SGN-16-227 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)7564972
Inspection Number: INS P-251731 Permit Number: SGN-1-16-227
Scheduled Inspection Date:April 04,2016 Permit Type: Sign
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner. , Work Classification: Addition/Alteration
Job Address:8700 BISCAYNE Boulevard
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060201030
Project: <NONE>
Contractor: DESIGNSTOGO INC Phone: (561)649-6499
Building Department Comments
FACE CHANGE FOR PYLON SIGN 1"fractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed c
Failed
Correction
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
April 01,2016 For Inspections please call: (305)762-4949 Page 11 of 35
Miami Shores Village 4 H a
10050 N.E.2nd Avenue
•.rte
Miami Shores,FL 33138-0000
Phone: (305)795-2204
a
Expiration: 08/2312016
Project Address Parcel Number Applicant
8700 BISCAYNE Boulevard 1132060201030
MIAMI SHORES SERVICE
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Coll
MIAMI SHORES SERVICE 9701 NW 89 Avenue
MEDLEY FL 33178-
Contractor(s) Phone Cell Phone Valuation: $ 7,572.00
DESIGNSTOGO INC (561)649-6499
Total Sq Feet: 0
Type of Sign: Available Inspections:
Electrical Sign: Inspection Type:
Height: Final
Width: Review Planning
Color: Elevation: Review Building
Plans Submitted:Yes Additional Info: Review Building
Classification:Commercial Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $4.80 Invoice# SGN-1-16-58472
DBPR Fee $3.41 02/25/2016 Check#:11131 $205.78 $50.00
DCA Fee $3.41
Education Surcharge $1,80 01/27/2016 Check#:11081 $50.00 $0.00
Permit Fee $227.16
Scanning Fee $9.00
Technology Fee $6.40
Total: $255.78
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 and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to d the work stated.
February 25,2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
February 25,2016 1
a Miami Shores Village CF n
Building Department JAN 2 7 2015
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Y:
Tel:(305)795-2204 Fax:(305)756-8972
\`(0 INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 4
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
�f �i r CONTRACTOR �� DRAWINGS
JOB ADDRESS: ` 1 3 ib
le �-
City: Miami Shores //�� Coun : Miami Dade Zip:
Folio/Parcel#: // - U�•��� - 0 14� 0 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): l>�G1' (99fil, Phone#:
01
Address: D �(eYJ <S
City: iagj,r hOloL— r State:-- Zip:
Tenant/Lessee Name: s�.S' Phone#:
Email: //�� /
CONTRACTOR:/Company Name: V r,C> Phone#:
Address: /
City: L �z / /6� State: Zip: & �/ 7
Qualifier Name: CR&4z Phone#:
State Certification or Registration#: �S` ®��� Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
lt� Value of Work for this Permit:$ �ua near Footage of Lrk: t 17 _ G#-
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ RepaldReplace ❑ Demolition
Description of Work: d /
Specify color of color thru tile: ,j,
Submittal Fee$ �]�41io Permit Fee$ CCF$_ l '9�9 CO/CC$
Scanning Fee$ Radon Fee$ <. ='iii DBPR$ 1 Notary$ X�
Technology Fee$ Training/Education Fee$ ' GO- Double Fee$
Structural Reviews$ Bond$ _
TOTAL FEE NOW DUE$_
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State L 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 Ind icated. 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 attachm t. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the just Inspection which o se. after the building permit Is Issued. In th sence of such posted notice, the
Inspection will not be ro d ee will be charged.
Signatu Signatur
ER NT OR
The foregoi in ru nt was ackno ged beforemethis The foregoing nstru wa acknowledged before a this
d of Z44 20 //� .by day f 20 by
.who is persona ly known t who personally known t
me or who has produced �s��e 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: �-- Print:
Sea(: MA,RJA C.VIOLI Seal: P�� MARIA C.VIOLI
�,. MY CO,�AMISSION N EE218146 MY COMMISSION#EE219146
EXPIRES-July 19,2016 ° EXPIRES:July 19,2016
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (880) 487-'1355
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
SANCHEZ, CESARA
DESIGNSTOGO INC
431710TH AVE N
LAKE WORTH FL 33461
Con tons! With this license you become one of the nearty
one w"on Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range STATE.OF,FLORIDA
from architects to yacht brokers,from boxers to barbeque reafturants, DE= T BUSINESS AND
and they keep Florida's economy strong. PR tP1T1ON
Every day we work to improve the way we do business in order to ES12041177 "" w Q7l07l2014
serve you better: For Information about our
services,please log auto
www.myfloridalkense.com. There you can find more lnformiUon CST�pEc
about our divisions and the regulations that Impact you,subscribe i'; SANEHEZ,
to department newsletters and learn more about the Deparbrnent s DESIfPs(STC ' '°
Initiatives. CEAtWIED
Our mission at the Department is:License Efficiently,Regulate Fairly. SIGN _
We constantly strive to serve you better so that you can serve your a__
customers. Thank you for doing business in Florida. is_OERTIF[ED urWgr the pravisions of C'Ji.496 FS.
and congratulations on your new license) + auc�9i:aa,e L�apm7goa+a+a
DETACH HERE
RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY
STATE SOF FLORIDA
DEPAI EliCT t7FAu-tfkEts AND PROFESSIONAL,REGULA71ONEL.EC. Ri .COFACTORS'WEN9INi3 BOARD
M120011
The SPEOMTY ELECTRICAL CONTRACTOR;
Nab* below IS CERTIF-190
Vndw dw Oovisions of Chaplar 489 FS.
Ex sten date: AVG 31 2016
AS A SIGN E=LECTRICAL SPIRIC
SANCHEZt_CESAIR A '�
x43'171 0TH AVE1 _
L'wt WBRTH FL I'21 t
_-
ISSUM 0710712014 DISPLAY AS REQUIRED BY LAW SEQ# L140707CM1213
i
aF � fit•.
meso
� `�� � •�_, -= � °'ire ' � i
old , tawmasz- •`�r � . ��4e� e .
A.N N E M. G AX-N O N P.O.Box 3353,West Palm Beach,FL 33402-3353 "LOCATED AT'•
0 OONSYMMONAL.TAX OOLL90TOR www.pbctax.com Tet:(561)355-2284 4$17 10TH AVE N
Serofng Palm Beach eounty
LAKE WORTH,FL 33461-
���you.
TYPE OP elA3I M OWNER CMV"FMTM6 RECEIPT*MATE PAID WTPAID OL",
92-M SIGN CONTRACTORM-ECTMO& SANCHEZ CESM A MOM" 81&898678-1 GW18 $27.80 e40110M
This document is valid only When recelpted by the Tax Collectors Office. STATE OF FLORIDA
PALM BEACH COUNTY
2015/2016 LOCAL BUSINESS TAX RECEIPT
DESIGN&OGO INC LBTR Number: 200914125
DESIGNSTOGO INC EXPIRES: SEPTEMBER 30,2016
431710TH AVE N
LAKE WORTH,FL 33461 This receipt grants the privilege of engaging in or
�ill�ullnli 11111�����11 managing any business profession or=upatton
Within its Iu W101lon and MUST be conspicuotmly
displayed at the place of bushms and In such a
manner as to be open to the view of the public.
i
r _
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY)
*M 01127/2016
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Warren Insurance Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
950 Peninsula Corporate Circle ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Suite 1012
Boca Raton FL 33487 561-362-6005 INSURERS AFFORDING COVERAGE NAIC#
INSURED DesignsToGo,Inc. INSURER A: Technology Insurance Company
431710th Ave N. INSURER B: Wesco Insurance Company
Lake Worth FL 33461 INSURER C:
F 561.649.6499 INSURER D:
INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD`L
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1 000,000
SX COMMERCIAL GENERAL LIABILITY WPP123672"0 02/04/2015 02104/2016 DAMAGE TO RENTED $50,014
CLAIMS MADE �OCCUR MED EXP one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,WO
XGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s2,000,000
7
POLICY F PRO- LOC
AUTOMOBILE LIABILITY
ANY AUTO Ea accidentNED)
LE LIMIT $
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per Perm)
HIRED AUTOS BODILY INJURY
NON-OWNEDAUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LL40UTY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESSNMBRELLA UA&UTY EACH OCCURRENCE $
OCCUR F]CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X WC STATU- I OTH-
A EMP LOYERS'LIABILITY TORY I lmrrq PR
ANY PROPRIETOR/PARTNER/EXECUTIVE TWC3492621 07/10/2015 07110/2016 E.L.EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED?11YeS E.L.DISEASE-EA EMPLOYEE $1,000,000
S es,describe under E.L.DISEASE-POLICY LIMIT $1 1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
License#ES12001177 Officers are exempt from Workers'Compensation coverage
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THEA13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Miami Shores Village DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Bldg Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
10050 NE 2nd Ave IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
Miami Shores,FL 33138 REPRESENTATIVES,
AUTHORED REPRESENTAt$S> I
I I 7RA . . AaA.....
ACORD 25(2001108) ®A ORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001/08)
logo Miami shores Village
Building Department
R 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY 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 DADE 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 form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
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.
s�am���oos�s�a�s�s■���o����as���v���os�������������o�v��raamaoaosm��s�ss�a��ss�asose�ua�ss■ �
BUSINESS NAME: LNOPi S 72)' ign
BUSINESS ADDRESS: ` / 10144 • CITY ! � STATE)r-Z---ZIP Vy�
BUSINESS PHONE: V202` INJ FAX NUMBER 4 /7-10
CELL PHONE -� .5��3 QUALIFIER'S NAME: �uf'�'-s /�' 'Ir'al
QUALIFIER'S LIC NUMBER: S<"u ' ®C• , 2 (.)- 0
12/2/2015
Property Search Application-Miami-Dade Countv
� OFFICEOF THE A
P
PRAER
Summary Report
Generated On: 12/2/2015
Property Information
Folio: 11-3206-020-1030 1
Property Address: 8700 BISCAYNE BLVD +.. 1
Miami Shores,FL 33138-3342 k
Owner MIAMI SHR SERV STATION LLC " ' T
MailingAddress 9701 NW 89 AVENUE
MEDLEY,FL 33178-1435
Primary Zone 6200 COMMERCIAL-ARTERIALS=
Primary Land Use 2626 SERVICE STATION:SERVICE
STATION-AUTOMOTIVE �� F
Beds/Baths/Half 0/0/0 k
Floors 1 � ��
Living Units 0 r +4 m y
Actual Area Sq.Ft
Living Area Sq.Ft
e 6.
Adjusted Area 2,996 Sq.Ft
Lot Size 19,500 Sq.Ft Taxable Value Information
Year Built 1967 2015 2014 2013
County
Assessment Information Exemption Value $0 $0 $0
Year 2015 2014 2013 Taxable Value $561,942 $510,857 $497,135
Land Value $546,000 $405,600 $390,000 School Board
Building Value $93,343 $91,520 $93,154 Exemption Value $0 $0 $0
XF Value $13,490 $13,737 $13,981 Taxable Value $652,833 $510,857 $497,135
Market Value $652,833 $510,857 $497,135 City
Assessed Value $561,942 $510,857 $497,135 Exemption Value $0 $0 $0
Taxable Value 1 $561,942 $510,857 $497,135
Benefits Information
Regional
Benefit Type 2015 2014 2013 Exemption Value $0 $0 $0
Non-Homestead Cap Assessment Reduction 1 $90,891 1 Taxable Value $561,942 $510,857 $497,13501
Note:Not all benefits are applicable to all Taxable Values(i.e.County,School
Board,City,Regional). Sales Information
Short Legal Description Previous Sale Price OR Book-Page Qualification Description
09/01/2005 $1,870,000 23930-2566 Other disqualified
EL PORTAL SEC 4 PB 12-56
LOTS 24 TO 29 INC LESS NE 6 AVE 11/01/1996 $240,000 17510-2172 Other disqualified
BLK 23 06/01/1985 $277,778 12609-1676 Sales which are qualified
LOT SIZE 19500 SQUARE FEET 06/01/1985 1 $250,000 12609-1676 1 Sales which are qualified
COC 23930-2566 09 2005 6
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:
Detail by Entity Name Page 1 of 2
D ivisim Or CORPORATIONS
Detail by Entity Name
Florida Limited Liability Company
MIAMI SHORES SERVICE STATION LLC
Filing Information
Document Number L05000056387
FEI/EIN Number N/A
Date Filed 06/07/2005
State FL
Status ACTIVE
Principal Address
9701 NW 89TH AVENUE
MEDLEY, FL 33178
Changed: 04/25/2012
Mailing Address
9701 NW 89TH AVENUE
MEDLEY, FL 33178
Registered Agent Name & Address
URBIETA, IGNACIO M
9701 NW 89TH AVENUE
MEDLEY, FL 33178
Name Changed: 04/30/2014
Authorized Person(s) Detail
Name &Address
Title MGR
URBIETA MANAGEMENT INVESTMENTS, INC.
9701 NW 89TH AVENUE
MEDLEY, FL 33178
Annual Reports
Report Year Filed Date
2013 04/29/2013
2014 04/30/2014
2015 04/27/2015
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/26/2016
Detail by Entity Name Page 2 of 2
Document Images
04/27/2015—ANNUAL REPORT view image in PDF format
04/30/2014—ANNUAL REPORT View image in PDF format
04/29/2013—ANNUAL REPORT r—View image in PDF format
04/25/2012—ANNUAL REPORT F—View image in PDF format
04/29/2011 —ANNUAL REPORT F—View image in PDF format
04/30/2010—ANNUAL REPORT F—View image in PDF format
05/01/2009—ANNUAL REPORT r—View image in PDF format
04/29/2008—ANNUAL REPORT F—View image in PDF format
04/19/2007—ANNUAL REPORT View image in PDF format
04/20/2006—ANNUAL REPORT View image in PDF format
06/07/2005— Rofida Limited Liabilites View image in PDF form-at
Copyricht c and Privacy Policies
State of Florida,Department of State
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype--Entity... 1/26/2016
1 .
96res �xvice, C
'n N7�f/2_01f Ownership Entity)
n t p
Today's Date
Attn:Building Department
City or
i Countyof
Owners Address: `61
City/State:
Zip Code:
Phone ZQF�-A2>4-D
E-Mail RAougEdo C9 LX L&RAAOi L-CPYN
The undersigned being the owner of:
(Print address&suite o}P apt# of property)
(Prop. Control/tax folio#) -$94f.* - O 90- 1 dac-D
Cesar Sanchez qualifier of Desi sto o Inc. and/or his a ent(s)to act
Hereby authorize C , q gn g � g
as �
agent and sign permit application,apply for and secure permit(s),and install signage
S
for an illuminilluminated sign,per plans, at above referenced location.
at non-
Y
B : Ute`
(Authorized ature)
Print Name
Title: (Se"JEJ, CMAALVA
(If signed by a person other an President, V-President or partner,provide a Power of
Attorneyle authorization
or other al g )
State of Florida
County offifer, �
d before me this / da of c�� sir
The foregoin instrument was ackno ledge � y .�_
20 b who is personally known to me, Or( )
Ics�, Y
en ification
Produced th following type o id t I>J�
Notary Signature:
Notary Public Stamp:
"`a gnu,
°Fpxn�••, Erika Guido
-r; Via@COMMISSION#FF005953
s • o�F EXPIRES:APR.07,2017
�'�:., ;;•�'' WWW.AARONNOTARY.Com
,/*
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(A YYM
02/0612016
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Warren Insurance Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HLDER.9S0 Peninsula Corporate Circle ALTER THEHICOVERAGCERT�E AFFORD D BY THTE DOES NOT E CIES BEL
ircOW.
Sults 1012
Boca Raton FL 33467 661-3624MU INSURERS AFFORDING COVERAGE NAIC S
INSURED DesignsTaft,Inc. I n Technol9whouranceComPany
431710th Ave N. IMMEg m Wesco Insurance Company
Lake Worth FL 33461 INSURER C:
F 661.848,6499INSUR R D.
INSURER E
COVERAGES
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 POUCES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR IND NUM�R UCYBPF6CnY8 MEM
N LdrUTa
r:ICLAIVMS
EACHOCCURRENCE S 1 000 000
B ERALLmm nY WPP1236725.01 02/0412018 021 412017 DA AGE TO RE D 60 000
�OCCUR MED EXP one wwrO $6,000
PERSONAL a ADV INJURY 1,000j=
GENERALAGGREGATE I X000,00
GEN'LAGGREGATELIMIT APPU PER: PRODUCTS-COMptopAse s ZOOO.000
X PR
AUTUMOD E LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea eaident)
ATI'OWNED AUTOS BODILYlNJURY
SCHEDULED AUTOS (�P—) $
HIR
OS
NO DAUT'OS (perBODIPROPERTY DA
L N Y
(Per acmem MAGE $
GAMOELA ILnY &M ONLY-EAACCIDENT
ANY AITO OTHER THAN
AUTO ONLY: AGO
LIABIRY EACHOCCURRENCE S
OCCUR ❑CLAIMS MADE AGGREGATE
DEDUCTIBLE
RETENTION
WORIDNSCOMPENSATION AND X
A EMPLOVEWUAMLITY RO Elt r oR�PARrNER�FxEcunvE TWC3492621 07H1>MIS 07=2016 EL EACH ACCIDENT 1000OOp
OFRCERIMEMBER EXCLUDED?
rc tft
Yes EL DISF.48E-EA EMPLOYEE $1 000 000
desalba u
E.L.DSEASE-PWCY LIMIT 1 9 1.000 A00
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHMM I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROWSIONS
License#ES12001177 Officers are exempt from Workers'Compensation oov s
CERTIFICATE HOLDER CANCELLATION
SHOULD ANYOFTOM ABOVE DESCfdBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION
Miami Shores Village DATE THEREOF,THE ISSUING INSURER MLL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Bldg Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUTFAILURE TO DO SO SHALL
10050 NE 2nd Ave IMPOSE NO ORUGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
Miami Shores,FL 33136 REP�SENrATN
AUTHORMEDREPRERENTTA <88>.
ACORD 26(2001108) 0 &6,2=TION 1988
• 1
s
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the poilcy(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement A statement an this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
I
DISCLAIMER
The Certificate of Insurance an the reverse side of this form does not constitute a contract between
the issuing Insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies lister thereon.
ACORD 26(20010
jib 4
Invoice
Youre oNe sroP swoa srW
431710th Ave. N Lake Worth, FI 33461 Date Invoice#
Phone:561-432-1313 Fax:561-649-6499 Jtl 2016
1/5/2016 DSTG-18891
UL Cer~Manufacturer FILE#:E317454 kjj�ol
SI n Master Electrical Contractor State Uc#ES12001177
Bill To Ship To
URBIETA OIL COMPANY MIAMI FL FREDDY LAVERDE
9701 NW 89T14 AVENUE 561-386-7171
MEDLEY,FL 33178 flaverde@urbietaoil.com
Rep Due Date P.O.No. Terms Project
DB 1/5/2016 500/aDEP/50%COD
Item Description Qty Rate Amount
PERMIT PROCU... *********MIAMI SHORES U-GAS: 8700 BISCAYNE 1 600.00 600.0OT
BLVD.MIAMI SHORES FL 33138************
PERMIT PROCUREMENT,INCLUDES
CONTRACTOR FEE,SUBMITTING PERMIT TO
CITY,PICK UP PERMIT ONCE APPROVED.ANY
ADDITIONAL TRIP WILL BE CHARGE$50.00 PER
HOUR
ENGINEERING ENGINEERING DRAWING WITH SEAL.PER 1 140.00 140.00T
ELEVATION FOR SIGN SIGNS.EAST ELEVATION
"UGAS",SOUTH ELEVATION"UGAS", 1 ST
CANOPY NORTH&SOUTH"U",2ND.CANOPY
EAST&WEST"U",BUILDING FRONT"U SHOP"&
"CAR WASH"
NOTICE OF CO... NOTICE OF COMMENCEMENT NEEDED ON ITEMS 1 150.00 150.0017
OVER$2500.00 THIS FEE INCLUDES RECORDING.
PERMIT ELECT... CITY PERMIT FEE WILL BE BILLED AT COST. 1 116.20 116.20T
WHAT EVER THE CITY BILL US WE WILL BILL
YOU. WE WILL PROVIDE RECEIPT OR E-MAIL
YOU THE INVOICE FROM CITY. PERMIT FOR ALL
NEW CHANNEL LETTERS AND GRAPHICS
***DEPOSIT FOR PERMIT$50.00,CK#11081****
Thank you for your business.
Subtotal
Sales Tax
APPv:
Total
Proj.No..
Code: Pa menta/Credits
station: Y
R.E.Co..
Funding: Balance Due
Page 1
rwme-O�N ® h1VOICe
YOUR ONB STOP SKiN STQI#�
431710th Ave. N Lake Worth, F133461 Date Invoice#
Phone:561432-1313 Fax:561-648-6499 1/5/2016 DSTG-18891
UL Cerdfled Manufacturer RLE#:E317454
SI n Master Electrical Contractor State Llc#ES12001177
Bill To Ship To
URBIETA OIL COMPANY MIAMI FL FREDDY LAVERDE
9701 NW 89TH AVENUE 561-386-7171
MEDLEY,FL 33178 flaverde@urbietaoil.com
Rep Due Date P.O. No. Terms Project
DB 1/5/2016 50°/.DEP/50%COD
Item Description Qty Rate Amount
SURVEY SURVEY 1 300.00 300.00T
Survey to include photos and measurement of existing
exterior signs,relevant sign bands on exterior locations of
the building,window measurements,exterior wall
construction material and color. If interior access is
available survey will include a check for access,
impediments to install,and available j-box at site.The
survey is not warranted to have examined or researched
electrical power,structural components,internal or
concealed items.
SIGNS (2)PAN FACES EMBOSSED FOR PYLON SIGN 2 2,086.32 4,172.64T
WITH U GAS LOGO(APPROXIMATED SIZE
96"X96")*************************NOTE:WE
NEED TO GO WITH BUCKET TRUCK TO DOUBLE
CHECK SIZE OF EXISTING FACES****************
SIGNS (2)LEXAN FLAT FACES BOTTOM SECTION OF 2 1,100.00 2,200.00T
PYLON SIGN WITH NEW GRAPHICS DIGITAL
DISPLAY (APPROXIMATED SIZE 96"X96")
*************************NOTE:WE NEED TO GO
WITH BUCKET TRUCK TO DOUBLE CHECK SIZE
OF EXISTING FACES****************
PRICE OF LETTER INSERT NOT INCLUDED.
Thank you for your business.
Subtotal
Sales Tax
Total
Payments/Credits
Balance Due
Page 2
T-
/GNsr Invoice
YOUR ONE STOP SMN STORE
431710th Ave. N Lake Worth, FI 33461 Date Invoice#
Phone:561-432-1313 Fax:561-649-6499 1/5/2016 DSTG-18891
UL CerMled ManufacturwRLEP.E317454
Sig in Master E/ectrlca/Contractor State Uc#ES12001177
Bill To Ship To
URBIETA OIL COMPANY MIAMI FL FREDDY LAVERDE
9701 NW 89TH AVENUE 561-386-7171
MEDLEY,FL 33178 flaverde@urbietaoil.com
Rep Due Date P.O. No. Terms Project
DB 1/5/2016 500/oDEP/500/oCOD
Item Description Qty Rate Amount
INSTALLATION INSTALLATION OF 4 NEW PANELS FACES ON 1 900.00 900.00T
PYLON SIGN
REMOVAL REMOVAL OF SIGN THAT READS ATM$85.00 PER I 300.00 300.00T
HOUR
INSPECTION FINAL INSPECTION FOR PERMITTING PER CITY 1 425.20 425.20T
(NOTE:SOME CITIES REQUIRE SEVERAL
INSPECTIONS,FINAL STRUCTURAL,FINAL
ELECTRICAL,FINAL ZONING,AND/OR FIRE)
THESE ARE NOT ALWAYS ALLOWED TO BE
COMPLETED IN ONE DAY AND MAY REQUIRE A
SECOND OR THIRD TRIP DEPENDING ON EACH
CITIES PROCEDURES.
Thank you for your business.
Subtotal $9,304.04
All prices are valid for thirty days.Signature approval&50%deposit is required to initiate Sales Tax
order.Deposit is Non refundable.Payment due in full at time of completion and/or $558.24
installation.Delivery fee of$15.00 minimum if requested.There might be additional charges
due to structure of building or pylon sign,we will no fy customer of this.On digital print Total
there can be a+/-10%color variance. $9,862.28
A
I agree to above terms: Payments/Credits -$6,500.00
AP IV:
Pro).No.:
Code:
Station: Balance Due $3,362.28
undin..g:
FPage 3
Fundin
90.21"
I ,
,a Allowable=
Sign Size=Top Box 93"Hx90.21"W, Bottom Box 94.5"Hx90.21"W Total= 117.4 Sq.Ft
Proposed=Top Box 93"Hx90.21"W, Bottom Box 94.5"Hx90.21"W Total= 117.4 Sq.Ft
d10A 4aff93" Existing= Top Box 93"Hx90.21"W, Bottom Box 94.5"Hx90.21"W Total= 117.4 Sq.Ft
Elevation= North/South
Description:
— • Existing pylon sign with new embossediw
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and pan faces that reads powered `
1 I 1 I by Ugas quality fuels.
. 1 Tracks and interchangeable acrylic numbers
4.
94.5„
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Ethanol
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ATMI JAN 27 20
INSIDE STORE
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PROPOSED ! Miami Shores village
Zd' APPROVED
BY'ZO^5l!�iG DEPT
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This is an original unpublished drawing created by Designs2go Date Description Int. --
d+eS�CN F It is submitted for personal use connection with shown is not to be project being _
Customer Name:Urieta Oil Company,Miami FL outside your for o ganiou zatio ,no2r is t the used eproduced,anyone ) l rJ C DEPT I t
YOUR ORE STOP SIG STORE or exhibited in any fashion. _ 1
Location'8700 Bizcayne Blvd,Miami Shores,FL 33138
Cesar A.Sanchez Plaza Name:
Drawing Reviewed By: Date: ;1'..II C"-TO CU,MPLIANCE WITH ALL FEDERAL
4623 10th Ave.N.,
LIC.#U-21310 Contact Freddy Laverde
Lake Worth,FI 33463 1 have carefully reviewed and hereby accept the drawing(S)as '( Ci 1NTY RUL FS AND RFC;ULATIONS
sales@designs2go.net Sales Person:Denis Brenes shown.1 realize that any changes to these designs made before or
after may alter the contract price_All changes must be in writing
T.561-432 1313 WWw.designs2go.net Designer:Denis Brenes and approved by both parties prior to production.
F.561-649-6499 Licensed,Bonded&Insured Date:01125/15
The custom artwork depicted here in is for representational purposes only and may not exactly match the colors of the materials proposed.Electric signs produced at Designs2go conform to UL 48 standards and may display the Underwriters Laboratory Label
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This is an original unpublished drawing created by Designs2go Date Description Int.
® Itis submitted for personal use connection with a project being
s
prepared for you by Designs2go,.It is not to be shown to anyone
Customer Name: Urieta Oil Company,Miami FL outside your organization,nor is to be used,reproduced,
YOUR ONE STOP S16111STORE or exhibited in any fashion.
Location:8700 Bizcayne Blvd,Miami Shores,FL 33138
Cesar A.Sanchez Plaza Name: Drawing Reviewed By: Date:
LIC.#U-21310 462310th Ave. N., Contact:Freddy Laverde
Lake Worth, FI 33463 I have carefully reviewed and hereby accept thedraw ng(S)as
sales@designs2go.net Sales Person:Denis Brenes shown.I realize that any changes to these designs made before or
after may alter the contract price.All changes must be in writing
T.561-432-1313 www.designs2go.net Designer:Denis Brenes and approved by both parties prior to production.
F.561-649-6499 Licensed,Bonded&Insured Date:01/21/15
The custom artwork depicted here in is for representational purposes only and may not exactly match the colors of the materials proposed.Electric signs produced at Designs2go conform to UL 48 standards and may display the Underwriters Laboratory Label