CC-11-1693 (3)a
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 •
Permit Type: 8l) L t. D l I4 e
Permit No.
Master Permit No. 11 -16 9 3
4 . t
OWNER: Name (Fee Simple Titleholder): Shores Square Investments Phone#: 3 0 5- 7 7 9- 804 R
Address :9017 Biscayne B1vr1
City: Miami Bhnre State: Fr.
Zip: 33138
Tenant/Lessee Name: Edmundo R. Tamayo , M. . Phone#: 3 0 5- 8 3 5 - 63 2 2
Email: tama157@bellsouth.net
JOBADDRESS: 9025 Biscayne Blvd
City: Miami Shores County: Miami Dade
Folio/Parcel#: 1132060110051 -25
Is the Building Historically Designated: Yes NO Flood Lone:
Zip: 33138
CONTRACTOR: Company Name: T &G Constructors Phone#: 305- 592 -0552
Address: 8348 NW 56th Street
City: Doral
QualifierNnme: Ricardo Gonzalez Phone#: 305- 592 -0552
State Certification or Registration #: CGC 0 3 6 0 5 9 Certificate of Competency #:
Contact Phone#: 305 - 592 -0552 x202 Email Address: jctoyco(glt- and -g.corn
DESIGNER: Architect/Engineer: Jose Ramos Phone#: 3 0 5 - 5 0 6- 73 8 8
State: FL
lap: 33166
Value of Work for this Permit:
Type of Work: OAddress
Description of Work:Rev_
to be blocked
Project layo
has been
new pha
Submittal F
Seannin
Notary '• ', Training/Education Fee $ Technology Fee $
Double Fee $ =- k Structural Review $ {I
00.00 Square/Linear Footage of Work: 5 , 0 0 0 SF •
on ONew ORepair/Replace DDemolition
- Three existing exterior doors are schedu1pd
erior egress corridor has been_modified_ Peneral
en reconfigured. Existing storefront Footing detail
s through window and security mesh has been added at
******** *************Fe **** ******** ****ate** r*** ► * *I� ****
Permit Fee $� CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
TOTAL FEE NOW DUE $ ■jkC) 03
Bonding Company's Name (if applicable) N/A
Bonding Company's Address N/A
City State Zip
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address N/A
City State Zip
Application is hereby made to obtain a pennit 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 Me issuance of a building permh with an estimated value exceeding $2500, the applicant must
promise in goad faith that a copy gfthe notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first insp et 'n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will at b approved and a reinspection fee will be charged.
Signatn
foregoing instru
y of
rho •
er or Agent
nt was acknowiedged before me this t O *'(
20 , , by
�� IQ 1t eta.
lot • to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: 1 e5 )t "� �•
LESLIE K. UNCAPHER
MY COMMII$SION # EE881
EXPIRES: May 28, 2015
yo. y FL Notaly Dismal Assoc. Co.
My Commission Expires:
Signature
Contractor
The foregoing instrument was acknowledged before me
, , this
day of Mae 20xby gaccrccu (orzjo G—
,z,
who ispersonally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
r ra wt41 * *** ►ss n as+4a4osa2to0v 1********Inl aaommaatwwwInall+ bees* r***msmtaw10a►a s4w eaaa4111**o*a
APPROVED BY
1p!
Plans Examiner Zug
11(MMA,d/Az& Structural Review Clerk
(Revised 07 /1W07)tltevLttM 06/10/2009)(ttevIsed 3/15/10)
Permit No: 11 -1693
Job Name:
March 20, 2012
Miami Shores Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
Building Critique Sheet Revision
1) Provide approval from Miami Dade County Fire Dept.
2) Provide approval from Miami Dade County DERM.
3) Provide approval from HRS /DOH/
4) The revision must have all revised areas clouded or otherwise identified prior to any
further review.
Plan review is not complete, when all items above are corrected, we will do a complete plan
review.
If any sheets are voided, remove them from the plans and replace with new revised sheets and
include one set of voided sheets in the re- submittal drawings.
Norman Bruhn CBO
305 - 795 -2204
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
BUILDING
PERMIT APPLICATION
FBC 20
I
Permit Type: PLUMBING
MAR 0 3 '1:?
Permit No. PLC -11 -11 -2106
Master Permit No. 11 -16 9 3
OWNER: Name (Fee Simple Titleholder): Shores Square Investments
Address: 9 03 7 Biscayne Blvd.
City: Miami Shore State: FL
Tenant/Lessee Name: Edmundo R. TamaYo , M.D.
Eine tama157 @bellsouth.net. .
Phone#: 305 - 779 -8048
JOB ADDRESS: 9 0 2 5 Biscayne Blvd. •
City: Miami Shores
FolloiPurcel#: 1132060110051 -25
vp: 33138
phone#: 305 - 83'5 -6322
County:
Miami Dade
zip: 33138
Is the Building Historically Designated: Yes • NO
Flood Zone:
CONTRACTOR: Company Name: Centerline Plumbing, Inc. Phone#: 305 - 885 =1925
Address: 12 5 5 Dove Ave
City: Miami Springs ' ' State: FL Zap: 'A 1 1 AA
Qualifier Name: Rafael A. Fernandez Phone#: 95,i-214-4916
State Certification or Registration #: C OS "f i Certificate of Competency #: , . .
Contact Phone#:
DESIGNER: Architect/Engineer: Arist
Value of Work for this Pe(".
Type of Work: O
Description
rem
Email Address:
s Reyes - Gavilan
Phone#:305- 828 -5205
Sho
Square/Linear Footage of Work: 5 , 0 0 0 SF
on ONew ORepair/Replace
ans - New meter shown on •- si
r supply will be tied -in to existing sPrvi!'.P
ODemolition
mate restroom has been replaced with a new Bidet_
*+ uw** al** ************** ***o* * *** *****a* * s* awa******* * * * **** * *** ****** * *********** **
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO/CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ ` - 03
Bonding Company's Nume (if applicable) 'N/A
Bonding Company's Address N/A
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zap
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 alI 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 Iaws 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." •
NIA
N/A
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 k subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection tv! ich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ,-;roved and a reinspectian fee will be charged
Signature
er or Agent
The foregoin y : ent was acknowledged before me this CIP 414
day of , 20 IL, by aAui Z-
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: 0.11..0
Print Les lt' e 0.. Un C cx-.
My Commission Expires:
tebed $O$itteiep#ip* #
APPROVED BY
LESLIE K. UNCAPUER
lath
MYCCOMtvliSSION # 93898131 ARY Ys P4D Assoc. Co.
Cony ■r �h
The foregoing instrument was acIotowiedged efore me this
day of M r4I , 20,x �n
, by R q k A. FevrrA,
who is _x_____y_loinmLtior who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: ;,
My Co
#Olki>lN+bO
4t— Plans Examiner
Structural Review
(Revised 07 /10/07XRevised 06/10/2009)(Revised 3(15/09)
Zoning
Clerk
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
BUILDING
PERMIT APPLICATION
FBC 20 s
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): Shores Square Investment s Phone#: 3 0 5 - 7 7 9 - R 04 R
Address: 90'I7 Ft araynP R1Ir l
MAR U 8 2::;h2
Permit No. ELC -12 -11 -2278
Master Permit No. 11 -16 93
•
City: Miami ghe ra State: Fr. Zip: 33138
Tenant/ essee Name: Edmundo R. Tamayo, M.D. Phone#: 305-835-6322
Email; tama157 @bellsouth.net . ..
JOB ADDRESS: 9025 Bi Rrayne R1vri
City: NMiami Shores County: Miami Dade Zip: 3 313 8
Folio/Parcel#: 113 2 0 6 0 110 0 51- 2 5 '
Is the Building Historically Designated: Yes NO Flood one
CONTRACTOR: Company Name: Ohms Electrical Contractor Phone#:954- 974 -3840
Address; 1761 Banks Rd
City: Margate
State: FL Zip: 3 3 0'63
Qualifier Name: Jose Espaillat Q Phone# 954- 520 -9466
State Certification or Registration #: EC 000 S' _I _ n I Certificate of Competency #:
Contact Phone#: 954- 974 -3840 Email Address: jespaillat @ohmselec.net
DESIGNER: Architect/En
istides Reyes- Gavilan Phone#: 305 -828 -5205
Value of Work for . P , y y�'e 0 ,, 0 0-0 U0 Square/Linear Footage of Work: 5 , 0 0 0 SF
Type of Work , x ®'AIteration °New ORepair/Replace °Demolition
Deseripti ew Plans - Meter has been reduced from 300 Amps to
200'w tonal lighting and power receptacles, and additional
D u.s. These changes are due to project layout reconfiguration
7 Y gu
s3rn4**** *a* **a *s**m** ****sFe wa *** * *** ms *ro*r * **aea*roass *****x** **1
Sub u Fee $ Permit Fee $ Y" en6 cCF $ COICC $
Scanning Fee $ Radon Fee $ DBFR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Doable Fee $ Structural Review $
TOTAL FEE NOW DUE $ .71f.-03
Bonding Company's Name Of applicable) - N/A
Bonding Company's Address
City State Zip
N/A
Mortgage Lender's Name (if applicable) N/A
Mortgage Lender's Address N/A
City State Zip
Application is hereby :trade 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, FURNACFS, 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 10 Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy retire notice of commencement and constriction lien law brochure will be delivered to the persan
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be app ' e t and a reinspection fee will be charged.
Signature Signature
Agent
The for�e %oing ` s r�- e 1 acknowledged before me this (4) The foregoi
day of J4 - , 20(e_, by E nar lai I day of
who is personally }mown to me or who has produced who is p
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Pent:
Lea.114._ 4 nC-
My Commission Expires:
APPROVED BY
LESLIE I IONS 89BR
MY COMMISSION # iu�sei
EXPIRES: May 28, 2015
1.9004. OTARY FL Notary Discount Auoo. Co.
Contractor
nt was acknowledged before me this
__ mm . Ex rg
a, t1en4l latidlp#e a
NOTAR
onded Through National Notary Assn
oath.
M>WFMtrRtit** tt6tA****+ IWt# titMtWY tatRdlb3#tk16s9np$Otllps$$tF datalaAAdtM1k
g/1/1-12- Plans Examiner
Structural Review
(Revised 07 /10/07Xtte rased 0511012009)(Revt sed 3115109)
Zoning
Clerk
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
BUILDING
PERMIT APPLICATION
FBC 20
MAR 0
Permit No. MC -11 -11 -2206
Master Permit No. 11 -16 9 3
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder) :Shores Square Investments Phone#:305- 779 -8048
Address:9017 Ri snayne 1:11vr1
City:]vliami_ Shcre State: Fr. Zip: 33138'
Tenant/Lessee Name: E dmundo R Tamayo. M. D. phone#: 3 0 5- 8 3 5 - 6 3 2 2
Email:tama157 @bellsouth.net
JOB ADDRESS: 9 02 5 Biscayne Blvd
City: Miami Shores County: Miami Dade Zip: 3 313 8
Folio/Parcel#: 1132060110051 -25
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company Name: Results Air Conditioning Co Phone#: 305 - 885 -2634
Address: 7451 NW 72 Avenue
City: Miami Stare: Florida
Qualifier Name: Jose A. Corbera
State Certification or Registration #: G Ac 05q. 653 Certificate of Competency #:
Contact Phone#: Email Address: re c V ItS Q 1 r° CO e 1(sou -(-ti • ne r
ides Reyes - Gavilan Phone#:305- 828 -5205
Zip: 33166
Phone#: 305 - 785 -7983
DESIGNER: Architect/En
Value,of Work. o
Type of We
Descri
5 5 0.0 0 Square/Linear Footage of Work: 5, 0 0 0 SF
CDAlterution
QNew ORepair/Replace CDDemolition
view Plans - Provide new condensate water pumps
* ****m *+ *** * ** a+*e a***** **pews ti**** as mn a4m11t*** ******** ** *e* ****
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1. 0 ID
Bonding Company's Name (if applicable) N/A
Bonding Company's Address N/A
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
N/A
N/A
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 sepantte 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 'hi h occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not approved and a reinspection fee will be charged.
er or Agent
The fo going ' ; ent was acknowledged before me this _O
clay !;, s f i 20 j by .th 0 ,
who is personally known to me or who has produced J
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
APPROVED BY
.L.
Signature
Contractor ek
The foregoing instrument was acknowledged before me this
day of AFli,krtik , 20 IS., by 3.9ife Ale (91r OA,
who is personally known to me or ' has mtina ,c ® 6 6/6—
(
x2Uv(S' 1TO ` Oas identification and who did take an oath.
NOTARY PUBLIC:
Si ✓�i7"� 7'1 f
Print: P vfr.vArrvA X6/9 K r jt■cp
Plans ' xtunineri7V
Zoning
Structural Review Clerk
(Revised 07110107)(Revised 0511013009)(Revised 3/15109)
Miami shores Village
Building Department
10050 N. E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air condltloning replacement permit applications. Each unit change -out must be on Its own data
sheet. Multiple units on single sheets are not acceptable.
Job Address (where the work Is being done): 9025 Biscayne Blvd .
City: Miami Shores Village County: Miami Dade Zip Code: 33138
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
AR! (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU CU
PKG
1) M.C.A
AHU CU
PKG
AHU CU
PKG
2) M.O.P
AHU GU
PKG
AHU CU
PKG
3) VOLTS
AHU CU
PKG
PKG UNIT
/
/
PKG UNIT
/ 1
EER/SEER
YES
NO
REPLACING DUCTS
YES
NO
YES
NO
REPLACING THERMOSTAT
YES
NO
YES
NO
NEW 4 °CONCRETE SLAB
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
NO
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: Results Air Conditioning Co Phope: 305 - 885 -2634
State Certificate or Registration N. G AC 0 s 6 5-3 Certificate of Competency N.
Signature
. r44 eo ,h e „ti
(Quellflar's signature only)
Date: 03 /09/20/2,
IVI iami
Shores
Viiiage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: 69'
DATE: 0 3 Z2 12l
I,
AAJ6E x
$Contractor
o Owner
o Architect
Picked up 2 sets of plans and (other) C-7-1 f )a—t C_(f Z 7o -flt j
Address: 90 2-5 6 i ssC_ )'LQ 1 vc
From the building department on this date in order to have corrections done to plans
And /or get County stamps. l understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
01114,
PERMIT :
CLERK INITIAL. 41■4
Acknowledged by:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
OP ID: ILGU
Ai DATE (1/17/1♦ 1)
CERTIFICATE OF LIABILITY INSURANCE �MMIDDI 2
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 SY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN T)IE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the potic/(ies) must be endorsed. If SUBROGATION 1S 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 I)eu of such endorsement(s). CUn,A
305-202-5244 NAM
PRUNE
788-388-7244 4�Eryl1l:—
ADDRES&
-MoDud R RESUL 9
PISURER('S) AFFORDING COVERAGE
PRODUCER
All Safe Insurance
7171 Coral Way _8209
Miami, FL. 33155
Jorge Pena, PIAM
mix= RevallS AIr Condiontlanin9
CampanY
7461 Nw 72 Ave
Miami, FL 33166
• - �amsim e A I WESTERN WORLD
omsuREK nr3 : BRIDGEFiELD
INSURER C : COMMERCE AND INDUSTRIES
INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:
TH13 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIME INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
-- PCLTOr EFr IRICETEXI,
TYPE OF nasURANCE )1,4* POLICY NUMBER I • , *um. , LIMITS
F.A014 OCCURRENCE
DAMAC;t =En IF-I
PREMISES (Ea cc Mmicc)
MEDEXP(? yore person) s
PERSONAL 4 ADV INJURY
GENERAL AGGREGATE
PRODUCTS. COMPIOP AGG
NAIL*
10701
REVISION NUMBER:
GE3?ERAL LtAINUTY
A X COMMERCIAL GENERAL UAMLITY
CLAIMS -MADE FK OCCUR
X BI/PDED DED 9260
GEN'% AGGREGATE IJMIT APPLIES PER:
T1 POLICY fl JL°CT r LOC
AUTOMOBILE LIAB1).LSY
ANY AUTO
ALL OWNED AUTOS
acHEDULED AuTOS
HIRED AUTOS
NON-ONNED AUTOS
B
UMBRELLA LAB
EXCESS LAB
x
NPP1322777
OCCUR
CLAIMS -MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPERE/Mom
AND E1PI,dYERS' LIABILITY
Y iN
ANY PROPRIETOR/PARTNER/EXECUTIVE
ny
a M NH) EXCLUDED?
It vet, CM: WPM ender
DESGkRIPTION OF OPERATIONS below
N/A
EBU01E273340
830 -35872
10/20/11
10/28/12
$
1,000,000
100,000
5,000
1,000,000
$ 2,000,000
$ 2,000,000
11/09/11
10/29112
$
COMBINED ENGLE LIMIT $
(Re acddbbt)
Boun.Y INJURY (Per peen) 3
BODILY INJURY (PRA' act$ ant) $
PROPERTY DAMAGE
(Por aeeldent)
s
3
EACH OCCURRENCE
AGGREGATE
3
$
1,000,00_0
1,1100,000
s
01/26112
01/26/13
DESCRIPTIOK OF 0P3RATIONS l LOCATIONS !VEHICLES (AttaoR ACORD 101, Additional Rcmaek9 Bet educe If MOM spade 18 mguLted)
CERTIFICATE HOLDER
CANCELLATION
VILLAGE OF MIAMI SHORES
10050 NE 2 AVE
MIAMI SHORES, FL 33138
ACORD 25 (2009109)
VILMIAM
I, IMF- sIxLE-
EL EACH ACCIDENT $ 500,000
BA., DISEASE. EA EMPLOYEE $ 800,000
EL DISEASE - POLICY OMIT $ 500,000
SHOULD ANY OP THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREoP, NOTICE WILL BE U5LIVERI3t IN
ACCORDANCE WITH THE POLICY PROVISIOtt8.
AUTHORIZED RCPRESSNTATLV
cl
F
Q 19882009 ACORD CORPORATION. An rights reserved.
The ACORD name and Togo are registered marks of ACORD