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ELC-14-1868 (r, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218582 Permit Number: ELC-8-14-1868 Scheduled Inspection Date: October 03, 2014 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Addition/Alteration Job Address: 11300 NE 2 Avenue Landon Student Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-32 Project: BARRY UNIVERSITY Contractor: C DAVIS ELECTRIC COMPANY, INC Phone: (954)432-4334 Building Department Comments INTERIOR BUCKY'S COVE Infractlo Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed 1z Failed � v Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 02,2014 For Inspections please call: (305)762-4949 Page 10 of 29 CDAVISE-01 LGLEASON CERTIFICATE 4F LIABILITY INSURANCE F °A' `3123/2o1s12016 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 poll y(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terns 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 endomement(s). PRODUCER Collinsworth,Alter,Lambert,LLC CONTACT T Lori B. Gleason 23 Eganfuskee Street LAW,No arc No): 681)427-6730 Sulte 102 E'AAAi1L ;I Lasso calllc.com Jupiter,FL 33477 INSUREP48)AFFORDING COVERAGE NAIL 0 INSURERA:Amerisure Insurance Co 19488 INSURED INSURER 8:Amerisure Mutual Ins Co 23396 C.Davis Electric Company,Inc. INsuRERc:Brid efield Casualty Ins CO 10335 1701 Southwest 100th Terrace INSURER D:Travelers Property S Casualty Co.of America 25674 Miramar,FL 33025 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE1 POLICY NUMBER MNYDDY M AAM 1C Y XP` LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fjq OCCUR CPP20919620201 0410112016 04/0112017100,000 X XCU,Contmctual,BFPD MED E (Es ocarina $ MED EXP(Arty one person) $ 6,000 X Independent Contr. PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY Q JPECO-' 0 LOC PRODUCTS-COMPIOP AGG $ 2,000.000 OTHER: $ AUTOMOBILE LIABILITY COaMSWWEJ3mS $ 11000,000 ,OOO,O dd A X ANYAUTO CA20677570701 04/0112016 0410112017 BODILY WJURY(Per Person) $ ALL OWNED SCHEDULED AUTOS AUTOBODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OVINED P $ AUTOS pgr I PIP Coverage $ 10,000 X UMBRELLA L tAB X OCCUR EACH OCCURRENCE $ 5,000,00 B EXCESS UAB CLAIMS-MADE CU20577640602 04101/2016 04/01/2017 AGGREGATE $ 5,000,0 DED X RETENTION$ 0 S WORKERS COMPENSATIONOTH AND EMPLOYER&LIABILITY X STAT ITE Ci ANY PROPRIETORIPARTNE_RJEXECUIIVE Y f N 19634344 04101/2016 04/01/2017 E.L.EACH ACCIDENT $ 11000,00 OFFICERlMEMBER EXCLUDED? rl N i A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 DES�RId PATI N OF F OPERATIONS below E.L.DISEASE-POLICY LIMIT It 11040,00 D lRentedfLeased Equip. QT6602G167243TIL1b 04/01/2016 0100112017 Limit 260,00 D Inland Marine QT6602GIO7243TILIS 04/01/2016 04/0112017 Scheduled Equipment DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD fol,Additicnal Remarks SchedWe,may be attached H more space Is regWred) Certificate Holder Is named as additional insured Including products and completed operations for general liability per C07048,auto liability,and umbrella liability when required by written contract. General Liability,Auto Liability,and Umbrella are primary and non contributory when required by written contract. Waterer of subrogation applies to general Iiabiitty,auto liability,umbrella liability,and workers'compensation when required by written contract. Umbrella extends over general liability,auto liability,and employer's liability.Cancellation applies as per policy terms and conditions. ELECTRICAL CONTRACTOR-LICENSE#EC0001038 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WrrH THE POLICY PROVISIONS. 10060 NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE a` or� 8• 071988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Send Result Report 19 KY01EM MFP TASKalfa 3551 d 09/03/2014 11:13 Firmware Version 2N42000.003.032 2014.01.16 [2N41000.002.0011 E2N41100.001.0021 E2N47000.003.0321 ............ ............. ............ Job No.: 004182 Total Time: 0000'26" Page: 001 Complete Document: doc00418220140903111203 MCK SCOTT.GOVERNOR K69 WMOK WOWURY STATE OF FLONDA DapAR"MNT OF BUSIMM ANO PROFENKMI.REGULAIMM ummim=4TRAOTORD LJOEWNG WARD The ELECTRIM CONTRAL;MK Nwriodbubw]SCEFTMIED UsW0W2=v,11�jr4a9r& B"Vt- 8 8WRATUX0 E JR ELECIMCgyp,INC 1701 BOUTHVIR�T 100 FH TERRACE L4 RMMI. dMIM14 EUSPLAYASHEQUIREDBYLM SWO L14MIOWTIN No. Date and Time Destination Times Type Result Resolution/ECM 001 09/03/14 11:13 3057568972 0'00'26" FAX OK 200x100 Normal/On 1 [ L8H3X00677 1