Loading...
PL-16-3060 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax:(305)7564972 inspection Number: INSP-270869 Permit Number. PL-11-16-3060 Inspection Date: December 21,2016 Permit Type: Plumbing- Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: FABLE, ELISE Work Classification: Drainfield Job Address:941 NE 91 Terrace Miami Shores,FL 33138-3219 Phone Number Parcel Number 1132060030050 Project: <NONE> Contractor: WESTLAND PLUMBING CORP Phone: (305)863-6223 Building Department Comments DRAINFIELD Iffffl-cuo Passed Comnlents INSPECTOR COMMENTS False Inspector Comments Passed HRS APPROVAL ON FILE Failed Correction Needed Re-Inspection D Fee No Additional Inspections can be scheduled until re-inspection fee is paid. a Pq � s �1 4 q Miami Shores Village !F � � 10050 N.E.2nd Avenue NE k ' '•" Miami Shores,FL 33138-0000 Rt�ED `. ti M Phone: (305)795-2204 s ✓Y u Expiration: 05/22/2017 Project Address Parcel Number Applicant 941 NE 91 Terrace 1132060030050 Miami Shores, FL 33138-3219 Block: Lot: MONTANA 13 HOLDINGS III LLC Owner Information Address Phone Cell MONTANA 13 HOLDINGS III LLC 970 SOUTH SHORE Drive MIAMI BEACH FL 33141- 970 SOUTH SHORE Drive MIAMI BEACH FL 33141- Contractor(s) Phone Cell Phone Valuation: $ 2,100.00 WESTLAND PLUMBING CORP (305)863-6223 (786)236-0198 ...,._ _._.. ,._ . _.T._. ._:._.. ...,,.,... _... .,.,.__ ..,. Total Sq Feet: 0 Type of Work:DRAINFIELD Available Inspections: Type of Piping: Inspection Type: Additional Info:DRAINFIELD HRS Approval Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# PL-11-16-61998 CCF $1'80 11/08/2016 Cash $50.00 $772.80 DBPR Fee $4.50 DCA Fee $4.50 11/23/2016 Check#:1323 $772.80 $0.00 Education Surcharge $0.60 Bond#:3262 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $822.80 In consideration of the issuance a of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict con ity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit sume re nsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECT A ,PLUMB G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID 1 I certify t 11 the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a g. Fut authorize the above-named contractor to do the work stated. November 23,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 23,2016 1 to Miami Shores Village �Aa Building Department 9103 8 AON 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/q BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: ��° City: Miami Shores County: Miami Dade Zip: 251 ?)4f Folio/Parcel#: ) 1 - 3206-06)3,,! - 00'j--b Is the Building Historically Designated:Yes NO l4 Occupancy Type: //"ad: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 0A-T0 k7A1 �� / Phone#: Address: 07 aL/sem eo^ h XoGL � �. !p IG 3 ai 3 City: 4 State: Zip:_ 3 3/3 ✓ Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: .(2-`J r/ h 1'4-"/1J1-7 /1 'b ie Phone#: ✓7"��76 Address: r®f CV �/S> City: q />- State: Zip: 3 -3 C7 / Qualifier Name: 6& jzj D V UT— O Phone#: State Certification or Registration M _ �J�7 / C7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ o;2 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: l l If1 Specify co tola`�,thr '>r' e:� Submittal Fee$ -Pgrv*,F *.1 CCF$ Q CO/CC$ Scanning Fee$ Radon Fee$ ® DBPR$ �1 �® Notary$ �J Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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 inspecti which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will n e appy o e and a reins ection fee will be charged. Signature Signature K�) r- �V�\Jt 0�� k OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1/1 lSl, ,20� f#4 'by day of /g -.20 20 (f by who is personally known to 6dZOS �{71WUS ,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: c� NOTARY PUBLIC: Sign: ""�"`" x Sign: E A RODRIGUF Print: ' ° Print: a lei „' My Comm.Expires Oct 1.201 t ' ��•��..P.. Seal: "%; t}c(;:I NWary Public Commission N FF 129175 Seal: } KDEL PRA00 . �, c•State o1�Florift IonCommission#FF 981913y Co � .• , Mmm.Expires Jun 8.2020 APPROVED BY !� '1 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) L , PERMIT #:13-SC-1714895 STATE OF FLORIDA APPLICATION #:AP1260127 DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT40PO EM FEE PAID: CONSTRUCTION PERMIT RECEIPT #: . G DOCUMENT #: PRI 036974 CONSTRUCTION PERMIT FOR: OSTDS Existing Mc i catlo APPLICANT: (Montana 13 Holding III LLC) " (WY PROPERTY ADDRESS: 941 NE 91 Ter Miami, FL 33138 LOT: na BLOCK: 1 SUBDIVISION: PROPERTY ID #: 11-3206-003-0050 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH :)99;$.• FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. : 000 ° •• • 0000•• SYSTEM DESIGN AND SPECIFICATIONS 0000• 000000 0 • • T •9060• [ 1,200 ] GALLONS / GPD Existinq Septic tank to remain CAPACITY •6•• •••6 • • [ ] GALLONS / GPD ° • • • A N/A CAPACITY •°°° 0660 •°0.6 N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK?r45V r.ALLOVgr•0• 69°06 K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PES2°2%OHRS °#P&ps [ °°°°j:° •••••0 • • D [ 667 ] SQUARE FEET Bed configuration drainfiel SYSTEM ° ° ° ° 000000 06 R [ ] SQUARE FEET N/A SYSTEM i 006 ° :0060: A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ j MOUND [ ] °° • —0080.0 • • I CONFIGURATION: [ ] TRENCH [g] BED [ 1 N F LOCATION OF BENCHMARK: cl ne 91 TER., 10.30'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 7.20 11 INCHES FT ] [ ABOVEBELOW BE Cy KJREFERENCE POINT ;+ E BOTTOM OF DRAINFIELD TO BE [ 33.20 ] [ INCHES FT ] [ ABOVE BELOW BENCHMARK/REFERENCE POINT L D FILL REQUIRED: [ 0.001 INCHES EXCAVATION REQUIRED: [ 72.00 ] INCHES *Invert elevation of drainfield to be no less than 7.70' NGVD. O *Bottom of drainfield elevation to be no less than 7.20'NGVD. PLT MU1gG nAN5 T *Install 42°of slightly limited soil under the bottom of drainfield. Date H -Perimeter of excavation area shall be at least 2 ft.wider and longer than the p> 66 The system is sized for 4 bedrooms with a maximum occupancy of 8 persons( opmwAr a total estimated ate E of 400 gpd. a!'Y R SPECIFICATIONS BY: Septic TITLE: APPROVED BY: TITLE: Dade CHD Ls M IcaDATE ISSUED: 100 EXPIRATION DATE: 04/28/2018 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC The contractor(or designee)is required to perform a Page 1 of 3 1 swf boring adjacent to th&*aaitaeld 00mation at the sE1o1192e time of final inspection./Prior to Final Approval,the DOH inspector shall witness1he soil boring and compare the results to the original sire evaluation submitted.A reinspection tee wtil be assessed if the contractor is not at the jobsite at the arranged time. Nov 07 16 11:31 p Westland Plumbing Septic 3058216007 p.3 4 E:� STATE OF FLORIDA 4` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING_ BOARD 118501 487-1395 260" BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 COB03 CARLOS hA INESTLAND PLUMBING CORP 101 WEST 24TH STREET HIALEAH FL 33010 Congratulations' With this license you oecome one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation Our professionals and businesses range • STATE OF FLORIDA frcm architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants. and they keep Florida's economy strcng. - PROFESSIONAL REGULATION Every stay we work to improve the way we do business in order CFC037110 ISSUED 08118/2016 to serve you better. For informal or about our services, please to onto www.myfloridalicense.com. There you can find more CERTIFIED PLUMBING CONTRACTOR information about ou•divisions and the regulations that impact COBOS, CARLOS IM you subscribe to department newsletters and learn more about WESTLAND PLUMBING CORP the Departmerr.'s initiatives. Our mission at the Department is. License Efficiently. Regulate Fairly.IJe constantly sWve to serve you better so that you can serve your customers. Thank you for doing business in Florida. r s '•-=a T,=I c ~r;°�' and congratulations tin vour new license, DETACH HERE RICK SZ--CTT GOVERNOR KEN LAV4'SOiv STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFCG3?1110 �� r :t f ,.�:�?•:- The PLUMBING CONTRACTOR Named below IS CERTIFIED a , Under the provisions of Chapter +8S FS. Ex6rabon date: AUG 31. 2018 m CCBOS, CARLOS 10 ,y . . ®_ VESTLAND PLUMBING CORP 1101 WEST 24TH STREET I •s:':�y 4 � HIALEAH FL:33010 ' r• 1111 r"t � 1SSU=D o8i�8r25'F DISPLAY AS REOUIRED BY LAW SEC,# 1-1608?aocGZL'1• Nov 07 16 11:31 p Westland Plumbing Septic 3058216007 p.4 City of Hialeah 2015- 16 4�,..........f,�'y W Business Tax Receipt �. �`DRioea'�`o mayor Carlos Hernandez No: 238220-68 (OLD-1711-12) Amount: $ 150. 00 The person,firm or corp. listed Mare has paid the business tax required to engage in or operate the business specifiod sub;ect to the regulations and restrictions of the City of Hialeah,Florida Owner. CARLQS h1 CQ13QS TypenfEnsiness.plumbing, Heating, and Air-Conditioning Contractors WESTLAND PLUMBING CORP 1-01 W 24 ST Business Location: HSALEAH, FL 33014 101 W 24 ST Validating No. : 368282 Expires September 30, 2016 THIS IS NOT A BILL . 0003CS Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 156253E L. BT N_ BUSINESS NAME/LOCATION RECEIVr NO. EXPIRES WESfLAND PLUMBING CORP RENEWAL SEPTEMBER 30, 2016 I Ol W 24 Sf 1 1562538 Must be displayed at place of Business HIALEAH FL 33010 Pursuant to County Code Chapter SA—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED Ulic.STLAND PLUMBING CORP 198 PLUME NG CONTRACTOR BV TAX COLLECTOR Warker(s) 10 CFC037110 $45.00 09/18/2015 ECHECK-15-163513 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license. Permit.or a certification of the holders qualifications,to do businass. Holder must comply with any governmental atnonprarmnental regulatory laws and requirements which apply to the huslaess. The RECEIPT NO.above must be displayed on all commercial vehicles—Miami—Dade Code Sac 80-276. For more information,visit Jettar Nov 071611;30p Westland Plumbing Septic 3058216007 p.1 WESTPLU-01 LHUTTO #%�R'� CERTIFICATE OF LIABILITY INSURANCE DATE(MMMrr MJ 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 POUCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER-__ _ _ IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pdicypesl must ba endorsed. If SUBROGATION IS WANED,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 endersement(s). PRODLCEtt License 0 L077730 C Assured Risk Solutions PHONE E30-4396 I A�E_©244 1000 Sawgrass Corporate Parkway STE 552 r No Sunrise,FL 33323 E-MAL ADDRESS: INSURER(S)AFFORDING COVERAGE I NAIC 2 INs�n:Arch Specialty Insurance Company 21183 INsuR1B3 INsu1xERB• _ Westland Plumbing Carp ; JNsuRER c 101 W 24 Street _INSURER 0. 1 Hialeah,FL 33010 INSURER E: INSURER F: i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWfrH RESPECTTOVIHICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.IECTTOALLTHE TERMS, EXCLUSIONSAND CONDITIONS OFSUCH POLICIES-LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. 1NSR v . LTg TYPEOFINSLWANCE I l POLICY EFF�NYRE POLICY EXP -- _..- --- -- ---___---- IVSD�WVU;_ POL1(yA IBER D JIMlDD LIMITS -- A X COMMERCIAL GENERAL LIA91LITY E.;r]-t ocCUPPEW:E _ $ _ _ 1,000,00 y{ �L4iM5-R1P_•^.c' ' X.: o•.�I-'a AGL001285502 D5/0912016 0510912017•.F ''T.iE �t 'x'e, :e�^ IC)O,0010 T. 10,0_0_ s rDv IN,LIRY I :, 1,000,00 CGN'.AGGREC-ATELGAIT.APP.IE:PEP- t�ENERPL sf XF0E 000,00- LR:Y ,E'T L!�'= FFrJC.�C-:r-.41:s'"�M�A�r: 7: _ 2,000,00 CC r'THER' '- -- _ AUTOMOSILE LIABILITY _• ALL - v M61'•1FL SCIGLE Ln.Sl4T $ .. ALLtr4>ZF, ['-...� S�HEDULEU --�..----' -_ _... .•�'.RG:: L..._ N:I;C:$ E•JDIL'r I\.0.1F'i(r:arB:i'idanlJ 5 HIREDPJ.Tr_S� N::lN-jW1:ECr , �. F•F'dPGrtT'I L�INA3E UM1&2ELLA LIARi n-Cil Fi nC_iIFFE`J'E _ $ EXCESS LIAR CLAIb':-MADE Ju:i FE6hTE T - - .CFC F�TcIJ"tyFJ; --- _ r WORKERS COMPENSATIONl / FEFi AND EMPLOYERS'LIABILITY Y 1 N I ( I ATl I ^ A TI FRrlPPIET Q,PAP7NER1E;E:'LiIN-F TF AFFICERJWE SER..Ex.iL'CS:x; NJA j E rl+AC,=1C JT $ (Mandatory In NHI CI E_ i .aE-Ei+EA1FiC':'E c It hes.•Jesuibe u r<_r CSE: RIF•Tir}W-rF ti•PEF'AT:JJ'�t:•Ir,.y _I ... E_.C SER zE PCi'ICY'IR:IT I i _ DESCRIPTION OF OPI3iA"nDNSJ LOCATIONS J VEI•IICLES(ACORD 101,Addleonal Remarks ScbedL".may be attached df more space Is required) CERTIFICATE HOLDER CANCELLATION i sHOULQANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 Northeast 2nd Ave i ACCORDANCE WITH THE POLICY PROVISIONS. fdlaml,FL 33138 i AU'rH0Ri290 REPRESENTATNE ®1988-2014 ACORD CORPORATION. Ail rights reservers. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Nov 071611:30p Westland Plumbing Septic 3068216007 p.2 ACl�Rt7' CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDD.YVYi1 12,'29:2015 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(ies) must be endorse(l. It 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 Libertate insurance LLC 'NAME Mary Be!h Eater 7107 East Washington Street PHONE FAx Orlando, FL 32801 IAJC,No,Extl: 844 5.1.0810 IAIC,Nos: 407-613-5477 E-UAl_ AD7RESS: mDea1cn:@Iiber1atelns.Ccn1 INSURERISI AFFORDING COVERAGE NAIC 0 VMw.iiberlateris._am (INSURER A: TeChnulbgy:nsJrdnce'o 42376 .NSURED INSURER 8: The S2 HR Grouc. LLC dba Engage PEO 3001 Executive Drive. Suite 347INSURER C: St_ Petersburg FL 33752INSURER C: INSURER E; INSURER F COVERAGES CERTIFICATE NUMBER: 27877167 REVISION NUMBER: '•HIS 13 TO CERTIFY THA-THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE. INSURED NAMEC ABOVE FOR THE POLICY PERIOC INCICA,TEC N07-VOTHSTANDING ANY REOUiREVENT• IcRNI OR CONDITION OF ANY COVTRACT OR OTHER DOCUMENT k-14TH RESPEC`TO wH1CH THIS CERTIFICATE MAY BE .SSJED CR MAY PERTAIN -HE !NSU"..NCE AFFORDED BY THE POLIO ES CESCRI!!ED HEREIN IS SUBJECT TO ALL THE TERMS ExCLJSIOVS ANC CONDITONS CF SUCH POLICIES LIMITS S�0AIN MAY[-AVE BEEN REDUCED BY PAID CLAIMS '-S TYPE pF INSURANCE ADD_SLOB POLICY EFF POLICY EXP IN so Wyn POLICY NUMBER MMrDOlY'!W MMJDD.M/Y'r LIVITS COMMERCIAL GENERAL LIABILITY I ' ,'Ct•::ddG?!..,.'i:_"." ..-W.:kr G'F.k aF.'::. .�. S I AUTOMOBILE LIABILITY !f �ct;tes: UMBRELLA LtAe ........ ^:k E..`E EXCESS LIAR ~~ ! l,A WORXERSCOMPENSATION TVVC3524477 12131;2015 12:21.2016 _n I AND EMPLOYERS'L-ABILITY Y:N - F. !•N _ I iir'•'rFe!PL\'r=?°`'......__ __. .. NIA - r.^.. „_a...._t.T o t.Jr10.t:D.^r {Mandatory ir•NHI _ „ hYCS yL'� 'a^ •-: D:�_AS� �4P:'Ib' f: S 1,000.000 ;1'-8:;4'•%':: ::.R,1 qti Ort:.v .. ;ii:-Ac-c. ir:icy IRA:1 S 1.000.000 DESCRIPTION OF OPERATIONS;LOCATIONS,VEHICLES(ACORD 101.Additional Rontarks Sehodule,•nay be atucried R mon:spaco is requimlt PLC)Cite'Tt:W,v sllan0 Runibing Corp 8151011 Effective: 12j.311201 F Coveroge is extend-tc-the leased employees of a:terrate employer Ir.all states except ir.monopollstic States CERTIFICATE HOLDER CANCELLATION Mlarri Shores Villagei SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1005 f THE EXPIRATION DATE THEREOF. NOTICE WALL BE DELIVERED IN 1005 v VE 2nd Avenue Shores A nue ACCORDANCE WITH THE POLICY”"PR��OVISIONS. Miar0.UTHORIZEDREPRESEVTATtbE t t Paul R.Hughes a 1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /1164N WESTPLU-01 LHUTTO ACORO DATE IMMMONYM `, CERTIFICATE OF LIABILITY INSURANCE 516/2016 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. It 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 Hsu of such endorsemerd(s) PRODUCER License#L077730 NpsCT Assured Risk Solutions PHOT 886 FAX 954 346-0244 1000 Sa ss Corporate Parkway STE 552Lag,No Sunrise,FL 33323 CA eg; INSURERM AFFO U NJG_COVERAGE NAIL aR INsuRERk:Arch Specialty Insurance Company 21199 INSURED INSURERS: Westland Plumbing Corp INSURER c: 101 W 24 Street INSURER D: _ Hialeah,FL 33010 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 OTH ER DOCU MENT WITH R ES PECT TO VM ICH TH IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H ER EIN IS SU BJECT TO ALL TH E TER MS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. wSR L TYPE OF INSURANCE POLICY NUMBER PMMO EFF OCXLIMITS A X COMMERCIAL GENERALLmiLnY EACH OCCURRENCE $ 1,000,0 CLAIMS-MADE 0 OCCUR AGL001285502 05/09/2016 05/09/2017 PREMISE$iE, - rren $ 100, MED EXP(Any one person) $ 10, PERSONAL 8 ADV rNJURY $ 1,000,00 GENT.AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 X POLICY D QCT EILOC PRODUCTS-COMPlOP AGG $ 2,000, OTHER. $ AUTOMOBN,E LIABILITY COMBINEDptideM SINGLE LIMIT $ a ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY NIJLIPY(Per amnent) $ AUTOS AUTOS HIRED AUTOS ON-OWNED PROPERTY DAMAGE $ AUTOS (Pe'.. Pe'. -d n UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LLAB HCLAIMS-MADE AGGREGATE $ DEC) I I RETENTION $ WORKERS COMPENSATIONH' TA- AND EMPLOYERS'LIABILITY YIN T ANY PROPRIETORIPARTNEWD ECUTIVE N I A E L EACH ACCIDENT $ OFFICERIMBABER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOY $ Mdescribe under RIPr1ON OF OPERATIONS below I E.L.DISEASE-POLICY LIMB I$ DESCRIPTION OF OPERAT10NSI LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached N more space is roqulred) License#CFC037110 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,Mland Shares Village ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN 10050 NE 2nd Avenue Mlaml,FL 33338 ALmHORIY®REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ACCORV CERTIFICATE OF LIABILITY INSURANCE DATE(M11!116/2 6/2016 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 have ADDITIONAL INSURED provisions or 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 endorsemen s. CONTACT PRODUCER Libertate Insurance LLC NAME: Engage PEO Certificate of insurance Dept. 707 East Washington Street PHONE 727-565-2950727-214-9088 Orlando,FL 328 1 SAIL 7z7-2�4-9oa6___ — 9a9 wc@enWo.corn _�-- INSURERjS)AFFORMNGCOVERAGE NAIC0 www.libertateins.com INSURERA: Technology Insurance Co_____ 42376 The S2 HR Group, LLC dba Engage PEO INSURERS_ 3001 Executive Drive Suite 340 Wsuc --- - -- - - St. Petersburg FL 33`/62 INSURER D: INSURER E 1 URER F COVERAGES CERTIFICATE NUMBER: 32858422 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. W SR TYPE OF INSURANCE AWL SUER POLICYNUMBER POLICY EFF POLICY EXP OMITS COMMERCIALGENERALUABIUTY EACH OCCURRENCE $ 'DAMAGE AGE To RENT€ 4--- CVUMS-MADE FIOCCUR I PREMISES Ea occurrence) S _ rMED EXP(Airy'orre parson) __$ -- --_ --- __- PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ! GENERAL_AGGREGATE PRO- j •PRODUCTS-COMPIOP AGG POLICY i—�JJECTT J S LOC ---- $ ---- ' � OTHER- AUTOMOBILE LIABILITY THERSAUTOMOBILELIABILITY COMBINED�d,'J SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY ��AUTOS -- - HIRED I !NON-OWNED i rPROPERTYOAMAGE $ AUTOS ONLY AUTOS ONLY (Per a=aenU _--- .UMBRELLA OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE -_-_- S.—__-- DED RETENTIONS $ 77 WORKERS COMPENSAMN TWC3524477 i 12/31/2015 12/31/2016 STnrurE ER AND EMPLOYERS'LIABUUTY �ANYPROPRIETORIPARTNERIEXECUTIVE YIN NIA! �. E.L.EACH ACCIDENT S 1,000,000 iOFFICF_RIMEMBEREXCLUDED? ^_ -- --- (Mandatory In NH) E L DISEASE-FA EMPLOYEE S _ 1,000,000 I �'MIibe antler ,E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF PERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddMonal Remarks Schedule,may be attached H more space Is required) PEO Client:Westland Plumbing Corp #131011 Effective:12/31/2015 Coverage is extended to the leased employees of attemate employer in all states except in monopolistic states. License#CFC037110 CERTIFICATE HOLDER CANCELLATION 131011 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 Paul R.Hughes ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 32856422 1 ENGAPEO-0: I we PEO Master I Amy MacDonald 1 11/16/2016 12:32:16 Py. (ED:') 1 Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates. 44~ DIVISION OF Environmental Health Florida Health 00, 9�QA Miami-Dade County OSTDS/Well Division A 11805 SW 24 th Street•Miami,FL 33175 d Inspector� iz ! l+�►�? i �oDate ^ Address /y "07OSTDS#- � Comments: We- Signature DIVISION OF Environmental Health Florida-Health •��� Mi ami-DadeCounty 10R,� OSTDS/Well Division �Y 11805 SW 26th Street•Miami,FL 33175 Inspector .�el a r} o Date f i'�4/riG Address r� {j 71 }tr OSTDS# If Comments: Signature.