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HomeMy WebLinkAboutFolio 2024-2026 Permit - CR 7882 CR 7882 - 9/24/2024 Ard q bz-fg-0 4- fug D- CONTRACTOR REGISTRATION 100 West Dania Beach Boulevard•Dania Beach,FL 33004 (954)924-6805.3651,3633 or 3652 Fax(954)922-2687 DANIA BEACH vI.T r r.s r I cM lr PLEASE PRINT LEGIBLY Type of Contractor &ten e vtU Co -�4YO1(, or Company:Name EOLCAV SMPCACi Sok---'-o s C Office Address ec ) S` 4,Pcve., ( Q cJ City/State/zip 44Cl.(. c,v1UCGLQ ' 2.c4c,i ,T, 33coc1 Office Phone# ('3O - ) . - c - 4S 341 Qualifier:Name IVIO1URACLO Sifp4-L Office Address S E 4)-Ike. 4- 14'1 City/State/zip c--,0( � � (7-t 330067 Home Phone# (.SUS ) (pd%- $4L0-i /(3os-) 44-1_43-3c • Owner. Name N(cite,tte, 0‹,1(0cla, Office Address A00 S.S 4 _ ( 4'1 City/State/ ip -ftc-U_P.AMALt..._ 4ty.c- 'i Wit, :300`t Home Phone# (` ) }-a 4G1 PROVIDE PHOTOCOPIES OF THE FOLLOWING DOCUMENTS Qualifier's Driver's License Oh Sd40-S40-9-0-4 SC-O State: -FL City Business Tax License City: 4401 L1/41cl Lt_. (€ ct1 County Business Tax License County: 62-ocuctra, Nuiril State License COCA S 3a 9-c14 Certificate of Competency Certificates of Insurance must show the City of Dania Beach as the Certificate Holder General Liability Expiration Date: Off. - 1'r - a S Workers Compensation Expiration Date: ( a-acl - 014 I hereby certify that the in��•`u' ion co -airldd her 'n is true and accurate to the best of my knowledge. Qualifier's Signature Date The for oing instrument was acknowledged before me this 6 day of 20 a4 j WNW Q�I(l(} .SKaI who is personally known to me or has produced as identification and did(or did not)take an oath My Commission Expires: 10/ 21 I TT- ppllll/f/ *ter, P, Nicolle Delga o o ° ` Comm.:HN 189955 ==i y.,�,: Expires.Oct.21,2025 Contractor R stration Rev. '%',;E OwF.' S Notary Public•State of Florida """"". 09/26/2017 • ..(:) O n W U = v) 0 W V 10 Ce I- 7 (� Q W W 3I., vi Q O o I - CO Z co D F- o Z V Q • 1 0 Z t~ N 8 vv) IMIIIIIMCA in LT MIMI 0. If) Z F- 0 Z co ^ tV p u Q LL Li,' W p[ M :; M M J A .N O _V u z J ra GL "� LI- M w U .- N c C QO a u� _ www LLi o #LL U NQa. wZ = i ' . -� o Z Z v U Q Q -"St- roc>. . Y °0 z W " p v) N a� OI- Z ZU a o c z _ uto IfO 1 . w _ -Z O 0 -J J ,W � Q QV ( im 3 IO � Z ..� , p. �- CaV U Z 0 c=W " .O lto : - 3 w5 _ 4-1 Z Z O Q 0W Z o cc I > 2 O W a- I a W Oyu 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 R@CBipt#:GE E ALB CONTRACTOR (GENE AL YP Business Name:SOLAR IMPACT SOLUTIONS INC Business T e: CONTRACTOR) Owner Name:SIGAL, MAURICIO (QUALIFIER) Business Opened:09/02/2023 Business Location:800 SE 4TH AVE STE 142 State/County/Cert/Reg:CGC1532794 HALLANDALE Exemption Code: Business Phone:305 772-9539 Rooms Seats Employees Machines Professionals 2 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 Brower('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. Malting Address: SOLAR IMPACT SOLUTIONS INC Receipt t#10A-23-00006113 800 SE 4TH AVE STE 142 HALLANDLE BCH, FL Paid 07/30/2024 27.00 33009-6493 111, 20'9A 'IAnC A CERTIFICATE OF LIABILITY IN SURANCE DATE(MM/DD/YYYY) 9/6/2024 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 Cinszone Insurance Services, LLC PCT PHOkNNE Certificate Team 2721 Citrus Road,Suite A PHONE (A/c.No.Ext):877-308-9663 FAX ,No):916 400-2625 Rancho Cordova, CA 95742 E-MAIL ADDRESS: certs@inszoneins.com — — INSURER(S)AFFORDING COVERAGE NAIC# INSURED License#:0F82764 INSURER A:Sutton Specialty Insurance Company 16848 Solar Impact Solutions, Inc. SOLAIMP-01 INSURER B: 800 S.E.4th Avenue, Suite 142 INSURERC: Hallandale, FL 33009 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1632174803 ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE N 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 SUER LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY (MM/DD/YYYY) (MM/DD/YYYY) LIMITS ISCP04000022433 2/14/2024 2/14/2025 EACH OCCURRENCE $1,000,000 J CLAIMS-MADE I X I OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $50,000 MED EXP(Any one person) $5,000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $1,000,000 EC X POLICY I I I I LOC GENERAL AGGREGATE $2,000,000 OTHER: PRODUCTS-COMP/OP AGG $2,000,000 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS HIRED NON-OWNED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLALU>,B OCCUR $ EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ DED I I RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY I STATUTE I I OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N (MandaOFFICEtory In NEREXCLUDED? I I N/A E.L.EACH ACCIDENT (Mandatory In NH) $ (yes,describe under E.L.DISEASE-EA EMPLOYEE $ If 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) Verification Of Insurance CERTIFICATE HOLDER CANCELLATION City of Dania Beach 100 W. Dania Beach Blvd. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Dania Beach, FL 33004 AUTHORIZED REPRESENTATIVE ACORD©1988-2015 CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A Rom® CERTIFICATE OF LIAB ILITYINSURANCE DATE(MM/OD/YYyy) 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 POLICIES0 2 4 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 South Fl Commercial Insurance NAME: ANGEL CASTRO 8181 NW 154 Street,Suite 270 PHONE A/C,No,Ext: (305)819-8618 r ADDRESS: angel@sfcins.com (A/C,No): Miami Lakes INSURER(S)AFFORDING COVERAGE NAIC# INSURED FL 33016 INSURER A: Berkshire Hathaway Direct Insurance Company 10391 SOLAR IMPACT SOLUTIONS INC 800 SE 4TH AVE SUITE 142 INSURER D: HALLANDALE BEACH COVERAGES FL 33009 CERTIFICATE 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 VWITH RESISION PECT WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ��.��EaXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ■+�:a TYPE OF INSURANCE ' t COMMERCIAL GENERAL LIABILITY POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) ■CLAIMS-MADE ❑OCCUR EACH OCCURRENCE �•.. • PREMISES(Ea occurrence)MED EXP(Any one person) ®- 13111111111111111.1 'L AGGREGATE LIMIT APPLIES PER: monammmintiomm PERSONAL&ADV INJURYPOLICY ❑JECTJECT LOC OTHER: PRODUCTS-COMP/OP AGG AUTOMOBILE LIABILITY 11111111111111111 IIIIIIIIIIIIIIIIMMIIIIIIIIIIM III ANY AUTO •�e ' ' ■HIRED R pS ONLY ■AUTODULED BODILY accident) (Per person) ■AUTOS ONLY AUTOSNON-OWNEDONLY 111111111111111111 BODILY INJURY(Per accident) ■ : ONLY ■UMBRELLA LIAR ■OCCUR IIIEXCESS LIAB .111111111111111.111.1111111111111 ■DED ■RETENTION CLAIMS-MADE EACH OCCURRENCE ORKERS COMPENSATION el 1112101111111111111111111 •ND EMPLOYERS'LIABILITY NY PROPRIETOR/PARTNER/EXECUTIVEDY/N ■ ■ +FFICER/MEMBER EXCLUDED? Mandatory in NH) II If N9 WC013043 Dyes, DESCRIPTION OF OPERATIONS below 12/29/2023 12 2 E.L.EACH ACCIDENT 11111.111111111111 / 9/20_4 5 1,000,000 is E.L.DISEASE-EA EMPLOYEE $ 1,000,000 E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Sc hedule,may be attached if more sp ace is required) License#CGC1532794 CERTIFICATE HOLDER CANCELLATION City of Dania Beach 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. AUTHORIZED REPRESENTATIVE Dania Beach FL 33004 A,+jN,T C,as,fro ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. s r; ' s.. 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