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EL-16-101 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 I Inspection Number: INSP-265673 Permit Number: EL-1-16-101 Scheduled Inspection Date: August 18,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type: Final Owner: KLEIN, NELSON Work Classification: Alteration Job Address:9310 BISCAYNE Boulevard Miami Shores, FL 33138- Phone Number (786)344-2378 Parcel Number 1132060141610 Project: <NONE> Contractor: AE TECH CORPORATION Phone: (786)245-0733 Building Department Comments KITCHEN AND 3 BATHROOM RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed ffl Failed Correction �� Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid August 17,2016 For Inspections please call: (305)762-4949 Page 33 of 33 " ' st+eR ns i, Miami Shores Village ■ � � I-I teaclt�nail Miami Shores,FL 331310050 N.E.2nd Avenue &0000 Phone: (305)795-2204 00"R i now:e{4t201 Expiration: 10/0V2016 Project Address Parcel Number Applicant 9310 BISCAYNE Boulevard 1132060141610 Miami Shores, FL 33138- stock: Lot: KLEIN&SALOME INVESTMENT Owner information Address Phone Cell KLEIN&SALOME INVESTMENTS LLC 9310 BISCAYNE Boulevard (786)344-2378 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,500.00 AE TECH CORPORATION (786)245-0733 Total Sq Feet: 3300 Type of Work:KITCHEN AND 3 BATHROOM RENOVATION Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee Invoice# EL-1-16.58328 $3.38 04/04/2016 Credit Card $467.96 $0.00 DCA Fee $3.38 Education Surcharge $0.40 Notary Fee $5.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $1.60 Work without Permit Fee $225.00 Total: $467.96 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zon Futhermore,I authorize the above-named contractor to do the work stated. April 04,2016 Authorized rg ure:Owner / Applicant / Contractor / Agent Date Building Department Copy April 04,2016 1 Miami Shores Village Building Department JAN 2�1� 10050 N.E-2nd Avenue, Miami Shores, Florida 33138 Tel: ;335; 795 22C4 Fax: (305, 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FSC 20kiL-( BUILDING Master Permit No. 'P_C-1 ('0 —C�t PERMIT APPLICATION Sub Permit No. f1L11(4P" Id i BUILDING ( j ELECTRIC ROOFING REVISION - EXTENSION RENEWAL PLUMBING C MECHANICAL =PUBLIC WORKS C CHANGE OF — CANCELLATION = SHOP CONTRACTOR DRAWINGS JOB ADDRESS: v 510 SCJ Q City: Miami_Shores_____ _____pp_ County: --Miami Dade Zip: Folio/Parcel#: ��' `� '" 1 I© Is the Building Historically Designated:yes NO Occupancy Type: OLAIN60-Load: Construction Type: Flood Zone: 3FE: oQ, FFE: OWNER: Name 4� +.Fee Simple Titleho derj: ltZYJ &AID SWAG I�td65t�►64AS 1'l'Phored: �lJlo- %�3�� QQ - Address: D 1$ �-) __-_T-so- City: : ivi. 5. State: it Z;pQ�: QQ� 3 ��1(0 pp Tenant/Lessee Name: Phone#:_ - (3 Email: CONTRACTOR: Company Name:_jiOriOPhoney: C78'(, _ S033 Address City: Qualifier Name: Cuflos _.-- State Certification or Registration z1: EC 13003 5t 1-�- Ce-- `ca:e c` DESIGNER: Architect/Engineer: Address: tv: State: Z p ¢¢ v� Value of Work for this Permit:$ T' �� .S0 0 ' Square/Linear Footage of Work: Type of Work: Addition L_ Alteration Repair Replace _ De-c: t o^. Description of Work: ) 1 .-- +fch en and �uf�+roor'►'t V, Je- r+nG - 3 Specify color of color t ru tile: r Submittal Fee$ Permit Fee$ aplj- �`O�F$ �_°__OO _ _ CO/CC$ Scanning Fee$ 00 Radon Fee$ ,DB'•PRR�$ 3 •'SG Notary$ c• �J Technology Fee$__�_, _0-.__ Training/Education Fee$ D TV Double Fee$ --- Structural Reviews$ rl) Bond$__-(0-.-- TOTAL FEE NOW DUE$ �� ;Revsed02'21 �C�� i e 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. 1 Signature Signatuiiii:. �� CONTRACTOR The foregoing iAtrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of5�� 201 .by � /OS `Qanu/ar*Z ,20 Cy by N�-S ON rc.�.+�-IN ,who is personally known to cav!OS 6ancedO,who is personally known to me or who has produced P_ D2AVrVL as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: _ `�.: f_�. �;•_ �_ Sign: Print: 0� o¢ Print- vPQ'1 emseis Ubeda � Seal: 's �"` �n, ;:Q.` Seal: _? N"s_COMMISSION6`EE216169 EXPIRES:JULY 15,2016 i�� •••• d 4\`` ��q •ii e``� wwwAARONNOTARyccm APPROVED BY �1�L�Bl� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) xrasss I VSs Tax 1t1 � d�i�Co �T A�ei 'State 0 15 ti. - Do NOT gay XPIRES F6USCi4 DdAME!!-OArlE7N 3�r � u txe dist $8t place crt business ✓ G 4 ORP 6246, RAT[9 $ INS Purl+ant to rstijnt code X246 9 € chapter 8A WEST MIAMI FL 3�9 �. tt►1E OF BUSINESS PA�t�NfEP��€i6CEtiA�f) oweutF� �� Et, �Icai aONTRcTQ -oV TAX aa alzfaais AE c cx G€)RPoitAfit}i�F x REa�TrA a-t5-042115 Worked s) ween ental t t t ► �Pao entoit eLooal Business Tax.the AHaider mom ► w�A is not a any goveenm BtcsinPeissoe Nesse haide3 s iiiicationg.to do basins rise busi+le This pee n caracert; atorp(awssn 4o�rementswknchaPP1Y Miami cede se"a-276. or .noo 1�otat tegn3 ed on all coromerciai vewm os- The:. a RECEIPT NO,above lust be disp Y a #t� ilect4S t or oxore;intormation,vi9 t moy.'— 01 X06}20113 16 F DATE JWMDW--,, CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED ASA MATTER Of INFORMATION ONLY AND CON ERS 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. SUBROGATION IS WAIVED,.SUO)Cct to IMPORTANT: if the cerifficMe holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If the terms.and conditions of the policy,certain policies may requins an endorsement A statement an fhls certificate does not confer rights to the cartfficate holder in lieu of such andorsernent(s). - NAMF—' Michael Turbay "Ro"', eR 287-0565 ..i1!+.FA Maii,1:1n,uran Ce rl-@aILn-t 2138,SW 87 Ave IWR8AFP RD1NGc0VERAGE NAIL Miami FL, 33155 INSURER A. ARCH SPECIALTY INSURANCE COMPANY 21199 INSURED INSURERB: AE TECH CORPORATION 13690 Sw So ST. —----- MURERE: Miami FL 33183 ,lNSURERF- COVERAM CERTIFICATE NUMBER. RiEVISION NUMBEW THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THL POLICY PERIOD INDfCATED. NOTWITHSTANDIN6 ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIG THIS CERTIFICATE MAYBE 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, Po POLICYEW tuff TYPE Of INSURANCE 1Wyn POLICY numsm h DlyYYy) COMEa--H OCCURRENCE 3,OOG,000 X COMMERCIAL GENERAL LIABILITY Ea 200,WC CLAIMS-MADE: OCCUR 10:000 Ii PERSONAL A�D\�INJLTY A W0112015 104/0112016 1_!!E , GENL AGGREGATE LIMIT APPLES PER GENERAL AGGREGATE 3 000,000 PROPRODUCTS-qQ� 10P AGG $ 3f000,000 POLICY jECT LOC 'OT'ot COIN KGLELIMIT $ 'T�E-' tEa aeddent) AUTOMOBILE LIABILITY SDOILYtNJURYjPel`PA?S0a) ANYAU'rO BODILY INJURY!Per 30CWe-Q -S ALL OWNED SCHEDULED Fw, �AGE ED PROPERT Y DANIA AUTOS 1HIARIF-DALUT05 AUTOS ---------- U RE D� �A MBRELLA LIAS OCCUR X ::_, �AGGREQATE EXCESS LIA.15 CLNMS-MA0E Rj t PER OTH- KCOMPENSATION - WORKERS EMPLOYERS'LIABILITY N E.L.E�1;0E14T 4KY PRomiEToRPARTNE EXECUTIVE N IAJ OFFICERAASMSeR EXGLLK 0 E.-L.-DISEASE-EA EMP�LOYS S (Mandatory in NH) �if de E,L-DISEASE-POLICY MIT I S Und !IFICRPT10 OMPERATION,%b1140AN l � i DESCRIPTION OF OPERATIONS I LOCATIONS I VENCLES(AGGRO 101,Add4ficnal Remarks Schedule,r"Y be 01180WO If mom space IS reaubred) ELECTRICAL CONTRACTOR EC13003912 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAAICELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE "LL BE ID'ELIVERED IN ACCORDANCE MTH THE POLICY PROVISIONS- miatnil Shares Villages Building Depanment AUTHORIZED ROMESMAME 10050 NE 2nd Avenue Miwfi Shares Villages FL 33138 Q 19W20UACORD CORPORATIOU.All rights reserved. ACORD 25(2014t01}i) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY I INSURANCE DaT�t DrYYYYI 01/062016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH'T'S 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 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 certificate does not confer rights to the certificate holder In lieu of such endorsemerit(s). PRODUCER CONTACT Sonia Toruno NAME: .� PHONE 786 601-2654 T_ Fi4X {786)601-2998 Florida City Insurance DBA Enter continental incur eiteS; ( } ar N°p 1485 PIE 1sT AVE Suite 103 Ap°r»RELss floridacttyins(rgmail,.com IN$URER(S)AFFORDING COVERAGE X NAIC# Miami. FL 33034 "m�TECHNOLOGY INSURANCE COMPANY _ INSURED AE TECH CORPORATION > R g:__- 13690 :-_13690 SW 90 ST INSURER D.: MIAMI FL 33183 InsuRER F: COVERAGES CERTIFICATE NUMBER: REVISION E FOR THE POLICY PERIOD NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE©NAMED ABOVE FOR INDICATED. NOTWITHSTANDING ANY REOLAREMENT, 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. - lNSR �. POLICY EFF POLICY EXP LJA6rFS LTR TYPE OF INSURANCE POLICY NUMBER Mtl9ID AAIDD COMMERCIAL GENERAL LIABILrAG rY EACH OCCURRENCE 5 _... QAM �REi+fil<P CLAIMS-MAGE OCCUR PREMISES£a� 1 ocrAarHnaO ..... MED EXP{Any one Pelson) ff PERSQNAL.&ADV INJURY GEN LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _.._._ ----' [ i i PRODUCTS.COMP,OP AGG S ..^_,� _j POLICY�LLa J�ECOT I,._,..,I LOG S 1 S OTHER: OMBtNE S LE LWIT $ AUTOMOBILE LIABILITY BODILY INJURY(Par Person) S j ANY AU1'O -- — ALLOWNED SCHEDULED i BODILY INJURY(Per acddern) S AUT05 1AUTOS U �NED VROPERTY DAMAGE S�= HIRED AUTOS AUTOS S UMBRELLA LIAB OCCUR i C-LHOCCURRENCE f� EXCESS LLAB CLAIMS-MADE AGGREGATE_ Y _... DED RETENTIONS PER TH- WLIR%£RS CaOfiPENSATION ER ___ -.. AND EMPLOYERS,LIABIUTY F L.EACH ACCIDENT M $ 1,Dtl0,OtX) ANY PROPRIETORJPARTNEPJMX UTNE Ya PJ t A s TWC3&037$$ 10!14!2015 10/14/2016 -- — A. OFFICERWEPABER EXCLUDED'. N i E.L.DISEASE-EA EMPLOYE S 1,000,000 (Mandatory in NH) — IFdescribe under E.L.DISEASE-POLICY LIMIT S 1,t]Gi0+0Q0 DWIPTIOF OPERATIONS bWow it k DESCRIPTION OF OPERATIONS I LOCATIONS I VMtCLES IACORD 109,Additional Remarks Safied"maybe allachO if Mum space Is raq If d) ELECTRICAL CONTRACTOR EC13003912 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE'ASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANGE WITH THE POLICY PROVISION& Warni Shares Village Building Department AUTHORIZED REPRESENTATIVE 16050 NE 2and Avenue - Miami Shores Village FL 33136 011188-2014 ACORD CORPORATION.All rights reserved. ACORD 25(20141111) The ACORD name and Togo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION .�h ELECTRICAL CONTRACTORS LICENSING BOARD (850}487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GANCEDO, CARLOS ALBERT® AE TECH CORPORATION 6246 SW 9 STREET MIAMI FL 33144 Congratulations! With this license you become orie'of She nearN one million Floridians licensed by the Department of Business and Professional Regulation, our professionals and businesses range � STATE OI= FL47FiiI�A from architects to yacht broker ,from boxers to barbeque restaurants; DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong, PROFESSIOt REGULAI ION Every day we work to improve the way we do business in order to EC13GO3912 1 LIED: .x}$13112014 serve you better, For information about our services,please log onto CI�EtTtFIED ELEi:�R6oAL Ct7NTRAGT£1R wwnar.myfioridaticense.cr�m. There you can find more information G NoEot7;CANS Ai BEFiT0 about our divisions and the regulations that impact you,subscribe to department newsletters and learn more about the Department's ATECi{CORF�C1#�ATid3N initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. We constantly strive to serve you better so that you can serve your is tiveTiFrio under the pr,Yvraions of Ch 4a�3 FS customers. Thank you for doing business in Florida, t aosasa - ixpirataen date .:AUG 3; 2015 and congratulations on your neve license! DETACH HERE KE.N LAwSON,SECRETARY RICK,St;;OTT,GOVERNOR " *.::,*.-11.,. STATE OF FLORIDA DEPARTMENT OF St9$INESs AND P I�QFESSIONAL REGULATtOt� U� ELECTRICAL CQI9TRAQ TARS LICENSINt313OARt� 0".k, , The ELECTRICAL'CONTRACTOR Named below.tS CERTIFIED w. Under th6*PFcttuisioris of Chapter 489 FS: ort-cute-AUG 31;2016 ■ GA cARLOS ALBERTO-; AE TECH C(5RPORATION -y 6246 SW 9'STREET MIAMI FL"33144' 1 issUM 08131/2014 DISPLAY AS REQUIRED BY LAVH SEQ# L1408310006716 4/4/2016 08 : 16 70: 13057568972 FROM:8505837863 Page: 2 AC RO v® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDWYYYY) 04/04/2016 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 WEA;cT Sonia Toruno Florida City Insurance DBA Inter continental insur PHONE 786)601-2654 F� I(A�X.No). 786 601-2998 1485 NE 1st AVE Suite 103tl0ridacdY'ridacityins@gmail.com MAIL mail.com ADDRESS: INSURE S AFFORDING COVERAGE NAIL# Miami FL 33034 INSURER A: ARCH SPECIALTY INSURANCE COMPANY 21199 INSURED INSURER 8: AE TECH CORPORATION INSURER C: 6246 SW 9th Street INSURER D: INSURER E Miami FL 33183 1 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. -(N—SR ADDL SUBR MMIDDY EFF MPOM�ucY EXP DIYYYYI LIMITS LTR TYPE OF INSURANCE POLICY NUMBER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE OCCUR PREMISESOe $ 100,000 Me 1 _ MED EXP(Any one person) $ 10,000 AGL0023971-01 04/01/2016 04/01/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY a jEa 0 LOC PRODUCTS-COMPIOPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Fa aoddent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED -- AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per McIdent $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB - CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS,LIABILITY Y/N SPT'ATUTE ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBEREXCLUDED? NIA E.LEACHACCIDENT $ (Mandatory in NMI Ifs under E.L.DISEASE-EA EMPLOYE $ S,descftsundDRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I -J— - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) License*EC13003912 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 2 Ave AUTHORIZED REPRESENTATIVE Miami Shores Village FL 33138 f ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD