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SGN-13-1757Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 196551 Permit Number: SGN -8 -13 -1757 Scheduled Inspection Date: November 05, 2013 Inspector: Rodriguez, Jorge Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9031 -9069 BISCAYNE Boulevard 9061 Miami Shores, FL 33138 -0000 Project: <NONE> Permit Type: Sign Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)779 -8040 Parcel Number 1132060110051 Contractor: FAST PLASTERING INC Phone: (786)316 -7796 Building Department Comments SIGN INSPECTOR COMMENTS False November 04, 2013 For Inspections please call: (305)762 -4949 Page 5 of 40 Inspector Comments Passed ji�g- Failed Correction Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. November 04, 2013 For Inspections please call: (305)762 -4949 Page 5 of 40 A-) 63- 10050 N.E. SECOND AVE. MIAMI SHORES, FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (305) 756 -8972 DAVID A. DACQUISTO, AICP PI- ANNING 6 ZONING DIRECTOR DEVELOPMENT ORDER. File Number: PZ -6 -13. 241338 Property Address: 9031 -9069 Biscayne Blvd,, Miami Shores FL 33138 Property Owner: Shores Square Properties LLC Address: 696 NE 125x', North Miami, FL 33161 Applicant: Jose G. Santaella Address: 16200 NW 2 °a Avenue #104, Miami, FL 33169 Whereas, the applicant Jose G. Santaella with the consent of Shore Square Properties, LLC (Owner), has filed an application for site plan review before the Planning Board on the above property. The applicant sought approval as follows: Special site plan review and approval. Wall Sign. Whereas, a public hearing was held on July 25, 2013 and the Board, after having considered the application and after hearing testimony and reviewing the evidence entered, finds: 1. The application was made in a manner consistent with the requirements of the Land Development Code of Miami Shores Village. 2. The conditions on the property and the representations made at the hearing merit consideration and are consistent with the requirements of the Land Development Code. The Board requires that all further development of the property shall be performed in a manner consistent with the site plan, drawings, and the conditions agreed upon at the hearing: 1) Approval is granted for 20.4 square feet of signage consisting of a window sign and a door sign in addition to the previously approved wall sign. 2) Applicant to obtain all required building permits before beginning work. 3) Applicant to meet all applicable code provisions at the time of permitting. Pagel of 2 DO PZ -6-13- 201338 Shores Square Santaella 4) This zoning permit will lapse and become invalid unless the work for which it was approved is started within one (1) year of the signing of the development order by the board chair, or if the work authorized by it is suspended or abandoned for a period of at least one (1) year. The application with conditions was passed and adopted this 25th day of July, 2013 by the Planning and Zoning Board as follows: Mr. Abramitis YES Mr. Busta YES Mr. Reese ABSENT Mr. Zelkowitz ABSENT Chairman Fernandez YES Dati Page 2 of 2 DO PZ -6 -13- 201338 Shores Square Santaella 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 FBC 20 10 BUILDING Permit No. PERMIT APPLICATION Master Permit No.��1.�° i' 1 Permit Typ 1� 1 1 na . J JOB ADDRESS: C4 C° e W) ) a City: Miami Shores County: Miami Dade Zip: l Folio/Parcel #: Is the Building Historically Designated: Yes REG Zone: OWNER: Name (Fee Simple Titleholder): t d - 44hone #: �yf) Address: / 125ctl S-F r City: /bfe F/, zip: T3` 9l �`� �'id/s1�1 State: p: Tenant/Lessee Name: K ®QC—K1 KA Of E {'h Phone #:(7St/ ) S� "� f Email: kn 4 g jG s P <'� 1'� (i ctnyl CONTRACTOR: Company Name: fasr sic %s c, 'TlU c Phone #: C7 8,6 S %7 g4 Address: < �,o N� p City: �j� l 1 A4 1 R CAC, 6 State: 1. Zip: l 6Z Qualifier'Name: n)0 &!A zb - M. G � 1 E2., Phone #: ('7910 2)16- 7 � 9{a State certification or Registration #: Certificate of Competency #: Contact Phone #: (Z 2J f �a ° 171`/cl,6 Email Address: DESIGNER: Architect/Engineen SI lG$S�C%21 N� (� Y!'fY.1 t e CbW7 Phone #: CZ 96> 3/6-:27 �?6 300 Squa Y0144 uAWW' O_ Alteration ISNew >N�0 01 Footage of Work: ORepair/Replace ODemolition Submittal Fee Scanning Fee $ Notary Permit Fee $ Radon Fee $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE $ 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 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 wo Hance 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 oc s seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be appr ve d a reinspection fee will be charged. Signature, O or Agent The foregoing ins�trpun t as acknowledged before me thi day of5 .I'll I �(1t0 �J , by `7t? lrzPP who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Si Print: ^ G' My Commission Expires: �Qt�`; ;;�&,� SL%gAFERDLAFZ W COMMISSION # EE 16 M * EXPIRES: Mardride18, 2017 ��q�___ IIIIU 131�gCr.b"""i S�N�E Signature Con or The foregoing instrument was acknowledged before me thiV 0 day of 20 I_b by who is l2qrsonally known to me or who has produced_ as identification and who did take an oath. APPROVED BY Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07/10/07 )(Revised 06 /10 /2009)(Revised 3/15/09) NOTARY Sign: My Commission r WUMm. lea Oct 6 201 Zoning Clerk DOJO FRONT SIGN ili ami SFiores Village APPPO, EC BY DPITE 2'NC ^LP O NI y! �y 31-.DG DEPT 0 UD!EC'iT 10 CGNIPIWICE WlFH ALL FEUE -7 STATE ANL) CC ( -)N,Y RL,L_S AND REGULATION 11 12" 1 1 14,6„ 74" ' AUG 0 5 2013 A-M I 12" KOGEKI DOJO SIGN f f 0 MEN 3/16 x 3 1/2 long aluminum stubs raised raised mounted lettering. 12" height lettering Color: Red Black PVC 1/4" Note: Clear silicone glue to the stubs penetrated to the wall 9061 CLASSES FOR CHILDREN ADULTS 22" 1 MON - SAT CALL NOW (754) 368 -0415 22" DOJO WINDOW SIGN all .o Detail by Entity Name Page 1 of 2 HORE SQUARE PROPERTIES, LLC ment Number L11000075982 IN Number 452672348 Filed 06/3012011 FL is ACTIVE tive Date 06/28/2011 NE 125TH STREET RTH MIAMI, FL 33161 NE 125TH STREET tTH MIAMI, FL 33161 IERT A. BRANDT, PA NE 125TH STREET I:TH MIAMI, FL 33161 & Address :HAK, YORAM 36 NE 125TH STREET ORTH MIAMI, FL 33161 MGR PTON, ALAN I.9 OCEAN BLVD OLDEN BEACH, FL 33160 Report Year Filed Date 2012 03/29/2012 http: / /search.sunbiz.orgl Inquiry/ CorporationSearch/ SearchResultDetail lEntityName /flal -11... 7/30/2013 J�c��i X13 Miami Shores Village Building Department "o N2-2nd Avenue, Miami S110fes, Florida 33138 Tel: (305) 7951204 Fax: ow 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit T"e: BUILDING JOB ADDRESS: qQ 4 fS j':5 r—,qyne •13 Permit No. - Master Permit No. AU J 0 0 2013 FBC 20 0 ROOFING City: county. - NNW Dade Foliolparcolk. Is the Building Mdwtdy Dedpated:- Yes NO Floodzme; OWNER: Name Mee Simple Titlaolder). h - -1 2 o t e 1�1� 2- -.. 1/ 4/9 Cur— 11. Mko-va-i — State: -FL TemtlesseeNamc: Email: CONTRACTOR: Company Nam: --Akrg612A / �d411'0,41S a you p X—Phonet. Address: -icse) fir-, )�4oz- jjqo W5, ft- State Certification or Registration #- - Cerdfiicate Contact phouck. —Email Address: -7 DkSIONM Architect/Engine,. Phouct. Value 8f Work for this Permit: $--!000 $quareffJnear Footage of Work: --------- Type of Work DAddition UAheraSon VNEW MemolWon Description of Woric -,LL �J>s aw A Submittal Fee $ Permit Fee $ CCF $. CO/CC t Radon Fee$ DBPR $ Bond NOWT $, Tmining)FAucation Fee $ � Technology Fee $ Double Fee $ —S&udural Review TOTAL In NOW DUE 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 �P 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 attar Also, a cert�ied copy of the recorded notice of commencement must be posted at the job site for the first inspection which urs seven (7) days after the building permit is issued. In the Bence of such ed notice, the inspection will not bar and a reinspection fee will be charged. Owner or Agent Contractor The foregoing msHment was acknowledged before me this _ The foregoing instrument wads acknowledged before me this day of 20 .La by T , W day of 3 0 , 20 41 by who is personally known to me or who has produced.________ who is personally known to me or who has produced As identification and who did take an oath. NOTARY POBLIC: Sign: Print: My Commission Expires: ;.L KATYA GONZALEZ of Ae° 201 E Aires J uy 2, 032722 as identification and who did take an oath, NOTARY PUBLIC.- My APPROVED BY . , 'I 41L V 1- 1 I,r S _ Plans Epp. R Structural Review %Cvised 3 /12/2012)(Revised 07 /10 /oWc -AsW 06/10mm)(Revised 3/15/09) EXPIRES: N01413, 2013 w'WAARONNOTAft m l Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Oiker's Name (Fee simple Title Holder): �kv a � I� f�.� l Phone #: Owner's Address: bqU A) City: ktkomi State : 4. Zip Code:-3b 11� r Job Address (Of where work is being done):_ City: Miami Shores State:_Flodda Zip Code: 3 3 / Contractor's Company Name: F'#'T ? /RSA,)G T /uC, Phone # :C786 Address: City: N O (�>CAc44 State: Zip Code: 3.3 / 2, Qualifier's Name : 0,AJA Z )lJU ;Pr -2 Lic. Number: Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Work: I hereby certify that the work has been abandoned and/or the contractorlarchitect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involvement. Signature Signature oNhe gent The foregoing mstrument s aknowledged before me The foregoing instrument as akA now edged before me this day of ,20l Y r-a `� this day of �'W by 7h/> vrt9 Who is personally known to me or who has produced o is personally known tom or who has produced �����► as indents ication. as indenthIcation. SAY p� g0 •'"I••Gp SLVIAfGNANDEZ Nota Pu c L cMSIONHEOM IREs: mad 18,mury �`` a ` 0* Si nwY Sign: NO O2011 Se 7,i 333 NOW NW M Seal: Z3aNVNlf3�VU� a7e�d srLa Seal: •.�� Pdr CitNN�n�S 0 02 ser" 4 • Complete items 1, 2, and 3. Also complete item 4 If Restricted Delivery Is desired. • Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailplece, or on the front if space permits. 1. Article Addressed to: ��,> ��e7-aas I�<J 1GSr� F. / lO rI A /I ►; F/, X 316 2 A. Signature X ILA B. Received I* (Printed Name) ❑ Agent C. Date of Delivery D. Is delivery address different from Item 1? ❑ Yes If YES, enter delivery address below: �1V0 3 Service Type k-Certifled Mail 17 Express Mail 0 Registered ❑ Return Receipt for Merchandise O Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 17 Yes 2. Article Number - 1x _ — 0 -- - _ 710 0001 2473 195 (rmnsferfrom service iabeo PS Form 3811, February 2004 Domestic Return Receipt 102595.02 -M -154, UNITED STATES POSTAL SERVICE First -Class Will Postage & Fees Paid USPS Permit No. G -10 • Sender: Please print your name, address, and ZIP +4 in this box • tl I'll _ IlnIII I III IIIiIIIIIImllullNyl�'l� �l �� liF..IIIIIIIII -1 Miami Shores Village September 20th, 2013 To: Integral Solutions Group General Contractors 1680 NE 168th St. North Miami, Fl. 33162 This letter is to notify you that we no longer need your services. Thank you for your time and concern. Atte. a Jo a Santaella ' Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S,STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. -L�OPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■■ rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr ■rrrrrrrrrrr� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: ks��kreg6wh is BUSINESS ADDRESS: %C,0 � `tea CITY 1.) •%I • C3 STATE V— ZIP CODE 33N Li BUSINESS PHONE: ( �5VOTgC- FAX NUMBER 725 3Z.75 CELL PHONE (290_) ;?00)'74;G QUALIFIER'S NAME: -:10VIkP-40 t30�►'9 QUALIFIER'S LIC NUMBER:"' �, • , E -MAIL ADDRESS (IF APPLICABLE):����' Created on 3119109 BY MLDV I RV 3126109 MLDV I RV 6127111 AS gown Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT A BILL - 00 NOT PAY LBT ROED71 BUSINM NAME/LOCATION RECEIPT NO. EXPIRES FAST PLASTERING INC RENEWAL SEPTEMBER 30, 20'14 760 NE 182 ST 7171697 Must be displayed at Place of business NORTH MIAMI BEACH FL 33162 Pursuant to County code' Chapter 8A - Art 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED FAST PLASTERING INC 996 SPL,.IALTY BUILDING CONTRACTOR BY TAX COLLECTOR 918S004i9 $45.00 07/08/2413 Worker(s) 1 TXtisi -13- 013022 This tart M sincss Tau Reeweaty confrrnts payment e1 *0 L"d Swim" Tea. The itecet'pt is not a license Permit Ora timr rdURe Yeir�`s quad# #icatisns. ao do business. "Otdar -M cuwptY Itr map "verumentai or Inulli erem nlni reguletary lam and raquiremsuft winch appiy to Rho business The RECEIPT no shoes must be displayed an aN c ercial aetdctes- MM1 Bade Corte Sac Be -276. QUALIFYING TRADE(S) 0026 LATHING & PLASTERING 0099 GYPSUM DRYWALL FINISH Report Viewer .WF ATwa7ER OW FIAANCIAL OFFICER STATE OF FLORIDA DEPARTWNT OF FINANCIAL SERVICES DIVISION OF WORI(ERW COMPENSAPM "* CERTIFICATE OF ELECTION TO BE EXERT FROM FLORIDA WORKWW COMPENMTION LAW. CONSTRUC770N INDUSTRY EXEMPTION This certifies that the individual listed below has e%cW to be exempt from Florida Uhl "rs; Compensation law. EFFECTIVE DATE: 10120/2013 EXPIRATION DATE: 1=012015 PERSON: NUNEZ DONARDO FEIN: 282547300 BUSINESS NAIVE AND ADDRESS: FAST PLASTERING INC 780 NE 182 ST NORTH M1AW f BEACH FL 33182 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING SWIMMING POOL LATHING AND DRIVERS PLASTERING NOC AND CONTRACTOR CONSTRUCTION -NOT DRIVERS ROOFING - ALL KINDS AND DRIVER f3F&M -DWC -M CERTIFICATE OF ELECTION TO BE EXEW i REVISED 07 -12 QUESTXMS? JW0)4131609 Page 1 of 1 l,ttr.0•II�n..PSt flfifo nT%o7^,v- T7lTTT01 nlns Inns- From: 09/20/2013 10:07 #091 P.001/001 ^C:"Jw �' CERTIFICATE OF LIABILITY INSURANCE �"""'�f DATE 09120D/YYYY) 09/20/i 3 ! 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 Accurate 8300 West Flag)er Suits 114 Miami, FL 33144 Phone (305)226-8727 Fax (305)226 -8767 CANTACT Lucia Estrella PHONE (305)226 -8727 N Na)• (305)226 -8767 IMESS! ludaestrelia@bellsouth.net INSURERS AFFORDING COVERAGE NAIC e INSURER A : Accident Insurance Company 11573 INSURED Fast Plastering Inc 760 NE 182nd Street North Miami, FL 33162- 786- 316 -7796 INSURER B 11/1312012 INSURER c , CH OCCURRENCE I INSURER D: DAMAGE TO RENTED P S (Ea occurrence) INSURER E: MED ExP (An one arson) INSURER P: PERSONAL & ADV INJURY 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. INTSRR TYPE OF INSURANCE ADD UB POLICY NUMBER POLICY EFF M POLICY EXP LIMITS A GENERAL LIABILITY ® COMMERCIAL. GENERAL LIABILITY ❑ ❑ CLAIM 414ADE ❑ OCCUR ❑ - 102511000002555 11/1312012 11/13/2013 CH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED P S (Ea occurrence) $ 1 00,000.00 MED ExP (An one arson) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE s 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMPIOP AGG s 2,000, 000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED ❑ SCHEDULED ❑ AUTOS ❑ HIRED AUTOS ❑ NON -OWNED ❑ COMBINEDLSINGLE LIMIT BODILY INJURY (Per person) s BODILY INJURY (Per accident; $ PROPERTY AMAGE $ s ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 0 RETENTION WORKERS COMPENSATION EMPLOYERS LIABILITY ANY PROPRIETOWPARTNERIEXECUTME/ N OFFICER/MEMBER EXCLUDED? El (Mandatory In NH) Ifyee ascribe under DESCRIPTION OF OPERATIONS below N t A WC STATU- RR ; 5 ❑ F_E $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) rrccrrttarA•r= Lint nsn City of Miami Shores 1 D050 NE 2nd Ave Miami Shores, FL 33138 305 - 756 - 8972/305 -705 -3275 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 Lucia ACORn CORPARA nnrj ait — e...,,.r The ACORD name and logo are registered marks of ACORD W] z