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PL-18-2019Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-7-18-2019 Permit Type: Plumbing - Residential Work Classification: Gas Permit Status: APPROVED Issue Date: 8/7/2018 Expiration: 02/03/2019 Parcel Number Applicant 435 GRAND CONCOURSE Miami Shores, FL 33138-2462 1132060170280 Block: Lot: CURTIS RUDBART TRS Owner Information Address Phone Cell CURTIS RUDBART TRS 435 GRAND CONCOURSE MIAMI SHORES FL 33138- 435 GRAND CONCOURSE MIAMI SHORES FL 33138- Contractor(s) EH WHITSON PLUMBING Phone 954-929-3599 CeII Phone Valuation: Total Sq Feet: $ 1,893.00 0 Type of Work: INSTALL NEW NATURAL GAS LINE, NATUR Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $2.62 $2.00 $0.40 $175.00 $3.00 $1.60 $185.82 Pay Date Pay Type Invoice # PL-7-18-68368 08/07/2018 Check #: 937 Amt Paid Amt Due $ 185.82 $ 0.00 Available Inspections: Inspection Type: Final Press Test Review Plumbing 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 that all w. k will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor ttt the work 1 at l , _tfo �1 r August 07, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy August 07, 2018 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Ave, Miami Shores, Florida 33138 Tel: 305-795-2204 Fax: 305-756-8972 Inspection Number: INSP-001384-2018 Permit Number: PL-7-18-2019 Scheduled Inspection Date: November 06, 2018 Inspector: Massanet, Maykel Owner: CURTIS RUDBART TRS Address: Project: 435 GRAND CONCOURSE Miami Shores , FL 331382462 Contractor: EH WHITSON PLUMBING JOHN LIPKA Permit Type: Plumbing - Residential Inspection Type: PlumbingTin If Work Classification: Gas Phone Number: Parcel Number: 1132060170280 Phone Number: 9549293599 Building Department Comments INSTALL NEW NATURAL GAS LINE, NATURAL GAS TANK LESS WATER HEATER, NATURAL GAS RANGE AND TEE FOR FUTURE GA: GENERATOR Checklist Item General Comments Passed False Comments Inspector Comments Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 05, 2018 For Inspections please call: 305-762-4949 Page 23 of 53 E.H. WHITSON PLUMBING 421 S 21 AVENUE HOLLYWOOD, FL 33020 (954) 929 — 3599 STATE LICENSE #CFC1425789 DROP TEST CERTIFICATION OWNERS INFORMATION: NAME: Ruir ADDRESS: y �/l fS Qz3 �) �'9�� - CITY: % , � 1V R € STATE: F,L TYPE OF INSTALLATION: NEW UPGRADE DESCRIPTION OF WORK: 32 /9- 5 / t 7-) SYSTEM PRESSURE FROM METER: 12 P 5_1 IF YBRID SYSTEM, BRANCH PRESSURE: WATER COLUMN: / TEST DURATION: /)n2/ ( DATE OF TEST: f l CON ACT6R (QUAL i PRINTNAME State of florida County of ijai , .lo R) SIGNATURE { �... , DATE sworn to and subscribed before me this day of ("personally known ( ) produced identification — type of identification (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 hk:L:EIVED JUL 3 0 1018� �CX— b FBC �2j0nn BUILDING Master Permit No. (FLI PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL *PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 435 Grand Concourse City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-017-0280 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Curtis Rudbart TrS Phone#: 617-599-0841 Address:435 Grand Concourse City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: E. H. Whitson Plumbing Address: 421 South 21 Avenue Phone#: 954-929-3599 City: Hollywood State: FL 33020 Zip: Qualifier Name: John Lipka Phone#: 954-868-0264 State Certification or Registration #: CFC1425789 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1893.00 Square/Linear Footage of Work: Type of Work: 0 Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of work: Install new natural gas line, natural gas tankless water heater, natural gas range, and tee for fuure natural gas generator Specify color of color thru tile: Submittal Fee $ 4k Permit Fee $ / --)* - °` CCF $ 1 • ?A CO/CC $ Scanning Fee $ S Radon Fee $ 1.09 DBPR $ 2 .62 Notary $ Technology Fee $ t . LQ Training/Education Fee $ 0 .4 Double Fee $ Structural Reviews $ ZS1 Bond $ lAt TOTAL FEE NOW DUE $ 18s • a2 L 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 t. e . rson whose property is subject to attachment. Also, a certified copy of the recorded noti . co ence nt st be . oste• . t th - ob site for the first inspection which occurs seven (7) days after the building permit ' issued. I the .bse� a of ch .. te. otice, the inspection will be approved and a rein ection fee will be charged. Signatur OWNER or AGENT The foregoing instrum nt was acknowledged before me this day , 20 d , by CLI it 11 5 0 4 who is personally known to me or who has produced ( y i Iii Li ( ' s identification and who did take an oath. NOTARY. PUBLIC: Sig Print: Seal: Sign The for instrum s a nowledged before me this day of , 20 ) -9 , by. Ci\ h S - Lt _ who is personally known to moor who has produced identification and who did take an oath. NOTUB C: Sig Print: Seal: J1f.C.lEL as CL_ =°" '° PATRICIA KARAMBIS MY COMMISSION # GG36523 ocFl.oe° EXPIRES: October 05, 2020 a , ************************************************************************************************************ PATRICIA KARAMBIS MY COMMISSION # GG36523 - .„,,od EXPIRES. October 05, 2020 APPROVED BY !'7—"` "7,(41 Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) ACCORD CERTIFICATE `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/1/2018 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 Keyes Coverage lnsurance 5900 Hiatus Road Tamarac FL 33321 NAMEACT Michellita Mercado -Swaney PHONE 954-724-7000 FAX A/C,_Nr' Ext): (A/C, No): Ao DR' mmercado@keyescoverage.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Colony Insurance Company 39993 INSURED 12193 E. H. Whitson Plumbing Al & John Enterprises Inc d/b/a 423 S. 21st Avenue Hollywood FL 33020 INSURER B :Wesco Insurance Co 25011 INSURER c:Commerce and Industry Ins. Co 19410 INSURER D :Zenith Insurance Co. 13269 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1925037311 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 INSD SUBR MD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY Y Y GL 0022592-00 3/7/2018 3/7/2019 EACH OCCURRENCE $1,000,000 DAMAGE RENTED PREMISESO(Ea occurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE X LIMIT APPLIES JE X PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 $ B AUTOMOBILE X X LIABILITY ANY AUTO X S SCHEDULED W NON-ONED AUTOS Y Y WPP1616821 3/7/2018 3/7/2019 COMBINaPoINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X O OCCUR CLAIMS -MADE Y Y EBU0637188869 3/7/2018 3/7/2019 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 DED X RETENTION$0 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A y Z127057804 4/12/2018 4/12/2019 X STATUTE OTH- ER InClds Blkt WOS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is included as an additional insured when required by written contract State of Florida License #CFC1425789 CERTIFICATE HOLDER CANCELLATION 30 Days Notice /10 Days for Non -Pa i MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES FL 33138 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE * IT ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RECEIVED JUL 3 0^1018 .H. WHITSON PLUMBIN 421 S 21 ST �P\, OLLYWOOD, F �F� �� r- �.•'''4 (954) 929-3 �,\-P� G�,c� r` (954) 921-5050 ,c ���� ,�F^ i ` info(ehwhitson.co \�G���• GCS^���P a �T CFC142578 SURVEY'SHEETS / PLANS CUSTOMER NAME: ADDRESS: CITY: ZIP CODE: PHONE #: ALL WORK TO COMPLY WITH N.F.P/A/ CODE#: ESTIMATED JOB COST: DESCRIPTION OF WORK: �� ��� /�y��d' "e`- -y� r<y� �'/ te_y\ / / _ /,• /�Ir - ./�i •Ps I"Y �!/ 7-C��/�/�/- -" • /./PAg°- PLUMJTNTG PLANS Approved .—�--� Disapproved A- I.. 4 -+.• M� Date? Date • •• .. . • • • • • • • • • • • • • • •••• • • y . . • • • •• • • • • . • • • • • • •• • • • • •. • uo oF65 EXPIRES: October 05. 2020 PUBn PATRICIA KARAMBIS MY COMMISSION n GG36523 is Survey Sheets / Plans Customer Name: Address: City, State, Zip Code: Phone #: All Work to Comply with N.F.P.A. Code #: Estimated Job Cost: Description of Work: ‘4,,,,49,7ede.4/et/c,/,•;vie-- 43, / E.H. WHITSON PLUMBING 421 S 21 ST AVE HOLLYWOOD, FL 33020 (954) 929-3599 (954) 921-5050 fax info@ehwhitson.com CFC142578 ITii ,01 Piping ISO v#404, • • • • ate•••/.Q Disapproved" i/1 wpp oved• • . • • • * ••• • • • • • a • • •• •• • • • • • • • .. . '•p//i �• , • • • •• •• • • • • • s•.• • • • • PATRICIA KA.RAMBIS Ml' Ci)2.1MISSirw # GG36523 �oF�oe° EXPIRES- October 05, 2020 ►., vvvvv, • • . • I • • • • •• s••• • • • Property Search Application - Miami -Dade County https://www.miamidade.gov/propertysearch/#/report/summary OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: 11-3206-017-0280 Property Address: 435 GRAND CONC Miami Shores, FL 33138-2462 Owner CURTIS RUDBART TRS CURTIS S RUDBART LIVING TRUST Mailing Address 435 GRAND CONCOURSE MIAMI SHORES, FL 33138 USA PA Primary Zone 1300 SGL FAMILY - 2801-3000 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 3/4/0 Floors 1 Living Units 1 Actual Area 3,799 Sq.Ft Living Area 3,224 Sq.Ft Adjusted Area 3,512 Sq.Ft Lot Size 19,500 Sq.Ft Year Built 1964 Assessment Information Year 2018 2017 2016 Land Value $686,288 $686,288 $623,898 Building Value $763,860 $663,712 $662,665 XF Value $41,747 $0 $0 Market Value $1,491,895 $1,350,000 $1,286,563 Assessed Value $1 316,423 $1,289,347 $1,262,828 Benefits Information Benefit Type 2018 2017 2016 Save Our Homes Cap Assessment Reduction $175,472 $60,653 $23,735 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description PB 15-14 AMD PL OF MIAMI SHORES SEC 4 LOTS 18-19 & 20 BLK 87 LOT SIZE 150.000 X 130 OR 13290-1045 0487 1 Generated On : 6/20/2018 Taxable Value Information 2018 2017 2016 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $1,266,423 $1,239,347 $1,212,828 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $1,291,423 $1,264,347 $1,237,828 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $1,266,423 $1,239,347 $1,212,828 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $1,266,423 $1,239,347 $1,212,828 Sales Information Previous Sale Price OR Book - Page Qualification Description 10/06/2014 $100 293454533 Corrective, tax or QCD; min consideration 05/04/2012 $1,475,000 28102-2572 Qual by exam of deed 07/01/2006 $1,525,000 24764-3967 Sales which are qualified 04/01/2005 $960,000 23370-2166 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: 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.myfforidalicense.com There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's 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! RICK SCOTT, GOVERNOR STATE OF FLORIDA J DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CFC1425789 ISSUED. 07/07/2016 CERTIFIED PLUMBING CONTRACTOR LIPKA, .JOHN S E H WHITSON PLUMBING IS CERTIFIED under the provisions of CR 489 FS Ezt3vituandale AUG3` 2018 11507070000839 UE IALH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS Expiration date: AUG 31, 2018 LIPKA, JOHN S E H WHITSON PLUMBING 421 SOUTH 21 ST AVE HOLLYWOOD FL 33020 ISSUED 07It37/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607070000839 I) 115 S. Andrew ID OCTOBER 20170. Ft. a uderdale, FL 33301-1895 — 000 VALID THROUGH SEPTEMBER 30, 2018 DBA: I NG Business Name: H wH Ts Otv PLUMB PLUMB Owner Name: Jel-t+ s LI F'KA Business Location: 4 21 S 21 AVE HOLLYWOOD Business Phone: 954 - 929 - 3 '99 Rooms Tax Amount Seats Number of Machines: Transfer Fee NSF Fee 54.001 0.00 THIS RECEIPT MUST BE THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: JOHN S L I PKA 3 .. ..:E:_,E HOLLYWOOD. FL 3 0 G Receipt #: rh FLumBI12N"vl LWN SPfiNKL/CoN ,ACTOt Business Type: t PLUMP InG CONTRACTOR! Business Opened::, /C: ; State!CountylCertlReg Fci425` 89 Exemption Code: Employees 11 For Vendin4 Business Only Per.atty 0,00 0.00 Machines Professionals Vending Type: Prior Years. 0 .00 Coliecaon Cost 0.00 Total Paid .0 POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS This tax is levied for the privilege of doing business within Broward County and is Ow -regulatory in nature, You must meet all Cr i ty andfnr Municipality planning 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 i',, is in compliance with State or'tocai laws and regulations 2017 - 2018 Receipt a01C-16-00002346 Paid 09/15/2017 54.00 A� i® CERTIFICATE OF LIABILITY INSURANCE DATE(MMID18 ) 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 Ileu of such endorsement(s). PRODUCER Keyes Coverage Insurance 5900 Hiatus Road Tamarac FL 33321 CONTACT NAME: Michellita Mercado -Swaney PHONE FAX (A/C. No. Ext): 954-724-7000 (A/C, No): ADDRESS: mmercado@keyescoverage.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Colony Insurance Company 39993 INSURED 12193 E. H. Whitson Plumbing Al & John Enterprises Inc d/b/a 423 S. 21 st Avenue Hollywood FL 33020 INSURER B : WeSCO InSUranCe Co 25011 INSURERC: Commerce and Industry Ins. Co 19410 INSURER D : Zenith Insurance Co. 13269 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1924758545 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 LIR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GL 0022592-00 3/7/2018 3/7/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE X LIMIT APPLIES jE X PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X X — LIABILITY ANY AUTO ' ALL OWNED X SCHEDULED Y Y WPP1616821 3/7/2018 3/7/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1 00Q 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per acEGRdT DAMAGE ent) $ $ C X UMBRELLA LIAB EXCESS LIAB X O OCCUR CLAIMS -MADE EBU0637188869 3/7/2018 3/7/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENT ON $ p $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below y / N N / A Y Z127057804 4/12/2018 4/12/2019 Xy PER STATUTE EH R Indds Blkt WOS E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is included as an additional insured when required by written contract *H******-kL**i***AAA..A..Ak****-k********************.***********************A********************** CERTIFICATE HOLDER CANCELLATION 30 Days Notice /10 Days for Non -Pay MIAMI SHORES VILLAGE 10050 NE 2 AVENUE PERMIT#PL-4-16-888 MIAMI SHORES FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD