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HomeMy WebLinkAboutFolio 2024-2025 Permit - CR 395 CR 395 - 9/24/2024 (r) A� ® DATE(MM/DD/VYYY) CERTIFICATE OF LIABILITY INSURANCE 9/5/2024 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(ies) 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: Acentria Insurance-Miami PHONE Nandi Gutrierrez FAX 8700 W Flagler, Suite 402 (A/C.No.Ext): 305-446-5474 (A/c,No):305-444-8796 Miami FL 33174 ADDRESS: RECEIVE INSURER(S)AFFORDING COVERAGE NAIL# License#:L100460 INSURER A:Nationwide General Insurance Company 23760 INSURED R&AELEC-01 INSURER B:Safehold Special Risk,Inc. R&A Electric Inc. SEP � 6 2024 INSURER C: Roberto Rivero — P.O. Box 611835 INSURER D: Miami FL 33261 { INSURER E: v• INSURER F: COVERAGES CERTIFICATE NUMBER:1114731805 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 LTR INSD DDL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (POLICY EFF (POLICY EXP A X I COMMERCIAL GENERAL LIABILITY Y ACPCG013230476402 9/5/2024 9/5/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X J OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 _ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 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 LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION TWC4299495 9/9/2024 9/9/2025 X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF DANIA BEACH ACCORDANCE WITH THE POLICY PROVISIONS. 100 West Dania Beach Boulevard Dania Beach FL 33004 AUTHORIZED REPRESENTATIVE USA y �� I - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ron DeSantis,Governor STATE OF FLORIDA Melanie S.Griffin,Secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS' LICENSING BOARD LICENSE NUMBER: EC13010362 EXPIRATION DATE: AUGUST 31,2026 THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES ARRIOLA, JORGE L CI ' 7..,. .: El R &A ELECTRIC INC • j :•r4�� 7871 NW MIAMI TERRACEarlr..11 If MIAMI LAKES FL 33016 oN7 • o ISSUED:08/08/2024 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license.It is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt LBT Miami—Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY 3701613 RECEIPT NO. ` RENEWAL BUSINESS NAME/LOCATION 3866465 EXPIRES R&A ELECTRIC INC 7871 NW 160TH TER SEPTEMBER 30, 2025 MIAMI LAKES, FL 33016-6632 Must be displayed at place of business I]' ID.. Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS R&A ELECTRIC INC 196 ELECTRICAL PAYMENT RECEIVED C/O ARRIOLA JORGE LUIS BY TAX COLLECTOR (DIIAIIFIFR CONTRACTOR 45.00 09/06/2024 Worker(s) 3 EC13010362 0206-24-002281 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. MIAMIDA- DE For more information,visit www.miamidade.gov/taxcollector Ott