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HomeMy WebLinkAboutFolio 2024-2025 Permit - CR 7895 CR 7895 - 9/24/2024 Pt) CONTRACTOR REGISTRATION 100 West Dania Beach Boulevard• Dania Beach,FL 33004 .5 (954)924- 805*3651,3633 or 3652 Fax(954)922-2687 it it DANIA KV II SEP 1 8 2024 t ?if PLEASE PRINT LEGIBLY Type of,:ontract or .30rago Door Company Name cot coast Garage Door Office fess I)!-)i NW 50 St Suite 106 — — Su mise,FL 33351 Office Phone# ( )053-1600 Qualifier;Name JervInx,Payne Office Address 10501 NW 50 St Suite 106 Cily/Stati47.1p Survisc,Ft 33351 ilorr:e P ione# <950653-1600 Owner:Name Jerome Payne Office Address 1050 NW 50 St Suite 106 City/Stategjp Sunrise,FL 33351 Home Pion # (054)653-1600 PROVIDE PHOTOCOPIES OF THE FOLLOW NIG WaiMENTS flua,ifies Driver's license P500-430-87-24640 State: FL City Bus ress Tax License City: County Business Ta>:License County: 189-262491 State Lcense Cortificiite of Compc?.tency 13-GO-13700-X Certificil n of Insurance must show the City of Dania Beach as the Certificate Holder lieneral Li aLility Expiration Date: 10/29/2024 Itl'orkeri c.ompensation Expiration Date: 1012912024 herebl,cerify that the information contained herein is true and accurate to the best of my knowledge. Jerome Payne 11(U44,/ :11./alifieei Signatliri'; Date be foril,oing instrument was acknowlecged before me this )/j,' day of 20 y_ jot ,r' t. who is Ressopagylcnowato me_or has produced as identification and did(or did not take an oath •••,.-71.;•., TA 1410,1E1101,10,3 tyk_c__ornnission kt.Isi 420441( E XII RES:Ali!11,202i . 4114 Nam I k i:ontrac:cr Regist rat.on Rev. OW26/2017 BR OWAIRD COUNTY LOCAL BUSINE;S TAX RECEIPT 113 . Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895— 954-357-4829 VALID OCTOBER 1,2023 THROUGH SEPTEMBER 30,2024 DBA: 1 COAST TO COAST GARAGE DOOR Receipt#:ALL OTHER TYPESCONTRACTOR Business Name: Business Type: (INSTALL GARAGE DOOR) Owner Name:JEROME PAYNE Business Opened:02/01'2 C__3 Business Location: 10501 NW 50 ST #106 State/County/CertlReg:CC#13-GD-18700-X SUNRISE Exemption Code: • Business Phone: 9546079054 Rooms Seats Employees Machines Professionals 3 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 1 27.00 0.00 0.00 0.00 0.00 0.00 27.03 , Receipt Fee 27.00 _____ i-- 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 Brcw3rd County and is non-regulatory in nature. You must meet all County and/or Mun cipality 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: COAST TO COAST GARAGE DOOR Receipt #WWW-22-00255310 10501 NW 50 ST #106 Paid 07/13/2023 27.00 SUNRISE, FL 33351 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 DBA:COAST TO COAST GARAGE DOOR Receipt#: 18° 26249= Business Name: Business Type:ALL '01 2 TYPES CONTRACTOR (INSTALL GARAGE DOOR) Owner Name: JEROME PAYNE Business Opened:02/01/2013 Business Location: 10501 NW 50 ST #106 State/County/CertlReg:CC#13-GD-18 7 0 0-X SUNRISE Exemption Code: Business Phone: 9546079054 Rooms Seats Employees Machines Professionals 3 Signature For Vending Business Only Number of Machines: Vending Type: Tax A 27 nt00 Transfer FeeJ NSF Fee0.001 Penalty .00� Prior Years 0.00 Collection Cost Total Paid II— Receipt #WWW-22-00255310 Paid 07/13/2023 27.00 4111 I rl. in t ', GARAGE DOOR ! 13-GD-13700-X PAYNE,JEROME -QUALIFYING i COAST TO COAST GARAGE DOOR, LLC/COASTAL FENCE&GATE, Lk 1 0501 NW 5(}th ST SUITE 106 55, i ;` SUNRISE FL 33351 i EXPIRES 06/30/2025 F4 ffi E1',, 3 t, '. ri CERTIFICATE OF COMPETENCY hA��JZ VIi SU Detach and SIGN the reverse side of this , t„ COUNT` ,card IMMEDIATELY upon rs.aeipt!You —,., ` t > o R 1 n A 3houid carry this card with you at all tunes. r Co'tractor must obtain a photo I.D.Certificate of Competency Card BiCC?WARD COUNTY,I L i d every two years. N CC# F'AYD E: s, :OF :Lla _ F.,'a!'!,3 _ coASTT(: ( CA : .:J ,'('E t C 2 FAY NE JEROME Li CJC A:.': .l. r. \...E' .i.," 7960 t\�W 51 S C 1q }t"iV1`a,:i; ` 0..; f 13' LAUDERHILL FL 33351 5. suNRI5E: =i. 33C 1 EXPIRE: ii3) ', 103- )7 Hey 1'12)FC2:1 a790? „lit:D CERTIFICATE OF LIABILITY INSURANCE DAM (MkuDr' YI It%, •-- 5/23/2024 'fl-I 3 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS GE i:TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BE.0W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHc RIZED RE,RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMl'IDRTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, sutject 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 cal:ificate holder in lieu of such endorsement(s). PiyDOL CER !CONTACT - Keyes Coverage Insurance I NAME: Gina Barragat0 5900 Hiatus Road I•(A/C No.Extl:954-724-7000 • FAX Ho);954-724-7024 Tam am FL 33321 E-MAIL ra ADDRESS: barra ato ke escovera e.com INSURER(S)AFFORDING COVERAGE • NAIC/t 1 --- license#:L0681 09 INSURER A:Clear Blue Insurance Co INSUR D 17641 INSURER B:FCCI Ins.Company . .0178 Coast To Coast Garage Door LLC 10501 NW 50th Street INSURER c:Monroe Guaranty Insurance Company 32506 Suite 106 and 107 INSURERD: $ Sunrise FL 33351 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:948392793 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. E SR ADDL SUBRI --- Ti LTR TYPE OF.INSURANCE INSD WVD! POUCY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYYI (MM YY/DD/ VY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y BGFL0026530601 10/29/2023 10/29/2024 EACH OCCURRENCE $1,000,000 • DAMAGE TO RENTED CLAIMS-MADE X OCCUR I PREMISES Ea occurrence) $300,000 I MED EXP(Any one person) S 10..000 -_,i j J._-.— _ PERSONAL 8 ADV INJURY S i,000,00C :EN'L 4GCREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE S 2,000,00C i _ POLICY II_ - 'LOC --- - — --_ -t PRODUCTS-COMP/OP AGG $2,OOQ000 - -'-OTHER: $ .UTCMOBILE LIABILITY CA100080513-01 10/29/2023 10/29/2024 COMBINED tSINGLE LIMIT S 1,000,006 • ANY AUTO BODILY INJURY(Per person) $ ALL OWNED I--SCHEDULED — - AUTOS AUTOS BODILY INJURY(Per accident) $ •_ H!RE AUTOS NON-OWNED PROPERTY DAMAGE X C REDAUT X AUTOS (Per accident) S Cot$1 000 P,P S 10 000 A _:< UMBRELLA LIAB X OCCUR BXFL0026530601 10/29/2023 10/29/2024 EACH OCCURRENCE _ S 4,000,00CW EXCESS LIAB CLAIMS-MADE -- - i AGGREGATE $4,000,000 DED X RETENTION$0 I $ B WORKERS COMPENSATION ; Y WC0100080515-01 10/29/2023 10/29/2024 ' X I PEATUTE I ERH AND EMPLOYERS'LIABILITY Y/N -_ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1000,00C OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,00C If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,00C DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Dania Beach is included as additional insured with respect to General Liability and Auto Liability coverage when required by written contract A waiver of subrogation is included with respect to General Liability and Worker's Compensation coverage when required by written contract. C E_R :IFI,:ATE li 3 D SLR CANCELLATION 30 days notice-10 for non-payment I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Dania Beach 100 West Dania Beach Blvd Dania Beach, FL 33004 AUTHORIZED REPRESENTATIVE ,y ,�,f1 ©1988-2014 ACORD CORPORATION. All rights reserved. .ACORD 25(2014/f11) The ACORD na-r e and logo al e registered marks of ACORD N a fir' ' �$ s� ': ''''',11?';...,''' ;:''' I''''It'''';'''1.,,,..:',' :!l'i'l i'.'11:::,,L1,1''',;'''‘';'147:'%, ' .",'{'Iiit,i'' ;:1:11.1',:1-;;.,i4'''..:1'4 Hb r ff 4� Te , v g ya , 9 � , '".•grii 3 f ''.,'{ £ ,�! ilia 1 l l i <,4„ 4_ . .. „1