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DS-16-2349 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-265827 Permit Number: DS-8-16-2349 Scheduled Inspection Date: November 04,2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Mesa, Michel Inspection Type' ;Ion Owner: RENICK, RALPH Work Classification: Addition/Alteration Job Address:1579 NE 104 Street �{ �_ L Miami Shores, FL 33138- Phone Number 6{ Parcel Number 1122320320170 Project: <NONE> Contractor: G&G EQUIPMENT RENTALS INC Phone: (786)534-9151 Building Department Comments REPLACE PAVERS ON POOL DECK Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ !J Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 03,2016 For Inspections please call: (305)762-4949 Page 10 of 28 - -'i Miami Shores Village 1 AUG 19 2016 Building ,r . ,T r 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 I°RC 2014 BUILDING Master Permit No. D5 I�0— ` 3tij PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP �( j CONTRACTOR DRAWINGS JOB ADDRESS: I �9 F_ ���'I �' 5 4,e4 City: Miami Shores �y County: Miami Dade Zip: 33).3P Folio/Parcel#: I/— a�� � —®�d� ' � I It) Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: I ' Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): l �C'v�➢t�lt_ ��cn�eAhone#:3©S L—gqQJ Address: ��"l Cl 91�. ®� '4fe-y d` City: Q �: �J�wYsL S State: F`CIL, Zip: 13 V Tenant/Lessee Name: Phone#: Email: MrJY�t`71A��►y�CvC �Y`nC�C • t �� CONTRACTOR:Company Name:_�a �I f ►�Sy"/�Phone#: 3 r_-1 1 Address: ®°, 011 `7R City: �yye�1 State: L Zip: ,41� Qualifier Name: d[A-Vi W\C'A1'_0 zV%l1 v,� Phone#: 7A. a_n J S3 State Certification or Registration#: 1 Ooh y 0 Certificate of Competency it: DESIGNER:Architect/Engineer: Phone#: Address: r t� City: State: Zip: Value of Work for this Permit:$ 6 l o ' Square/Linear Foo age of Work: U-D S _ Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: � r� P6 b) (De CUz. 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$ (Revised02/24/2014) A � 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 a Signature OWNER or AGENT CONTRACTOR The foregoing instru a was acknowledged before me thisThe f egoing instrument was acknowledged before me this 1 .day of W.�� 20 ! by day of U� 20 IU by OLY Mo R K'9 n LC,L who is personally known to $�-�.( )iC.�Y +rho is personally known to me or who has produced.FL— L-- �ras me or who has produced as identification and who did take a�Pi oafi� o b identification and who did take an oath. NOTARY PUBLIC: C`S L NOTARY PU LIC: Sign: rp EXIS IA GUTI Sig a-,J axao Print: �9••••...••'a`°f IBES Fab rua 26,2018 Print: / eah (40 398.0183 Florldehlotaryservice.com Sea �✓_ Notary PublicLopez Stale cd Fbride. Myrw y Canvyftsion FF 188368 �1 pd Expires 1212=18 rt�x* � *s�x�** * •�xw*+�x +r *w* �xs * *��s�x�x*s� *a��xa�,x �x** x�xFowl 4 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) PROPERTY ADDRESS. 1579 N.E. 104th Street FLOOD ZONE: AE(EL;'9)11-4-87 Miami Shores, Florida 33138 Panel 0093 LEGAL DESCRIPTION: BLOCK 3 LOT 18 SUBDIVISION: RIVER-BAY PARK ADDITION 40 AT PAGE 72 ACCORDING TO THE. PLAT THEREOFDA S RECORDCOUrJTYpLFLORAT OIDA. OF THE PUBLIC RECORDS OF CERTIFIED TO: PALMER, MCTITLEKEY INSURANCERFUNDTTONCEYS, ATTORNEYS CONSUMERS SAVINGS-B-BNITe SUCCESSORS AND/OR ASSIGNS, �- p AS THEIR INTERE�T'MAY RALPH RENICK, JUNIOR- ANI17 a.p, c,hc lc^s Villi \6 CARMEN RENICK ^D BY DATA 122, R ?R e 4 —►S' 0: -:Es z ` LOCATION SKETCH 1� = 100 ' IONi r It TE CERTIFY: That the attached BOUNDARY SURVEY the above de scribed as yroperty is true and correct to the best of our knowledgeround recently surveyed under ourandrmeetsdiectionminimumttherehat above setground technical standardsby encroachments unless shown, the FLORIDA BOARD OF LAND SURVEYORS, willuant havettocbep2 made to determine Examination of the abstract of J property. Location aa-d COPY xecorded instruments, if any, affect in the prop y �p identification of utilities on and/o adjacent to the property were not '�,osecured as such information was not equested. Ownership is subject to ;cr4opinion of Titlek-kRVEYOR DATE: February 22, 1992 NARCISO RAMIREZ PROFESSIONAL LANN0: 2779 FOR: RENICK STATE OF FLORIDA NOT VALID_ WITHOUT EMBOSSED SEAL SCALE: 1" = 20' B.P.I. LAND SURVEYING, INC. 92-3478-19 ' 11330 S.W. 56th Street ORDER N0. Miami, Florida 33165 FIELD BOOK: 42 PG: 69 (305) 274-4292 ' to .t ,Legend: Centerline, R & M = Recorded and Measured, Conc = Concrete, A/C = Air Conditioner, P/E = Pool Equipment, Res = Residence, No = Number, St = Street, F1. =' Florida, Typ = Typical, WD = Wood Deck, Clr = Clear. a R Q, fl 4 " - �• �'1rATo25 �� �\X&N-o X14' t.1O wo ..,o FCJU>\10 c7• o t0 d%.-J-1• %q.4' * NdtL p -to �. '9 :cao;Z 0.40' CLpk t2.►o. v -ao v Pool„ .• ��;^�-j'v uLI N �� `2'f. .a V ¢ 19 ►O t P� N �tL� •Q1 06 p� t2.25' q.4' y o:10 J E CE W• � z . .. .Q Q 1'1.10' 06 w w N 10.1p' z = to � � � � Ot..1E STO�y CPRS 2.>=S• Q . z _ Q t.gyp. tS`1q �1E 104 ST 9 O� o z U! r<t��ti-ti shoe. �. c- a 6 6 �3 p Q . U 1-,.4p o. 0 N IO.cc 21 SCS' 0 11114'T5 :4-) AUG 92 �� ' "' :v ,:'• _ N BY: D' FQU1..iC� i A tti1LtL x it .4' 3 t`1S.cx�... ro Fa,woo s 4stc��v:lac yz', 0 13' PI�RKvJ�j/ .`� Pti Qj U, N. P: S, N( BEARINGS WHEN SHOWN REFER TO RECORD PLAT BOUNDARY SURVEY SgoRES L<< a 'ff J 619 p.. Miami * hores illage Building Department fi�OlttDp° 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ®NT CT®RS' 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. 1' COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. 1✓ COPY OF LOCAL BUSINESS TAX RECEIPT C. _V 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. ivvvvveav�v®®®v®o®e®evv®m®®v®aae®m®ovv®vvvvavn®®vevvvvv®®vmvv®vavvseesvav®rrvva�■®ooavovr®® BUSINESS NAME: G f G EQ ut PmF_N r �EvrALs f t,c, MA I?AyF 7-i4E WAY Q61A196VIV6 BUSINESS ADDRESS: 3961VLU 79 q✓E !!�3?9L_CITYDU YL _ STATE zip _33J( BUSINESS PHONE: (7 8 6 ) 53 5_/ FAX NUMBER(73 ) -5 3 t-9 y S l CELL PHONE ( ) a77- 8S 3 9 QUALIFIER'S NAME: _TO RN MAP-1IVOff90 r A1VbF_ QUALIFIER'S LIC NUMBER: E / ( a 0 0 10 Construction Trades PifyingBoard .-.i BUSINESS CERTIFICATE OF COMPETENCY E1600040 G & G EQUIPMENT RENTALS INC D. :PAVE THE WAY ENGINEERING #HEANOr-7 JOHN MARINO Is certified under the Provisions of Chapter 10 of Miami-Dade County QUAIJIFYING TRADE(S) 0007 PAVING ENGINEERING MlAMlM Jtim K Salts P.E. Sl.lt S—e-y OMW B—d J A�Ind-Dada rmafaad he+� ww�damMade.B��f Municipal Contractors Tax Receipt Miami-Dade County,State of Florida -THIS IS NOT A BILL-00 NOT PAY M C CC NO:eI60U040 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES PAVE THE WAY ENGINEERING SEPTEMBER 30 2016 3900 NW 79 AVENUE STE 562 7483871 DURAL,R 33166 Pursuant 1¢Caunty Code Sec 10-24 OWNER TYPO OF BUSINESS PAVE THE WAY LNGINLLRINC, SPECIALIY ENGINEERING PAYMENT RECEIVED BY TAX COLLECTOR C/O G 8 G EQUIPMENT RENTALS INC CONTRACTOR 175.00 05/03/2016 0200.16-001443 This aowpt is act vmtd in we lollavei g Mssfcipelhles:Avemm¢.Owal.Hi¢leah Key Biscay". Mieod Gardens,Mimi lakes.Palamll¢Bey,Plpecies6 Stacy Was Banc%Tmvu of Cutler Bay- r�wmt `' Fat me inlwmmioe,visit www miemitladsaavfmi¢of Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT ABILL--DO NOT PAY �ILBT 7197335 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES PAVE THE WAY ENGINEERING NEW BUSINESS SEPTEMBER 30, 2016 3900 NW 79 AVENUE STE 582 7479689 DORAL,FL 33166 Must be displayed at place of business Pursuant to County Code Chapter BA Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED PAVE THE WAY ENGINEERING 196 SPECIALTY BY TAX COLLECTOR C/o G&G EQUIPMENT RENTALS ENGINEERING Mr. CONTRACT 45.00 02/11/2016 Worker(s) 1 E1600040 0247-16-002394 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 comply with any governmental or nongovernmental regulatory lows and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 80-276. MIIAMI— For more inlormation,visit www.miamidade.gov/texeollector . ___11 ,� `�►r 'CDlil7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 08/18/16 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). PRODUCER CONTACT NAME: Hemisphere Insurance Group ac°NN Ell: (305)501-2801 A/C No): (305)553-9010 11401 SW 40 St Ste 340 -MAIL hemisphereinsgrp@aol.com Miami,FL 33165 INSURERS AFFORDING COVERAGE NAIC# Phone (305)501-2801 Fax (305)553-9010 INSUR A:TRAVELERS INS COMPANY INSURED INSURER B: UNITED SPECIALTY INSURANCE COMPANY G&G EQUIPMENT RENTALS INC DBA PAVE THE WAY ENGINEERING INSURER C: 3900 NW 79 AVE#582 INSURER 0: DORAL,FL 33166 INSURER E: 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. ILTR TYPE OF INSURANCE ADDL UBR pOUCY NUMBER fA OM/DDY EFF MPO/Upp EXP OMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISESS(Ea occurrence $ 100,000.00 j I ❑ ❑ CLAIMS-MADE U OCCUR MED EXP(Any one person $ 5,000.00 B ❑ Y Y DCG00469-0 110/27/2015 10/27/2016 I� PERSONAL 8 ADV INJURY $ 1,000,000.00 J GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 E] POLICY ❑ JECT PRO- ❑ LOC _-__ _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ! BODILY INJURY(Per accident) $ B ❑ AUTOS ❑ AUTOS en _ ❑ HIRED AUTOS NON"OWNED PROPERTY DAMAGE $ ❑ AUTOS Per,accident ❑ 11 $ ❑ UMBRELLA UAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS UAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ _ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TQRY_II ITSER - ANYPROPRIETOR/PARTNER/EXECUTIVE 6FR 1 3U B-2864C57-6-14 EL.EACriACCIDENT $ 1,000,000.00 A OFFICER/MEMBER EXCLUDED? NIAI N 07/24/2016 07/24/2017 t (Mandatory in NH) E L.DISEASE-EA EMPLOYE $ 1,000,000.00 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 i i I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) LICENSE NO.E1600040 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE 7 ', ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD t 016322 Local Business Tax Receipt Miami-Dade County, State of Florida THIS IS NOT A BILL-0p NOT PAY LBT 7197335 y BUSINESS NAME&OCATION RECEIPT NO. EXPIRES PAVE THE WAY ENGINEERING RENEWAL SEPTEMBER 3 , 2077 3900 NW 79 AVENUE:STE 582 7479889 Must be displayed at place of business DORAL FL 33166 Pursuant to County Code Chapter BA-Art.,9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED PAVE THE WAY ENGINEERING 196 SPECIALTY ENGINEERING CONTRACT PAYMENT TAE COLLECTOR C/O G&G EQUIPMENT RENTALS INC E1800040 Worker(s) 1 $45.00 07/11/2016 CREDITCARD-16-038252 This local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license. permit or acortificationofthe holder's gusliRcations,todobusiness.Holder must comply with any governmental or nongovernmental regulatory laws sadd requirements which apply to the business. The RECEIPT N0,above must be displayed on all commercial vehicles-Miami-Dade Code Sec So-27& For more Information,visit mpNw miamidedo,govitexooNectar f1k Q- 4 { HUM Municipal contractor's Receipt'- Miami—Dade County,State of FloW —THIS ISNOT ASILI--OO NOTPAY W 7197335 Mc BUSINESS NAiAsb3ILOCA;TION R lel'NO. EXPIRES PAVE THE WAY ENGINEE RING NEW SEPTEMBER 30, 2017 3900 NW 79 AVE STE 582 7495349 Must be displayed at place of business DORAL FL 33166 Pursuant to County Cade Chapter IIA-Art.9&10 OWMBR Sec.Tyra of BUSINESS eluT ti lV1F� G$G EQUIPMENT RENTALS INC MMC SPECIALTY ENGINEERING CONTRA S csti t OR CIO WILION HERNMDEZ PILES E1600040 $175.00 10/1$/2016 Got(a) +C31EC]t1`t'ARD-17-W)133 TNs tatml I Iaess flax Rscoi�only eaalitms ps aaat of die laosi ewosos Tax The lie ipt ht not a liseose> "ok w a aordficsllsa of Me botdef sgHolmes to do business:Ntdder masttr p wig ssY govaratnantal at ell tegule"leets s�9 requirements wwah apply,to 60 The RECEIFY NO.above must he displayer an all to ercial veElclas.-Ml »Iletin Code,See 80-27& Prot mos Inboraretion.visit. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 11/02/16 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(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 Hemisphere Insurance Group PHONE (305)501-2801 FAC NO: (305)553-9010 LAM 11401 SW 40 St Ste 340 L hemisphereinsgrp@aol.com Miami,FL 33165 INSURERS AFFORDING COVERAGE NAIC# Phone (305)501-2801 Fax (305)553-9010 INSURER A: NORMANDY INS COMPANY INSURED INSURER B: UNITED SPECIALTY INSURANCE COMPANY G&G EQUIPMENT RENTALS INC DBA PAVE THE WAY ENGINEERING INSURER C: 3900 NW 79 AVE#582 1 INSURER D: DORAL,FL 33166 INSURER E: 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 CONTRACTOR 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. ITR TYPE OF INSURANCE ADD UBR POLICY NUMBER M DDY EFF PMLI D EXP LIMIT'S GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 Q GE TO RENTED COMMERCIAL GENERAL LIABILITY PRAEM SES Ea occurrence)encs $ 100,000.00 ❑ B F—] CLAIMS-MADE Y CLAIMS-MADE 0 OCCUR DCGO0469-010/27/2016 10/27/2017 1 MED EXP(Any one person $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 El ❑ PRO ❑ LOC $ AUTOMOBILE LIABILITY OMBINEDa accident INGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AUTOSALLOWNED ❑ SCHEDSCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ F] HIRED AUTOS Per accident ❑ ❑ 1 1 $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ©W C STATU- ❑OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE NHFL0058232016 E.L.EACH ACCIDENT $ 1,000,000.00 A OFFICER/MEMBER EXCLUDED? N/A N 10/03/2016 10/03/2017 (Mandatory In NH) El E.L.DISEASE-EA EMPLOYE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD