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PL-15-1768 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239133 Permit Number: PL-7-15-1768 Scheduled Inspection Date: May 24,2016 Permit Type: Plumbing- Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner: GREENBERG, DAVID Work Classification: Addition/Alteration Job Address:534 NE 95 Street Miami Shores, FL Phone Number (786)333-8567 Parcel Number 1132060140820 Project: <NONE> Contractor: HERNANDEZ PLUMBING COMPANY Phone: 305-267-2346 Building Department Comments REMOVE&SET PLUMBING FIXTURE& ROUGH Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 23,2016 For Inspections please call: (305)762-4949 Page 8 of 42 Dade Gas Contractors, Inc. 12392 SW 213th Terrace Miami, FL 33177 Phone#:786-316-3021 License#: 26163 Drop test Certification Florida Building Code, Fuel Gas SECTION 406 (IFGS) INSPECTION, TESTING AND PURGING 406.1 General. Prior to acceptance and initial operation, all piping installations shall be inspected and pressure tested to determine that the materials, design,fabrication, and installation practices comply with the requirements of this code. Owner Information: Permit Number: PL Name /03/ jUAl 1k' Address ,YjIU E9 ' ee City State �L Type of Installation: New ® Upgrade to Existing Description of work: (Must include test details and include piping and appliances). 661VCA vii-;-e cur) o�- 3 )I -{-D --eed ooqe, dri er and *111c f ess iuo-er G1ea 4er. Lockup: ` Water Column: // Test Duration: SM Date Tested: 15-/'7-3)/(0 Julio Orta S ' L ttateo ( er)Signature Print Name Date of Florida County Of RktCrwt 00 C6Un 69rn to and subscribed before me this day of i 2016, by -� 1 Personally known ❑ Produced Identification-,Type of Identification Signature of Notary Public: Dater Melm� ori Nfty of Flda My COMM MWM EE 560302 E)q*u 1110MI5 6� Miami Shores Village 10050 N.E.2nd Avenue NE '' •�• Miami Shores,FL 33138-0000 tbnivp• Phone: (305)795-2204 rPQ £ s ; P 1 .3 Expiration: 1/1212016 .;- Project Address Parcel Number Applicant 534 NE 95 Street 1132060140820 1031 FUNDING&REVERSE COR Miami Shores, FL Block: Lot: Owner Information Address Phone Cell 1031 FUNDING&REVERSE CORP. 681 ENCINITAS Boulevard (786)333-8567 ENCINITAS CA 92024- 681 ENCINITAS Boulevard ENCINITAS CA 92024- Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 HERNANDEZ PLUMBING COMPANY 305-267-2346 Total Sq Feet: 0 Type of Work:REMOVE&SET PLUMBING FIXTURE&ROU Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# PL-7-15-56347 DBPR Fee $3.15 07/16/2015 Check#:195 $228.90 $0.00 DCA Fee $3.15 Education Surcharge $1.20 Permit Fee $210.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $228.90 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 V : 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 zo g. F e I authorize the above-named contractor to do the work stated. July 16, 2016 A i nature: er pplicant / Contractor / Agent Date Bui in epartment Copy July 16,2015 1 e Miami Shores Village JUL 6 2015 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 l3 BUILDING master Permit No._24 ;- " &o +s PERMIT APPLICATION Sub Permit No. —1-1 G9 BUILDING ELECTRIC M ROOFING REVISION M EXTENSION MRENEWAL VPLUMBING []MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP A t CONTRACTOR DRAWINGS JOB ADDRESS: 5,3 7'L /v qg St- City: Miami Shores County Miami Dade Zip: 33118 / Folio/Parcel#: (- S 2-0(v-p 14. 0 $o`L-0 Is the Building Historically Designated:Yes NO Y Occupancy Type: sF Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 149.3 1 -FUND TAK, q &+A,&7( Phone#: S Address: s-35s- ef(66 -aUt t NhS 2-�3 City: CA-P�L-SBA-h State: CA- Zip: q,o®0 Tenant/Lessee Name: Phone#: Email: I-AA I/Q4AM Q &�?� Ge-y^ ' CONTRACTOR:Company Name:_H7U9 lJ A**)E3,- i'W!461 C-S Phone#:_ 30 aq7 -a?)q(o Address: 16(1C) Su� S3 eve. - City: k1 a. t&z• State: Z-- Zip: Qualifier Name: IPCDRO kW&-�3 DC-2-- Phone# State Certification or Registration#:af—C41)10-5'9- t Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City: State Zip: Value of Work for this Permit:$ (D � - 43t-0 / Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration s,❑I New ,Re/p-air/Repliccee El Demolition � Description of Work: PV-g- � f (.� o, �L,(,/�yt.�g �Q -7; , `;' 7►01 Specify color of color thru tile: - S Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ gond$ 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 Trp 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$250, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the of such pasted notice, the inspection will not be approved and a reinspection fee will be charged. 1 Signature Signature OWNER o AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing Instrumenwas acknowledged before me this U day of 20 t by cI / day of / .20 fi" .by who is p a y k wn to � 'IP Her'`i�/ CGl .who is personally known to Jm n uu///// me or who has produced ado V®,N,. as me or who has produced as `�. .........., '%. identification and who do talge'agat�os,' identification and who did take an oath. ea NOTARY PUBLIC: NOTARY PUBLIC: Sign: Si Print: ��in„ i�� Print: Ita4d Seal: Seal: AREM W COMMUKIN f FF 163486 EXPIRM:Ocbbw 1,2018 ea�dmua010rPdkts APPROVED BY ? r Plans Examiner Zoning Structural Review Clerk (Re&W02/24/2014) sK '< au z y��.<,. �b6 s� `,'t r ' '_ x '".?a .s$ , .: v +,' 'ey 6 i' �'3 6- $,r- r�+ .� ,9� gx..'r �g -5 :'S a 'c K , � `L 5 r, 1 g r a <_• ��'--� sw ': '�, x f`` �:;. iy `' ',^.a, 4 i , � n 1k $a k a ; i r•yt�' ve a aKx 25 jj XPJIW! rftD��'�:$js,�4:rt.+��ykr>r;,a-r��i',i4 4,F�1x'f54,w5r�fi$��4 a'r'>rt��r3-�•,�&..`•'�k{a�-kaEf�+��S�'afs,�k ao Y�"�,s��}$r34ta?��_w{�7q�`.'�f�7�>,Fp�$�r�'�r`.:'+e'''S��'y':!n,``}�r�v'.�,�71��5altii��r�"reiy,hrYY�y�j"rYt`amr`�gi IfsTr4,�.kj,+T'st��,�•atp.•-lo��-zy�r,�s'�i''��rfy�t'"tY,�uCf��"e�4,_�'�-t.vr'�a:"t.�5S',':.`4��4,<�k��+s''x a a8�s�ar�4 t��tt`w�1re!t'v!i-- ��g�h,�,=I'��`4ap.sfya�r"p�:dJrti�'�„l/�3�Sy'"`7�.��'oQ"�-.°��',Y--P`R.•-,e'�3e"t�y,r�R�x�t�o'1'�Ak�'kzi,.4''k°$I�t�'►f-Ak'<t�Cyy,r"e.:I..��:'�.._�.S�r�rF.'-f'�ak�fi4Gr-7l.n>^C`!o-�_A.r!^-.';S3x:tifiF..7r�d"�''+,�-�u.`kal3`>S w�sO"'N'''¢<7yy�ssN.�y.��'t�StiY.y,.,'T�.t_-'.^�'F�i4".��v''�R,r�`��rra�s�st+-wit�i��'�b�{�irfx'�"C"?4��w a�.4�#.�_•r+;4"s�..�r-_S'_"��.-�r�Y rx 'I,'4u �a�!ittp 4 S��i b�w_I,T.N,"�°h"ti,"pF,,�e;JQ;�"`'��_.��L`.s`�d�EBc-ry.,�"o�fl•"T.c,`'I3`�a�`�'-;Fp.��D��Ra 4y>. '_ p ys �a��ts�3Sr'.'ysuz �ff� Ry��uH•?� j'ab+ qeh4 ES §,�5��."rtv ,Fik 77 Witt t¢ .;- "'mi7 OEMPL fap.4 "$tNCk, Y TAXFC032 O 500 18j2 E 1 TW Tex M TV RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY O+ST FLORIDA PAftAEMT.Qf B31 h $AD-MOFESSIONAL REGULAnON ® %% N."\ ,'.., ' ur(,' �.F ' ' t,{I, } .. 1 - _ - ��-w-� -`°' '�4 ,�"'\.a "_.`w'�.ie`'q-� _,.'°�`4� ■ 's � .^'`r!""�ya: �;. f.r• _tea. _ ? - �.,..,��.c` 1..�.3-��.�..��.:5..3 h.aa , ISSUED: 08/0712014 DISPLAY AS REQUIRED BY LAW SEQ# L1408070001555 C�® CERTIFICATE OF LIABILITY INSURANCE DATE(bIMIDD/YYYY)07/10/2015 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 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). NTA PRODUCER �E:CT Xamet BarreraS Temax Insurance PHONE D. , (786)539-5989 AI No): (305)356-1235 7990 SW 117 ave#113 ADDRESS: xamet@temaxinsurance.com INSURER(S)AFFORDING COVERAGE NAIC S Miami FL 33183 INSURER A: CAPACITY INSURANCE COMPANY 32930 INSURED INSURER B: Hernandez Plumbing Company INSURER C: 1840 SW 83 Ave INSURER D: INSURER E: Miami FL 33155 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEImmu— POLICY NUMBER D WD LIMITS X COMMERCIAL GENERAL LW31LnY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE FKOCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A CLM01009098B 09/16/2014 09/16/2015 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY F1 JECOT F-1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COM13INED 91–NUM LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ �� X SSCHHEDU LED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Peracddent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION ER AND EMPLOYERS LIABILITYY/N STATUTE oERTH ANY PROPRIETORIPARTNERIEXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ N yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-PbLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addidonal Remarks Schedule,maybe attached H more space is required) Plumbing Contractor 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 AUTHORIZED REPRESENTATIVE 2 Ave Miami Miami Shores VillageFL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD To: Page 4 of 4 2015-07-10 18:38:32(GMT) 305-270-0765 From: . . • �'"'�1 HERNA 1 OP ID:ALYS CERTIFICATE OF LIABILITY INSURANCE °A0711 2015 07/10J2015 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 pollcy(€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 endorseme s. PRODUCER CONTACT Javier A.Fernlindez €Sure Insurance Brokers 8700 W.Flagler St.,Suite 270 PHONE305-223-2533 .305 220-0765 Miami,FL 33174 L Javier A.Fernandez ADDRESS:Certiftate iSureBrokers.com ENSURERS AFFORDING COVERAGE NAIL 0 INSURER A:Technology Insurance Co. 42376 INSURED Hernandez Plumbing Company INSURER B: Pedro Hernl3ndez 1840 SW 83 Avenue INSURER C: Miami,FL 33155 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI..OW 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, IN LTR TYPE OF INSURANCE POLICY NUMBER MPOLIC EFF kP9AA�ID EXP LIMITS GENERAL LUU3ILITY VWQEACH OCCURRENCE S CLAIMS-MADE D OCCUR PREMISES Ea occurrence $ MED EXP(Any one Person) S PERSONAL a ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY❑ GENERAL AGGREGATE $ JECT E LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY u $ Ea accident ANY AUTOALL BODILY INJURY(Per Person) S AUTOS OWNED Al1THOS LED BODILY INJURY(Per accident) $ HIRED AUTOS NON AWNEO AUTOS PROPERTY DAMAGE $ Pet accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS M�4DE AGGREGATE S DED RETENTION S WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY X ST TUTS OR A ANY OFFICERIMEEMBEEXCLUDED?ERECUTiYE Ya N I A TWC34878$3 Q4/14/2016 04/14/2x16 E.L.EACH ACCIDENT $ 1001 (MandatorydOsci In and EL.DISEASE-EA EMPLO S 1001 IIyes�deset�le under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 5001 00( DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarlrs Schedule,may be attached N mots qmc#is required) PLIMMING CONMRCIAL 6 RESIDENTIAL CERTIFICATE HOLDER CANCELLATION VILLAMS 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. Fax:305-75641972 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered mafks of ACORD AC ROS DATE(MMIDON"n CERTIFICATE OF LIABILITY INSURANCE 07/10/2015 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 NAME:C Xamet BaITeras Temax Insurance PHONE , (786)539-5989 AI No): (305)356-1235 7990 SW 117 ave#113 ADDRESS: xamet@temaxinsurance.com INSURER(S)AFFORDING COVERAGE NAIC A Miami FL 33183 INSURERA: CAPACITY INSURANCE COMPANY 32930 INSURED INSURER B: Hernandez Plumbing Company INSURER C: 1840 SW 83 Ave INSURER D: INSURER E: Miami FL 33155 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 ADDTYPE OF INSURANCE L SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR X COMMERCIAL GENERAL UA131U Y EACH OCCURRENCE $ 1,000,000 cLAIMS-MADE FX OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A CLM01009098B 09/16/2014 09/16/2015 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY E]JECTT 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SI UM $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LI1B CLAIMS-MADE AGGREGATE $ DED I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVEEl N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory M NH) E.L.DISEASE-EA EMPLOYE $ H yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached H more space Is required) Plumbing Contractor 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 AUTHORIZED REPRESENTATIVE 2 Ave Miami Miami Shores Village FL 33138 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD