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MC-16-967 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL A�4 Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-256622 Permit Number: MC-4-16-967 Scheduled Inspection Date: October 05,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: HAGHAYEGH,ALIREZA Work Classification: A/C Replacement Job Address:1700 NE 105 Street 102 Miami Shores, FL Phone Number Parcel Number 1122300500020 Project: <NONE> Contractor: HACKERS AIR CONDITIONING APLNCE SVC INC Phone: (954)452-1117 Building Department Comments REPLACE 2 TON HEAT PUMP WATER COOL Infractio Passed Comments INSPECTOR COMMENTS False J a� ! Inspector Comments PassedE/- Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 04,2016 For Inspections please call: (305)762-4949 Page 3 of 21 Par>4l"C446- 6 " Miami Shores Village tem*?Type:M hi11loS1,--It ntlAl 10050 N.E.2nd Avenue NE ' w0*Cjftsffloatton' G Iplacornll Miami Shores,FL 33138-0000 Phone: (305)795 2204 PBn"if Status:AP"PI VED, �CroORIS " U0 414412016 Expiration: 10/1112016 Y Project Address Parcel Number Applicant 1700 NE 105 Street Number: 102 1122300500020 Miami Shores, FL Block: Lot: ALIREZA HAGHAYEGH Owner Information Address Phone Cell ALIREZA HAGHAYEGH 1271 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,495.00 HACKERS AIR CONDITIONING APLN( (954)452-1117 Total Sq Feet: p Tons:2 Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.60 Invoice# MC-4-16-59369 DBPR Fee $2.00 04/14/2016 Check#:3837 $67.80 $50.00 DCA Fee $2.00 Education Surcharge $0.60 04/11/2016 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 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 zoning. Futhe I uthorize the above-named contractor to do the vyrork stated. Y..,,-., .� April 14, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 14, 2016 1 Miami Shores Village Building Department APR 1.1!_ L 1 . 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 2011 s-ly► BUILDING Master Permit No. fnc l(D —01(y�' PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING [+MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �✓ �` l�lS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: LOWNER:Name(Fee Simple Titleholder) Phone#: Address: City: ( ak State: Zip: Tenant/Lessee Name: Phone#: Email: c CONTRACTOR:Company Nam/e: ���� ti-� t later Phone#: ftS-4 Address: �( ��. 414,. -3-7 Y 115 City: (!�6 e:_�O"'L C-C-r "e--wee. State: A/®A ey 14 Zip: '33 Ci (n Qualifier Name: jV iA1�, v I`® /<e t ej Phone#: State Certification or Registration#: °-4-C.-0 -df- Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ i;? o Square/UnearFF000tage of Work: Type of Work: 1:1Elr Addition Alteration ❑ New I�1rcepair/Replace ❑ Demolition Description of Work: p16 `37G/%� car,U, Specify color of color thru tile: Submittal Fee$ Permit Fee$ IN vu CCF$ ( 83 CO/CC$ Scanning Fee Radon Fee$ DBPR$ G '00 Notary$� Technology Fee$ "f Training/Education Fee$ 0 Double Fee$ Structural Reviews$ Bond$ 0 TOTAL FEE NOW DUE$ � (Revised02/24/2014) L 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 occurseven (7) day after the building permit is issued. In the absence of such posted notice, the inspection will not be app bved and a,reinspection fe will be charged. Signature P �` I Signature 7 OWN or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -day of 'W� 20 by day of Vld 20 %t ,by !� A1.71 VC4�1fwho isersonally kno to �kif Ii.nG, ll rkld-?> ,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: Sign-- j Sign' ��,L Print: YGkh, CHI(tUlmPO3TELL l,[L,//a Print: •1 LA. '� T-a` 4k Seal' 'poa EXPIRES:July 11,2018 77� �� Seal: LE; � DAWN M.TAR °,'' 8.dW Thru*tay PuW U;*M*M MY TE COTE MMISSION#EE 847046 EXPIRES:December 3,2016 Bonded Thru Notary Public Underwriters APPROVED BY s Examiner Zoning Structural Review Clerk (Revised02/24/2014) �SNOR,s Miami Shores Village g� Building Department 'cn. 10050 N.E.2nd Avenue Miami Shores, Florida 33138 s 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): 1-766 City: Miami Shores Village County: Miami Dade Zip Code: JY/39 ALL CONDENSING UNITS MUST BE ON A 41NCH 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❑ ARHI Sheet Attached:YES g"'NO❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER yeed-t I AHU or PKG.UNIT MODEL# COND.UNIT MODEL# KW HEAT NOM TONS AHU Cu PKG 1)M.C.A AHU CU PKG AHU CU PKG 2)M.O.P AHU CU PKG AHU Cu PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): //• / 2. Maximum Overcurrent Protection (Fuse/Breaker Size): �, 3. Voltage of Circuit(208/240/480): i 4. Size Disconnecting Means: Dr, Contractor's Company Name: Hofa<& kA 6^w Phone: �' � •/!l State Certificate orRe ' ration No. �� �� Certificate of Competency No. Signature / P: Date: 6q (Qualifier's signature) (Revised02/24/2014) Property Search Application- Miami-Dade County Page 1 of 2 9R) ` ;R. ' OFFICIIIE OF Ti"HE P PP Summary Report Generated On:4/11/2016 Property Information Folio: 11-2230-050-0020 q"Ep Properly Address 1700 NE 105 ST UNIT: 102 v Miami Shores,FL 33138-2145 ` a fA �E Owner ALIREZA HAGHAYEGH ANA HAGHAYEGH Mailing Address 567 GRAND CONCOURSE MIAMI,FL 33138 USA r:K ,°.` �� € �a 4900 MULTI-FAMILY- Primary Zone .y CONDOMINUM 0407 RESIDENTIAL-TOTAL { ' 6. Primary Land Use VALUE:CONDOMINIUM- RESIDENTIAL � 3tiT � Tm Beds/Baths I Half 1/1/0 I �� a _ Floors 0 Living Units 0 � Actual Area Sq.Ft Taxable Value Information Living Area 878 Sq.Ft 2015 2014 2013 Adjusted Area 878 Sq.Ft County Lot Size 0 Sq.Ft Exemption Value $0 $42,233 $41,240 Year Built 1965 Taxable Value $78,400 $25,0001 $25,000 Assessment Information School Board Exemption Value $0 $25,000 $25,000 Year 2015 2014 2013 Land Value $0 $0 $0 Taxable Value 1 $78,400 $42,233 $41,240 City Building Value $0 $0 $0 Exemption Value $0 $42,233 $41,240 XF Value $0 $0 $0 .11_'11__1111_.'__-'_'_I 1-1--_ -__---- Taxable Value 1 $78,400 $25,000 $25,000 Market Value $78,400 $78,400 $66,240 Regional Assessed Value $78,400 $67,233 $66,240 Exemption Value $0 $42,233 $41,240 Benefits Information Taxable Value $78,400 $25,000 $25,000 Benefit Type 2015 2014 2013 Sales Information Save Our Homes Cap Assessment Reduction $11,167 Previous OR Book- Homestead Exemption $25,000 $25,000 Sale PriceOR Qualification Description Second Homestead Exemption $17,233 $16,240 12/18/2015 $125,000 3990 Qual by exam of deed Note:Not all benefits are applicable to all Taxable Values(i.e.County, School Board,City,Regional). 27999_ 10/20/2011 $70,000 0391 Qual by exam of deed Short Legal Description 24634- Sales which are disqualified as a result THE SHORES CONDOMINIUM 06/01/2006 $0 2124 of examination of the deed APT 102 FIRST FLOOR 06/01/2006 $189,000 24634 Sales which are qualified UNDIV.0081%INT IN COMMON 2125 ELEMENTS CLERKS FILES 64R-124472 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp http://www.miamidade.gov/propertysearch/ 4/11/2016 Page No. of Pages PROPOSAL SUBMITTED To PHONE DATE STREET JOB NAME Y1. CITY,STATE and ZIP CODE JOB LOCATION 7 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: F % VI—P 7 Or propm hereby to furnish material and labor complete in accordance with above specifications, for the sum of: if C, dollars($ Paymerit-to be made as follows: N -4 --------------------- All material is guaranteed to be as specified. A!I work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized 4 involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our Note:This proposal may be workers are fully covered by Workman's Compensation Insurance. withdrawn by US if not accepted within days. Arreptanct of proposal—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD } r � =` CAC045861 The CLASS AAIR CONDITIONING CONTRACTOR Named below IS CERTIFIED •� `' Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0 0 PERKINS, STARLING M HACKERS AIR CONDITIONING APLNCE SVC INC 2155 NW 37TH AVE COCONUT CREEK FL 33066 0 .. ISSUED: 08/31/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408310002633 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895-954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 44 DBA: Receipt#:HEATING/ AIRCONDITION CONTRACTR Business Name:HACKERS A/C APLNCE SVC INC Business Type: (CLASS A A/C CONTRACTOR) Owner Name:STARLING M PERKINS/QUALIFIER Business Opened:12/0 3/2 0 0 3 Business Location:2155 NW 37 AVE State/County/Cert/Reg:CAC045861 COCONUT CREEK Exemption Code: Business Phone: 954-452-1117 Rooms seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 2.70 0.00 0.00 32.70 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: STARLING M PERKINS/QUALIFIER Receipt #05A-15-00000265 2155 NW 37 AVE Paid 10/21/2015 32.70 COCONUT CREEK, FL 33066 2015 - 2016 -RPnWARn nn1 wry I nr-All RI Icwl=cc TAY 01=PPIDT - DATE(MM/DD/YY) A Q CERTIFICATE OF LIABILITY INSURANCE 04/11/16 PROOUCEIi , Florida First Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3543 N.Andrews Ave. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Oakland Park,FL 33309 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Phone (954)558-8323 Fax (954)5W-4784 INSURERS AFFORDING COVERAGE NAiC# INSURED HACKER'S AIR CONDITIONING AND APPLIANCE SER INSURER A: Federated National � 912 SW 132nd TERR INSURER B: Progressive INSURER 0: DAVIE, FL 33325 INSURER D: _ INSURER I:: COVERAGES THE POLICIES OF INSURANCE LISTED 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lNSR ADD'L POLICY EFMCTIVI POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MWDDrfYYY DATE(MWO LIMITS GENERAL.LIABILITY EACH OCCURRENCE 10000_00 ®COMMERCIAL GENERAL LIABILITY GL.OrO Q3800-04 05/05/2015 05/05/2016 DAAMA GETPREMS TO 500.000 ' ❑❑ CLAIMS MADE © OCCUR MED EXP(Any one person) 5.0001 A ® ❑ PERSONAL&ADV INJURY 500.000 ❑ GENERAL AGGREGATE 2.000.000 OEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO 500.000 © POLICY C3 PROJECT ❑ LOC _ 'T AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 100001 ❑ ANYAUTO 02879301-0 02/19/2016 02/1912017 (Ea aocidenl) _I I ❑ ALL OWNED AUTOS sODILY INJURY 20000 B © ❑ SCHEDULED AUTOS Per person) _ i ❑ HIRED AUTOS BODILY INJURY ❑ NON OWNED AUTOS (Per accident) I ❑ PROPERTY DAMAGE - Per acclden GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC CJ AUTO ONLY-, AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 0 i I ❑ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE Oi ❑ DEDUCTIBLE r ❑ RETENTION 3 WORKERS COMPENSATION AND ❑ WC STATU OTH- EMPLOYERS'LIABILITYITS ANY PROPRIETOR/PARTNER/EXECUTIVEY/N E.L.EACH RCGDENT ER OFFICER/MEMBER EXCLUDED? (MandabDry In NH) E.L.DISEASE-EA EMPLOYEE l M descri"under -; SPECIAL PROVISIONS below I EE,L,DISEASE-POLICY LIMIT i OTHER I M- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS �! LICenr e#CACO 45861 i -CERTIFICATE HOLDER + _ CANCELLATION SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INS WILL ENDEAVOR TO MAIL I Miami Shores Building Dpt DAYS WRITTEN NOTICE TO THE CERT IC TE HOLDER NAMED TO f 10050 NE 2nd Ave TWE LEFT,BUT FAILURE TO SNAIL IMP E N OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1 URER, AGENT OR PRESENTATIVES. Misini Shores, FL 33138 AUTHORIZED REPRESEN A E fax:3057568972 A )A ACORD 25(2009/07)QF ®1 -x PO TION.All rights reserved. The AC RD Name and logo are registered marks of ACORD P Paychex, Inc. RF 6 4/11/2016 2 : 14 : 27 PM PAGE 3/003 Fax Server CERTIFICATE OF LIABILITY INSURANCE °ATE`2""'°°"""Y' 04/11/2016 THIS CERTIFICATE IS ISSUED ASA 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 Ileu of such endorsement(s). . )DUCER CONTACT Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. PHONE FAX 150 SAWGRASS DRIVE • 877-266-6850 585-389-7426 ROCHESTER,NY 14620 EMAIL Certs@paychex.com AESS- INSURER($)AFFORDING COVERAGE NAIC# JRED INSURER A: Associated Industries Insurance Company li ic23140 HACKERS AIR CONDITIONING AND INSURER B: APPLIANCE SERVICE INC 912 SOUTH WEST 132ND INSURER C: TERRACE DAVIE,FL 33325 INSURER D: INSURER E: INSURER F: IVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE NSR UBR POLICY NUMBER POLICY EFF POLICY EXP LJMrr$ IIID 1Bi/D GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ES(Ea E::1 $ CLAIMS•MADE�DCCUR MED EXP(Arty one poison) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ ENI.AGGREGATE LIMIT APPLIES PER: POLICY O PRaECT=LOC PRODUCTS-COMP/OP AGO $ AUTOMOBILE (COaSINGLE LIMIT �YEaw $ ALL OWN® SCHEDULED BODILY INJURY AUTOS AUUT�O�SW� (Per person) $ HIREDAUTOS AUrp3 ED (BPOerDILY IN URY $ O PROPERTY DAMAGE (Peracdderrt) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS„An CLAIM-MADE AGGREGATE $ DED I I RETENnoNj $ WORKMW COMPENSATION AND X WC STATII- OTH- EWLOYEW LWBILnY AWC1052534 10/28/2015 10/28/2016 ANY PNOPRIETOWARTM77JF ECUTIVE EL EACH ACCIDENT $ 100,000.00 OFRCEFUMEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE $ 100,000.00 Mnlrakin NH) N TWA Ifyea,damerlhe under E.L DISEASE-POLICY LIMIT $ 500,000.00 If CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,If more apace Is required) CACO#45861 RTIFICATE HOLDER CANCELLATION Miami Shorts Vlllage Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1050 grid Ave DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Miami Shores,FL 33138 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IIID UPON THE COMPANY,IT$AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE L ORD 25(2010/05) 01888-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MMlDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/11/2016 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:R the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to Me terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the cerifiicate holder In lieu of such endorsame s. PRODUCER INTACT Paychex Insurance Agency Inc PAYCHEX INSURANCE AGENCY,INC. 150 SAWGRASS DRIVE . 877-266-6850 FAX PH E . 585-389-7426 ROCHESTER,NY 14620 E-MAIL Certs@paychex.com ADDRESS- INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: Associated Industries Insurance Company li ic23140 HACKERS AIR CONDITIONING AND INSURER B: APPLIANCE SERVICE INC 912 SOUTH WEST 132ND INSURER C: TERRACE DAVIE,FL 33325 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. m TYPE OF INSURANCE NSR R POLICY NUMBER POLICY EFF POLICY EXP UMITS D/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ F—]CLAIMS-MADEOCCUR MED EXP(Arty cte pe—) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ POLICY LOC rn AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ PRO.IECi� $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ ANY AUTO (Ea accident) ALL_ SCHEDULED BODILY INJURY AUTOS AUTOS (Per een P ) $ I1UtED AUT03 rT�Wn�D BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (PeracideM) $ WBREL A VAS u OCCUR EACH OCCURRENCE $ MCESS LtAS C AMM MADE AGGREGATE $ DEDI I—$ $ BWRIM CONPENSATM AM X WC STLA OTH- EMOYEMUASILI Y AWC1052534 10/28/2015 10/28/2016TO. I FIR E.L.EACH ACCIDENT $ 100,01)0.00 ANY PROWiIETORIPARTNERIE7EcuT1VE OFFICERNAEMSER EXCLUDED! YIN E.L.DISEASE-EA EMPLOYEE $ 100,000.00 waralatwy in P" '` I N/A EL DISEASE-POLICY LIMIT $ 500,000.00 g yes,demibe under DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 107,Addltlenal Remarks Schedule,H mme space M regcdrad) CACO#45861 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1050 2nd Ave DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY Miami Shores,FL 33138 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered narks of ACORD lin Cc JrJFRd% MAW WHOLESALE DISTRIBUTORS RIGERATION—AIR CONDITIONING i CERTIFIED ATING SUPPLIES&EQUIPMENT r to-eirtiffickatte 0A 1'J1&*%A-3dnUm5c.A Ratiha%ns AHRI Certified Reference Number: 7931924 Date: 4/11/2016 tStatus: Active Product:Water/Brine to Air Heat Pump Packaged Unit Model Number:SV024-1VT/CF/HZ-i*"P*B Manufacturer: BOSCH THERMOTECHNOLOGY CORP Trade/Brand name: BOSCH Rated as follows in accordance with ANSUAHRUASHRAE/ISO Standard 13256-1 for ter-to-Air and Brine-To-Air Heat Pumps and subject to verification of rating accuracy by AHRI-sp" p eo,,independent,third party testing: ��. Air Flow Rate-Cooling: 850/850 Air Flow Rate-Heating: 850/850 WLHP(Water-Loop Heat Pumps) Full Load ° Cooling Capacity(Btuh) 23400/23400 Cooling EER Rating(Btuh/watt) 13.40/13.40 I Cooling Fluid Flow Rate(gpm) 6.00/6.00 Heating Capacity(Btuh) 26600/26600 , Heating COP(wattlwatt). 4.40/4.40' s�' ` Heating Fluff- .IbW Ikate(gpm) 6.00/6.00,,. GWHP(Ground-Water Heat Pumps) Cooling Capacity(Btuh) Cooling,EER Rating(Btuh/watt) Cooling Fluid Flow Rate(gpm) Heating Capaclty(Btuh) Heating COP(watflwatt) Heating Fluid Flow Rte(gpm) GLHP (Gt'ound-Loop Heat Pumps) Cooling Capaeity(Stuh) 25000/25000 Cooling EER Rating(Btuh/watt) 1550/15.50 Cooling Fluid Flow Rate(gpm) 6.60/6.00 Heating Capacity(Btuh) 17000/17000 Heating COP(watt/watt) 3.40/3.40 Heating Fluid Flow Rate(gpm) 6.00/6.00 Indoor Blower Motor Fan Type: Sold In: Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. 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.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.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, AM personal and confidential reference. MR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahrldirectory.org,click on"Verify Certificate"link we maize 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 - - - - -- 02014 Air-Conditioning,Heating,and Refrigeration Institute f 131048525500686551CERTIFICATE NO : MAIN OFFICE: 11401 ROOSEVELT BLVD. PHILA.,PA 19154-2102 PHONE: (215)698-9100 EMAIL: info@uri.com TERMS AND CONDITIONS OF SALE 1. Title to merchandise shall remain in Seller until invoice is fully paid in legal tender. Delivery shall not be deemed to be complete until such payment, notwithstanding any agreement to pay transportation charges. ALL TRANSPORTATION CHARGES AND RISK OF LOSS OR DAMAGE IN TRANSIT SHALL BE BORNE BY BUYER. 2. Prices do not include local, state or Federal sales, use, excise or similar taxes. Any such taxes or other governmental charge imposed on this transaction shall be added to the price and paid by the buyer. 3. No merchandise shall be returned without first obtaining Seller's written permission and shipping instructions, which must be followed. Transportation charges and risk of loss shall be borne by Buyer. A minimum charge of 20% of the invoice price shall be paid by Buyer to cover cost of handling any returned merchandise. 4. Unless otherwise expressly stated, Seller shall have the right to make delivery installments. Each installment shall be separately invoiced and paid without regard to subsequent deliveries. Failure to pay for any installment when due shall excuse Seller from making further deliveries. Delay in delivery of any installment shall not relieve Buyer of its obligation to accept remaining installments. 5. To any invoice not paid in accordance with its terms, there shall be added thereto and made an integral part thereof a late charge at the rate of 2% per month on the unpaid balance for each month, or fraction of a month, that such balance becomes or remains unpaid, plus all costs incurred in collection, together with attorney's fees in an amount equal to 20% of such unpaid balance. 6. Seller's liability hereunder shall be limited to honoring the manufacturer's warranty with respect to defective merchandise, provided that written notice shall he given to Seller within the manufacturer's warranty period. In no event shall Seller be liable for the cost of processing labor charges, lost profits, injury to good will or any other special or consequential damages, for defective goods, late delivery or non-delivery. 7. THERE ARE NO WARRANTIES WHICH EXTEND BEYOND THE DESCRIPTION ON THE FACE HEREOF AND SELLER MAKES NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR SPECIFIC PURPOSE. 8. If Seller is prevented from carrying out the herein contained provisions by reason of any war, revolution, strike, epidemic, fire, hurricane, flood, embargo, Providential, governmental or other cause, whether of the same or a different nature, existing or future, beyond Seller's reasonable control and interfering with the production and delivery of the merchandise as herein contemplated, Seller shall be excused from making deliveries as required by the contract. 9. This contract may not be modified or terminated orally. No claimed modification, termina- tion or waiver of any of its provisions shall be valid unless in writing signed by Seller's duly authorized representatives. 10. This contract shall be governed by and construed according to the laws of the Common- wealth of Pennsylvania.