYPE OF BUSINESS OWNER PAYMENT RECEIVED MASTER MECHANICAL SERVICES INC 196 GENERAL MECHANICAL CONTRACTORBy TAX COLLECTOR Worker(s) 4 CMC057200 $45.00 07/23/2014 CHECK21-14-032043 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 complywith 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 Ila-276. For more information,visit www.mismidade.gov/toxcollector h --"� MASTE-2 OP ID:SD AC®RO® CERTIFICATE OF LIABILITY INSURANCE DATE 9/20151� 06/09/2015 THIS CERTIhCATE 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 does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kahn-Carlin&Company,Inc. PHONE Fax 3350 S.Dixie Highway A/c No Ext): AIC,No): Miami,FL 33133-9984 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:FCCI Insurance Company 10178 INSURED Master Mechanical Services Inc INSURER B:National Trust Insurance Co 20141 NW 33 Place Miam INSURERC:Federal Insurance Com an 20281 Miami, FL 33054 p y INSURER D:North River Insurance Co. 21105 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 RDDLSUOR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSE MUL POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY GL00116385 03/31/2015 03/31/2016 DAMAGE TO-Rt:N I U) PREMISES Ea occurrence $ 300,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 X PER PROJ-PER LOC GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICYFX PRO LOC $ AUTOMOBILE LIABILITY COMBINED itSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED (Per accident)AUTOS AUTOS ( )BODILY INJURY Pident $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PER ACCIDENT $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 4,000,00 D EXCESS LIAR CLAIMS-MADE 581-104700-1 03/31/2015 03/31/2016 AGGREGATE $ 8,000,00 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N O Y LIMITS A ANY PROPRIETOR/PARTNER/EXECUTIVE 001-WC15A72097 03/31/2015 03/31/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 Uyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Equipment Floater 06642183ECE 03/31/2015 03/31/2016 Limit 100,00 Leased/Rented Deductibl 1,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) License Number: CMC057200 CERTIFICATE HOLDER CANCELLATION MIAM-04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD 2016 details - Business Tax Account MASTER MECHANICAL SERVICES INC - TaxS... Page 1 of 1 miamida&,GOV Tax Collector Home Search Reports Shopping Cart Please do not include any special characters in the name,address,and e-mail field such as#,&,hyphens,comma, dashes. i We have moved.Our new address is: 3 200 NW 2nd Ave,Miami,FL 33128 The information contained herein does not constitute a title search or property ownership. i i 2015 Tax Bills are Payable on Sunday,November 1,2015. Business Tax Account#4549821 Account details :' Account history 2016 2015 2014 2013 ... ( 2010 PAID PAID PAID PAID PAID Account number: 4549821 Owner(s): MASTER MECHANICAL Business start date: 07/01/2001 SERVICES INC Business address: MASTER MECHANICAL WILLIAMS S FLOWERS SERVICES INC QUALIFIER 15181 NW 33 PL 15181 NW 33 PL MIAMI GARDENS,FL 33054 MIAMI GARDENS,FL 33054 Physical business location: MIAMI GARDENS Mailing address: MASTER MECHANICAL SERVICES INC JOANN PINNA PRES 15181 NW 33 PL MIAMI GARDENS,FL 33054 Print account application (PDF) Rece"474840 PAID 2015-07-15$45.00 Contracting 10/01/2015 NAICS code: Receipt#CHECK21-15-094989 Print GENERAL MECHANICAL —09/30/2016 238990 this bill CONTRACTOR Units:4 Documentation Required by Occupation: State/County License or Certificate Document Received: CMC057200 https://www.miamidade.county-taxes.com/public/business tax/accounts/4549821 12/7/2015 Apr. 5. 2016 12: 57PM Master Mechanical Services No. 1286 P. 1/2 AC d� MASTE-2 OP ID:SD ��- CERTIFICATE OF LIABILITY INSURANCE °A03/31/2016 03/31/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOMMAT1ON ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED RY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 13ETWEEN 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 cartifleate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Kahn-Carlin&Company,Inc. rtANS: 3360 S.Dixie HI hwa5+ AI�e X1.306.446 2271 arc Nd1,1305-448-3127 Miami,Fl,33133--9984 r;-MAILADDRESs. rocessin hn•cariin.com INSURE $AFFORDINGWVERAOE NAICN INSURI:AA:National Trust Insurance Co 20141 INSURED Master Mechanical Services Inc INsuRERe:North River Insurance Co. 21106 15181 NW 33 Place 40178 Miami,FL 33054 INSURER c;FCCI Insurance Com an lNsuRER D;Federal Insurance Company 20284 INSURER E;"MAPFRE Ins Co of Florida 134932 INUUREB F; COVERAGES CERTIFICATE NUMBER: REVISION NUMi3ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BSEN ISSUED TO THE INSURED NAMED ABQVE 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, 1J� EXCLUSIONS ANP CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L.TR TYPEOFINSURANC2 LWL POLICYNUMBER EFF 1 P LIMITS X COMMERCIAL GENERALLULBRITY am MN11 CL IMS MADE O OCCUR GLOO116386 03/31/2016 03/31/2017 EACH accLrRR 1.000,000 PRI III S 300,00 X PER PROd-PER LOC MED ' ace versarl s 10,00 PERSONALaADVINJURY S 1,000,00 GENLAGGREiOATEiUMITAPPUESPER GENERALAGGREGATE S 2,000,00 POLICY M jE� a LRC F1TODLIers-COMP/OPAGG g 2,000,110 OTHER: 3 . AUTONOBILH UABIUTI' Xeaca I LIMIT $ 1,000,000 ANYALRO 4160140010422 0313112016 03131/2017 OWLYINJURY(Per PMUM) S ASMEDULED BODILY IWURY(per amd�nl) S HIREDAVTOS UMMED PereoGQeruLTrOS $ X UMBRELLA LIAR X OCCUR $ B EX0E58VAB CLAIM84VME581-104700-1 03/31/2018 03/31/2017 EACHO=RRD= s 4,000,00 CEO X RETENTIONS 0 AGGREGATE g 8,000,00 WORKERS COMPENSATION 5 AND EMPLOYBR5'LIABILITY' T C OOFFICER"SSMW-R.R E:(MLLUDaW Ypdatwy In NR) IN "'00" N/A TNEROMMVE 001 WG46A72097 03181/2016 03/31/2017 EL.EACHACCIDEVI' S 1,000,000 I�fs��s d65cttbGurow E.L OMEASE-EAEMPLOYE $ 1,000,00 PESCRlPT78N OF OPERATIONS below EL DiSEASP-POLICY LIMIT S 11000,00 D Equipment Floater 08642183ECE 031$112016 03/31/2017 limit 100,Op I-eased/Rented DGd. 1,00 DESCRIPTION OFOPERATIONSILOCATMS IVENICLES(ACORD 101.Additional Remarks Schedule,may beattaciwd if mora spacals requI adl 1RZ: 34IC.ense #CMC057200 CERTIFICATE HOLDER CANCELLATION MIAM•04 SHOULD ANY OF THE ABOVE:Drr.SCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAT9 THEREOF, NOTICE VALL BE DELIVERED IN Miami Shores Village 1 ACCORDANCE WITH THE POLICY PROVISIONS. 10060 NE 2nd Avenue Miami Shores,FL 33138 I AUTIMIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks Of ACORD