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MCC-19-77Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: MCC-01-19-77 - Permit Type: Mechanical - Commercial Classification: Fire Suppression System Permit Status: Approved Issue Date: 01/22/2019 1 Expiration: 07/22/2019 Parcel Number 9050 BISCAYNE BLVD, Miami Shores, FL 33138 1132060100010 Contacts PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC P 0 BOX 407, LAKELAND, FL 338020407 Other: 863688747 WAYNE AUTOMATIC FIRE SPRINKLERS Contractor INC JOHN P DUFFIN 3121 NW 16 TER, POMPANO, FL 33064 Business: 9549173030 Inspection Description: RIOR RENOVATION OF THE FIRE SPRINKLER Valuation: $ 5,000.00 Requests: 4949 SYSTEM. TO REPLACE PERMIT#MC16-2215 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 Permit Fee $125.00 Total: $175.00 Building Department Copy Payments Date Paid Amt Paid Total Fees $175.00 Credit Card 01/14/2019 $50.00 Credit Card 01/22/2019 $125.00 Amount Due: $0.00 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 informatio accurate and that all work will be done in compliance with all applicable laws regulating co9struction and zoning. Futhermore, I authorize 1heabove named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date January 22, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION 4WBUILDING ❑ ELECTRIC O PLUMBING U MECHANICAL 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 RECEIV0q J N 14 019 BY: 54 FBC 20 1 `-/ �AG1 6 771 C "019 - � � Master Permit No. Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [:]PUBLIC WORKS [—]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9050 BISCAYNE BLVD City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-010-0010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): NORTHERN TRUST BANK ETAL TRS % PUBLIX SUPERMARKET INC Phone#: Address: PO BOX32025 City. LAKELAND State: FL Zip: 33802 Tenant/Lessee Name: PUBLIX 794 Phone#: Email: CONTRACTOR: Company Name: WAYNE AUTOMATIC FIRE SPRINKLERS Phone#: 9549173030 Address: 1500 S POWERLINE RD STE A City: DEERFIELD BEACH State: FL -Zip- 33442 Qualifier Name: JOHN P DUFFIN Phone#: 9549173030 State Certification or Registration #: 93137100012007 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 5,000.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: INTERIOR RENOVATION OF THE FIRE SPRINKLER SYSTEM Specify color of color thru tile: Submittal Fee $ Qs - Ox) Permit Fee $ CCF $ CO/CC $ Scanning FQe $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Z �' (Revised02/24/2014) s\� 11 �Tr jolt ............. lay. Bonding Company's Name (if applicable) Bonding Company's Address City State 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 issu d. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 11 I Pi 4 Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by 4 day of DECEMBER 20 18 by "�XQx <:�� I who i ersonall kno o JOHN P DUFFIN 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: Sign: Sign:_ Print: ��(�'"1�J�j� Print: Notary Public - State of Florida Seal: N►nv pier DIANA SHECKLER Seal: {a°,',t� My Comm. Expires Jan 21, 2021 � Commisslon 9 GG 230606 Expires June 19, 2022 1 ' 1 APPROVED BY Aan1 s Examiner Zoning Structural Review Clerk (Revised02/24/2014) socti'll fit -lop - L�wj e-r F� Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, FI 33138 Tel: (305)795-2204 • Fax: (305)756-8972 01 /02/2019 To: Current Owner 9050 BISCAYNE BLVD Miami Shores, FL 33138 Permit: MC-8-16-2215 Address: 9050 BISCAYNE BLVD Miami Shores, FL 33138 Dear Sir or Madam, Our records indicate that the above referenced permit has expired without obtaining the proper final inspection. In order to serve you better, we need to keep our files up to date. As per section 105.4.1 of the Florida Building Code, "Every permit issued shall become invalid (expired) unless the work authorized by such permit is commenced within six months after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of six months after the work is commenced, or completed without obtaining the final inspection of the work performed.." Please be advised that open permits will hinder your ability to obtain new permits, refinance or sell this property. Please contact the Building Department, within 15 days of receipt of this letter in order to take care of this matter. Sincerely, ( /I /-z-/9 Ismael Naranjo (CBO) Building Director OP6 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 BUILDING PERIV T APPLICATION ,BUILDING ❑ ELECTRIC ❑ ROOFING Master Permit No Sub Permit No AUG 05 2016 A . FBC 20 N� M0j(-AJZ- ❑ REVISION ❑ EXTENSION ❑RENEWAL QPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9050 BISCAYNE BLVD City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-010-0010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: OWNER: Name (Fee Simple Titleholder): NORTHERN TRUST BANK ETAL TRS % PUBLIX SUPERMARKET INC Phone#: Address: PO BOX 32025 City: LAKELAND State: FL Zip: 33802 Tenant/Lessee Name: PUBLIX 794 Email Phone#: CONTRACTOR: Company Name: WAYNE AUTOMATIC FIRE SPRINKLERS INC. Phone#: 954-917-3030 Address: 3121 NW 16 TERRACE City: POMPANO BEACH State: FL Zip: 33064 Qualifier Name: JOHN P DUFFIN Phone#: 954-917-3030 State Certification or Registration #: 93137100012007 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ 5,000.00 City: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace Description of Work: INTERIOR RENOVATION OF THE FIRE SPRINKER SYSTEM te: Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ � ' CO/CC $ Scanning Fee $ �( a Radon Fee $ DBPR $ off• Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ nW TOTAL FEE NOW DUE $ (Revised02/24/2014) AQ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zi 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. Signature ( N NER or AGENT The foregoing instrument was acknowledged before me this (� day of 20 �J by who is per to me or who has produced— — as identification and who did take an oath. NOTARY PUBLIC: 1 Signature NTRACTOR The foregoing instrument was acknowledged before me this 9 day of MAY JOHN P DUFFIN me or who has produced 20 16 by who is,personally known tp as identification and who did take an oath. NOTARY PUBLIC: P4Sig Sign:_ Print: i Print: �pav v�B Seal: ro :...,.�,� JODI L. SLOAN Seal: * * MY COMMISSION # FF 184644 EXPIRES: February 5, 2019 Bonded Thru Budget Notary Services t APPROVED BY I Plans Examiner ZOPP KAITLYN ZOPP Notary Public - State of Florida Commission N FF 950780 My Comm. ,X* lins*wx Zoning Structural Review (Revised02/24/2014) Clerk I • It NOTE: ALL SHEETS MUST BE REVIEWED MIAMI-DADE COUNTY BUILDING DEPARTMENT Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way), - Miami, Florida 33175-2474 - (786) 315-2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI-DADE FIRE RESCUE AND/OR DEPARTMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT PROVIDE MUNICIPAL PROCESS NUMBER HERE Contractor No. 93137100012007 y Job Address 9050 BISCAYNE BLVD 0: z Last four (4) digits of Qualifier No. c z W Folio 11 3206 010 0010 22 u a Contractor Name WAYNE AUTOMATIC FIRE 02 Lot Block Qualifier Name JOHN P DUFFIN o IL Subdivision SHORES CENTER PBpg o U. — Address 3121 NW 16 TERRACE ' Metes and bounds City POMPANO State FL Zip 33064 [ ] New Construction on [ ] Demolish [ ] Shell Only Current use of property N Vacant Land [ ] Addition Attached o [X] Alteration Interior [ ] Addition Detached Description of Work INTERIOR RENOVATION OF THE W a> [ ] Alteration Exterior [ ] Re -Roof FIRE SPRINKLER SYSTEM z [ ] Relocation of Structure [ ]Foundation Only IL [ ] Enclosure Sq. Ft. Units Floors [ } Repair Value of Work 5,000 [ j Repair Due to Fire [ ] MBLD - [ ] Chg. Contractor Owner NORTHERN TRUST BANK ETAL TRS Category [ ] Re -Issue W Address PO BOX 32025 W n. [ ] MELE a U [ } Re -stamp z W City LAKELAND State FL Zip 33802 [ ] MLPG [ ]Revision N Phone [ ] MMEC Last four (4) digits of [X] FIRE 032 [ ] Not Applicable for Owner's Social Security No. Fire U) z Name Name z g Address " Address U3 �a Zip StateWY wPhonePhone City State ZpCity 1 am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and a z a S65 per each addition hour in addition to the review fees. Minimum charge one -hour. vain nw 1"Request: Date: W cl 2"0 Request: Date: a 3id Request: Date: z g 1 am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additiona a a review fees may apply. o__ 1" Request: Date: I IL 2"d Request: Date: W 3`d Request: ate: Y:Te"e%8QL02-h1u :P.lPamh APP -11-d e Miami shores V11age Building Department 10050 N,E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A --���-C'OPY-OF QUALiFIER'S•STATE LICENCES B - COPY OF LOCAL BUSINESS TAX RECEIPT C COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI MADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B• COPY OF LOCAL BUSINESS TAX RECEIPT C, COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E, COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER farm and Contractor Affidavit) sssssssssss•sss BUSINESS NAME: -YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FO�.LOW Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number, sssssssssb 1G• BUSINESS ADDRESS: Z--1 \1\(M CITY C� sTATE zIP`E BUSINESS PHONE:a!L FAX NUMBER ��q-2 CELL PHONE (,j QUALIFIER'S NAME: _ k bhy) T 1jfh i QUALIFIER'S LIC NUMBER: Jeff Atwater CHi F FINANCIAL OFFICER ARL Julius Hulas DMSION DIRECTOR Casia 5inco BUREAU CHIEF Keith McCarthy • SAFETY PROGRAM MANAGER FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF STATE FIRE MARSHAL 200 East Gaines Street - Tallahassee, Florida 32399-0342 Tel. 950-413-3644 Fm $50410-2467 CERTIFICATE OF COMPETENCY OFFICIAL COPY THIS 6FxrI'F1Es THAT: Jahn P Du £ n 3121 NW 16th Terrace Pompano Beach FI, 33064 BUSINESS ORGANIZATION: WAYNE AUTOMATIC FIRE SPRINKLERS Inc. Contractor H is limited to the execution of contracts requiring the ability to layout, fabricate, install, inspect, alter, repair, and service water sprinkler systems, water spray systems, foam -water sprinkler systems, foam -water spray systems, standpipes, combination standpipes and sprinkler risers, all piping that is an integral part of the system beginning at the point of service, sprinkler tank heaters, air lines, thermal systems used in connection with sprinklers, and tanks and pumps connected thereto, excluding pre-engineered systems. Issue Date: Type: Class: County- License/Permit #: Expiration Date: 07/01/2016 07 12 Broward 93137.1-0001-2007 06/30/2018 1 1 .1 Chief Financial Officer 9 n BROWtAR© COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 95"31-4Q00 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 i3BA:WAYNE AUTOMATIC FIRE SPRINKLERS FtBCeipt 'PLUMBING/L?ON SPRNKL/CONI Business Name: INC - Business Type: i FIRE SPRINKLERS CONTRAC Owner Name:.7OHN P DUFFIN Business Opened:09/12/2008 Business Location: 3121 NW 16 TERR StatSfCOUnty/Cert/Reg:93137100012007 POMPANO BEACH Exefnption Code: Business Phone: 954-917-3030 Rooms Seats Employees Machines Profeasbnals 1 For V"all Business 0* Number of Machines: For Tvew Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cast I Total Paid 27.00 0.00 0 00 0.00 0.00 1 0.00 27.00 C 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 i non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VAUDATI.D and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the l business location. This receipt does not indicate that the business is legal or that it is in compliancewith State or local laws and regulations. !; Mailing Address: ! JOHN P DUFFIN Receipt #ZCP-14-00017700 3121 NW 16 TERR Paid 07/23/2015 27.00 POMPANO BEACH, FL 33064 07/22/2015 Effective Date . _ _ 2015 .. 2016i 8 AilUIURLYCERTIFICATE OF LIABILITY INSURANCE DA TE 1 DD/4/ 8/4/2016 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 Brown & Brown Of Florida, Inc. 2290 Lucien WayE-MAIL CONTACT Samantha Murray PHONE (407)660-8282 F NO:(407)660-2012 ADDRESS: smurray@bborlando. com Suite 400 Maitland FL 32751 INSURERS AFFORDING COVERAGE NAIC # INSURER AGreenwich Insurance Co. 22322 INSURED Wayne Automatic Fire Sprinklers, Inc. INSURER B Amer.isure Insurance Co. 19488 -INSURER C:Navi ators Specialty Ins Co 36056 222 Capitol Ct INSURER D -Amer i sure insurance Com an 19488 INSURER E Alterra America Ins. Co. 21296 Ocoee FL 34761 INSURERF: COVERAGES CERTIFICATE NUMRFR-CL1632405340 0c1knetnut All uteQro. 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 ADOL UBR POLICY NUMBER POLICY EFF MM D POLICY EXP MM DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGET RENTED PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ 5,000 Contractual Liab RMG640012408 9/1/2015 9/1/2016 XCU Liab Per Cont PERSONAL BADVINJURY $ 1,000,000 X AGGREGATE LIMIT APPLIES PER: POLICY � PEC LOC GENERAL AGGREGATE $ 2,000,000 GEN'L PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER. AUTOMOBILE LIABILITY COMBINED Eaccid.nSINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CA2100561 4/1/2016 4/1/2017 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Underinsured motorist $ 500,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE S 1,000,000 C X EXCESS LIAB CLAIMS -MADE DED RETENTION $ NYI5EXC169817IC 9/1/2015 9/1/2016 rJ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ N/A WC2081958 OTHER PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 000 000 (Mandatory in NH) It es, describe under WC2081956 FL 4/1/2016 4/1/2017 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below E Inland Marine MAXA31MOO47756 9/1/2015 9/1/2016 Per Item 500r000 1%/$1,000 Min Ded Rented/Leased Equipment Aggregate 750,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Contractor of Fire Protection Services Miami Shores Village Building Department 10050 NE 2nd Avenue 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 T D' Avanzo, CPCU, CPA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) INS025 rpmdnn The ACORD name and logo are registered marks of ACORD COMMENTS/REMARKS ADDITIONAL INSURED- OWNERS, LESSEES, CONTRACTORS CG 2038 0413 ADDITIONAL INSURED- OWNERS, LESSEES, CONTRACTORS -COMPLETED OPERATIONS CG 2037 0413 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG 2404 0509 ENDORSEMENTS CG 2038, CG 2037 AND CG 2404 APPLY AS REQUIRED BY CONTRACT, PROVIDED CONTRACT IS EXECUTED PRIOR TO LOSS OFREMARK COPYRIGHT 2000, AMS SERVICES INC. '