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RC-12-2386Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 186903 Permit Number: RC -12 -12 -2386 Scheduled Inspection Date: March 07, 2013 Inspector: Bruhn, Norman Owner: WILKINS, ROLAND JAMES Job Address: 726 NE 92 Street 6 -L Miami Shores, FL Project <NONE> Contractor: FLORIDA EXECUTIVE BUILDERS LLC Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)610 -5113 Parcel Number 1132060440440 Phone: (954)979 -6364 Building Department Comments REMODEL HALL BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 07, 2013 For Inspections please call: (305)762 -4949 Page 44 of 46 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 IL' DING � ( PERMIT APPLICATION Permit Type: JOB ADDRESS: ADDRESS: 1 Z l0 N E 92 nsi DEC 18 2612 FBC 20 (. O Permit No. Master Permit No. (''" °� (3 ROOFING (QI_ City: Miami Shores County:. Folio/Parcel #: I— 3 c c- -6(4 Li D Is the Building Historically Designated: Yes Miami Dade Zip: 33 )3B NO Flood Zone: OWNER: Name (Fee Simple Titleholder): re. I Q nd �a,z�es • LU 1 1 K 1 h)5 Phone #: C Address: % Z, (p 4J E 9212° -31" 44- City: (l 1 a. ry 1 cy I O✓ State: F %r zip: 331 c E Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: P.-JOY CY. EYe C 1-L4 i ® U t. Address: 19 25" M ' th City: Porn p tr) tr . Cb State: —4-1 Qualifier Name: 12 ■ 1 M.� cr )e ✓ -s State Certification or Registration #: CC 2 ) 5� (n Contact Phone #: 9 5y ' LI tV ' (0331--P Email Address: DESIGNER: Architect/Engineer: g (D3Co. -/ Zi Phone # :95z-i 977- 4°3(4 Certificate of Competency #: Flop Plc» u h k.k. Ueis . Phone #: Value of Work for this Permit: $ Z, 5bc:) o Square/Linear Footage of Work: Type of Work: DAddition XAlteration ONew / ❑Repair/Replace Description of Work: le'"2 - L— u 6 100 ❑Demolition Color thru tile: ?Ar..0. ******** *> k> k** ** **** **** ********** ** **** Fees* * * ** * * * *** ****** * **x *** *** * * ** *** ** * * **** ** Submittal Fee $ ermit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL ii E NOW DUE $ ► 1 L -' Bonding Company's Name (if applicable) Bonding Company's Address City 1 State ' ` f / if " 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. Signature /Qom Wdkei.r' Owner ok®[gent The foregoing instrument was acknowledged before me this 1 d r y of Nov ,20 it, by 'fLola.nd W 4Mit, who is personally known to me or who has produced cation and who did take an Sign: I Print: 1 %4 /L My Commission Expires: / ° - z **************************** * * * * * ** * * * ** *4* ** *g� * *, * * * ** * * * * * * * * * * * * * * ** :* ** * * * * * * *** *** * * ***** * * * * * *** ** Az-- ` oa_ Plans Examiner Zoning Contra tor h The foregoing instrument was acknowledged before me this day of " ✓ , 2011, by [L. ! e j Rober-15, o me or who has produced as identification and who did take an oath NOTARY ' UBLIC: ca z <. Sign:. �1 1 `l V, 0 is Prin t C� Wit/ eiv p My Commission Expires: L S //� ow c m 09 0 X:, APPROVED BY Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) ACCIREP CERTIFICATE OF LIABILITY INSURANCE `.- ..'-' DATE(MM/DDlYYYI) 11 /28/2012 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 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 Bateman Gordon and Sands 3050 North Federal Hwy Lighthouse Point FL 33064 CONTACT NAME: PHONE -941 -0900 FAX (A/c. No):954 -941 -2006 (A/c No Extp954 ADD'REss:certs ©bgsagency.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A :Amerisure Insurance Co. 19488 INSURED SENIN Senoma, Inc. Florida Executive Builders Inc. Florida Executive Builders LLC; 1935 NW 18th St. Pompano Beach FL 33069 INSURER B:American Safety Indemnity Company INSURERC: INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1765555455 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 TYPE OF INSURANCE INSR S WYD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POUCY EXP (MM/DD/YYYY) LIMITS B GENERAL LIABILITY ENV0247671102 2/13/2012 2/13/2013 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL IJABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) 850,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS - COMP /OP AGG $5,000,000 POUCY %( JEOaT LOC SIR $5,000 A AUTOMOBILE LIABILITY CA20753460002 3/9/2012 3/9/2013 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS HIRED AUTOS _ X SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ENU0247681102 2/13 /2012 2/13/2013 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENT ON $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY WC205837003 . 12/1/2011 12/1/2012 X WC STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNER/EXECUT1VE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) Y / N Y N 1 A E.L EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, desaibe under DESCRIPTION OF OPERATIONS below E.L DISEASE - POUCY UMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Named Insured Continued: South Florida Carpets, LLC & Micro Remediation, LLC. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami FL 33138 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD , 6 ACC0R° CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYTY) 11/20/2012 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 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 Bateman Gordon and Sands 3050 North Federal Hwy Lighthouse Point FL 33064 CONTACT NAME: PHONE A Ext) :954 941 -0900 FAX (A/C, No:954- 941 -2006 MAI�Q• ADDRESS:certs(ibgsagency.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA Amensure Insurance Co. 19488 INSURED SENIN Senoma, Inc. Florida Executive Builders Inc. Florida Executive Builders West, LLC 1935 NW 18th St. Pompano Beach FL 33069 INSURERS :American Safety Indemnity Company INSURER C: INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 1724431231 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS B GENERAL LIABILITY ENV0247671102 2/13/2012 2/13/2013 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY PREM SES (Ea occurrence) $50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 X XCU /Contractual PERSONAL &ADV INJURY $2,000,000 X Broad Form PD GENERAL AGGREGATE . $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OPAGG $5,000,000 7 POLICY X PRO- JECT LOC SIR $5,000 A AUTOMOBILE LIABILITY CA20753460002 3/9/2012 3/9/2013 (Ea ritSINGLE LIMIT $1,000,000 $ X X ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS HIRED AUTOS X SCHEDULED NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ENU0247681102 2/13/2012 2/13/2013 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENT ON $10,000 Follow Form $ A WORKERS COMPENSATION WC205837003 12/1/2011 12/1/2012 X WC STATU- OTH- TORY LIMITS ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Y/ N N N /A E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 Pollution Liability CPL ENV0247671102 2/13/2012 2/13/2013 2,000,000 Per Occurrence 5,000,000 Aggregate 5,000 SIR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Named Insured Continued: South Florida Carpets, LLC & Micro Remediation, LLC. CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2 Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami FL 33138 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ROBERTS, RILEY D FLORIDA EXECUTIVE BUILDERS LLC 1935 NW 18TH ST POMPANO BEACH FL 33069 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalleense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487-1395 OF FLORIDA It •,••••••.:4 • 'OR • LLC 6 CERTIFXED under the prpviatioAs of Ch.iti 9 F13:.' iatiOfl date AUG f31 V12061900443 This DOCUMENT HAS A COLORED BACKGROUND ;MICROPRINTING • LINEMARK" PATENTED PAPER P. STATE OF FLORIDA TMENT OF BUSINESS AND r;fidit•isiOnsr . - CONSTRUCTION MILAT ION SEQ#1.,12061900443 BATCH NUMBER /19/2012 11049096 ENERAX CONTRCTOR , CE TIFI1q, nder e% Provisions of ap ter Expiration date: AUG 31, 2014 :,..17LORIDA•‘EXECUTI 1935 NV 18TW-ST POMPANO BEACH VERNO DISPLAY AS REQUIRED BY KEN LAWSON. SECRETARY 4,,Xf --2,0CINR,`7.20::7-2101 -'ZC>ZVA-e*tr.SEr-E-*AZ_k'Y.'gnac'ZEY,I"PX:'-ftW>TL,Pr:ZCYZ!;;):RWZO3-LN" Z.r.),IVt`,1737.1b1:ZOg,:,11f4.071PargtractrIA-ZOil,. aki-SEK-M4--.11:arlt a AI Ompano beach norlda's Warmest Welcome • OWNER City of Pompano Beach Business Tax Receipt ZO -V, 013 REGISTRATION NO. -00074322 • NEW . . RENEWAL . , . . DATE ISSUED ' • COUNT NO. • 03;1 USINESS NAME FLOil IDA XE LIT TVF BUIL DE = , LOCATION - 1935 NtAl_ 18 ST i$ j - 3 CLASSIFICATION t (GC) REGISTRATION FEE pELIN aUENT CHG. .TRANSFER FEE TOTAL AMQUNT PAID ‘. • oo 249 E.? EFFECTIVE DATE ` ' EXPIRATION DATE OCTOBER' 1 " SEPTEMBER 3Q BUSINESSES MUST CONSPICUOUSLY DISPLAY THIS , 'BUSINESS TAX RECEIPT TO PUBLIC VIEW AT BUSINESS LOCATION CONTRACTORS MUST MAINTAIN ON FILE „CURRENT LICENSING AND INSURANCE • ' NOTICE: A NEW APPLICATION MUST BE FILED IF THE BUSINESS NAME, OWNERSHIP OR ADDRESS IS CHANGED, THE ISSUANCE OF A BUSINESS TAX RECEIPT SHALL NOT BE DEEMED A WAIVER OF ANY PROVISION OF THE CITY CODE NOR SHALL THE ISSUANCE OF A BUSINESS TAX RECEIPT BE CONSTRUED TO BE A JUDGEMENT OF THE CITY *5 10 THE COMPETENCE OF THE APPLICANT TO TRANSACT BUSINESS. FX:OnPthi;:s"..KYL-tatt "etTA,Za.::/=s4C4.taatf..-C3C'rn"-‘$ - 115 Business Name: Owner Name: Business Location: Business Phone: Rooms - - - - - - - - - - - - v S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 - 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 2 DBA: Receipt #: 1.Q.._ CONTRACTOR FLORIDA EXECUTIVE BUILDERS LLC Business Type: CONTRACTOR) ROBERTS, RILEY D /QUAL Business Opened:02 /01/1998 1935 NW 18 ST StatelCounty /Cert/Reg:CGC 1520689 POMPANO BEACH Exemption Code: 954- 979 -6364 Seats Employees Machines = Professionals 5 (GENE - I 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 :0. 0 <0 00 0.00 30.00 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: ROBERTS, RILEY D /QUAL Receipt #032 -11- 00003236 1935 NW 18 ST Paid 07/12/2012 30.00 POMPANO BCH, FL 33069 2012 -2013 AC RC7 D� i..r CERTIFICATE OF LIABILITY INSURA NCE DATE (MM/DDIYYrn 11/3012012 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: Otto certificate holder is an ADDITIONAL INSURED, the policy(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 endorseme • s PRODUCER Bateman Gordon and Sands 3050 North Federal Lighthouse Point FL 33 INSURED SENIN Senoma, Inc., Florida Executive Builders Inc. and Florida Executive Builders West, LLC 1935 NW 18th St. Pompano Beach FL 33069 u.• • � ygME, rAJC N F�ar95-1 -9 41. Q 900 ka- t izaSS CertaCrBzas et y„Cc n INSURER(S) AFFORDING COVERAGE INSURER A:,AmBD9UCe1oSUr"aACE t. INSURER B iAraerlreElliagaiyinaetanity 1A.1Upa y INSURER C : NA10 j2 .88 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 PERI_ OD INDICATED, NOT+MTHSTANOINO 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, 1N$R TYPE OF INSURANCE ADDL ;NM SUER WVD POLICY NUMBER POLICY EFP (MMVDDIYYYY) POLICY UP (MM1DD/YYYY) -- -� . LIMITS B GENERAL X LABILITY COMMERCIAL GENERAL LIABILITY ENVa247871102 2/13/2012 2/13/2013 EACH OCCURRt NCE 92,000,000 SEE.($ ore) $50,000 X X .I OLAJMS -MADE X XCU/Oonlraotuel OCCUR MED EXP (Any one perm) 35,000 PERSONAL A ADV INJURY 32,000,000 35,000,000 $5,000,000 Broad Form PD GENERAL AGGREGATE GGEEN % AGGREGATE LIMIT APPLIES PEI 7 I POLICY F7 .I FC • LCD PRODUCTS- COMP/OP A00 SIR 35,000 A AUTOMOBILE X — LIABILITY ANY AUTO ALL OWNED HIRED AUTOS X AUTO t,£o NON -OWNED AUTOS CA20753460002 3/9/2012 3/9/2013 COMBINED SINGLb LIMI I „(E DDIneat) 51.000,000 9 B0DIIY INJURY (Perpitmen) BODILY INJURY (Peraccldant) $ PROPERTY DAMAGE (Per scalene $ B — X UMkR> i.I & I.fAD EXCESS LAB X OCCUR OLALM3- MACS ENU0247881102 2/13/2012 2/13/2013 EACH OCCURRENCE 55,000,000 AGGREGATE 95,000,000 $ DED IX RETI=.Nr.ION$1b000 Fellow Form A WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y 1 N ANY PROPRIETORIPARTNERIEJCEOUTIvE QFFhCER ET aE# f Lune ? (�Myaggndatorr,y� In NH) IilatR VA OF OPERATIONS below Q N 1A _ tiIVC205 $3700401 12/1/2012 12/1/2013 )( S�A'r- o _ selav JAa175 E.L EACH ACCIDENT $1 OOO,OOO $1,000,000 EL DISEASE - EA EMPLOYEE 2,L DISEASE• POLICY LIMIT $1 000 400 B Pollution CPL$dy ENV0247671142 2/13/2012 2/13/2043 2,000,000 Per Occurrence 5,000,000 Aggregate 5,000 SIR DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarlts Schedule, If More some I3 reached) Named Insured Continued: South Florida Carpets, LLC & Micro Remediation, LLC. nweerve. 1' ,_IA1 w.p.m. Miami Shores Village 10050 NE 2 Avenue Miami FL 33138 NCELLATION SHOULD ANY OF THE ABOVE DESCRIER() POLICIES ER CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL RE DELIvERFD IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD z5 (2010/05) +H 1088 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and Togo are registered marks of ACORD 1111111 1111111111 11111 11111 11111 11111 11111111 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. id, -- ° " r TAX FOLIO NO. / /3(406'© 'OW STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. FN 2012R0868109 Bk 28383 Fs 2607; (fps; RECORDED 12/04/2012 13 :54 :36 HARVEY RUVINv CLERK OF COURT IAIII -DADE COUNTY? FLORIDA AST PAGE 1. Legal description of property and street / address: '-1(, I `�—�. , & ko'r 7t9 iti3E 44 6; 13 9 L:.� 2. Description of improvement: /3/47/1,.. .w»ch 3. Owner(s) name and address: Interest in property: kat" c S. V.0.4,---e S p'f.. . 1 Name and address of fee simple titleholder 4. Contractor's name and address: 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: / Amount of bond $ 6. Lender's name and address: vG / (d am /Y f 3snw `� Q o / 7. Persons within the state of Florida designated by Owner upon whom noticesrpr other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: ?Ole/1424o 1� 1(01,3 S n Cti C Pt- 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) >Ro . W ti%- Signature f weer %/� /�1/�,� Print Owner's Name ifek/70/ ��i'& ns Prepared by �'� -17/t! L 4 ` Z Sworn to and subscribe Before me this /941 day of / V OV , 20 /9- . ess: /93 /%W (t ,- Notary Pub Print No =m My co n expires: TOM ' ''' NOTARY RUt UO STATE OF FLORIDA comma EE1627 oR 312512016 u f' DOLZ01.35 t vardo1.4 3grlAS Onund )1iON STATE OF FLORIDA, COI ` {- „�„+ I HEREBYCE�Y aiming this is original WITNESS my hand and HARVEY RUVIN, CLERK D Ciro r Coes ?fie Shores Plaza East Condaminturn .Association, Inc. 745 North East91' Street Miami Shores, FL 33138 305 - 759 -9069 / FAX 305 -759 -2101 E-MAIL spe123 @att.net November 9, 2012 Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 Dear Sir / Madam: This letter will serve as your confirmation that "Florida Executive Builders" (Contractor) has been contracted and is authorized by the Board of Directors of the Shores Plaza East Condominium Association to perform repairs in the bathroom of unit 6L at 726 NE 92 Street, Miami Shores, Fla. Should you have any questions regarding the enclosed, please feel free to contact the condominium office. Sincerely yours, '7/e/xs"k(1/ Robert Gonzalez President cc: file The Shores Plaza East Condominium Association, Inc. Miami Shores Village Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 Dear Sir / Madam: 745 North East 91"t Street Miami Shores, FL 33138 305 - 759 -9069 / FAX 305 -759 -2101 E -MAIL spe123@att.net November 9, 2012 This letter will serve as your confirmation that "Florida Executive Builders" (Contractor) has been contracted and is authorized by the Board of Directors of the Shores Plaza East Condominium Association to perform repairs in the bathroom of unit 6L at 726 NE 92 Street, Miami Shores, Fla. Should you have any questions regarding the enclosed, please feel free to contact the condominium office. Sincerely yours, r.'4'''11"14(// Robert Gonzalez President cc: file