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ELC-14-503Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 209009 Scheduled Inspection Date: April 02, 2014 Inspector: Devaney, Michael Owner: PROPERTIES LLC, SHORE SQUARE Job Address: 9099 BISCAYNE Boulevard BURGER KIWI Miami Shores, FL 33138- Project: <NONE> Contractor: ZIP ELECTRIC comments Permit Number: ELC -3 -14 -503 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)779 -8040 Parcel Number 1132060110040 Phone: (954)456 -9999 WIRE TABLES TOGETHER THRU PRE -WIRED TERMINAL I " "' - - -- BLOCK AND CONNECT BREAKER PANEL IN EQUIPMENT INSPECTOR COMMENTS False TO BUILDING MAIN PANEL Inspector Comments Passed EA Failed Correction Needed ❑ Re- inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 01, 2014 For Inspections please call: (305)762 -4949 Page 17 of 42 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 Permit Type: Electrical JOB ADDRESS: 9099 BISCAYNE BLVD FBC Permit No-F w I q— 503 Master Permit No. City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11- 3206 - 011 -0040 Is the Building Historically Designated: Yes NO NO Flood Zone: OWNER: Name (Fee Simple Titleholder): SHORE SQUARE PROPERTIES Phone#: AAA-. 695 NE 125 ST City: MIAMI Tenant/Lessee Name. BURGER KING Email: State: FLORIDA Zip: 33161 CONTRACTOR: Company Name: ZIP ELECTRIC Address: 1970 PORPOISE STREET City. MERRITT ISLAND State: FLORIDA Zip: 32952 Qualifier Name: FRANK JAMES Phone #: 407 - 298 -6388 State Certification or Registration t EC0001591 Certificate of Competency #: Contact Phone#: 321 235 0440 Email Address: fjames@zipelectric.us DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ? G C0 , 4 8 Square/Linear Footage of Work: Type of Work: ❑Address VAlteration ❑New ❑Repair/Replace ❑Demolition Dew iption of Work: V/ 94% ��},t S % oC � � 4 %SGPG eRk% L✓ /fie J/ T`AFRhs /&-*.0 Aack a,U,a o o w�Nit'c /3.Q,�`i4A'tcq �'�9'—Ki i �/ �G: y�� O.eti.r,�{ %d Rui.LD /x� Submittal Fee $ "—"2- Permit Fee $ /� �, ' PO CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural' Review $ 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 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 properly 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 uch posted notice, the inspection will not be approved and a reinspection fee will be charged. L/ Signature Signature Owner or Agent h& tractor The foregoing instrument was acknowledged before me this day of A , 20 Al, by c/0ft'A T&% r , w is personally kno to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission OPAY COmmiasion EE 191707 Exphm 04!2312018 The foregoing instrument was acknowledged before me this `Z day of 20 , by FW f& , XI who is personally known to me or who has produced_ as identification and who did take APPROVED BY Plans Examiner Structural Review (Revised 3 /12J2012)gevised 07 /10/07)(Revised 06110/2MXRevised 3/15/09) NOTARY PUBLIC: Sign: '''h�„„::•`° Print: My Commission Expires: s Zoning Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C NEED COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIWI SHORES VILLAGE BLDG DEPT) D NEED COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR CEEB( MPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER 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 WORKER COMP INSURANCE (DITHER CERTIFICATE OR IXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE MOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10060 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: ZIP ELECTRIC BUSINESS ADDRESS: 1970 PORPOISE STREET CITY MERRITT ISLAND STATE FLORIDA Zip CODE 32952 BUSINESS PHONE: 4( 07 ) 298-6388 FAX NUMBER 4( 07 ) 98-6265 CELL PHONE ( QUALIFIER'S NAME: FRANK JAMES QUALIFIER'S LIC NUMBER: EC0001591 E -MAIL ADDRESS (IF APPLICABLE): fjames @zipelectric.us Created on 3h 9109 BY 01LDV I RV 3126109 MLDV STATE OF FLORIDA DgpARTIMT OF BURIMBS AM PROFESSIONAL REGUIATION ZMTRECAL COXTMCTORS LICENSING BOAJW (680) 407-1395 1940 NORTH MXMROE STREET TALLAHASSEE M 32399-0743 JAMEM I FRAM ID ZIP ELECTRIC 960 a FA FIRRY RO HE RTE 417 ATLANTA CA 30325 Cwqratw&-lAs! will ims lWoflee yea bead ns of* cit " amity cm nmthan i FW49M WmtW by rm oppw"nt of sudross and Pttftsvionid R"k Wn, Our profomiartab and businessm rurq* km 80"-10 W YaOlt tfOWS- km wxws to borbeque woutents, and My ks" Fion0als QrAwwnY NUMB. kery day we wuft tc• iwpvwa thowzy we di txaWite 1A orbW W WNW fft teto% For Wfiormstion oodt air eaftleas, pmese ba oft wwwmwmwida� wxom. j Thm VW Daft isrA me mbmagon obwo our divalurks and the reguladurts Vul. DeXeinw-irs Out nussm W. the 13qmrtmwd is: tiverse Efflckifilly, %90818 F810y, W8 Mr wtmuy Wive t gem vw b" so tat you Can garm, Ywf CuNtanvm M WON IV, dWg WMm".; In FkWd,, ard cm9ralulaborm urn -orjut new lxmim! HFRF AU-6287742 STATE OF FLORIDA D"ARTMW OF BUS GrATE W Ftg=k KiJF t3 CU f T% 'OF =91=98 Alm Rio—rim i !7 a &, - = G u L AT -1 TRW CERTIFIED, JAMB 219 =C-TR Is cm7zn= -C RICK aOTT, GOVIUMOR SEC .9$ -DJSPLAYAS REQLWWDVYAAW.- 2013 -2014 BUSINESS TAX RECEIPT AftMICHAEL CORRIGAN, DUVAL COUNTY TAX COLLECTOR 231 E. FORSYTH STREET, SUITE130, JACKSONVILLE, FL 32202 -3370 IV Phone: (904) 630 -1916, option 3; Fax: (904) 630 -1432 Website: www.coi.net/tc: Email: taxcoiWctor@wj.net Note — A penalty is imposed for failure to keep this receipt exhibited conspicuously at your plane of business. This renewal application is fumished pursuant to Municipal Ordinance Code, Chapters 770 -772, for the period October 1, 2013 through September 30, 2014. JAMES, FRANK D ZIP ELECTRIC 4100 SILVER STAR RD STE A ORLANDO, FL 32808 ACCOUNT NUMBER: 1000050527 LOCATION ADDRESS: 1970 PORPOISE ST MERRITT ISLAND, FL 32952 QUALIFYING AGENT, CONTRACTORS QUALIFYING AGENT, CONTRACTORS COUNTY TAX: 0.00 MC M.325 MUNICIPAL TAX: 110.00 TOTAL TAX PAID: 110.00 VALID UNTIL September 30, 2014 ***ATTENTION *** THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY. CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING. This is a business tax receipt only. It does not permit the receipt holder to violate any existing regulatory or zoning laws of the County or City. it does not exempt the receipt holder from any other license or permit required by law. This is not a certification of the receipt holder's qualifications. TAX COLLECTOR THIS BECOMES A RECEIPT AFTER VALIDATION. PAID- 5503268.0001 -0001 WEB 10/30/2013 110.00 AME11113 OP ID: TP CERTIFICAT F.OF LIABILITY INSURANCE LLTRR THIS CERTIFICATE IS ISSUED AS A MATTER OF INI:Q' TIOWONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS . CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANIFEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CO&TITUTE 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 pol)cy(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 Phone: 770 -512 -5000 Brown $Brown Ins of Georgia Fax: 770- 512 -5050 3483 Satellite Blvd, Suite 100 Duluth, GA 30096 E m Tara Denning NE FAX FAX No). 770 - 512-5050 ; tdenning@bbatianta.com Clay Collins INSU 3 AFFORDING COVERAGE NAIC INSURER A • Travelers Indemnity Co 25658 $ 1,000, INSURED Ameritech Services, Inc. 1500 Airport Drive Ball Ground, GA 30107 INSURER 8: Great Amwicen Insorenee Co 16691 INSURER C :Travelers Prop Cas of America 25674 $ 1,000, INSURER D $ 2,000, INSURER E: PRODUCTS - COMPIOP AGG $ 2,000, INSURER F : $ 11000, C r_nVERArrES 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 BY PAID CLAIMS. LLTRR TYPE OF INSURANCE ADDL SU POLICY NUMBER POLICY EFF MP c EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 4v:sm A '%S� DT- CO-0D873717- IND-13 03/11/2013 03H1/2014 EACH OCCURRENCE $ 1,000, PREMISES CE, occutrancel $ 300r MED EXP (Any one person) $ 51 0 PERSONAL &ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000, GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOG PRODUCTS - COMPIOP AGG $ 2,000, Emp Bon. $ 11000, C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS NON -OWNED X HIRED AUTOS X AUTOS DT- 810.0D0737- 7IL -13 03/11/2013 03/11/2014 Ee accident) BANE SINGLE LIMIT 1,000,00 BODILY INJURY (Per pennon) $ BODILY INJURY (Per aWdent) $ PROPERTYDAMAGE par. decd $ B X UMBRELLA LIAB EXCESS LIA6 X OCCUR CLAIMS -MADE T0002SM701 03/11/2013 03/11/2014 EACH OCCURRENCE $ 5500, AGGREGATE $ 510001 DIED I X I RETENTION $ 1 $ C WORD COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/IXECUTIVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA DTUB OD07371 7 -13 03/11/2013 03N1/2014 WC STATU- OTH- X TRY LI E.L. EACH ACCIDENT $ 1,000' E.L. DISEASE - EA EMPLOYEE $ 1,000,0 E.L. DISEASE - POLICY LIMIT $ 1,0001 C fred Physical DM9 Short Tern 5082690038 03/11/2013 03/11/2014 Comp Dad 1, Coll Ded 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rmnarim Schedule, U more space Is required) Zip Electric is a named insured. CERTIFICATE HOLDER CANCELLATION ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg Dept 10050 NE 2ND Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 4v:sm A '%S� ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AMER113 OP ID: TP '44c°ROR CERTIFICATE OF LIABILITY INSURANCE °"x 03/04/,04,°'"2014 4 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 endorseme s PRODUCER Phone: 770 - 512-6000 Brown 8 Brown Ins. of Georgia Fax: 770 -612 -6050 3483 Satellite Blvd, Suite 100 Duluth, GA 30096 NcoNT, acr Tara Denning ac° I"ENo 770 -612 -5037 a No : TTO -612 -6050 aoD: tdonninglabbatianta.com Clay Collins INSURER(S) AFFORDING COVERAGE NAIL ffi INSURER A : Travelers Indemnity Cc 25658 DRENTED PREMISES (Ea INSURED Zip Electric 1500 Airport Drive Bell Ground, GA 30107 INSURER B : Travelers Prop Cas of America 25674 INSURER C : Great American Insurance Cc 16691 INSURER D : GENERAL AGGREGATE INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO Loc PRODUCTS - COMP /OP AGG INSURER F : Emp Ben. $ 1,000,0 CAVF_RArFS 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 BY PAID CLAIMS. INSR TYPE OF INSURANCE am POLICY NUMBER POLICY EFF MID EXP LBAITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR A DT- CO-OD0737174ND -13 03/11/2013 03/11/2014 EACH OCCURRENCE $ 1,000,0 DRENTED PREMISES (Ea $ 300,0 MED EXP Any one person $ 6,0 PERSONAL b ADY INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO Loc PRODUCTS - COMP /OP AGG $ 2,000, Emp Ben. $ 1,000,0 B AUTOMOBILE LIABILITY ANY AUTO X ALLOWNED SCHEDULED AUTOS AUTOS ED X HIREDAUTOS X AUTOS DT- 810-0D073717 TIL -13 03111/2013 03/1112014 COMED Ea ardent E IT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE PeraccideM $ $ C X UMBRELLA LIAR EXCESS LIAB X OCCUR I CLAIMS -MADE 700025694701 03/11/2013 03/11/2014 EACH OCCURRENCE $ 5,000,0 AGGREGATE $ 5,000,0 DED I X I RETENTION $ 100w $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE F- OFRCERMIEMBER F�CCLUDED4 (Mandatory U NH) If yes, desaibe under DESCRIPTION OF OPERATIONS below N / A DTUB-0D073717 -7 -13 03/11/2013 03/11/2014 X WC STATU OTH- $ 1,000,0 E.L. EACH ACCIDENT E.L. DISEASE - EA,EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,0 DESCRIPTIONOF OPERATIONS- /tACAT13NS / VEHICLES (loch ACORD 101, Additional Remarks Schedule, if more space is required) CFRTIFICATF 14nl nFR CANCPI I ATInN MISHVIB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND Ave AUTHORUD REPRESENTATIVE Miami Shores, FL 33138 A ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD AMER113 OP ID: TP T CERTIFICATE OF LIABILITY INSURANCE DAM "My" 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 cerdflcate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may rewire an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorseme s . PRODUCER Phone: 770- 512 -5000 Brown t Brown Ins. u e 1018 Fax: 770- 512 -5050 3483 Satellite Blvd, Suite 100 Duluth, GA 30088 TF-ACT Tara Dennis PHONE . 770,512 -5037 —T—FAX- No : 770 - 512.5050 ADDRESS. tdenning@bbatianta.com Clay Collins INSURER(S) AFFORDING COVERAGE NAIC A INSURER A: Travelers Wlerar ly Cc of CT 25582 PREMISES Ea occuRence INSURED Zip Electric 1500 Airport Drive Bail Ground, GA 30107 INSURER 0: Travelers ImismnHy Cc 25658 INSURER C : Great American Insurance Cc 16691 INSURER 0: GENERAL AGGREGATE INSURER E; GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMPIOP AGG IV RER F Emp Ben. $ 1,000,0 r+nvooA#=_e CFRTIFICATF IAIIMRFR* 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. @18R TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NUMBER A U EFF L[CY EXP OMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7X OCCUR AUTH�OI��(D�R,EPRESENTA,T f I DT- 004IDO 7174ND -14 e 03/11/2014 03J1112015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occuRence $ 300,0 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000, GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMPIOP AGG $ 200,0 Emp Ben. $ 1,000,0 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS x AUTOS DT4104=73717- TIL -14 03/11/2014 03/11/2015 COMBINED SINGLE LI a a13INED 1,000, BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per ecdd $ C X UMBRELLA t Lew EXCESS LIAR X OCCUR CLAIMS -MADE 00025594702 03/11/2014 03/11/2015 I EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,OOC DED FXI RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORtPARTNER !EXECUTIVE❑ OFFICERIMEM13EREXCLUDED7 (Mandatory In NH) IDESCR �ON OF OPERATIONS below NSA DTUB-0D07971 7 -14 03/11/2014 03/11/2015 X WC STM O R 7 IYIN E.LEACHACCIDENT $ 1,000, EL DISEASE - EA EMPLOYE $ 1,000, E.L. DISEASE - POLICY LIMIT $ 1,000,0 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Add0lonal Remarks Schedule, I more space Is requtred) C0001591 CFRTIFICATF NOI nFR CANCELLATION MiSWB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Bldg Dept 10050 NE 2ND Ave AUTH�OI��(D�R,EPRESENTA,T Miami Shores, FL 33138 +IVE m 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD