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Local Business Tax Receipt
Miami—Dade County, State of FloridaLBT
-THIS IS NOT A BILL-DO NOT PAY
6088348 RECEIPT NO.
RENEWAL
BUSINESS NAME/LOCATION 6350953 EXPIRES
ONE STOP PAVING INC SEPTEMBER 30, 2025
1463 NE 173RD ST
MAMI BEACH, FL Must be displayed at place of business
NORTH I
NORTH 3M E rt A-El Pursuant to County Code
Chapter 8A-Art.9&10
1 yi' 7t
151c
❑� • ywn+
OWNER SEC.TYPE OF BUSINESS
PAYMENT RECEIVED
ONE STOP PAVING INC 196 GENERAL BUILDING BY TAX COLLECTOR
C/O CARLOS ACOSTA QUALIFIER CONTRACTOR
45,00 09/11/2024
Worker(s) 1 CGC1513719 0217-24-002022
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.
MIAMFDADE For more information,visit www,miamidade.gov/taxcollector
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-357-4829
VALID OCTOBER 1,2024 THROUGH SEPTEMBER 30,2025
Receipt ERA8L 8 ONTRACTOR (GENLAL
Business Name:ONE STOP PAVING INC Business Type:CONTRACTOR)
Owner Name:CARLOS M ACOSTA Business Opened:08/26/2008
Business Location: 1463 NE 173 ST State/County/Cert/Reg:0001513719
MIAMI DADE COUNTY Exemption Code:
Business Phone:
Rooms Seats Employees Machines Professionals
1
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 0.00 27.00
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:
CARLOS M ACOSTA Receipt #04C-23-00006117
1463 NE 173 ST Paid 09/17/2024 27.00
N MIAMI BEACH, FL 33162
-LI 2024 - 2025
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: 3/1/2023 EXPIRATION DATE: 2/28/2025
PERSON: CARLOS M ACOSTA EMAIL: CARLOSMARCIA@YAHOO.COM
FEIN: 020688821
BUSINESS NAME AND ADDRESS:
ONE STOP PAVING, INC.
ONE STOP PAVING INC
1463 NE 173 ST
MIAMI, FL 33162
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)appty 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 E01 862425 QUESTIONS?(850)413-1809
RULE 69L-6.012, F.A.C.REVISED 01/2023
' ►' ' CERTIFICATE OF LIABILITY INSURANCE tk rE(Mbabort-tY)
07112/2024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVEI-Y 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 en ADDITIONAL INSURED,the poltcy(Ies}must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of ttte policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsements}.
PRODUCER CONTACT
NAME'
First Class Insurance Market Nhloe EAT), (305)441-2997 FaxtNam; {305}+Is41 64+t3
4101 NNW9th Street t aaatL
ADoness; cam
Miami,FL 33126 IN$URER(S)AFFORDING COVERAGE NM e
Phone (305)441-2997 Fax (305)441-6443 INSURER A: EVANSTON SPECIALTY INSURANCE COMPAN
_
INSUR INSURER:a
ED .. ... . ... ._-_.-. _.._._
ONE STOP PAVING INC.. 111SURER_G_:
1463 NE 173 STREET INSURER t>
INSURER I :
NORTH MIAMI BEACH FL 33162
#NgURER F".....
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1NSR TYPE OP IN$[IRANCE ADDLSUBR POLICY EPF POLICY EXP
TR
_-.._. DIsR WVD POtIOY NUMBER : (PWODNYYY)'IMPARID/YYYYI Liters
;#1i COMMERCIAL,GENERAL LIABILITY EACH OCCURRENCE '--. $ I,000,000.00
0 GLANS-MADE R1 OCCUR taAMwGtT?)RENTED 100,000.00
PREMISES(Ea oceter I...:..
l MED EXP(Anyone person) , $ 5,000.00
A - 3AA691329-0 07/13/2024 07/13/2025
_. PFRSONAt 3 ACV INJURY $ 1,000,000.00
GF.N'L AGGREGATE LIMIT APPLIES PER GIiNLRALAGGREGATE t 2;000,000.00
Li POLICY L i JE 0 E] LOG PRODUCTS-COMPIOP ADO $ 2,000,000.00
OTHER
AUTOMOBILE LIABILITY COMBINEDtSP4GLELIMIT
ANY AUTO BODILY INJURY(Per person) $
SCHEDULE()
OWNED _ ..
AUTOS ONLY tj AUTOS ppB��O(DIIL�gY INJURYT (Per s1) 5
I-I HIRED L NON-OWNED (Per eaERTV AMAGE
{AUTOS ONI Y AUTOS ONLY �$
0
UMBRELLA Luke El OCCUR ...EACH OCCURRENCE $
EXCESS LIAN 1 CLAIMS MADE AGGREGATE $
DEO U RETENTIONS_
WORKERS COMPENSATION PER ---
R
H ---
._ _
AND EMPLOYERS'LIWBIUTY Y $1 ATUTE
ANY PROPRIETOR/PARTNER/EXECUTNE F EACH ACCIDENT $
OFFICER!MEM BER EXCLUDED? N I A
{Mandatory in NH) S L DISEASE-EA EMPLOYEE$
I It yes,Sescrgsunder E.L.DISEASE-POLICYLI IT
DE PTION OF OPERATIONS below S
DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(Attach ACORO 101,Additional Remarks Schedule,If more space is requlredi
LIC#CGC 1513719
E231500
CERTIFICATE HOLDER CANCELLATION
SH D ANY OF.THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF DANIA BEACH 1EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
100 W DANIA BEACH BLVD ACCORDANCE Wi THE POUCY PROVISIONS.
DANIA BEACH,FL 3300E
Atilt( PRESEN ATIVE
}
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