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MC-14-2788 4 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-225677 Permit Number: MC-12-14-2788 Scheduled Inspection Date: December 16,2015 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Fire Suppression System Job Address:11300 NE 2 Avenue Landon Student Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-32 Project: BARRY UNIVERSITY Contractor: CITY FIRE INC Phone: (954)987-1338 Building Department Comments RE PIPE EXISTING FIRE SUPRESSION SYSTEM TO Infractio Passed Comments NEW"CHEN COOKING APPLIANCE INSPECTOR COMMENTS False LANDON BUCKYS COVE KITCHEN 12-07-15 l Z The expiration date was extended due to the fact that the Fire Department final inspection for this project was approved on July 1, 2015 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 15,2015 For Inspections please call: (305)762-4949 Page 4 of 51 Arlenis Silvera From: Arlenis Silvera Sent: Friday, December 04, 2015 8:53 AM To: 'Jordan Morgan' Cc: Ismael Naranjo Subject: RE: CC-7-14-1465 Good Morning Jordan, Please provide the Fire Department inspection record for this project. Our Building Official can review these to determine if your permit can be extended. Kind regards, re Ali S o%�✓l rte_ ��✓�'� e Arlenis Silvera Permit Clerk Supervisor Miami Shores Village 10050 NE 2 AVE Miami Shores, F133138 305-795-2204 www.miamishoresvillage.com From: Jordan Morgan rmailto:jordan@jpeLs.net Sent: Monday, November 30, 2015 9:05 AM To: Arlenis Silvera Subject: CC-7-14-1465 Good Morning Arlenis, I hope you and your family had a wonderful Thanksgiving weekend. The above permit has expired and I couldn't find online what the process is to correct this. Can you please let me know what we need to do to comply? Thank you for your assistance and I look forward to hearing from you. Kind regards, Jordan Morgan Jordan's Permit Expediting Construction Services, Inc. 954.789.9363 CBE/SBE Certified in Broward County 1 "0 14 12 a 59 YDEItiI I 189- 20 MUNICTf SI �it_�raTcti=tAL haQa i.5— i i ; �Ect7RD JOB SITE ADDRESS 113 r' i 729 FOLIO: 1 1 E t 364°�0�t'_►k+0.50 A PROPOSED USE RESTAURAN T/BA _i I �i�t�• ' � :CRE SUPPRESS 1. P R EOU I RED INSPECTIONS FIRE — DALE 0043 FIRE CHEMICAL - �- 202 FIRE FARE 204 FIRE DUMi - 206 FIRE ROU �- -- - 209 FIRE F I fdA i Soo so 00 r • i . • a •••.•• ••..•• • • • f * • • • of MIAMI-DADE MUNICIPAL I � ECORI142/01/2014 «Zf 15 V.tI �" 'MUNICIPAL hbYA{ t y ^ :3fiet0i.' �+,4 0K 1a.} }, JICE SITE ADDRESS 11300 A� {g- PRCE=OSE D USE:. RESTAURAN �. T;'BA 'r _ 3 m IEEE SUPPRESS UPD LE=OAL 3G 52 41 40 AC - 4 �_E EBG E2;5FT L: LE VS APPLICATION T`a P ;�#. �Ia: -_ � . ~� t4 i TOn 1=L00,?;_ ONE.R NAME BARRY C€ II_f CONTRACTOR CITY TY r I CC: QUALIFIER :max!UatM }I R; PERMIT T''Pr: e-1 !�IZ..,iPA CATEGORIES 027143 MUNI }.3ATE z t i=,;0 l i i:.0 l q PRO � d. 'S4# 'k}'{i':�So,4k.. ; PA d D - Ll. 20 Ty,rAL S FIRE 18 FIRE 300 At F E RA} I fwtNIS !RE SPP S ,9E, 50 FIRE 1 SUPPRESSION U 1 LES°F'Rt3NT FEE F x.:5. 0 MUNICIPRL :I ECC]R� MUNICIPAL N0. 2015-011;21319 � - 12/01/2014 JW.SITE ADDRESS . .:11 oo AVS 721 POLIO: PROPOSED USE RESTAURAN T/BA IRE SUPPRESS, UPD REQUIRED INSPECTIONS IT FIRE ". ;° DATE 0043 FIRE CHEMICAL .„, - P02 FTRE..PREE Rim 204 FIRE. QUf E -_-__-w--w-- E06 FIRE-. ROU 2109 FIRE FINA f L . ,4co p® 12/9/22015015 CERTIFICATE OF LIABILITY INSURANCE DAT " 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(ies)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 endorsement(s). PRODUCER CONTACT NAME: Krisfina Snelling Keyes Coverage Insurance PHONE FAX 5900 Hiatus Road - "O E-MAIL-MAIL Tamarac FL 33321 D INSURERS AFFORDING COVERAGE NAIC# INSURER A ASSOCuated Industries Ins.Co. 23140 INSURED 7678 INSURER 8: City Fire, Inc.;Gerard 8r Larraine Stumm INSURERC: 5708 S.W.25th Street INSURER D: Hollywood FL 33023 INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER:1735194495 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 ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMID MMIDD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGES(Ea R PREMISES EoccuNTED rrence) $ CLAIMS-MADE F—I OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY171 PRO- LOC $ AUTOMOBILE LIABILITY BINED SINGLE LIMIT— (Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PeraocIdeM $ UMBRELLA LUU3HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION y AWC1047706 6/17/2015 6/17/2016 X I WC STATU- I 10TH- AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Waiver of Subrogation when required by written contract. Fire Suppression System Installation CERTIFICATE HOLDER CANCELLATION 30 days except 10 days nonpayment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Bldg Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 0653 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA Bill - DO NOT PAY ILBTI/ 2482602 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES CITY FIRE INC RENEWAL SEPTEMBER 30, 2016 DOING BUS IN DADE CO 2605600 Must be displayed at place of business MIAMI R 33000 Pursuant to County Code Chapter SA-Art,9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED CITY(1RE INC 196 SPEC MECHANICAL CONTRACTOR BY TAX COLLECTOR Workers) 1 686957121989 $75.00 07/15/2015 CHECK21-15-095672 This local Business Tax Receipt only cogaasarms payment of fie local Business Tax.The Receipt is not a license, pmrnongoovernmer�i regulatory fication of the holder's end requirements whicto do h Holder smust comply errifh any goeemmental Q apply to the business The RECM N0.above must be displayed an all commercial vehicles-AAiami-Salla Code See b-276. For more information,visit www.miamidada.mayA mllecmr DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/30/2015 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 °NAMIE: Michelle Dickson Insurance Solutions of AmericaACT PHONE 407-332-0033 FAX 407-332-0030 925 West State Road 434,Ste 201 E-INL .certs@isolutionsfi.com Winter Springs FL 32708 sG INSURERS AFFORDING COVERAGE NAIC S INSURERA:Arch Insurance Company 11150 INSURED CITYFIR-01 INSURER 8: City Fire, Inc. INSURER C: 5708 SW 25th St Hollywood FL 33023 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:105146880 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. NOTIMTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WATH 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. IL SR AVOLIZUISR TYPE OF INSURANCE D POLICY NUMBER POLIO EFF POLICY MD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY MFGLO7917902 12/16/2015 12/16/2016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCURDAMAGE TO RENTED $100,000 PREMISES Ea occurrence X E&O Included MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X JEa LOC PRODUCTS- $2,000,000 POLICY El OTHER: $ AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY(Per person) $ AUTOS AUWNED TOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Per accident $ A X UMBRELLA LIAB X OCCUR MFUM07992401 12/16/2015 12/16/2016 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETORJPARTNER/EXECUTNE ❑ NIA A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS t LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space is required) Certificate is subject to all policy limits,conditions and exclusions. Fire Suppression System Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores FL 33138 AUTHORJZED REPRESENTATIVE n ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i `�� '� Miami Shores Village �. � g c EIVED Building Department DEC 22 0,4 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 20 LO BUILDING Master Permit No. LEA — /O W PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING 0 MECHANICAL PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11300 NE 2 AVE City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:1121360000050 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Barry College Phone#: Address: 11300 NE 2 AVE City: Miami Shores State: Florida Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: City Fire Inc. Phone#: 954-987-1338 Address: 5708 SW 25 St City: Hollywood State: Florida Zip: 33023 Qualifier Name: Gerard Stumm Phone#: 954-987-1338 State Certification or Registration#: 68695700121989 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1240.00 Square/Linear Footage of Work: Type of Work: ❑ Addition R Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Repipe existing fire suppression system to new kit hen cooking appliances. zu A LqA o 13 LAA." Specify color of color thru tile: Submittal Fee$�� Permit Fee$_ d CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if apF licable) 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. S*e00 Signature —CK rL4 Z Signature �---4v- OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 ,L by 25 day of November 20 2014 by SU&AIQ P49MMALQ , who is personally known to Gerard Stumm who is personally known to me or who has produced as me or who has produced Personally Known as identification and who did take an oath. identification and who did take an oath. NOTARY PU LIC: NOTARY PUBLIC: �1ppY oLO Notary Public State of Florida �¢. Celina Aarons N'�'pr t CMy elinExpires Aa Tns 199409 Sign. Sign Pr' t: Print: Celinna Aarons JNby J Yao S • �y��r 16MI Seal: Expo 11/1212018 APPROVED BY lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i 'AC RV CERTIFICATE F Lel ILI I SU C DATE(MMIDD/YYYY) ka. 12/17/2014 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 pollcy(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 CNANMTACT Michelle Dickson Insurance Solutions of America PHONE 407-332-0033 IFAX 407-332-0030 925 West State Road 434, Ste 201 E-MAILc. Inter Springs FL 32708 .certs@isolutionsfl.com INSURERS AFFORDING COVERAGE NAIL 0 INSURERA:Arch Insurance Company 11150 INSURED CITYF I R-01 INSURER 8: City Fire, Inc. INSURER C: 5708 SW 25th St Hollywood FL 33023 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1047484672 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, MLTR SR ADDLSUBR TYPE OF INSURANCE 1 POLICY NUMBER PMIDDI EFF MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MFGL07917901 2/16/2014 12/16/2015 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGEC RENTED PREMISESSEaocwrrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY❑JEa F—] LOC PRODUCTS-COMPIOPAGG; $2,000,000 OTHER: $ MBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANYAUTOBODILY INJURY(Per person) $ AUT&" SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per scadent 1 L $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE a N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space Is required) Fire Suppression System Installation 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 NTH THE POLICY PROVISIONS. Village of Miami Shore 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 a ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Dec 21,21 2014 1245PM HP FaxCityfire 9549876989 page 1 6 f� a CERTIFICATE OF LIABILITY INSURANCEWM(MM NY" 6/11/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO MONTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES SELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT SETVVEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,f11e polky(les)must be endorsed. If SUHROGA'I'EON 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 Keyes Coverage Insurance Mr Kristina Sneliin 5900 Hiatus Road g`Tooe tA(c.N01:954-724-702 Tamarac FL 33 321 ADDR@$8; kaaell ing�ke-�scoveraae.com eusto_Mtom 7678 ----------- INSURER(8)AFFORDING COVERAGE INVANtA: j,,�tpd Industrlee Z CO. 23140 City Fire, Inc.; Gerard & Larraine Stumm 5708 S.W. 25th Street INSURM5: Hollywood FL 33023 WwRERC: INN>A1RER O•—_ INSURER E._COVERAGES CERTIFICATE NUMOM 7853694 72 I ER _. REVISION NUMBED THIS IS TO CERTIFY THAT THE POLICIES of INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RECLIIREMENT.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 T-E TERMS,E)=-USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. Imi TYPE OF NISURANCE POLICYUl GENERAL LIASNttrY INVO EACH OCCURRENCE $ C40MLIEMIALGENERAL UASIUTY PR 14!1$£6(Ee deeutre�roal. $ _ CLAIM54lNADE F—IOCCUR MED EXP(AhY 0lterreotl� S__ — M r PERSONAL S ADV INJURY S GENERAL AGGREGATE 8 GEN'LAGGREGATE UNITAPPLIESPER. PRODUCTS-COMP(OPAGG $ POLICY �O' L.00I I— AUTONOBUILMWItuTy COMBINED SINGLE LIWT ANY AUTO Me acelderrt) $ ALL OWNED AUTOS BODILY INJURY(FarpBl9oa) $ ..... SCHEDULED AUTOS BODILY#dJURY(Pd•aCxtdarlt) $ HIREDAUTOS PROPERTY DAMAGE $---------- (ParaOddero NON-OVI84EA AUTOS $ OCCUR EXCESS UABHEACH OCCURRENCE $. CLAIMSMAD£ AGGREGATE $ DEDUCTIBLE -- — RETENTIOH " $ A TNORKERSCOMPE,MSATION $ MC1033093 AMDEMPLOYERB'UA98lIY 6/17/x016 6/17/2015 7t IMC ATW AN1/P�PRIErORfPARTNERIEXECUrIVE Y!N --- IOFFICOUMEMIM IeNE EXCLUMW NIA EL.EACH ACCIDENT $1,DAO,000 ffraedaeerpm wider EL.DISEASE-EA EMPLOYEE 81,000,000 DESCRIPTION OF OPOtATtONBN»Iwe EL,01$EASE-POUCYLEMR $1.000.000 17- t RWTIpN OFOPERATKNL9l L)CA'ggW3IVEMCLES tAEaah ACORD 101.AddldotW Ratearks$aha wle.Htttom spaln N rcqu om Fire Suppression System Installation { CERTIFlCATE HOLDER CANCELLATION SHOULD ANY OF THEABOV6 pEs MaD POLM"BE CANCELLED BEFORE THE EXPIRATION DATE THEROF,NOTICE WILL BB DELIVEM Miami Shores village 81dg Dept. IN ACCORDANCE WITH THE POLICY PROWOMs. 10050 NE 2 Ave. Miami Shores FL 33138 AUTHDROMREPRUENTATNVH a ACORD$5(2QD9J09) The ACORD nartteand0 7998 9 ACORD CORPORATION. All tights reserved. logo are reglsbwW marks of ACORD I 001758 - _ - --- - LocalBusiness Tax Receipt u_Miami-Bade County. State of Florida THGS l9 NOT A BILI - Do NOT PAY 1' 48 IRDS pGATtON art SER 30, 101 , CO K Ox -00 1A�DN3E Co ' b 51" TL�3 ;. _ 8EC. ( 01�BU NESS PAYMEMF OWN�t 7� S C CHA CP TAXtS 24 291"4 GTY FIRS� - X869,I 29 'x'/5.00'{�'T/ Work�r(s)` pPU09-14-�OS(}55 of tbetow-eosi s . e aot a Roenso. P ea1190 Bess i T� ��04B to do b certftf !�- which - tothe m all foie!vow" s Code Sec 8 _]Iee�tE1�IPTbIO.ttibo+re m¢st ForM M biota doa.0A -- .1 Jeff Atwater Lasia Sipco CHIEF FINANCIAL OFFICER BUREAU CHIEF Julius Halas Keith McCarthy DIVISION DIRECTOR SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street -Tallahassee,Florida 32399-0342 Tel.850-413-3644 Fax.850-410-2467 FIRE EQUIPMENT DEALER LICENSE OFFICIAL COPY 'HIS CERTIFIES THAT: City Fire Inc. 5708 SW 25th Street Hollywood FL 33023 )UALIFIER: Gerard J. Stumm, Sr. las Complied with Florida statutes and has qualified for the type and class shown here on to service,repair,install or aspect all types Pre-Engineered Fire Extinguishing Systems. ssue Date: 01/01/2014 'ype: 07 ,lass: 04 , :ounty: Broward . = �; .icense/Permit#: 686957-0012-1989 :xpiration Date: 12/31/2015 Chief Financial Officer e