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HomeMy WebLinkAboutFolio 2024-2026 Permit - CR 7892 CR 7892 - 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 '1 DANIA BEACH SEP 1 7 2024 SEA IT LIVE IT LOVE IT PLEASE PRINT LEGIBLY /,,/� �1 Type of Contractor Filkli ,A W�fraelOr ` 9 Z '• Company: Nam e r ove I'�1('�1�V p j e I' Office Address ot(70f S W4 City/State/Zip t 6I4 ,/Ze( ,2 cam r-G 5&(Jt79 Office Phone# 9Lt1 Y-99016y Qualifier: Name (2tJ8( ,, tadtaite Office Address ,.(.2a 1 Sry a 9 City/State/Zip 14.41A4MCI,Cde PX.OPA4 Ft 33t9 Home Phone# Owner: Name Office Address City/State/Zip Home Phone# PROVIDE PHOTOCOPIES OF THE FOLLOW,FOLLOWING DOCUMENTS A Qualifier's Driver's License !�'1 2" `77 -cf5 1 6 D State: FL City Business Tax License /g(k 3 it f q# City: County Business Tax License County: PO'� + State License C/ C Certificate of Competency Certificates of Insurance must show the City of D 0i each as the Certificate Holder General Liability Expiration Date: /lo Workers Compensation Expiration Date: loWai/ I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Notary Public State of Florida Qualifier's Signature Shirley Amir Date ���� My Commission HH 294$49 Expires 7484024 The foregoing instrument was acknowledged before me this day of 20 By who is personally known to me or has produced as identification and did (or did not)take an oath My Commission Expires: 09/26/2017 Contractor Registration Rev. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-357-4829 VALID OCTOBER 1,2023 THROUGH SEPTEMBER 30,2024 Receipt#:GENE ALICONTRACTOR (CERT Business Name:NE HOME IMPROVEMENTS LLC Business Type:BUILDING CONTRACTOR' Owner Name:STEPHEN MAHN/QUAL Business Opened:10/19/2023 Business Location:2320 SW 30TH AVE State/County/Cert/Reg:CBc1 267248 HALLANDALE Exemption Code: Business Phone: (954) 761-5761 Rooms Seats Employees Machines Professionals 7 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 25.001 52.30 Receipt Fee 27.00 Packing/Processing/Canning Employees 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: NE HOME IMPROVEMENTS LLC Receipt #WWW-23-00207739 2520 SW 3CTH AVE Paid 03/05/2024 52.00 HALLANDALE BEACH, FL 33009-3082 2023 - 2024 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-357-4829 VALID OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024 Receipt#: 180-341947 Business Name:NE HOME IMPROVEMENTS LLC Business Type:GENERAL CONTRACTOR (CERT BUILDING CONTRACTOR) Owner Name: STEPHEN MAHN/QUAL Business Opened:10/19/2023 Business Location: 2520 SW 30TH AVE State/County/Cert/Reg:CBC1267248 HALLANDALE Exemption Code: Business Phone: (959) 761-5761 Rooms Seats Employees Machines Professionals 7 Signature For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid II _ I_ E .� `1 .�1.' fir{,ii .: o 1r 5 .1 i r • . MI v 7o --Irn 3 7 i, "CIo co o = 70 Z n 0 ' fl1 et, CD > O r < X D Z 0n co v 0 r Z = cn OZ V m� � SZ -I fD m Zm°c • -iZ0K D�, L) Zm Ln (/) _ Z rt c ° C ' C I- 00 O Ivm o Er,' D 3 _< ,_, s IT1 o 73 c o 1 m m 0 E = mi "4 Z ' 1 r`° rDN Cn cnmZ Z- — rm0 - _ j_ ' 0 ° Cr) Cl)v I- O N m -IZ � `` Dco 5 .W �. _67 UMW Oa CA co T1-' Na N.) " Dv' rTIrD Z Ow D > 0 !m -IC .CZr c C 7 rD , , m m iv.. �, rD 7. 73 mom N Y 1 j v v, 0. o m C c 3 rD Clo r+ Z CY:-.77- moomis !� AC-OR[3i' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/02/2024 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: Next First Insurance Agency,Inc. PHONE (855)222-5919 I FAX PO Box 60787 (A/C,No,Extl: (A/C,No): Palo Alto,CA 94306 E-MAIL ADDRESS: pp SU ort@nextinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Next Insurance US Company 16285 INSURED ---- - ----- — ------ _INSURER B: NF Home Improvement LLC INSURER C 2031 Harrison St Ste 11 Hollywood,FL 33020 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:006696960 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 INSD SWVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS '(MMIDD/YYVY)'.(MM/DD/YYYY) X • COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000.00 MED EXP(Any one person) $15,000.00 A X NXTDLJPRWK-00-GL 12/01/2023 12/01/2024 PERSONAL BADVINJURY $1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000.00 PRO POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000.00 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$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Each Occurrence: $25,000.00 A Contractors Errors and Omissions X NXTDLJPRWK-00-GL 12/01/2023 12/01/2024 Aggregate: $50,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is Pembroke Pines Building Dept.This Certificate Holder is an Additional Insured on the General Liability policy per the Additional Insured Automatic Status Endorsement.All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured,and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Dania Beach SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 W Dania Beach Boulevard THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Dania Beach,FL 33004 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/VYYY) ACORL CERTIFICATE OF LIABILITY INSURANCE 05/03/2024 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 NAMEACT Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. PHONE Ext): 1-800-524-7024 FAX No): E-MAIL ADDRESS: 1 Adp Boulevard INSURER(S)AFFORDING COVERAGE NAIC# Roseland NJ 07068 INSURER A: Technology Insurance Company,Inc. 42376 INSURED NF HOME IMPROVEMENTS LLC INSURER B: INSURER C: 2520 SW 30th St INSURER 132 INSURER E: Hallandale FL 33009 INSURER F: COVERAGES CERTIFICATE NUMBER: 3614352 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 ADDL SUBR POLICY EFF I POLICY EXP LTR! TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MWDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENT ED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 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 DBE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER C PEATUTE ERH AND EMPLOYERS'LIABILITY A OFFICER/MEMBEREXCLUDED?ANY ECUTIVE YN/N N/A N TWC4346628 12/01/2023 12/01/2024 E.L.EACH ACCIDENT $ 1,000,000 (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/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 W Dania Beach Boulevard Dania Beach, FL 33004 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • 1,,E ;"' p z $ I . : t- ., 259-(-)' ... ' �, , ` , Q.` / ..ram' - �"' - z;- ..,.. . . x }, Avg