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CLB Agenda 08/21/2013CONTRACTORS LICENSING BOARD Agenda August 21, 2013 Co er C014ftty COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA AUGUST 21, 2013 9:00 A.M. COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING BOARD OF COUNTY COMMISSIONERS CHAMBERS ANY PERSON WHO DECIDES TO APPEAL A DECISION OF THIS BOARD WILL NEED A RECORD OF THE PROCEEDINGS PERTAINING THERETO, AND THEREFORE MAY NEED TO ENSURE THAT A VERBATIM RECORD OF THE PROCEEDINGS IS MADE, WHICH RECORD INCLUDES THAT TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL IS TO BE BASED. ROLL CALL ADDITIONS OR DELETIONS: III. APPROVAL OF AGENDA: IV. APPROVAL OF MINUTES: DATE: July 17, 2013 V. DISCUSSION: VI. NEW BUSINESS: (A) Jimmy M. Dean — Review of credit report(s) (B) Misena Spahiu — Review the and marble application per board's order (C) William M. Barns — Reinstatement of license without re- testing (D) Cruz Olivarez — Review of credit report(s) VII. OLD BUSINESS: (A) Orders of the Board (B) Darleen Rowe /Dazzling Floors, Inc. — Review six month credit report VIII. PUBLIC HEARINGS: (A) Case #2013 -07 — Albert J. Scott — D /B /A — Beaumont Communications Inc. IX. REPORTS: X. NEXT MEETING DATE: WEDNESDAY, SEPTEMBER 18, 2013 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONERS CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 July 17, 2013 MINUTES OF THE MEETING OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD July 17, 2013 Naples, Florida LET IT BE REMEMBERED, that the Collier County Contractors' Licensing Board, having conducted business herein, met on this date at 9:00 AM in REGULAR SESSION in Administrative Building "F," 3rd Floor, Collier County Government Complex, Naples, Florida, with the following Members present: Chairman: Richard Joslin Vice Chair: Patrick White Members: Michael Boyd Terry Jerulle Robert Meister Excused: Ronald Donino Kyle Lantz Thomas Lykos ALSO PRESENT: Michael Ossorio — Supervisor, Contractors' Licensing Office Kevin Noell, Esq. — Assistant County Attorney James F. Morey, Esq. — Attorney for the Contractors' Licensing Board Karen Clements — Licensing Compliance Officer July 17, 2013 Any person who decides to appeal a decision of this Board will need a record of the proceedings and may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the Appeal is to be based. I. ROLL CALL: Chairman Richard Joslin called the meeting to order at 9:16 AM and read the procedures to be followed to appeal a decision. Roll call was taken and a quorum was established. Five voting members were present. II. AGENDA — ADDITIONS OR DELETIONS: Additions: Under Item V, "Discussion" o (A) Work Shop Review from July 8, 2013 - ADD (Pages 38 and 39) Under Item IX, "Reports" o ADD: (A) Senate Bill #50 (effective date: October 1, 2013) (Summary provided by James Morey, Esq., Bond, Schoeneck & King, PLLC) Rescheduled: Under Item VIII, "Public Hearings" o Case Albert J. Scott, d/b /a Beaumont Communications. LLC was withdrawn. It will be heard at the next Board meeting. Chairman , Joslin requested to hear Item V, "Discussion" following Item IX, "Reports." Vice Chairman Patrick White moved to approve the changes to the Agenda as noted. Second in support from Michael Boyd. Carried unanimously, S — 0. III. APPROVAL OF AGENDA: Bice Chairman White moved to approve the Agenda as amended. Second in support from Chairman Richard Joslin. Carried unanimously, S — 0. IV. APPROVAL OF MINUTES — JUNE 19, 2013: Vice Chairman White moved to approve the Minutes of the June 19, 2013 meeting as submitted. Second in support from Michael Boyd. Carried unanimously, S — 0. 2 July 17, 2013 VI. NEW BUSINESS: (Note: Regarding cases heard under Section VI and Section VIII, respectively, the individuals who testified were first sworn in by the Attorney for the Board.) A. Andrew Seiias - Qualify Second Entity • Mr. Seijas is the owner of "Gulf Coast Home Services, Inc." (GCHS). • He is a partner in and the qualifier for "Southwest Floor Design, Inc." (SWFD). Andrew Seijas stated: • He was the initial qualifier for Gulf Coast Home Services, Inc., which is an installation company. • He became a partner in Southwest Floor Design, Inc., which is a flooring dealership • He transferred his license from GCHS to SWFD. • He has petitioned to qualify GCHS as a Second Entity. • The purpose is to keep his businesses separate since GCHS does installations for SWFD. Michael Ossorio stated he has not received any complaints against Gulf Coast Home Services, Inc. He recommended approving the application to Qualify Gulf Coast Home Services, Inc. as a Second Entity. Vice Chairman White moved to approve the application ofAndrew Seijas to qualify Gulf Coast Home Services, Inc. as a "Second Entity. " Second In support from Robert Meister. Carried unanimously, S — 0. VII. OLD BUSINESS: A. Orders of the Board Michael Boyd moved to approve authorizing the Chairman to sign the Orders of the Board! Second in support from Vice Chairman White. Carried unanimously, 5 — 0. VIII. PUBLIC HEARINGS: (A) Case #2013 -07: BCC vs. Albert J. Scott, d /b /a "Beaumont Communications, LLC" • To be heard at the August meeting (per amended Agenda) (B) Case 92013 -08: Misena Spahiu, d/b /a "Naples Expert Flooring, Inc." Chairman Joslin outlined the manner in which the Public Hearing will be conducted: July 17, 2013 • Hearings will be conducted pursuant to the procedures contained in Collier County Ordinance #90 -105, as amended, and Florida Statutes, Title XXXII, "Regulation of Professions and Occupations, " Chapter 489. • The Hearings are quasi-judicial in nature. • Formal "Rules of Evidence" shall not apply. • Fundamental fairness and due process shall be observed and shall govern the proceedings. • Irrelevant, immaterial, or cumulative evidence shall be excluded. • All other evidence of the type commonly relied upon by reasonably prudent persons in the conduct of their affairs shall be admissible, whether or not such evidence would be admissible in a trial in the Courts of the State of Florida. • Hearsay evidence may be used for the purpose of supplementing or explaining any evidence but shall not be deemed sufficient by itself to support a Finding, unless such hearsay would be admissible over objection in a civil action in Court. • The "Rules of Privilege" shall be effective to the same extent that such Rules are now, or hereafter may be, recognized in civil actions. • Any member of the Contractors' Licensing Board may question any witness before the Board. • Each party to the proceedings shall have the right to call and examine witnesses; to introduce Exhibits; to cross - examine witnesses; to impeach any witness regardless of which party called the witness to testify; and to rebut any evidence presented against the party. • The Chairperson or, in his /her absence, the Vice Chair, shall have all powers necessary to conduct the proceedings at the Hearing in a full, fair, and impartial manner, and to preserve order and decorum. • The general process of the Hearing is for the County to present an "Opening Statement" to set forth the charges and, in general terms, how the County intends to prove the charges. • The Respondent will present his/her "Opening Statement" setting forth, in general terms, defenses to the charges. • The County will present its Case in Chief by calling witnesses and presenting evidence. • The Respondent may cross - examine the witnesses. • After the County has closed its Case in Chief, the Respondent may present his/her defense as described previously, i.e., to call and examine witnesses, to introduce Exhibits, to cross - examine witnesses, to impeach any witness regardless of which party called the witness to testify, and to rebut any evidence presented against the party. • After the Respondent has presented his/her case, the County will present a rebuttal to the Respondent's presentation. • When the Rebuttal is concluded, each party is permitted to present a Closing Statement. • The County is allowed a second opportunity to rebut the Respondent's Closing Statement, July 17, 2013 • The Board will close the Public Hearing and begin deliberations. • Prior to beginning deliberations, the Board's Attorney will give a "charge" to the Board, similar to the charge given to a jury, setting out the parameters on which the decision will be based. • During deliberations, the Board can request additional information and clarification from the parties. • The Board will decide two different issues: • Whether the Respondent is guilty of the offense as charged in the Administrative Complaint. A vote will be taken on the matter. • If the Respondent is found guilty, the Board must decide the sanctions to be imposed. • The Board's Attorney will advise the Board concerning the sanctions which may be imposed and the factors to be considered. • The Board will discuss the sanctions and vote. • After the matters are decided, the ChairNice Chair will read a Summary of the Order to be issued by the Board. The Summary is a basic outline of the Order and may not reflect the same language contained in the Final Order. • The Final Order will include complete details as required under State laws and procedures. Vice. Chairman Patrick White moved to approve opening the Public Hearing in Case No. 2013 -08: Board of County Commissioners vs. Nlisena Spahiu, d1b /a "Naples Expert Flooring, Inc., " License No.: 28588, and to enter the information packet into evidence as County's Exhibit "A. " Second in support from Terry Jerulle. Carried unanimously, 5 — 0. Karen Clements, Licensing Compliance Officer, presented the County's "Opening Statement. " • The County was prepared to show that the Respondent violated Ordinance #90 -105, as amended, Section 22.201(6) by violating Florida State Insurance Statutes 440.10(1)(a) by not providing Workers' Compensation insurance coverage to employees Renaldo Frasheri and Alex Galarza on June 14, 2013. Respondent, Misena Spahiu, presented her "Opening Statement. " • Naples Expert Flooring, Inc. is a family -owned business. • Ms. Spahiu's husband, her brother, and her cousin are employed by Naples Expert Flooring. • They began working in flooring installation in Michigan. The family moved to Naples. • They opened Naples Expert Flooring in 2006 with four owners /officers. • They worked primarily as subcontractors to Hadinger Flooring. • In 2006, up to five officers could be listed as "exempt" from Workers' Compensation insurance coverage. July 17, 2013 As the company grew, she obtained Workers' Compensation insurance coverage for a period of two years. Chairman Joslin explained the purpose of the "Opening Statement" was to answer the charges against the company, i.e., to admit or deny same. Ms. Spahiu stated the charges were admitted. She further stated the workers in question were not scheduled to work at the job site because she was in the process of securing insurance coverage for them. • She began trying to obtain Workers' Compensation insurance coverage for the business since May, 2013. • Obtaining the insurance coverage in 2013 was more complicated than when she obtained it initially — there was an underwriting process that she was not aware of previously which took longer than anticipated. • She obtained a quote from the insurance company on June 14, 2013. • She was unable to sign the papers on June 14th due to errors contained in the documents, i.e., the company installs carpeting as well as hardwood flooring. • She obtained insurance coverage on June 18, 2013. • She apologized, stating the workers were not to have been at the job site. Karen Clements referenced the following pages within County's Exhibit "A:" • E 1 through E--3: Code Case detail sheets; • E -4: "Stop Work" Order; E -5: Photo of Renaldo Frasheri and Alex Galarza who initially provided false names to her at the job site; • E -12: Notification of Complaint sent to Ms. Spahiu via certified mail; • E -14: Verification of delivery by USPS of certified mail; • E -17: Workers' Compensation exemption listing; • E -24: Copies of drivers' licenses correctly identifying Bernard Spahiu and Edrit Frasheri (the names previously given by Renaldo Frasheri and Alex Gal arza); • E -28: Quote for insurance coverage; Ms. Clements verified insurance coverage was current for Naples Expert Flooring, Inc. as of June 18, 2013, E -37: Copy of Citation #4226, issued by Ian Jackson on October 1, 2008, for the same violation; E -41: Copy of Citation #6790, issued by Karen Clements on March 16, 2012, for the same violation. Ms. Clements noted the company has been issued a total of three Citations for the same Workers' Compensation violation. She further stated: • On June 14, 2013, she observed men working at 238 Stanhope Circle. July 17, 2013 • She spoke with Mark Mazoni from J. L. Bruce Contracting who verified that a carpet installation was taking place. • Two workers identified themselves as Eddie Frasheri and Bernard Frasheri. They stated they were officers of Naples Flooring, Inc. and exempted from Workers' Compensation requirements. • They stated the job had been subbed out through Hadinger Flooring. • She contacted Hadinger who verified the job had been subbed out to Napes Flooring. • She found only two Workers' Compensation exemptions: Edrit Frasheri and Misena Spahiu who is the Qualifer for the company. • The two workers could not provide identification and claimed to have been dropped off at the job site by a van. • They did try to call the driver to return to the job site with the identification. • She called Misena who stated only Bernard Spahiu and Edrit Frasheri should be at the job site. • When she went to speak to the workers, they had walked off the job site. • The "Stop Work" Order was posted. • She contacted Misena Spahiu to request that she accompany Bernard and Edrit to the Contractors' Licensing Office with their identification. • Ms. Spahiu brought the identification for Bernard and Edrit to the Office. • Neither had been present at the job site during the site inspection. • Misena presented a quote for the Workers' Compensation coverage (E -28) and was informed it was not acceptable because it was not proof of coverage. • Bernard Spahiu and Edrit Frasheri appeared at the Contractors' Licensing Office to explain they had taken the two men to the job site to "try them out." • The workers were identified as Renaldo Frasheri and Alex Galarza. • Renaldo Frasheri was also identified as an "Assistant Secretary /Director" on the Annual Report of Naples Expert Flooring, Inc. at Sunbiz.org website (Florida Department of State — Division of Corporations). • Alex Galarza is a friend. • Ms. Spahiu was notified of the Hearing by personal delivery and via certified mail. Chairman Joslin noted there appeared to be a pattern of repeat behavior. Ms. Spahiu explained her brother left the country for a period of one year. Since only Edrit and Bernard were working, continuing the Workers' Compensation insurance coverage was not necessary and she cancelled the policy. After her brother returned and business picked up again, she began the process to obtain a new policy since she knew additional workers would be hired. • Renaldo Frasheri is Edrit's brother. He was hired and made a director so he could work. • Since the incident, he has moved to New York City and no longer works for the company. • His name will be removed from the paperwork as an officer of the company. • Alex will be hired as an employee. IIe is covered under the new policy. 7 July 17, 2013 Ms. Spahiu apologized again for the behavior of the men. She admitted that her husband and cousin should not have brought Renaldo and Alex to the job site. The purpose was to assess their skill levels. She stated she has applied for a tile and marble license and she will ensure that they have the proper insurance in the future. It was noted the County had concluded its case. Vice Chairman White asked for an explanation of the March 16, 2012 violation. Ms. Spahiu stated she misunderstood because she thought all five officers were exempt and didn't require insurance coverage. Nigret Brace was an officer. She understands now that only three officers are allowed to be exempt. He asked her to explain why it took so long to obtain coverage. She stated she was not sure if whether or not Nigert Brace was going to work for the company on a permanent basis. Edrit had been working for a company on Marco Island. After it closed, he began to work with Bernard on the Hadinger jobs. Edrit and Bernard were exempt, but Nigert Bruce should not have been working. Vice Chairman White observed two problems: (1) there may not be sufficient communication within management, and (2) there is a pattern and practice of disregarding the law. He slated the Respondent appeared to have the process backwards. In other words, potential employees are not evaluated before they are placed on Workers' Comp — it is the other way around. First, they are covered and then you decide. You pay the premium or you pay the penalty. He further stated he appreciated that the Respondent accepted responsibility and admitting that she understood a violation had been committed. The problem is the number of times the same violation was committed. He asked why this was the third violation. Respondent Spahiu replied that perhaps she had not managed the process correctly, i.e., to insure first and then hire. She admitted she did not understand how serious the requirement was to obtain Workers' Compensation insurance coverage for the employees. Vice Chairman White noted the penalties on both the State and County levels could be severe. The "Stop Work" Order prevented the men from working. If they could not perform the work, the contract could not be fulfilled. He stated he was trying to understand the Respondent's thought process and her ability to effectively communicate within the company, and what was her intent. He further stated if the intent was to follow the law, the penalties might be less but, considering it was the third offense, it was difficult to reach that conclusion. Chairman Joslin stated he was disturbed by the behavior of the two men at the job site who lied to the Licensing Compliance Officer to conceal their identities. He questioned whether they had been instructed to do so if they were ever questioned by an authority. Respondent Spahiu stated Renaldo is Edrit's brother. She stated, "We have had July 17, 2013 this conversation before that we couldn't have them on the job because only Edrit, Bernard and I were insured. So they had heard that from us before — they heard our conversation — and also that we were trying to get Workers' Comp and that's where the lying came from." She further stated while she could not control the fact that he lied, she will remove his name as an officer from the Annual Report on the Sunbiz website, and confirmed Renaldo no longer works for Naples Expert Flooring, Inc. Chairman Joslin asked why the Respondent had not initially contacted a leasing company to insure the company's employees until she was able to secure Workers' Comp. coverage. Ms. Spahiu replied she had not thought of it at the time. She stated she began the process in May and did not receive an answer until June. She further stated she has emails with other companies which prove that she was trying to obtain Workers' Comp. coverage. She questioned the delay and was informed that Underwriting was the problem. Chairman ,Toslin again asked why she had not obtained Workers' Comp insurance since the March, 2012 violation. She stated it was not required because only Bernard and Edrit were working on the Hadinger jobs. They were exempt. There were no employees from March, 2012 until April, 2013 when business began to improve and we thought about hiring new employees. Vice Chairman White stated it was a rather expensive way to learn about the opportunity to use a "temp" leasing service and be covered for Workers' Comp. to `try out' potential employees. He continued the reality was — even if they were not supposed to — the men were on the job site. He noted the better business practice, for the future, would be to use a temp leasing service to evaluate the skill level of an individual before actually hiring him/her as an employee. Ms. Spahiu agreed. Terry Jerulle asked the Respondent if she was the Qualifer of the company and she replied, "Yes." When asked if she could control her brother, Ms. Spahiu responded she could control him and he knew the two men should not have been at the job site, but it was her husband and her cousin who brought the men to the job site. Ms. Spahiu acquiesced to his point, i.e., that she had not been able to control her employees in the past but reiterated she would control them in the future. He noted the Respondent stated she was not aware of the consequences of not having Workers' Compensation, i.e., penalties, even though she was the Qualifier for her company. She responded she was not aware of how long the process took and how difficult it would be to obtain the policy. She said she thought the process would have been similar to obtaining general liability insurance. i.e., make a phone call — obtain a quote — pay the premium. E July 17, 2013 Mr. Jerulle reminded the Respondent that her company had been cited for two previous violations, i.e., in 2008 and 2012. She replied she obtained a policy in 2008 and it remained active for one and one - half years. She stated obtaining coverage in 2013 was more difficult because she had cancelled the previous policy in 2012. Vice Chairman White stated while the Respondent's explanations sounded rational, some of the facts were troubling. He continued as a Qualifier, Respondent should have a firm grasp of the financial and operational management of the company. He asked if she understood the two methods of obtaining Workers' Compensation insurance for employees: (a) to cover them under her company's policy, or (b) to use the coverage provided by a leasing company until the workers were hired. The point was to break the pattern. He stated, "This should be the last time anyone has a conversation about Workers' Compensation and your business." Chairman Joslin reiterated the Respondent's testimony was the she was guilty of the charge. The County did not present a "Closing Statement." The Respondent stated she will have Workers' Compensation coverage "going forward" and, in the future, she will use a leasing company to "try out" employees until they are permanently hired. She asked the Board to allow her company to remain open and to obtain the tile and marble license. Vice Chairman White explained that the application for a tile and marble license was not part of the current proceeding before the Board. Vice Chairman White moved to approve closing the Public Hearing. Second in supportfrom Terry Jerulle. Carried unanimously, 5 — 0. Chairman Joslin asked the Board's Attorney to present the Charge. Attorney Morey outlined the Charge to the Board: • The Board shall ascertain in its deliberations that fundamental fairness and due process were accorded to the Respondent. • Pursuant to Section 22- 203(g) (5) of the Codified Ordinance, the formal Rules of Evidence set out in Florida Statutes shall not apply. • The Board shall consider solely the evidence presented at the Hearing in its deliberation of the matter. • The Board shall exclude from its deliberations irrelevant, immaterial, and cumulative testimony. • The Board shall admit and consider all other evidence of a type commonly relied upon by reasonably prudent persons in the conduct of their affairs, whether or not such evidence would be admissible in a Court of Law. a July 17, 2013 • Hearsay evidence may be used to explain or supplement any other evidence but hearsay, by itself, is not be sufficient to support a Finding unless such hearsay would be admissible over objection in a civil action in Court. • The Standard of Proof in actions where a Respondent may lose his/her privileges to practice his/her profession is that the evidence presented by the Complainant must prove the Complainant's case in a clear and convincing manner. • The Burden of Proof on the Complainant is a larger burden than the "Preponderance of Evidence" standard set in civil cases. • The Standard of Evidence is to be weighed solely as to the charges set out in the Complaint. • The only charges the Board may decide upon are the ones to which the Respondent has had an opportunity to prepare a defense. • The damages awarded by the Board must be directly related to the charges. • The decision made by the Board shall be stated orally at the Hearing and is effective upon being read, unless the Board orders otherwise. • The Respondent, if found guilty, has certain appeal rights to the Contractors' Licensing Board, the Courts, and the State's Construction Industry Licensing Board ( "CILB "), if applicable. • The Board shall vote upon the evidence presented in all areas and if the Respondent is found in violation, shall adopt the Administrative Complaint. • The Board shall also make Findings of Fact and Conclusions of Law in support of the charges set out in the Complaint. Chairman Joslin opened the floor to discussion. Chairman Joslin stated the Respondent admitted, through her testimony, that she was guilty of the violation. Ile further stated the fact that there have been a total of three citations for the same violation indicates a definite pattern. He expressed concern regarding the conduct of the men at the job site, i.e., lying to hide their identify and employer. Vice Chairman Patrick White moved to approve finding the Respondent, Misena Spahiu, d1b /a "Naples Expert Flooring, Inc., " License Number 28588, guilty of Count I of the Administrative Complaint based upon the testimony and evidence presented. Second in support from Michael Boyd. Carried unanimously, 5 — 0. Attorney Morey noted the Respondent is a Collier County licensed Contractor. With respect to holders of Collier County Certificates of Competency Contractor who have been found to be guilty of misconduct under Section 22 -203 of the Ordinance, the Contractors' Licensing Board may, but is not required to, impose any of the following Sanctions: (1) Revocation of the Collier County (or City) Certificate of Competency, (2) Suspension of the Collier County (or City) Certificate of Competency, July 17, 2013 (3) Denial of the issuance or renewal of the Collier County (or City) Certificate of Competency, (4) Imposition of a period of probation, not to exceed two years in length, during which time the Contractor's contracting activity shall be under the supervision of the Collier County Contractors' Licensing Board, (5) Imposition of a fine not to exceed $5,000, (6) Issuance of a public reprimand, (7) Requirement for re- examination or participation in a duly- accredited program of continuing education directly related to the Contractor's contracting activity, (8) Recovery of investigative costs incurred by the County for the prosecution of the violation, and (9) Denial of the issuance of Collier County or City building permits or requiring the issuance of such permits with specific conditions. Attorney Morey further advised the Board that, when imposing any of the possible Disciplinary Sanctions on a Contractor, the Contractors' Licensing Board may consider all the evidence presented during the Public Hearing as well as: (l) The gravity of the violation; (2) The impact of the violation on public Health/Safety or Welfare; (3) Any actions taken by the violator to correct the violation(s); (4) Any previous violations committed by the violator, and (5) Any other evidence presented at the Hearing by the parties relevant to the Sanction which is appropriate for the case, given the nature of the violation(s) or the violator. Chairman Joslin requested the County's recommendations. Michael Ossorio stated the case paralleled the Irene Lee case, previously heard by the Board, and the same penalties would be applied. • Imposition of a $5,000 fine, to be paid within thirty (30) days; • Requirement to take and pass the Business Procedures test within thirty (30) days; • Imposition of a two -year probationary period during which Ms. Spahiu is to notify the Contractors' Licensing Office of her company's jobs, via email, on a weekly basis; • If the fine is not paid or the Business Procedures test is not taken and passed within thirty days, her Certificate of Competency will be revoked; • Reimbursement to Collier County for investigative costs incurred in the prosecution of this case in the sum of $650. Discussion: Robert Meister asked if the County is automatically notified if a company's general liability insurance or Workers' Compensation coverage is no longer in effect. Michael Ossorio replied the County is notified if it is the Certificate holder. He noted the Respondent had obtained Workers' Compensation coverage and the County had a certificate on file. 12 July 17, 2013 Michael Ossorio added another condition to the County's recommendation: • For any additional licenses that the Respondent wishes to acquire in the future are to be approved by the Contractors' Licensing Board. She is required to petition the Board for review. Vice Chairman White asked to Board's attorney if the Board had the authority to re -write its own rules with regard to a specific applicant. His concern: due process for the Respondent. Attorney Morey referred to the Municipal Code, Article 22 -184: "Standards for the Issuance or Denial of a Certificate of Competency." b. Referral of Application to Contractor's Licensing Board for Decision. If it does not appear on the face of the application that the Applicant has complied with the requirements of this Article so as to be eligible for a Certificate of Competency, then the Contractors' Licensing Supervisor shall refer the application to the Contractors' Licensing Board for a decision regarding approval or denial of the application. Vice Chairman White suggested a better way might be to impose the County's recommendation as a condition of probation rather than a specific penalty. Michael Ossorio stated he would withdraw the condition. Mr. White suggested adding the following language: "For all pending or future ... within the two -year probationary period ..." Mr. Ossorio stated a public reprimand should also be added to the County's recommendations. Vice Chairman White moved to approve that, based on a finding of guilty, the following penalties are to be imposed: • Imposition of a two -year probationary period during which Ms. Spahiu is to notify the Contractors' Licensing Office of her company's jobs, via email, on a weekly basis; • During the probationary period, any pending or future applications for additional Certificates of Competency for other trades will be brought before the Contractor's Licensing Board; • Imposition of a $5,000 fine, to be paid within thirty (30) days; • Imposition of a requirement to take and pass the Business Procedures test within thirty (30) days; • If the fine is not paid or the Business Procedures test is not taken and passed within thirty days, her Certificate of Competency will be revoked; • Reimbursement to Collier County for investigative costs incurred in the prosecution of this case in the sum of $650 within thirty (30) days • Issuance of a public reprimand. Vice Chairman White noted the penalties will become effective as soon as approve by the Board while the appeal period begins as soon as the Order is signed. Michael Ossorio confirmed the public reprimand will not be issued until twenty 13 July 17, 2013 (20) days after the Order is signed. A second in support of the motion was offered by Terry Jerulle. Carried unanimously, 5 — 0. Chairman Joslin outlined the Board's Order: This cause came on for public hearing before the Contractors' Licensing Board on July 17, 2013 for consideration of the Administrative Complaint in Case #2013 -08 filed against Misena Spahiu, d/b /a "Naples Expert Flooring, Inc." the holder of record of Collier County Certificate of Competency Number 28588. Service of the Complaint was made in accordance with Collier County Ordinance 90 -105, as amended. The Board, at this Hearing, having heard testimony under oath, received evidence and heard arguments respective to all appropriate matters, and thereupon issued its Findings of Facts and Conclusions of Law as follows. Findings of Fact: • Misena Spahiu, d /b /a "Naples Expert Flooring, Inc.," is the holder of record of Collier County Certificate of Competency Number 28588. • The Board of County Commissioners, Collier County, Florida, Contractors' Licensing Board is the Petitioner (Complainant) in this matter. • The Board has jurisdiction of the person of the Respondent. • Respondent, Misena Spahiu, was present at the Public Hearing but was not represented by Counsel at the Hearing held on July 17, 2013. • The Respondent had been properly noticed concerning the Hearing. • All notices required by Collier County Ordinance 90 -105, as amended, had been properly issued and were personally delivered. • The Respondent acted in a manner that is in violation of Collier County Ordinances and is the one who committed the act. • The allegations of fact as set forth in Administrative Complaint as to: o Count 1, under Section 22- 201(6): "Disregards or violates, in the performance of his /her Contracting business in the County, any of the building, Safety, heath, insurance or Workers' Compensation laws of the State, or Ordinances of this County. " has been found to be supported by the evidence presented at the Hearing. Conclusions of Law: The Conclusions of Law alleged and set forth in the Administrative Complaint as to Count 1 has been approved, adopted and incorporated herein, to wit: "The Respondent violated Section 22- 201(6) of Collier County Ordinance 90 -105, as amended, in the performance of her contracting business in Collier County by acting in violation of the Section set out in the Administrative Complaint with particularity." 14 July 17, 2013 Order of the Board: • Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and in Collier County Ordinance 90 -105, as amended, by a vote of five (5) in favor and none (0) in opposition, a majority vote of the Board members present, the Respondent has been found in violation as set out above. • Further, it is hereby ordered by a vote of five (5) in favor, and none (0) in opposition, a majority vote of the Board members present, that the following disciplinary sanctions and related Order are hereby imposed upon the holder of Collier County Certificate of Competency #28588, to wit: o Imposition of a two -year probationary period during which Ms. Spahiu is to notify the Contractors' Licensing Office of her company's jobs, via email, on a weekly basis; • During the probationary period, any pending or future applications for additional Certificates of Competency for other trades will be brought before the Contractor's Licensing Board; • Imposition of a $5,000 fine, to be paid within thirty (30) days; • Imposition of a requirement to take and pass the Business Procedures test within thirty (30) days; • if the fine is not paid or the Business Procedures test is not taken and passed within thirty days, her Certificate of Competency will be revoked; • Reimbursement to Collier County for investigative costs incurred in the prosecution of this case in the sum of $650 within thirty (30) days • Issuance of a public reprimand. Chairman Joslin noted the case was closed. BREAK: 10:29 AM RECONVENED: 10:45 AM V. DISCUSSION: (A) Work Shop Review from July 8, 2013 — Pages 38 and 39 Michael Ossorio stated Pages 38 and 39 of the Ordinance had been distributed to the Board members. He explained the code -key: • If a word or phrase was highlighted in red with a line through it, it was delete . • If a word or phrase was highlighted in red and underlined, it was added. The following typographical errors were found: • On Page 38: o Under 4.3.1(a), 5th line, Deleted the word, "Mechanical" at the start of the line; K, July 17, 2013 o Under 4.3.1(a), 91" line, the phrase "three hundred dollars" should be deleted and the phrase "one thousand dollars" should be inserted; o Under 4.3.1.(a), the word "re isg erted" should be changed to "registered" (3`d line from the bottom) Vice Chairman White asked if the term, "License Compliance Officers" was a defined term. Michael Ossorio confirmed it was defined under "Human Resources." He will verify the location of the definition within the Ordinance. Attorney Morey stated the Contractors' Licensing Board could recommend drafting a new Ordinance for inclusion in the Code of Laws, but suggested using the current document to identify the changes. Michael Ossorio noted the Ordinance was last revised in 2006 although it was reviewed in 2010. The Board of County Commissioners elected not to amend the document at that time. He stated the reason why an amendment to the Ordinance is under consideration was to comply with the changes in the law. • Page 39: o Under subparagraph "e ": Delete the word "minor" (2nd line) Terry Jerulle asked how a third offence was handled. Vice Chairman White replied if it was uncontested, it was referred to the State Attorney's Office for "criminal prosecution." There was no applicable fine. Discussion ensued concerning Section 2.1 and 2.2 of the Ordinance. Michael Ossorio explained the various items that comprised a "completed" application. Mr. Ossorio stated he was on the Agenda for last week's DSAC meeting. He provided an overview of the Workshop and noted the Development Services Advisory Committee has been very supportive. Vice Chairman White moved to approve recommending the proposed text with the changes as outlined above and to authorize the Chairman to sign a Resolution or other appropriate document to support an Executive Summary which will be presented to the Board of County Commissioners. Second in support from Michael Boyd. Carried unanimously, S — 0. A question was raised concerning the vote to approve the minutes. Attorney Morey researched the issue as follows: "Question: Can a member vote on or second a motion to approve the minutes of a meeting that he did not attend? Answer: Yes. (ROHR (IOth ed.), pp. 343 - 344)" N July 17, 2013 IX. REPORTS: (A) Senate Bill #50 (effective: October 1, 2013) (Summary provided by James Morey, Esq., Bond, Schoeneek & King, PLLC) Attorney Morey explained Senate Bill #50 will create a new Section (286.044) in Florida Statutes, effective October 1, 2013. The new Section codifies and places into the FS recognition of an individual's right to be heard at a public meeting even if the individual was not a participant in the proceeding. Vice Chairman White noted the 4th bulleted point created an exception for meetings when a Board, such as the Contractors' Licensing Board, is acting in a quasi-judicial capacity and stated a different set of rules apply to ex -parte proceedings. Attorney Morey stated his purpose was to bring the new Section to the attention of the Board. He suggested the item could be discussed in depth at a future meeting to develop a written policy concerning who could speak, under which circumstances, for how long, and to "carve out" the exceptions presented by Vice Chairman White, Mr. Morey cited an example of an administrative complaint being heard in a public hearing and a member of the public who is not a party to or affected by the case wishes to make a statement. The Statute would allow the Board to create a rule to prevent a casual observer from commenting during the proceeding. Vice Chairman White requested the Board's attorney consult with the County Attorney's Office for direction regarding drafting a policy or procedure. Consensus. The topic will be brought back as "Old Business" on a future Agenda. X. MEMBER COMMENTS: (None) XI. NEXT MEETING DATE: Wednesday, August 21, 2013 BCC Chambers, 3`d Floor — Administrative Building "F," Government Complex, 3301 E. Tamiami Trail, Naples, FL There being no further business for the good of the County, the meeting was adjourned by the order of the Chairman at 11:36 AM. 17 July 17, 2013 COLLIER COUNTY CONTRACTORS LICENSING BOARD Richard Joslin, Chairman The Minutes were approved by the Vice Chairman on , 2013, "as submitted'[_] OR "as amended'[_]. IN] s . -6 3 � 7 Mkh CDES Operations -& Regulatory +Management Licensing Section. 2800 North Horseshoe Drive aQV 011-7 Naples,' FL 34104 APPLICATION FOR COLLIER COUNTYICITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application :fee must accompany. this application. The fee is not refundable- after the application has . been accepted and entered on the records. -AH checks should be made payable 'to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 904-05, as-amended. NAME OF COMPANY: Ekact Corporate /Business Nau1e: 0-4. ri.►Ghe:. INC- Fiction Name /DBA: � d. O�r.Y Go.tisl�rvGfsvf. NlG. Qualifier Name �j...- .....��D: -�•. physical Address: 4014 - S-040 (Number 8s Street) (City) (State) (Zip Code) MailingAddress::!2o.3G 3� irQt;✓ /1/ �-�-• ��! /� (Number 86 Street) (City) (State) (Zip Code) Telephone: ';SS.S- 876?7 TYP OF LICENSE: General, $230.00 Q Building $230.00 - Q Residential $230.00 Mechanical -$230.00 Roofing $230.00 Specialty trade: mere. _0' - C.�v±'�� : -•_ QHANGE -OF- STATUS: ( ) Reinstatement-- ( ) From One Business to Another Page I of 4 E -Mail: 4.N ❑ Electrician . $230.00 Q. Plumber $230.00 0 Air Cond.° $230.00 0 Swimming Pooly'. b 0 Specialty2b5 ( ) Dormant 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. 2. _Last all businesses, --firm. ms, entities or contracting businesses you have been associated with during the fast ten years (ex. Held a license for or been a partner). Attach extra pages if needed. LiD Ges A� . 066 &,144- 621.'A , a"' . y< (064.1 4b.) 'j"v�nJCs GCfrtSr'•w�'�o fC Gvs1�� _ Qw/ �.�. . J 3. List all debts you or any company(s).assooiated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. AFFIDAVIT certify that the - foregoing is true and coned to the best of my knowledge. Authorized Officer of the Firm STATE OF FLORIDA COUNTY OF, The foregoing Instrument as acknowledged bafore me this 71t 120 r 3 (Date) �( By .,J of ..f 0. Oe J 15 '' cc K S t t V L T. e (Name of officer, titletagent) (Name of Corporation) a Flo C_ orporation on behalf of the corporation. (State or Pladel1 of Corporation) He/She •has- produced- -.. Urt cj-ei;"s- identification and did not take an oath. (Type of identification) NO ' k31 L TAIM JR tikW� Fdit - SIM a F*ft iMp COMW Evian oa te. m COIIIItAMM I11M111445 - Mail April IpYaar Nel�ryt Aaa. Page 2 of 4 (SIGN ATU RE OF NOTARY) et $,a" QUALIFIER INFORMATION.- m. Name: Address: (Number & Street) Telephone: �9 - S'jS _ p 4.j S.S. M 000 -00- Driver's License: _ _ 2Z _ 0 (Zip Code) Date of Birth: 1. Type of Certificate of Competency for which application is made. 2. The names -and telephone numbers of two persons who will know your whereabouts. kelh 3 3. Have you ever been convicted of a crime related to Contracting? (If yes attach extra sheet with explanation) 7. Have. you or any fins you have been associated with ever filed bankruptcy?__ xUn 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. 9. List your business or work experience during the past ten years. J. n 10. Statement of any formal training you have had in the area for which the application is made. z E �•rlk. �— - o vim,.. ��. �.G...,.� ' r P 3 F A age C,40 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No._ 2006 -46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all .matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful faisdication of any information contained herein is grounds for disqualification. r—� m. CJ!! R"111v1�•f A V C APPLICANT ( UEASE PRINT) a a. c NAME OF COMPANY GNATURE OF APPLICANT STATE OF FLORIDA / COUNTY OF - - 6 t(� ` The foregoing instrument as acknowledged befbre me this 7 (� 2 o l -3 n (Date) By .� -"` y l who has produced r� ✓-t� L (Name of of person acknowledging) (Type of identification) as identification and did not take an oath: NOTARY'S -SEAL E(D&y COOL li o ni Od td. 20ti COM1100 # N 1"144 l 11 NUrrWpMUlMebnL�a ------ (SI TU OF NOTARY) Page 4 of 4 AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if 1 fail to acquire, or maintain at-all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. jSrGNA'fURE OF APPLICANT BUSINESS NAME DATE BEFORE ME this day personally-appeared *"'Y `'' who affirms and says that he has less than-one.employee and does not require Workmen's Compensation and understands that at any lime he employs one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF J The foregoing instrument was acknowledged before me this 7/( (Rate) by i' M-- who has - produced (nz iime of person acknowledging) (Type of Idenowtion) as identification and who did not take an oath.- DAYS L TARN A Newry ft*w • 6aa of Rorer * Coin. ewm 001% 2016 NOTARY SEAL C=MkftR 0 EE 211443 6a�o>NogryAun. 1 7 7 SIGNATUU OF NOTARY NOTARY PUBLIC i t DSH Construction Company Inc. 25000 Tamiami Trail East Naples, Fl. 34145 239 - 821 -4565 Scott@dshfi.com June 13, 2013 To Collier County Licensing Board, To whom it may concern, 1 have been a State Certified General Contractor since 1999 and a State Certified Plumbing Contractor for 5 years. Before that, 1 was a carpentry contractor in Collier County for about 7 years. 1 have known Jimmy for about 5 years and he has helped me out by drawing plans to code for submittal to the various building departments and also has helped me out on various construction projects with technical and manual support. Having the years of experience in all phases of construction 1 know that Jimmy Dean has more knowledge and experience in the construction business than most contractors 1 know. 1 find that he has integrity and good character and would make a good addition to the construction trade here in Collier County. D. Scott Hunt `�gnUy ROWE +q. MY COMMISSION # EE 42035 EXPIRES: December 13.2014 9ondeaTWOugt+Nwan I"AWL f AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER 'J • SLR w . am a resident of n/11" County, (State) and have resided here for more than five (5) years. wring the last five years I have Imown J m''K -( 0 e l- r l (Applicant)- I have had ae opportunity to observe his or her business and personal dealings and find him or her to be a person of onesty, integrity and good character. 1-7 � -.17 (Signature) (Name) Q. ,Sc e l% a rQ j �r (Address) Z qam / G&wc i 7Z Telephone) 7— 3 2 P Z I – Y • L 5— STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this / LVCt y � iD Cl7(� C �adm�owled�ging) who has produced/ ! S �� / % 2y y 5� ame of person (`hype of identification) as identification and who did not take an oath. SHARON L ROWE cw, My COMMISSION # EE 42035 EXPIRES: DOCOMb" 13, 2014 .;.�. r 9or -d7h -g Na odNodryAML NOTARY'S SEAL (P A11E OF NOTAR NOTARY PUBLIC 10 I CUSTOM BUILDERS June 18, 2013 Collier County Licensing Board To Whom It May Concern: I have been a State Certified General Contractor since 2005 and have known Jimmy for about 9 years and he has drafted architectural drawings for submittal to the various building departments and also has helped me out on various construction projects with technical and manual support. Having the years of experience in all phases of construction, I know that Jimmy Dean has more knowledge and experience in the construction business than most contractors I know. I find that he has integrity and good character and would make a good addition to the construction trade here in Collier County. Please feel free to contact me with any questions. Thanks, f Kenneth ox fr Iq l PMB #40 8595 Collier Blvd, Naples, FL 34114 ♦Phone: (239) 261 -1082 ♦ Fax: (239) 261 -1084 F' AFFIDAVIT OF INTEGRITYAND GOOD CHARACTER ��1 n rw am a resident of _ .fl l 1�C County, (State) and have resided here for more than five (5) years. luring the last five years I have known J k Y e, m C,�Y1 (Applicant). I have had ae opportunity to observe his or her business and PeAonal dealings and find him or her to be a person of onesty, integrity and good character. STATE OF FLORIDA COUNTY OF (Signature) (Name) (Address) Telephone) 'the foregoing instrument was acknowledged before me this L'� Y � � 3 by ��Niy�f�r (Date) ' C who has produced / ra�Z,14 R (name of person acknowledging) ('type of identification) y . as identification and who did not take an oath LeEM LVANO # EE 1a9W er30 ms wll �nq NOTARY'S SEAL S GNA ;6M QF NOTARY tl Cli44' (PRINT NAME OF NOTARY} NOTARY PUBLIC Ia Randall Packard Construction, Inc - General Contractor #027881 5790 Houchin Street Naples, Ff. 3410q Office: 23+5411-2663 F ac: 239-591 -0452 Mobile: 239- 289 -8939 June 26, 2013 Collier County Licensing Board To Whom It May Concern: I 'am a State Certified General Contractor and have known Jimmy for about 5 years and he has done many architectural drawings for submittal to the various building departments- He has helped me on various construction projects with technical and manual support. Having the years of experience in all phases of construction, I know that Jimmy Dean has knowledge and experience in the construction business to be able to run a construction company. He has more knowledge than most contractors I know. I find that he has integrity and good character and would make a good addition to the construction trade here in Collier County. Please feel free to contact me with any questions. Thanks, iN I � �p�xur„ JANET P. GRAY Randall Packard -�'t " Notary Pubfk - State of Florida :s My Comm. Expires Mar 14. 2017 Commission -#t EE 858808 Bonded Through WON AWary Assn. Aft AN r� At Q � 4-4 r O C6 �r i O `C v C T . rN.•i bb 0 N 0 I� O U w 0 z u 4-a rA �-t N a� ILI �4 V] tH U .S .i O O c� O o a� Cd .rn U 8 V O O � 4t O d � N a3 O 0 0 x 3 O w • t O N h O w �o a � r ' o -i-� .cn Ul b b O U Q Cl Cad U 03 O 0 0 L v M N 4-i N U O N N O 0 L CL I- 0 U m L U O O X CREDIT CHECK CONFIDENTIAL Individual Credit Report AMERASSIST 130628 11 /10 03/10 300 310 ORIGINAL CREDITOR: TRULY NOLEN OF AMERICA INC BK OF AMER 71397983 DLA =06/06 CAP ONE 515599001244 DLA =02/13 CAPITAL 1 FA 62062116599481001 DLA =09/09 CITIRL 8740098235518 DLA =06/08 06/06 05/05 218400 CLOSED 06/13 01 /11 973 05/13 08/05 34531 03/09 05/06 340000 973 COLLECTION 310 COLL -- -- -- 09-* 00 A AS AGREED 0 0 00 00 00 M1 12 A PASTDUE 60 34 30 0100 00 R3-* 28 A COLLECTION 9947 9947 674 -- -- "-* 09 A PD WAS 120 0 0 0 12 07 07 Mr* 33 C AS AGREED CREDITACPT 06/13 08/12 29268 24672 0 513 0000 00 I1 C 48854558 DLA =05/13 COLLECTION DESGN REC _ __ -- 09-* 01 A HLT2HMA1432695912 06113 06/12 157 158 158 COLL - ORIGINAL CREDITOR: MEDICAL COLLECTION ENHANCRCVRCO _ __ __ 09-* 00 A 49562531 05/11 04/11 981 981 981 COLL - ORIGINAL CREDITOR: SPRINT Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 - (561) 616 -5556 Ordered By: Name....: DEAN, JIMMY MICHAEL Customer :9999 Address : 2036 50TH TERRACE SW Received :06/27/13 NAPLES, FL 34116 Completed :06/27/13 Bill Amt :$60.00 Social #: Applicant: -1631 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date.) Date pate High Unpaid Past Pay Historic stat Current Nos 30 60 90 Status Rev C Creditor Account Number Reported opened Credit Balance Due Terms SETTLED 5TH 3RD BK 07/09 01/04 27468 CLOSED 0 0 0905 02 11 -* 34 85648 DLA =07/09 AMERASSIST 130628 11 /10 03/10 300 310 ORIGINAL CREDITOR: TRULY NOLEN OF AMERICA INC BK OF AMER 71397983 DLA =06/06 CAP ONE 515599001244 DLA =02/13 CAPITAL 1 FA 62062116599481001 DLA =09/09 CITIRL 8740098235518 DLA =06/08 06/06 05/05 218400 CLOSED 06/13 01 /11 973 05/13 08/05 34531 03/09 05/06 340000 973 COLLECTION 310 COLL -- -- -- 09-* 00 A AS AGREED 0 0 00 00 00 M1 12 A PASTDUE 60 34 30 0100 00 R3-* 28 A COLLECTION 9947 9947 674 -- -- "-* 09 A PD WAS 120 0 0 0 12 07 07 Mr* 33 C AS AGREED CREDITACPT 06/13 08/12 29268 24672 0 513 0000 00 I1 C 48854558 DLA =05/13 COLLECTION DESGN REC _ __ -- 09-* 01 A HLT2HMA1432695912 06113 06/12 157 158 158 COLL - ORIGINAL CREDITOR: MEDICAL COLLECTION ENHANCRCVRCO _ __ __ 09-* 00 A 49562531 05/11 04/11 981 981 981 COLL - ORIGINAL CREDITOR: SPRINT Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 - (561) 616 -5556 SM CONFIDENTIAL CREDIT' CHECK Name....: DEAN, JIMMY MICHAEL Customer: 9999 Page: 2 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date.) Creditor Date Date High Unpaid Past Pay Historic Stat current 140s Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA COLLECTION FFCC - CLVLAND O}* 02 A 12420154 05/13 02/11 160 160 160 COLL -- -- ORIGINAL CREDITOR: MEDICAL AS AGREED FRD MOTOR CR 24353915 08/03 07/00 22466 CLOSED 0 0 00 00 00 11 01 A DLA =08/03 AS AGREED FREMONT INV 6000083995 06/04 12/03 136000 CLOSED 0 0 0000 00 M1 06 P DLA =04/04 FST PREMIER 517800642156 03/13 12/12 375 DLA =03/13 FST PREMIER 461007420521 12/10 06/09 714 DLA =07/09 GULF CST COL 2829035 06/13 10/07 150 ORIGINAL CREDITOR: MEDICAL HOMEWARDRES 6474001318296 03/13 05/06 540000 DLA =02/13 HSBC BANK 544045501128 09/05 01/04 530 DLA =09/05 JEFFCAPSYS 2782164169003 06/13 06/11 767 ORIGINAL CREDITOR: WACHOVIA BNK CHK ACCT LITTON LOAN COLLECTION 375 375 11 -- -- -- R9-* 00 A COLLECTION 714 714 21 -- -- -- R9-* 01 A COLLECTION 150 150 COLL -- -- -- 09-* 06 A PD WAS 30 0 0 0 18 02 06 M2-* 39 C AS AGREED PAID 0 REV 00 00 00 R1 20 A COLLECTION 767 767 COLL -- -- -- 09-* 02 A 12019063 05/05 12/03 34000 CLOSED AS AGREED 0 0 0000 00 M1 09 P DLA =05/05 COLLECTION MED BUSI BUR 702014425335 06/13 11/07 118 118 118 COLL -- -- -- 09-* 06 A ORIGINAL CREDITOR: MEDICAL Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check. Inc. - 3017 Exchange Court, Sufte H. West Palm Beach, FL 33409 . (561) 616 -5556 SM CONFIDENTIAL CREDIT CHECK Customer: 9999 Page: 3 Name....: DEAN, JIMMY MICHAEL CREDIT RECORD Credit histor has been checked for a period of seven years or from o en date.) Date High unpaid Past Pay Historic stat Current Hos Date Creditor Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA Account Number COLLECTION MIDLAND FUND __ Og-* 01 A 8542938316 05/13 10/11 2481 2481 2481 COLL - _ __ ORIGINAL CREDITOR: T MOBILE N MIDLAND FUND 8536099861 05/13 09/10 1267 ORIGINAL CREDITOR: VERIZON WIRELESS MIDLAND MCM 07/10 04/09 765 8530714981 ORIGINAL CREDITOR: HSBC BANK NEVADA ONYX ACCEP 1057231896 DLA =09/05 SEARS /CBNA 504994018707 DLA =02/08 SEARS /CBNA 504994017121 DLA =04/07 SLM FINC CO 1058959 DLA =02/08 SLM FINC CO 1061241 DLA =02/04 SUNCOAST CU 41482 DLA =07/07 SUNCOAST CU 41482 DLA =08/05 TOYOTA MTR 70403660643780001 DLA =01/07 COLLECTIO 1267 1267 COLL -- -- -- 09'* 03 A COLLECTION 1043 1043 COLL -- -- -- O9"* 01 A 10/05 08/05 34531 CLOSED 0 AS AGREED 0 00 00 00 11 01 A PD COLLECT 02/08 04/06 8238 PAID 0 REV - _ -- -- R9-* 02 A PD COLLECT 06/07 09/05 1283 PAID 0 REV - - -- -- Rte* 02 A COLLECTION 06/13 04/03 19010 8290 8290 310 -- -- -- I9-* 12 A AS AGREED 02/04 06/03 20105 CLOSED 0 0 0000 00 11 07 A COLLECTION 05/13 01/04 20000 1542615426 475 -- __ __ 19-* 11 A AS AGREED 08/05 09/04 27756 CLOSED 0 0 0000 00 11 11 A PD WAS 90 01/07 02/06 28724 CLOSED 0 0 0201 01 11 - -* 10 S Ordered by: APPLICANT - SEE NAME ABOVE 33409 • i 501 ) 616 -5556 Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, 600 H, West Palm Beach, FL CREDIT CHECK CONFIDENTIAL WELLSFARGO 101019552 DLA =04/09 WILSHIRE CRD 122205 DLA =05/05 04/09 05/08 0 PAID 05/05 12/03 136000 CLOSED PD COLLECT 0 0 -- -- -- 09-* 01 C AS AGREED 0 0 00 00 00 X1 08 C Total trade lines on this report: 34 PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS AS OF 06/27/13: SEE BELOW. - -- TRANSUNION PUBLIC RECORD - -- SOURCE DATE LIAB ECOA TYPE COURT LOC Z 05064186 11/09/07 $15,426 I CIVIL JUDGMENT COLLIER COUNTY COURT Z 05064207 02/03/09 $8,290 I CIVIL JUDGMENT LEE COUNTY COURT SOURCE(S): EQUIFAX TRANSUNION INQUIRIES: 06/27/13 by CREDIT CHECK (TU) #00630273 05/06/13 by CAP ONE (TU) #02699824 DOCKET# PLAINTIFF /ATTORNEY 73250CA SUNCOAST SCHOOLS FEDER 8CCO06249 SLM FINANCIAL CORPORATON COMMENTS: FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS. SAFESCAN / EQUIFAX, HAWK ALERT / TRANSUNION CHECKED FOR FRAUD. REPORT WORKED BY RENEE CREDIT SCORE: APPLICANT FICO SCORE: 494 (spores range from 300 to 850) Ordered by_ APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616 -5556 Customer: 9999 Page: 4 Name.__.: DEAN, JIMMY MICHAEL CREDIT RECORD SCredit history has been checked for a period of seven years or from open date.) Creditor Date Date High Credit Unpaid Past Balance Due Pay Historic Stat Terms 30 60 90 current MOB Status Rev ECOA Account Number Reported Opened AS AGREED TOYOTA MTR 70403660544400001 03/06 07/05 24680 CLOSED 0 0 0000 00 I1 07 S DLA =03/06 WELLSFARGO 101019552 DLA =04/09 WILSHIRE CRD 122205 DLA =05/05 04/09 05/08 0 PAID 05/05 12/03 136000 CLOSED PD COLLECT 0 0 -- -- -- 09-* 01 C AS AGREED 0 0 00 00 00 X1 08 C Total trade lines on this report: 34 PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS AS OF 06/27/13: SEE BELOW. - -- TRANSUNION PUBLIC RECORD - -- SOURCE DATE LIAB ECOA TYPE COURT LOC Z 05064186 11/09/07 $15,426 I CIVIL JUDGMENT COLLIER COUNTY COURT Z 05064207 02/03/09 $8,290 I CIVIL JUDGMENT LEE COUNTY COURT SOURCE(S): EQUIFAX TRANSUNION INQUIRIES: 06/27/13 by CREDIT CHECK (TU) #00630273 05/06/13 by CAP ONE (TU) #02699824 DOCKET# PLAINTIFF /ATTORNEY 73250CA SUNCOAST SCHOOLS FEDER 8CCO06249 SLM FINANCIAL CORPORATON COMMENTS: FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS. SAFESCAN / EQUIFAX, HAWK ALERT / TRANSUNION CHECKED FOR FRAUD. REPORT WORKED BY RENEE CREDIT SCORE: APPLICANT FICO SCORE: 494 (spores range from 300 to 850) Ordered by_ APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616 -5556 _ SM CONFIDENTIAL CK CREDIT CHE Name....: DEAN, JIMMY MICHAEL Customer: 99 Page: 5 99 * ** END OF REPORT * ** 7hispers or�el�epurtBNnahaGSrtnplyagataid�da 9MsaeQRd�a j'dCs�p Is} Risbesed ?! ln gt"wfrm oerer nr9msagldE8�16 .tq�rWef,k�tlowe�9los$iBB� �7ara�10e �dy��„� � rypceetclnidCreQt Itnlfar[ franmy W Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency- Credit Check, Inc_ - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616 -5556 Electronic Articles of Incorporation For J.D. DESIGN CONSTRUCTION INC. F 3000053923 June 24 2013 Sec. of Mate jshivers The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: J.D. DESIGN CONSTRUCTION INC. Article II The principal place of business address: 2036 50TH TERRACE SW NAPLES, FL. 34116 The mailing address of the corporation is: 2036 50TH TERRACE SW NAPLES, FL. 34116 Article III The purpose for which this corporation is organized is: ANy AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: Article V The name and Florida street address of the registered agent is: JIMMY M DEAN 2036 50TH TERRACE SW NAPLES, FL. 34116 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: JIMMY M. DEAN Article VI The name and address of the incorporator is: JIMMY M. DEAN 2036 50TH TERRACE SW NAPLES, FL. 34116 FILED 453923 June . of ttat 3 jshivers Electronic Signature of Incorporator: JIMMY M. DEAN er in I am the incorporator submitting these Articles of Incorporation and affirm that the of State constitutesa true. I am aware that false information submitted in a document to the Department third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1 st and May 1 st in the calendar Year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is /are: Title: PRE JIMMY M DEAN 2036 50TH TERRACE SW NAPLES, FL. 34116 Article VIII The effective date for this corporation shall be: 06/24/2013 Detail by Document Number ii by Document Number .D. DESIGN CONSTRUCTION INC. i ment Number IN Number Filed Date 50TH TERRACE SW .ES, FL 34116 50TH TERRACE SW .ES. FL 34116 1, JIMMY M 50TH TERRACE SW .ES. FL 34116 e & Address PRE EAN, JIMMY M 336 50TH TERRACE SW APLES, FL 34116 No Annual Reports Filed P13000053923 NONE 06/24/2013 FL ACTIVE 06/24/2013 06/24/2013 -- Domestic Profit View image in PDF format Page 1 of 2 http: / /search.sunbiz.org/ Inquiry/ CorporationSearcb/ SearQhResultDOtail /DocumentNumber /d... 7/212013 A� R °® CERTIFICATE OF LIABILITY INSURANCE 06/28/2013 °"' 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("les) must 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 endorsemenlis). PRODUCER Custom Contractors Insurance LLC 390 Concord Dr Sedona, AZ 86336 Phone_ (888) 652513 Fax: (888) 274 -7438 NAME Raleigh Gibson PHONE ggg 52 4513 a No): (888)274-7438 E infoacustomcontractDrSinSurance.CDM B'' A �"� NAtc # INSURER A • Preferred Contractors insurance Co. RRG GENERAL UABIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r;Z;7-1 OCCUR INSURED JD Design Construction Inc. INSURER 8: PCIC5025- PCA500925 INSURER c DAMA PREMISES Ea occtmance INSURER D: MED EXP (Any orm Pew) 2036 50th Terrace SW Naples FL 34116- INSURER E: $ 1,000,000 INSURHtF: $ 2,000,000 1rUVCKFM7C0 VGI[I 1r'1Vf11 G 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. TR TYPE OF INSURANCE P011CY NUMBER POL.ICYEFF POLICYEXP 06/28/201 UWTS EACH OCCURRENCE $ 1,000,000 A GENERAL UABIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r;Z;7-1 OCCUR X PCIC5025- PCA500925 06/28/2013 DAMA PREMISES Ea occtmance $ 50,000 MED EXP (Any orm Pew) S 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG S 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO ALL SCHEDULED NON-OWNED HIRED AUTOS AUTOS UMBRELLA UAB OCCUR EXCESS LIAB CLAIMS-MADE —COMBINED SIR a ntSINGLE LIMIT $ 1,000 t BODILY INJURY (Per person) $ BODILY INJURY (PeracddeM) $ pRer DAMAGE $ $ EACH OCCURRENCE $ AGGREGATE $ $ Om RETENTIONS WNORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE ❑ OFFICERIMEM13EREXCLUDED? (Mandatory in NH) LDEye s, describe under CRIPTION OF OPERATIONS below NIA WCSTATU- OTH- EL EACH ACCIDENT $ EL DISEASE - EAEOWAPLO $ EL DISEASE - POLICY LIMB $ rl ION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Ad"Onal Remarks Schedule. ff more space [s required) RE_ ADDITIONAL INSURED LISTED AS HOLDER 2TIFICATE HOLDER Collier County Licensing Department 2800 N Horseshoe Dr Naples, FL 34104 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE % ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF ELECTION TO BE EXEMPT Please dwroughly read the instructions before completing this application. Print legibly in each data entry field. If this application contains incomplete or inaccurate information or if the bandwaiting is not legible, it may cause a delay in the issuance of your esenption. SECTION l: Applicant Name (please print): Applicant's social security number: Applicant's E-mail address (optional): SECTION 2: I am applying for exemption as a (You must check only one box in this section): CONSTRUCTION INDUSTRY ($50 FEE REQUIRED) - The Division will accept a money order or a cashier's check made payable to the DFS WC ADMINISTRATION TRUST FUND. [Officer of a Corporation (Title): fr e S -OR- ❑ Member of a Limited Liability Company (LLC) NON - CONSTRUCTION INDUSTRY (NO FEE REQUIRED) ❑ Officer of a Corporation (Title): ) An officer electine an exemption under Chapter 440, Florida Statutes is not entitled to benefits under this chapter. SECTION 3. The corporation of which you are an officer or the limited liability company of which you are a member must be registered and in an active status with the Florida Division of Corporations. Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with the Florida Division of Corporations- List the document number (document number shown on your Annual R on file with the Florida Division of Corporations. P 13 e Q o os3 t3 SECTION 4. This exemption application applies only to the person signing the application, the Corporation/LLC that is listed below, and the scope of business or trade listed: _ Name of Corporation or LLC: -j- 13- &J(1511 �e "5�' `' c�� v .1nc . FEIN: X16- 305343 Y AS RRGNTERED WTTH THE FLORHIA Dr-W014 OF CORPORA' IONS Business Name: Phone: (,23q) IF APPLICABLE- LJWr PICmiOUS NAME; DOING NEWNESS AS (DRAY. ALSO KNOWN As NAME (AKA) Applicant's Address of Record: TNrIMAPARTMENTORSUITENUMBER City: /U' -ale S State: �t' Zip: �y �� G County: ` R� Scope of Business or Trade: 1. ��'�� ' ` 2. 3. 4. SECTION 5. List all certified or registered licenses issued pursuant to Chapter 489, F.S. held by the applicant, or the certified or registered license numbers held by the qualifier for the corporation or LLC listed on this application of which the applicant is a corporate off 6. If you have submitted an electronic payment for this application, write the transaction confirmation number in the following space: SECTION 7. Are you affiliated with any corporation (including LLC) other than the corporation (including LLC) to which this application applies? ❑Yes 2-go- IF YES, PLEASE LIST THE NAME(s) AND FEIN(s) OF THE AFFILIATED CORPORATION(s) OR LLC(s): NAME: FEIN: SECTION & If your corporation or LLC is engaged in the construction industry, you must provide the required proof of ownership in the corporation or LLC. A. To be eligible for a construction industry exemption as an officer of a corporation, the applicant must be a shareholder, owning at least 101/o of the stock of the corporation. A COPY OF A STOCK CERTIFICATE EVIDENCING THE REQUIRED OWNERSHIP MUST BE ATTACHED. B. To be eligible for a construction industry exemption as a member of a limited liability company, the applicant must confirm ownership of at least 10% of the company. THE REQUIRED OWNERSHIP MAYBE ESTABLISHED BY PRODUCTION OF DOCUMENTATION REFLECTING THE REQUIRED OWNERSHIP, OR BY SUBMITTING A STATEMENT ATTESTING TO THE REQUIRED OWNERSHIP. THIS APPLICATION IS CONTINUED ON PAGE 2 0M 260, NOTICE OF eLEGTOM TO WE E%EYPT — REVISED 12MB; RULE 69L -"09, F.A.C. SECTION 9. NOTICE OF ELECTION TO BE EXEMPT — Page 2 FRAUD NOTICE A. Any person who, knowingly and with intent to injure, defraud, or deceive the department or any employer or employee, insurance company or any other person, files a notice of election to be exempt containing any false or misleading information is guilty of a felony of the third degree - B. Attestation of applicant - By signing below, I attest that I have read, understand and acknowledge the foregoing notice. SECTION 10. You must identify the workers' compensation insurance carrier that covers any non - exempt employees of your business. Carrier Name: AFFIDAVIT OF APPLICANT: I hereby certify that the information contained herein is true and correct to the best of my knowledge and belief, that this election does not exceed exemption limits for corporate officers, including any affiliated corporations as provided in §440.02 Florida Statutes. APAUCAWSSIGNATM DATE SIGNED NOTARY STATE OF FLORIDA, COUNTY OF Swom to and subscribed before me this_(_ day of J d , by e A Personally Known OR Produced Ice 'fication ✓Type of Identification Produw -OL� QV S c -e"s .z NOTARY SIGNATURE My Commission Exp DAiM �►— 'The collection of the social security number on this form is specifically authorized by Section 440.05(3), Florida Statutes. The social security number will be used as a unique identifier in Division of Workers' Compensation database systems for individuals who have applied for and/or been issued a certificate of election to be exempt It will also be used lo identify information and documents in those database systems regarding individuals who have applied for and/or been issued a certificate of election to be exempt for internal agency tracking purposes and for purposes of responding to both public records requests and subpoenas that require production of specified documents. The social security number may also be used for any other purpose specifically required or authorized by state or federal law.' DWC 260, WMCE OF ELECTION TO BE EXEMPT— REVISED 13!08; RULE WL•6.008, F.A.C. 40Wy Adit - igtt N fi0til Please mail or submit your completed application, application fee, and any required attachm to The Division of Workers' Compensation at the district office nearest your place of basin NIMWYvAm 2295 Victoria Avenue, Suite 163 921 Not Davis Street 401 NW 2°d Avenue Expiration Date: Ft Myers, FL 33901 Suftrig B, Suite ##250 Suite #f321, South Totter Telephone (239) 4614006 Jacksonville, FL 32209 Miami FL 33128 Telephone (904) 798-5606 Telephone (305) 536-0306 Control Number: R0 610 E. BurgeRoad Pensacola, FL 325046320 400 West Robinson Street TALLAHASSEE SUBMrrTERS Telephone (850) 453 -7804 Room 0512, North Tower Postmark Date: Orlando FL 32801 Wank -in submissions. 3111 S. Dixie H' ghway, Suitee # 123 Telephone (407) 835 -4406 or 2012 Capital Cirde SE West Palm Beach FL 33405 (407) 245-0896 Suite #102, Hartman Bldg. Payment Number: Telephone (561) 8375716 Tallahassee FL 32399 -2161 1313 N_ Tampa Street Suite # 503 499 Northwest 701h Ave., suite # 116 TeleMlone (850) 413 -1609 Tampa FL 33602 Peron FL 33317 Telephone (954) 321 -2906 Mad in submissions: Received Date: Telephone (813) 221 -6506 200 East Gaines Street 1111 NE 25° Ave., Suits # 403 Live Oak Business Center 5969 Cattlemen Lane Tallahassee FL 32399 -4226 Telephone (850) 413.1608 Ocala FL 34470 Sarasota FL 34232 Telephone (352) 369 -2806 Telephone (941) 329 -1120 'The collection of the social security number on this form is specifically authorized by Section 440.05(3), Florida Statutes. The social security number will be used as a unique identifier in Division of Workers' Compensation database systems for individuals who have applied for and/or been issued a certificate of election to be exempt It will also be used lo identify information and documents in those database systems regarding individuals who have applied for and/or been issued a certificate of election to be exempt for internal agency tracking purposes and for purposes of responding to both public records requests and subpoenas that require production of specified documents. The social security number may also be used for any other purpose specifically required or authorized by state or federal law.' DWC 260, WMCE OF ELECTION TO BE EXEMPT— REVISED 13!08; RULE WL•6.008, F.A.C. IR DEPARTMENT OF THE TREASURY �++Pp 11�t.�JJ INTERNAL REVENUE SERVICE CINCINNATI OH 45999 -0023 JD DESIGN CONSTRUCTION INC % JIMMY DEAN 2036 50TH TERRACE SW NAPLES, FL 34116 Date of this notice: 06 -26 -2013 Employer Identification Number: 46- 3053939 Form: SS -4 Number of this notice: CP 575 A For assistance you may call us at: 1- 800 - 829 -4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 46- 3053939. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 940 Form 944 Form 1120 01/31/2015 01/31/2015 03/15/2014 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year), see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004 -1, 2004 -1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION 8L MON: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120 -S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. (IRS USE ONLY) 575A 06 -26 -2013 JDDE B 9999999999 SS -4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT -1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System ( EFTPS). A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized a -file Providers, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS a -file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1- 800 -829 -3676 (TTY /TDD 1- 800 - 829 -4059) or visit your local IRS office. * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax- related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is JDDE. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. '(IRS USE ONLY) 575A 06 -26 -2013 JDDE B 9999999999 SS -4 Keep this part for _your records. CP 575 A (Rev. 7 -2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address_ CP 575 A 9999999999 Your Telephone Number Best Time to Call DATE IAOYER THIS NOTICE: IDENTIFICATION 6 3 NUMBER: 46- 3053939 ( FORM: S9-4 NOROD INTERNAL REVENUE SERVICE CINCINNATI OH 45999 -0023 �I�II�I�I�I�1�1t�1�11�1�1 /��111�� /1111�1�11��1�1�N� JD DESIGN CONSTRUCTION INC JIMMY DEAR 2036 SOTH TERRACE SW NAPLES, FL 34116 1 COLLIER COUNTY GOVERNMENT DEPT. OF ZONING & LAND DEVELOPMENT REVIEW WWV1/.COLLIERG02V.NET (239) 252 -2400 FAX (239) 643 -6968 LAND USE AND ZONING. CERTIFICATE HOME OCCUPATION Please. take the time to fill out this form as completely as possible. Remember that only someone actually living at the address given below may engage in the home occupation described: ployees not living at this Customers -or em address are prohibited from traveling to and from the residence If visits are related to This home occupation. The applicant is the person in whose name the-occupational license will be I sued ;'and the applicants-signature, must appear on this form. - Ve>fcation as property owner or lessee in the form of a Valid Florida or Florida Identiricatfon Card and/or copy of valid lease agreement is required. 's Driver License APPLICATION DATE��/ �p� 3 ZONING CERTIFICQ; E # TC- APPLICANT'S NAME PHONE: APPUCANTS HOME ADDRESS TYPE OF BUSINESS TO BE CONDUCTED,,/ an - BUSINESS NAME (IFANY).____M /o, I, the undersigned, hereby affirm that I am the legal owner of the PrOPelty right to conduct the business desenbed above at this address by v jfu o at fhe above address or that have the legal have read, understood, and agree to abide by the provisions of LDC Sew n 5 02 OOd`Home Oecupations'4ee back of application)_ APPLICANT SIGNATURE DATE._- FEE: $50.00 CHECKS P' TO: "CO LLIER COUNTY TAX COLLECTOR" ZONING: PROPERTY ID # REVIEWED BY APPROVED HOLD. - DENIED COMMENTS /RESTRICTIONS: Must comply with Section 5.02.0. .02.00 of the LDC {'see back of application). Tax Collector Staff.. Please forward a Copy of issued certificate and receipt to Collier County Zoning Department. COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION 2800 N. Horseshoe Drive, Naples, FL 34104 Make Check Payable to: Collier County Tax Collector Phone: 239 - 252 -2477 Fax: 239 - 643 -4788 Website: www colliertax.com CHECKLIST Copy ofArticles of Incorporation and/or Fictitious letter Yellow Fur Compliance (list of fire district phone number from the State stating that your business name is on file. enclosed) (850- 245 -6052 or 6058) www.sunbi2.org Copy of State license from Department of Business and Professional (850 -487 -1395) or Department of Health. (850- 488-0595) Copy of City Business Tau Receipt (239 -213 -1800) Copy of Motor Vehicle Repair Registration Certificate from Department ofAgriculture. (800-435 -7352) �w s� :u con U. Copy of Marco Zoning Certificate. (239 -389 -5000) Completed Zoning application with appropriate fee made payable to: Board of County Commissioners. (239- 252 -5603) Completed Business Tax Receipt application with appropriate fee made payable to: Collier County Tax Collector. (239- 252 -2477) Other. Copy of Health inspection from Department of Hotels and Please contact the Property Appraiser's office at 239 -252 -8145 Restaurants (850 -487 -1395) or Department ofAgriculnue. regarding tangible tax. (800 -435 -7352) CEWCK ONE: Date: Original Application Classification — Transfer of License # Code Number - - Renewal of License # License Amount CORPORATE NAME - -r D. r&f o 1a) DBA NAME - 1b) BUSINESS OWNER OR QUALIFIER'S NAME - ; eo. , 2) PHYSICAL ADDRESS - ZD 3G S" ,0°wk T'c, .� /%aD�(e,: � -W / /(. (No P.O. Box allowed) 7 2a) IS RESIDENCE USED AS AN OFFICE - e/ Yes No 3) BUSINESS MAILING ADDRESS - ,gp3(. Sty l tC/r.. S.1✓.: �? d /+ter L. .��,c // Street eity ' Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - Ss...., 5) TELEPHONE - Business: S r..S- Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership _�orporation LLC LLP 'n OPENING DATE OF BUSINESS OR DATE ASSUMED - 8) OFFICE WITHIN CITY LIMITS OF NAPLES - _ Yes o' No If Yes, City License No. 9) SOCIAL SECURITY NO. or FE DERAL EMPLOYER yIDENTIFICATION NO. -4/6- ^ 3 F - 3a — ? / *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: 1- j:u j ,..,�/ `10) NUMBER OF EMPLOYEES - Including number of owners: / 11) FILL IN THE APPROPRIATE AREAS - a) Rental units (motel/hotel/apts.) Number of units: b) Seating Capacity (rest. /cafes, etc) Number of seats: c) Number of coin - operated machines owned by business or individual: 12) STATE LICENSE OR CERTIFICATION NUMBER - Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT AWITRUE TO THE BEST OF MY KNOWLEDGE. XUAPPLICANT'S SIGNATURE: (Owner and/or representative of bus'TITI ""THIS LICENSE IS NON DATE: FOR BUSINESS STATED ABOVE * *w* .4 A jimmy M. Dean July 23, 2013 To: Whom ever it concerns This is a letter to let you know why my credit is at the stage it is at. The reason is when everything was going good I had a lot of toys and cars. When the economy went bad it was a choice between my house and my toys, I obviously picked my house for I have 8 kids and they need a roof over there heads. I'm working on cleaning it up, but as we all know it takes time. I really hope that this will not keep me from being able to provide a better life for my family and me. Thank you for you attention to this matter. Thank You, Jimmy M. Dean CDES Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive _ Naples, FL 34104 ? APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES /CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany. this application. The fee is not refundable after the application has. been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90 -105, as amended. NAME OF COMPANY. Exact Corporate /Business Name: %M5 RMRA V(T- n)z. Fiction Name /DBA: Qualifier Name: Physical Address: akGl Mopak) 1 N& S) N L NVVU�� (Number & Street) (City) (State) (Zip Code) Mailing Address: (Number 8v Street) (City) (State) (Zip Code) Telephone: 0'5k' S -11 - M3Z E- Mail: �1Q �1C ��i�r( �l c�1Mt • TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician .$230.00 Building $2.30.00. ❑ Plumber $230.00 U. Residential $230.00 ❑ Air Cond. $230.00. {l Mechanical $230.00 ❑ Swimming Pool $230.00 Roofing $230.00 Ll Specialty $205.00 Specialty trade: CHANGE OF STATUS: ( ) Reinstatement { ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm yard Sku,�, 1�1io �� gro► Q �Ir4Si►Y�n �ro�� - �f1 i plea ,��Dcal�i AAA 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years (ex. Held a license for or been a partner). Attach extra pages if needed. 3. List all debts you or any company(s).associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. AFFIDAVIT I," SQU d . . TAU k, certify that the .foregoing is true and correct to the best of my knowledge. STATE OF FLORIDA COUNTY OF The foregoing instrument as acknowledged before me this J Authorized r of the Firm (Date) By of (Name of officer, titletagent) (Name of Corporation) a Corporation on behalf of the corporation. (State or Place of Corporation) He/She has-produced - identification and did not take an oath. (Type of identification) NOTARY'S sEganne M, Modzelenki ��PY Rye State of Florida 04 MY COMMISSION # EE 372492 OF f�p Expires: June 3, 2017 Page 2 of 4 (SIGNATURE OF NOTARY) QUALIFIER INFORMATION: Name:�(11�Qr�► �'(JDIh1 �I,IJI, Address: (orl YnQn 1 ra Slan (Number & Street) Telephone: S.S. #:000 �1Na 0 (State) (Zip Code) Date of Birth: � E- Mail: �1► j�- �—' Q�S> �QX.--- �"�If�f�Y�l`1� @�9fYW�1.0 ' Driver's License: Sk 010 5q D 1. Type of Certificate of Competency for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. �1CY1D►� �n� i ► � �� :R'l 1 _22ia � -rJh1- 3. Have you ever been convicted of a crime related to Contracting? IW (If yes attach extra sheet with explanation) 7. Have. you or any firms you have been associated with ever filed bankruptcy? 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. . _ 9. List your business or work e: St ftek =Q S,y=%� n ;e during the past ten years.—I V1wk uxxtL i 1t1W. )RoOVA WS' M1X- SSL,r\ donl h W rnm>W -Vo � `COV(00 - � V\ Q- TIM IRi5A baw(N \ n +V%,�S \OxS�nt. -%s SCanCJL 10. Sta ement of any formal training you have had in the area for which the application =-* Paae 3 of 4 qa4 - U, =114 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006 -46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. STATE OF FLORIDA COUNTY OF The foregoing Instrument as acknowledged before me this n5E-T\) ft 3? A"l V APPLICANT (PLEASE PRINT) PEAS NAME OF COMPANY SIGNATURE OF A CANT (Date) By who has produced (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL Dianne M, Mocizelewski We of Florida (SIGNATURE OF NOTARY) MY COMMISSION # EE 872492 � Ve Expires: June 3, 2017 Page 4 of 4 Gress Re•erim I Sales 1 Deposits and Bonds 4 Documents and 1—gas I Comnpidnd— 1 Vhki, Registration I Insurance, Backg...d Check j Company Examination Reft Licensee Information 'i Licensee Number Q27453 Dlw�— — — , I .......... . .............. ... ip.cr , T.11--,— . ................ Name 15pahiu, M—na Type C-tr-to, Scat- Open ......... ............. ..... .. ........... . - 41., 14. star Proiect . All Acpvces for this bc.n-a Add a ra. Qtmgn ..- b,,in,gss t. Address Book Examination Results Add Exam Result l—'. p-nit Date Anays,; lmpctxzport Settings Configursoon Diagnostics Sea,&. Ribb— Search PA-1 Casa", u— Addresses as a 05,rM*Z013 Ocala 78 Pass ep.s tic, On sa C Up- GSCCt People Search Lire '"ka Mum- M-it - Show More Fields .. ... ...... Lit V,,l; Cont—, Gress Re•erim I Sales 1 Deposits and Bonds 4 Documents and 1—gas I Comnpidnd— 1 Vhki, Registration I Insurance, Backg...d Check j Company Examination Reft Licensee Information 'i Licensee Number Q27453 Dlw�— — — , I .......... . .............. ... ip.cr , T.11--,— . ................ Name 15pahiu, M—na Type C-tr-to, Scat- Open ......... ............. ..... .. ........... . - 41., 14. star Proiect . All Acpvces for this bc.n-a Add a ra. Qtmgn ..- b,,in,gss t. Address Book Examination Results Add Exam Result nk. T3(pe . ..... 4 E� Owuv r5upc e" ii, ea�t; • GENERALCCHSTRUCTICN <,<,y- PAINTING 05,rM*Z013 Ocala 78 Pass Tl;E FAKARELE 05;'6&11013 Ocala Pass Show More Fields .. ... ...... ................ — A—.4 Charge Exam Fee e-m lode lEGEIA Sponsoring County --.0 S;,,hs.rsh,,p AppDat, f64,22i2 i Sponsorship Expiration Date I Q1 2 2 2 0 1 3 Testing Facilet, AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all tunes effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. BUSINESS NAME DATE BEFORE ME this day personally appeared who affirms and says that he has less than one employee and does not require Workmen's Compensation and understands that at any time he employs one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF The foregoing instrument was acknovAedged. before me this (Date) .by who has.produced (name of parson acknowledging) (Type of Identlflcation) as identification and who did not take an oath. Dianne M, Modzelewski `A T My LAL SIGNATURE OF NOTARY NO State of Florida COMMISSION # EE 872492 NOTARY PUBLIC OF F�° f Expires: June 3, 2017 Applicant's Name: Certificate Categor TION OF CONSTRUCTION GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide Information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following Information: Name, Title and license number of the person signing below and verifying Applicants relevant experience: Name: ,� :, % + ca z "k'. , F , Title:,, License Number (if applicable): Name of Business: __- :� Business Address: C- C-11Z Business The Applicant's years of experience from �� ='w �- to , The applicant's scope of work (specific duties) included: z - o - e Additional Comments: Falsifying any information provided herein may subject your license to revocation. Signature Slate of Florida Print Name:~ -a County of Collier The foregoing instrument was acknowledged before me on this day of by who is personally known to me or produced as identification and who did not take an oath, Signature of Notary - .......... LAURA E REYNOLDS Notary PubliC -State of Florida =y INy Comm. Expires A" 21, 2015 '% c� �` Comodssion 0 EE 1; 0 �� aen�� 1 RIP W 4p 11111 .TION OF CONSTRUCTION EXPERIEN GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: s1 #�.l1Jf li t Certificate Category Requested: _ T 4. 1 Q Q yQ— - The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, T_itJand license number of the person signing below and veil ying Applicants relevant experience: Name: C.: Title: `'" ` �-�'`i l'')�' License Number (i;;applicable): Name of Business: L G- e :.( r�• - �. ' , Business Address: Business Phone: >,V lIC S / The Applicant's years of experience from _ _ 1 The applicant's scope of work (specific duties) included: Additional Comments: Falsifying any information provided herein may subject your license to revocation. Signature Print Name: '" r State of Florida County of Collier < i The tge oing in r ment was acknowledged before me on this l 7 day of 'l r by �,�.- c r tq /1� �1, , who is personally known tome or duced as identification and who did not take an oath. Signature of Notary r L- y/�p /► N � p p Y `��® �AY6i�.�im 5 i MY COMMISSION # EE168500 ' EXPIRES February 12, 2016 407 388-0963 F _ -- rY3enrce.can l La�S AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER ' am a resident of County, (State) and have resided here for more than five (5) years. luring the last five years I have known ie opportunity to observe his or her business and personal dealings and find him or hereto beaa person of had �nesty, integrity and good character. p (Signature) . (Name) (Address) Telephone) STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this by who has produced (Dam) (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIGNATURE OF NOTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC Dianne M, Modzelemllcl State of Florida MY COMMISSION # EE 872492 1410P Expires: June 3, 2017 10 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER b� S re"i ) )'L' 0--, , am a resident of County, (-3-- (State) and have resided here for more than five 5 ()Years. uring the last five years I have known t- 1S2 ncl (Applicant). I have had ie opportunity to observe his or her business and personal dealings and find him or her to be a person of Dnesty, integrity and good character. (Signature) \ �- ---=- (Name) _ H , (Address) 12 -7 0' C', 6),t- S r Telephone) 1— ` STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this by (Date) who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIGNATURE OF NOTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY. PUBLIC Dianne M. ModzelewsM State of Florida �e MY COMMISSION # EE 872492 °F V Expires: June 3, 2097 10 %p MM ani ij O �141F9! WAXiI i OiZVAl /Lk olp0 Organized under the laws of the state of FLORIDA [ Insert NarAe Of. Corporation Here] This Certifies that _ 1_ 1s2na —iUr� , is the holder of Insert Owner's Name Herel 150 [Insert of the 1 00 [Insert The # Of Shares Owned Here] [Insert total # of shares issued] shares of the total stock issued by the above named Corporation. This evidences 50 % of the total shares [Insert Percentage Of Shues Issued That You Own Here] of stock issued by the corporation. In Witness Whereof, the said Corporation has caused this Certificate to be signed by the duly authorized officer this day of �,(InQ. A.D. [Must have Signature n officer of the Corporation] 1411LWAV&P 04 4-4,1L Midi— 04 U Air JM§r;6�' "'Affil" ..%d MW— Id MN&O , L bi 'A 84 000 � i Ect 0 ?4 0 W40 V419 40 4V�©1( Business Profile - NAPLES EXPERT FLOORING INC Subcode: 970135 Ordered: 06/17/2013 13:03:53 CST Transaction Number: 0510242665 =:r« ` E t eria r Search Inquiry: NAPLES EXPERT FLOORING INC/16121 CALDERA n A �,v :f i„ r:.` iwi; k hf LN /NAP LES/FU34110/US/N/A/930735692 This information is the primary name and address for the business you inquired on. All data in this report pertains to the business. NAPLES EXPERT FLOORING INC Business Identification Number: 930735692 16121 Caldera Ln Experian File Established: 01/2006 Naples, FL 34110 -2831 Date of Incorporation: 02/01/2006 SIC Code: Floor Laying & Other Floor Work, Nec - 1752 Tax ID: 72- 1610124 Bankruptcy filings: Tax lien filings: Judgment filings: Total collections: Sum of legal filings: UCC filings: Cautionary UCC filings present? Additional information may be available on this business. A ''Trade, lrrforrriatfon' 0 Monthly average DBT: 0 Highest DBT previous 6 months: 0 Highest DBT previous 5 quarters: 0 Total continuous trades: $0 Current continuous trade balance: 0 Trade balance of all trades (0): No Average balance previous 5 quarters: Highest credit amount extended: 6 month balance range: Sinmaryof Business JUN13 MAY13 APR13 MAR13 FEB13 JAN13 DEC12 NOV12 OCT12 Category PAINTS 1 Totals ' ^crQora bl ' r .,.,NO- THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA. State of Origin: FL Date of Incorporation: 02/01/2006 Current Status: Active Business Type: Institutions - Profit Charter Number: P060000103 Federal Tax ID: 72- 1610124 Agent: SPAHIU MISENA Agent Address: 16121 CALDERA LANE NAPLES, FL Key Personnel Principal(s): NESIM BRACE, TREASURER Business Profile - NAPLES EXPERT FLOORING INC 1/2 Operating Information Business Type: Institutions Primary SIC Code: FLOOR LAYING & OTHER FLOOR WORK, N - 1752 Secondary SIC Code: FLOOR COVERING STORES - 5713 Number of Employees: 2 Sales: $150,000 Experian prides itself on the depth and accuracy of the data maintained on our databases. Reporting your customer's payment behavior to Experian will further strengthen and enhance the power of the information available for making sound credit decisions. Give credit where credit is due. Call 1- 800 - 520 -1221, option #4 for more information. End of report 1 of 1 report The information herein is fumished in confidence for your exclusive use for legitimate business purposes and shall not be reproduced. Neither Experian Information Solutions, Inc., nor their sources or distributors warrant such information nor shall they be liable for your use or reliance upon it. © Experian 2013. All rights reserved. Privacy olicv. Experian and the Experian marks herein are service marks or registered trademarks of Experian. Business Profile - NAPLES EXPERT FLOORING INC 212 7 in aria a d *1 t & MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS), STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800- 371 -3348 OR 239 - 277 -3202. COMPANY NAME: NAPLES EXPERT FLOORING INC FEDERALID:721610124 CURRENT STATUS: ACTIVE BUSINESS PRINCIPAL(S): MISENA SPAHIU TITLE: PRESIDENT NIGERT BRACE TITLE: VP EDRIT FRASHERI TITLE: DIRECTOR BERNARD SPAHIU TITLE: CEO NESIM BRACE TITLE: DIRECTOR RENALDO FRASHERI TITLE: ASSISTANT DIRECTOR DATE INCORPORATED: 01/20/2006 Prepared By: Merit Credit (239) 277 -3202 (800) 371 -3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] (I) Z NP6284423 MERIT CREDIT [SUBJECT] SPAHIU, MISENA [ALSO KNOWN AS] BRACE,MISENA [CURRENT ADDRESS] 2167 MORNING SUN LN., [FORMER ADDRESS] [MKT SUB] [INFILE] [DATE] [TIME] 16 NP 9/03 06/17/13 13:02CT [SSN] [BIRTH DATE] -2712 6/85 NAPLES FL. 34119 [DATE RPTD] 9/10 16121 CALDERA LN., NAPLES FL. 34110 9/06 36393 DOMINION CI., #65. STERLING HEIGHTS MI. 48310 [POSITION] [CURRENT EMPLOYER AND ADDRESS] [VERF] [RPTD] ROYAL PALM BANK [FORMER EMPLOYER AND ADDRESS] RAM S HORN FAMILY RESTAURANT SERVER 11/08 10/08 9/03 S P E C I A L M E S S A G E S ** *ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES) * ** -------------------------------------------------------------------------- M 0 D E L P R O F I L E * * *FICO CLASSIC 04 SCORE +695 : 039, 010, 013, 014 * ** C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR =O COL =O NEG =1 HSTNEG =1 -24 TRD =22 RVL =21 INST =O MTG =1 OPN =O INQ =4 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $22.5K $14.2K $4589 $0 $102 68% TOTALS: $22.5K $14.2K $4589 $0 $102 ---------------------------------------------------------------------------- T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1 -12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT -MOP PAYPAT 13 -24 ECOA COLLATRL /LOANTYPE CLSD /PD BALANCE REMARKS MO 30/60/90 WFHM B 82TE004 8/06 $343K 360M2374 1/09 555555555555 M05 7080154945687 10 /10A $0 $9495 05 555555555432 I CONVENTIONAL REAL 10 /10C $0 SETTLED [ FULL BLNC 48 1/ 1/22 KOHLS /CAPONE D 12EN005 12/11 $143 639305063217 6/13A $600 I CHARGE ACCOUNT 7/12P $0 BRCLYSBANKDE B 1ZZB001 11/05 $685 000022124 6/13A $800 I CREDIT CARD 11 /08C $0 $0 111111111111 RO1 111111 18 0/ 0/ 0 111111111111 RO1 $0 111111111111 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 GECRB /KIRKLN H 9992729 12/10 $222 111111111111 R01 604412103453 6/13A $200 $0 111111111111 I CHARGE ACCOUNT 1 /12C $0 GECRB /SMRTCN D 9992730 3/11 $0 604407103516 6/13A $600 I CREDIT CARD 3/13C $0 5/3 BANK CC B 21AV061 9/03 $1601 5444 6/13A $3000 C CREDIT CARD 4/09C $0 GECRB /JCP D 235058D 10/09 $316 600889534146 6/13A $200 I CHARGE ACCOUNT 12/11P $0 GRDN /CBNA J 215GO03 8/12 $0 603525306376 5/13A $1000 I CHARGE ACCOUNT $0 CAP ONE B lDTV001 3/06 $0 411507263458 5/13A $500 I BUSINESS CREDIT C $0 CHASE B 26QK001 11/12 $5237 426690204350 5/13A $5000 I FLEXIBLE SPENDING $3102 CHASE B 26QK001 5/12 $5518 426684132093 5/13A $3000 I CREDIT CARD $1250 BK OF AMER B 6331059 4/05 $9604 2898 5/13A $400 I CREDIT CARD $237 CB /EXPRESS C 8349001 7/08 $158 32734454327344540 9/12A $500 I CHARGE ACCOUNT 8/12P $0 KAY JEWELERS J 722D62X 8/10 $0 311783 8/12A $2000 I CHARGE ACCOUNT 8/12C $0 CHASE- CHA F 1VZP001 5/08 $3724 00090200400581 7/12A $9000 I CHARGE ACCOUNT 7/12C $0 CITI B 64DB002 6/08 542418057229 11 /10A $500 I CREDIT CARD 7/10C $0 KAY JEWELERS J 722D62X 5/05 $4187 308043 9/10A $4187 I CHARGE ACCOUNT 1 /06C $0 CHASE B 26QK001 12/04 $2992 426684102262 5/09A $1000 I CREDIT CARD 1/09C $0 CLOSED 30 0/ 0/ 0 111111111111 R01 $0 111111111111 CLOSED 27 0/ 0/ 0 111111111111 R01 $0 111111111111 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 111111111111 Rol $0 111111111111 43 0/ 0/ 0 111111111 R01 $0 9 0/ 0/ 0 111111111111 R01 $0 111111111111 48 0/ 0/ 0 MIN62 11111 R01 $0 5 0/ 0/ 0 MIN25 11111111111 R01 $0 11 0/ 0/ 0 MIN15 111111111111 R01 $0 111111111111 48 0/ 0/ 0 111111111111 R01 $0 111111111111 48 0/ 0/ 0 111111111111 R01 $0 111111111111 INACTIVE ACCOUNT 24 0/ 0/ 0 111111111111 Rol $0 111111111111 INACTIVE ACCOUNT 48 0/ 0/ 0 111111111111 R01 $0 111111111111 CLOSD BY CRDT GRANTOR 29 0/ 0/ 0 R01 $0 INACTIVE ACCOUNT 48 0/ 0/ 0 111111111111 R01 $0 111111111111 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 CHASE B 26QK001 3/06 $2675 111111111111 R01 426684108783 5/09A $1000 $0 111111111111 I CREDIT CARD 1/09C $0 CLOSD BY CRDT GRANTOR 37 0/ 0/ 0 CB /EXPRESS C 8349001 5/05 $0 111111111111 R01 68332821355983672 9/08A $500 $0 111111111111 I CHARGE ACCOUNT 6/05P $0 39 0/ 0/ 0 CB /VICSCRT C 16US001 7/08 $0 1 R01 58057041897242207 8/08A $500 $0 I CHARGE ACCOUNT $0 1 0/ 0/ 0 5TH 3RD BK B 21AV006 9/03 $1601 111111111111 R01 5444 4/05A $2000 111X111 C CREDIT CARD ---------------------------------------------------------------------------- 19 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 6/17/13 ZNP6284423(FLA) MERIT CREDIT 6/06/13 ZCH0008281(CHI) EQUIFAX MTG 5/10/12 BPH4188229(EAS) BK OF AMER 11/21/11 BPH3880046(EAS) FIA CSNA ---------------------------------------------------------------------------- C R E D I T R E P O R T S E R V I C E D B Y TRANSUNION 800 - 888 -4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http: / /www.transunion.com ---------------------------------------------------------------------------- CREDITOR CONTACT INFORMATION WFHM BM82TE004 (800) 288 -3212 7255 BAYMEADOWS WA DES MOINES IA. 50306 KOHLS /CAPONE DC12EN005 (262) 703 -7000 PO BOX 3115 MILWAUKEE WI. 53201 BRCLYSBANKDE BZIZZB001 (866) 370 -5931 P.O. BOX 8803 WILMINGTON DE. 19899 GECRB /KIRKLN HZ9992729 (866) 230 -9175 PO BOX 965005 ORLANDO FL. 32896 GECRB /SMRTCN DZ9992730 PO BOX 965005 ORLANDO FL. 32896 5/3 BANK CC BC21AV061 (800) 972 -3030 5050 KINGSLEY DR CINCINATTI OH. 45263 GECRB/JCP DC235058D (866) 227 -5213 PO BOX 965007 ORLANDO FL. 32896 GRDN /CBNA JA215GO03 PO BOX 6497 SIOUX FALLS SD. 57117 CAP ONE BClDTV001 (800) 955 -7070 POB 30281 SALT LAKE CITY UT. 84130 CHASE BC26QK001 (800) 955 -9900 P.O. BOX 15298 WILMINGTON DE. 19850 BK OF AMER BC6331059 PO BOX 982235 EL PASO TX. 79998 CB /EXPRESS CW8349001 PO BOX 182789 COLUMBUS OH. 43218 KAY JEWELERS JA722D62X 375 GHENT RD AKRON OH. 44333 CHASE- CHA P.O. BOX 15298 CITI POB 6241 CB /VICSCRT PO BOX 182789 5TH 3RD BK 5050 KINGSLEY DR EQUIFAX MTG 6 E CLEMENTON RD BK OF AMER PO BOX 982238 FIA CSNA PO BOX 982238 FZlVZP001 (800) 955 -9900 WILMINGTON DE. 19850 BC64DB002 SIOUX FALLS SD. 57117 CZ16US001 COLUMBUS OH. 43218 BC21AV006 (800) 972 -3030 CINCINATTI OH. 45263 Z 0008281 (800) 333 -0037 GIBBSBORO NJ. 08026 B 4188229 (800) 421 -2110 EL PASO TX. 79998 B 3880046 (800) 421 -2110 EL PASO TX. 79998 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800 - 371 -3348 OR (239) 277 -3202. Detail by Entity Name Pagel of 3 P- Detail by Entity Name EXPERT FLOORING INC ocument Number P06000010330 EI /EIN Number 721610124 ate Filed 01/20/2006 tate FL tatus ACTIVE ffective Date 02/01/2006 ast Event AMENDMENT vent Date Filed 04/13/2006 vent Effective Date NONE 167 MORNING SUN LN JAPLES, FL 34119 ;hanged: 04/29/2010 Railing Address 1167 MORNING SUN LN JAPLES, FL 34119 :hanged: 04/29/2010 teaistered Aaent Name & Ai ►PAHIU, MISENA .167 MORNING SUN LANE JAPLES, FL 34119 kddress Changed: 03/15/2011 >fficer /Director Detail lame & Address 'itle PD PAHIU, MISENA 167 MORNING SUN LANE IAPLES, FL 34119 itle VPD http:H search. sunbiz. org / Inquiry/ CorporationSearch/ SearchResultDetail /EntityName /domp -... 6/12/2013) Detail by Entity Name BRACE, NIGERT 9580 VICTORIA LN #104 NAPLES, FL 34109 Title SD FRASHERI, EDRIT 2731 ORANGE GROVE TRL NAPLES, FL 34120 Title CEOD SPAHIU, BERNARD 2167 MORNING SUN LN NAPLES, FL 34119 Title TD BRACE, NESIM 9580 VICTORIA LN #104 NAPLES, FL 34109 Title Asst. Secretary, Director FRASHERI, RENALDO 2731 ORANGE GROVE TRAIL NAPLES, FL 34120 Report Year Filed Date 2011 03/15/2011 2012 01/12/2012 2013 03/08/2013 Page 2 of 3 03/08/2013 -- ANNUAL REPORT View image in PDF format 01/12/2012 -- ANNUAL REPORT View image in PDF format 03/15/2011 --ANNUAL REPORT View image in PDF format 04/29/2010 --ANNUAL REPORT View image in PDF for 04/17/2009 -- ANNUAL REPORT View image in PDF format 01/21/2008 -- ANNUAL REPORT View image in PDF format 10/08/2007 -- ANNUAL REPORT View image in PDF format 03/22/2007 -- ANNUAL REPORT View image in PDF format 04/13/2006 -- Amendment View image in PDF for 01/20/2006 -- Domestic Profit View image in PDF format Copyright © and Prvdcy.Pplicies http:Hsearch. sunbiz.org/ Inquiry/ CorporationSearch /SearchResultDetail /EntityName /dome -... 6/12/2013 A Cl. dp , < < + a +er mntY 3(5jjg%M Operations & Regulatory Management Licensing Section AUG 0 1. 2013 2800 North Horseshoe Drive Naples, FL 34104 - - APPLICATION FOR COLLIER COUNTY /CITY OF NAPLES /CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90 -105, as amended. NAME OF COMPANY: Exact Corporate/ Business Name: Fiction Name /DBA: Qualifier Name: Physical Address: Mailing Address: (Number & Street) (Number & Street) Telephone: o q- 5421- 51 DU TYPE OF LICENSE: (Ci i ift (State) (Zip Code) E -Mail: Ar 511-► c_11 Aiii LI' ®'`��` ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 Ll swimming Pool $230.00 ❑ Roofing $230.00 l.`3 Specialty $205.00 Specialty trade: joso l CHANGE OF STATUS: (X Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 The names, titles, home address and phone numbers of all Officers /Managing Members of the Firm. �r►�st t1 p 1 s� 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years (ex. Held a license for or been a partner). Attach extra pages if needed. M�f 3. List all debts you or any company(s) associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. 4W:iA W -n ni fi AFFIDAVIT I, ifNl 'g AM 1A 1160 /16 certify that the foregoing is true and correct to the best of my knowledge. w Authorized Officer of the Firm STATE OF FLORID COUNTY OF P� The foregoing instrument as acknowledged before me this or/Lky cq3 a?43 1441); (Date) By of IWI)e.-S (Name of officer, title /agent) (Name of Corporation) a a Corporation on behalf of the corporation. (State or Place of Corporation) �j d W g33S� a JAI D He /She has produced lrilxr:5 t je*66 Sid�entification and did not take an oath. (Type of identification) TARY'S ,SEAL _" .`? MICHAEL GLENN ERION o: MY COMMISSION #EE883973 Flo": � EXPIRES March 14, 2017 (407) 398 -0153 FloridallotaryService.com C-- ( NAT R O NOTARY) Page 2 of 4 QUALIFIER INFORMATION: Name: 04-am M,&/-66 ,&%66 Address: JaA 5&) / (Number & Street) Telephone: � 39 qq4 q' /J(� S.S. #: 000 -00- 12:W_ 9j-��c4� YNA Driver's License: -0 r%4j )1"/ ` OV (State) (Zip Code) Date of Birth: E -Mail: 1. Type of Certificate of Competency for which application is made. 2 The names and telephone numbers of two persons who will know your whereabouts. 3. Have you ever been convicted of a crime related to Contracting? del (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? W 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. r ) JA 9. List your business or work experience during the past ten years. c(4c�,AG A 1,N/y. 1ggq. Cs�l.S hOsa_jA 10. Statement of any formal training you have had in the area for which the application is made. Page 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006 -46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. 1'0j1�jw\ -A % S)acr,es APPLICANT (PLEASE PRINT) ►_u I wei a einI SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF The foregoing instrument as acknowledged before me this (Date) By f J/ ! who has produced )r,*yt° f's L-JLe4s`� (Name of person acknowledging) (Type of identification) Tl S GSA 93? 5'0 c-) -o as identification and did not take an oath. NOTARY'S SEAL Page 4 of 4 dl /9 MICHAEL GLENN ERION MY COMMISSION *EEa63973 EXPIRES March 14, 2017 (407) 393 -0153 FloridallotaryService.com Page 4 of 4 dl /9 AFFIDAVIT IT IS understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. W%D e, t�ry Q C->� SIGNATURE OF APPLICANT BUSINESS NAME lj.0 DATE BEFORE ME this day personally appeared !d) / / /'fOtwho affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this -7 1 (Date) by _1.4 AO J&We who has produced lJY'1 'y YS (name of person acknowledging) . (Type of identification) 41 D 3s identification and ho did not take an oath. NOTARY'S SEAL MICHAEL GLENN ERION • E MY COMMISSION #EE883973 _; EXPRES March 14.2017 (407) 394 0153 *10 idallotaryService.com SIGN OF NOTARY 106441 e � 67 le'lVAJ be, d1r� (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC 4 RESOLUTION OF AUTHO.RIZATON WHEREAS "pjcAL—a")J,rcpoSest0 (Name of Business Entity) engage in contracting as _ Cd Y/� in (Type of legal entity: Corp., partnership, etc. .Colher.County, Florida, according to Collier County Onrdivance 20--0.6( -46, as amended; and WHEREAS � i4Koo �2Ay1��' � I `lrl�u 1t�r— �lproposes to (Name ofBusmess Enti iY) qualify'for a Certificate of Competency with L•l,�' �f`' �q�j �� ,rfk�l (Name of Individual) NOW, THEREFORE, BE IT HEREBY RESOLVED THAT: We the undersigned - -- �/ P S � /� -'2AA j L 4", �S 1 (Officere, Ownrs, Partners) hereby resolve and represmt to the Collier County (Name of Business Entity) f , Contractors' Licensing Board Hutt the qualifying agent; GU' l , is active (Name of Individ ) in all matters COruiectcd with the couUwl;ting business of and am of Business En 'ty) We further resolve and represent that is �j � ( �f T awes of Individual) legally empowered to act for QYII►� in all matters connected with its (Name ofBusiness Entity) contracting busmes q has the a4ori to sup a cpnsttuction undertaken by I4r y. S l r t pro J OPV (Name of Business Entity) DULY PASSED AND AI)C7YTED THIS day of� 3 % Corporate Seal (ifApplicable) . Or NotmyPublic Certificate Swotu to and gubsml3ed before me this 2L1 day of b Notary Public Name Printed ? Notary Pu -c Signatum Commission Number 8 b � j 3 MY Commission expires: MICHAEL GLENN ERION MY COMMISSION #EE883973 EXPIRES March 14, 2017 (407) 398-0153 Floridallotary8ervice.com' Prepared By: Merit Credit (239) 277 -3202 (800) 371 -3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT Mm I 3Z85 07/23/13 10:15CT [SUBJECT] �'�>',j SNl [BIRTH DATE] BARNES, WILLIAM M. SR. JUL , L 2 2013 1425 6/54 [ALSO KNOWN AS] d U BARNES,WM,M [CURRENT ADDRESS] BY:— -------- ---- -- °- [DATE RPTD] 5204 SW. 11TH CT., CAPE CORAL FL. 33914 4/99 [FORMER ADDRESS] 9/93 5313 DELANO CT., CAPE CORAL FL. 33904 16150 BAY POINTE BV., #105. FORT MYERS FL. 33917 ------------------------------------------- M 0 D E L P R O F I L E * * *FICO CLASSIC 04 SCORE +809 : 004, 014 * ** ------------------ --- - - - - -- C R E D I T S U M M A R Y * ** T 0 T A L F I L E H I S T O R Y PR =O COL =O NEG =O HSTNEG =O TRD =10 RVL =6 INST =O MTG =4 OPN =O INQ =1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $14.8K $15.OK $600 $0 $25 96% TOTALS: $14.8K $15.OK $600 $0 $25 ------------------------------------------ T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1 -12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT -MOP PAYPAT 13 -24 ECOA COLLATRL /LOANTYPE CLSD /PD BALANCE REMARKS MO 30/60/90 CAP ONE B lDTV001 3/01 $14.8K MIN25 111111111111 R01 546630736719 7/13A $15.OK $0 111111111111 C FLEXIBLE SPENDING $600 48 0/ 0/ 0 EXXMBLCITI B 282EO45 11/89 $752 730282700601 1 /13A $300 C CREDIT CARD 3/09C $0 BK OF AMER B 1597029 2/09 $963 9781 12/12A $4000 I CREDIT CARD 12/12C $0 CITIMORTGAGE B 462SO15 7/06 770806870 6 /10A C CONVENTIONAL REAL 6/10C FDICASRECGC B 1YKTO01 605030204 C HOME EQUITY LOAN TARGET N.B. D 1ZX5001 435237669567 I CREDIT CARD 111111111111 R01 $0 111111111111 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 R01 $0 ACCT CLSD BY CONSUMER 46 0/ 0/ 0 $201K 18OM1783 $0 $0 CLOSED 7/03 $272K 4 /10A 4/10C $0 6/05 $284 4 /10A $1000 5/07C $0 111111111111 MO1 111111111111 43 0/ 0/ 0 M656 111111111111 MOl $0 111111111111 TRNSFRD: OTHER LENDER 48 0/ 0/ 0 111111111111 R01 $0 111111111111 CLOSED 48 0/ 0/ 0 FDICASRECGC B lYKTO01 7/06 $201K 60614000187 10 /06A C SLDTO AMERICAN HO 10 /06C $0 FDICASRECGC B lYKTO01 8/03 605030345 7/06A C REAL ESTATE 7/06C $0 18OM1783 11 M01 $0 TRNSFRD OTHER OFFICE 2 0/ 0/ 0 120M 111111X11111 M01 $0 1X1111111111 CLOSED 34 0/ 0/ 0 FDICASRECGC B lYKTO01 12/01 $200K 11X111111111 R01 60805 12/03A $200K $0 X11X1111111 C 9/03C $0 CLOSED 123 0/ 0/ 0 FDICASRECGC B lYKTO01 5/03 $100K 11X111 R01 60808 12/03A $100K $0 C ---------------------------------------------------------------------------- 9/03C $0 CLOSED 6 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 7/23/13 ZNP6284423(FLA) MERIT CREDIT ---------------------------------------------------------------------------- C R E D I T R E P O R T S E R V I C E D B Y TRANSUNION 800- 888 -4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http: / /www.transunion.com ---------------------------------------------------------------------------- CREDITOR CONTACT INFORMATION CAP ONE BCIDTV001 (800) 955 -7070 POB 30281 SALT LAKE CITY UT. 84130 EXXMBLCITI BC282EO45 (800) 950 -5114 PO BOX 6497 SIOUX FALLS SD. 57117 BK OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 CITIMORTGAGE BM462SO15 (800) 283 -7918 PO BOX 6243 SIOUX FALLS SD. 57117 FDICASRECGC BZlYKTO01 (239) 656 -7525 13761 N CLEVELAND NORTH FORT MYE FL. 33903 TARGET N.B. DZlZX5001 PO BOX 673 MINNEAPOLIS MN. 55440 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800 - 371 -3348 OR (239) 277 -3202. Premier Profile - BARNES MECHANICAL INSULATION INC Subcode: 970135 Ordered: 07/23/201:: �=� •i: Experian Transaction Number: 0500030511 Search Inquiry: BARNES MECHANICAL INSULATION INC/5201 SW 11TH CT /CAPE JUL 2 4 2013 A world of insight CORAL/FL/33914/US/239-542-5106/737097607 Model Description: Intelliscore Plus V2 Primary Address: 5201 SW 11TH CT Phone: (239) 542 -5106 CAPE CORAL, FL 33914 -7009 Tax ID: XX- XXX3368 This business is the ultimate parent. See the corlorate hierarchy by clicking here TOP Q Years on File: State of Incorporation: Date of Incorporation: Business Type: Contacts: Active Business Indicator: Possible OFAC Match Business Victim Statement: TOP Q 18 (FILE ESTABLISHED 11/1995) SIC Code: PLASTERING, DRYWALL & INSULATION CONTR. - 1742 FL NAICS Code: Drywall and Insulation Contractors - 238310 10/17/1989 Number of Employees: 18 Institutions - Profit Sales: $2,817,000 SUSAN L BARNES Experian shows this business as active l 1 No OFAC match found I No victim statement on file TOP Q The primary Business Name, Address, and Phone Number on Experian File were reviewed for High Risk indicators, no High Risk indicators were found. TOP 0 Premier Profile - BARNES MECHANICAL INSULATION INC 1/4 This score predicts the likelihood of serious credit delinquencies for this business within the next 12 months. Payment history and public record along with other variables are used to predict future risk. Higher scores indicate lower risk. Factors lowering the score > RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY > BALANCE OF AGED COMMERCIAL ACCOUNTS THAT ARE CURRENT Quarterly Score Trends �\ L REF G� AEC 3 P -t�� P ,,C3\y6 Current Financial Stability Risk Score: 14 This score predicts the likelihood of financial stability risk within the next 12 months The score uses tradeline and collections information, public filings as well as other variables to predict future risk. Higher scores indicate lower risk. Factors lowering the score > NUMBER OF ACTIVE COMMERCIAL ACCOUNTS > RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR > RISK ASSOCIATED WITH THE BUSINESS TYPE > EMPLOYEE SIZE OF BUSINESS Industry Risk Comparison 42% of businesses indicate a higher likelihood of severe delinquency. The Quarterly Score Trends provide a view of the likelihood of delinquency over the past 12 months for this business. The trends will indicate if the score improved, remained stable, fluctuated or declined over the last 12 months. Risk Class: 3 �4LOWN11 RISC€; 3 The risk class groups scores by risk into ranges of similar performance. Range 5 is the highest risk, range 1 is the lowest risk. Industry Risk Comparison 13% of businesses indicate a higher likelihood of financial stability risk. Credit Limit Recommendation $12,000 This recommendation compares this business against similar businesses in the Experian business credit database. It is based on trade information, industry, age of business and the Intelliscore Plus. The recommendation is a guide. The final decision must be made based on your company's business policies. TOP Q Legal Payment and "'0s'- '"^»�° d:*4r.,rc},i Pa ent Performance ; � ' , and Qollection Balance � � ,� � �- ega F�1 gs „l,rTrade Current DBT: 0 Total trade and collection (6): $0 Bankruptcy: No Predicted DBT: N/A All trades (6): $0 Tax Lien filings: 0 Judgment filings: 0 Monthly Average DBT: 0 All collections (0): $0 Sum of legal filings: $0 Highest DBT Previous 6 Months: 0 Continuous trade (4): $0 UCC filings: 0 Highest DBT Previous 5 Quarters: 0 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended: N/A Premier Profile - BARNES MECHANICAL INSULATION INC 2/4 Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms not available Industry DBT Range Comparison The current DBT of this business is 0. 80% of businesses have a DBT range of 0 -5. DBT for this business: 0 DBT Range 0-5 6 -15 16+ TOP 0 Trade Line Type Lines Reported DBT Recent High Credit Balance Current 01 -30 31 -60 61 -90 91+ Continuous 4 $0 New -- -- 0 -- $0 Combined Trade 4 $0 Additional 2 $0 Total Trade 0 $0 TOP 0 TOP 0 THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA. State of Origin: FL Date of Incorporation: 10/17/1989 Current Status: Active Business Type: Institutions - Profit Charter Number: L25837 Agent: BARNES, WILLIAM M. Agent Address: 5204 SW 11 TH CT CAPE CORAL, FL TOP 0 TOP Premier Profile - BARNES MECHANICAL INSULATION INC 3/4 The inquired upon business, BARNES MECHANICAL INSULATION INC, is the Ultimate Parent BARNES MECHANICAL INSULATION INC 5201 SW 11TH CT - CAPE CORAL, FIL _ 737097607 Branches of the inquired upon business: BARNES MECHANICAL INSULATION INC 808 LAFAYETTE ST - CAPE CORAL,FL 737097606 TOP TOP Q Experian prides itself on the depth and accuracy of the data maintained on our databases. Reporting your customer's payment behavior to Experian will further strengthen and enhance the power of the information available for making sound credit decisions. Give credit where credit is due. Call 1- 800- 520 -9221, option #4 for more information. End of report 1 of 1 report The information herein is furnished in confidence for your exclusive use for legitimate business purposes and shall not be reproduced. !Neither Experian Information Solutions, Inc., nor their sources or distributors warrant such information nor shall they be liable for your use or reliance upon it. © Experian 2013. All rights reserved. Privacy policy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. Premier Profile - BARNES MECHANICAL INSULATION INC 4/4 Tff Merit Credit iNc Fast, Accurate & Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS), STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: EXPEPJAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800- 371 -3348 OR 239 - 277 -3202. COMPANY NAME: BARNES MECHANICAL INSULATION INC FEDERALID:650153368 CURRENT STATUS: ACTIVE BUSINESS PRINCIPAL(S): SUSAN BARNES TITLE: PRESIDENT WILLIAM BARNESTITLE: VP DATE INCORPORATED: 10/24/1989 Detail by Entity Name etail by Entity Name Florida Profit Corporation BARNES MECHANICAL INSULATION INC. Filing Information Document Number L25837 FEI /EIN Number 650153368 Date Filed 10/24/1989 State FL Status ACTIVE Effective Date 10/17/1989 S >W> 11 TH CT. CORAL, FL 33914 hanged: 04/17/2012 ianinq Aaaress 204 S >W> 11TH CT. :APE CORAL, FL 33914 :hanged: 04/17/2012 :eaistered Aaent Name ARNES, WILLIAM M. 204 SW 11TH CT APE CORAL, FL 33914 dress Changed: 04/12/1999 Name & Address Title P BARNES, SUSAN 5204 S.W. 11TH COURT CAPE CORAL, FL 33914 Title VPS BARNES, WILLIAM 5204 S. W. 11TH COURT CAPE CORAL, FL 33914 Page 1 of 2 http: // search. sunbiz. org / Inquiry/ CorporationSearch IScarchResultDetail /EntityName /domp -1... 8/1/2013 Detail by Entity Name Page 2 of 2 Report Year Filed Date 2 01/07/20 1 �1 1 om e Contact Us -Filing Services Document Searches Forms Help 2012 04/17/2012 2013 01/26/2013 0112612013 -- ANNUAL R E P 0 RT View image in PDF format 04/17/2012 -- ANNUAL REPORT View image in PDF format 01/07/2011 --ANNUAL REPORT View image in PDF format 03/30/2010 --ANNUAL REPORT 061118/2009 ANNUAL REPORT View image in PDF format View image in PDF format 01/06/2008 ANNUAL REPORT View image in PDF format 01/11/2007 ANNUAL REPORT View image in PDF format 01x'16/2006 ANNUAL REPORT View image in PDF format 01/26/2005 ANNUAL REPORT View image in PDF format 01/19/2004 ANNUAL REPORT View image in PDF format 03/03/2003 ANNUAL REPORT View image in PDF format 02/26/2002 ANNUAL REPORT View image in PDF format 04/05/2001 --ANNUAL REPORT View image in PDF format 02/24/2000 ANNUAL REPORT 04/12/1999 ANNUAL REPORT View image in PDF format View image in PDF format 04/27/1998 ANNUAL REPORT 05/14/1997 ANNUAL REPORT View image in PDF format View image in PDF format 05/01/1996 ANNUAL REPORT View image in PDF format 02/28/1995 ANNUAL REPORT View image in PDF format-7] Coovricint :e' jnd Pfl"::cv P00cies State cF Florida. Department & State httr):Ilsearch.sunbiz.org/lnquiry/CorporationSearchISearchResultDetail/EntityName/domp-I... 8/1/2013 iF of tate �roriaa Ohm i9ppartmpnt of 16tatr RUNI certify that the attached is a true and correct copy of the �p Articles of Incorporation of_KBARNES MECHANICAL INSULATION INC., �. NO%- a corporation organized under the Laws of the State of Florida, filed MWon October 24, 1989, effective October 17, 1989, as shown by the D �n records of this office. The document number of this corporation is L25837. CR2E022 (8 -89) Given under mg 4anb anb #4e (Sreat Sisal of #4e Static of Alariba, at cllttlitcs ee, #lie (Eapital, #liis tot 27th dxg a# October, 1989. dim erretarg of JS#tt #e EFFECTIVE DATE ARTICLES OF INCORPORTION OF rlj_J�D IXg OCT 24 SECrT 11: 42 SSte' Ft RID, BARNES MECHANICAL INSULATION INC. The undersigned, acting as incorporator of a corporation under the Flordia General Corpotation Act, adopts the following Articles of Incorporation of such corporation: ARTICLE I The name of the corporation is BARNES MECHANICAL INSULATION - - -- - - INC. ARTICLE II The period of its duration is perpetual, and it shall commence business on October 17, 1989 or upon approval of these r Articles. ARTICLE III The purpose is to engage in any activities or business permitted under the'laws of the United States and Flordia. ARTICLE IV The address of its initial registed office is 5313 Delano • 4F Court, Cape coral, F1. 33904 and the name of its initial registered agent at said address is William M. Barnes. ARTICLE V The corporation shall have authority to issue 100,000 shares, all of one class, at $1.00 par value. ARTICLE VI The number of directors constituting its initial board of directors is one, whose name and address is William M. Barnes, 5313 Delano Court, Cape Coral, Flordia 33904. ARTICLE VII The name and address of the incorporator is William M. Barnes, 5313 Delano Court, Cape Coral, Flordia 33904. STATE OF FLORDIA COUNTY OF LEE Before me, undersigned authority, personally appeared WILLIAM M. BARNES, to me well known to be the person described in and who subscribed the same for the uses and purposes therin mentioned and set forth. IN WITNESS WHEREOF, I have hereunto set my hand and offical seal at Cape Coral, Lee County, Flordia this . /j.A day of October. 1989 • j .� ....... _ • Nortary Public Notary Publi;, Stata of F :rid'q. My commission4�l9� Expir�s.fr'.oy 17, 1993 ' Banded Thru Ttay Fain • Insurance Inc.. ACCEPTANCE BY REGISTERED AGENT r Having been designated as the Registered Agent of BARNES " MECHANICAL INSULATION INC.to accept service of process for said rte{ corporation at theplace designated in the foregoing Articles of Incorporation, I hereby accept to act in this capacity, and agree to comply withthe provisions of said Act relative to keeping open said office, - Registered Agent .5 1 x - T ` ti Lee County Division of Natural Resources Management Small Quantity Generator Activity Certification AfEdavit IQdo hereby certify that: me 11 e5 DG Business Name „ Mailing Address State 3 Physical Address Lee County Occupational License Number: Renewal of Existing Number: — _LNew Application Type of Business Activity jA. 5azz/ I Dd Zip Code Phone Number 'Lip Code' Phone Number does not generate hazardous waste, as defined by Chapter 40, Code of Federal Regulations (CFR), from any process, maintenance or service associated with the operation of the business. I further certify that any waste materials possessing hazardous characteristics, as defined by Chapter 40, CFR, are fully utilized in processes on -site and are not removed by vendors or other agents of the company under contract or direct employ. Additionally, it is attested that hazardous wastes, as defined by Chapter 40, CFR, are not treated/disposed on -site through evaporation, thermal treatment, solidification, sewer /septic discharge or other treatment/disposal methods. M' ❑ has multiple licenses and has paid/will pay the Hazardous Waste surcharge on ONE of those licenses. License number which will pay surcharge: Any false or misleading statements in completing this form may be regarded as failure to disclose hazardous waste management practices and may result in fines of up to $100 per day for up to 100 days, per Chapter 403.7234(5), Florida Statutes. Signed: VJ��Ce'1r� 1 �` 99 Signature of Authorized Company Agent Date This I foregoing affi avit was signed and acknowledged before me this 'Y. day of ��-, 19 �/ , by, as identification. Vrunt Nome of Company Aheut No;e Notary Public Signature • "': ; `.;`.� Cr; Print Nam of Notary Mlic }_� ,s:,'.' :`r. ^r• ":_; 'J? ", � '::.A�a �:i:.:+n. —':_ ._•n M�r�. t+•.--/.•• �v.!.:.'.' 4tl L^.'. Y�' L'{ tiE,. �l:/: YO! Crt`] �c• N; u' Yflr. S% J:\' Yi_:!.•.Y tiS: iVkG( �: R' �l:/. t^ V1r+ 2UfA# 5�:: YJlW,'✓ iL'). l" N_. t�. �rS' !i[R'tYtr^.4'!t3!:t"ii'!irs•f:l r' ?�rti'✓':t:'•:.ri DO No'r WRITE BELOW TMS LINE: REASON FOR ANNUAL SPECIAL EXCEPTION: _ DOES NOT GENERATE HAZARDOUS WASTE - PER AFFIDAVIT DUPLICATE LICENSED FACILITY OTHER Authorized DNRM Agent /-1/_00 Date For Inspection Year 00 Form 941 for 2013: Employer's (Rev. January 2013) Dep —F"ef*9 1.4e_ TERLY Federal Tax Return 970113 '-kjternal Revenue Service OMB No. 1545 -0029 'E'N) 65- 0153368 Employer identification number Name (not your trade name) "S�S AL INSULATION, INC. Trade name (if any) Barnes Mechanical Insulation, Inc. Address 5204 S.W. 11TH COURT CAPE CORAL FL 33914 Read the separate instructions before you complete Form 941. Type or print within the boxes. Report for this Quarter of 2013 (check one.) 1: January, February, March Q2: April, May, June 3: July, August, September 4: October, November, December Instructions and prior -year forms are available at www.irs.gov /form941. Part 1: Answer these questions for this quarter. O5MT2901 03/08/13 1 Number of employees who received wages, tips, or other compensation for the pay period including: Mar. 12 (Quarter 1), June 12 (Quarter 2), Sept. 12 (Quarter 3), Dec. 12 (Quarter 4) ...... 1 9 2 Wages, tips, and other compensation ......................... ............................... 2 71,829.00 3 Income tax withheld from wages, tips, and other compensation . ............................... 3 6,968.00 4 If no wages, tips, and other compensation are subject to social security or Medicare tax ................ Check and go to line 6. Column 1 Column 2 5 a Taxable social security wages ..... 71,829.00 x-124= 8, 9 0 6. 8 0 5 b Taxable social security tips ....... x .124 = 5c Taxable Medicare wages & tips .... 71 , 8 2 9. 0 0 x .029 = 2,083.04 5 d Taxable wages & tips subject to Additional Medicare Tax withholding ............. x .009 = 5e Add Column 2 from lines 5a, 5b, 5c, and 5d .................... ............................... 5e 10,989.84 5f Section 3121(q) Notice and Demand — Tax due on unreported tips (see instructions) ............ 5f 6 Total taxes before adjustments (add lines 3, 5e, and 50 ........ ............................... 6 17,957.84 7 Current quarter's adjustment for fractions of cents ............. ............................... 7 0.02 8 Current quarter's adjustment for sick pay ..................... ............................... 8 9 Current quarter's adjustments for tips and group -term life insurance ........................... 9 10 Total taxes after adjustments. Combine lines 6 through 9 ....... ............................... 10 17,957.86 11 Total deposits for this quarter, including overpayment applied from a prior quarter and overpayment applied from Form 941 -X or Form 944-X filed in the current quarter ................ 11 17,957.86 12a COBRA premium assistance payments (see instructions) ....... ............................... 12a 12 b Number of individuals provided COBRA premium assistance .......... 13 Addlines 11 and 12a ......................................... ............................... 13 17,957.86 14 Balance due. If line 10 is more than line 13, enter difference and see instructions ................ 14 15 Overpayment. If line 13 is more than line 10, enter difference Check one: R Apply to next return. El Send a refund. ► You MUST complete both pages of Form 941 and SIGN it. Next ► For Privacy Act and Paperwork Reduction Act Notice, see the Payment Voucher. BAA Form 941 (Rev. 1 -2013) Filing and Printing Instructions FEDERAL QUARTERLY FORM 941 /SCHEDULE B Name BARNES MECHANICAL INSULATION, INC. Address 5204 S.W. 11TH COURT City, State, and ZIP Code CAPE CORAL, FL 33914 INSTRUCTIONS FOR FILING YOUR PAYROLL TAX RETURN Please file your federal 941 return by 07/31/2013. If f iling by mail send your return to the following address: Department of the Treasury Internal Revenue Service Cincinnati, OH 45999 -0005 Remember to sign and enter required information in the signature line SPECIAL INSTRUCTIONS FOR EXEMPT ORGANIZATIONS OR NO LEGAL ADDRESS If your business has no principal legal residence or place of business in any state, please mail your return to: Internal Revenue Service P.O. Box 409101 Ogden, UT 84409 If you are filing this return for an exempt organization or government entity, please mail your return to: Department of the Treasury Internal Revenue Service Ogden, UT 84201 -0005 Remember to sign and enter required information in the signature line PRINTING AND FILING INSTRUCTIONS The printed form may look different from the form provided by the U.S. government. However, the format has been approved by the U.S. government as long as you print the form with black ink on white bond 8- 1 /2 -in x 11 -in sized paper of at least 20 lb weight Please staple multiple sheets in the upper left corner when filing KEEP THIS PAGE FOR YOUR RECORDS -- DO NOT MAIL. INWKS941 970213 Form 941 (Rev. 1 -2013) Page 2 Name (not your trade name) Employer identification number (EIN) BARNES MECHANICAL INSULATION, INC. 165-0153368 Part 2: Tell us about your deposit schedule and tax liability for this quarter. If you are unsure about whether you are a monthly schedule depositor or a semiweekly schedule depositor, see Pub. 15 (Circular E7, section 11. 16 Check one: ❑ Line 10 on this return is less than $2,500 or line 10 on the return for the prior quarter was less than $2,500, and you did not incur a $100,000 next -day deposit obligation during the current quarter. If line 10 for the prior quarter was less than $2,500 but line 10 on this return is $100,000 or more, you must provide a record of your federal tax liability. If you are a monthly schedule depositor, complete the deposit schedule below; if you are semiweekly schedule depositor, attach Schedule B (Form 941). Go to Part 3. You were a monthly schedule depositor for the entire quarter. Enter your tax liability for each month and total liability for the quarter, then go to Part 3. Tax liability: Month 1 Month 2 Month 3 Total liability for quarter Total must equal line 10. You were a semiweekly schedule depositor for any part of this quarter. Complete Schedule B (Form 941): Report of Tax Liability for Semiweekly Schedule Depositors, and attach it to Form 941. Part 3: Tell us about your business. If a question does NOT apply to your business, leave it blank. 17 If your business has closed or you stopped paying wages ................... ............................... ❑ Check here, and enter the final date you paid wages 18 If you are a seasonal employer and you do not have to file a return for every quarter of the year .............. R Check here. Part 4: May we speak with your third -party designee? Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with the IRS? See instructions for details. ❑ Yes. Designee's name and phone number QBMT2902 03/08/13 Select a 5 -digit Personal Identification Number (PIN) to use when talking to the IRS. No. Part 5: Sign here. You MUST complete both pages of Form 941 and SIGN it. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign your name here Date Paid Preparer's Use Only Preparer's name Preparer's signature Firm's name (or yours if self - employed) Address Print your name here Print your title here Best daytime phone Check if you are self - employed .......... PTIN Date EIN Phone City State ZIP code LEE COUNTY License Holder WILLIAM M BARNES game: Firm Name: BARNES MECHANICAL INSULATION INC Address: 5204 SW 11TH CT CAPE CORAL FL 33914 LIC2007 -02184 BARNESMECHANICALQAOL.COM RENEWAL Thank you for assisting Lee County Contractor Licensing in their effort to "Go Green ". Please keep this document/file in a safe piece as you will not be receiving any additional copies of your license from this office. Be sure to keep your email address current with us at all times. Beiow please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if you wish to perform work in Unincoprorated Lee County. Renewal will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.les-county.00mided/contractoilicensing.htm In addition to this Certificate, it is your responsibft to maintain your worker's compensation, general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector while performing work in Unincorporated Lee County. You may email your certificates of insurance to Contractod icensingQLeegov. com. Our phone number is 239 - 533 -8895. Please send e-mail address and/or telephone changes to ContractorLicensing@Leegov.com IMPORTANT CHANGE PLEASE READ: In an effort to reduce costs and "go green" we will no longer be mailing renewal reminders. If you wish to receive a renewal reminder via email please provide us with your email address along with your Case number LIC2007 -02184 to ContractorLicensingaLeegov.com. Re: 'renewal by email ". Renews) due Im active and inactive certificate each year in September. COMP. NO. shelf appear on aM advertiewneft indudinp vehidas refteding a businass name. Shall only contract in D/WA name as it appeere on cettifiealle. BWd of Approval required on business name dwn0ru. CAA film LEE COUNTY CERTfFICATE OF COMPETENCY (239) 5934895 NAME: WILLIAM M BARNES DJBIA BARNES MECHANICAL INSULATION INC LICENSED FOR: Insufaftn CntrAlf Typs COMP. NO.: IN 000008 NOT VAUD AFTER: OW30rx013 pnMure of LaWW Holder Shah maintain required insurances on active certificates. Shag Worm flee Conlracbr Licensing Office of any Addresa or telaptmw N dange. fordrloenn2spt 'VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: �`. ZL9lYl�t Certificate Category Requested- The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the person signing below and verifying Applicants relevant experience: Name: L /.S IV 15�7 PC)R1r TSCI21 Title: A"S/ ve"a r License Number (if applicable): C MO Q S 7 / S Z Name of Business: /( I.- 974 -esl e f / /fG'fi/9itli «9� �ti G Business Address: G ZG O £T.2d A? 4d) TAT /dX/ R49 �T %%%y oees., G 33 Business Phone: 239. 3 3 2 -7 Z51 `% The Applicant's years of experience from / 9 10 to Z Q/ 3 The applicant's scope of work (specific duties) included: 40Sd4A7-1d.y TD /aJCt d P of pi Pi,e) e5 4AJQ DUC764-)0-'21- Additional Comments: Falsifying any information provided herein may subject your license to revo n 1J�I A _ P Pri n t _ N a me: 11,5,4 /4• 7d,2/7-.5 -c14 State of Florida County of Cuftieri. The foregoing instrument was acknowled ed before me on this a3 � day of by L� � 3G. f�- � wi't •ks C� who is personally known to me or prodaced � as identification and who did not take an oath. Signature of Notary RHONDA K. MOORE MY COMMISSION # EE 055030 EXPIRES: March 15, 2015 8 of `' Bonded Thru Notary Pubhc Underwriters VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: //,)1- A-am A &tlie Certificate Category Requested:51,(%1}�l' The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the person signing below and verifying Applicants relevantexperience: Name: rIN VIII u. i Title: 1 fie.. License Number (if applicable): C,MC,I 24--q 6 9 i Name of Business: FLC? -�f7A AjDrooc SOWTtoM6 -W Business Address: 1 q S f 1J FtiT f Vlt f ECS FL. Business Phone: 73`j-S�r `� �1 i The Applicant's years of experience from 410 �Z co C, to The applicant's scope of work (specific duties) included: P O C I .Ioc-F _ osuuf 1 1 n 1 i A ►U i7 o P-e LA--n D rJ Additional Comments: Falsifying any information provided herein may subject your license to revocatit;�ii >gnature Print Name: IIA ROM of Florida County of Collier The by _ as it acknowledged who did not take an �ppY P� ?� ; • • • ;�% AMBER PACE * * MY COMMISSION f EE 853821 EXPIRES: November 25, 2016 N11 , foe Bonded Thru Budget Notary Services day of L �� is personally known to or produced Si a o of 6 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, am a resident of 1 Ze z County, ti Oz., 0a (State) and have resided here for more than five (5) years. During the last five years I have known �,.V, �1 +�� 0,ar ,� s applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signatur �- -� (Name) - R;-,k', V% , ,*, (Address) 6E�c el-11Z WEE- We Z J F-6, 3 39 "LO Telephone) -0 -2 3 —5- W S STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this D who has produced (name of pe on acknowledging) as identification and who did not take an oath. NOTARY'S SEAL AMBER PACE 20 • �i0 * * MY COMMISSION # EE 853821 EXPIRES; November 25, 2016 Bonded Thai Budget Notary Services (Type of iden -�y L IG TURE OF NOTARY Noftr P, , . (PRINT NAME OF NOTARY) NOTARY PUBLIC 9 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, / /Sfl '0!�• -DiJ,P / 7`SCN , am a resident of L'r £ County, e7R.,0,9 (State) and have resided here for more than five (5) years. During the last five years I have known S/c L i7w eA/£S' (Applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) (Name) L /S009 /�- ,l?yr?lTS'C // (Address) 3038' We' -e7o'—R-,F e1e `✓ "'v /'il�f,Ps, f 339'l� Telephone) 23 9 - yZS- SO 38' STATE OF FLORIDA COUNTY OF L-o- The foregoing instrument was acknowledged before me this 4�� DDS ca 4 2.0 by (Date) Li = )L,-r! -SC'.V \ who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIGNATURE OF NOTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC ;1 RHONDA K. MOORE +: +: MY COMMISSION # EE 055030 EXPIRES: March 15, 2015 Bonded Thru Notary Public Underwdters 10 From:Tiffany Quroilo FaxiD: Page 2 of 2 Date:8/112013 10:59 AM Page:2 of 2 BARNE -2 OP ID: TQ ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 08/01/2013 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 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 Phone: 239-945-1900 Olin Hill & Associates Inc. Fax: 239 -945 -3163 2804 Del Prado Blvd. #107 Cape Coral, FL 33904 Derek L. Holnes CONTACT NAME: gHCNNo E AIX No ADDRESS: GENERAL LIABILITY INSURER(S) AFFORDING COVERAGE NAIC 0 INSURERA:Safeco Insurance Company 24740 1,000,00() INSURED Barnes Mechanical Insulation INSURERB: FCCI Insurance Company 10178 Inc 5204 SW 11th Court INSURER C: 1212212012 12/22/2013 PREMISES�'Ea oc�ur`ence; Cape Coral, FL 33914 INSURER D: CLAIMS -tdADE 7 OCCUR INSURER E: INSURER F: J$ 10,000 PERSONAL &ADVINJUR° 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 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. I�TR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH O CC.URR ENCE 1,000,00() A X C.,MMERCIAL GENERAL LIABILITY 01CG47611700 1212212012 12/22/2013 PREMISES�'Ea oc�ur`ence; is 200,000 CLAIMS -tdADE 7 OCCUR MED EXP Any o ,ie persons J$ 10,000 PERSONAL &ADVINJUR° $ 1,000,000 GENERAL AGGREGATE i $ 1,000,000 GE "J'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- (,OMP? ;-'P AGG $ 1,000,000 $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ,Ea accident) $ ANY A!!TO BODILY INJURY (Per person) ! $ ALL OWNED (—' SCHEDULED AUTOS AUTOS NON -OWNED HiREDAUTOS AUTOS BODILY INJURY (Per acdoent) $ PROPERTY DMAAGE fPeraccident I $ $ UMBRELLA LIAB OCCUR EACH OCC=URRENCE Is HCLAIMS-MADE AGGREGATE is EXCESS LIAB DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRI PTO P :PARTNER. EXECUTIVE YIN O= FICER/MEMBER EXCLUDED? [N] (Mandatory In NH) NIA 001 WCIOA23406 01/01/2013 01/01/2014 "NC �TP.TI_r- i •TH- -'� IvUT^ -R E L. EACH ACCDENT $ 100,000 EL OISEr' -..SE - EA EMPLC � EEI `F 100,000 II y..%S, dascrlbe undar DESCELPTII-N OF OPERATIONS below E L DISEASE - POUCY LIMIT ' $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) William Barnes is included. COLL101 Collier County Contractor's Licensing Board 2800 N Horseshoe Drive Naples, FL 34104 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Proof of Coverage Page 1 of 1 JEFF ATWATER CHIEF FINANCIAL. OFFICER FLORIDA DEPARTMENT OF FINANCIAL SERVICES We flame WC Da i:abasr.s CFO Horne Exemption Detail Page This database was last updated Thursday, August 01, 2013 12:13 AM. Return to Previous Page Exemption Details Name Title Effective Date 'Termination Data Exemption type - -tSusmess Ac.-- c-isrvv.;, -- """""""""` Click Here to View BARNES SUSAN L BARNES VP Feb 7 2013 Feb 7 2015 Construction Activities Listed on MECHANICAL Exemption INSULATION INC Click Here to View BARNES SUSAN L BARNES ; VP Feb 82011 Feb 7 2013 Construction Activities Listed on MECHANICAL i Exemption INSULATION INC Click Here to View BARNES SUSAN L BARNES VP Marl 2009 Feb 8 2011 Construction Activities Listed on MECHANICAL Exemption INSULATION INC Click Here to View BARNES SUSAN L BARNES ! VP Mar 2 2007 Mar 1 2009 Construction Activities Listed on MECHANICAL Exemption INSULATION INC g SUSAN L BARNES j VP Mar 2005 Mar 2 2007 Construction Click Here to View Activities Listed on BARNES MECHANICAL Exemption INSULATION INC Click Here to View BARNES SUSAN L BARNES VP Jan 1 2007 Jan 25 2005 Construction Activities Listed on MECHANICAL Exemption INSULATION INC Click Here to View BARNES SUSAN LBARNES VP Jan 262003 Dec 31 2003 Construction Activities Listed on MECHANICAL Exemption INSULATION INC Click Here to View BARNES SUSAN LBARNES VP Jan 262001 Jan 26 2003 Construction Activities Listed on MECHANICAL Exemption INSULATION INC' 'Termination may be through the revocation of the exemption, or expiration of the exemption. "The exemption only applies to the business activities listed on the exemption. Return to Search Page htt„c• / /a,,,,eR fldfc rnm/ nrnnfnfr. nvernae/Fxemntionnetail.asnx ?nr Derson id= 031892750 8/1/2013 Tax Co for °''• of Acee Dear Business Owner: SUM= Lee County Tax Collector 2480 Thompson Street Fort Myers, Florida 33901 www.leetc.com Tel: (239) 533 -6000 Local Business Tax Account: 0003037 Your 2012 -2013 Lee County local Business Tax Receipt is attached below. The receipt is non - regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector "ax Co for % Detach and display bottom portion and keep upper portion for your records LEE COUNTY LOCAL BUSINESS TAX RECEIPT 2012-2013 ACCOUNT NUMBER: 0003037 ACCOUNT EXPIRES SEPTEMBER 30, 2013 Locadon 808 LAFAYETTE ST CAPE CORAL FL 33914 BARNES MECHANICAL INSULATION INC BARNES WILLIAM M 5204 SW VTH CT CAPE CORAL FL 33904 Nlky engage In t ie business : ACOUSTICAL A INSULATION CONTRACTOR THIS LOCAL BU3INE33 TAX RECEIPT 18 NON REGULATORY THIS IS NOT A BILL - DO NOT PAY PAID 018454- 189 -1 OW20/201210:58 DP500 $50,00 CITY OF � v to v ��OR100 City of Cape Coral et' Business Tax Receipt BT13 -02058 Issue Date: 09/21/2012 DBA: BARNES MECHANICAL INSULATION INC Owner Name: BARNES WILLIAM Expiration Date: 09/30/2013 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9 -72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the pubic and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 100/0 for the month of October, plus an additional 5% for each month thereafter. The total delinquency penalty shall not exceed 25% of the tax. A 25% penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities, nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Annual renewal notices are mailed on July 1 st to the address of record at that time. If you need to transfer your Business Tax due to a change in business name, ownership, location or are closing the business, please come to our office to have the records updated. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT #:BT13 -02058 City of Cape Coral —1015 Cultural Park Blvd -- Cape Coral Florida 33990 -- (239) 574 -0430 This receipt expires September 30, 2013. Visit our website at www,capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. - THIS TAX IS NON REFUNDABLE - Location: 808 LAFAYETTE ST Business Phone: (239) 542 -5106 ,- CITY OF � � v 9A � � v BARNES MECHANICAL INSULATION INC BARNES WILLIAM 808 LAFAYETTE ST CAPE CORAL, FL 33904 Number of Employees: Classification: CONTRACTOR/SPECIALTY CONT Classification Code: 140A Issued Date: 09/21/2012 Amount: $ 88.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state, county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. ne —fill n 7 S Operations & Regulatory p g ry Management AUG 0 6_.2013 Licensing Section. �j� AAt AA 2800 North Horseshoe Drive r1 J (•i*t•1�4i•l� Naples, FL 3.4104 013 - j (0�� APPLICATION FOR COLLIER COUNTY /CITY OF NAPLES /CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany. this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90405, as amended. NAME OF COMPANY: EXactCorporate %Business Name: �' \ uz- `' r "ot)WQRV<� Fiction Name /DBA: Qualifier Name: Physical Address:, Mailing Z 0U'JA9Z -_7_ (Number & Street) . ..9 n ,, _nA p� (Number & Street) Telephone: - I� 2,4(p--4-2 Z L TYPE OF LICENSE: General Building Q. Residential ❑ Mechanical Q Roofing Specialty trade: $230.00 $230.00 . $230.00 $230.00 $230:00 CHANGE OF STATUS: ( )Reinstatement { ) From One. Business to Another .� ao L V 0 Page 1 of 4 tv T L `34 (city) (State) (Zip Code) of S l( (City) (State) (Zip Code) E =Mail: ,B1 e ckgz o t (� -� 01L t carp ❑ Electrician ❑. Plumber ❑ Air Cond. swimming Pool Specialty AA I $230.00 $230.00 $230.00. $230.00 $205..00 ( ) Dormant License to Active QUALIFIER INFORMATION• Name: CA-Z, OtA ,7 Address: 3Z-30 LA [ A lj P- ' 'Pr ZOcj We 22(NumberrI& Street) Telephone: Z Jq - Z,�� 't' ZZ'Z (City) (State) (Zip Code) Date of Birth: S.S. #: 000 -00 -_ E -Mail: ��'r'V2- �°/ L .lam i✓� Driver's License:. C14 I.lo'10O--'S9 [j'2 -0 1. Type of Certificate of Competency for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. K s�L- OL- LL[A1?&-Z 6-70-4-L-7 -0993 . JPCNF_ V-M-Di-e- ZO2 -044 - SO7 3. Have you ever been convicted of a crime related to Contracting? �j n (If yes attach extra sheet with explanation) 7. Have. you or any firms you have been associated with ever filed bankruptcy? 00 why. 9. List your business or work experience during the past ten years. ©t�A 15.Oprol- q his Ott 6,/i i O 0' nA+a6e u)aopwd_tu 10. Statement of any formal training you have had in the area for which the application is made. 40 9A-W[ VftVjOf4 �X_ Vo T-60K 05APAL E;0-0&& A-Mr> OAaPWrjF9_ &*-w( 1. The names, titles, home address and phone numbers of all Officers /Managing Members of the Firm. (1, TO 0LtJ 2. 0 W 0 4 Eg-t � TI-o� 3Z30 LA- ft5g A iD(o 2. List all businesses, firms, .entities or contracting businesses you have been associated with during the last ten ye rs (ex. Held a license for or been a partner). Attach extra pages if needed. :�* A- LtCtl,,) din Cab) PoL ©f 2 -j- 0 W QMrKG- P& lSS (o 4 3. List all debts you or any company(s).associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. AFFIDAVIT certi that the fore r ,. fy foregoing g is true anq correct tot best of my knowledge. Authorized Officer of the F STATE OF FLORID COUNTY OF -_ to\\"\ ev The foregoing instrument as acknowledged before me this <�— I(, I oZ d � 3 t (D te) By ( YV� \Jc;v� Z� of toZJY�s ( ame of officer, title /agent) (Name of Corporation) a �0�� f^ f �� Corporation on behalf of the corporation. (State or Place of Corporation) He /She.has- has-produced P Lc-tv\-S' 'identification and did not take an oath. (Type of identification) NOTARY'S SEAL We Of F16dda MY COMMISSION # FF 4785 a •►'� Expires: Apn13, 2017 SIGNATURE OF 1ARY) ! ! Page 2 of 4 AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain' at-all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. SIGNATURE OF APPLICANT J�yz woob wx<_� z C, BUSINESS NAME DATE BEFORE ME this day personally appeared cyu, . who affirms and says that he has less than one employee and does not require Workmen's Compensation and understands that at any time he employs one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF �« v The foregoing instrument was acknowledged before me this 6 a (Date) -by t /� .fy L W\,\,iwa7 who has.produced _ _ �L ,�o)ev (name of person acknowledging) (Type of fdortflGatioh) as identification and who did not take an oath. State of Florida NOTARY SEAL '`50MYCOMMISSION # FF418S ExpftA;d 3, 2017 SIGNATURE ' NOTARY NOTARY PUBLIC AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006 -46, as amended, and vouches for the truth and accuracy of all statemen ts and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification.of any information contained herein is grounds for disqualification. �*Vz O APPLICANT (PLEASE PRINT) 6 1] 7 K/00/) W0441 NAME OF COMPANY 4 SIG ATURE OF APPLICANT STATE OF FLORIDA COUNTY OF C.)1 rev The foregoing Instrument as acknowledged before me this a 0 �3 t jDate) By , �YU� I�JGy��, who has produced (`R" �ftv�ev (Name of person acknowledging) (Type of identification) as identification and did not take an oath. l Davy L" NOTARY'S SEAL ` of Florida W COMMISSION # FF 4785 Expires. April 3,20 17 (SIGNA OF NOTARY) Page 4 of 4 STATEMENT OF OWNERSHIP This certifies that I, �&z 0 (APPLICANT'S NAME) Managing member of � �� W" Wo�� I own 160 Company listed above. (LIMITED LIABILITY COMPANY NAME) am a member or % of the units issued by the Limited Liability Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. &Z, DG1U,414Z T z a , e� ( APPLICANT'S sIGNATIIR ,) (DATE) F PROME'T'"RIC EXAMINATION RESULTS NOTIFICATION October 17, 2012 Cruz Olivarez 3230 LaCosta Cir Apt 208 Naples, FL 34105 Dear Candidate: XXX -XX -3925 We are pleased to inform you that you achieved a passing score on your recent Collier County examination. Your score(s) are as follows: 10/13/2012 Bonita Springs, FL Business and Law Collier County requires a passing percentage of 75 %. iss Please note that passage of the exam is no guarantee a certificate of qualification will be issued by the Licensing Board. To help you gain the recognition you deserve, Prometric has prepared a Certificate of Achievement, beautifully designed and very suitable for framing (8 -1/2 x 11) for only $30.00 per category. Please fill out the order form below, cut along the dotted line, then send the completed form to Prometric . Payment options: check, money order, Visa or MasterCard. Credit card orders may be faxed to (800)813 -6670. All others send to Prometric , 1260 Energy Lane, St. Paul, MN 55108. Allow 2 -3 weeks for delivery. Certificate of Achievement Request Cruz Olivarez 3230 LaCosta Cir Apt 208 Naples, FL 34105 Collier County - Business and Law - 10/13/2012 For credit card payment, complete the following Card No. Signature XXX -XX -3925 Quantity x $30.00 = Card Type: Visa Mastercard Exp. Date F159 - fl -bonsp - C PROMETRIC * 1260 Energy Lane * St. Paul, MN 55108 Toll Free: 800.280.3926 * Fax: 800.813.6670 * www.prometric.com Prepared By: Merit Credit (239) 277 -3202 (800) 371 -3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 17 WP 4/85 07/30/13 09:14CT [SUBJECT] OLIVAREZ, CRUZ 3. [ALSO KNOWN AS] OLIVEREZ,CRUZ [CURRENT ADDRESS] 135 E. 4TH ST., WYOMING PA. 18644 [FORMER ADDRESS] 222 E. 8TH ST., WYOMING PA. 18644 410 W. 8TH ST., WEST WYOMING PA. 18644 [CURRENT EMPLOYER AND ADDRESS] CTC FRAME AND FINISH CARP [FORMER EMPLOYER AND ADDRESS] SELF [SSN] [BIRTH DATE] -7328 4/59 [DATE RPTD] 5/08 2/07 [VERF] [RPTD] 8/12 7/12 2/87 S P E C I A L M E S S A G E S ** *ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESSES) * ** ---------------------------------------------------------------------------- M 0 D E L P R O F I L E * * *FICO CLASSIC 04 SCORE +582 : 038, 020, 016, 015 * ** ---------------------------------------------------------------------------- C R E D I T S U M M A R Y * ** T 0 T A L F I L E H I S T O R Y PR =3 COL =8 NEG =1 HSTNEG =O TRD =3 RVL =O INST =3 MTG =O OPN =O INQ =3 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE INSTALLMENT: $26.6K $ $23.8K $0 $538 TOTALS: $26.6K $ $23.8K $0 $538 ---------------------------------------------------------------------------- P U B L I C R E C O R D S SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF /ATTORNEY Z 4780341 6/08R $3036 I CI 83342008 CIVIL JUDGMENT PPL GAS UTILITIES CORP Z 4780341 12/07R $191 I CI 00700014023 CIVIL JUDGMENT WYOMING VALLEY SANITAR Z 4780341 7/04R $12.OK I CP 1670 FEDERAL TAX LIEN ---------------------------------------------------------------------------- C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS ABLTY RECVRY Y 2DFY001 C 5/13 $328 01 STORE IT ALL 09B D2898615N1 7/13A $328 PLACED FOR COLLECTIO PENN CREDIT Y 26GF003 I 2/09 $109 10 PPL 09B 134116064 7/13A $109 PLACED FOR COLLECTIO PENN CREDIT Y 26GF003 I 2/09 $752 10 PPL O9B 194116044 7/13A $752 PLACED FOR COLLECTIO NCO FIN /99 Y 73CJ001 I 3/07 $94 06 PROGRESSIVE INS O9B 692111945 5/12A $94 PLACED FOR COLLECTIO NRTHESTCRCOL Y 1NLG001 I 6/07 $80 PAPER SHOP O9B D7583107N1 6 /11A $80 PLACED FOR COLLECTIO AFNI Y 96ER009 I 4/09 $203 10 VERIZON INC O9B 2035415884 5/09A $203 PLACED FOR COLLECTIO NRTHESTCRCOL Y 1NLG001 I 2/10 5/10F $123 COMCAST CABLE COMM O9P D21500289N1 6/10A $0 PAID COLLECTION AFNI Y 96ER009 I 7/09 12/09F $148 10 VERIZON INC O9P 2037370905 ---------------------------------------------------------------------------- 12/09A $0 SETTLED [ FULL BLNC T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1 -12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT -MOP PAYPAT 13 -24 ECOA COLLATRL /LOANTYPE CLSD /PD BALANCE REMARKS MO 30/60/90 GMAC Q 2592669 4/04 $31.1K 60M I9P 24905113408 8/09A $0 I AUTOMOBILE 8/09F $0 PAID /WAS A CHARGE OFF CAPITAL 1 FA F 1W2K001 7/12 $26.6K 72M538 11111111111 I01 62062113245561001 6/13A $0 I AUTOMOBILE $23.8K 11 0/ 0/ 0 MTBANKES B 63PX005 5/01 $10.3K 39M318 111111111111 I01 10000160886520001 3/04A $0 11X111XX1111 I AUTOMOBILE ---------------------------------------------------------------------------- 3/04C $0 CLOSED 33 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 7/30/13 ZNP6284423(FLA) MERIT CREDIT 7/04/12 FPC1246538(NTL) COAF 7/04/12 ACH9698604(CHI) ---------------------------------------------------------------------------- FORT MYERS T C R E D I T R E P O R T S E R V I C E D B Y TRANSUNION 800 - 888 -4213 2 BALDWIN PLACE, P. 0. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http: / /www.transunion.com ------------------------------------------------------------------------- CREDITOR CONTACT INFORMATION LUZERNE CP ZP4780341 (570) 825 -1500 200 NORTH RIVER ST WILKES BARRE PA. 18711 ABLTY RECVRY YC2DFY001 (855) 207 -1892 PO BOX WYOMING PA. 18644 PENN CREDIT YC26GF003 (717) 238 -7124 916 S 14TH ST HARRISBURG PA. 17104 NCO FIN /99 YC73CJ001 (800) 709 -8613 POB 15636 WILMINGTON DE. 19850 NRTHESTCRCOL YClNLGO01 (570) 347 -1115 245 MAIN STREET DICKSON CITY PA. 18519 AFNI YC96ER009 (800) 371 -3645 POB 3097 BLOOMINGTON IL. 61702 GMAC QZ2592669 (800) 200 -4622 P.O. BOX 380901 BLOOMINGTON MN. 55438 CAPITAL 1 FA FA1W2K001 (800) 946 -0332 ATTN- CREDIT BUREA PLANO TX. 75093 MTBANKES BZ63PX005 (800) 724 -2445 1100 WEHRLE DRIVE WILLIAMSVILLE NY. 14221 COAF F 1246538 (888) 396 -2623 3905 N. DALLAS PAR PLANO TX. 75093 FORT MYERS T A 9698604 (239) 936 -4114 2555 COLONIAL BLVD FORTMYERS FL. 33907 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800 - 371 -3348 OR (239) 277 -3202. Detail by Entity Name etail by Entity Name RUZ WOODWORKS LLC ocument Number EI /EIN Number ate Filed tate tatus ffective Date 230 LA COSTA CIRCLE 106 IAPLES, FL 34105 L13000108490 NONE 08/01/2013 FL ACTIVE 08/04/2013 230 LA COSTA CIRCLE 106 IAPLES, FL 34105 eaistered Aaent Name & Address �LIVAREZ, CRUZ, III 230 LA COSTA CIRCLE 106 APLES, FL 34105 lanaaer /Member Detail ame & Address e MGRM LIVAREZ, CRUZ, III ?30 LA COSTA CIRCLE #106 APLES, FL 34105 1T1M.1 No Annual Reports Filed ument Imaaes 08/01/2013 -- Florida Limited Liability View image in PDF format Page 1 of 2 http: // search. sunbiz. org/ Inquiry /CorporationS earch ISearchResultDetail /EntityName /flat -113 ... 8/6/2013 Detail by Entity Name Page 2 of 2 C'onvr oiit t4- and Privacy Policies :..tntf of Florid:,, oepa.zn,ert of State. Home Contact Us E- Filing Services Document Searches Forms Help http:/ /search. sunbiz.org/ Inquiry/ CorporationSearch /SearchResultDetail /EntityName /flat- 113... 8/6/2013 0 Cer�i�i zcq, k of status I certify from the records of this office that CRUZ WOODWORKS LLC, is a limited liability company organized under the laws of the State ofFlorida, filed electronically on August 01, 2013, effective August 04, 2013. The document number of this company is L13000108490. I further certify that said company has paid all fees due this office through December 31, 2013, and its status is active. I further certify that this is an electronically transmitted certificate autho rized by section 15.16, Florida Statutes, and authenticated by the code noted below. Authentication Code: 130801091937- 700250327007 #1 Given under my hand and the Great Seal ofthe State ofFlorida at Tallahassee, the Capital, this the First day of August, 2013 OA4. 4* sett Metzner e�Utarp Of *t& G Applicant's Name: Certificate Categor The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the erson signing below and Verifying Applicants relevant experience: Name: t Title: i License Number (if applicable): Name of Business: L, f,I yd lq s C(LJ 6 Business Address: 1/, fo , � Business Phone: 570 S4 AW The Applicant's years of experience fr( U p 'ca 's scope of wor (sp cifc duties� ) in ludcd: 61 Qa-�l ©� ct I 1�- s�i gc o o tit/0 iS i✓ Cf- P to 2 t Additional Co ents: V 1499 'OVA d T Falsifying any information provided herein may subject your license to PA State ofa 'ounty of-euWeil-l"'erY%)'Q Signature Print Nan Cl�-o L-,— 6's PA (ki40 to 2-0 Z WGa u1 10,--Lv" fth V COS - l �dLZ an i'S 4K-/ i iv ►i I;ol iw c??f 1'he foregoing instrument was acknowledged before me on this�� day of DQ Lip f, j X �-O ) �, ry A A !9 who is personally known to me or produccd � is identificati n and who did not take an oath. ,--� c,--v, - ) Signature of Notary COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL DONNA M. KNALIER, � tart' Public My Commission ExZires J tyC25, 2013 8 [VERIFICATION OF CONSTRUCTION EXPERIENCES GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: Certificate Category Re q uested: r ot� j �JTL� The Applicant is seeking a Collier „'County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the person signing below and Verifying Applicants relevant experience: Name: - 0 5 '2- P 14 (2- 1) C3 k.7 [_01 1 t-_ ' Title: L w 1V-k ►P K) C 6 Kk W T License Number (if applicable): J a� Name of Business: 1A a?t x (L ti o C ►n L Business Address: cl PZ,A P, S T 5 C i2 0 PJ io c.-) Business Phone: 5 7o (.Sc- / S d 4 The Applicant's years of experience from l n b g to q/140// The applicant's scope of work (specific duties) included: IY -�`�I WCL f c)G %,'-, 10”, /-1 /z-(- e-) a—, I AJ A)G �yOi�S A,Jh LJ S Additional Comments: Falsifying any information provided herein may subject your license to revocation. *fiatuff y�vxni) Print Name:_ JOS�pM (2&? CQO�_ Cor,�r,,nnwc?alk o�' �C�nnr a County ofColl� Lctci(awa+lha) )SS: The fore oing instrument was acknowledged before me on this agJ4 by ,I n.i @ o C r Q to who is personally known 1 as identification and who did not take an oath. COMMO ^ Ei;�_,- s- JYLVANiA 4 Alain 1". ChlnsE i4! fi' "" Pub!ic City of .1icranton, La:_- k u'+?ia it' : County My Comn-iissia„ xt ? ; i.'ay 1 2013 r 8 CATION OF CONSTRUCTION EXPERIEN GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: y �V e Certificate Category Requested: i lJ I f OA I The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Ti -t'lee and license number of the \ person signing below and verifying Applicants relevant experience: Name: : TC � C, V- e, �� Title: U"''\'r Name of Business: �e\\ Business Address: License Number (if applicable): Y Pi ' 03 d 2) 03 Vt, Yo Business Phone: 570 - Q17 -505" 3 The Applicant's years of experience from , S to c^"' The applicant's scope of work (specific duties) included: Additional Comments: k�,,SN P ?��' n- �`� Cpl tk/\:4 C S "-�3 M,A ✓o Falsifying any information provided herein may subject your license cation. ) > ZF - COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Signature Thomas J Roberts Jr, Notary Public Print Name: P' State of- F4ofWa ig City of Luzerne, Lucerne County County of Collier My commission Expires January os, 201 a The ;Mir strument acknowledged before me on this_ �y e f� LL who is personally know is identification and who did not to a an oath. 8 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER am a resident of Lo -Z'Wn ( County, ?tAs\SU \kI A,nto- (State) and have resided here for more than five (5) years. During the last five years I have known & C-O L applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) 7_9 (Name) (Address) fWAG y\ S-i- A �+0� 157.5 Telephone) 70-J37'SD.5-3 STATE OF FbOR+I)* %,,�7 COUNTY OF The foregoing instrument was acknowledged before me this _/ J, ?-gW% a by (Date) /01 C/� /�i 11 who has produced Pe) - G /V_S'AZ (name of persuti acknowl dg (Type of identification) as identification and who did not take an oath. NOTARY'S SEAL coMMONWEALTH F PENNSYLVANIA NOTARIAL SEAL Thomas J Roberta Jr, Notary Public City of LuWrlo, Luxbrna County My Commission €Xpltas J6nudry 06, 2014 SIGNATUR F OTARY ✓tL Ab (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER D ,5 e,p k C r e g dO v, , am a resident of L# z r County, e In InSV ( UQ nt Pl. (State) and have resided here for more than five (5) years. zring the last five years I have known C. r (t l U Q re, z (Applicant). I have had e opportunity to observe his or her business and personal dealings and find him or her to be a person of nesty, integrity and good character. (Signature) (Name) J o s -r-p f-i (2 2 *--, p a j (Address) $�o ,q h 4 -1 s s T boA/fI4 ,P%4 /, Z-z9,; 1, Telephone) S 70 6 50 /s a 9 COMPIOAJWEALThj aF PENNS'�i-VAA11A) COUNTY OF L p CKAWANW) )SS-- The foregoing instrument was acknowledged before me this A) VP vh6C r �q by (Date) J DWP6 CrUdDh who has produced —PP P Dri er s L 16 et�s� (name of person acknowledging) (Type of identification) as identification and who did not take an oath. t,QtV!M0rE�� ,dl 1i 1JalLVANIrk !< ( � AL.SE -Ai < dzm is i ( tG r y PUbiic City of SC anL ,n, _a; �.a °wainna County Mv klay18,2013 NOTARY'S SEAL SIGNATUR910F NOTARY Adam R, (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER am a resident of L U County, (State) �� IUt� 'U yl �� G� (State) and have resided here for more than five (5) years. During the last five years I have known ` ru Z C) I l l�q�°LZ applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. D A n A (Signature) (Name) (Address) laaz � g- -- FLA Telephone) STATE OF-F4294UBA COUNTY OF LUZ`P�l,►v� The foregoing instrument was acknowledged before me this ) 0-\-N' aD - L by �.p (Date) 1�� L \)A who has produced -6-8?_ �3�' �� fl c L. c---p (name 6Y person acknowledging) (Type of identification) as identification and who did not take an oath. �7'-) cn"Z'� , Yk- k)Ma�A� SIGNATURE OF NOTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC '€/,YY3176VI iLT GF PE- ' ['F' dS�TM NOTARIAL SEAL DONNA M. KNAUER, d�orsry P�a�bc WYOMING, L?1ZER�lE �OE1 ub V Gomm!!s ExAi s.lufy 25,201 9 A CERTIFICATE OF LIABILITY INS URANCE DATE(MMDWYY 08/05/13 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 Poiky((es) must be endorsed. If SUBROGATION IS WAIVED, subject to the tennis 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 andorsemamt -L A. G. Family Insurance, Inc. 9420 Fountain Medical Ct. Ste. 101 Bonita Springs, FL 34135 Phone (239) 322 -5310 INSURED Cruz Woodworks LLC 3230 La Costa Circle #106 Naples, FL 34105 COVERAGES Fax (239) 244 -9059 (239) 246 -4222 CERTIFICATE NUMBER: Y'jjo. E,at• (239) 322 -5310 FAX No): (239) 244 -9059 First •• rv�•� cc�iv iDOucu I v I r1t 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. LTTRR TYPE OF INSURANCE A U POLICY NUMBER POLICY EFF M LICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0( Q COMMERCIAL GENERAL UABIUTY PREMISES ES REoNa:ulrence $ 100,000 A ❑ ❑ CLAIMS MADE ❑OCCUR GFL- 10291512 12/17/2012 12/17/2013 MED EXP (Any one parson $ 5,000.0( ❑ ❑ PERSONAL &ADVNJURY $ 1,000,0C , GEN'LAGGREGATE UMITAPPUES PER: 000,OC GENERAL AGGREGATE $ 2 El POLICY El PRO' ❑ LOC PRODUCTS- COMP/OPAGG $ 1,000,OC AUTOMOBI & M N -D SINGLE LIMIT ❑ ANY AUTO ❑ AUT OWNED OS ❑ SCHEDULED BODILY INJURY (Per parson) $ NON-OWNED ❑ HIRED AUTOS ❑ BODILY INJURY (Per axMen $ AUTOS El PPR OPERTYIAMAGE $ aacccc((ddeenn ❑ UMBRELLA LWB ❑OCCUR $ ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ DED 0 RETENTION $ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY YIN I—I WCA I—I NTH B OFFICER/MEMBERE:XCLUDE�tL;ulivt: NIA MWC0042574 -01 (Mandatory in NH) 12119/2012 12/1942013 E.L. EACH ACCDE If yyes describe under E.L DISEASE - EA DESGR1PT1ON OF OPERATIONS below E.L DISEASE - PO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) CERTIFICATE HOLDER Collier County Contractor's Licensing 2800 N. Horseshoe Drive Naples, FL 34104 ACORD 25 (2010105) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gina Raciopp( ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and 1090 are registered marks of ACORD �fl� �z3q -23 COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION 2800 N. Horseshoe Drive, Naples, FL 34104 Make Check Payable to: Collier County Tax Collector Phone: 239 - 252 -2477 Fax: 239 - 643 -4788 Website: www.colliertax.com CHECKLIST o f THE s� 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. 9a) 10) 11) 12) *see back of application for explanation TYPE OF BUSINESS CONDUCTED: NUMBER OF EMPLOYEES - Including number of owners: FILL IN THE APPROPRIATE AREAS - a) Rental units (motel/hotel /apts.) Number of units: b) Seating Capacity (rest. /cafes, etc) Number of seats: c) Number of coin - operated machines owned by business or individual: STATE LICENSE OR CERTIFICATION NUMBER - Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: DATE: (Owner and/or representative of business) TITLE: * ** *THIS LICENSE IS NON - REFUNDABLE FOR BUSINESS STATED ABOVE * * ** Copy of Articles of Incorporation and/or Fictitious letter Yellow Fire Compliance (list of fire district phone number from the State stating that your business name is on file. enclosed) (850- 245 -6052 or 6058) www.sunbiz.org Copy of Marco Zoning Certificate. (239- 389 -5000) Copy of State license from Department of Business and Professional (850 -487 -1395) or Department of Health. Completed Zoning application with appropriate fee made payable (850- 488 -0595) to: Board of County Commissioners. (239- 252 -5603) Copy of City Business Tax Receipt. (239- 213 -1800) Completed Business Tax Receipt application with appropriate fee made payable to: Collier County Tax Collector. (239- 252 -2477) Copy of Motor Vehicle Repair Registration Certificate from Department of Agriculture. (800- 435 -7352) Other: Copy of Health inspection from Department of Hotels and Please contact the Property Appraiser's office at 239 - 252 -8145 Restaurants (850- 487 -1395) or Department of Agriculture. regarding tangible tax. (800- 435 -7352) CHECK ONE: Date: Original Application Classification Transfer of License # Code Number - - Renewal of License # License Amount 1) CORPORATE NAME - 1 a) DBA NAME - lb) BUSINESS OWNER OR QUALIFIER'S NAME - 2) PHYSICAL ADDRESS - (No P.O. Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - Yes No 3) BUSINESS MAILING ADDRESS - Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - 5) TELEPHONE - Business: Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 8) OFFICE WITHIN CITY LIMITS OF NAPLES - Yes No If Yes, City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. 9a) 10) 11) 12) *see back of application for explanation TYPE OF BUSINESS CONDUCTED: NUMBER OF EMPLOYEES - Including number of owners: FILL IN THE APPROPRIATE AREAS - a) Rental units (motel/hotel /apts.) Number of units: b) Seating Capacity (rest. /cafes, etc) Number of seats: c) Number of coin - operated machines owned by business or individual: STATE LICENSE OR CERTIFICATION NUMBER - Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: DATE: (Owner and/or representative of business) TITLE: * ** *THIS LICENSE IS NON - REFUNDABLE FOR BUSINESS STATED ABOVE * * ** *e count COLLIER COUNTY GOVERNMENT DEPT. OF ZONING & LAND DEVELOPMENT REVIEW WWW.COLLIERGOV.NET (239) 252 -2400 FAX (239) 643 -6968 LAND USE AND ZONING CERTIFICATE HOME OCCUPATION Please take the time to fill out this form as completely as possible. Remember. that only someone actually living at the . address given below may engage in the home occupation described. Customers or emp.layees not living at this address are prohibited from traveling to and from the residence if visits are related to this home occupation. The applicant is the person in whose name the occupational license will be issued, and the applicant's signature must appear on this form. Verification as property owner or lessee in the form of a Valid Florida's Driver License or Florida Identification Card and/or copy of valid lease agreement is required. APPLICATION DATE APPLICANT'S NAME APPLICANT'S HOME ADDRESS TYPE OF BUSINESS TO BE CONDUCTED BUSINESS NAME (IF ANY) ZONING CERTIFICATE # TC- PHONE: 1, the undersigned, hereby affirm that I am the legal owner of the property at the above address or that .1 have the legal right to conduct the business described above at this address by virtue of my leasehold interest in this property, and that I have read, understood, and agree to abide by the provisions of LDC Section 5.02. 00 "Home. Occupations" (see back of application). APPLICANT SIGNATURE DATE FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" now TO .BE COMPLETED RY COUNTY STAFF ZONING: REVIEWED BY PROPERTY ID # DATE APPROVED HOLD DENIED COMMENTS /RESTRICTIONS: Must comply with Section 5.02.00 of the LDC ('see back of application). Tax Collector Staff: Please forward a copy of issued certificate and receipt to Collier County Zoning Department. C',rowth .Management Division Plannina & Regulation Operations Department Licensing Section July 31, 2013 Darleen Rowe 7935 Airport Pulling Rd 4 -111 Naples, FL 34109 RE: Review six month credit reports Dear Ms. Rowe, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, August 21, 2013. The meeting is held at 9:00am at the W. Harmon Turner Building (Bldg. F, Admin. Bldg.), 3299 Tamiami Trl. E., Naples, FL in the Commissioner's Meeting Room on the 3rd floor. If you have any questions or concerns, please call (239) 252 -2431. Sincerely, Jennifer Blanco Customer Service Specialist Licensing /Operations r_ ivision''`Pl3nning & Regulation "2800 North Horseshoe Drtve *Naple> , Florida 34104'239.252- 2400`vvww.coHierzov net To. Poge 6 of 1 O 05/08/20'13 I14 4.29 EDT 12392360210 Frc�ri�. Agl�ley Paulus u Prepared By: Herit Cre< .- ,239; 277 -3202 ;800.= 371 -3398 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] (I;1 Z NP6284423 MERIT CREDIT Y................ «....,.. [MK'.i SUB' [.'.:NFILE] [GATE] 71 Ill E 16 NP I2 /R4 08/ i5 /1.3 __:3CCT [SUBJECT] 15.SN "! [BI ptTfI DA T E_ ROWE,, DARLEEN MACKLIN -30.3 2 1. 1. i 66 1'ALSCi KNOWN AS] MACKLIN,DARLE�EN, MAC KLIN MACKLIN,DARLENE [CURRENT ADDRESS] [UAT_; t V 33 27 SANDPIPER. WY., NAPLES FL. 34109 8/12 [FORMER ADDRESS] 5835 YO BOX 5835, DESTIN FL. 32540 /08 337 TEQUESTA DR., DESTIN FL. 32541 [CURRENT EMPLOYER AND ADDRESS] [RPTD] DAZZLING FLOORS 5/04 [FORMER EMPLOYER AND ADDRESS] LAW CFFIC E OF GAIONO DU NA 12/9E ---------------------------------------------------------------------------- P E C I A L M E S S A G E _. * * { AL DRESS ALERT: CURRENT I N PUT' ADDRESS DO ES NOT MATCH F' LE DDRi= SS ---------------------------------------------------------------------------- M O D E L P R O FF T+ L ** * A L E R T` ** * *'FICO CLASSIC 04 ALERT: SCORE +519 . 038, 010, 013, 020 * "* IN ADDITION * * *iO THE FACTORS LISTED ABOVE, THE NUMBER OF Ii`:;UIRIES ON PilF `C;PiC?i.J;`F;r'.` * * *C'REDTT FILE ir HA S AWERSELY AFFECTED THE (-REDIT SCORE. ---------------------------------------------------------------------------- C R E D T `I S U M M A R Y * ** T O T A L F 1 I: r. H I S T 0 R y PR -U COL=1_2 NEG =11. H.3TNEG =2 -4. TRD =18 RVL -8 INST =6 MTG =3 OPN -1 If, +k; =8 HIGH CRED C_R.ED LrIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $336 $300 $131 $0 $25 INSTALLMENT: $12.OK $ $9617 $0 $436 OPEN: $1.790 $3285 $3285 $ 0's' CLOSED W/ BAL: $5672 51450 $ TOTALS: $14.2K $300 $1.8.7K $4735 $461. ---------------------------------------------------------------------------- C O L L F, C T I O N S SUBNAME SOBCODE ECOA OPENED CLOSED $PLAC;ED CREDITOR. i!iP ACCOUNT!# VERIFIEED BALANCE REMARK::: MIDLAND) FUND Y 36ET009 i 6/1.1 $3916 CHASE BANK U A. N ,. lj9F 8540000195 7/1.3A $5623 ACCT I'dF D F BY C;Sti ASSET ACCEPT Y IFJ3001 I 6/11 $7843 01 GE; CARE. :11277.5922 1 /13A $8799 ACCT !NFC �,SP BY 8 °i ASSET ACCEPT Y IFJ3001 I 8%11 $602, Gil :TANK OF AP,iER�`:A. C)`r 1130 ?o'llps 7/13A $6683 PLACED `OR 00LLEICTIO SW _'RDT SYS Y 978t]4J01 1 6/13 $237 11 C-INGULrA.R. W.1Rl -71LE °r. To' Page 7 of 10 12392360270 Fr'o n�'. Ackley Paulus 41382951 7/13A $237 ACCT INFO DSP C.SM CSI Y 2667001 1 12/12 $380 10 GULF POWER CO 099 2793952 7/13A $380 PLACED FOR COLLECTIO RJM ACQ LLC Y IM7S003 1 12/11 $376 08 BANK OF AMERICA 30B 8988001516255 6/13A $376 ACCT INFO DSP BY CSl CST Y 2667001 1 2/12 5381 MEDICAL O)a 2571112 2/13A $411 DISP INV ':;MP -CNS D&S CS1 Y 2667001 1 9/12 $172 11 COX COMMUNICATI 09B 2719489 2/13A $117 DISP INV CMP-CNS DSS CST Y 2667001 1 8/11 $201 MEDICAL 03B 2464110 2/13A $201 DISP INV CMF-CNS DSS CST Y 2661001 1 7/11 $4118 MEDICAL 09EI, 2447590 2/13A $4118 DISP INV CMP-CNS DSG CST Y 2667001 1 9/11 $1494 MEDICAL 09E 2475309 2/13A $1494 DISP INV CMP-CNS Dsu CST. Y 2667001 1 9/21 $230 Vi E D 1 CA L 095 2486229 2/13A $230 DISP INV CMP-CNS DSG ---------------------------------------------------------------------------- I P, A D E S SURNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT4 VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 RK OP AMER B 6331059 9/05 $5672 R09 1651 1/13A $4500 $1450 I CREDIT CARD 2/09F $5672 CLOSD BY CRDT GRANTOR. 51K OF AMER B 1597029 2/07 $6027 809 319 8/12A $5000 $0 1 CREDIT CARD 2/09F $0 PURCH BY OTHER LENDER LVNV FUNDING F 21T9002 3/09 $1790 093 517805731314 1/13A ?3293 1 12 CAPITAL ONE BA $3285 ACCT INFO DSP BY CSMR CHASE B 26QK00I 11/06 $3915 R92 418586800966 2/13M $3000 $0 I CREDIT CARD 1/09F $0 PURCH BY OTHER LENDER CHASE B 26QKOOI 9/06 $4524 P9.p 540168303099 I/11m $3500 $0 I CREDIT CARD 1/09F $0 PURCH BY OTHER LENDER CB/NPRTNWS C INZ8090 9/06 $508 ME' 585637338844 7/09M $450 $() - .1. CHARGE ACCOUNT 7/09F $0 PURCH BY OTHER LENDER CB/JUSTICE C 122P002 11/06 $457 RU 98030 7/09M S250 $0 I CHARGE ACCOUNT 7/09F $0 PORCH BY OTHER LENDER ' -^`" 05~8=01"`~°~.=-� �=� CA P omE' B IorVC0l 6/07 $1758 m9 �l78O57�I3l� 3/090 VI000 $C z sLozo ouERmnm uaz 2/09r $0 ecmcu BY OTHER Lcmouu nsp�C/ms r 225197C 4/06 $360u 30w 19p 142845-74 2/09M I omSmzoRoo 2/09F $0 -,oaECL000uF,oLrPL oio eoMCwaRoRE3 F 194800I 1/06 g474x 480m2387 4/08 4321-lllIIXlx n05 30928576 4/08M $0 O5 IlxlIx-1llll I C0mvEmTzDNAL REAL 4/08C $0 F0-Rl--,,CLOSUR2,Cl,Tel; SI.o 23 l/ I/ l cngzrAL z FA c ]w2K001 1.0/06 $32'2K 7 2M 57 8 1I1 I11. l 1,Ill �o2 62062l588554Dl00I 11/I2v 0 lll liz� z eoz0MOBTL F I1/12c $O cLoSso 48 l/ n/ o wEz.Lo ,;AuGo a 906m664 7/12 $336 vizm25 zzl 11 zz11.1 eS1 442644101851- 7/13A $300 $0 c SEECDBso CREDIT c* $l3I ll O/ 8/ O aozorn-IFLSnv F 2087001 7/I2 $I2.0x 39M436 llIllIl z0l I'7299 7/I3A �0 z AUTOMOBILE, $9617 7 0/ 0/ 0 eK Or AMER B 6331205 12/05 $37.7a 60,M792 IIll IIIlll 1 D 63010005742726 1,0/06A $0 T AoToMoazLE 10106c $V cLoy Eo lO O/ 0/ o eSac AUTO F IB6A00I 5/04 $25.1n 60�595 llllll2lIlIl zOl j000010061 2 G �0 lIlllll z aozu1Moozco 2/0 6o 0 CLOSED, 719 B HILL aoro A IoaZ001 7/04 �7835 40M259 zlllllzllzll zGl x5O0 2/06A �0 11lllI z m]rOM0Bz 2/06C $O CLOSED 18 C/ 011' 3 noMEO r IB6FI33 9/03 $206x 560Ml538 IllllIl1�l1l mDl 693032o6l I/06A I11I1Illl z SECURED z/oGC $n cLooso 21 o/ o/ o moW- CmI"z MrG r II26002 9/03 $206K 360m1335 11 m0] 982487 l2/0In �U z ComvEmTIcmaL PEAL z3/03(' $0 Tamscno: nrnon Lmxooe 2 O/ 0/ 0 ---------------------------------------------------------------------------- INQUIRIES oAro ooBcoor, SoBmnsE cxeF- nmoumr 81/05/13 omP6284433(FLe) MEnTT Caoozz 5/24/13 omvO005628(2aS) SArE8ENz 2/02/I3 uOT6303148(Mwe) RENTING nOT* I/29/1 J C0p6284423<FLlA> KsDIr CBEozz I0/O2/l2 YPIS5B55836(IND) CSI 7/l0 /l2 DCO8256078(CnL) CREDCO ZMS 6/1I/z/2 zmP62844Z3(FLa) MERzr CREDIT I0- /0 6/Il xn74587653(MCa> nsas"J' ACCEPT ---------------------------------------------------------------------------- cF.soIT Pogo Rr aonvTcno nr: TRAHSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.coa) -------------------------------------------------------------------------- CREDITOR CONTACT INFORMATION MIDLAND FUND YC36ET009 (800) P25-8131 8875 AERO DR SAN DIEGO CA. 92123 ASSET ACCEPT YC1FJ3001. (800) 614-4730 POB 1630 WARREN MI. 46090 SW CRDT SYS YC978m001 (912) 246-5913 59LO W PIANO PKWY PIANO TX, 7L093 CS1 YC2667001 (850) 434-0883 POB 1431. PENSACOLA FL. 32596 RJM ACQ LLC YClMlSO03 1800) 266-0623 575 UNDERHILL BLVD SYOSSET NY. 11791 BX OF AMER BC6331059 PO Box 982235 EL PASO TX. 79998 BK OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 LVNV FUNDING FY21T9002 (866) 464-1103 625 PILOT ROAD LAS VEGAS NV. 89119 CHASE BC26QK001. (800) 955-9900 P.O. BOX 15298 WILMINGTON DE. 19850 CB/NPRTNWS CWINZ8090 PO BOX 182789 COLUMBUS OH. 43218 CB/JUSTICE CS122002 PO BOX 182769 COLUMBUS OH. 43218 CAP ONE BClDTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 64130 HSBC/MS FM235197C PO BOX 9068 BRANDON FL. 03509 HOMEWARDRES FM1946001. (871) 304-300 1525 S BELTLINE COPPELL TX. 75019 CAPITAL 1 FA FAIW2K001 (800) 946-0332 ATTN- CREDIT BURSA PIANO TX. 75093 WELLS FARGO BC90BN664 (800) 642-4720 CREDIT BUREAU DISP DES MOINES IA. 50306 AUTOPRTFLSRV FA2D81001 (807) 761-3111. PO BOX 4097 ENGLEWOOD Co. 80111 BK OF AMER 816331205 (800) 215-619', 9000 SOUTH SIDE BLV JACKSONVILLE FL. 32256 HS BC AUTO F2186AOOI (214, 237-343.) PO BOX 96124• FORT WORTH TX. ?6161 5 HTI& AUTO AZlUAZ001 (850) 763-9005 3302 W. 23RD ST PANAMA CITY FL. 32405 HOMEQ FM1B6FI23 (877) U67-7319 P.O. BOX 13716 SACRAMENTO CA. 95853 NEW CNTY MTG FMlYP6002 210 COMMERCE IRVINE CA. 92602 SAFERENT Z 0005628 (800) 999-0350 7300 WESTMORE RD ROCKVILLE MD. 20850 RENTING AUTH Z 6303148 (888) 674-9171 230 S 700 E PROVO UT. 64606 CSI Y 5055636 To Pale 10 of 10 olmw"013 14 sw25 umT a 180 E BURGESS ROAD PENSACOLA FL. 32503 CREDCO IMS Z 8256078 (80D) 637-21k2 12395 FIRST AMERIC POWAY CA. 92064 ASSET ACCEPT Y 4587653 28405 VAN DYKE WARREN MI. 48090 END OF TRANSUNTON REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-331-3348 OR 12391 277-3202. P-Q- I of 1 0 EFEDT 23� +2360270 From: AsF,lay Paulus Pretnior Profile - DAZZLING FLOORS, INC Subcode: 9701135 Ordered: OW 01 U6`0 Transaction Number: G50004846T EE Search Inquiry: dazldinq fjoors'PO BOX 583 51DESTIN,'FL�32540!US!,N,!A,!/39,,9/657 Model Description: infelliscom PIUS V2 BY% . **-a -Experian- A vmwky 04iMgtru TOP 0 Prefvi�f Profile - DAZZLING FLOORS, INC JM To'. Peke 2 of '10 Os /0$/20'13 '14:54:25 EST 123923e0270 From: Ashley Paulus T his score predicts the likelihood of serious credit delinquencies for this business within the next 12 months. Payment h istorr and public record along with other varables are used to predicifuture risk.. Higher scores indicate lower risk. i Factors lowering the score > NUMBER OF RECENTLY ACTIVE COMMERCIAL. ACCOUNTS > NUMBER OF COMMERCIAL AC AUNTS WITH NET 1 -:30 DAYS TERM > NUMBER OF COMMERCIAL COLLECTION ACCOUNTS > AGE OF MOST RECENTLY OPENED COMMERCIAL COLLECTION ACCOUNT loo �a 80 70 FO 50 40 3© 20 147 0 Quarterly Score Trends Current Financial Stability Risk Score: 2 I Illy sr;•ore predicts the, likelihood of financial stability risk within the next 12 months Tl e score uses trade-fine and collections information, public filings as well as other variables to predict future risk. higher scores indicate lower risk. performance. Range 5 is the highest rissk� range 1 is }he lowerit risk. Industry Risk Comparison 6% of businesses indicate a higher likelihood cf severe delinquency. The Quarterly Score Trends provide a uie',v of the likelihood of de €inqut ±ncy o-rer the pass 12 mordis for this business. The trends will irldi ;ate if the score, i nrrcv +.:d, remains d slabie, fluctuated or declined :)ver the; last 12 months. Risk Class: 5 The risk class groups scores by risk into ranges of similar performance. Range 5 is the highest risk, range 1 is the lowest risk. Factors lowering ttie score Industry Risk Comparlson s NUMBER OF ACTIVE COMMERCIAL ACCOUNTS t% of tru4in. sses indicate ra his }hc:r likc:ittlo xi of finirri::ia3i > NUMBER OF COMMERCIAL COLLECTION ACCOUNTS stability risk. > RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR > NUMBER OF COMMERCIAL ACCOUNTS Credit Limit Recommendation This recommendation compares this business against similar businesses in the Exporian; business credit database. it is bases: on trade information, industry, ag(. of husilress ar i the 'ntellisvoro `SlAOL) Pius. The recommendation is a guide. The tinal dc-dsk)n must be madr- bast,.d o, your comp•.3ny's business policies. rop �..ut #eat rxc 1 Predicted DDT: t 10141 Iratle arlu vorfeullon ( "t): All trades (Q ): txankruptcy: Tax Lien filings: .judgment filings: l fr< rmer Profile - OAZZLING FLOORS, INC 2/4. of 1 0 OS/0E/2013 14:54'29 Monthly Average DBT: 0 All collections (1): Highest DDT Previous 6 Months: 0 Continuous trade (0): Highest DB7 Previous 5 Quarters: 0 6 month average: Payment Trend Indication: Highest credit amount extended: Payrnent trr;nd indicator .ric)[,,.ivLiiljt)le Most frequent industry purchasing terms: Industry purchasing terms not available Industry DDT Range Comparison The current DBTof this business is Not Available. DBT for this business: Not Available ................................ DBT Date PI; 119MMEM Outstanding B 12as23e0270 Fr— A—I y Paulin S12X)51 Surn of IQ9al filings: S0 UGC filings: NIA Cautionary UGC fiiings: No N/A "'Op 0 Kmm Date of incorporation: 01/14/2002 Current Status; Active Business Type: InSfifUlions - Profit .charter Numb+,r: P020000047 Agent-, DARLEEN ROWE The inquired upon business, DAZZLING FLOORS, INC, is the Ultimate Parent DAZZLING 3 FLOORS, INC; P. U. BOX 5835 - DESTIN,FL Bram-hes of the inquired upon business: DAZZLING FLOORS, !NC, 380 EVERGREEN GIR - DESTIN,FI- .... . ... . . .... DAZZLING FLOORS, INC 337 TE QUESTA DR - DESTI N, F L 13939T65,i TOP 40 roc TOOO Experian prides itself on the depth and accuracy of the data maintained on our databases. Reporting your customer's payment behavior to E-Aperian will further strengthen and enhance the power of the information available for making SC)Und Pry n!ier Profike - DAZZLING FLO(DRS, INC 'V114' 4 of 10 05/08/20'13 14:54:2£ EOT 12352360270 From. P..shley Paulus To. Pages credit decisions. Give credit where credit is due. Calf 1-800-520-1221, option #4 for raore information. ,End of rer�ml. 1 Of 1 "ho q ho'emn is fuinishc-.,dio ro.ofidonco for Your Ilse and shoU not t',,o E'.xPCmiv', fpformms tiol, I sokl?j . oPs, /nc- nor Mom sources 01 d!sl,Wulm warfant im"00ration, too, fhoy bo to,, You. uscr orlolia.,)co t,P()rs 0. : D Lxperia � 2013 All r c1hus rese� V Pd. j?rjLv Lxperian and he Lxperipti rnar�,,s hareiri are service marks or registered tradpmarki of Lxperiar,. Of,.-;-rntu Ptafic - DAZZLAN.G FLOOPS, INC 4A, To. P.o- S of 10 05/08/2013 14:54:29 EST l2a92�eO270 Fr'o ni -. A--hfe, Paulus oll Merit Credit 2IN Fast, Accurate & Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS), STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800- 371 -3348 OR 239 - 277 -3202. COMPANY NAME: DAZZLING FLOORS INC FEDERAL ID: 41- 2025049 CURRENT STATUS: ACTIVE BUSINESS PRINCIPAL(S): DARLEEN ROWE TITLE: DIRECTOR JOEL ROWE TITLE: OPERATOR DATE INCORPORATED: 01/14/2002 February 20, 2013 Findings of Fact, Conclusions of Law and Decision of the Board Collier County Contractors' Licensing Board For Applications Submitted to the Board for Review Type of Application: X Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity Other (specify) THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on February 20, 2013, for consideration of the application submitted to the Board for review. The type of application is set out above. The Board having heard testimony under oath, received evidence, and heard arguments relative to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law and Order of the Board as follows: FINDINGS OF FACT 1. That Darleen Rowe d /b /a Dazzling Floors, Inc. (the "Applicant ") had previously submitted an application to the Collier County Contractor Licensing Supervisor or his designee for a Certificate of Competency as a Floor Covering Installation Contractor and based on the credit reports supplied by the Applicant the Licensing Superviser determined a review of the credit by the Board was necessary. 2. The Board previously issued the requested license subject to a probationary period and a six (6) month review period. 3. That pursuant to Section 22A184(b) of the Collier County Contractors' Licensing Ordinance (Ordinance 90 -105, as amended) applications which do not appear on their 1 307375.1 316!2013 face to be sufficient require referral to the Board for a decision regarding approval or denial of said application. 4. That the Board has jurisdiction over this matter and that Darlene Rowe d /b /a Dazzling Floors, Inc. was present at the public hearing on February 20, 2013, and was not represented by counsel. 5. All notices required by Collier County Ordinance No. 90 -105, as amended, have been properly issued. 6. The facts in this case are found to be: a. Applicant has adequately demonstrated through testimony and evidence presented at this hearing that her licensure will not result in risk of economic loss resulting from the Applicant's ability to pay lawful contractual obligations, subject to her satisfaction of the terms set out herein. b. Credit report does not meet the standards of Florida Rule 61 G4- 15.006 for Financial Responsibility. C. It is appropriate for the Applicant to be issued a probationary license and subject to further credit review. CONCLUSIONS OF LAW 1. Based upon the foregoing facts, the Board concludes that the applicant has met the standard set out in Ordinance 90 -105, as amended, subject to the restrictions and stipulations set out herein. ORDER OF THE BOARD 2 307375.1 3/6/2013 1. Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and Collier County Ordinance No. 90 -105, as amended, by a vote of 6 in favor and 0 opposed, a unanimous vote of the Board present, the Applicant's credit report is approved so that a license may be granted subject to the following conditions: a. One year probationary license shall be issued; b. Applicant is to provide updated business and personal credit reports to the Contractor Licensing Supervisor six (6) months from the date of the hearing held February 20, 2013 and one (1) year from the date of the hearing held on February 20, 2013 and shall appear before the Board for a review of the credit reports at the next regularly scheduled Board meeting after submitting the reports. ORDERED by the Contractors Licensing Board effective the 20th day of Feburary, 2013. CONTRACTOR'S LICENSING BOARD COLLIER COUNTY, FLORIDA I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorio, Licensi . g e Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this th day of ebruary, 2� 013._, Secretary/Contractor's Licensing Board 3 307375.1 316!2013 :Papa 7 of 7 20'13 -01 -29 20:,29:00 (GMT) 1239 3 00270 From: Avl-'ley 1 nu[u EXPERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 01/29/2013 14:24:02 -AN2 REPORT 404 -------------------------------------------------------------------------------- DAZZLING FLOORS, INC BIN: 739397657 7935 AIRPORT RD #4 -111 NAPLES, FL 34109 COMPANY DESCRIPTION --- ---- ------ -- ---- THE PRIMARY BUSINESS FOR DAZZLING FLOORS, INC IS Floor Coverings- Retail (SIC 57130800) WITH A SECONDARY BUSINESS CATEGORY OF Floor Covering Stores (SIC 57130000). THE BUSINESS WAS INCORPORATED ON JANUARY 14, 2002 IN FLORIDA. SIGNIFICANT DEROGATORY DATA JUDGMENT FILED 05 -09 -06 $11,269 ACCOUNT PLACED FOR COLLECTION WITH STERLING AND ICING (TELEPHONE NUMBER 407- 339 -9033) IN 10/09 DUE TO UNPAID BALANCE OF $12,051. LAST REPORTED IN 12/12, ACCOUNT REMAINS OPEN WITH THE AGENCY. PUBLIC RECORD INFORMATION PUBLIC RECORD REPORT JUDG -FILED 05-09 -06 $11,269, 05CC1222, OXAI,OOSA COUNTY CIR PLAINTIFF: DESTIN FLOORING INC COPYRIGUT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL !BIGHTS RESER'V -9D. * *CONTINUED ** CO/0 � yb� 'naflo 2 or � 2013 -01 -29 20:2FJ:00 (GMT) 12392380270 Fr : Aohfay F vi J c EXPERIAN BUSINESS REPORT - - -- - -- -- - -- - -- - -- - - -- ----- - - - - -- ---- --- ---- ------- ---- -- - - - --- --- ---- ------ - - - -- PAGE 2 01/29/2013 DAZZLING FLOORS, INC BIN: 739397657 ------------------------ ---------------------------------------------------- - - - - -- COMPANY BACKGROUND INFORMATION -- ---- -------------- ---- - - - - -- THE FOLLOWING WAS PROVIDED BY THE STATE. OF FLORIDA. HISTORY BUSINESS INCORPORATED ON JANUARY 14, 2002 AS A FOR- PROFIT CORPORATION. FEDERAL TAX. ID IS 412025049, CHARTER NUMBER IS P020000047. CURRENT STATUS ACTIVE BUSINESS. AGENT IS DARLEEN ROWE LOCATED AT 7935 AIRPORT PULLING RD, NAPLES, FL. PRIMARY PRODUCT /SERVICE: FLOOR COVERING STORES SIC: 5713 ADDL PRODUCT /SERVICES FLOOR COVERING STORES SIC: 5713 NO, OF EMPLOYEES 2 ESTIMATED SALES $566,000 PRINCIPAL(S) ; DARLEEN ROWE TITLE: PRESIDENT MICHAEL ROWE TITLE: OFFICER JOEL ROWE TITLE: OFFICER INQUIRIES BUSINESS 2013 2012 CATEGORY JAN DEC NOV OCT SEP AUG JUL JUN MAY ----- ----- - -- - -- --- --- - -- - -- - -- - -- --- BUREAU 1 ---------- - -- - -- - -- --- --- - -- ---- - -- --- TOTALS 1 THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INFORMATION SOLUTIONS, INC., NOR ITS SOURCES OR DISTRIBUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE LIABLE FOR YOUR USE OR RELIANCE UPON IT, COPYRIGHT 2013 EXPERT-AN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED, * *END REPORT ** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUSSTBO ay THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE B&EN CHECKED AND V'ERIF'IED AT THE COUNTY (INCLUDING PINELL)kS), STATE AND FEDERAL LEVELS, PUBLIC RECORDS LEARNED: 1 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800 - 371 -3348 OR 239 -277 -3202. Pupn 3 of 7 201 3..p'{_29 20:26 :00 (GMT) '12352360270 From: Astliey pyuluo Prepared By: Merit Credit (239) 277- 3202 (800) 371 -3348 TRANSUNION CREDIT REPORT [FOR) [SUB NAME] (1) Z NP6284423 MERIT CREDIT (SUBJECT) ROWE, DARLEEN MACKLIN [ALSO KNOWN AS] MACKLIN,DARLEEN,MACKLIN MACKLIN,DARLENE (CURRENT ADDRESS] 3327 SANDPIPER WY., NAPLES FL. 34109 (FORMER ADDRESSI 5835 PO BOX 5835, DESTIN FL. 32540 337 TEQUESTA DR., DESTIN FL. 32541 (CURRENT EMPLOYER AND ADDRESS] DAZZLING FLOORS E] [TIME) 9/13 14:19CT (RPTD) 5/04 (FORMER EMPLOYER AND ADDRESS) LAW OFFICE OF GAIONO DUNA (BIRTH DATE) 1.1/66 [DATE, RPTD) 8/12 4/08 12/96 -------------------------------_---------_----------------------------------- M 0 D E L P R O F I L E * * * A L E R T * ** * * *FICO CLASSIC 04 ALERT: SCORE +499 : 038, 013, 018, 010 * ** IN ADDITION * * *TO THE FACTORS LISTED ABOVE., THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***('RED XT FILE HAS ADVERSELY. AFFECTED THE CREDIT SCORE. ---------------------------------------------------------------------------- G R E Di 11, S U M M A k X " * '" T O T A L F Y L E H i S T O R Y PR =O COL =12 NEG =10 HSTNEG =4 -21 TRD =20 RVL =9 INST =6 MTG=4 OPN =1 INQ =6 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVULVING: $1911 $300 $$274 $0 $25 9% INSTALLMENT: $12.OK $ $11.1K $0 $436 OPEN: $1790 $ $3117 $31.17 $ 0� CLOSED W /BAL: $512K $15.4K $2:38- -/ TOTALS: $14.1K $300 $526K $).8.5K $2.848 -- - - ---- ----------------- -------------------_------------------------- - - - - -- C 0 L L E C T T O N S SURNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT#( VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 6/11 1/13F $3916 CHASE BANK USA N A 098 8540000195 1 /13A $5484 ACCT INFO DSP BY CSM ASSET ACCEPT Y 1FJ3001 I 6/11 $7843 01 GE CAPITAL CARE 09B 11271592.2 1/13A $8576 PLACED FOR COLLECTIO RJM ACQ LLC Y 1M7SO03 T 12111 $376 08 BANK OF AMERICA 09B 898ROO1516255 12/12A $376 PLACED FOR COLLECTIO CSI Y 2667001 T 7/11 $411.8 MEDICAL 0D13 2447590 11/12A $4118 PLACED FOR COLLECTIO CST Y 2667001 1 8/1.1 $201. MEDICAL 095 Pa90 A car 7 2013 -0'1 -25 20:29:00 (O MT) ti239�36'02T0 Fro 1-r�: Amhlcy Pn ulum 2464 110 11/1.2A $201 PLACED FOR COLLECTIO CSI Y 2667001 I 9/11. $1494 MEDICAI, 098 2475309 11 /12A $1494 PLACED FOR COLLECTIO CST. Y 2667001 I 911.1 $230 MEDICAL 093 2486228 11/12A $230 PLACED FOR COLLECTIO CST Y 2667001 I 2/12 $381 MEDICAL 09B 2571112 11/12A $406 PLACED FOR COLLECTIO CSI Y 2667001 I 9/1.2 $.1.72. 11 COX COMMUNICATI 09B 2719489 11/12A $174 PLACED FOR COLLECTIO CB SERVICES Y 51CQ005 1 1 /10 $93 10 SOUTH WALTON UT 09B 1649572 3 /10A $93 PLACED FOR COLLECTIO NCO FIN /33 Y 1EDM015 T 2/08 $13.2K MEDICAL 098 16206693 5/08A $13.2K PLACED FOR COLLECTIO CER STS REC Y 548NO04 is 12106 $702 MEDICAL 09B 4051214 3/07A $702 PLACED FOR COLLECTIO ---------------------------------------------------------------------------- T R A D E S SURNAME SUBCODE OPENED RIGHCRED TERMS MAXDELQ PAYPAT 1 -12 MOP ACCOUNT41 VERFIED CREDLIM PASTDUE AMT —MOP PAYPAT 1.3 -24 ECOA COLLATRL /LOANTYPE CLSD /PD BALANCE REMARKS MO 30/60/90 BK OF AMER B 1597029 2/07 $6027 R09 319 8/11A $5000 $0 I CREDIT CARD 2/09F $0 PORCH BY OTHER LENDER CHASE 8 26QK001 9/06 $4524 R09 540168303099 1 /11A $3500 $0 I CREDIT CARD 6/09F $0 PORCH BY OTHER LENDER CHASE,; B 26QK001 11/06 $3915 R09 418586800986 6/09A $3000 $0 I CREDIT CARD 6/09F $0 PORCH BY OTHER LENDER SK OF AMER B 6331059 9/05 $5672 R09 1651 5/09A $4500 $1450 T CRnnTT CARD 2/09F $5672 CLOSD BY CN,D`i' GRANTOR GECRB /CARECR F 9992742 4/07 $7843 R09 601918230412 4/09A $7000 $0 I CHARGE ACCOUNT 10108F $0 PORCH BY OTHER LENDER 1 CAP ONE B lDTV001 6/07 $1758 R 0 9 517805731314 3/09A $1000 $0 I SLDTO SHERMAN QRI 2/09F $0 PORCH BY OTHER LENDER s HSBC /MS F 235197C 4/06 $148K 12M M09 14284574 2/09A $0 T CONVENTIONAL REAL 2/09F $0 FORECLOSURE,CLTRL SLD r LVNV FUNDING F 21T9002 3/09 $1.790 O9B 51780573131.4 1 /13A $31.17 Papa 6 of 7 24'13 -07 -z9 z0:2S;gq (p MT) l23'3z36g2TO From; Aohlay Pevulum T. 12 CAPITAL ONE $3117 PLACED FOR COLLECTION HOMEWARDRES F 1946001 1/06 $474K 48OM2387 3/08 4443211111.1X M04 30928576 6/08A $1.3.9K $7456 04 1XllX1.1X1111. I CONVENTIONAL REAL 4/08C $506K FORECLOSURE INITIATED 25 1/ 1/ 3 CAPITAL 1 FA F 1W2KO01 10/06 $32.2K 72M578 111111111111, 202 62062158855401001 11 /12A $0 1111.11111111 I AUTOMOBILE 11/12C $0 CLOSED 48 1/ 0/ O WELLS FARGO B 90BN664 7/12 $297 MIN25 1.1111 R01. 442644101851 1/13A $300 $0 I SECURED CREDIT CA $274 5 0/ 0/ 0 AOTOPRTFLSRV F 2DS7001 7/12 $12.OK 39M436 I01 137299 12/12A $0 2 AUTOMOBILE $11.1K CB /NPRTNWS C 1NZ8090 9/06 $508 4/09 55543211.2111. R01 585637338844 7/09A $450 $0 05 1111111.11111. I CHARGE ACCOUNT 7/09C $0 PURCH BY OTHER LENDER 34 21 1/ 4 C13 /JUSTICE C 122P002 1.1/06 $457 4/09 555432113211 R01 98030 7/09A $250 $0 $78 05 11111.1111111. I CHARGE ACCOUNT 7/09C $0 PURC11 BY OTHER LENDER 33 2/ 21 4 BK OF AMER B 6331205 12/05 $37.7K 6OM792 111.1111111 101 63010005742726 10 /06A $0 I AUTOMOBILE 10/06C $0 CLOSED 10 0/ 0/ 0 HS8C AUTO F 1B6A001 5/04 $25.1K GOM595 111111111111 101 5000010061 2/06A $0 111111.1 I AUTOMOBILE 2/06C $0 CLOSED 19 U/ U/ 0 B HILL AUTO A 1UAZ001 7/04 $7835 1.75M259 1.11111]..1111.1 .T.01 K506 2/06A $0 111111 I AUTOMOBILE 2/06C $0 CLOSED 18 0/ 0/ 0 HOMEQ F lB6F123 9/03 $206.K 360M].538 117.1111.3 ] 7 1 1 M01 693032061 1/06A 111111.111 1 SECt.)RFD 1 /06C $0 CLOSED 21 0/ O/ 0 NEW CNTY MTG F 1YP6002 9/03 $206K 360MI335 1111 M01 982487 12/03A $0 I CONVENTIONAL, REAL 12/03C $0 TRNSFRD: OTHER .LENDER 4 0/ 0/ 0 VANGUARD BK B 439YO01 8/02 $5067 12M433 X111.iXX11.X1.1. I01 5110543700010 8/03A $0 I SECURED ----------------------------------------------------------------------------- 8/030 $0 CLOSED 12 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 1./29/13 Zf1P6204423 (FLA) MERIT CREDIT 10/02/12 Y.P 58556;36(IND) CSI 7/10/12 ZC08256078(CAL) CREDCO INS 6/1.1/12 ZNP6204423 (FI,A) MERIT CREDIT 10/06/11 YDT4 5 8 7 6.5 3 (MCH) ASSET ACCEPT Pape 6 of 7 2013 -01-217 z0 ;20:00 (OM T) 12302360270 From; Ayhlev F auJ4 7/22../1.1 YDT4.587653 (MCH) ASSET ACCEPT -------------_--------------------------------------------------------------- C R E D I. T R E P O R T S E R V I C E D B Y TRANSUNION 800- 888 - 421.3 2 BA.LDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained on1.J.ne through T.ransUnion at: http: / /www.transunion.com ----------------------------_------------_-_---------------------------------- CREDITOR CONTACT INFORMATION MIDLAND FUND YC36ET009 (800) 825 -8131. 8875 AERO DR SAN DIEGO CA. 92123 ASSET ACCEPT YC1FJ3001 (800) 614 -4730 POB 1630 WARREN MI. 48090 RJM ACQ LLC YC1.M7S003 (800) 268 -0623 575 UNDERHILL BLVD SYOSSET NY. 11791 CST YC2667001 (850) 434 -0883 POB 1431. PENSACOLA FL. 32596 CB SERVICES YC51CQQ05 (850) 862-2154 P.O. BOX 4127 FORT WALTON BE F.L. 32549 NCO FI14/33 YCIEDM015 (800) 786 -9330 POB 15609 WILMINGTON DE. 19850 CER STS REC Y 548NO04 (620) 663 -8811 1314 N MAIN HUTCHINSON KS. 67501 BK OF AMER SC1.597029 PO BOX 982235 EL PASO TX. 79998 CHASE BC26QKOOI (800) 945 -2006 P.O. BOX 15298 WILMINGTON DE. 19850 BK OF AMER BC6331059 PO BOX 962235 EL PASO TX, 79998 GECRB /CARECR FZ9992742 (866) 396 - 8254 C/O PO BOX 965036 ORLANDO FL. 32896 CAP ONE BCIDTV001. (800) 955 -7070 POS 30281. SALT LAKE CITY UT. 84130 HSBC /MS FM235197C PO BOX 9068 BRANDON FL. 33509 LVNV FUNDING FY21T9002 (866) 464 -11.83 P.O. BOX 10584 GREENVILLE SC. 29603 HGMEWARDRES FM1946001 (877) :3()4 -31nn 1525 S BELTLINE COPPELL TX, 75019 CAPITAL 1 FA FA1W2K001 (800) 946 -0332 ATTN- CRRD7T MURRA Pf ANC) TX. 75093 WELLS FARGO BC908N664 (800) 642 -4720 CREDIT BUREAU DISP DES MOINES IA. 50306 AUTOPRTFLSRV FA2D87001. (877) 761--3111 PO BOX 4097 ENGLEWOOD CO. 80111 CB /NPRTNWS CWlNZ8090 PO BOX 182789 COLUMBUS OH. 43218 CB /JUSTICE CS122P002 PO BOX 182789 COLUMBUS OH. 43218 BK OF AMER BI6331205 (800) 215 -61.95 9000 SOUTHSIDE BLV JACKSONVILLE FL, 32256 HSBC AUTO FA1.R6A00l (214 ) 231-3430 PO Rox 961245 FORT WORTH TX. 76161 B HILT, AUTO A21UAZ001 (850) 763 -9005 3302 W. 23RD ST PANAMA CITY FI.. 32405 HOMEQ FMIB6F123 (877) 867 -7378 Paced 7 or 7 20-15 -0l -Z9 20:29:00 (Ofv1"r) Dram: ^phloy Paulus P.O. BOX 13716 SACRAMENTO CA. 95853 NEW CNTY MTG FMIYP6002 210 COMMERCE IRVINE., CA. 92602 VANGUARD BK BZ439YO01 (904) 678 - 4141 23 JOHNSON PARKWAY VALPARAISO FL. 32580 CSI Y 5855636 180 E BURGESS ROAD PENSACOLA FL. 32503 CREDCO IMS Z 8256078 (800) 637 -2422 12395 FIRST AMEBIC POWAY CA. 92064 ASSET ACCEPT Y 4587653 28405 VAN DYKE WARREN MI. 48090 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1 -800- 371 -3348 OR (239) 277 -3202. August 15, 2012 Findings of Fact, Conclusions of Law and Decision of the Board Collier County Contractors' Licensing Board For Applications Submitted to the Board for Review Type of Application; X Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity Other (specify) THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on August 15, 2012, for consideration of the application submitted to the Board for review. The type of application is set out above, The Board having heard testimony under oath, received evidence, and heard arguments relative to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law and Order of the Board as follows: ` FINQINQS OF FACT I. That Darleen Rowe d /b /a Dazzling Floors, Inc. (the "Applicant ") has submitted an application to the Collier County Contractor Licensing Supervisor or his designee for a Certificate of Competency as a Floor Covering Installation Contractor and based on the credit reports supplied by the Applicant the Licensing Superviser determined a review of the credit by the Board is necessary. 2. That pursuant to Section 22- 184(b) of the Collier County Contractors' Licensing Ordinance (Ordinance 90105, as amended) applications which do not appear on their face to be sufficient require referral to the Board for a decision regarding approval or denial of said application. E 293902.1 1125/2012 3. That the Board has jurisdiction over this matter and that Darlene Rowe d/b/a Dazzling Floors, Inc. was present at the public hearing on August 15, 2012, and was not represented by counsel. 4. All notices required by Collier County Ordinance No. 90 -105, as amended, have been properly issued. 5. The facts in this case are found to be: a. Applicant has adequately demonstrated through testimony and evidence presented at this hearing that her iicensure will not result in risk of economic loss resulting from the Applicant's ability to pay lawful contractual obligations, subject to her satisfaction of the terms set out herein. b. Credit report does not meet the standards of Florida Rule 61G4- 15.006 for Financial Responsibility. C, It is appropriate: for tho Applicant to bo i a suod a probationary iiconso and subject to further credit review. CONCLUSIONS OF LAW 1. Eased upon the foregoing facts, the Board concludes that the applicant has met the standard set out in Ordinance 90 -105, as amended, subject to the restrictions and stipulations set out herein. ORDER OF THE BOARD 1. Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 469, Florida Statutes, and Collier County Ordinance No. 90 -105, as amended, by a vote of 7 in favor and 0 opposed, a 2 283902.1 1/25/2012 unanimous vote of the Board present, the Applicant's credit report is approved so that a license may be granted subject to the following conditions: 2012 a. One year probationary license shall be issued; b. Applicant is to provide updated business and personal credit reports to the Contractor Licensing Supervisor six (6) months from the date of the hearing held August 15, 2012 and one (1) year from the date of the hearing field on August 15, 2012 and shall appear before the Board for a review of the credit reports at the next regularly scheduled Board meeting after submitting the reports. ORDERED by the Contractors Licensing Board effective the 15th day of August, CONTRACTOR'S LICENSING BOARD COLLIER COPNT�;"FLORIDA By: Lee Horn, Chairman I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorlo, Licensing ompliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this ��h day of August, 2012. 3 ecretary /Contractor`s Licensing Board 299902.1 1/25/2012 EXPERIAN BUSINESS REPORT PAGZ RPT DATE TIME PORT TYPE 1 06/11/2012 14:03:30 -AN3 REPORT 404 DAZZLING FLOORS INC . .-- ..•.`__~......- -"k3I1V_ - - --- "739397657_____..______ _______ 337 TEQUESTA DR DESTIN FL 32541 -3747 PHONE: 850 -650 -8007 COMPANY DESCRIPTION THE PRIMARY BUSINESS FOR DAZZLING FLOORS INC IS Legislative Bodies (SIC 91210000) WITH A SECONDARY BUSINESS CATEGORY OF Floor Laying & Other Floor Work, Nee (SIC 17520000). THE BUSINESS WAS INCORPORATED ON JANUARY 14, 2002 IN FLORIDA SIGNIFICANT DEROGATORY DATA JUDGMENT FILED 05 -09 -06 $11,269 ACCOUNT PLACED FOR COLLECTION WITH STERLING ANA KING (TELEPHONB NUMBER 407 -339 -9033) IN 10109 DUE TO UNPAID BALANCE OF $12,051. LAST REPORTED IN 6112, ACCOUNT REMAINS OPEN WITH THE AGENCY. PUBLIC RECORD INFORMATION ----------- - - - - -- - - - - -- PUBLIC RECORD REPORT JUDG -FILED U5 -09 -06 $11,269, 05CC1222, 6XALOOSA COUNTY CIR PLAINTIFF: DESTIN FLOORING INC COPYRIGHT 2012 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED, * *CONTINUED ** rented with Print2PDF. To remove this line, buy a license at: http://www,software602.com/ EXPERIAN BUSINESS REPORT --------------------- ----------------------- - - - - -- ------------------ - - - --- PAGE 2 06/11/2012 DAZZLING FLOORS INC BIN: 739397657 ---------------------------------------------------------- ------ -------- ---- - - - - -- COMPANY BACKGROUND INFORMATION THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. HISTORY BUSINESS INCORPORATED ON ,JANUARY 14, 2002 AS A FOR- PROFIT CORPORATION. FEDERAL TAX ID IS 412025049. CHARTER NUMBER IS P020000047. CURRENT STATUS : ACTIVE BUSINESS. AGENT IS DARLEEN ROWE LOCATED AT 337 TEQUESTA DRIVE, DESTIN, FL. PRIMARY PRODUCT /SERVICE.- FLOOR LAYING AND FLOOR WORK, NEC SIC: 1752 ADDL PRODUCT /SERVICES FLOOR COVERING STORES SIC: 5713 PRINCIPAL($) DARLEEN ROWFS TITLE: DIRECTOR THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INFOP$MTXON SOLUTIONS INC., NOR ITS ROTWER on nTSTnTnT,TTORq WARRANT SUCH INFORMATION NOR, SHALL THEY BE LIABLE FOR YOUR V$F OR RELIANCE UPON IT, COPYRIGHT 2012 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED, * *END REPORT ** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHF:CX(ED AND VERIFIED AT THE COUNTY (INOLUDINa PINELLAS,), STATE AND rEDERAL LEVELS. PUBLIC M -CORDO LEARNED. 1 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES FRS LIEN SECTION COUNTY COURTHOUSE RECORDS IL' YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CRkVXT AT: 1- 800 - 371 -3348 OR 239 -- 277 -3202. reated with Print2PDF. To remove this line, buy a license at: htt : / /www.software602.com/ Prepared By: Merit Credit (239) 277 -3202 (800) 371 -3348 TRANSUNION CREDIT REPORT [FOR] (SUB NAME) [MKT SUB] [INFILE) [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 15 MO 12/84 06/11/12 13:59CT (SUBJECT) TSSN1 [BIRTH DATE] ROWE, DARLEEN MACKLIN 11/66 [ALSO KNOWN AS] NCA Y 9883003 I MACKLIN,DARLEEN,MACKLIN $6835 MACKLIN,DARLENE 09B [CURRENT ADDRESS] [DATE RPTD] 5835 PO BOX 5835, DESTIN FL. 32540 4/08 [FORMER ADDRESS) RJM ACQ LLC Y 1M7S003 I 337 TEQUESTA DR., DESTIN FL. 32541 11/06 1632 TOWN PARK DR., PORT ORANGE FL. 32129 AMERICA 09B [CURRENT EMPLOYER AND ADDRESS] [RPTD] DAZZLING FLOORS PLACED FOR COLLECTIO 5/04 [FORMER EMPLOYER AND ADDRESS] LAW OFFICE OF GAIONO DUNA 12/96 ---------------------------------------------------------------------------- S P E C I A L M E S S A G E S ** *ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES) * ** ---------------------------------------------------------------------------- M 0 D E L P R O F I L E * * * A L E R T * ** * * *FICO CLASSIC 04 ALERT: SCORE +474 : 038, 013, 018, 016 * ** IN ADDITION * * *TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ** *CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. ----------------------__-------.._-------------------------------------- - - - - -- C R E D I T S U M M A R Y * ** T 0 T A L F I L E H I S T O R Y PR -0 COL -13 NEC--11 HSTNEG -4 -21 TRD -20 RVL -0 IN3T -5 MTG -4 OPN-3 INQ =3 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE INSTALLMENT: $32.2K $ $2955 $0 $578 OPEN: $2886 $ $3951 $3951 $ 0% CLOSED W /BAL: $512K $15.41( $2387 TOTALS: $35.1K $ $518K $19.3K $2965 ------------ - - - - -- ----------------------------------------------_----__-_--- C 0 L L E C T I 0 N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS ASSET ACCEPT Y 1FJ3001 I 8/11 $6027 01 BANK OF AMERICA 09B 113070788 6/12A $6303 PLACED FOR COLLECTIO ASSET ACCEPT Y 1FJ3001 I 6/11 $7843 01 GE CAPITAL CARE 09B 112715922 6/12A $8305 PLACED FOR COLLECTIO NCA Y 9883003 I 6/11 $6835 01 CHASE 09B 5401683030998519 6/12A $6835 PLACED FOR COLLECTIO RJM ACQ LLC Y 1M7S003 I 12111 $376 08 BANK OF AMERICA 09B 8988001516255 5/12A $376 PLACED FOR COLLECTIO treated with Print2PDF, To remove this line, buy a license at: http: / /www.Software602,com/ MIDLAND FUND Y 36ET009 I 8540000195 CSI Y 2667001 1 2447590 CSI Y 2667001 I 2475309 CSI Y 2667001 I 2571112 CSI Y 2667001 I 2464110 CSI Y 2667001 I 2486228 CS SERVICES Y 51CQ005 I 1649572 NCO FIN /33 Y IEDMO15 1 16206693 6/11 $3916 CHASE BANK USA N A 09B 5/12A $5195 PLACED FOR COLLECTIO 7/11 $4118 MEDICAL Q9B 5/12A $4118 PLACED FOR COLLECTIO 9/11 $1494 MEDICAL 09B 5/12A $1494 PLACED FOR COLLECTIO 2/12 $381 MEDICAL 098 5/12A $389 PLACED FOR COLLECTIO 8/11 $201 MEDICAL 098 5/12A $201 PLACED FOR COLLECTIO 9/11 $230 MEDICAL 09B 5/12A $230 PLACED FOR COLLECTIO 1 /10 $93 10 SOUTH WALTON UT 09B 3 /10A $93 PLACED FOR COLLECTIO 2/08 $13.2K MEDICAL 09B 5/08A $13.2K PLACED FOR COLLECTIO CER STS REC Y 548NO04 I 12/06 $702 MEDICAL 09B 4051214 3/07A $702 PLACED FOR COLLECTIO ----------------------------------------------------- _----------------- -_ - -_- T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1 -12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT -MOP PAYPAT 13 -24 ECOA COLLATRL /LOAN:CYPE CLSD /PD BALANCE REMARKS MO 30/60/90 BK OF AMER B 1597029 2/07 $6027 R09 319 fl/11A $5000 $0 I CREDIT CARD 2/09F r0 PURCH BY OTHER LENDER CHASE B 260001 9/06 $4524 5401618303099 1/11A 41113`00 ,r,n I CREDIT CARD 6/09F $0 PORCH BY OTHER LENDER CHASE B 26QKOOI 11/06 $3915 418586800986 6/09A $3000 $0 I CREDIT CARD 6/09F $0 PURCH BY OTHER LENDER BK OF AMER B 6331059 9/05 $5672 1651 5/09A $4500 $1450 I CREDIT CARD 2109F $5672 CLOSD BY CROT GRANTOR GECRB /CARECR F 9992742 4/07 $7843 601918230412 4/09A $7000 $0 I CHARGE ACCOUNT 10 /08F $0 PURCH BY OTHER LENDER CAP ONE B 1DTV001 6107 $1758 517805731314 3/09A $1000 $0 1 SLDTO SHERMAN ORI 2/09F $0 PURCH BY OTHER UNDER HSBC /MS F 235197C 4/06 $148K 12M reated with Print2PDF. To remove this line, buy a license at: http: / /www.software602,com/ R09 Ro9 R09 R09 R09 M09 14284574 2/09A I CONVENTIONAL REAL 2/09F $0 CVF CAC F 2DL3001 8/11 $519 98030 5/12A T 12 WFNNB 480M2387 $507 LVNV FUNDING F 21T9002 3/09 $1790 517805731314 5/12A I 12 CAPITAL ONE $0 $2880 CVF CAC F 2DL3001 8/11 $577 585637338844 5/12A I 12 WFNNB NEWPORT 05 111111111111 $564 AMRCN HM MTG F 1946001 1/06 $474K 30928576 6/08A PURCH BY I CONVENTIONAL REAL 4/08C $506K CAPITAL 1 FA F 1W2K001 10/06 $32.2K 62062158855401001 5/12A 111111111111 101 I AUTOMOBILE 1111111 $2955 NEWPORT NEWS C 1NZ8090 9/06 $508 585637338844 7/09A $450 I CHARGE ACCOUNT 7/09C $0 Wk'NN8 /J:3T1CN C 122P002 11/06 ;457 98030 7/09A $250 I CHARGE ACCOUNT 7/09C $0 SK OE' AMER B 6331205 12/05 $37.7K 63010005742726 10/06A 12 0/ U/ U I AUTOMOBILE 10 /06C $0 HSBC AUTO F 1B6A001 5/04 $25.1K 5000010061 2/06A 3' AOTAMOP,ILE 21060 $0 B HILL AUTO A I fIAZO03 7/04 $7835 K506 2 /06A I AUTOMOBILE 2/06C $0 HOMEQ F 1A6F123 9/03 $206K 693032061 1 /06A I SECURED 1 /06C $0 NEW CNTY MTG F 1YP6002 9/03 $206K 982487 12/03A I CONVENTIONAL REAL 12/03C $0 VANGUARD BK B 439YO01 8/02 $5067 5110543700010 8/03A I SECURED 0 /03C ;0 I N Q 0 X R 7 F S DATE SUBCODE SURNAME $0 FORECLOSURE,CLTRL SLD 09B $507 PLACED FOR COLLECTION 09B $2880 PLACED FOR COLLECTION TYPE AMOUNT reated with Print2PDP. To remove this line, puy a license at: ham: / /wvwv,software602.com/ 09B $564 PLACED FOR COLLECTION 480M2387 3/08 44432111111X M04 $13.9K $7456 04 1X11X11X1111 FORECLOSURE INITIATED 25 1/ 1/ 3 72M578 111111111111 101 $0 111111121111 48 1/ 0/ 0 4/09 555432112111 R01 $0 05 111111111111 PURCH BY OTHER LENDER 34 2/ 1/ 4 4/09 5!. b432113211 R01 $0 $78 05 111111111111 PURCH BY OTHER LENDER 33 2/ 2/ 4 60M792 1111111111 101 $0 CLOSED 10 0/ 0/ 0 6OM595 111111111111 101 $0 1111111 0110 ;RD 3 n 0/ n/ n 175M259 1111111.11111 TO1 $0 111111 CLOSED 18 0/ 0/ 0 360MI538 111111111111 M01 111111111 CLOSED 21 0/ 0/ 0 360MI335 1111 M01 $0 TRNSFRD: OTHER LENDER 4 0/ 0/ 0 12M433 X1111XX11X11 101 $0 CLOSED 12 0/ U/ U TYPE AMOUNT reated with Print2PDP. To remove this line, puy a license at: ham: / /wvwv,software602.com/ 6/11/12 ZNP6284423(FLA) 10/06/11 YOT4587653(MCH) 7/22/11 YDT4587653(MCH) 9/07/10 YPE5556540(IND) 9/02/10 RNR2691233(FLA) "----------------- - - - - -- C R E D I T R E P O R T MFRTT CREDIT ASSET ACCEPT ASSET ACCEPT FIRSTSOURCE CRYSTAL WATE S E R V I C E D B Y TRANSUNION 800 -- 888 -4213 2 BALDWIN PLACE, P.O.BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http: / /www.transunion.com ---------------------------------------------------- _------ CREDITOR CONTACT INFORMATION .- _- _----- _- _-- - - - - -- ASSET ACCEPT YCIFJ3001 (800) 614 -4730 POS 1630 WARREN MI. 48090 NCA YC9883003 (866) 964 -5259 P.O. BOX 550 HUTCHINSON KS. 67504 RJM ACQ LLC YC1M7S003 (800) 268 -0623 575 UNDERHILL BLVD SYOSSET NY. 11791 MIDLAND FUND YC36ET009 (800) 825 -8131 8875 AERO DR SAN DIEGO CA. 92123 CSI YC2667001 (850) 434 -0883 POB 1431 PENSACOLA FL. 32596 CB SERVICES YC51CQ005 (850) 862 -2154 P.O. 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BOX 13716 SACRAMENTO CA. 95853 NEW CNTY MTG FMIYP6002 210 COMMERCE IRVINE CA. 92602 VANGUARD BK BZ439YO01 (904) 678-4141 23 JOHNSON PARKWAY VALPARAISO FL. 32580 ASSET ACCEPT Y 4587653 28405 VAN DYKE WARREN MI. 48090 FIRSTSOURCE Y 5556540 (716) 564 -4400 205 BRYANT WOODS S AMHERST NY. 14228 CRYSTAL WATE R 2691233 (850) 654 -4659 137 MARIGOT BAY CI MIRAMAR BEACH FL. 32550 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/ PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: CREDIT DATA SERVICES, INC /EXPERIAN IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800-371 -3348 OR (239) 277-3202. treated with Print2PDF. To remove this line, buy a license at: ham_ / / / /www.Software602,cam/ BEFORE THE COLLIER COUNTY CONTRACTORS, LICENSING BOARD BOARD OF COUNTY COMMTSSIONERaS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner V. Albert J. Scott D/B /A — Beaumont Communications Inc. Respondent Case Number: 2013 -07 License Number: EF2000 073 6 /C. C.g33194 STIl'UL.A.TED S£1"7'LEMElVT AGREEMENT AND AGREED ORDER ALBERT J. SCOTT and BOARD OF COUNTY COMI USSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Ofiereafter BOARD) hereby stipulate and agree: 1. Respondent admits the allegaiions in Administrative Complaint for the proposes of this stipulation and settlement of this matter. 2. Respondent and the Board hereby agree that he will be subject to probation for a period of twenty four (24) months whereby the Respondent will performm, his contracting activities under the supervision of the Board, and will obtain all permits prior to performing any work requir ng Bach permitting.. 3. Respondent voluntarily, agrees to pay seven hundred and fifty dollars ($750.00) in administrative costs to Collier County within. ten (10) days of the August 21 2013 C.L.B. hob• 4. In the event the Respondent violates paragraph. 2 of noted stipulation agreement white on probation, his license /certificate will. be immediately suspended, and a complaint will be forwarded to the State Construction Industry Licensing Board with a recommendation for fiuther action. Albert J. Scott Respondent Executed this 21 st day of August, 2013. Contractors' Licensing Supervisor ORDER ADOPTING STIPULATED SET'MEIWIENT AGREEMENT TIM BOARD BELNU FULLY" ADVISED on the Stipulated Settlement Agreement, it is hereby. ADJUDGED that the foregoing Stipulated Settlement Agreement is adopted in its entirety, and the parties are ordered to comply therewith. DONE AND ORDERED at the regularly set Contractors' Licensing Board hearing at Naples, Collier County, Florida on this 21 st day of August, 2013 Richard Joslin Chairman Contractors' Licensing Board 3 BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, V. Albert J. Scott D /B /A — Beaumont Communications Inc. Respondent. Case Number: 2013 -07 License Number: LP20000736 /C.C. #33194 ADMINISTRATIVE COMPLAINT Collier County (County) files the Administrative Complaint against Albert J. Scott ( Respondent), a State of Florida licensed Alarm Contractor 1 ( license # EF20000736 /Collier County Certificate #33194), and states the following facts and allegations in support of the cited violations below: 1. The Respondent is currently licensed by the State of Florida as a Certified Alarm Contractor 1 with License number EF20000736. 2. Under the provisions of Florida Statute 489.516(3), the Collier County Contractors' Licensing Board is authorized to impose penalties against State Certified Contractors for willfully violating Building Codes. 3. Under the provisions of Collier County Ordinance 90 -105, as amended, Section 22- 201.1, the following actions by a holder of a Certified Alarm Contractor 1 shall constitute misconduct and grounds for discipline pursuant to Section 22 -202. a. In November, 2012, East Naples Fire Inspector Lt. Michael Cruz discovered the unpermitted installation of GSM radio communication fire alarm systems in 17 separate buildings located within the Green Links Golf Villas community located at 7995 Mahogany Run Lane. b. A STOP WORK order was issued by Lt. Cruz and the contractor was notified of the violations. c. Subsequent permit applications submitted by the contractor were all rejected for discrepancies. d. Directives to address discrepancies with the permit applications were provided by the Collier County Planning and Regulation Department. e. The contractor's inability or refusal to implement the directives of the Collier County Planning and Regulation Department now result in a willful building code violation. f. Thereafter, pursuant to Collier County Ordinance 90 -105, as amended, Section 22 -202 (b) and Section 22 -202 (c), the complaint was investigated and found sufficient cause to file formal charges. 4. Collier County brings the following charge in this formal complaint against the Respondent. COUNT 5. Collier County Ordinance 90 -105, as amended, Section 22.201.1(2) states "Willfully violating the applicable building codes or laws of the State, City, or Collier County " WHEREFORE, the Petitioner asserts the above facts and charges are grounds for disciplinary action under Section 22 -201 of Collier County Ordinance 90 -105, as amended, and WI IEREFORE, in consideration of the foregoing, the Petitioner respectfully requests the Collier County Contractors' Licensing Board to find the Respondent guilty of the violationA charged. Dated: '�� f Signed: (— ,e-� Collier County Con#ractors' Licensing Supervisor or Designee SUMMARY In April, 2013 The Collier County Contractors' Licensing Office received a complaint from East Naples Fire Inspector Lieutenant Michael Cruz regarding seventeen (17) separate unpermitted installations of GSM radio communication fire alarm systems by Beaumont Communications Inc. /EF20000736 within the Green Links Golf Villas located at 7995 Mahogany Run Lane Naples, FL. 34113. Lt. Cruz advised that the unpermitted installation was first discovered on September 13th, 2012 and that the contractor was formally notified of the permitting violations. Database research indicates that eight (8) permit applications were submitted in January, 2013, but all were rejected by the Collier County Planning & Regulation Department for discrepancies. Despite corrective measures being provided by the County, no permits were issued at the time of the last check of databases. No other permit applications were ever submitted for the other addresses with existing violations. In May, 2013, a meeting was held with the qualifier of Beaumont Communications Inc., Albert J. Scott where a Notice of Hearing was served to him for an appearance in front of the Contractors' Licensing Board for having committed a willful building code violation. The installation of seventeen (17) GSM radio communication fire alarm systems within the Green Links Golf Villas community without a building permit in issuance is a violation of Florida Building Code Section 105.1. Mr. Scott's inability or refusal to take the corrective measures required for permit issuances construes a violation of Collier County Ordinance section 22- 201.1(2) for "Willfully violating the applicable building codes or laws of the State, City, or Collier County." C.L.B. Case #2013 -07 Albert J. Scott D /B /A — Beaumont Communications Inc. Table of Contents E1 /E3 — Formal Complaint E4 —State D.B.P.R. Licensing Detail Report E5 — Collier County Certificate Detail Report E6 — Hand Delivered Notice of Hearing E7 — Complaint from E. Naples Fire Prevention Bureau E8 — Contract Proposal for Work Performed E9 — Payment to Contractor for Work Performed E10/E17 — Correction Directives for Rejected Permit Applications E18/E53 — Photographs of Jobsite and Unpermitted Installations E54 — Florida Building Code Section 105.1 Pertaining to Permitting E55 — Collier County Ordinance 22- 201.1(2) Outlining Misconduct by State Certified Contractors. Contractors' Licensing Board 2800 North Horseshoe Dr. Naples, Fl. 34104 Complaint Number- 2013 -07 Complainant: Any person who believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90 -105, as amended, may submit a sworn complaint to the Contractor Licensing supervisor, or his / her designee. The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor. The complainant shall pay a fee of $50.00 to defray the costs of administering the complaint, at the time of filing the complaint. The complaining party shall state with particularity which section(s) of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Please print or type and return signed copies of the complaint. Date: May 29th, 2013 Against: Contractor's Name: Albert J. Scott Phone: (239) 643 -7635 Business Name: Beaumont Communications Inc. License Number if known: #EF20000736 Collier County Competency number: #33194 Contractor's Business Address: 4600 Enterprise Ave. unit "D" Naples, FL. 34104 Filed By: —t Name: Collier County Contractors' Licensing Address: 2800 N. Horseshoe Dr. Naples, FL. 34104 Business Phone: (239) 252 -2914 Address where work done: Green Links Golf Villas 7995 Mahogany Run Lane (17 separate buildings) City: Naples, FL. County: Collier Date of contract: July 14th, 2011 Date job started: Unknown Date job completed or new home occupied: Unknown Were there plans and specifications? Yes Is there a written contract? Yes. If yes, amount of Contract: $12,648.00 Has Contractor been paid in full ? Yes. If not, what amount? Not Applicable Was a Building Permit obtained? No Building Permit number if known: Not Applicable Have you communicated by letter with the licensee? Yes Date: May 8th, 2013. Do you have a reply? Yes Please attach to this form all copies of the purchase agreement, building contract, home improvement contract, copies of receipts and /or cancelled checks available and any additional evidence to substantiate your allegations. List any subsections of Section 4 of Collier County Ordinance number 90- 105, as amended, which, in your opinion, have been violated by the contractor which is the subject of this complaint, (list subsection number): Collier County Ordinance #90 -105, as amended, section22- 201.1(2) "Willfully violating the applicable building codes or laws of the State, City, or Collier County." — --- Please state the facts which you believe substantiate your charge of misconduct against the subject contractor. List facts separately for each subsection number above: Failure to obtain required permitting for GSM radio communication fire alarm installations. ( Complainant's signature) State of: . Ur' County of: � 1 �) Sworn to (or affirmed) and subscribed before me this 29th day of May, 2013, by bin C . (� (� (signature of person making statement). (signature of Notary Public) W LYNN ROE * MY OOMMISSWN f EE $709 // EXPIRES: February 17, 2017 Krint, type or stamp commissioned name of Notary Public: +,,,� BoWed 7hru Bu* No" Swkes Personally known E L QL— or produced identification V�--3 DBPR - SCOTT, ALBERT JOE; Doing Business As: BEAUMONT COMMUNICATIO... Page 1 of 1 3:53:30 PM 512812013 Licensee Details Licensee Information Name: SCOTT, ALBERT JOE (Primary Name) BEAUMONT COMMUNICATIONS INC (DBA Name) Main Address: 4600 ENTERPRISE AVENUE UNIT D NAPLES Florida 34104 County: COLLIER License Mailing: License Location: License Information License Type: Rank: License Number: Status: Licensure Date: Expires: Certified Alarm System Contractor I Cert Alarm I EF20000736 Current,Active 06/09/2008 08/31/2014 Special Qualifications Qualification Effective View Related License Information View License Complaint 1940 North Monroe Street Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1 3951 The State of Florida is an AA /EEO employer. Copyright 2007 -2010 State of Florida. Privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public- records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. Please see our Chapter 455 page to determine if you are affected by this change. ,x_14 view Mlaster Proiect View Ail Activities for this Licensee Add new e� rson or business to Address Book Licensee inforrttation New Licensee (current pr Neva Licensee (no praleckj„ _._ Licensee Number ,033134 ! _: .. Status !Active Name / Description E~EAUMONT Cr3NIMUNIC#TIONS INC Start Date Type Contractor End Date Inspector Submitted on Jurisdiction T Collier County _.. Department 10perations _.. . ,&ctt'e'Jty Description .�._.__ Afl' Certificates from CDPIus. 13674, 3313 Description Tie Pr � I RifDisplays Collier County Growth Management Division / Planning and Regulation Operations Department / Licensing Section CERTIFIED MAIL # HAND DELIVERED% -� Mr. Albert J. Scott d/b /a — Beaumont Communications Inc. 4600 Enterprise Ave. unit "D" Naplcs, FL. 34104 Date: May 8"', 2013 RE: Complaint filed against you by Collier County Contractors' Licensing regarding a violation of Ordinance 90 -105, as amended, Section 22- 201.1(2) in (date of violation) November, 2012 Dear: Albert J. Scott • complaint has been filed against you by the above referenced individual. • hearing of this complaint will be held by the Contractors' Licensing Board on June 19'', 2013 at 9:00 AM in the Board of County Commissioner's Room, Third Floor, Administration Building (W. Harmon Turner Bldg.), at 3301 East Tamiami Trail, Naples, Florida. Your presence before the Contractors' Licensing Board is required at this time. The packet you will receive marked composite exhibit "A" will be delivered to the members of the Contractors' Licensing Board one week prior to the hearing. If you wish to prepare a defense packet and have it delivered in conjunction with composite exhibit "A ", you must make fifteen copies and have them in our office by 8:00 AM on Wednesday, one week prior to the hearing. In your packet, you may give a summary of events. At this meeting, you may present evidence and be represented by an attorney of your choice. In the event the Contractors' Licensing Board finds you in violation of Section number(s) 22- 201.1(2) of Ordinance # 90 -105, as amended, the range of disciplinaly sanctions which may be imposed are from an oral reprimand to a suspension or revocation of your Collier County Certificate #33194 and/or suspension or revocation of your permit privileges against your state license #EF20000736 . Licensing Compliance Officer Coller County Contractors' Licensing Phone - (239) 252 -2914 cf — G. v GROWTH MANAGEMENT DIVISION FIRE DEPARTMENT REPORTING FORM Please check the Fire Department that applies: ( ) North Naples FD ( ) Big Corkscrew FD ( ) Ochopee FD KEast Naples FD ( ) Immokalee FD Please check who report is directed to: ( ) Building Department (/j Contractor Licensing () Golden Gate FD () Isle of Capri FD ( ) Code Enforcement Date of report: `-, 1-1k, 1 Person making report: Phone number of person making report: Date violation observed: C� Address of violation: Are there Fire Code violations on this property: () YES KNO If YES please attach copies of all documents, notices of violation, red tags, citations, etc. Please describe r-mm"lairft- bl 1� Z - - ri 6 Fax completed form to Department directed to: Building Department: 239 - 252 -2334 Contractor Licensing: 239- 252 -2469 Code Enforcement: 239 -252 -2343 REVISED FORM 7/2012 I: -:7 Beaumont Communications, Inc. 4600 Enterprise Ave., Unit D Naples, FL 34104 Office (239) 643 -7635 * Fax (239) 643 -8560 * UL 58474 -1 Name / Address Greent-inks Gel'f`Villas 7995 Mahogany Ron Lane Naples. FL 341 13 -1624 Job Site Location Proposal Date Proposal # 7/14/2011 7129 Contact Rep Ai Qty Description Amount Total 'l'i tE F0LL0WING PROPOSAL IS FOR WIRELESS FiRE ALARM MONITORING FOR (17) BUILDi?NGS (see attached spread sheet for cost sayings) 17 Wireless Communicator (cacti building requires a radio) PRICING: INCLUDES: 744.00 12.648.00 * *First pears Monitoring " *Permitting Fees * *Pest & hispection * *Installation & Proi!ramina ADDRESS " *7990 NInhn£rtnay Rnn tam * *79711 Mahngnnay Run Lahr * {7970 Mabuguuap Run l,artc *''7915 i alrogoray Run Lane "7965 Mahogonay Ran (.tine * *7910 Maihogona) Run Lanc "79ill Mahoaonay Run l-ane * *7905 Mahogtmay Run Lane *':7955 Mahogomy Run Lane * *7895 Mahosonay Ruff Lane ' *7935 Maltog-ouay Rim ]-true 7 °7885 Mttbu-1oitay Ruli Lane * 7940 Mahoeonay Run (-,Inc * *7880 MahogortxyRun I,.anC *07930 Mahogonny Run Laic ""'7970 Mnliogonay= Run Lane *7925 Mahogonay Run Lane MONTHLY MONITORING FEE AFTER 1'111: FIRST YEAR $50.00 per building We hereby propose to furnish labor- and materials - complete in accordance Total $12,648.00 with the above specifications for the sum of------------------ Payments wilt be made as follows. 100% deposit payment due ror equipment In receq?t of your deposit. you are accepting all terms and conditions Labor will ix billed acconlingk All Materials are guaranteed to be as speafied All woik to becompdetcd in a work manlike manor according to standard pincuces Any alteration or deviation from the above specie ications involving exuna costs, will be executed onev upon xvritten orders and will becimu an extra charge over and above esmnate All agreements conting e nt upon strikes, accidents or delays beyond our control One y r %mirianty on parts liom Iinrr of insuall, 'rile price provided does not include any parts or labor not listed above This proposal subject to acceptance within 30 days and is void thereahlerat the option of the undersigned Acceptance of Proposal The above prices, specifications and conditions are hereby accepted. Vou are authorized to do the work specified. Payments will be made as outlined above. The undersigned has read and accepts the conditions of the proposal and all of its terrors as a binding contract. Date: Signature: r- — V --------------------- 4r4t Greenlinks III OD001420 clo Benson's KT Orion Bonk B9 to9ers�o 3450 Horseshoe Dr. #275 771. Airpoft Rovcl Check Date N� r-L 3AI04 Naples, FL 3 . 41 ap--s. . 04 Sep 2, 2011 M z M 0 Two Thousand Mina H Lin d red Seventy Six Dollars and Zern Cents -ok Amount ChL ,.. Pay to the order of M Beaumont Communicatigns, inc. 4600 Enterprise Ave, Unit D Naplea, FL 34104 PON M . ................. ZZ Q IvIdA —M 6. Date:09/09/2011 Sequence:8139758 CapSequence:O Account:8300075259 Amount:$2,976.00 Serial:1420 Transit/Routing:67010169 Tran Code:O Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:Q Branch:O Pay:- End Point:19 Application ID:19 M z M 0 M M M < M . ................. ZZ —M 6. IM (a fA w 0 Z i 0' z P 2 C: z M rS yl Date:09/09/2011 Sequence:8139758 CapSequence:O Account:8300075259 Amount:$2,976.00 Serial:1420 Transit/Routing:67010169 Tran Code:O Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:Q Branch:O Pay:- End Point:19 Application ID:19 Greenlinks 11 00001404 c/o Benson's KT Orion Sank 3050 Horseshoe DrW275 775 Airpoit Road Check Date Naples, FL 3-4104 Naples, FL . 34104 Sep 2, 2011 Two Thousand Nine Hundred Seventy Six Dollars and Zftro Cents Check Amount Pay to the order of Beaumont C orn m u n Ications, Ina 4600 Ente rp rise Ava. Unit D Naples, FL 34104 ff% q I In I or.% r M JM 6 r-11 4 ro r1.■ Date:09/09/2011 Sequence:8139756 CapSequence:O Account:8300075283 Amount:$2,976.00 Serial:1404 Transit/Routing:67010169 Tran Code:Q Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:O Branch:O Pay:- End Point:19 Application ID:19 -to M 0 0 0 W, E3 0 M ------- ---- M N ii k I A U.? 1, 4, "!J* X : . 11 ; J. 73 -33 0 'X 0 0 ? Ul RM M M zr" ;:TY r.'1 A i . ...... ... z iD n? ell _VX Date:09/09/2011 Sequence:8139756 CapSequence:O Account:8300075283 Amount:$2,976.00 Serial:1404 Transit/Routing:67010169 Tran Code:Q Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:O Branch:O Pay:- End Point:19 Application ID:19 -to D M M U) M 9 rfir M GreenTinks 1 00001348 clo BenfDn's KT 1b,131ria Bank Operating G-1- 10075 63 1816f67D 3()50 Homtshoe Dr. #275 775 Airport Road Check Date ftaple*, FL 34104 Naples, FL 34164 Sep 2, 2011 One Thousand Four Hundred Eighty Eight Dollars and Zero Cents CheckAmcunt 7-51 Pay to the order of Beaumont C orn rn u n Icatlans, Inc 4600 Enterprise Ave, Unit D Naples, FL 34104 Sr J jam. V' v A L ii I., J:.; 0 nT M 0 as M 0 T -K O M M T M Date:09/09/2011 Sequence: 8139754 CapSequence:O Account: 8300075275 Amount: $1, 488. 00 Serial:1348 Transit/Routing:67010169 Iran Code:O Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:O Branch:O Pay:- End Point:19 Application ID:19 F-:- - I I M A-3 rn F 1. J4 ,A zI 'r < Greenlinks IV 00DO14DO clo Benson's KT Iberia Bank 3050 Horseshoe Dr #275 775 Airport R021 Check Date z NopLe% FL 341 D4 Naples, rL 34104 Sep 2, 2011 id w�'A" ........... Five Thousand T ondred Eight Dollars and Zero Cents ChoGk Amount 0 hay to the order ef Beaumont Communications, Inc M z M 0 4600 Enterprise Aye, Unit D Naples, FL 34104 M w M A-3 rn F 1. J4 ,A zI 'r < Date:09/09/2011 Sequence:8139760 CapSequence:O Account:8300075267 Amount:$5,208.00 Serial:1480 Transit/Routing:67010169 Tran Code:O Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:O Branch:O Pay:- End Point:19 Application ID:19 E— I a. M z 0 M z M 0 M M M- M C. M U 3,pwp M n Oros 9 Ila TA M To 35 IM 51 Date:09/09/2011 Sequence:8139760 CapSequence:O Account:8300075267 Amount:$5,208.00 Serial:1480 Transit/Routing:67010169 Tran Code:O Debit/Credit:D Run:4 Batch:4 Pocket:l Return Item Code:O Branch:O Pay:- End Point:19 Application ID:19 E— I a. COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010076001 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100760 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7870 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit:BLDG 1700 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. .1013 DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7870 MAHOGANY RUN LN - BLDG 1700 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone:239- 687 -5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3: The Monitoring Company Information Form (MCIF) provided is not the current edition. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map ( DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted _ _prior _to March 30 2012. but issued after March 29, 2012, must be in compliance with the DFIRM requirements. r -(I COLLIER COUNTY GOVERNMENT . GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 Contact Name: BEAUMONT COMMUNICATIONS INC Address: 4600 ENTERPRISE AVE UNIT D City, State Zip: NAPLES, FL 34104- - Fax: (239) 643 -8560 Dear Applicant: PERMIT NO: PRFR2013010075501 APPLICATION NO: PRFR20130100755 JOB SITE ADDRESS: 7880 Mahogany Run LN, Unit:BLDG 1600 Email: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. JOB DESCRIPTION. WIRELESS MONITORING TAKE OVER - 7880 MAHOGANY RUN LN - BLDG 1600 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone:239- 687 -5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3. The Muniluiiny Company Information Form (MCIF) provided is not the current edltlon. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map (DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted prior to March 30, 2012, but issued after March 29, 2012, must be in compliance with the DFIRM requirements. 5 —ILf COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010075301 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100753 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7885 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit:BLDG 1500 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. JOB DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7885 MAHOGANY RUN LN - BLDG 1500 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone:239- 687 -5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3. The Munitwing Company Information Form (MCIF) provided is not the current edition. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additiurral deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map ( DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted prior to March 30, 2012, but issued after March 29, 2012, must be in compliance with the DFIRM requirements. V -tt� COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010074801 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100748 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7895 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit:BLDG 1400 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. JOB DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7895 MAHOGANY RUN LN - BLDG 1400 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone: 239-687-5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided is not the current edition. Ploaso obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3: The Monitoring Company Information Fonni (MCIF) provided is rust the current edition. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map ( DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted prior _to_March 30, 2012, but issued after March 29, 2012, must be in compliance with the DFIRM requirements, , (G COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010074301 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100743 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7905 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit :BLDG 1300 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. ,JOB DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7905 MAHOGANY RUN LN - BLDG 1300 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone:239- 687 -5650 Email:mjani @ccfco.org Correction Comment 1: 1 he plan checklist provided is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3: The Monitoring Company Information Form (MCIF) provided is not the current edition. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent reviews) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map (DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted prior to March 30, 2012, but issued after March 29, 201.2, must be in compliance with the DFIRM requirements. T-_ -�'-T COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010074701 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100747 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7910 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit:BLDG 1200 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. JOB DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7910 MAHOGANY RUN LN - BLDG '1200 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone:239- 687 -5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3: The Monitoring Company Information Form (MCIF) piovided is nol the current edition. In addltlon when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map ( DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted prior to March 30, 2012, but issued after March 29, 2012, must be in compliance with the DFIRM requirements. COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive, Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010074401 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100744 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7915 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit:BLDG 1100 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. JOB DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7915 MAHOGANY RI 1N I N - RI DG 1100 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone: 239-687-5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3: The Monitoring Company Information Form (MCIF) provided is not the current edition. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map ( DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. Please note that applications submitted prior to March 30, 2012, but issued after March 29, 2012, must be in compliance with the DFIRM requirements x--19 COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DIVISION / PLANNING AND REGULATION 2800 N. Horseshoe Drive,. Naples FL 34104 * Phone (239) 252 -2400 Outstanding Corrections Date: January 16, 2013 PERMIT NO: PRFR2013010075801 Contact Name: BEAUMONT COMMUNICATIONS INC APPLICATION NO: PRFR20130100758 Address: 4600 ENTERPRISE AVE UNIT D JOB SITE ADDRESS: 7980 Mahogany Run LN, City, State Zip: NAPLES, FL 34104 -- Unit:BLDG 100 Fax: (239) 643 -8560 Email: Dear Applicant: Plans submitted with the referenced permit have been reviewed. We are unable to approve your permit application for the reason(s) indicated below. All corrections must be clouded. Corrections must be submitted in person, the office receiving corrections is open until 4:00 pm. JOB DESCRIPTION: WIRELESS MONITORING TAKE OVER - 7980 MAHOGANY RUN LN - BLDG 100 Rejected Review: Fire Review Reviewed By: Margaret Jani Phone: 239-687-5650 Email:mjani @ccfco.org Correction Comment 1: The plan checklist provided Is not the current edition. Please obtain, complete and submit the correct plan checklist. Correction Comment 2: Please ensure all documentation /information requested in comments 15, 17, 18, 19 and 23 of the current edition of the plan checklist is provided. Correction Comment 3: The Monitoring Company Information Form (MCIF) provided is not the current edition. In addition when complete the correct MCIF, please ensure the following documentation /information is provided: - The UL category and file number was not included on MCIF. - Copies of the monitoring company's state license and UL Certificate of Compliance were not observed in the submittal package. Please provide. Correction Comment 4: This review shall be considered incomplete pending receipt of additional information. Subsequent review(s) may reveal additional deficiencies Submit 4 sets of revised sheets along with 4 letters of response addressing each item. PLEASE NOTE: Collier County Plan Review and Inspections routinely reviews all outstanding permit applications in order to determine their status. The review process includes appropriate responses from the permit applicant when the permit cannot be approved. When the applicant is advised of deficiencies and does not respond within six (6) months with corrected plans or an appeal to the Code Enforcement Board, the permit application will be canceled as per Collier County Ordinance 2002 -01, Section, 104.5.1.1 to 104.5.1.4. IMPORTANT: The new Digital Flood Insurance Rate Map ( DFIRM) will be effective on March 30, 2012. All development and building permit must be in compliance with the DFIRM flood zone and flood elevation requirements beginning on March 30, 2012. 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Q 1 U r SECTION 105 PERMITS Page I of 7 105 SECTION 105 PERMITS 105.1 Required. Any owner or authorized agent who intends to construct, enlarge, after, repair, move, demolish, or change the occupancy of a building or structure, or to erect, install, enlarge, alter, repair, remove, convert or replace any electrical, gas, mechanical or plumbing system, the installation of which is regulated by this code, or to cause any such work to be done, shall first make application to the building official and obtain the required permit. 105.1.1 Annual facility permit. In lieu of an individual permit for each alteration to an existing electrical, gas, mechanical, plumbing or interior nonstructural office system(s), the building official is authorized to issue an annual permit for any occupancy to facilitate routine or emergency service, repair, refurbishing, minor renovations of service systems or manufacturing equipment . installations /relocations. The building official shall be notified of major changes and shall retain the right to make inspections at the fagility site as deemed necessary. An annual facility permit shall be assessed with an annual fee and shall be valid for one year from date of issuance. A separate permit shall be obtained for each facility and for each construction trade, as applicable. The permit application shall contain a general description of the paramotcrs of work intended to be perfortned during the year. 105.1.2 Annual permit records. The person to whom. an annual permit is issued shall keep a detailed record of alterations made under such annual permit. The building official shall have access to such records at all times or such records shall be filed with the building official as designated. 105.1.3 Food permit. As per Section 500.12, Florida Statutes, a food permit from the Department of Agriculture and Consumer Services is required of any person who operates a food establishment or retail store. 105.2 Work exempt from permit. Exemptions from permit requirements of this code shall not be deemed to grant authorization for any work to be done in any manner in violation of the provisions of this code. Permits shall not be required for the following: Gas: 1. Portable heating appliance. 2. Replacement of any minor part that does not alter approval of equipment or make. such equipment unsafe. Mechanical: 1. Portable heating appliance. 2. Portable ventilation equipment. l—S-+ ARTICLE V. BUILDING TRADES* Page 30 of 36 .Sec. 22- 201.1 Misconduct- -State certified contractors. The following actions by. state certified contractors shall constitute misconduct and grounds for discipline pursuant to section 22 -202 of this article. (1) Failing or refusing to provide proof of public liability and property damage insurance coverage and workers compensation insurance coverage as required by .Florida Statutes. (2) Willfully violating the applicable building codes or laws of the state, city or Collier County. (3) if the CLB finds through its public;hearing process that the contractor was found by another county or municipality within the past 12 months, to have committed fraud or a willful building code violation and the CLB finds that such fraud -or other willful violation would have been fraud or a willful violation if committed in Collier County or- within the respective city. (4) Fraud. (Ord. No. 94 -34, § 4; Ord. No. 99-45, § 4.2-- 4.2.3, 6 -8 -99; Ord. No. 06-46, § 1(4.1.8.2)) Sec. 22 -202. Disciplinary proceedings, including minor violations. (a) There are three categories of violations: violations of subsection 489.132(1), F.S.; and contractor's licensing board. (i) violations of subsection 489.127(1), F.S.;' (ii) (iii) other violations within the jurisdiction of the (1) Subsection 489.127(1), F.S., is incorporated herein. (Lack of required license, certificate, or registration). The following are designated to enforce subsection 48!.127 (1); F= S•: Collier County Building. Official, all -license compliance officers, the chief building inspector, chief electrical inspector, chief plumbing /mechanical inspector, and /or other inspectors authorized from time4o- tiriie by the building official. Procedures specified in this section shall apply except, to the extent, if any, that Sedtion 489.127 or Section 489.132, May require different procedure(s). The penalties for each uncontested violation of subsection 4891;27(1) and /or 489.132(1), F_S., are $300.00 for the first uncontested violation and $500.00 for each subsequent uncontested violation by the same individual or entity. Penalties for contested violations of subsection 46.9.127(i), F.S., are as now or hereafter specified in Section 469.127, F.S. Penalties for contested violations of subsection 489.132(1), F.S., .are as now or hereafter specified in Seotion 489.'132, F.S. They citation form 'attached hereto as Exhibit "A is approved, which form may be amended from time =to -time by resolution of the board of county commissioners. (2) Minor violations: The contractor licensing supervisor or designee shall issue. a of of noncompliance" as the county's first response to a minor violation of any provision of any regulatory law, including this section, when (i) it is reasonable for staff to assume that the violator; at the time of violation, was not aware of:'. f the.provision that was Violated or it can be assumed that it was not clear to the violator hovtir to.comply with the violated provision; and (ii) that - violation has not then resulted in 'economic. harm or physical harm to any person; and :(iii) the violation has neither adversely affected the public health, safety, or welfare*, nor cro aced any significant threat of any such .adverse affect.: The notice of noncompliance should identify, the sppoific provisioh that was violated, should provide information on how to comply with that provision and should specify a reasonably' time for full compliance. The notice of noncompliance shall not be accompanied with any immediate threat of any monetary fine.or any other disciplinary penalty; but may specify that failure of the Volator.to correct the violation within the time specified in the notice for compliance may result in disciplinary proceedings. Each -j