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HomeMy WebLinkAboutFolio 2024-026 Permit - CR#7872 CR#7872 - 9/24/2024 CONTRACTOR REGISTRATION 100 West Dania Beach Boulevard•Dania Beach,FL 33004 (954}924.6805•3651,3633 or 3652 Fax(954)922-2687 an ago R BCARIM ii 8=#yf PLEASEPRINT LEGIBLY Type of Contractor 5.0Ver L r eWa r Company;Name /4 K. rrTri CDI7) Of ice Address Ov/stateizp , m� /4� Offke Phone# •:� £i ' Qualifier:Name r)d t"'� rci Office Address ! cc-) rr' City/StaLer/1p r L LiZ� Home Phone# Owner;Name 1tfl S C'7 '.dal, Office Address a 2R /54 7'"v'r Citv/Sp GCrr) I Home Phone# (P CPC? Igo t PROVIDE PHL7TOCOPIES OF THE FOLLOWING DOCUMENTS Qualls s Driver's License 455' tv2'5"4/ -749 011-b State: rL-Crt - City Business Tax License City: County Business Tax License u State License Certificate of Competency Certificates of Insurance must show the City of Dais Beach as the Certificate Holder General Liability Expiration Date: O - g-LO Workers Compensation Expiration Date: i0 L� I hereby certify that the information contained herein is true and accurate to the best of my know. Cd•-t-t-4.--**1 Qualifier's Signature Date The foregoing instrument was acknowledged before me this day of Zia A who is personally known to me or has produced as identification and did(or dki nest)take an oath My Commission Expires: Notary«Ρybuo itst.ai Fiori+is er(4,1, 4 Koyny Do Marcos ►" 4 My Commlosion NN o7337S Contractor Registration Rev. 4 Bxpiroo 141202s 09/26/2017 ,4E) CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 05/30/2024 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Yousy Rodriguez A-PLUS INSURANCE GROUP (NC.No.Ext): 305-260-9884 FAX No): 305-364-6552 8325 W 24th Ave,Ste 10 E-MAIL a lusinsurance ahoo.com ADDRESS: P ©y INSURER(S)AFFORDING COVERAGE NAIC# Hialeah FL 33016 INSURERA: ASCENDANT UNDERWRITERS,LLC INSURED INSURER B: WIC Excluded Y&K CONTRACTORS CORP INSURER C: 13738 SW 157TH TER INSURERD: INSURER E: Miami FL 33177 INSURER F: COVERAGES 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE X]OCCUR PREMISES(EaENTED occurrence) $ 1,000,000 MED EXP(Any one person) $ 5,000 A Y N GL-76359-0 1 05/18/2024 05/18/2025 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jE8T LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONPER AND EMPLOYERS'LIABILITY STATUTE OTH- ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE G"' c5'a- E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? Y N/A EXCLU CE (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is also listed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 W Dania Beach BLVD ACCORDANCE WITH THE POLICY PROVISIONS. Dania Beach,Fl 33004 AUTHORIZED REPRESENTATIVE Ci fine; �r C GGUC.(LGGti ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW* * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 5/30/2024 EXPIRATION DATE: 5/30/2026 PERSON: YANDYS GARCIA MARTINEZ EMAIL: SALES@AMERICANWINDOWSANDDOOR.COM FEIN: 992892388 BUSINESS NAME AND ADDRESS: Y&K CONTRACTORS CORP 13738 SW 157TH TER MIAMI, FL 33177 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT:Pursuant to subsection 440.05(13),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to subsection 440.05(11), F.S.,Certificates of election to be exempt issued under subsection(3)apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12),F.S.,notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01937821 QUESTIONS?(850)413-1609 RULE 69L-6.012, F.A.C. REVISED 01/2023 Local Business Tax Receipt LBT Miami-Dade County, State of Florida -THIS IS NOT A SILL-DO NOT PAY 7383221 RECEIPT NO. NEW BUSINESS BUSINESS NAME/LOCATION 7679074 EXPIRES Y AND K CONTRACTORS CORP SEPTEMBER 30, 2024 137838 SW 157TH TER MIAMI. FL 33177 Must be displayed at place of business XQ Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS Y AND K CONTRACTORS CORP 196 GENERAL BULDING PAYMENT RECEIVED BV TAX COLLECTOR C/O YANDYS GARCIA MARTINEZ PRFS CONTRACTOR 75.00 06/06/2024 Worker(s) 1 CGC1536284 0217-24-001206 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license. permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business, The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276. 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