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MC-16-1178 '4C RlJr CERTIFICATE OF LIABILITY INSURANCE 1514/(2016Yvv) 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 CONTACT A&D ALL-LINES INS ASSOC INC PHONEtA1C 305 463-6781 F4X (305)387-2918 5600 SW 135 Ave Ste 106 E-MAIL .sama or a Bout .net Miami, FL 33183 INSURERS AFFORDING COVERAGE NAICp INqLIRFRA AMELIA UNDERWRITER INSURED AIR-Q, INC. INSURERB: LLOYDS OF LONDON 9010 SW 32ND STREET INqtIRPP r. MIAMI, FL 33165 INSURER D: 786-486-7810 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 MAYHAVE BEEN REDUCED BYPAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 O00,000 X COMMERCIAL GENERAL LIABILITY $ 100,000 CLAIMS-MADE D OCCUR MED EXP An one erson $ 5,000 B Y CIBFL0006487 09/23/15D9/23/16 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2 OOO OOO PRO- M LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO BODILY INJURY(Per person) $ ALLOWNEDN SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS Par UMBRELLA LIAB OCCUR [AGGREGATE H OCCURRENCE $ EXCESS LIAR CLAIMS-MADE $ WORKERS COMPENSATION X nR S, , OTH- AND EMPLOYERS'LIABILITY FR ANY PROPRIETOR/PARTNER/EXECUTIVE 106-52223 05/08/16D5/08/17100,000 A OFFICER/MEMBER EXCLUDED? Y N/A E.L.EACH ACCIDENT $ (Mandatory in NH)If E.L.DISEASE-EA EMPLOYEE 100,000 D es,describe under 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) License# CMC1249976, Mechanical Contrator ERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACOR 1 N.A ng s reserve . ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD t\)Ic lj� Permit NO. MC- -16-1178 `yeORES Miami Shores Village Permit Type:Mechanical-Residential 10050 N.E.2nd Avenue N Perlill"t Work Classification:Addition/Alteration " Miami Shores,FL 33138-0000 Permit Statist APPROVED yFH ',d-° Phone: (305)795-2204 tOR10 Issue nate:5/6/2016 Expiration: 11/02/2016 Project Address Parcel Number Applicant 9301 N BAYSHORE Drive 1132050270560 GUY&SELIN KURLANDSKI Miami Shores, FL Block: Lot: Owner Information Address Phone Cell GUY SELIN KURLANDSKI 9301 N BAYSHORE Drive MIAMI SHORES FL 33138- 15811 COLLINS Avenue SUNNY ISLES FL 33160- Contractor(s) Phone Cell Phone $ 31,800.00 Valuation: AIR Q INC (786)486-7810 Total Sq Feet: 0 Tons:5.2 Available Inspections: Additional Info:2 AC UNITS(5.2 TONS)AND INTERIOR Inspection Type: Classification:Residential Final Approved: In Review Rough Duct Comments: Date Approved: : In Review Review Mechanical Date Denied: Type of Work: Underground Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $19.20 Invoice# MC-5-16-59611 DBPR Fee $16.70 DCA Fee $16.70 05/02/2016 Check#:7866 $50.00 $1,150.60 Education Surcharge $6.40 05/06/2016 Check#:7901 $ 1,150.60 $0.00 Permit Fee $1,113.00 Scanning Fee $3.00 Technology Fee $25.60 Total: $1,200.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work a done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to M ork st May 06, 2016 Authorized Signature:Owner / Applicant / Contractor / A t Date Building Department Copy May 06, 2016 1 Miami Shores Village g Ma o 2 2016 _ Building Department BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 rr '' Tel: (305)795-2204 Fax:(305)756-8972 't C INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20140- BUILDING Master Permit No--?—P—1 5— 31 2:�- PERMIT APPLICATION Sub Permit No. IAS. 16 - � � _�8 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING (MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP Q CONTRACTOR DRAWINGS 106 ADDRESS: -1 N 0�cw kI o ry_ T)'r 0� City: Miami Shores County: Miami Dade Zip: 2->-313 C� Folio/Parcel#: s, (0 C) Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: �iFFE: OWNER:Name(Fee Simple Titleholder): CO C �� Phone#:7� —I I p —& 563 Address: 0 t4� w City: � ki ShOr�,s State: F.I.- Zip: W Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: DAL Phone#: '78(2- q g,o"-7 8-1 Address:9 0 10 S W 3,2 C'f City: Mi GIM'+ __II rr,� AlState: �L Zip:: 3 3156 Qualifier Name: Q_D&O�b? Al0Nk") Phone#:1 k -4 b ''1910 State Certification or Registration#: CAA C I IMc17 6 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit. ' ` Square/Linear Footage of Work: Type of Work: 0 Addition LJ Alteration El New l❑ Repair/Replace ❑ Demoliitii►on Description of Work:��C i'' �S S ) r x100 �CQ� + 2Nd kog( cfcw`'�-'Y) Specify color 7—of�color thru tile: Submittal Fee$ Permit Fee CCF$ CO/CC$ Scanning Fee$ �' r`p Radon Fee$ C6 DBPR$ Notary$ Technology Fee$ D S ' rOC) Training/Education Fee$ 0 Double Fee$ � Structural Reviews$ Bond$ z TOTAL FEE NOW DUE$ / 50 'Go (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 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 Signature (—g/, 1 SiV %Fgnature WNER or AGENT CONTRACTOR The foregoing instru ent was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1 Q6ek4A—b� .20 15 by /�Z'� p�day of{� A OAC;1 20 1 G , by 1L who is personally known to dol fv FY,01O ,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: NOTARY PUBLIC: Sig Sign: Print: C� Print: �i Si Qif`f ANA LUCIA SIERRA Seal: _: MY COMMISSION NFF224104 Seal: '"Y' ANA LUCIA SIERRA MY COMMISSION#FF 224104 s EXPIRES:April 23,2019 =q; a EXPIRES:April 23,2019 4, Bonded Thru Notary Public Underwriters % Rd��d:°� Bonded Thru Notary Public Underwriters APPROVED BY lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) . ,A Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY � LBTJ 6824099 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AIR Q INC RENEWAL SEPTEMBER 30, 2016 9010 SW 32 ST 7097645 MIAMI,FL 33165 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMERECEIVED AIR Q INC 196 , GENERAL MECHANICAL BY TAX COLLECTOR CONTRACTOR 75.00 07/06/2015 Worker(s) 1 CMC1249976 0223-15-005637 This Local Business Tax Receipt only conknus paymeid of the Local BlsinassTax.The Receipt is not a license, permit ora certification of the holders qualfffcadens,to do business.Holder meat comply with any governmental or nongoveraanmal regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Bade Code See on-V6. nIa rtl For mare information,visit www.mismidade.govitaxcollector m I STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ALONSO, RODOLFO AIR-Q INC 9010 W 32ND ST MIAMI FL 33165 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 STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. �� PROFESSIONALSREGULATION Every day we work to improve the way we do business in order to r CMC1249976,� ISSUE&—.05/29/2014 serve you better. For information about our services, please log onto ° www.myfloridalicense.com. There you can find more Information CERTIFIED MECHANICAL CONTRA, TOR about our divisions and the regulations that impact you, subscribe ALONSO,,RODOLFO to department newsletters and learn more about the Department's AIR-Q INC 4 - 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, IS CERTIFIED underthe.provisions of Ch.489 FS. and congratulations on your new license! r `Exp,rationdate.AUG31,2016 L1405290002469 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY l _ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION n+�, CONSTRUCTION INDUSTRY LICENSING BOARD + CMC1249976 - The MECHANICAL CONTRACTOR • •� ._': ' Named below IS CERTIFIED Under ttie provisions_of Chapter 489 FS. ExplratloWdate:-AUG 31, 2016 SLONSO,-RODOEFO . 9010:W:32ND ST -- ",<'�1,MIAMI .. ".;,FL 33165 icct mr). nFnaronia nISpi AY AS RFOUIRED BY LAW SEQ# L1405290002469 ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYWY) 9/23/2015 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 TA A&D ALL-LINES INS ASSOC INC PHONE (305)463-6781 FAX (305)387-2918 5600 SW 135 Ave Ste 106 E-MAIL gapg or a south.net Miami, FL 33183 INSURERS AFFORDING COVERAGE NAIC N AMELIA UNDERWRITER INSURED AIR-Q, INC. INSURERB:LLOYDS OF LONDON 9010 SW 32ND STREET MIAMI, FL 33165 INSURER D: 786-486-7810 INSURER 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 BYPAID CLAIMS. INSR LTR TYPE OF INSURANCE SR POLICY EFF POLICY XP LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000. OGE COMMERCIAL GENER1�AL LIABILITY $ 100 000 CLAIMS-MADE 0OCCUR MED EXP An one rson $ 5 000 B YCIBFL0006487 09/23/15 9/23/16&GENERA ADV INJURY $ 1 000 000 GREGATE $ 2,000,000 T AGGREGATE LIMITAPPLIES PER: COMP/OP AGG $ 2,000,000 PRO- $ AUTOMOBILE LIABILITY SINGLE LIMIT ANYAUTO RY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( I HIRED AUTOS NON-OWNED AUTOS DAMAGE $ $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ WORKERS COMPENSATION $I WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 106-52223 05/08/1505/08/16 E.L.EACH ACCIDENT $ 100,000 A OFFICEMMEMBER EXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,067 lryes.descri eundN 0,er 500 000 SC DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddiUonal Remarks Schedule,if more space is required) License# CMC1249976, Mechanical Contrator CERTIFICATE HOLDER NCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE O 1988-2010 ACOR I N.Ali rignts reserve . ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD