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RC-16-231
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'u^"-'-' a-T i}* s,ra.:�d^ ate`- ,`a -t-L;. .w s.,;a+ ,, '-va„u a k .+ .s:.- _ f V t a r " _ �� ,, w �ad' w.� x � t• � �s _ i , 1i FOR DATE s I TIMEr Av pm M OF PHONE �3W 33 a 1 M CELL uj MESSAGE MTELEPHONED FIRETURNED YOUR CALL z C) �,rof 10� ®PLEASE CALL MOW- WILL CALLAGAIN opq CAME TO SEE YOU WANTS TO SEE YOU W SIGNED n 3rx � 'A�� sti�o�s� Miami Shores Village 10050 N.E.2nd Avenue NE Work Ct �c Miami Shores,FL 33138-0000 APPLIED F ` Phone: (305)795 2204M Pa , Expiration: 1 05/2016 lam Ia#e.6f .6 ih Project Address Parcel Number Applicant 1632 NE 105 Street Number: A-2 1122300530020 Miami Shores, FL Block: Lot: KEITH M BACON Owner Information Address Phone Cell KEITH M BACON 1632 NE 105 Street (305)332-6164 MIAMI SHORES FL 33138- 1632 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 47,850.00 CHRIS BURKE IN (954)532-7738 ..._.. p,,, _ _.. ,. -.M...Y Total Sq Feet: 1130 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:INSTALL APPX 1130 FT OF TILE TH Occupancy:Other Window Door Attachment Stories:2 Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms:2 Bathrooms:2 1-2 Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Plumbing Review Mechanical Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $P8.80 Review Electrical CO/CC Fee $50.00 Invoice# RC-1-16-58476 Review Building DBPR Fee $21.54 06/08/2016 Credit Card $3,134.88 $50.00 Review Building DCA Fee $21.54 01/27/2016 Credit Card $50.00 $0.00 Review Building Education Surcharge $9.60 Review Building Permit Fee $1,435.50 Review Structural Plan Review Fee(Engineer) $120.00 Scanning Fee $24.00 Technology Fee $38.40 Work without Permit Fee $1,435.50 Total: $3,184.88 In consideration of the issu ce me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in stri con rmity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I ass me re ponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, LUMB NG,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI VIT: I ify t t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and pini Fut I authorize the bove-named contractor to do the work stated. ` A June 08,2016 Authorized S gnature:Oner, Applicant / Contractor / Agent Date Building Department Copy June 08,2016 1 a • Miami Shores Village Department , BuildinIAN 2 g p , .72016 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 'J\ J INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20//// BUILDING Master Permit No. c PERMIT APPLICATION Sub Permit No. GZ§UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP N.3.1 . c CONTRACTOR DRAWINGS JOB ADDRESS:1JA �. j. ,♦ .`STN City: Miami Shores County: Miami Dade Zip: 3-31.3r Folio/Parcel#: It - as 3Cj- 0!53-00c2 0 Is the Building Historically Designated:Yes NO_Lo-,' Occupancy Type. Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): k ( Uj :1 k4,co j Phone#: 6. S.UA -WAO Address: �P �Q • �+ ��� �—T. City:H11m ng&w State: T-I Zip: 33 ( 3 Tenant/Lessee Name: Phone#: Email: k& Ak ,!(Q & AnL'C&yl CONTRACTOR:Company Name:cHA-16 BUA-kE., WC,. Phone#.-CL5 4 4U o? '7 3 g ZZ � Address: -J0 7 or`• :6w, - ? City: j' f�(f �� State. zip: .7�70 en t� ? Qualifier Name: c#�/ �/31k,e _ Phone#:'76.,x!1 State Certification or Registration#: Certificate of Competency M QR B � DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ f Square/Linear Footage of Work: 4-7 55 Type of Work: ❑ Addition �R Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: no%'. "No 64-�(/(7AJ � S . Specify color of color thru tile:Q'h i Submittal Fee$ � alp Permit Fee$� H-35 CCF V7(:�- CO/CC$ �� • �a�,A Scanning Fee$ ® Radon Fee$ DBPR$ Notary$ Technology Fee$ , VQ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 9 (Revised02/24/2014) i r 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 o attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection ll h occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not e a pro ed and a reinspection fee will be charged. SignatureNV Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of by & .day of JQ 20 by wl=personally to w is personally kn n 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: Sign: Print: 0 A Print: Seal: My COMMISSION Seal: -'' EXPIRES Juno 06,20f9 ..EXPIRES June APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) CFN:20150780102 BOOK 29884 PAGE 256 DATE:12/10/2015 08:42:36 AM DEED DOC 2,100.00 HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY Prepared by and Return to: M.Cruz in behalf of Masters Title;Inc. 1806 North Flamingo Road,Suite 240-B Pembroke Pines,Florida 33028 File Number: 150044CD General Warranty Deed Made this December 7,2015 A.D.By David Bane,a single man whose address is: 1632 NE 105 Street,Miami,Florida 33138,hereinafter called the grantor,to Keith M.Bacon,a single man,whose post office address is: 1632 NE 105 Street #A-2,Miami Shores,Florida 33138,hereinafter called the grantee: (Whenever used herein the term"grantor"and"grantee"include all the parties to this instrument and the heirs,legal representatives and assigns of individuals, and the successors and assigns of corporations) Witnesseth,that the grantor,for and iri consideration of the sum of Ten Dollars,($10.00)and other valuable considerations,receipt whereof is hereby acknowledged,hereby grants,bargains,sells;aliens,remises,releases,conveys and confirms unto the grantee,all that certain land situate in Miami-Dade County,Florida,viz: Townhouse Parcel A-2,of HARBOUR CLUB VILLAS CONDOMINIUM,according to the Declaration of Condominium thereof as recorded in Official Records Book 6529, Page 654,of the Public Records of Miami-Dade County,Florida. Parcel ID Number 11-2230-053-0020 Grantee (purchaser) herein is prohibited from conveying captioned property for any sales price for a period of 30 days from the date of the Deed. After this 30-day period, grantee is further prohibited from conveying the property for a sales price greater than$420,000.00 until 90 days of this deed. These restrictions shall run with the land and are not personal for the grantee. Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land,that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free of all encumbrances except taxes accruing subsequent to December 31,2015. DEED Individual warranty Deed-Legal on Face r CFN:20150780102 BOOK 29884 PAGE 257 Prepared by and Return to: M.Cruz in behalf of Masters Title,Inc. 1806 North.Flamingo Road,Suite 240-B Pembroke Pines,Florida 33028 File Number: 150044CD In Witness Whereof, the said grantor has signed and sealed these presents the day and year first above written. Signed sealed and del' red in ourpresence: Lp (seal) David Bane Witness Printed Name — f /�'�� Address: 1632 NE 105 Street,Miami,Florida 33138 Witness Printed Name f2mrW ad D41 1 G U � State of Florida County of Miami-Dade The foregoing instrument was acknowledged before me t is thni2g; ane, who is/are personally known to me or who has produced ca No `�; `•H e MICHAEL JOSEPHS71BER II n ame: '�,_ Commission#FF 148169 My Commission Expires: Expires August 27,2018 '•rhorf,7A�`'� aonda07hu 7my Fdalmu�anae�0.983.7U19 DEED Individual'Warranty Deed-Legal on Face CFN:264780102 BOOK 29884 PAGE 258 AlJIZ9l1.O.lYO•Y1/N V..,9.J8iYL V JtR.fJL22Ay�� �YH��S"VY.1�l,JQt.®U1;YJ{4�l.�YYb�J6Y AMOCIATION(thO"A sgociation`)does hereby cettify khat the SAID of miit at,l N.b;. 10 Street MAA. S.ho ea,Florida,a'condominium awned ti�$ by skand owners.a co�rdingtQ`the feoords of the A.ss dation,as�rrantox(s),to Grantee,has bem approved by the Association. Dated�tihis ARB:OTII UE MLAS. cormo . oWMGTJSES COND' A�iS CT zo3V Na4 . a -�- �—�- Tide:I'resi erit , -STATE OF FLORIDA r :COUNT OF MIAMI DADB. The foregoing' ument was acJmovidedged before me this_aday of gnjC� zoo, —, L ,Z as � Sr llll' of ARBOUR CLUB VIII Coh O M TO�t�I�iHO ISES COIVDQN NICTM ASO IATIOI� who, is personally Jmown to ire or his produced. :as ' ide � cation. 1VIy Oomrnrn�ssion�pres, y.Fublic Print Name:, iaF sW AtUR+NnnA at:;AWC Notlkry Fwft.Stile a1:Flat4�t • 041M..1 #a,Matt MY cwmm.94treo M*r24,xo1n . 'l�MrdedttrauplitNlta�it�aterYAash . .I• 1 s �.� ConWi nn1radio— lifyinq Burd BUSINESS CERTIFICATE OF COMPETENCY V 1 BURKE CHRISTOPHER Is cetti»W Ewmd�.�tilte•.p�r�t�j�,, ,ons f gf�a�er 1 Q of N�)a.�i4�', ftlV r 004642 Local Business Tax Re . Miami Dade County, Receipt -THIS IS NOTA ILL-DO NOT PAY Florida ` 6425417 BUSINESS NAMEJLOCATION CHRIS BURKE INC RECEIPT NO. DOING BUSINESS IN DADE COUNTY RENEWAL, EXPIRES 6693601 SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code . ' Chapter 8A-Art,9&10 OWNER CHRIS BURKE INC SEC.TYPE OF BUSINESS Worker(s) i 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED 098SO0241 BY TAX couEcroR $82.50 10/01/2015 This Local Business Tax Receipt only coafirms CREDITCARD-16-000490 pemd�or a mentaa4ua of the holdefsquallficatio o� Business Tax.The Receipt is not a license, or RECEIPmmernal regalatory laws and requiremems which apply to the dusmass imp y with an The RE Holder I RECEIPT N0.-hove must he Y governmental displayed on all commercial vehicles- for mare information,visit Miami-pada Code Sac>m-?76. ann�m emidade oovltex Ite,. i �ACC>R& CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y1fYY) 01/26/2016 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 CONNAMTACT KIM AMEEN Price My Policy PHONE (954)977-1551 Fax No): (954)301-0820 100 North State Road 7 Suite 202 E-MAIL kim@pdcemypolicy.com Margate,FL 33063 INSURERS AFFORDING COVERAGE NAIC# Phone (954)977-1551 Fax (954)301-0820 INSURER A: United Specialty Insurance Co INSURED INSURER 8: Bridgefield Employers Incurance. CHRIS BURKE INC INSURER C: 507 S Dixie Hwy E INSURER D: INSURER E: Pompano Beach FL 33060 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. 1L7R TYPE OF INSURANCE ADD UBR POLICY NUMBER M�DY EFF LID/EXP LIMITS O COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS-MADE Q OCCUR 0 REND PR IS Es occcuurrence $ 100,000.00 F1 MED EXP(Any one person $ 5,000.00 A ❑ N DCG00395-01 10/17/2015 10/17/2016 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 POLICY ❑ PRO- ElJECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY REM iBINED SINGLE LIMIT accdent ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AUTOS OWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ ❑ ❑ AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ❑ PER ❑OTH- AND EMPLOYERS'LIABILI Y Y/N AnrM FR ANY PROPRIETOR/PARTNER/EXECUT E.L.EACH ACCIDENT $ 1,000,000.00 B OFFIC N N/A 0830-53435 02/25/2015 02/25/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,h more space is required) installation of floor covering License#09BS00241 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 N.E.2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014M1)OF The ACORD name and logo are registered marks of ACORD page 1 CHRIS IBURKE9 INC. 507 S. Dixie Hwy, fast EXPERT MSTALLATION IZI Pompano Beach, FL 33060 c, G T Datei ZJ IS Ph: (954) 532-7738 FaX: (954) 532-7741 '-`/ - Ga .S - * }- we Accept Email: chrisburkeinc@aol.com V115 ESTIMATE, CONTRACT and AGREEMENT r' Irl c, rr we agree to complete the following work listed below in a professional manner and in accordance with standard industry practices: Fir t6) , - 7t-;-:e- ci S Total Contract 21 J �1 c '�-) ;,• 20 n G r> �-, 1 Deposit ? �o 'j`v •,� i 2— N �J" �11J L• �. '- Balance 2.3 T . "! Method of Payment Balance due upon completion Delivery Fee THIS CONTRACT SUBJECTTO THE APPROVAL OF THE MANAGEMENT. The undersigned warrants that he/she Is (they are)the owner(s)of the above mentioned premises. Chris Burke, Inc. is not responsible for settlement cracks or surface wear. Chris Burke, Inc. is not responsible for trimming doors to accomodate new floor height or exlsting appliances to fit back properly. Major fault in floor slab will be at the expense of the customer.Chris Burke, Inc.is the installer and not responsible for any defects,color or variations in the products that you purchase. Installation to be performed by Chris Burke, Inc.according to industry standards. Receipt of a copy of this contract is hereby acknowledged by the undersigned that the foregoing provisions have been read and accepted.Customer agrees to sign all necessary papers upon installation of flooring or any other services mentioned in this contract. Exchange or refund will be at the sole discretion of the management. Chris Burke, Inc. reserves the right to require payment by bank or cashiers check A finance charge of 1-1/2%per month will be charged on balances over 30 days. Purchaser agrees to pay all costs,including a reasonable attorney's fee in case it as Hake ary to enforce this contract, whether suit be brought or not. Authorized Agenit Purchaser G10 7✓31 CERTIFICATE F LIABILITY INSURANCEDATE iMMroD 1lYYYv, PHIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND Ott ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE'OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHt3RIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:K the aartl8aate holler Is an ADDITIONAL INSURBO,tiro Policygea)must be endarsed.N$UBROQATiON IS WAIVt pr sublsct to the tense and conditions of tho policy!certain p6gal s may require an endorsement.A statement on this certificate does not confer rights to the card icate holder In Beu of such endomement(s), PRODUCER - - - ..Ct,-- ---- ....._-... KIMAMEEN _ Price My Policy E (1164)9771651_ { .N (964)301 0820 100 Nath$#eta Road 7 Suite.202 L kim piieenypoilcy.com ---- Margate.FL 33063 i INSURERS AFFORDING. GE NA!q#---., Picone (954)977-1561 Fails (04)$01-0820 INSURER A: United Specialty insurance Co INSURED ......._-.............. N u M q: Bridgefleid Employers incumnoe. CHRIS BURKE INC I SURE C 507 S Dbde Hwy E —_ -- Pompano Beech ; FL 33060 INa -R E:1 ---- ........ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 16 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. --- 1 TYPE OF INSURANCE WON AM POLICY MEEK omwm Y LIMITS ® COMMERCIAL GENERAL:LiABI.nY EACH OCCURRENCE 1,000 000.00 ❑CLAIMS MADE © OCCUR DAMAGE-�' O --. �tE i_oa .Lan�I $ 100,000.00 F1 MED EXP(Any ons mon $ 5,000.00 A ❑ N DC00039501 10t1712Ef16 10117!2016 PERSONAL&ADV INJURY $ 1,000,000.0_ R1 ,toy AGOREGATE pL�IMpIT.APPLES-:PER: -GENERALA00REOATF $ 000000.0 POLICY ❑JECT ❑ LOO PRODUCTS•COMPIOP AGO $ 2,000,000.00 ❑OTHER $ AUTOMOM LIABILITY MEIN OI NGLE L"T -..-_-... ❑ ANY AUTO SODILY INJURY(Per gersmt) $ ❑ AALLULtD ❑ SC U� EOpiLY INJURY(Pm acdclol $y� F] HIRED.AUTOS f-1ANUD,rN�WNED OPE.. A �._......_..._� $ - ❑ U6IHRELLA LU/6 ❑OCCUR - EACH OCCURRENCE S EXCESS LIAR [j CLAIMS-MADE AGGREGATE----- $El - D $ VR)WJMSCOMPENSATION OTH• AND EMPI:OY6R8'LIABILITY YIN El PE. ._..El ER ANY PROPRiETORIPA1tTNERiEXECUT�� E.L.EACH ACCIDENT $ 1.000.000.00 B OPPICERIMEMSER EXCLUDEDT L'_..J N IA. OM-53435 02/25/2016 02/25/2017 (Mm+iMWy N NH) E.L.DISEASE.EA EMPLOYE $ 1.,000,000.00 HH rax,dusaiba umler DESCRIPTION OF OPERATIONS WOW E.L.DISEASE•POLICY LIMIT $ 1,000,000.0 DESCRIPTION-OF OPERATIONS I LOCATIONS I VEHICLES(Anach AOM 101,AddMmW Rmnmks Sehoduia,if more epees Is r"Wrod) Installation of of flow covering Miami Dade County--098500241 CERTIFICATE HOLDER CANCELLATION —-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE mom Stmras Vllage THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN I005DN.E.2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Mlerrd Shores,FL 23138 AUTHOtl MI)REPRESENTATIVE 01OW2014 ACORD CORPORATION.Ali rights reserve& .CORD 20(2014!01)OF The ACORD name and logo are registered inatlts of ACORD 2Killa s esu'Im 4' " s, MOOS z ms MIER