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MC-16-2862 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-269420 PermitNumber: MC-10-16-2862 Scheduled Inspection Date: November 02,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: CRESPO,FEDERICO&ESTHER Work Classification: A/C Replacement Job Address:1191 NE 103 Street Miami Shores, FL 33138- Phone Number Parcel Number 1122320310050 Project: <NONE> Contractor: COOL BREEZE AIR COND CORP Phone: 305-226-2665 Building Department Comments EXACT CHANGE OUT OF 4 TONS Split SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False I L Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 01,2016 For Inspections please call: (305)762-4949 Page 29 of 51 �; pork N I 1 � Miami Shores Village Permit*t ,Mph 1 a) 'R etial 10050 N.E.2nd Avenue NE fMi, b �'Sh'.S0oaf or A C Replacernerit .. Miami Shores,FL 33138-0000 �z PRf'�YED Phone: (305)795-2204 � F:w :Issue Date:IW8/2016 ;:, Expiration: 041 6/2017 Project Address Parcel Number Applicant 1191 NE 103 Street 1122320310050 Miami Shores, FL 33138- Block: Lot: FEDERICO&ESTHER CRESPO Owner Information Address Phone Cell FEDERICO&ESTHER CRESPO 1191 NE 103 ST MIAMI SHORES FL 33138-2651 Contractor(s) Phone Cell Phone Valuation: $ 5,074.00 COOL BREEZE AIR COND CORP 305-226-2665 Total Sq Feet: 0 Tons:4 Available Inspections: Additional Info:EXACT CHANGE OUT OF 4 TONS Split SY Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work:EXACT CHANGE OUT OF 4 TONS Sp Scanning:2 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 DBPR Fee Invoice# MC-10.16-61733 $2.66 10/20/2016 Check*5317 $50.00 $148.51 DCA Fee $2.66 Education Surcharge $1.20 10/28/2016 Check#:5337 $ 148.51 $0.00 Permit Fee $177.59 Scanning Fee $6.00 Technology Fee $4.80 Total: $198.51 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 AFFID IT: I rti that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an zoning. u ermore,I authorize the above-named contractor to do the work stated. October 28,2016 Aut ri d Si ature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 28,2016 1 Miami Shores Village C: IV7,`® ��s► Building Department OCT 20 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 5 VA 201 /� B ILDING Master Permit No. ►v ► PERMIT APPLICATION Sub Permit No. F-IBUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION DRENEWAL [--]PLUMBING X MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: r/9/ AJ- City: JCity: Miami Shores County: Miami Dade Zip: 33i30 Folio/Parcel#: /0--7,23e- 03 00�5 0 Is the Building Historically Designated:Yes NO '14 Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Z S 2iAl&!?e Phone#: �5�aS Vg'-'6- Address: g'-'Address: //e3/ O✓ G- /®mss S� CitState: Zip: Tenant/Lessee Name: Phone#: Email: /� / CONTRACTOR:Company Name: Cr-•c� e- ZZ&Fe-�� XZW 6LO zs �J r,�;� _Ph onem KSnn; Z26-ze-6-1 Address: sa'i{'c� 3 L� ISO City: e��%ate✓ State: Zip: _Y-�1496 r Qualifier Name: -`/ Phone#: State Certification or Registration M G,/f«° 4�3�s� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: u.9e'7 C�i9iJCi�= -®vi ✓/' �� S r�c�7 ��/S/cJ� Specify color of color thru tile: Submittal Fee$ 50 P A t b ' Permit Fee$ CCF$ J • CO/CC$ oC' v� Scanning Fee$ (/Qo�Radon Fee$ °Z. DB RQ$ 2 . Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ , TOTAL FEE NOW DUE$ a' (Revised02/24/2014) S 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. SignatureSignature OWNER or AGENT CONTRA-CTB The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of OL-AX'J'G61-7 20 by '-)'-Lf day of ,20 c(o by C-a-IESI`50who is personally known to TfZONA�7 C-0-t YVQ1LC4 who is personally known 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: Sik: Sig Print: Print: k S Seal: Seal: "•�;; MINI J SUAREZ MINI J SUARLZ MY COMMISSION M FF958985� My COMMISSION 0 FF9"9W EXPIRES Apol 1a.Z020 •wm APPROVED BY a iner Zoning V Structural Review Clerk (Revised02/24/2014) 0R�s G, Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done): 119/ At/•&7. /o.} %Z City: Miami Shores Village County: Miami Dade Zip Code: 3-F198 ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO R1 ARHI Sheet Attached:YES ® NO ❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT saw MANUFACTURER ►ZK� Lac,-0 AHU or PKG.UNIT MODEL# 9-. -► ti'? z%S-T 1,?Ae,4e>ele.�-,4 OF COND.UNIT MODEL# i%(NNy%krd 3� 113A ze).Cce.) KW HEAT i O V-LZ Q j®„ NOM TONS AHU,sV CU .3e> PKG 1)M.C.A AHU:sir CU ?e,, PKG AHU4c-, CU ye) PKG 2)M.O.P AHLI&O CU V0PKG AHU.'br'CU W?PKG 3)VOLTS AHU_41/CU;10?PKG PKG UNIT / / PKG UNIT / / /'0.v S&&jc EER/SEER /6--. ® YES N REPLACING DUCTS YES O YES NO REPLACING THERMOSTAT YES N YES NO NEW 4"CONCRETE SLAB YE NO YES NO NEW ROOF STAND YES YES NO NEW RETURN PLENUM BOX YES N 1. Minimum Circuit Ampacity(Wire Size): WS CAS:ccc�7 2. Maximum Overcurrent Protection (Fuse/Breaker Size): &-;0 3. Voltage of Circuit(208/240/480)1 BOG �ILIs`1 S 4. Size Disconnecting Means: ..L 2cr� c���.a� Contractor's Company Name: avc d��'t,Z�t /Yr.l 4»v�i'Zc7su r u Phone: Cze sj?16 •-zG6 S State Certificate or Registration No. mac'& ys'-'.i ' Certificate of Competency No. Signature $, Date: /61-6 -/G (Qualifiee si n (Revised02/24/2014) MCIL --2((� 2 i r ��� A 7 e Certificate of Product Ratings AHRI Certified Reference Number: 7492558 Date: 10/6/2016 Product:Split System:Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: RA1448AJ1 Indoor Unit Model Number: RH1T4821STAN Manufacturer: RHEEM SALES COMPANY,INC. Trade/Brand name: RHEEM; RUUD Region:All(AK,AL,AR,AZ, CA, CO, CT, DC, DE, FL,GA, HI, ID,IL, IA, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH,OK, OR, PA, RI,SC,SD,TN,TX, UT,VA,VT,WA,WV,WI,WY, U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name: a ;.<AIR a Manufacw>ter tesp'neible to'r°the°'hating of this;system:combination is RHE iII SALES COMPANY,INC, Rated as follc5ws in accordance with AHRI Stan darsl llil�� 00 { I�if �� nci)i ii�niing trld Air-Source Heat lPum�,Equipment and su*oto verification of r`a It g�uracy AFl visored, independent,third partyltutg: ;. { l"N F '@ a /'hey i} C Cling C$ilatYn 4E15€ 'l 7EER Rating(06oling) 1250 f NE 1 's A .SEER Rating(Cooling): IEER Rating(Cooling): Ratings followed b an asterisk indicate a voluntary rerate of previously afro g y (q' ry p sty pubhslt ata, leS§a ,. panied wi,a WAS,which indicates an involuntary rerete. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahr€directory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRL This Certificate shall only be used for Individual,personal and confidential reference purposes.The contents of this Certificate may not,In whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's Individual, personal and confidential reference. AIR-CONDITIONING,HEATING. CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on`Verify Certificate"link we make life better– and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right '" = "" —"' 131202295399644469 02014 Air-Conditioning,Heating,and Refrigeration Institute I CERTIFICATE NO.: 13120 S.W. 0 Terrace•Miami,FL 33186 �rrr j_®�-_C_e�p Dade:305-226-2665 W.Broward:954-797-0067 Fax 305-253-4420 www.cool-breezeac.com Air Conditioning Corp® CACO 24325 (Licensed and Insured) "Req a41, 4 Heb"TM Proposal and Acceptance PROPOSAL SUBMITTED TO PHONE c,r - JOB PHONE DATE STREET JOB NAME '4/ CITY,STATE and ZIP CODE JOB LOCATION /�;0 s✓ �� !t, fir» /7 a�'i.S'✓ o�il.)isrY S//Gilt� /ca/y'e' PLAN#,DATE&ARCHITECT MAIN CONTACT: Scope of work:(attach additional description and/or drawings if necessary) 1 7 %5%C—..y f c-:�a'ye..✓' .r'-1G.7✓i L:7L ♦��.s•J f%IG%4 oI19. 9)i/J C ` `�/ Js .� C'-' /�:� i':a JG�.�..`e/'i/%. � /$':L•-Ta� l�J Cr,:S' �GGA/t°C ic/oJ+J aer ic'i7C.7, ✓�:� ��f�N%l. �i✓;7r�4C e 9.7 tC>>'v �ia,d C'CG+I.SL�' r77'i! Or'r'�i...�CCt'Jt .gs`'�i s+:y t.-t.'s�7�� L3'I•'''G?�f-C CJS. .is �/'C�7� .S6:�L:+iL T�`/ C' G°Od/��vS aY_.� �y/7'o✓v' f�'J!,' d`IL-� .✓.,,���41'i+ C L r7,S ��Fc'�iJ.J s:�%' TC L- YS 7!'.c.:L: L.SC.C-r'«/d l e-'V e o,`[.'!%41t�o�/! �'"s!•�C.T Z-'i��'C `.�1L� G.��iaC"/ ''/✓�° e�-,s-✓!'L:li✓['��5 /'�i.J., /'C_a1��17'. Proposed Start Date: Expected Completion Date: RESPONSIBILITY SHALL BE ASSUMED AS INDICATED BELOW: Cad Breeze Sub- Others Not Cool Breeze Sub- Others Not Air Contr. Applicable - co- Applicable Remove and haul away existing system...... LaJ Ll Ll Ll Service Change from Amps to Amps............. ❑ ❑ Cr Installation of ... a uipment............. ............... ❑ ❑ ❑ ❑ Wiring from existing disconnect to equipment................. L) Ll ❑ 9l ._ _ y Drain piping. :«'.r����: �:�................ Y IJ Ll ❑ Thermostat installation.....ilrc:rtra.j�.,,�r �cs' ❑'' Ll Ll ❑ Refrigerant piping.. Er ❑ ❑ ❑ Install condensate pump Water piping heat recovery........................... ❑ L1 r❑j Connect to existing duct system....................................... Ur ❑ ❑ ❑ Install ducts and grilles................................. ............................... ❑ Ll ❑ u Cutting............................................................................... ❑ ❑ ❑ M' Ductrepair................................................... ❑ ❑ ❑ � Patching............................................................................ ❑ ❑ ❑ U— Bath exhaust fans/ducts............................. ❑ ❑ ❑ Ur Access&clearance for ducts,grills&equip................... ❑ ❑ ❑ a-- Structural supports for equipment,'`!'-'d Lar ❑ ❑ ❑ Masonry............................................................................ ❑ ❑ ❑ a-- Pitch 'Pitch pans and or roof supports................... ❑ ❑ ❑ ❑' Carpentry......................................................................... ❑ ❑ ❑ Thermostat wiring. r�r�"��?off<J:r` ❑- ❑ ❑ ❑ Painting....................... ❑ ❑ Ll C� ................................................. Install new emergency drain pan................. ❑ ❑ ❑ Ll"� Start up and balancing equipment.................................... ❑ ❑ ❑ COOLB-1 OP ID: RAL CERTIFICATE OF LIABILITY INSURANCE DATE(M1/20 10/21/206 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 Brown&Brown of Florida,Inc. NAME: 1201 W Cypress Creek Rd#130 a/c No Ext:954'776-2222 aC No):954776-4446 P.O.BOX 5/27 E-MAIL Ft.Lauderdale,FL 33310-5727 ADDRESS: Christian Zanartu INSURERS AFFORDING COVERAGE NAIC# INSURERA:Zenith Insurance Company 13269 INSURED Cool Breeze Air INSURER B: Conditioning Corp 13120 SW 130th Terrace INSURER C: Miami,FL 33186 INSURER D: 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. 1EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F]OCCUR A E T PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY PRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY (CEO, S $INGLE LIMIT EaCOaccId.nt ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOSPer accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANY PROPRIETORIPARTNER/EXECUTIVE Z127101002 04/01/2016 04/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? Fk�N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Mechanical AC Contractor CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPICity of Miami Shores Village CCORDANCEIOWITH THE POLICY PROVISIONS.DATE THEREOF, WILL BE DELIVERED IN 10050 NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i 001760 r sln.ess'Tax Receipt Miami--aadip bounty, Stag of Fl rids 11 itf itNOTA OI L_AO NdTPAY 1856666 BUSINESS NAME/LOCATION RECEIPT NO. COOL BREEZE AIR CONDITIONING CORP RENEWALEXPIRES 13120 SW 130 TERR 1856666 SEPTI M139I1 30, 2017 MIAMI FL 33186 Must be diatejtedf:place of business Pursuant to County Code Chapter 8A—Art.9&10 OWNER _ SEC.TYPE OF BUSINESS -REC PAYMENT RECEIVED COOL BREEZE AIR COND CORP 196 SPEC MECHANICAL CONTRACTOR CACO24325 BY TAX COLLECTOR Worker(s) 10 $75.00 07/21/2016 CREDITCARD-16-042805 This pr noes TautBaca"!"tpayp pf moss Tax:Tho Recaipt is not a licoasa, or= r llaug*r'"meldaof�h Ifidatlarla to dA hasFn sw ltaldw elost ply with air Governmental +Y rairealsa{sn appiy3o tka iriaes ' j The RECEIartPT IJO.shove mast fie displayed oa alI commercial vehicles—Miami—Dade Code Sec 6a-276. For more iaformmion,visit DATE(MM/DD/YYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 10/21/2016 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 inJieu of such endorsement(s). PRODUCER CONTACT Holly Buten Frank H. Furman, Inc. PHONE (954)943-5050 aC No:(954)942-6310 1314 East Atlantic Blvd. E-MAIL ADDRESS:holly @furmaninsurance.com P. O. BOX 1927 INSURER(S) AFFORDING COVERAGE NAIC H Pompano Beach FL 33061 INSURER A:IMI—Gerlin America Insurance 41343 INSURED INSURERB:Travelers/St Paul Companies 40967 Cool Breeze Air Conditioning Corp. INSURERC: 13120 SW 130th Terrace INSURER D: INSURER E: Miami FL 33186 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 Master W/Out Forms 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 POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MMIDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE ( RENTED 100 000 PREMISES Ea occurrence $ � EGGCC000200316 4/6/2016 4/6/2017 MED EXP(Any one person) $ Excluded PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ]JECT F—]LOCPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A Ix ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED EAGCC000200316 4/6/2016 4/6/2017 BODILYINJURY(Peraccident) $ AUTOS AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Unisured Motorist Limits $ 20,000 X UMBRELLA LIASX OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 ZUP71142852116NF 4/6/2016 4/6/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ H yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) Mechanical AC Contractor 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 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Dirk De Jong/HB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2r)14on 1 " NATE O FLat RIi A _ ►E .ARTMENT O Ous-1 FESS ANS �CI«I`ESS1CIrtVA1�1 E Ut: 4T1Qth1 Ct��1 T����tC1�51,�[)1i3T�'MLalQE1+�Slh�C��{�el EG ., i c� .A "AAIB C 315 , 110MING.CON711m, t1�t 1SCE QED - CJh efIts ?slaas s f # ter 489 5 w. VdWnAMG:31'1�2 .107", �y yr. 0 '0/R�' Ewa IRA Md �s�•ie 4 ym� F F' yS 6 "4L,b 1 � :.L ° fi Vt' l z\•• :."`R w ISSUED: 05/31/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1605310000707 ACORO0 DATE(MM/DD/YYY`) �� CERTIFICATE OF LIABILITY INSURANCE F10/11/2016 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 CONTACT NAME: Holly Buzen Frank H. Furman, Inc. PHONE (954)943-5050 ac No:(954)942-6310 1314 East Atlantic Blvd. E-MAIL holly@furman:Lnsurance.com ADDRESS: y P P. O. BOX 1927 INSURERS AFFORDING COVERAGE NAIC# Pompano Beach FL 33061 INSURER A:HDI-Gerl:Lng America Insurance 41343 INSURED INSURERB:Travelers/St Paul Companies 40967 Cool Breeze Air Conditioning Corp. INSURERC: 13120 SW 130th Terrace INSURER D INSURER E: Miami FL 33186 1 INSURER F COVERAGES CERTIFICATE NUMBER:16-17 Master W/Out Forms 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE _ OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ EGGCC000200316 4/6/2016 4/6/2017 MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY II JECT 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)_ $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED EAGCC000200316 4/6/2016 4/6/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Unisured Motorist Limits $ 20,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 ZUP71M2852116NF 4/6/2016 4/6/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILnY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ H es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space is required) 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 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Dirk DeJong/HB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011 1� `�-3" �� "u ^�