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PL-16-100 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-267762 PermitNumber: PL-1-16-100 Scheduled Inspection Date: September 22,2016 Permit Type: Plumbing -Residential Inspector. Hernandez,Rafael Inspection Type: Final Owner. KLEIN,NELSON Work Classification: Addition/Alteration Job Address:9310 BISCAYNE Boulevard Miami Shores,FL 33138- Phone Number (786)344-2378 Parcel Number 1132060141610 Project <NONE> Contractor: SMART PLUMBING LLC Phone:(954)772-3446 Building Department Comments KITCHEN AND 3 ABTHROOM RENOVATION.ALL InfractioPassed Comments PLUMBING FIXTURES REPLACED TO EXISTING INSPECTOR COMMENTS False CONNECTIONS 05/03/2016-AS PER PLUMBING INSPECTOR, QUALIFIER MUST MEET INSPECTOR AT THE JOBSITE MUST PROVIDE ID AND SHOW STATE LICENSE Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-250882. not ady Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-Inspection fee is paid. Miami Shores Village M Prmri Tye Plumbing Resitil- , 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 � da Ail+dltlolll �ltoration � Phone: (305)795-2204 � 1* us� 4/41201 Expiration: 10/0112016 Project Address Parcel Number Applicant 9310 BISCAYNE Boulevard 1132060141610 KLEIN&SALOME INVESTMENT Miami Shores, FL 33138- Block: Lot: Owner information Address Phone Ceti KLEIN&SALOME INVESTMENTS LLC 9310 BISCAYNE Boulevard (786)344-2378 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 6,000.00 SMART PLUMBING LLC (954)772-3446 u _..... . Total Sq Feet: 500 Type of Work:KITCHEN AND 3 ABTHROOM RENOVATION. Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:1 R�eviewPlumbingound Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# PL-1-16-58327 DBPR Fee $5.25 04/04/2016 Credit Card $728.10 $0.00 DCA Fee $5.25 Education Surcharge $1.20 Notary Fee $5.00 Permit Fee $350.00 Scanning Fee $3.00 Technology Fee $4.80 Work without Permit Fee $350.00 Total: $728.10 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 certify 14al,all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an Futh or ,I authorize the above-named contractor to do the work stated. April 04, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 04,2016 1 t - Miami Shores Village Building Department JAN It 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 /� Tel:(305)795-2204 Fax:(305)756-8972 e-"A INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 ` BUILDING Master Permit No. V_C I co--C� PERMIT APPLICATION sub Permit No.TQ Q(14--1(:0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 3V S G A -Y a✓L" 3!- UD City: Miami Shores County: Miami Dade zip: 33135 Folio/Parcel#: 1 I-.3.Z` O(,, -®t 4- I(10 Is the Building Historically Designated:Yes NO ?� Occupancy Type: Qv )e 2Load: Construction Type: Flood Zone: BFE: FFE: k1,6 sv AVIDSAy004 6 J AI V &SrMOfS E-4G OWNER:Name(Fee Simple Titleholder): MEL SO IU K L i✓I N Phone#: C!S'L-3"_- 2375 Address: 8 5 0 W 6 15, x/D T 6P�' City: N- M I AM 1 3 t;4Gtj State: L zip: 33/(-_2 Tenant/Lessee Name: Phone#: Email: e� CONTRACTOR:Company Name: Address: �3(9 0 Scc,) 309 S M' City: � �/I� n tate: Zip: Qualifier Name: (, �`-�� �E l C/ Phone#: State Certification or Registration#: IT�903 T Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: r ,,.. 2:r City: State: Zip: Value of Work for*this permilt !$ rl ®` Square/Linear Footage of Work: '6� O/r Type of Work: ❑ Addition ealtion ❑ New IQ Repair/Replace ❑ Demolition Description of Works _I T G N 1v A-A!'D 3 t34-Tit p On.M S R /L/O c/!f T i o A,, , Pt LL `i L U AA h�v G r i ac-rUg�� S F-d1.4 G F_ D l O C k 5 T I A/c, GOAiAl&G710.,v5 Specify color of co or thru tile: Submittal Fee$_ Permit Fee$ 23Z)o S CCF$ J CO/CC$ Scanning Fee$ _� Radon Fee$ DBPR$_ Notary$ 1": 0) Technology Fee$ C 4 , po Training/Education Fee$ Double Fee$ �^ Structural Reviews$ ® Bond$ r1i TOTAL FEE NOW DUE$ ��• I (Revised02/24/2014) T 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 — LI �� NER or AGENT ONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 12— day of 751� ,20 5 , by _day of V 20 �� . by N(tL-!S ot-i CMN ,who is personally known to ,whe is personally known to me or who has produced �r as me or who has produced as identification and who did take an oath. identification nd•• i take aOMIL PEREZ NOTARY PUBLIC: \%o '��111"�����,� NOTARY PU I o P Uc-Stale of Florida �% mm.Expires Nov S.2016 ` ..ra , mm Ion#FF 174478 � . i��i y���up� ,• N;ftWNatmyAssn. Sign: Sign: Print: - O ����.L x� = Print: Seal: Seal: 5 TATS :�x�x���x�**�:*�r*w**r*�*a�*ww****w*::***��*��**�r*:*�*a*�**�+r�� APPROVED BYWz_)_f-&ans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ' CONSTRUCTION INDUSTRY LICENSING BOARD ) CFC1429034 $ The PLUMBING CONTRACTOR Named below IS CERTIFIED °� �``� Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 _ a 'a MENDEZ, CANDIDOABEL .. SMART PLUMBING, LLC 17360 SW 302 ST HOMESTEAD FL 33030 ISSUED 05/2012014 DISPLAY AS REQUIRED BY LAW SEQ# L1405200001227 nib/93 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DQ NOT PAY \� LBTJ 7169125 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES SMART PLUMBING LLC RENEWAL SEPTEMBER 30, 2016 17360 SIN 302 ST 7"7811 Must be displayed at place of business HOMESTEAD FL 33030 Pursuant to County Code Chapter$A-Art.9&10 OWNER SEC.TYPE Of BUSINESS SMART PLUMBING LLC 196 PLUMBING COMRACTOR PAYMENT,RECEIVEW, CFC1429034 BY TAX COLLECTOR Worker(s) 1 875.00 07/09/2615' CHECK21-75-086211 This liscal Business Tax Receipt only canli(M paYMat of the Lel Business Tax.The Receipt is no a Geense, per®l6 m a certification of the holdn's qqualidcatiom to do b"esa Holder must comply with any 4over mental ornohgaV WntalroWalarylawsstMrequireaMMwhich opA to thebasiness The RECEIPT No.above most be displayed on all cmnotercial VsWctes-Mismt-Bade Code$eC Ba-27fi. For more information visN vow midagav/taxcofloctor DaT£4,I(�7�2 YTY4 CERTIFICATE F LIABILITY IL I INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHF-CERTIFICATE HOLDER.TIfiS CERTIFICATE DOES NOT AFRIRMATIVELY 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(% AUTHORIZI�[} REPRESENTATIVE OR PFQDUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: it the cerfificate holder is art ADDITIONAL INSURED} the policy(ies)must be eudOrsed- It S1I8I�6ATIOa'�I5 WAIVED.sub}ect to the terms and cOntlitions of the policy.certain poficies may require an endorsement. A statesaeitt on this Certificate does not confer rights tv ttlL certif(cate hoider in lieu Of sUCh Customer Service Depaff nt r^a�uCE� CONTACT {+enn irUS.LLC arai ca: 941-927-9540 ,r. 941-927-9551 t„ arc latC:svaf' -Tofu cerlifiCBt�S�cenerairus:ct�tn c e n n a 3 r u S 711 South Osprey,Suite 2 kD6R£S5. SP.`5UrStPslSt.AF F CSDIKG C�RAC1= 3+iAiC.�. Sarasota,FL 3$236 IhSEIRER A Reta"First Insurance Comparrr 10.700 IusupF.[) 114WRFR s.: Smart Plumbing,LLC WSURFR c: 37360 SW 302nd St tP:.WRERB' Homestead FL 33030-3310 rasuRe�s Ila;URL-FZ F.: COVERAGES GEFZT1FtCATE AIU€ddBER: REVISION NUMBER: THIS Its TO CER-nFY T14AT THE POLICIES OF IPJSURATIC-t UESTED$ELOSfU mA.VE SEEP)?SSUED TO THE ItiSuRi, NAin:£N ABOVE fOI2 THE POLICY PERKS INDICATED. NC TWTHSTANL'4PIG ANY REQUIREMENT.TERM OR CONDITION OF iYN GLkI7RAC OR OTHER ROCU jAEi 4W.TH RESPECT TO 1AWCH TH:s CERTIFICATE t t iAY f? :SS13E63 OR?a AY PEQi+SP.YI?c fiidS#S2AitiCE AFFORD $Y THE ✓OLICIES D£SGRt$KiS�RETP: IS S43J>CT Try ALL THE TERMS, EXCLUSIONS APIC]CODUTION9S Cat=SUCH POLICIES.LIMITS SHOWN MAY HAVE 1JEEN REVD--ED r-.,Y HAIR GL r1It" - r�wR isi)0L St1EK P'7i UCTtfF POLICY EXP LIn,.r5 LTRTYPEIIi-,taSUs'aAriCE ,w: uv. P'JUCV B:Uidt3Lf2 ,y;Y7JlYe'1 .'!tA Y! GENERAL LIAMITY d fi::F:dr.".F=;,;a cr;•t:rLr::::.y . to TXP ALTs MIOMLC LIAOUTY f.a ate tit"•[I a 4L U1.1$REItA LIAO EXCESS UAS a. S6 K P'S C4 7.r<l7SATIQ\ .. F • ANO S,*t LIDYERS LIAE;UTY YIN o'!t- ri:q.t c._.F:.,—:rx• _7fi:a;E:aXi.:-lST'Y S�tfs E ifV-5LV-5(499 3117.12015 311712616 NA " tri;andacary m taut L` _.,�.._L. is i n >#�: •s :74G 43t}r3 lI'vCh c'L'cnnrr-%'tt^' -moi.ice':t4:-;a'.��_`r'd:a,'.?7.1•:^:'er;.,;.v 'Em—;Rq rt47a CF 01 EpATtot4sa LOCATIONS t VCRi4=1 IA%uh ACOA*iat•Additional RCM xr.=.Schedule.d mesa space 7s'a:4v,r4d} PLUMBING CONTRACTOR GFG1429034 CERTIFICATE HOLDER CANCELLATION Miarnit Shores Village.Building Department EAUTKORIaZEDREPRESENTATWE ANY air 7Opj"ION ABO%e D�,. ego,��`�slse c��o L���RE 10050 NE 2nd Ave NCE WITH THE POLICY PROVISIONS, lllliami Shores;FL 33136 r`- Forrest,:.Harm% President G3 998E-209U ACORID CORPORATION. All ragtats rasa rued. ACORD 26(20111105)' The ACORD naine and logo are reglsteretl Marks of ACM . e CERTIFICATE OF LIABILITY INSURANCE DATE(GM4YYYt ol:oarl 116 s THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not canter rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT tJA.tE Floridian Consultants Insurance I 'C PHONE.E*ti: (3C5}'—`$'9711 ;�c•rJox (305)225-7.377 9371 S W.40th St ADDRESS: F;rO[v1EZ353S^c ACl Cott Miami.FL 33165 iUSURERIS)AFFORDING COV:-.RAGE t1AIC C Phone (305)225-9711 Fax ',305)225-7:77 ENSURER A lAES TERN LV'JRLD INSURANCE CON;PANY NSUREO IrJSURER B. SMART PLUMBING LLC crsU-REIR C 17350 SVd 312 St I•,JSURER D: ; ItJSURFR E HOMESTEAD.FL 33030- (305)2Z4-2877 S i ItJSURfR F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAILED ABOVE Ftp THE POLICY PERIOD INDICATED. NOTVOTHSTANDING 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 CLAWS. ADDL SUER POLICY EFF POLICY EXP LIMITS IL7R- TYPE OF INSURANCE INSWINVD, POLICY NUMBER___,_...AR1r'1I0DryYYY)-Ifr:P.imrnrYYI; GENERAL LIABILITY - D^-�URRPtJCF 1,000.000.00 uAr,1A:L:o!:LrJIt-u 100,000.00 RC!At rhtt!-RAL IJ,1,70TY' P+tE ad1SF'i{E,or....:rr,•r::,•: 5,000.00 A L - CLNIU! ttAD[ .rj OCCUR ! NPP-1379857 N N 04.10912015 04109120116' r:)LD xP4+ny onrFer.on 5 PcRS:r..f,L:ADV IrVLRv 5 1,000,000.00 rFrarRA1 AC-fl-14f -ATI* 2,000.000 OD i I a!t�nlr..-:;.c«;1Pa);•r,1:;; 5 1,000,000-00 GilYl A.rrRE^_•AT=LRd:T APPUL•�rirt I - NIIoI ''RO -- - . PCLtCY _;:T LUC CDrAP.1Pk--D SI:3LE U'alT J AUTOMOBILE LIABILITY - I t[a xaden:, ` i?'][RL'r 1!l.iLgiY(Prr.^••ranJ < AtIY rl ITC Rrlry'.1 Y Irl i11R'r Ivor arndr•nte S ALL MIA:) 5C),F ou;I I: , AUTO:i PROP=RTYQ•i•.1.+rF -REC Al-:70S AUTOS U11A8RELLA LIAR EXCESS LIAR ^.LAI.! •.Tab; <...,.TF; j ViORKERS COMPENSATION T-•Y.I'-'T': _ AND EMPLOVERS'LIA131LITY Y 1 tJ NIA (61anaatory,n•NHJ DESCRIPTION OF C'PERATICNS 1 LOCATIOtJS!VEHICLES(Attach ACORD 1111,Addaaonal Remarks Schedule.,t more sgaee m required.) PLUMBING CONTRACTOR 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 ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE Miami Shores,FL33138 AUTHORtZEOREPRESE1,1177M I O1g$8-2010 41trORO CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD A � CETIFI3� F LIQ ELI l °A ,3a1,sY " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTFCICATE WES.NOT AFFIRMATIVELY 09 NEGATIVELY AMEND, EXTEND OR AL'T'ER THE coveRAOE AFFORDED BY THE POLICIES RELOW. THIS CERTIFICATE of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE.issunea Iw3URMgS), AUTtiORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLVER. IMPORTANT, It the Certiificate holder is an ADDITIONAL INSURED,the poficylles)nmrst be endorsed. U SUe#tataATiO�I 1$VdATVI D,subject to theterm s and conditions of the policy,certain policies may require an endorsement. A sladement on this Certificate does not confer rights to the certificate holder in lieu of.such endorsement(s). PRA6uceq IrCustomer Service Department t,Qnn3irus,LLG .tA° ,Exc}. 99-927 95QD_...... ... . ..._. . K,s8R1 927-9561 e n n a t U 711 South Osprey,Suite 2 �AVMESVrerUficates@oennalrus.com __ ._.. �._._ ...__ .... _. _. Sarasota, FL 34236 NAIC#._ II,WFIA: RetailFPrst Insurance Company 10,700 ,...__. Smart Plumbing,LLC red,tic__._...___.__...._,__..-- - _.. _...__........ .._,._......._.�..,M_.. .�...._._...-..__._. 17360 SW 302nd St IpsSSfRO: _.,....__...-_,..... ... _ ...... ............. Homestead FL 33030-331 G refsuarrc "... ...............____.�_..._.,.....-..._.__......_ _-.................... ._..--------...___.._. livSS3REF F; COVERAGES CERTIFICATEIr7iUMBER- REVI IdN NUMBER. THIS IS TO CERTIFY THAT THE P61..ICIES OF INSLVFNANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED IV AEA AROV9 FOR THE POLICY PERIOD INDICATED. .NOTINITHSTANDIM ANY REGUIREMENT:TEW OR'CO 4DITION OF ANY CONTRACT OR 07HER DOCUMENT trl+Y14 RESPECT TO WHCH THIS CERTIFICATE.MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE KUC1ES DESCRIBED HEREIN IS SUBJECT TO ALL Tt E T'ERIutS: EXCLUSIONS AND CONDITIONS OF SUCH POLICIE=S:LII UMSHOYM MAY HAVE BEEN REDUCED BY PAID CLAIMS, _ ���__....... ........._ ..:..._... ....... ...__... abaL;5U612;....._.__- _........._:. ._...._........ .._-PDLr�Y'�FF. !..iNSL"rGV��_ _.:._.._..._.... ., .... _:.... __..........._....._.-.... TYPE DF INSMANCF :t POLICY P1 Y Y' - ..._._.... Lt6'k'r3 6Eh'EiPIhtLIAl48,ITY GAC4 JcCU;ir -'IGF '.$ "'�.LheERt'gLGEr>G r HS•k=?i' � Pfi�^E9+FxcePu?erKar $.... —.. . 41 � '-7{ ..LAIM5 MAMA :CCCLO P4rz7J-�fiAtany mx.'S9-`sin S . 1...! __..... ._. . .............. .._. �i❑� F'L-i..>+P-dA,,E RG�V ip1.t.R'+ �5 .. : s G FN9KA.L AvrREC'TC 5 - ^ r L e7:GR 7E'Lt!,3rf APPtt£_.rtiR j pw': 7-,CCAI P-V f-r't^ SEz_f .. t ..__., .......... .,_..._.. ..... JEC7 AUTOMOBILE UAM ' WP�TdE .I,YGCE3_i�T i r R'vtAetperrnm'.) � Al:�3Vs1h2E;3 --..st:.s!?.";'SLEI"rAUTOS - ._ .._._.. ;.....,... ..�.......__.__.---- ' C "4- si J.Riv tPeraccxdelYt:S AUTOS 4"1PaED r t3E Uri OR LLA QLAe : v"Z^!SF's -E)ZE8s LIAffi ZETE WORKERS COMPENSATION � 7u 6 AND Er KOYENS'U1AWLrTY t TORY wk'TS' - (2. .... .. .... . ar v x C� 2t Tr ran?r� q,xr`c+Yr s Y{ n,fl,520-J0289 #117/2016 3/1712097 1 E � itr&raT S 5r 4U0 UestC.- -104FR EX4GE.t€ilE£+;' Bt@A iE 1: ..... ._._._. C rYint4ws E.k k EA ..EAENIPLO S WAN ,It F:rtIBE ....,..:........ . .. ....... ... :. ... ....... .. .. .. t firv"..RI?77GWr t+i'^+:S rt.'tTl n+I¢e tx?iav F.i..t,''tS'c?SE-PO'x,[CY kFIsWT i S M I QESCRIPTfON RIR OPERATIONS t LOCATIONS I VE NCL.ES(AMO ACOR3O 101:Adaiirosar Rwmwks Schedtft i(mora sp=o is regedretly PLUMBING CONTRACTOR CFC1429034 CERTIFICATE HOLDER CANCELLATION Miami Shares Village Bldg Dept SHOULD ANY OF THE ASOVE DESCRIBED POLCCI"LIE CANCW-L.EO 8EI1[rRE 10050 N.E.2nd Ave THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Miami Shores,FL 33138 ACCOMMNCe WITH THE POLICY PROVISIONS, AVYf ACEDPEPRESPAITATive Harric Presi.0e6t (.419118.2010 ACORD CORPORATION. All rights reserved. ACORD 25(20IMS) The ACCORD name and Ingo are registered marks of ACORD 'PC 2, (6 - too )JO A a DATE(MM/DDIYYYY) - CERTIFICATE OF LIABILITY INSURANCE 04/28/2016 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 poilcy(ies)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 NAME: Jackie Reye Trinity Insurance,LLC MPHONE E : (305)247-0205 ac No): (305)247-0208 11373 SW 211 Street -MAIL henry@buypip.com Cutler Bay,FL 33189 INSURER(S) AFFORDING COVERAGE NAIC# Phone (305)247-0205 Fax (305)247-0208 INSURERA: Ascendant Insurance Company INSURED INSURER B Smart Plumbing INSURER C: 17360 SW 302 St INSURER D: INSURER E: Homestead FL 33030 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 TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED ❑ PREMISESS Ea occurrence) $ 100 000.00 FV ❑ CLAIMS-MADE V OCCUR MED EXP(Any one person $ 5,000.00 A F-1PERSONAL04/16/2016 04/16/2017 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000.00 POLICY ❑ JECT PRO- ❑ LOC Ded 500.00 $ AUTOMOBILE LIABILITY EO, iN�D SINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL AUTOS OWNED ❑ SSCC,rHEESULED BODILY INJURY(Per accident) $ AUO❑ HIRED AUTOS NON OWNED PROPERTY DAMAGE $❑ AUTOS Per acc dent ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑PER ❑OTRH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS i VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space is required) Plumbing Contractor Lic#CFC1429034 DL#M532-101-74-050-0 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 Henry Maura ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF The ACORD name and logo are registered marks of ACORD