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CLB Agenda 04/16/2014
CONTRACTORS LICENSING BOARD Agenda April 16 , 2014 Cam► e-r County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA April 16, 2014 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. I. ROLL CALL II. ADDITIONS OR DELETIONS: III. APPROVAL OF AGENDA: IV. APPROVAL OF MINUTES: DATE: March 19, 2014 V. DISCUSSION: VI. NEW BUSINESS: (A) Orders of the Board (B) Terry L. Curtis,AAA Eagle Plumbing, Inc.-Verification of Construction Experience (C) Robert A. Zielinski, RAZ Construction, LLC-Second Entity Application (D) Jorge Ramirez, Jorge Ramirez Lawn Care LLC-Verification of Construction Experience (E) Russell G. Spokish,Alno Painting, Inc-Waiver of Exam(s)for Reinstatement (F) Bradley J. Garrod Jr., Garrod Painting, Inc.-Waiver of Exam(s)for Reinstatement (G) Mikel G. Diehl, Florida Hardscapes & Paver Maintenance, Inc.-Waiver of Exam(s)for Reinstatement (H) Daniel A. Haugen-Contesting Citations 08650& 08651 (I) Adriano Cordero, Eco' System Paint LLC-Review of Credit Report(s) VII. OLD BUSINESS: VIII. PUBLIC HEARINGS: (A) Case#2014-06 Hublar Lopez Rodriguez D/B/A-Nian Construction Inc IX. REPORTS: X. NEXT MEETING DATE: WEDNESDAY, MAY 21, 2014 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONERS CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 March 19,2014 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING March 19, 2014 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: Vice Chair: Thomas Lykos Members: Michael Boyd Ronald Donino Terry Jerulle Richard Joslin Kyle Lantz Gary McNally Robert Meister Excused: Patrick White, Chairman ALSO PRESENT: Michael Ossorio — Supervisor, Contractors' Licensing Office Colleen Greene, Esq. — Assistant County Attorney Kevin Noell, Esq. — Assistant County Attorney James F. Morey, Esq. —Attorney for the Contractors' Licensing Board Ian Jackson—Licensing Compliance Officer 1 March 19,2014 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: Vice Chairman Thomas Lykos called the meeting to order at 9:03 AM and read the procedures to be followed to appeal a decision of the Board. Roll call was taken; a quorum was established, and eight voting members were present. II. AGENDA—ADDITIONS,DELETIONS, OR CHANGES: Change to Agenda Order: Vice Chairman Lykos noted the following change: • Case#204-04: Richard J. Ranck, d/b/a "RV Lanai of SW Florida, Inc.," (Item VIII—(A), "Public Hearings") will be heard following Item V, "Discussion." III. APPROVAL OF AGENDA: Richard Joslin moved to approve the Agenda as amended. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. IV. APPROVAL OF MINUTES—FEBRUARY 19, 2014: Richard Joslin moved to approve the Minutes of the February 19, 2014 meeting as submitted. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. V. DISCUSSION (None) VIII. PUBLIC HEARINGS (Note: With reference to the case heard under Section VIII, the individuals who testified were first sworn in by the Attorney for the Board.) A. Case 2014-04: Richard J. Ranck, d/b/a "RV Lanai of SW Florida, Inc." Respondent, Richard J. Ranck, and his wife, Mary Ellen ("Molly") Ranck, were present and were not represented by counsel. Vice Chairman Thomas Lykos briefly outlined the order of the proceedings to be followed: 2 March 19,2014 • Open the Public Hearing; • Swear the witnesses; • Accept any evidence from the parties; • The County will present its "Opening Statement;" • The Respondent will present his/her"Opening Statement;" • The County will next present its "Case in Chief;" • The Respondent will present his/her defense; • The County may offer any rebuttal. That concludes the Public Hearing process. • The Board will close the Public Hearing and receive instructions from its attorney, which is similar to a"Charge" given to a Jury, setting out the parameters on which the Board's Members will base their decision. • During deliberations, the Board can request additional information and clarification(s) from the parties. • The Board will decide two different issues: o First, whether the Respondent is guilty of the offense as charged in the Administrative Complaint. o A vote will be taken on the matter. o Second, if the Respondent is found guilty, the Board will decide the Sanctions to be imposed. • The Board's Attorney will advise the Board of the Sanctions that may be imposed and the factors to be considered. • The Board will discuss Sanctions and vote. • The Chair will orally report the decision of the Board. Ian Jackson, Collier County License Compliance Officer,requested to enter the packet of information provided to the Board Members for Case 2014-04 into evidence. Kyle Lantz moved to approve opening the Public Hearing in Case No. 2014-04: The Board of County Commissioners, Collier County Contractors'Licensing Board vs. Richard J. Ranck, d/b/a "RV Lanai of SW Florida, Inc."License No.: 34532 (Aluminum Contractor), and entering the information packet into evidence as County's Exhibit "1." Richard Joslin offered a Second in support of the motion. Carried unanimously, 8—0. Ian Jackson presented the County's "Opening Statement:" • Collier County was prepared to show through documented facts and sworn testimony that the Respondent violated Collier County Ordinance #90-105, as amended, Section 4.1.18: "Proceeding on any job without obtaining applicable permits or inspections from the City's Building and Zoning Division or the County's Building Review and Permitting Department." 3 March 19,2014 • The Respondent also violated Collier County Ordinance #90-105, as amended, Section 4.1.2: "Contracting to do any work outside the scope of his/her competency as listed on his/her competency card and as defined in this Article, or as restricted by the Contractors'Licensing Board." Vice Chairman Lykos asked the Respondent to present his "Opening Statement." Mary Ellen ("Molly") Ranck replied: • I acknowledge that we did what you said we did. • The Permit had been applied for; however, because of various corrections that had to be done, and things that took a great amount of time (i.e., surveys), there was a big delay that the customer could not stand. • They wanted the horse shoe pits covered with a roof prior to the start of "season," and they pushed us really, really hard to just do it— so we did. • It was unfortunate, but that was the way it happened. • We did dig the little footers for the posts and we're not licensed to do concrete work. • That's my statement. Ian Jackson presented the County's "Case in Chief" • The case was referred on October 23, 2013 by Collier County Building Inspector John Serenko concerning an unpermitted aluminum structure at 1000 Wiggins Pass Road. • A site visit was conducted. Two aluminum structures were under construction while the Permit was under review. • Mrs. Ranck was contacted and advised of the "Stop Work" Order. She was also advised the Permit must be issued before the work could continue. • October 29, 2013: A "Correction" letter was sent to the Contractor by the Building Department o Issue: The structure was located within the required 8-foot rear yard setback • November 5, 2013: Permit was rejected. • December 3, 2013: Corrections were submitted. • December 11, 2013: Permit was under review and a second"Correction" letter was sent to the Contractor • December 31, 2013: Permit remained rejected. A second rejection letter was sent to the Contractor. • January 13, 2014: Corrections had not been made • January 29, 2014: Email was sent to Contractor asking to contact Investigator • January 31, 2014: Unable to contact Contractor 4 March 19,2014 • • February 3, 2014: Met with Susan Jackson, Manager of the Lake San Marino RV Resort, who provided contract information and payment records. Ms. Jackson stated she had been unable to contact the Contractor. Ms. Jackson indicated she will hire another Contractor to pull Permit and complete construction. • February 3, 2014: Unable to contact Contractor. No activity on Permit application. Notice of Hearing was prepared and sent via certified mail to RV Lanai of SW Florida, Inc. • The contract noted RV Lanai of SW Florida, Inc. was to perform concrete work (i.e., dig footers and install posts) which was outside the scope of the license held by Mr. Ranck and constituted a second violation. • As of March 19, 2014, no corrections had been submitted and there was no activity concerning the Permit application. Vice Chairman Lykos asked Mrs. Ranck if there were any details she wanted to share with the Board on behalf of her husband. Mary Ellen Ranck replied there were no details to add. She explained that, due to her husband's illness and slow recovery, she has become his sole caregiver and has not been involved in their aluminum business. She further stated they have not done any business since the end of 2013 and do not intend to pursue new work in the future. Ian Jackson presented the County's "Closing Statement:" • The Respondent has acknowledged the violations cited in both Counts of the Administrative Complaint; the County's case was closed. The Respondent's "Closing Statement:" • Mrs. Ranck asked the Board to consider that she and her husband have been in business for over fifteen years in Collier County without an incident and have also operated in Lee County without incident. Richard Joslin asked if the job had been completed. Ian Jackson responded when he spoke with the manager of the Lake San Marino RV Resort last month, Susan Jackson said she was in the process of hiring a new Contractor. There has been no change to the site which was photographed during his initial visit in October, 2013. • Contract amount: $5,972.00 • Deposit paid to RV Lanai: $3,165.16 • Balance remaining: $2,807 Investigator Jackson offered the County's services to Ms. Jackson if recovery of funds became an issue, i.e., if the new Contractor could not complete the required work for the remaining balance. He stated he has not heard from a representative of the Lake San Marino RV Resort. He noted the issue of set-back remains and the horse shoe playing field may be relocated on the property along with the aluminum structures already in place. 5 March 19,2014 Michael Ossorio explained the State's "Aluminum Contractor's License" is a Specialty License that allows concrete work to be performed in addition to aluminum while Mr. Ranck's license in Collier County was limited to aluminum work only. In response to a question concerning the site, Mrs. Ranck explained the materials had been delivered to the jobsite; all posts and beams had been installed and installation of the roof was the final phase to be completed. It was at that point the rear setback became an issue and work was halted. She stated RV Lanai exceeded the amount of deposit for materials and labor by approximately $500. She estimated the posts should be moved by up to nine inches from the rear fence to comply with the existing set back. Michael Ossorio explained since the original Contractor was not licensed to perform the work which was done, even though there were additional expenses, the Contractor could not place a lien against the property. The County would object. Lien rights apply to Licensed Contractors. He stated the County is rarely contacted in situations where a Contractor is owed money by a property owner. Richard Joslin pointed out a contradiction with Mrs. Ranck's earlier testimony. She stated RV Lanai had worked in Collier County"without incident." He referred to County's Exhibit"E-28"which cited six instances of fines levied against RV Lanai since 2006 for not obtaining permits or working outside the scope of the license. Michael Ossorio explained in 2006 a determination("Finding") was made that Aluminum Contractors could no longer perform glazing of glass and/or windows— which was the basis for one of the fines. He stated Mrs. Ranck is in the Building Department between two to three times per week. He was surprised this case was brought before the Board. He noted Mrs. Ranck is a licensed Contractor while Mr. Ranck is the Qualifier for the company. Ian Jackson clarified only two Citations had been issued; the other items were notes in the system concerning permitting fees. Vice Chairman Lykos asked if his initial question regarding potential funds owed to a Contractor should be discussed during the penalty phase of the proceeding. Attorney James Morey, Attorney for the Contractors' Licensing Board, stated he was not sure the Board had the ability to impose a fine upon a consumer. In such cases, civil court is the usual venue. Vice Chairman Lykos asked for a motion to close the Hearing. Gary McNally moved to approve closing the Public Hearing. Terry Jerulle offered a Second in support of the motion. Carried unanimously, 8-0. 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. 6 March 19,2014 • That, according 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. • 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 that evidence would be admissible in a Court of Law. • 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 are effective upon being read, unless the Board should order 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"), as well as rights under Florida Statutes in the Administrative Code. • 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. Vice Chairman Lykos outlined the Count I of the Administrative Complaint as follows: • Count I: Proceeding on any job without obtaining applicable permits or inspections from the City's Building and Zoning Division or the County's Building Review and Permitting Department." He noted the Respondents acknowledged guilt as to Count I. Richard Joslin moved to approve finding the Respondent,Richard J. Ranck, RV Lanai of SW Florida, Inc.,License Number 34532, guilty as to Count I of the County's Administrative Complaint of violating Collier County 7 March 19,2014 Ordinance #90-105, as amended, Section 4.1.18. Terry Jerulle offered a Second in support of the motion. Carried unanimously, 8- 0. Vice Chairman Lykos outlined the Count II of the Administrative Complaint as follows: • Count II: Contracting to do any work outside the scope of his/her competency as listed on his/her Competency Card and as defined in this Article, or as restricted by the Contractors'Licensing Board. He noted the Respondents also acknowledged guilt as to Count II. Robert Meister moved to approve finding the Respondent, Richard J. Ranck, RV Lanai of SW Florida,Inc., License Number 34532,guilty as to Count II of the County's Administrative Complaint of violating Collier County Ordinance #90-105, as amended, Section 4.1.12. Kyle Lantz offered a Second in support of the motion. Carried unanimously, 8- 0. Attorney Morey noted the second phase is deliberation of possible Sanction to be imposed. He stated since the Contractor was licensed by Collier County, the Contractors' Licensing Board may, but is not required to impose any of the following Sanctions, either alone or in combination: 1) Revocation of a Collier County (or City) Certificate of Competency, 2) Suspension of a Collier County (or City) Certificate of Competency, 3) Denial of the issuance or renewal of a 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) Restitution; 6) Imposition of a fine not to exceed $5,000, 7) Issuance of a public reprimand, 8) Requirement for re-examination or participation in a duly-accredited program of continuing education directly related to the Contractor's contracting activity, 9) Denial of the issuance of Collier County or City building permits or requiring the issuance of such permits with specific conditions, and 10) Recovery of reasonable investigative costs incurred by the County for the prosecution of the violation. 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: 1) The gravity of the violation; 2) The impact of the violation on Public Health/Safety or Welfare; 8 March 19,2014 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. Michael Ossorio noted the County incurred $910 in investigative costs. Recommendation: • Reimbursement to the County for investigative costs is to be paid within thirty days; • Imposition of a fine of$1,000 for working outside the scope of the license; • Imposition of a fine of$300 for working without obtaining a building permit; and • Revocation of the contractor's license. Robert Meister moved to accept and approve the County's recommendation and to also require the Respondent provide a Release of Lien. Michael Ossorio suggested either an affidavit or an email from the Respondent confirming that all suppliers had been paid would be sufficient. If the materials were delivered to the property by a vendor, he would have the right to place a material lien against it. Ian Jackson stated he contacted the property owner's representative twice and has not heard anything further. Vice Chairman Lykos expressed concern that requiring the Rancks to produce such a document could prevent them from filing a counterclaim if a civil suit were brought against them by the property owner in the future. Terry Jerulle stated if the Rancks accepted a deposit and delivered materials for the deposit, there should be a release just for the materials. Mrs. Ranck stated the materials were paid for at the time of delivery. She further stated the labor incurred during the partial completion of the job was paid, and she will provide a copy of the paid bill for the materials. Mr. Ossorio asked if the materials had been dropped off at the job site by the supplier and the response was, "Yes." He confirmed the supplier would be entitled to a lien if he/she had not been paid for materials. Robert Meister restated his motion: Robert Meister moved to accept and approve the County's recommendations concerning suspension of the Respondent's license and imposition of fines. The Respondent is to provide proof of payment of the materials. Michael Ossorio clarified the recommendation was to "revoke" the Respondent's license—not suspend it. Mr. Meister agreed to the clarification. 9 March 19,2014 Amended Motion: Robert Meister moved to accept and approve the County's recommendations concerning revocation of the Respondent's license and imposition of fines. The Respondent is to provide proof of payment of the materials. Kyle Lantz offered a Second in support of the motion. Carried unanimously, 8—0. Vice Chairman Lykos outlined the Findings of Fact: • The Respondent, Richard J. Ranck, d/b/a/RV Lanai of SW Florida, Inc., is the holder of record of Collier County Certificate of Competency Number 34532 (Aluminum Contractor). • 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, Richard J. Ranck, was present at the Public Hearing held on March 19, 2014 and was not represented by Counsel at said Hearing. • All notices required by Collier County Ordinance 90-105, as amended, had been properly issued and were personally delivered. • Based on the evidence presented,the Respondent acted in a manner that is in violation of Collier County Ordinances and is the one who committed the act. • The following Allegations of Fact set forth in Administrative Complaint were found to be supported by the evidence presented at the Hearing: o Count I: "Proceeding on any job without obtaining applicable permits or inspections from the City's Building and Zoning Division, or the County's Building Review and Permitting Department." o Count II: "Contracting to do any work outside the scope of his/her competency as listed on his/her competency card and as defined in this Article, or as restricted by the Contractors'Licensing Board." Conclusions of Law: • The Conclusions of Law alleged and set forth in the Administrative Complaint as to Count I and Count II were approved, adopted and incorporated herein, to wit: The Respondent violated Section 4.1.18 of Collier County Ordinance 90-105, as amended, regarding working without the required permits, and Section 4.1.2 regarding Scope of Work. 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 eight (8) 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 eight (8) in favor, and none (0) in opposition, a majority vote of the Board members present,that the following disciplinary Sanctions are hereby imposed upon Richard J. Ranck, the holder 10 March 19,2014 of Collier County Certificate of Competency#34532 (Aluminum Contractor), to wit: • Investigative costs of$900 are to be reimbursed to the County within thirty days; • A fine of$1,000 is imposed for working outside the Scope of the license; • A fine of$300 is imposed for working without obtaining the required permit; • Mrs. Mary Ranck is to provide proof to the Contractors' Licensing Supervisor of payment of all materials delivered to the jobsite; and • The Respondent's license is hereby revoked. Vice Chairman Lykos noted the case was closed. Richard Ranck asked for additional time to pay the fines since his income has been severely limited. Michael Ossorio stated he will meet with Mr. and Mrs. Ranck to discuss options. Richard Joslin moved to approve authorizing the Contractors'Licensing Supervisor to devise a payment plan of the fines imposed in Case 20124-04, as above noted. Gary McNally offered a Second in support of the motion. Carried unanimously, 8—0. (Note: The order of the Agenda was resumed.) VI. NEW BUSINESS: A. Orders of the Board Richard Joslin moved to approve authorizing the Vice Chairman to sign the Orders of the Board. Kyle Lantz offered a Second in support of the motion. Carried unanimously, 8—0. (Note: With reference to the cases heard under Section VI, the individuals who testified were first sworn in by the Attorney for the Board.) B. Olaf Kuemmel—Verification of Construction Experience (d/b/a "SW Florida Garage, LLC") Michael Ossorio provided the following overview: • Mr. Keummel has applied for a Specialty license as an Epoxy Stone Contractor under Section 22-162 (17): Epoxy Stone Contractor requires 24 months experience with a passing grade on a Business and Law test and means those who are qualified to batch and mix aggregates, epoxy, hardener, and gravel to specification, or to construct forms and framework for the casting and shaping of epoxy and aggregate, or to pour, place and finish over a concrete base. 11 March 19,2014 • The Licensing Board has approved three testing companies: PTI, Gainesville Independent, and ProMetric. • Per the Ordinance,the minimum passing grade is a score of 75. • The State's minimum passing grade is a score of 70. • Mr. Olaf is a State-certified Plumbing Contractor and a Certified General Contractor. His Scope of Work is unlimited. • Mr. Olaf wants to open another business which will be limited to Epoxy Stone work. • Mr. Olaf took the Business and Law test in 2002 and scored 73.75 which is slightly below the Collier County minimum score. • It will be less expensive for Mr. Olaf to obtain insurance if he has a Specialty license in the trade than to obtain additional coverage as a General Contractor. Mr. Ossorio reviewed the Ordinance and stated since the Applicant has been approved by the State of Florida, has maintained his continuing education, and the exam is superfluous to his work as an Epoxy Stone Contractor, he recommended approval of the application as presented. Attorney Morey noted the application was referred to the Board due to the language in the Ordinance. He stated the Board may consider the applicant's relevant experience in his trade and may waive testing requirements. Vice Chairman Lykos confirmed the sole issue before the Board was the test score. Mr. Ossorio stated Mr. Olaf has been a licensed Certified General Contractor since 2002 and was also a Plumber in Germany. He personally attested to the craftsmanship of the Applicant. He noted if the score had been 75, Mr. Olaf would have been approved for the Specialty Contractor license. Olaf Kuemmel stated: • He has been a Certified General Contractor since 2002; • His test score was 73.75; • The requirements for the Specialty license for the County is a score of 75; • The difference of 1.25 points is less than one question on the test; • He requested the Board grant his application for the Specialty license without requiring him to take the test again; • He has over 30 years of experience in the construction industry. • For the new business, he stated he knows what to do and how to do it. He will specialize in installing garage floor coatings. • He will keep the new business separate from his SWF Construction business. Richard Joslin moved to approve the application of Olaf Kuemmel for a Specialty License as an Epoxy Stone Contractor without requiring an examination. Kyle Lantz offered a Second in support of the motion. Carried unanimously, 8— 0. 12 March 19,2014 C. Veronica A. Compean—Verification of Experience (d/b/a "Compean Maintenance, Inc.") Michael Ossorio: • Mrs. Compean has applied to obtain a license as a Landscaping Contractor—Restricted under Section 22-162 (25): Landscaping Contractor requires 12 months experience and a passing grade on a Business and Law test and means any person who is qualified to install and/or remove trees, shrubs, sod, decorative stone and/or rocks, timber and plant materials, and concrete paving units for sidewalks, patios and decks only, whether or not incidental to landscaping; and pre-packaged fountains, or waterfalls, provided same does not include connection to a sanitary sewer system, portable water line, or to any electrical installation, which tasks must be performed by tradesmen licensed in the relevant trade. Landscape Contractors may contract only for removal and/or trimming of trees and/or other combination(s) of the authorized services. All new applicants applying for a Landscaping license are required to obtain a passing grade on an approved exam pertaining to pruning and safety, in addition to the Business and Law exam. • Mrs. Compean took the Tree Contractor test (score: 77%) as well as the Business and Law exam (score: 82%). • She did not include any affidavits to verify her experience for the past twelve months because she worked with her husband who is employed by a licensed company. She only worked part-time. Veronica Compean: • She and her husband, Alfonso, were before the Board because she does not possess the "hands on" experience required to obtain a Landscaping license. • Her husband has the required experience; he has worked in the trade for fifteen years but is hampered by his inability to read/write in English. • They are currently working in the field of lawn maintenance (mowing, edging, etc.) and their customers have asked for more services. • Advancement in the field will benefit their family of seven. • She stated it does not make sense to work for another company to gain the required experience when she can do so by working with her husband. • She has worked with her husband since 2002. • "Compean Maintenance, Inc." was incorporated in March, 2009. Alfonso Compean confirmed his wife has worked with him; first, she began in 2002 when he was employed by a landscaping company and since he opened his company in 2009. He has a total of 30 years working in the Naples area. Working in landscape maintenance does not generate enough money to support his family. He stated his wife passed the tests because he cannot. She will hold the license but he will perform the majority of the work. 13 March 19, 2014 Michael Ossorio noted Mr. Compean has been in business for 15 years and has never received a Citation for working without a license. Mr. Compean has been in the landscaping business for 15 years prior to opening his own company. Recommendation: • Approve the application but impose a twelve-month probationary period to be supervised by the Contractors' Licensing Office; • After one year,the Applicant will appear before the Board to review the business plan, and how the business has been operated. • Any complaints filed against the company will be reviewed by the Board. Vice Chairman Lykos asked Veronica Compean to explain the difference between lawn maintenance and a Landscaping license. Q. What are you allowed to do as Landscaper that you could not do in your lawn maintenance business? A. (Veronica Compean) Right now, we only mow the lawn. We can blow away clippings, we can edge, we can clean debris from plant beds. We want to be able to hedge—nothing big or huge. Customers want beautiful lawns with beautiful plants. We cannot replace a plant. Will we be commercial, `Yes.' But not a big or huge business. It will be the two of us. When we work with our customers, we want to give them the best service we can together. He [her husband] has all the knowledge and he has done it. He understands if it goes well or not. AIfonso Campean stated when a customer wants to change bushes, he must explain that he cannot and they must hire someone else. But I'm there and I could it if I had the license. Veronica Campeon continued she will be allowed to bring plants and flowers and plant them. Vice Chairman Lykos continued questioning Mrs. Campean. Q. Will you be allowed to trim trees? A. If it's in my path—I passed the tree trimming exam. I will do it when I am licensed. Not big or huge trees but medium trees as long as they are not near wires, yes. Q. Does the license allow you to plant new trees? A. I think so; yes. Vice Chairman Lykos stated it was important that the Applicant understand to avoid doing work that is outside the scope of the license. Q. Are you allowed to trim bushes? A. Yes. Q. Are you allowed to plant new grass and new sod? A. Yes. Q. And you're also allowed to maintain those as well? 14 March 19,2014 A. Correct. Q. What happens if a tree has to be taken down? Are you allowed to remove a diseased tree? A. We can take down the tree but we cannot treat the disease. Q. Do either one of you have the experience to take down a tree that is near a house so that it does not fall and damage the house? A. Yes. He does. Vice Chairman Lykos questioned Alfonso Campean. Q. What do you understand the license will allow you to do? A. I can take bushes out and plant new bushes. I can trim trees. I can please my customers. If I have a license, I will be happy to do it. Terry Jerulle asked who Mr. Campean worked for in Naples for the 15 years prior to starting his own company. A. Sunshine Landscape. I was the Crew Leader. I drove Bobcats and did installations—everything. Q. New construction,too? A. Yes. Terry Jerulle moved to accept the County's recommendation and approve the application to grant a restricted license as a Landscape Contractor. The Applicant will be placed on probation for a one-year period. Richard Joslin offered a Second in support of the motion. Motion carried, 7— "Yes"/1 — "Opposed." Vice Chairman Lykos was opposed. Vice Chairman Lykos explained to Mr. and Mrs. Campean they should take the time during the year to understand the restrictions under the license, and work within the scope of the license. D. Robert A. Zielinski—Second Entity Application (d/b/a "RAZ Construction, LLC") It was noted the Applicant was not present. Vice Chairman Lykos noted the following case was taken out of order; he assured Doug Nettles that his case would be heard next. F. Seth B. Hollander—Motion for Re-Hearing of Case #2014-02 (d/b/a "Hollander Construction Company, Inc.") The Applicant was present and represented by his attorney, Henry Johnson. Attorney Johnson explained the Motion for Re-Hearing was requested due to an Order entered against Seth B. Hollander and Hollander Construction Company, Inc., resulting from a Hearing held on January 15, 2014. 15 March 19,2014 Mr. Johnson stated: • We ask the Board to reconsider the penalties imposed by the Board against Mr. Hollander and Hollander Construction which were the subject of the January, 2014 Order. • The Order found Mr. Hollander and his company in violation of a section of the Code and Ordinance of Collier County relating to providing Workers' Compensation Insurance at a particular jobsite on a particular date. • The penalties imposed: o Suspension of Mr. Hollander's license for a period of 21 months to run concurrently with a previously imposed probationary period; o Imposition of a fine in the amount of$5,000; o The Respondent was also required to reimburse the County in the amount of$525 for administrative/investigative costs; o The Respondent was to be publically reprimanded. • We are asking the Board to reconsider the following: o To contemplate a lower suspension period. His license has been suspended for two months and that period may be appropriate given the facts and circumstances of this case. o To reduce the amount of the fine from $5,000 to $1,000. o We understand the reimbursement to the County of the costs incurred is appropriate. o To rescind the public reprimand. Mr. Johnson presented an update to the Board of events that happened since the Hearing: • Mr. Hollander was previously ordered to pay, on a monthly basis, $500 to the Contractors' Licensing Office as part of the previous probation; and he has been diligent in making the required payments. • Mr. Hollander's company has a fully active Workers' Compensation Insurance policy #106531, effective December 23, 2013 through December 23, 2014. • At the last Hearing, it may not have been made clear that Mr. Hollander was in the process of a Workers' Compensation audit; he met with an auditor on December 11, 2013 which was several days before the finding of a violation for lack of insurance coverage. o Please consider that Mr. Hollander was not ignoring law—he was in the middle of an audit. o We have supplemented the record by producing an Affidavit from Susan Weems, president of Weems Insurance of Naples, Inc. and agent for Hollander Construction. She verified that the previous policy expired in October, 2013 due to non-payment. A new policy could not be issued until an audit had been completed. o While the audit was ongoing, the violation occurred. Within two days of the Citation, the new policy became effective. 16 March 19,2014 • Since the Hearing, Mr. Hollander has been in contact with Counsel for the Florida Department of Financial Services to settle issues. The FDFS has requested records from Mr. Hollander's company. To date,there has been no Finding by the State regarding Workers' Compensation issues. • Mr. Hollander has been proactive since December and before then. • Mr. Hollander came to the previous Hearing and admitted his error. • The new facts presented to the Board could give the Board cause to modify the previously imposed penalties. Mr. Johnson opined it would be beneficial not only for Mr. Hollander but also for companies like his if probationary periods included a mentoring component. He noted even attorneys can obtain help [from their peers] if they experience issues in their practice, i.e., business problems. He continued: • I am respectfully asking the Board to please consider a substantial modification of the penalty phase. • Mr. Hollander wants to be a good Contractor. • Our office is working with Mr. Hollander and the Department of Financial Services to reach a resolution in the Workers Compensation matter. • You have Ms. Weems' Affidavit, and a packet has been provided to you. • We ask that you consider all of that in evidence as you discuss a Re- Hearing of the penalty phase of what the Board previously examined. • This is a Motion for Re-Hearing ... essentially a Motion for Reconsideration. There are some new developments and facts which the Board could consider to lessen the penalty phase. Vice Chairman Lykos asked the Board's counsel if the Board's only issue was to determine whether or not to schedule a re-hearing of the case, and the response was, "Yes." Attorney Morey referenced Section 22-204 of the Code, "Rehearing," (a copy of which had been provided to the Board for their review) as follows: • Any Request for a Rehearing must be in writing. o Respondent's attorney submitted a Motion for Rehearing, dated February 20, 2014, as required. o The Board is to consider that Request. • A Request for Rehearing shall be based only on the ground that fundamental error occurred which resulted in a failure of due process, the decision was contrary to the evidence, or that the hearing involved an error in a ruling of law and/or fact which was fundamental to the decision of the Contractors'Licensing Board. Vice Chairman Lykos asked Mr. Johnson to respond to the specific item that was the basis for the request for a rehearing. 17 March 19,2014 Attorney Johnson replied: • I think there has been fundamental error because you really have no guidepost of how you are to impose penalty. And the Board made the decision of failing to have appropriate Workers' Compensation insurance before the State's Department of Financial Services ever made its decision. Essentially, while Mr. Hollander was attempting to comply with the Department of Financial Services, we respectfully state, the Board pre-empted that process. In other words, the Department of Financial Services has not made a Finding. We believe that through negotiation, it is a correctable error. The fundamental error is that the Board imposed penalties which it really didn't have any clear guidelines for the imposing of those penalties, respectfully, certainly to the degree that it was done. The Board didn't consider the fact that there was, at the time, essentially a State issue that involved the Department of Financial Services. Kyle Lantz questioned if the Board was being asked to not pass judgment on anyone who has a Workers' Compensation issue until after the State has completed its investigation. What you are saying applies not only to this case but, obviously, we will apply it in the future. Attorney Johnson: • Respectfully, I think when it is time for a Finding of violation you don't need the State's input to make that Finding under your Ordinance. But when it comes to the penalty phase, I think that's where the Board needs to take a step back. • Because, certainly, the issues we examined with the Department of Financial Services would impact the penalty phase. If I were to come before the Board and state we had reached an accord with the Department of Financial Services—we complied with their requirements—that would be something that would be very important for the Board to consider in the penalty phase of anyone who violates your own Ordinance relating to Workers' Compensation issues. • I'm looking at it in terms of the penalty phase, and I think that would make a difference. He continued: • This has been our experience in our office: o There is an initial order that is provided on site. And it stops the project. o Then there is a period of time where, either through counsel or directly through the local Investigators, we work to determine if there is a substantial issue, a large issue, or a small issue. 18 March 19,2014 o At that point in time, Mr. Hollander began working through our office and the Counsel for the Department of Financial Services to determine the next step to resolve the matter, or not. Kyle Lantz: • My question is not at the State level but at the County level. • Michael, if your investigators stop someone on the side of the road who is doing work without Workers' Comp insurance, do you call the State office and ask them to take over, or do you issue a Citation with a fine, or ... how does that work? A. (Michael Ossorio) If the Applicant doesn't have the proper insurance, we assess a$1,000 fine. Q. Pretty much instantaneous? A. Yes. Q. You don't have the State investigate? A. No. For the most part, we try to work with the State and in this particular case, too, as well. There are four Workers' Comp Investigators out there in the field, so they are not very hard to get ahold of. And we communicate with them, probably, on a daily basis. We have Licensing and Financial Services working together on a daily basis. But, for a practical matter, if you are licensed and you work without insurance, it's a$1,000 fine. Now, unfortunately, in this particular case,the Respondent was on probation so the facts are different ... how we communicate to the Licensing Board and how the Board communicates to someone who is on probation. I am not here to dispute the facts. He has applied for a rehearing --- so, if you want to have a rehearing ... I am assuming that he opens the door to have the Workers' Comp agent bring more evidence—in good light or in bad. Q. No. The only issue that I'm bringing up is ... the reason why we're having a rehearing is because we didn't have all the facts ... Richard Joslin noted the Board was not having a rehearing yet. Q. ... a Request for a Rehearing is that the State hadn't finished its investigation ... we did it on our end. So, if that's the case, then does that mean that anybody who gets a$1,000 ticket in the future is going to be able to say, "Well, you let this case get retried ... A. That's his argument. We don't take orders from Financial Services. We conduct our own investigation. We just did one last month [January, 2014) with K. C. Tiles and Marble, Inc. That case has been heard, finished, completed, and now it's going through the civil court. But I believe we can run concurrent [investigations]. If our own investigation warrants a charge, the Licensing Board will file with the Clerk's Office. And that is what we did. Richard Joslin: • In my opinion, if this is going to be a Motion for Rehearing, I think the Motion is coming a little bit premature. Only because if there is something 19 March 19,2014 that's happening and this judgment has already been made, and the penalty phase has already been entered into, then there's a good chance that our ruling would stand until maybe it does go before the State Workers' Comp Board or before his concerns with them. Then maybe would be the time to have a Motion for Rehearing ... maybe to justify that particular phase that we did ... give penalties. Attorney Johnson responded: • There was a procedural mandate ... we had only so many days following the ruling to file our Motion or waive it for all time. Richard Joslin: • I understand you met the criteria of the law concerning when you can do it, but now would be the time for the Board to decide whether or not we're going to hear it or postpone it until you satisfy your own things through the State of Florida's Workers' Comp insurance because it could change our verdict as far as that ruling goes. Terry Jerulle: • This is Collier County. He did work—admitted working in Collier County; he hired employees without knowingly—without having Workers' Compensation. It's a County violation. He came before the Board, he admitted it, we found him to be guilty, and we assessed the fine. I do not see a"fundamental error" in that. Richard Joslin: • And it would be different if it were only a few days—but this went on from October to December—that's two months with no insurance. If there was a problem, then maybe Weems should have contacted him and said, "Hey your policy has run out and what's up with that? Why don't you have a new policy?" But it took him two months to get it done. We made the ruling and I think the ruling will stand. Terry Jerulle: • I'm not going to discuss the case. What I believe we should be discussing is whether we made a fundamental error in our ruling. And I've yet to be convinced by the [Respondent's] attorney that we made a fundamental error. Attorney Morey: • There are several possibilities that someone could put forth as a reason for the rehearing: o that a fundamental error occurred which resulted in the failure of due process; inadequate Notice; wasn't allowed to present a case; was cut off—wasn't afforded due process; 20 March 19,2014 o the decision was contrary to the evidence. We can consider only the penalty phase or we can narrow it down to an issue on that point; o if there was a fact in the Hearing or pleading that the Board relied upon to make a decision and then later learned that the fact was incorrect, i.e., said it happened on a Thursday when it happened on a Friday; o If we found out that something was a real crux of the decision— that's a significant error. He continued those are the limited reasons to grant a rehearing if the Board decides to grant a rehearing. If a rehearing is granted, it is conducted as a new Hearing and both sides will be given an opportunity to present new evidence or argument. It can be limited by the Board to a specific issue or it can be all over again. He explained if a rehearing is allowed, the Board could affnin, modify, or reverse its initial ruling. Vice Chairman Lykos stated he wrote in his notes that there were three reasons for a rehearing: (1) "A fundamental error occurred which resulted in a failure of due process." • He asked the Board members if they thought a fundamental error had occurred. o [No response] He continued, Item#2 is "the decision was contrary to the evidence." • He asked the Board members if they thought the decision reached was contrary to the evidence. o [No response] He continued,the third Item is "there was an error on a ruling of law and/or a fact which was fundamental to the decision of the Licensing Board." • He asked the Board members if they thought an error was made on a ruling or on a fact that affected our decision making. o [No response] Terry Jerulle: "No. And I haven't heard testimony otherwise." Vice Chairman Lykos asked,based on the three criteria, the question for the Board to answer, "Does the case as presented by the Respondent dictate us to schedule it for a rehearing?" Richard Joslin: "I would say not at this time." Attorney Morey stated Mr. Johnson should be allowed to make a Closing Statement to support his motion. The Respondent's request is, "Grant a rehearing." The Board's motion is, essentially, "Yes" or"No." 21 March 19,2014 Attorney Johnson presented the"Closing Statement" for the Respondent: • We provided a packet which we respectfully contend is our lawful basis for a rehearing. • Again, we would emphasize that, while I'm sensitive to Mr. Jerulle's comments, at this point in time,there are no established, clear criteria for how you handle the penalty phase of a matter such as this. • You have broad criteria but they can be applied a lot of different ways. • Given the affidavit of Ms. Weems; given the fact that there is a separate investigation by the State which I think could impact this Board's ultimate decision making power ... • I think there are two things here: o (1) If there's been a violation: We are in the process of attempting to mitigate damages and issues with the Florida Department of Financial Services. We think that if a resolution were provided to the Board, it could impact that Board's decision relating to the penalty phase. o (2) The affidavit of Ms. Weems supports the fact that there can be reconsideration of the penalty phase. • That's what we're looking for. Your Findings can stand as to your decision concerning guilt or innocence. But we think there's enough for you to be able to rehear the penalty phase. Terry Jerulle moved to approve denying the Motion for a Rehearing. Gary McNally offered a Second in support of the motion. [Note: There was no additional discussion by the Board members. Carried unanimously, 8—0. BREAK: 10:45 AM RECONVENED: 10:57 AM VI. NEW BUSINESS: (Continued) D. Robert A. Zielinski—Second Entity Application (d/b/a "RAZ Construction, LLC") Vice Chairman Lykos again asked if Mr. Zielinski was present. It was noted the Applicant was not present. E. Doug Nettles—Verification of Experience (d/b/a "Marco Island Home Services, LLC") Doug Nettles stated he was appearing before the Board because he lacked verification of experience concerning the pressure washing of roofs. Vice Chairman Lykos asked which license had he applied to obtain. Doug Nettles responded, "Roof coat, roof paint, roof clean." 22 March 19,2014 Michael Ossorio referenced Section 22 -162(35) as follows: Roof Coating, Roof Painting, and Roof Cleaning Contractor requires 24-months experience, a passing grade on a Business and Law test, and means any person who is qualified to clean, paint, or coat a roof by means of pressure-operated equipment, hand application, or otherwise. This category does not include roof repair. Criteria: • The Applicant did take/pass the Business and Law test(Score: 78); • Credit score must meet the threshold of the Administrative approval process; • Demonstrated experience. Mr. Ossorio continued: • Mr. Nettles owns and operates a pressure-washing business and has operated it on Marco Island for many years o Pressure washing pool decks and pool cages • His Business Tax Receipt restricts his work to maintenance service only/no contracting. • He is before the Board to obtain a license for roof coating and roof cleaning—he is to clarify the type of work he does. Doug Nettles: • He has been licensed since 2008 to work as a pressure washer. • His roofing experience is limited—he worked for Dally Roofing until the Board pulled the license in 2008. He attempted to contact Bruce Dally but has been unable to find a phone number for him. • His brother has over 35 year roofing experience who will vouch that he worked with him at Dally Roofing and his other experience in Oklahoma for Eagle Roofing. • He stated he has both pressure washing and roofing experience. His specific roof pressure washing experience that cannot be verified because his former employer (in Naples) is no longer in business and he not received a response from his former employer in Oklahoma. • He stated he has no experience with roof coating or roof painting. • He is limiting his scope of work to roof washing. • He currently performs all aspects of pressure washing from the eaves of the roof down to ground level. Vice Chairman Lykos noted the license includes roof coating and roof painting and stated if the Board issued the license to him, the Applicant would be allowed to do coating and painting. Mr. Nettles replied that his brother's experience would apply; his business is a family owned company and he has been part of the company for the past seven years. His brother is experienced in roof coating and roof painting. 23 March 19,2014 Michael Ossorio stated he can(and does) restrict this type of license and modify it to a particular category, i.e., roof cleaning. David Nettles: • He thirty-five years of roofing experience ranging from residential to commercial building • He does not believe a coating should be applied to a roof and would not be involved in roof coating • He knows how to paint and clean roofs safely; he has never been hurt on a job site • He wants to make his living washing roofs • He will be working with his brother Doug Nettles stated other employees include his nephews. He stated his brother will be responsible for training employees. He explained he has been on roofs when necessary to wash windows. He stated he is comfortable on roofs and very comfortable using the pressure washer. Michael Ossorio noted the application stated Doug Nettles owns 100% of the company and asked if his brother was an employee, and the response was, "Yes." Mr. Nettles stated his brother could be own 10% of the company if that would help to obtain the license. Mr. Ossorio explained if David Nettles is working for the company, he would feel more comfortable knowing that Mr. Nettles would a certain percentage of it. Recommendation: • David Nettles is to own 10% of Marco Island Homes Services, LLC • The license will be restricted to roof cleaning only Kyle Lantz asked the Applicant to explain how he cleans roofs. Doug Nettles relied he will pressure wash tile roofs; while bleach can be used to treat mold/mildew, in his experience 3800 pounds of pressure is sufficient to remove mold. Q. What do you use to protect yourselves—safety equipment? A. Safety shoes or rubberized soles work very well. We don't use harnesses or ropes or work when there is lightning. Richard Joslin moved to approve the application of Doug Nettles for a restricted license for roof washing/cleaning provided his brother has a 10% ownership in the company. Robert Meister offered a second in support of the motion. Carried unanimously, 8— 0. G. Christopher L. Adams—Waiver of Examination (Reinstatement) (d/b/a "Crescent Beach Custom Homes,LLC") 24 March 19,2014 Michael Ossorio stated: • The Applicant is a Registered General Contractor who allowed his Certificate to lapse; • His State registration is "current/inactive"which means it is in dormant status; • He has kept his Continuing Education requirements; and • Taking the exam would be superfluous. Recommendation: • Reinstate the license and waive the testing requirement; • The Applicant is required to pay all back fees for the past three years in the amount of$1,075. Christopher Adams stated: • He had been a General Contractor in Collier County; • He and his partners chose to close Marco Island Construction due to the economic downturn; • He waited until he was financially stable to open his own company (without partners); • He kept his license current with the State and remained current with the Continuing Education requirements; • He has applied to reinstate his license and to waive the testing requirement. • He stated he has remained in contact with friends in the industry and is aware of the changes to the Building Code. When asked about his connection to Premiere Sotheby's Realty, Mr. Adams explained when he and his wife initially moved to Florida, they each obtained a real estate license. When the construction company closed, he joined his wife who is a Realtor with Premiere Sotheby's. Richard Joslin noted for the record that he has worked with Premiere Sotheby's and with the Applicant's wife. Kyle Lantz moved to approve the application to reinstate Christopher Adams' license as a General Contractor and to waive the testing requirement. Ronald Donino offered a Second in support of the motion. Carried unanimously, 8—0. E. Robert A. Zielinski—Second Entity Application (d/b/a "RAZ Construction, LLC") Vice Chairman Lykos asked for the third time if Mr. Zielinski was present. It was noted the Applicant was not present. VII. OLD BUSINESS (Note: With reference to the cases heard under Section VII, the individuals who testified were first sworn in by the Attorney for the Board.) 25 March 19,2014 A. Roger Drouin—Review of Suspension (d/b/a "Novelte Construction and Design,LLC") Michael Ossorio provided background information: • Mr. Drouin appeared before the Board in February, 2013; • His licensed was renewed and he was placed on probation for a one-year period during which time he was to take and pass o Business and Law o Concrete (Foiniing and Placement) o Masonry • He missed the deadline and his license was suspended. • Mr. Drouin closed his business to concentrate on preparing for the exams. • He has passed all three exams: o Business and Law—score: 82 o Masonry (Forming and Placement)—score: 76 Recommendation: • Remove the suspension; return his license to active status Attorney Morey confirmed the Board has the authority to life the suspension. Roger Drouin stated: • Time "got away" from him; • Was dealing with some family issues; • Business increased by 300% - worked 16-hour days; • When notified of his suspension, he immediately shut down his business' • He took and passed the required tests as well as the Marine Contractor's exam; • He asked the Board to lift the suspension and activate his license. Richard Joslin moved to approve terminating the suspension of Roger Drouin. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. VIII. PUBLIC HEARINGS (Note: With reference to the cases heard under Section VIII, the individuals who testified were first sworn in by the Attorney for the Board.) B. Case 2014-05: William B. Neuzil, d/b/a "Naples Construction Group, LLC." The Respondent, William B. Neuzil, was present and was not represented by counsel. 26 March 19,2014 Vice Chairman Lykos briefly outlined the order of the proceedings to be followed: • Open the Public Hearing; • Swear the witnesses; • Accept any evidence from the parties; • The County will present its "Opening Statement;" • The Respondent will present his/her"Opening Statement;" • The County will next present its "Case in Chief;" • The Respondent will present his/her defense; • The County may offer any rebuttal. That concludes the Public Hearing process. • The Board will close the Public Hearing and receive instructions from its attorney,which is similar to a"Charge" given to a Jury, setting out the parameters on which the Board's Members will base their decision. • During deliberations, the Board can request additional information and clarification(s) from the parties. • The Board will decide two different issues: o First, whether the Respondent is guilty of the offense as charged in the Administrative Complaint. o A vote will be taken on the matter. o Second, if the Respondent is found guilty, the Board will decide the Sanctions to be imposed. • The Board's Attorney will advise the Board of the Sanctions that may be imposed and the factors to be considered. • The Board will discuss Sanctions and vote. • The Chair will orally report the decision of the Board. Ian Jackson, Collier County License Compliance Officer,requested to enter the packet of infoiivation provided to the Board Members for Case 2014-05 into evidence. Kyle Lantz moved to approve opening the Public Hearing in Case No. 2014-05: The Board of County Commissioners, Collier County Contractors'Licensing Board vs. William B. Neuzil, d/b/a "Naples Construction Group, LLC"License No.: CGC1508081 (Certified General Contractor), and entering the information packet into evidence as County's Exhibit "1." Gary McNally offered a Second in support of the motion. Carried unanimously, 8—0. Ian Jackson presented the County's "Opening Statement:" • The County is prepared to show through documented facts and sworn testimony that the Respondent violated Collier County Ordinance#90-105, as amended, Section 22-201.1(2)by "Willfully violating the 2101 Florida Building Code, Section 105.1." 27 March 19,2014 Respondent presented his "Opening Statement:" • I'm guilty of it. • I started construction without the permits. • We demoed the house and started laying up blocks and kept going without getting the proper permits. Ian Jackson presented the County's "Case in Chief:" • February 6, 2014: The case was referred by the City of Naples' Building Department by Tom Szempruch, Acting Deputy Building Official, concerning the reconstruction of a substantially demolished home which began prior to permits being issued. • February 7, 2014: A site visit was conducted. The Investigator met with the Respondent and advised him of the violation. A"Stop Work" Order was issued. • February 11, 2014: The Investigator was contacted by the City of Naples Building Department by Building Official, Paul Bollenback, and Tom Szempruch. The "Stop Work" Order had been violated, i.e., masonry construction had taken place. A second "Stop Work" Order was issued by the City of Naples. • The Respondent advised the Investigator that the Masonry subcontractor had not advised his sub-subcontractor of the "Stop Work" Order. The miscommunication was between the subcontractor and his sub. • A Demolition Permit had been issued on/about November 13, 2013 to settle a previous misconduct case at the same property where the Respondent began demolition prior to having a permit issued in violation of the 2010 Florida Building Code, Section 105.1. • The Investigator researched the Respondent's case history in the County's database. o May 10, 2012: The violation involved unpermitted roof repair and a/c wrap installation at 1155 Sandpiper Road, Units G-4. E-4, B-1 and B2. The case was settled when the Contractor abated the violations by obtaining after-the-fact permits and Certificates of Completion for all of the unpermitted repairs and installations at the location. o April 10, 2012: The Respondent was issued an uncontested Citation for engaging in the business or acting in the capacity of a Contractor or advertising self or business organization as available to engage in the business or act in the capacity of a Contractor without being duly registered or certified. The Respondent, a General Contractor, was performing roofing construction himself and not utilizing a roofing subcontractor as required. o The Respondent was issued a second Citation on April 10, 2012 for commencing or performing work for which a building permit is required pursuant to the adopted State Minimum Building Code or without such permit being in effect. Investigator Jackson called Paul Bollenback to testify as a Witness for the County. 28 March 19,2014 Investigator Jackson questioned the Witness as follows: Q. Could you state your name? A. Paul Bollenback. Q. What is your position and how long have you had that position? A. I am the Building Official for the City of Naples and have held that position for approximately seven years. Q. Do you know your Building Code Administrator License Number? A. Yes. BU-1433. Q. Are you familiar with the project referenced in the Administrative Complaint? A. I am. Q. In your opinion as the City of Naples' Building Official, has the Respondent willfully violated the 2010 Florida Building Code Section 105.1 with the violations established on this construction project? A. I believe that is correct. The County's "Case in Chief' was concluded. Respondent, William Neuzil, presented his "Case in Chief:" • Since the time I asked Cronin Engineering to go out there and give me a stamped, sealed plan stating what we did is to Code. I also did a change of contractor form because the reason all this stuff happened is because me and the homeowner just didn't get along. It was push, push, push, push. • I did it. I am guilty. I should have told the homeowner, "No" but I didn't. Vice Chairman Lykos asked the Respondent if he understood the charges against him, starting work without a permit on the same project—twice. A. Correct. Ian Jackson stated since the Respondent acknowledged there was a violation, the County would rest its case. Terry Jerulle requested an explanation of when the photographs were taken. Ian Jackson: The photos in the County's Exhibit E-34 through E-27 were taken on February 11, 2014 after the first"Stop Work" Order was issued. Terry Jerulle asked the Respondent if he poured tie-beams. A. No. It was a remodeled house. Q. There was no tie-beam support? A. There is a tie-beam around the existing home. [The Respondent was asked to explain what he did.] A. Took the existing roof off. Q. So every tie-beam I see is an existing beam? A. What we did was to take the roof off and raise it up by two feet, and then we poured another beam on top of it. Terry Jerulle requested to recall the Witness to testify. 29 March 19,2014 Terry Jerulle questioned Paul Bollenback: Q. Paul, did you go to the jobsite? A. I have been to the jobsite. Yes. Q. It looks like a new tie-beam. Vice Chairman Lykos requested Mr. Bollenback review County's Exhibit E-35 and stated it looked as if new block was on top of old block and a new tie-beam. A. I have not actually discussed this with Mr.Neuzil. To be honest with you, the extent of the work—both through the photographs that were presented to me, to the communication that I had with my own staff, and through having visited the site myself—it was my understanding that there is new tie-beam or bond beam— new beams were poured there from what I could tell. The Respondent interjected, "Partial." Mr. Bollenback continued: This was an existing concrete building that was—the entire roof structure trusses were removed. Obviously, there was the intent to go to a second floor here. There was obviously new block work and also tie-beam work associated with that—it was my understanding that tie-beam work was done. Q. That's what it appears to be in the photos—I just wanted it to be made clear. Robert Meister: I don't know how there couldn't be new tie beams because there are new roof truss straps. Terry Jerulle stated he was amazed someone could get that far into construction without a permit. Kyle Lantz asked the Respondent if he had a permit to demo the old roof. A. Yes. Q. And that was issued, so ... after the fact? A. No. I had the permit before the roof came off We got the "Stop Work" Order when I removed some drywall from the inside of the home. That time, we stopped and got a permit. Q. So you got a demo permit, took the roof off, took the drywall out, and then you got in trouble ...? A. No. We started taking the drywall off because it was going to be a small remodel. We started removing the drywall by hand because it was an older home—that's when I got the "Stop Work" Order. At that time, we stopped and got the permit. We proceeded with removing the rest of the drywall, and then hand removed all the trusses. Q. The permit encompassed all that—removing the drywall and the trusses? A. Correct. Q. And then you started doing concrete work? A. Started laying the block and cutting the windows open, and forming ... there's a little ribbon beam on top of the existing beam there. Q. And so you did all that—and you poured it without your permit? A. Correct. Q. You mentioned you had a stamped letter from an engineering company—did they come out and inspect it—or look at your pictures? How did they ...? 30 March 19,2014 A. They came out and did a full inspection on it, after the fact. It's Cronin Engineering—he engineered it originally and he came out as well. Richard Joslin asked the Respondent if there were any proof in the packet. A. No,he just finished it the other day. He didn't finish it in time to put it in the package. It was noted the letter should have been included with the application. Kyle Lantz asked the Respondent if he applied for a permit. A. No. The contracts changed on the job. Q. Had you ever applied for a permit? A. No—just had the demo permit. Q. Was the beam that you were raising `engineered' at least? A. It was all engineered with a full set of engineered plans. Q. It was just never submitted to the County? A. It wasn't complete—there was no drainage plan—but it was a full engineered set of plans. It wasn't like we went out there and winged it. Richard Joslin noted the Respondent's statement that the homeowner pressured him to begin work right away and said he would pay for any fines. The Respondent admitted he should have changed [jobs] a while ago. • But I finally did. I signed the paper over about a week ago. Vice Chairman Lycos requested to recall the Witness, Paul Bollenback,to testify. Q. It has been my experience working in the City that, in some circumstances, where a contractor can come to the City and apply for a demolition permit when the rest of the project has not been engineered or the plans have not been developed, and the Contractor can start to work. Is that correct? A. There is a provision in The Florida Building Code, Chapter 1, for what we call an"Early Permit Waiver" that allows a Contractor to begin work if he has properly submitted a Permit Application to the local Building Department. I think that's what you are referring to. Q. Correct. A. Such a thing does exist. That's correct. Q. So if you're "under the gun" time-wise, you can apply for the permit ... in my experience, I have met with you to review the plans ... and then the Contractor takes liability for anything that may not be Code-compliant in the plans. At least it allows you to start before the whole entire Plan Review process has been completed. A. The Building Code allows for such a thing at the discretion of the Building Official and I will entertain those requests on an individual basis. I don't recall ... have I done that with you before? Q. We've done it a couple of time .... A. Okay. Q. ... in condo buildings ... A. Typically, you cannot receive an inspection ... you can go up only to the point where you would receive your first inspection. It allows a builder to go ahead 31 March 19,2014 and show the owner that he is starting and making an attempt. But the permit— in order for that to be legal—the permit application must have been submitted to the local Building Department. Richard Joslin questioned the Witness: Q. What's the normal time for a permit to be issued? How long does it generally take for a permit to come out? A. It depends upon the permit type. This is a single family addition alteration permit and typically those are running about three weeks. Terry Jerulle questioned the Witness: Q. When someone such as a Contractor submits for a building permit,there's a review process by you and your staff—correct? A. That's correct. Q. In a single family home like this, there is a structural review, is there not? A. Absolutely. Q. And, during that structural review, you review the structural drawings to see if they comply with the Code—correct? A. Correct. Q. And that has not been done in this process? A. So, for someone to go out and start construction on a home that is supposed to be Code-compliant to 2010, the review hasn't been done by the City of Naples? Q. And the inspector—there's also a secondary check—that inspectors come out to the jobsite to verify not only were the plans per Code but that the work is being done per Code. Correct? A. Per the approved plans, that's correct. Typically, a very extensive set of structural drawings would have accompanied this permit had it been submitted to us. The design firm is an excellent one—unfortunately they [the drawings] never made it to our desk. We don't know what work would have gone on without us having done our typical process, i.e., submittal, plan review, approval, field inspection. Q. So the work that we see here—none of that has happened through the City of Naples to date? A. That is correct. Richard Joslin questioned the Respondent: Q. Didn't you say, I believe, you had signed engineered plans to begin the construction ... A. Correct. Q. ... if you had the permit, then it would have been built to those specifications— right? A. Correct. Plus he also—that same engineer came out and gave us a letter that I have to give to the City saying that what's out there—he has basically, I guess, taken liability for it ... Q. He has signed off on it ... everything is correct, according to Code and according to what the City of Naples would look at ... A. Correct. Q. ... as a finished product. 32 March 19,2014 A. Correct. Vice Chairman Lykos questioned the Witness: Q. Specifically in a residential addition alteration, there are other factors that come into play with a permit application before you even get the building construction drawings themselves—like zoning and FEMA and those types of things. Has this project gone through that process? A. It has not. Q. Can you explain for our Board members what the consequences might be if the plan fails that process? A. The two issues that you mentioned would be floodplain ... if this property were could be located ... actually is located in an identified flood zone—if the property was deconstructed to the point where it might violate what is commonly known as the "50% Rule"before the City involvement, we might have had to require the owner to completely demolish the home and rebuild it. Luckily, that did not happen. This home was built at an elevation that exceeds the required flood elevation but nobody knew that—at least nobody on our staff —knew that at the time. That was a very big risk that the owner and the builder took. The other thing was zoning. There are times when—any community has setback requirements and height requirements—things of a zoning nature. To go ahead and build in a vertical fashion, until you are sure that those zoning requirements are compliant, is extremely risky. It's just not done. There is a review process done by cities and counties throughout the State of Florida, and that was bypassed in this case. Q. There is also an architectural review because the City has requirements for the final appearance of a home as well. A. Well, not on a single family home. No, sir, only on commercial buildings. Kyle Lantz questioned the Respondent: Q. You had mentioned the homeowner was pushing you to get this done and said he would pay any fines. Did you ask him to show up today and vouch for you? A. No. I signed over ... no. Richard Joslin questioned the Respondent: Q. Obviously, there was a dispute of some sort? A. Yes. Q. Was it because of the ... was it that you weren't going fast enough ...or ... A. We just didn't .... Q. ... just didn't click? Okay. Vice Chairman Lykos called for a motion to close the Public Hearing. Terry Jerulle moved to approve closing the Public Hearing. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8— 0. Attorney Morey outlined the Charge to the Board: 33 March 19,2014 • The Board shall ascertain in its deliberations that fundamental fairness and due process were accorded to the Respondent. • That, 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. • 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. • 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 that 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 decisions made by the Board shall be stated orally at the Hearing and are 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, and pursuant to Florida Statutes, the Florida Administrative Code. • 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. Kyle Lantz noted the Respondent had admitted his guilt. Kyle Lantz moved to approve finding the Respondent guilty of Count I of the County's Administrative Complaint. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8— 0. Attorney Morey noted the Board found the Respondent to be guilty. The Respondent is a State licensed Certified General Contractor, as well as a Collier County licensed Contractor. (CGC 1508081//Certificate 201200000637). He stated the Disciplinary Sanctions for State-licensed Contractors are slightly different than those that might be imposed on a County licensed Contractor. 34 March 19,2014 If the Contractors' Licensing Board finds there has been misconduct by a State- certified Contractor,the Board may: 1) Deny the issuance or renewal of Collier County or City Building Permits or require the issuance of permits with specific conditions; 2) Notification of and information concerning permit denial will be submitted to the State's Construction Industry Licensing Board ("CILB"); 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: 1) 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. Vice Chairman Lykos asked for a recommendation from the County. Recommendation: • Under 22-203, "Disciplinary Sanctions:" Holders of State of Florida Certificates of Competency. (2) Notification of any information concerning such peirnit denial shall be submitted to the Florida Department of Business and Professional Regulation within 15 days after the Contractors' Licensing Board decides to deny the permit. Michael Ossorio recommended imposing a two-year probation of the Respondent's building permit pulling privileges concerning the issuance of any new building permit. During the probationary period, if the Respondent is found to have willfully violated the Code by any Building Official, his building permit pulling privileges should automatically be revoked. Mr. Ossorio requested that the Board authorize him to send a letter to the State within fifteen days of its decision to notify the State that Mr.Neuzil's building permit privileges have been denied under his license. The letter will also recommend that the State require Mr. Neuzil to reimburse the County for investigative costs incurred in the amount of$735. Richard Joslin questioned the Respondent: Q. The packet does not contain a copy of the contract or the dollar amount ... to do all the work that you did, was money transferred to you from the homeowner? A. Yes. Q. Where does it stand at the moment? 35 March 19,2014 A. Right now, it's even. He has releases from everybody—he has the signed, sealed letter from Cronin saying that everything out there is good—he's got the signed Change of Contractor form ... it's pretty much ... it's all done. Q. What about the building permit ... what if it isn't issued? A. He's going in as a private provider—he hired Alpha Building Systems to do that for him. Michael Ossorio noted the homeowner may choose to file a formal complaint with the Florida Department of Business and Professional Regulation. Attorney Morey clarified: • The Contractors' Licensing Board may impose conditions upon the Respondent's ability to pull permits. • The Board is not putting the Respondent's license on probation. • The Respondent must report each time he pulls a permit during the next two years. • If there is another building code violation, his permit pulling privileges will automatically be revoked. Michael Ossorio explained the State refers building code violations to the Counties —all Code issues are deferred to the Counties. Vice Chairman Lykos asked the Respondent if he had any open permits in the County. A. No, I do not. Q. Do you have any open permits within the City of Naples? A. No. Richard Joslin: Q. With Marco Island? A. Nope. Q. Do you have any submitted? A. Yes, I have one submitted in the City of Naples. Terry Jerulle expressed his incredulity that a house could be built to the stage shown in the photographs without any regard for building permits, inspections, or the review process. He stated the Respondent either didn't understand the process or understood the process and chose to disregard it, and did not deserve to hold a license. He further stated to not suspend the Respondent's license will send a message to other home builders and subcontractors. Vice Chairman Lykos agreed. He clarified the Board could not suspend or revoke the Respondent's license, it could only revoke his permit pulling privileges within Collier County. Kyle Lantz explained without permit pulling privileges, the Respondent could not be a prime Contractor on a job—he could only work as a subcontractor in Collier County. 36 March 19,2014 Michael Ossorio stated the letter to the Executive Director of the CILB will contain a copy of the Findings of Fact and Order of the Board. He explained he could send a copy of the Findings of Fact to Fort Myers and the Respondent will not be allowed to pull permits in Lee County. The Board can impact the Respondent's business. Richard Joslin noted if the Engineer's letter that stated what had been done was done incorrectly, he would support suspending or revoking the Respondent's license. Further discussion ensued. Vice Chairman Lykos stated the Respondent chose to work outside the rules and the laws rather than find out what his options were, i.e., he could have hired a private provided to submit the proper paperwork. Terry Jerulle noted this was not the first incident involving the Respondent who had been fined and reprimanded in the past, but he still continued repeating the same error, i.e., not obtaining required permits before starting construction. Ian Jackson referenced a previous case which began on May 10, 2012 concerning unpermitted roof repair and a/c rack installation on Sandpiper Drive. The case was closed on August 12, 2013. Vice Chairman Lykos noted revoking the Respondent's permit pulling privileges would not prevent him from working on a job that did not require a permit or partnering with a Contractor who could pull the permits while the Respondent did the work. He asked Michael Ossorio if a Contractor could be changed (substituted) during the middle of the permit review process and the response was, "Yes." Mr. Ossorio explained if a permit had been issued, the fee to change Contractors was approximately $50.00. Vice Chairman Lykos stated he supported revoking the Respondent's permit pulling privileges for a one-year period. It would not affect the Respondent's ability to earn a living. Gary McNally suggesting an additional penalty, i.e., a probationary period to become effective after the revocation period ended. Vice Chairman Lykos summarized the penalties discussed by the Board: • A one-year revocation of permit pulling privileges; • During the two-year period following the reinstatement of his permit pulling privileges, if any Building Code Official determines there has been a willful Code violation, the Respondent's permit pulling privileges will immediately be revoked. Terry Jerulle moved to approve imposing the following Sanction with regard to William B. Neuzil, d/b/a Naples Construction Group,LLC: to suspend Mr. Neuzil's permit pulling privileges for six months in Collier County, including the City of Naples, the City of Marco Island, and unincorporated Collier County. 37 March 19,2014 Additionally, the Contractor's Licensing Board will recommend to the State of Florida Construction Industry Licensing Board(CILB) that: • the Respondent reimburse the County for investigative fees incurred in the amount of$735, either voluntarily or through the State; • the State impose a fine on the Respondent in the amount of$5,000. Gary McNally offered a Second in support of the motion. Motion carried, 6— "Yes"/2— "Opposed." Richard Joslin and Ronald Donino were opposed. Vice Chairman Lykos outlined: • This cause came on for Public Hearing before the Contractors' Licensing Board on March 19, 2014 for consideration of the Administrative Complaint in Case#2014-05 filed against Richard B. Neuzil, d/b/a"Naples Construction Group, LLC." The holder of record is a State-licensed Certified General Contractor, as well as a Collier County licensed Contractor. (CGC 1508081//Certificate 201200000637). • 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: • The Respondent, William B. Neuzil, is a State-licensed Certified General Contractor, as well as a Collier County licensed Contractor. (CGC 1508081//Certificate 201200000637). • 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, William B. Neuzil, was present at the Public Hearing and was not represented by Counsel at the Hearing held on March 19, 2014. • All notices required by Collier County Ordinance 90-105, as amended,had been properly issued and were personally delivered. • Based on the evidence presented, 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 22-201.1(2) of Ordinance #90-105, as amended: "Willfully violating the applicable Building Codes or laws of the State, City, or Collier County" was 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 I were approved, adopted and incorporated herein, 38 March 19,2014 to wit: The Respondent violated Section 22-201.1(2) of Collier County Ordinance 90-105, as amended. 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 eight (8) 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 nine(6) in favor, and two (2) in opposition, a majority vote of the Board members present, that the following disciplinary Sanctions are hereby imposed upon William B. Neuzil, to wit: o Revocation of Mr. Neuzil's permit pulling privileges for a period of six months in Collier County, including the City of Naples, the City of Marco Island, and unincorporated Collier County. o The Contractor's Licensing Board will recommend to the State of Florida Construction Industry Licensing Board (CILB) that: • the Respondent reimburse the County for investigative fees incurred in the amount of$735, either voluntarily or through the State; • the State impose a fine on the Respondent in the amount of $5,000. Vice Chairman Lykos noted the case was closed. IX. REPORTS: (None) X. MEMBER COMMENTS: (None) XI. NEXT MEETING DATE: Wednesday, April 16, 2014 BCC Chambers, 3rd 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 12:35 PM. 39 March 19,2014 COLLIER COUNTY CONTRACTORS LICENSING BOARD Thomas Lykos, Vice Chairman The Minutes were approved by the Vice Chairman on , 2014, "as submitted" [ 1 OR "as amended" Li. 40 F ',I AAA Eagle Plumbing Terry Curtis 1495 Saint Clair Shores Road Naples, FL 34104 To Collier Licensing Board: My name is Terry Curtis, I am the owner of AAA Eagle Plumbing.I have been in business since 2005. I successfully passed the Class B A/C test in summer of 2013. I am also certified for the Type I-III EPA. I would like to add the A/C license to my existing plumbing business. I have built a large customer following and reputation here in Naples, FL. I would like to be able to service my current and future customers in both A/C and plumbing. Thank you for taking the time to read my letter,and hope you consider my request to add the A/C license to my business. Sincerely, Terry Curtis * rj ► GMD 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: Q Exact Corporate/Business Name: /9 r/]lr 1 E4.21/ Fiction Name/DBA: Qualifier Name: ft-it-; 6-(,)12-'{% S ,, Physical Address: /V s %/A - Aew.Es /VRjJ4,i rZ 3`//D (Number 86 Street) (City) (State) (Zip Code) Mailing Address: /17795— A„,,,x7, SS`//S" (Number & Street) (City (State) (Zip Code) Telephone: 03.0 71‘ /4 7 E-Mail: TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 Cil),,num ber $230.00 ❑ Residential $230.00 Er Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 / LI Specialty $205.00 Specialty trade: C.74 if 8 CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. ft. Oct (Or Q S � /V/Y-- ek;,. ._5-40/L e4. \tO. Nop(FJ r/ 35//0/ 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. Z / i_CJ s -o �� cz Eca S iro US A' • Co CGS N l 14 L c/ Tk V X64 /..k.)1.- i..4a.& 1,tiasi t9-yreec( • AFFIDAVIT Cji\-S certify that the foregoing is true and correct to the best of my knowledge. Authorized Officer of the Firm STATE OF FLORIDA,COUNTY OF CO I ter The foregoing instrument as acknowledged before me this• t" (Crf'(,Vt /3, 20/4i (Date) By ( effL: L Ciur l 1 S of A AI Ec`CI 1e (Name of officer, title/agent) (Name`bf Corporation) J a }- J C f i C1(k Corporation on behalf of the corporation. (State or Place of Corporation) F t He/She has produced 1- Dover Liceo5 e identification and did not take an oath. (Type of identification) NOTARY'S SEIf+L,LPpYPUBi, ADAM LYSIAK ,2 „°o_ Notary Public-State of Florida .„ ,•; My Comm.Expires Jul 6,2015 Commission#EE 109558 ) + ' "P' Bonded Through National Notary Assn. (SIGNATUR _ •2051-VA.Y Page 2 of 4 QUALIFIER INFORMATION: Name: j e eu)v s Address: I `i S 64.:./t-- e cps N<ynfee; FL 3`f`fa`F (Number& Street) (City) (State) (Zip Code) Telephone: (3'i) T' &C-I-/4 7 Date of Birth: S.S. #: 000-00- ' E-Mail: 19-11141- pl4Mh; Driver's License: 1. Type of Certificate of Competency for which application is made. )4/e- 2. The names and telephone numbers of two persons who will know your whereabouts. e rr S.yo 7 s—e ckc < („ 39 537 - 377k 3. Have you ever been convicted of a crime related to Contracting? !Vv (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? /C)c) 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. y�o 9. List your business or work experience during the past ten years. rl�lr� � L_ �`\ pn `I / Se.L.,-ce Clnk,,� r_ fr.�.J C_ Ot:k. /;4 LJo tR (. l� / 4.0 ( �lJ0hb..� 5. :T. ea' do 6°44,, . 10. Statement of any formal training you have had in the area for which the application is made. ( 1 L( ■tiG‘t �- I- 4- F �f,,.:� h� .s ��� tfA 11-1 m 4ec. fyC C/G fie s kV f- "c pre_ e f-c.z fke Page 3 of 4 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report June 3. 2013 Official Score Report: Candidate Information: Name—Terry Curtis Candidate#: 12680120C Testing Site: Ocala,FL Final Score Result: Class "B"Air Conditioning Score: 37% (First Attempt) Class`B"Air Conditioning Score: 75% These results represent the grade that has been achieved on the Class `B" Air Conditioning examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on June 3, 2013. If you have any further questions,please do not hesitate to contact us. Sincerely, Jay E.Bowermeister President PO Box 831127 Ocala,Florida 34483-1127—Voice(352)369-GITS –Fax(352)387-2443 800 997 2129 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. /@l2 ()r+ APPLICANT(PLEASE PRINT) 4/74- 10/,/,,,A;,), NAME OF COMPANY Y '7;1'2 Z711 SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF CO II/of The foregoing instrument as acknowledged before me this /��C4/G(\ / 3/ 20/4 (Date) By T?J;rLJ CiJ,(+ls who has produced FL > Ce►'ice (Name of bierson acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL '� N ADAM LYSIAK /- 1 _2* Notary Public-State of Florida (SIGNAT TARY) .; '!1; My Comm. Expires Jul 6,2015 ,a,'"o 4:� Commission#EE 109558 ,"'F;'',,'''c Bonded Through National Notary Assn. Page 4 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 BUSINESS N 3 %2/iy DATE BEFORE ME this day personally appeared e('(' ' C/r 1 I$ who affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any ;ime he employees one or more persons he must obtain said Workmen's Compensation Insurance. ;TATEOF FLORIDA ;OUNTY OF he foregoing instrument was acknowledged before me this 16U'A 13 2014/ (Date) y !err r1vi / CfJr+13 who has produced Ft- Ter LICeviSC, (name of person acknowledging) (Type of identification) s identification and who did not take an oath. `•,,,1Y P, ADAM LYSIAK �- `;`c,: Notary Public-State of Florida • • My Comm.Expires Jul 6,2015 SIGNA I`�TOTARY 9 - „* ��,o Commission#EE 109558 �O , Bonded Through National Notary Assn. (� NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC • .o. 4 _ . — ( a Program EPA Approved December 28,. 199 3 e6.-:-RTIFICATT NO. •666864149.230 EPA Certified T _�. , : TERRY L. CURTIS • • has been certified as a TYPE. I . . _, . _- TYPE III r - ,. .. .. R Y technician� n as required bT-4OCpa t lig■IlliiimormilimillY 1 • , „,I • • ., _ , , CERTIFICATION INFORMATION C27025 Certification Information •',. Collier County Board of County Commissioners Date: September 03, 2013 DBA: AAA Eagle Plumbing. Inc. , ._. ADDRESS: 1495 Saint Claire Shores Rd .., NAPLES, FL 34104 4---., I PHONE. 239-465-8167 1 CELL: 239-465-8167 _ FAX: ',J• . , . LICENSEE NBR: C27025 QUALIFIER: TERRY L.CURTIS TYPE PLUMBING CONTR.-REGISTERED CLASS ' V. V ' STATE NBR:RF 11067244 ISSUANCE NBR: 27025 STATE EXPIRATION: INSURANCE: ORIG ISSD: 5.7= -;, March 09,2005 :=7,-,;.._.„-„, .'-,,', August 31,2015 General Liability ,. March 19,2014 , Worker's Comp Exemption I September 12,2014 1 Ik. NOTE: It is the Qualifier's responsibility to keep all business,licensing and requirements current and to provide up to date copies for Collier county files. This includes all insurance certificates and any change of address information. . - 1 ; Collier County * City of Marco * City of Naples Cart Nbr: Contractor Licensing PLUMBING CONTR.-REGISTERED County Exp: Status: . 7025 September 30, 2014 Active State Nor: State Exp: '.. -.. U August 31, 2015 — , -- "E::12ellumbing, Inc. '..- 1 •4 STATE OF FLORIDA ,'" DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION '# CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET �O R E Tom! TALLAHASSEE FL 32399-0783 CURTIS, TERRY LYNN AAA EAGLE PLUMBING INC 1495 SAINT CLAIRS SHORES RD NAPLES FL 34104 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and a� 4 STATE OF FLORIDA Professional Regulation. Our professionals and businesses range DEPARTMENT OF BUSINESS AND from architects to yacht brokers,from boxers to barbeque restaurants, ` PROFESSIONAL REGULATION and they keep Florida's economy strong. R F 11067244 ISSUED: 08/26/2013 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto REGISTERED PLUMBING CONTRACTOR www.myfloridalicense.com. There you can find more information CURTIS,TERRY LYNN about our divisions and the regulations that impact you, subscribe AAA EAGLE PLUMBING INC to department newsletters and learn more about the Department's (INDIVIDUAL MUST MEET ALL LOCAL initiatives. LICENSING REQUIREMENTS PRIOR Our mission at the Department is: License Efficiently, Regulate Fairly. TO CONTRACTING IN ANY AREA) We constantly strive to serve you better so that you can serve your HAS REGISTERED under the provisions of Ch.489 FS. customers. Thank you for doing business in Florida, Expiration date AUG 31 2015 L1306260000734 and congratulations on your new license! The Department of State is leading the commemoration of Florida's 500th anniversary in 2013. For more information, please go to www.VivaFlorida.org. DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION D 1, D CONSTRUCTION INDUSTRY LICENSING BOARD ti LICENSE NUMBER 1 1 . RF11067244 •;L - - . The PLUMBING CONTRACTOR + t o• Named below HAS REGISTERED 0 ` Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2015 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) CURTIS, TERRY LYNN 1 AAA EAGLE PLUMBING INC 1495 SAINT CLAIRS SHORES RD NAPLES FL 34104 RICK SCOTT ISSUED: 08/26/2013 SEQ# L1308260000734 KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY ' ' AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I. &elv Li( 8,c (_ , am a resident of r ��i c�i+- County, F� 'C7 1 X14 (State) and have resided here for more than five (5) years. During the last five years I have known -7—€/I/1-mot C,",t{'; 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. ( _ \. `) i ' it (Signature) , (� { ( 1.'` ���%:. �th C (Name) Gam- i/ 017 6 '(A (Address) NO b /1-16"/06, (t_(', poPsc,c CJ , 1- / C), (,;,q1,55- k,C(/J 5 Telephone)Q ( /,8 Z— 6,57---i STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this Q1-'3115/14 by 1\ (Date) el.Q 1 11 I 1 be LL- who has produced IV1D D� (name of parson acknowledging) (Type of identification) as identification and who did not take an oath. `) 4 / c.</t t t 4 —k:-', .17:0T)" n SIGNATURE OF NOTARY ,Cal'al L JJ NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT OF t" INTEGRITY AND GOOD CHARACTER I. VQ.S c 2ck Cf) )2 r/'-e LTE-os , am a resident of (_o//,e ti- County, RoPzrda (State) and have resided here for more than five (5) years. During the last five years I have known /ta.e c y ec)rL�is (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) ��s;r a (pc,,,r r r`c/1 ) (Address) jO J i IS(3r1 P)I Vcp- -3ciC( Telephone) 2 59 — S 3 —373 STATE OF FLORIDA COUNTY OF CS The foregoing instrument was acknowledged before me this 3 I d b A by ate) Jai QIENI,TO who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath. ill all. A 1/4., 1.11=1. ,..* SIG ATURE OF N•TARY ��'I MARiE/PIERRE „,i' Notary Public;State of Florida 1 (2 )t "Pet-\44- ---. Commissiod I EE 863871 +� .r M *CA4eviegl7 (PRINT NAME OF NOTARY) NOTARY PUBLIC RESOLUTION OF AUTHORIZATON WHEREAS Ag77 £ z b;i+-, XWc proposes to (Name of B iness E tity) / engage in contracting as /4,14 & ,c �/, �j;�} -7--c. in (Type of legal entity: cdrp.,partnership,etc. Collier County,Florida,according to Collier County Ordinance 2006-46,as amended;and WHEREAS /9/(91-q -= �1�. t x17 w`'proposes to (Name of Business Entity) qualify for a Certificate of Competency with 7 i (Nathe of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned P of (Officers,Owners, Partners) &R Ft �f ',-A/- hereby resolve and represent to the Collier County (Name of sines Entity) / Contractors'Licensing Board that the qualifying agent, -7—e..4.1.1-1 (124 -( , is active (Name bf Individual) in all matters connected with the contracting business of ,and (Name of Business Entity) / We further resolve and represent that -7? C j rid, ; is (Names of Individual) legally empowered to act for A W f-�� cd/ur4; in all matters connected with its (Name of Business Entity)/ contracting business,and has the authority to supervise construction undertaken by (Name of Business Entity) DULY PASSED AND ADOPTED THIS day of (Officers,Partners,Owners-with Designation underneath) Witness Witness Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this day of , by Notary Public Name Printed Notary Public Signature Commission Number My Commission expires: COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples,Florida 34104 • 239-403-2400 • FAX 239-4-03-2334 MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number (SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statues. x 04*4,1ik, ./fit ��/ :04r001 / � Volk: 0*��V111 01 �7/� 0 Ilk,"0►. '� _. • �► ter, I" ..f �� NI Orb + !:141P1 -4 4- - 444*fa .1Z 4 * O. ti, 4 * 0. 14 4 * ort: 'NA *'10. be .4* 0 bkiils Al OA-.at 4. t.r:4, A tier 0 14 -ti AI r o�r4v* Q o ' o d 41440 dal V .,=„'.N 40Z, i-T-i t a) - 4-9 •4010- , {il 4-4 N i ill Q Q Ay m� V ink o> i # o c,„ x .� •�, ta «' o 0 0 +, g A MCI ar 4 t*.W. i ! g' .3j .1 6 ,ft1 < -`,:3 E c,)) „F V•A 407 0"‘Of Ow ,-c-1 a 4V, l' cd rizJ „, •,-, cid �i 04 C � � , o 0 2, `° OA A 4 ill6;1 S CC 0 tiA a) r 7k♦ rA O g 0 o 1'4 V0 It V— U X101 1Pr ArtAtit C) g ' <i) u (1) 11) OA U 4 �r`4� to la deb*1,��; H H 0 M-1 g Olk t,lif Alayrdizziblug(r.I.Tzom ypr T 71711"7-4 4._ ti, 0 .4 4 1::( tLiii 4 * 11-41k. w 044 i to AI I.14.4t1 24.)is..14.10a+20)101•14001 +-■Rmix•Iiiilta4plioqiiiiit,;e 4610)...; t& 40 ' a 1'`•0.: *00440, ��ir 4•4 Sy r i4 4' #?e 40 STATEMENT OF OWNERSHIP This certifies that I, 2iL(LU A �°,) ,i-t� am a member or (APPLICANTS NAME) Managing member of A-A 1-1- �1��// �� rp Li;- b:�''`) (LIMITED LIABILITYOMPANYNAME) I own /00 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. (PRINT NAME) ✓� (APPLICANT'S SIGNATIIRR) 3/0,7/57 A r USA Credit Bureau Credit Reporting & Collections 8546 W Homosassa Trl Ste 4, Homosassa FL 34448 Phone 352-628-2580 • 888-474-2270 • Fax 866-588-3604 CONTRACTOR CREDIT REPORT MARCH 13, 2Q14 BUSINESS CREDIT REPORT AAA EAGLE PLUMBING, INC. FED TAX ID#: 20-2455286 FILED: 3-7-2005 1495 SAINT CLAIR SHORES RD, NAPLES FL 34104 CORPORATE OFFICERS OFFICE SSN TERRY CURTIS PS FINANCIAL RECORDS CREDITOR/BANK TYPE OF HIGH RET PAST ACCOUNT NUMBER ACCOUNT OPENED BALANCE LIMIT CHECKS DUE NOT APPLICABLE BANKRUPTCY/JUDGMENT/LIEN SEARCH PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS ANY RECORDS FOUND MATCH ONE OF THE ELEMENTS SEARCHED AND MAY OR MAY NOT PERTAIN TO THIS SITUATION: LIEN & JUDGMENT RECORD DEBTOR - AAA EAGLE PLUMBING INC ADDRESS - 1495 SAINT CLAIR SHORES RD, NAPLES FL 34104-3854 SSN/FEIN - 202455286 CREDITOR - OGDEN DIRECTORIES INC FILINGS: NUMBER - 13SC000067 LOCATION - COLLIER COUNTY CIRCUIT COURT, FL TYPE - SMALL CLAIMS JUDGMENT ORIGINAL FILING DATE - 7/12/2013 AMOUNT - $1,860 BOOK/PAGE - 4944/182 USA CREDIT BUREAU • • • PAGE 1 OF BUSINESS CREDIT REPORT ELEMENTS SEARCHED: AAA EAGLE PLUMBING, INC. FED TAX ID#: 20-2455286 1495 SAINT CLAIR SHORES RD, NAPLES FL 34104 IN THE PREPERATION OF THE CONTRACTOR LICENSE REPORT, USA CREDIT BUREAU HAS USED CREDIT AND PUBLIC RECORD INFORMATION FROM ONE OR MORE OF THE NATIONALLY RECOGNIZED CREDIT AND PUBLIC RECORD INFORMATION REPOSITORIES. EACH OF THESE REPOSITORIES CERTIFIES THAT PUBLIC RECORD INFORMATION IS SYSTEMATICALLY COLLECTED AND ENTERED INTO THEIR DATA BASES. USA CREDIT BUREAU • • • PAGE 2 OF BUSINESS CREDIT REPORT • T. (ISA CrQ Bureau Credit Reporting S Collections 8546 W Homosassa Trl Ste 4, Homosassa FL 34448 Phone 352-628-2580 • 888-4742270 • Fax 866-588-3604 MARCH 13, 2014 PERSONAL CREDIT REPORT(COMPILED FROM NATIONAL RECORDS) [SUBJECT] [SSN1 [BIRTH DATE] CURTIS, TERRANCE L. - [ALSO KNOWN AS] CURTIS,TERRY,L [CURRENT ADDRESS] [DATE RPTD] 560 S. WILSON BV. , NAPLES FL. 34117 9/08 [FORMER ADDRESS] 111 OAKLAND HILLS DR., NAPLES FL. 34113 4/07 4830 TAHITI LN. , NAPLES FL. 34112 [POSITION] [CURRENT EMPLOYER AND ADDRESS] [RPTD] AAA EAGLE PLUMBING OWENERPLUMBER 9/06 [FORMER EMPLOYER AND ADDRESS] PLUMBING CONT OWNER 6/06 S P E C I A L M E S S AGE S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES)*** M O D E L P R O F I L E ***FICO CLASSIC 04 SCORE +567 : 038, 020, 016, 018 *** 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=1 COL=7 NEG=8 HSTNEG=2-23 TRD=24 RVL=10 INST=11 MTG=3 OPN=0 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE CLOSED W/BAL: $41.8K $17.2K $335 TOTALS: $ $ $41.8K $17.2K $335 P U B L I C R E C O R D S SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064186 10/10R $7850 I CI 100593CC CIVIL JUDGMENT SUNCOAST SCHOOLS FEDER C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 10/08 $4465 CITIBANK USA N A 09B 2/14A $6999 PLACED FOR COLLECTIO LVNV FUNDING Y 21T9002 I 9/11 $2809 12 WASHINGTON MUTU 09B 2/14A $3154 PLACED FOR COLLECTIO CREDIT COLL Y 1GZD001 I 10/13 $394 08 SUNTRUST BANK 09B USA CREDIT BUREAU • • • PAGE 1 OF PERSONAL CREDIT REPORT 8238307 2/14A $394 PLACED FOR COLLECTIO PORTFOLIO RC Y 1KSE003 I 11/10 $9605 NISSAN MOTOR ACCEP O9B 2/14A $9605 PLACED FOR COLLECTIO EOS CCA Y 49XV008 I 8/12 $219 10 AT T MOBILITY O9B 1/14A $345 PLACED FOR COLLECTIO CBE GROUP Y 1AHA004 I 10/13 $484 01 DIRECTV O9B 12/13A $484 PLACED FOR COLLECTIO EXPLORER Y 28LR001 I 2/09 5/09F $1003 06 EXPLORER INSURA O9B 5/09A $163 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/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 NMAC Q 507T078 4/07 $26.5K 72X I09 3/14A $9605 P AUTOMOBILE 8/07F $9605 UNPAID BLNC CHRGD OFF GMAC Q 2592669 5/06 I09 11/08A $0 C AUTOMOBILE 11/08F $7564 UNPAID BLNC CHRGD OFF GMAC Q 2592669 5/06 I09 11/08A $0 C AUTOMOBILE 11/08F $5228 UNPAID BLNC CHRGD OFF CHASE B 701N134 3/07 $2809 R09 7/08A $2500 $0 I CREDIT CARD 2/08F $0 PURCH BY OTHER LENDER SUNCST CU Q 298Q007 4/07 $7855 R09 1/08A $7500 $7692 I CREDIT CARD 9/07F $7850 TRANSFERD TO RECOVERY SUNCOAST CU Q 298Q001 12/06 $17.3K 60M335 I08 2/14A $0 I AUTOMOBILE 12/07F $11.6K REPOSSESSION CHASE B 1ULY006 4/07 $365K 480M2553 4/08 555XX5555432 M05 1/09A $0 $10.2 05 111111111 I CONVENTIONAL REAL 1/09C $0 FORECLOSURE,CLTRL SLD 21 1/ 1/ 8 WFHM B 72RP001 2/06 $325K 360M1846 2/08 555555555543 M05 12/08A $0 $7384 05 211111111111 C CONVENTIONAL REAL 12/08C $0 FORECLOSURE,CLTRL SLD 34 1/ 1/11 GECRB/JCP D 235058D 4/03 $257 111111111111 R01 2/14A $200 $0 111111111111 I CHARGE ACCOUNT 2/08C $0 CLOSED 48 0/ 0/ 0 GECRB/DILLAR D 235061C 11/03 $374 111111111111 R01 2/14A $0 111111111111 I CHARGE ACCOUNT 6/04C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 GECRB/LOW L 235041J 4/07 $140 8/07 111111111111 RO1 2/14A $100 $0 $47 03 111111111111 I CHARGE ACCOUNT 8/07C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 USA CREDIT BUREAU • • • PAGE 2 OF PERSONAL CREDIT REPORT T. • SEARS/CBNA D 6256443 8/04 $114 111111111111 RO1 2/13A $250 $0 111111111111 A CHARGE ACCOUNT 10/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 VW CREDIT F 2943003 9/06 $507 72M 111111111111 I01 2/08A $0 1X1 I AUTOMOBILE 2/08C $0 CLOSED 15 0/ 0/ 0 SUNTRUST BK B 423A022 6/06 $30.6K 72M578 111111 I01 12/06A $0 S BUSINESS 12/06C $0 CLOSED 6 0/ 0/ 0 FRD MOTOR CR F 3796761 2/05 $15.1K 63M362 111 I01 10/06A $0 C AUTOMOBILE 10/06C $0 CLOSED 3 0/ 0/ 0 HSBC BANK B 2DQ1004 8/03 $892 111111111111 R01 8/06A $800 $0 111111111111 I CREDIT CARD 8/06C $0 CLOSED 35 0/ 0/ 0 NISSN INF LT Q 507T085 12/04 $14.6K 39M375 XXXXIXXXIXXI I01 7/06A $0 X11111 C LEASE 7/06C $0 CLOSED 18 0/ 0/ 0 GMAC Q 2592669 11/05 $24.5K 60M510 11111 I01 5/06A $0 C AUTOMOBILE 5/06C $0 CLOSED 5 0/ 0/ 0 WFHM B 82TE004 3/03 $163K 360M1449 111111111111 MO1 3/06A $0 111111111111 C FHA REAL ESTATE M 3/06C $0 CLOSED 31 0/ 0/ 0 CAP ONE B 1DTV001 11/03 $346 111111111111 RO1 8/05A $0 111111111 I CREDIT CARD 8/05C $0 ACCT CLSD BY CONSUMER 21 0/ 0/ 0 FST PREMIER B 41PF016 4/03 $293 111111111111 RO1 12/04A $300 $0 1111111 I CREDIT CARD 6/04C $0 ACCT CLSD BY CONSUMER 19 0/ 0/ 0 SUNCOAST CU Q 298Q001 4/04 $20.5K 72M347 111 I01 8/04A $0 I AUTOMOBILE 8/04C $0 CLOSED 3 0/ 0/ 0 CAP ONE B 1DTV001 9/03 $255 11111111111 RO1 8/04A $0 I CREDIT CARD 8/04C $0 ACCT CLSD BY CONSUMER 11 0/ 0/ 0 WFDS/WDS F 839N077 9/03 $15.OK 60M334 1111111 I01 5/04C $0 CLOSED 7 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 3/13/14 ZNF1034779(FLA) STATEOFFLORI BANKRUPTCYIJUDGMENT/LIEN SEARCH PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS USA CREDIT BUREAU • • • PAGE 3 OF PERSONAL CREDIT REPORT .� ANY RECORDS FOUND MATCH ONE OF THE ELEMENTS SEARCHED AND MAY OR MAY NOT PERTAIN TO THIS SITUATION: LIEN & JUDGMENT RECORD DEBTOR - TERRY CURTIS ADDRESS - 4830 TAHITI LN, NAPLES FL 34112-3705 SSN/FEIN - LEXID - 556714771 CREDITOR - EDUCATIONAL PURSUITS INC FILINGS: NUMBER - 07216SC LOCATION - COLLIER COUNTY CIRCUIT COURT, FL TYPE - SMALL CLAIMS JUDGMENT ORIGINAL FILING DATE - 3/6/2007 AMOUNT - $3,920 BOOK/PAGE - 4198/1517 t********************************************************************************** DEBTOR - TERRY CURTIS ADDRESS - 560 WILSON BLVD S, NAPLES FL 34117-9361 SSN/FEIN - 403-21-9444 LEXID - 556714771 CREDITOR - SUNCOAST SCHOOLS FEDERAL CREDIT FILINGS: NUMBER - LOCATION - COLLIER COUNTY CIRCUIT COURT, FL TYPE - CIVIL JUDGMENT ORIGINAL FILING DATE - 10/21/2010 AMOUNT - $7,850 BOOK/PAGE - 4617/1681 ELEMENTS SEARCHED: TERRY CURTIS 1495 SAINT CLAIR SHORES RD, NAPLES FL 34104 SSN: IN THE PREPERATION OF THE CONTRACTOR LICENSE REPORT, USA CREDIT BUREAU HAS USED CREDIT AND PUBLIC RECORD INFORMATION FROM ONE OR MORE OF THE NATIONALLY RECOGNIZED CREDIT AND PUBLIC RECORD INFORMATION REPOSITORIES. EACH OF THESE REPOSITORIES CERTIFIES THAT PUBLIC RECORD INFORMATION IS SYSTEMATICALLY COLLECTED AND ENTERED INTO THEIR DATA BASES. USA CREDIT BUREAU • • • PAGE 4 OF PERSONAL CREDIT REPORT Detail by Entity Name 3/12/14 12:45 PM h • • FLORIDA DEPARTMENT OF STATE DIVISIO` OF CORPORATIONS <r� Detail by Entity Name Florida Profit Corporation AAA EAGLE PLUMBING, INC. Filing Information Document Number P05000034839 FEI/EIN Number 202455286 Date Filed 03/07/2005 State FL Status ACTIVE Effective Date 03/02/2005 Last Event CANCEL ADM DISS/REV Event Date Filed 04/05/2010 Event Effective Date NONE Principal Address 1495 saint Clair shores rd NAPLES, FL 34104 Changed: 02/05/2014 Mailing Address 1495 saint clair shores rd NAPLES, FL 34104 Changed: 01/28/2013 Registered Agent Name & Address TERRY, CURTIS 1495 saintclair shores rd NAPLES, FL 34104 Address Changed: 01/28/2013 http://search.sunbiz.org/Inquiry/Corporation5earch/5earchResultDet...-d7564042-dca5-48fa-9009-e7557f14c13f/aaa%20eagle%20plumbing/Pagel Page 1 of 3 Detail by Entity Name 3/12/14 12:45 PM Officer/Director Detail Name & Address Title PS CURTIS, TERRY 560 WILSON BLVD SOUTH NAPLES, FL 34117 Annual Reports Report Year Filed Date 2012 02/16/2012 2013 01/28/2013 2014 02/05/2014 Document Images View image in PDF 02/05/2014 -- ANNUAL REPORT format 10/17/2013 -- Off/Dir Resignation View image in PDF format 01/28/2013 -- ANNUAL REPORT View image in PDF format 02/16/2012 -- ANNUAL REPORT View image in PDF format 12/03/2011 -- ANNUAL REPORT View image in PDF format 09/07/2011 -- ANNUAL REPORT View image in PDF format 07/20/2011 -- ANNUAL REPORT View image in PDF format 04/05/2010 -- REINSTATEMENT View image in PDF format 12/06/2008 -- REINSTATEMENT http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDet...-d7564042-dca5-48fa-9009-e7557f14c13f/aaa%20eagle%20plumbing/Pagel Page 2 of 3 Detail by Entity Name 3/12/14 12:45 PM • r VicAm imari(a in Pf1F 05/04/2007 -- ANNUAL REPORT View image in PDF format 12/19/2006 -- Amendment View image in PDF format 07/20/2006 -- ANNUAL REPORT View image in PDF format -- ANNUAL REPORT View image in PDF 07/10/2006 format Profit View image in PDF -- 03/07/2005 Domestic format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResuitDet...-d7564042-dca5-48fa-9009-e7557f14c13f/aaa9620eagle%20plumbing/Pagel Page 3 of 3 OP ID:SM ALC-C7FECO. CERTIFICATE OF LIABILITY INSURANCE °"`13/214 `� 02/13/2014 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 1 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 WANED,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). CONTACT PRODUCER NAME: Insurance Agency PHONE I FAX NO 236 Pine Ridge Road �o'Eae: Naples,FL 34109 ADDRESS: Sara Mason CUSTOMER ID A: AAAEA-1 INSURERS)AFFORDING COVERAGE NAIC I INSURED AAA Eagle Plumbing,Inc. INSURER A:SLB Insurance Group 1495 St Claire Shores Rd PISURER e: Naples,FL 34104 INSURER c INSURER D: ICE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1WITHSTANOING 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. vvisreR POLICY EIJI TYPE OF INSURANCE N W VD POLICY NUMBER POLICY IMMIDDIYYYY1 LAWS GENERAL UARLITY EACH OCCURRENCE _$ 1,000,000 A X CCMME NCIAL GENERAL LIABILITY CL1039433 0211212014 02/1212015 DAMAGE TO RtEa ENTED ► $ 100,000 PaeNUSES LAASIS.,MADE n OCCUR MED EXP(My one pennon) $ 6,000 PERSONAL.aADV INJURY $ 1,000.E GENERAL AGGREI3ATE $ 2,000,000 GEM AGGREGATE APPLIES PER: PRODUCTS-COMP/OP AGC $ 2,00000.000 ,--1 POLICY n n Loc COMBINED AUTOMOBILE LIABILITY � �(E,accident) $ — ANY AUTO BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS —� PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ $ IMIBRLA LAB OCCUR EACH OCCURRENCE S EXCESS LLIB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ – $ $ WORKERS COMPENSATION I T C Ti.al I E AND EMPLOYERS*UAINLRY YIN ANY EXCLUDED? n NIA EL EACH ACCIDENT $ arsess EL DISEASE-EA EMPLOYEE $ IDESCRP)ON OF OPERATIONS below EL DISEASE-POLICY MET $ DESCIEPTION OF OPERATIONS/LOCATIONS/VEHICLES(Mach ACORD 101,AdNBonel Ruche Sd s de,N mom space Is required) CERTIFICATE HOLDER CANCELLATION . COW-2 SHOULD ANY OF THE ABOVE DESCRIBED POIJCES BE CANCELLED BEFORE THE EXPIRATION THEREOF, NOTICE Collier County Contractors ACCORDANCE WITH DATE POLICY PROVISIONS. WILL BE DELIVERED IN Licensing Board 2800 N.Horseshoe Drive AUTHORED REPRESENTATIVE Naples,FL 34104 Sara Ma- . , I -.,. 2009 ACORD CORPORATION. All Lights reserved. ACORD 25(2009109) The ACORD name and logo are regi Bred marks of ACORD • � •JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 9/12/2012 EXPIRATION DATE: 9/12/2014 PERSON: CURTIS TERRY FEIN: 202455286 BUSINESS NAME AND ADDRESS: AAA EAGLE PLUMBING INC 560 WILSON BLVD S NAPLES FL 34117 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 • ■•• • COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: 110193 COLLIER COUNTY TAX COLLECTOR-2800 N.HORSESHOE DRIVE-NAPLES FLORIDA 34104-(239)252-2477 VISIT OUR WEBSITE AT:www.colliertax.com THIS RECEIPT EXPIRES SEPTEMBER 30, 2014 DISPLAY AT PLACE OF BUSINESS FOR PUBUC INSPECTION LOCATION:560 WILSON BLVD S FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. ZONED: HOME OCCUPATION LEGAL FORM - THIS TAX IS NON-REFUNDABLE - CORPORATION BUSINESS PHONE: 465-8167 AM EAGLE PLUMBING,INC CURTIS,TERRY 1495 SAINT CLAIRES SHORES RD { NAPLES FL 34104-0000 ( - i { NUMBER OF EMPLOYEES: OWNER ONLY-NO EMPLOYEES - CLASSIFICATION:MAINT.SERVICE/NO CONTRACTOR WORK DATE 09/03/2013 AMOUNT 10.00 CLASSIFICATION CODE: 03703306 NO FERTILIZING RECEIPT 4113.42 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 any other taxes or permits that may be required by law. ( COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: 042867 COLLIER COUNTY TAX COLLECTOR-2800 N.HORSESHOE DRIVE-NAPLES FLORIDA 34104-(239)252-2477 VISIT OUR WEBSITE AT:www.colliertax.com THIS RECEIPT EXPIRES SEPTEMBER 30, 2014 DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION LOCATION:560 WILSON BLVD S , FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. ZONED: HOME OCCUPATION LEGAL FORM - THIS TAX IS NON-REFUNDABLE - BUSINESS PHONE: 465-8167 CORPORATION MA EAGLE PLUMBING,INC COUNTY LIC: 27025 CURTIS,TERRY 1495 SAINT CLAIRES SHORES RD NAPLES FL 34104-0000 { i I NUMBER OF EMPLOYEES: 1-10 EMPLOYEES CLASSIFICATION:PLUMBING CONTRACTOR DATE 09/03/2013 CLASSIFICATION CODE: 02101701 AMOUNT 18.00 This document is a business tax only.This is not certification that licensee is qualified. RECEIPT 4112.42 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 any other taxes or permits that may be required by law. j _ � u N," # ta , ..' ', r},.It '„- �� '."'.:.:;.,,,,t',7.,' 1111 .1 � J 3se r . 1-' d 'gyp � S rS � � � � -: S 341 „ .� . sue...: : .•sowoc, u .w e r ._ ,..,.."4(e' 3p �atecan #a vehicle' Hies consent to any Say test i sd by taw. • a• • s Co ler County 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 employees 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 3//o/// ZONING CERTIFICATE#TC- APPLICANT'S NAME /e,2/1.1 ecia-f S PHONE: (423 0 �((cS--� j 67-7 APPLICANT'S HOME ADDRESS //9S- ;„�f C-7ai.. Stir,tet 72cq TYPE OF BUSINESS TO BE CONDUCTED /9 h/ilikni }- BUSINESS NAME(IF ANY) n11-17 f //.t �vrn(J•,�•� ? •t 1, the undersigned, hereby affirm that I am the legal owner of the property at the above address or that/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 "Hume.Occupations"(see back of application). APPLICANT SIGNATURE DATE �a %�! x _ / FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" usimmummil 4 TO BE COMPLETED BY COUNTY STAFF ZONING: PROPERTY ID# DATE REVIEWED BY APPROVED HOLD DENIED COMMENTS/RESTRICTIONS: Must comply with Section 5.02.00 of the LDC ('see back of application). lax Collector Staff: Please forward a copy of issued certificate and receipt to Collier County Zoning Department. • COLLIER COUNTY BUSINESS TAX RECEIPT "` APPLICATION y 1. ee,-1 2800 N.Horseshoe Drive,Naples,FL 34104 Make Check Payable to: Collier County Tax Collector Phone: 239-252-2477 Fax: 239-643-4788 Website:ww.colliertax.com 'SD. tQUs` w CHECKLIST 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 staurants(850-487-1395)or Department of Agriculture. regarding tangible tax. o(iu-435-7352) CHECK ONE: Date: Original Application Classification Transfer of License # Code Number - - Renewal of License# License Amount 1) CORPORATE NAME - t=1 ►a f��/� ��lv:��j%.�-� Zr' �- la) DBA NAME - ib) BUSINESS OWNER OR QUALIFIER'S NAME - e Aft_ ('La--E1s 2) PHYSICAL ADDRESS - (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - X Yes No 3) BUSINESS MAILING ADDRESS- % ct;`r t Skerce i Ne ptei # /3.I/o/ Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - /5"95- 54.`• h" c/uAe• 449 5) TELEPHONE-Business: g--,132) s-a/ '7 Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership n 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. - - � - SEJ IS—c2 C7 p((7 *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: 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- jZF ((0 6, 17 14(1, 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 TRU TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: DATE00Af (Owner and/or representative of business)TITLE: 45 ****THIS LICENSE IS NON-REFU DABLE FOR BUSINESS STATED ABOVE**** SECTION A, B,AND C FOR OFFICE USE ONLY THIS SECTION TO BE FILLED OUT BY CONTRACTORS/BCC LICENSING BOARD SECTION A Classification of Contractor: County Certification Number: Department Supervisor Date: THIS SECTION TO BE COMPLETED BY PLANNING SERVICES SECTION B Business is an in-home occupation and the applicant has agreed to adhere to the requirements as set forth in the Collier County Zoning Ordinance. PROPERTY Business DOES COMPLY with the Collier County Zoning Ordinance. ZONED Signed: Title: Date: Comments: THIS SECTION TO BE COMPLETED BY THE HEALTH DEPARTMENT SECTION C Business DOES COMPLY with the local and/or State requirements. Signed: Title: Date: * In accordance with Florida Statute 205.0535(5),we require you to provide us with either a Federal Employer Identification Number (FEIN) or a Social Security number. MAR/18/2014/TUE 11 ', 35 AM Alpha Accounting FAX No, 877 353 4719 P. 002 6 4'••:•212(114 httpsJ/www.oltpro.com2012/oltproc/show w2s.php7o9LOFE23EA017-7AF3-4306-9E23-22008721312A'18DAF133C3-C45A-4823-AE313-1E06B9893523&qt... Wage and Tax Statement W2 :#1 a.Control Number b.Employer Identification number 1.Wages,tips other compensation 2.Federal income tax withheld 650406161 $16434 $0 c.Employer's name,address,and ZIP 3.Social security wages 4.Social security tax code withheld $16433.57 $690.21 5.Medicare wages and tips 6.Medicare tax withheld JACKSON TOTAL SRVICE INC -- P O BOX 9589 $16433.57 $238.29 NAPLES , FL,34101 - 7.Social security tips 8.Allocated tips $0 $0 d.Employees social security number 9.Advance EIC payments 10.Dependent care benefits ) $ $0 -- e.-E nployee's first name and •• Lasf - initial name 11•Nonquallfled plans I2a.Code&Amount TERRY CURTIS $0 $0 Statutory Retirement Third- Employee's address and ZIP code party 12b.Code&Amount employee employee sick pay No No No $0 14.Other 12G.Code&Amount TERRY CURTIS, 1495 SAINT CLAIRS RD a. 0 $0 NAPLES,FL ,34104 b 0 - 12d.Code&Amount G. p d. 0 $0 Errs ployer's State wages,tips Local wages,tips Locality State state ID etc., State income tax etc., Local income tax name number ' $0 $0 $0 $0 L -- $0 $0 $0 $0 $0 $0 $0 $0 E---7] ______.. .____.__._ L11--- SO s SO SO $0 hops_//wwoltpro_conf2012/oltproclshow vas.php7o9Liv E23EA017-7AF3.4306-9E23-220 0 872 8 1 2&18DAEFB313-C45A-4323-AE3B-1EOfiB9893523&qt con__ 1/1 ,ievo RAZ Construction LLC PO BOX 2186, FORT MYERS FL 33902/PH: 239-337-0003—FX: 239-334-1374 EMAIL: razconstrucitonl @aol.com February 24, 2014 Contractors Licensing Board Community Development & Environmental Services 2800 North Horseshoe Drive Naples, FL 34104 Board Members, I request that I be allowed to qualify a second entity in Collier County. I wish to maintain my present license (11923 A-Z Masonry Inc) to complete the work already contracted by that company. I feel over the years I may have missed out on work based on the name of my current company and it being assumed that I do only masonry work. If my application is approved, I will contract all new work under my new company, RAZ Construction LLC. Once A - Z Masonry Inc. has fulfilled all its contractual obligations I will most likely request that company be made dormant while I consider my options and decide how I should proceed. Thank you for your consideration, Robert A. Zielinski Owner/Manager A - Z MASONRY, INC. PO BOX 1109, FORT MYERS FL 33902 PH: 239-337-5000 / FX: 239-334-1374 EMAIL: AZMAS1601 @AOL.COM February 24, 2014 I, Robert A. Zielinski, Qualifier and Authorized Agent for A - Z Masonry, Inc. do hereby attest to the fact that I am aware that I, Robert A. Zielinski, Authorized Agent for RAZ Construction LLC has applied to also Qualify RAZ Construction LLC in Collier County. Signature: Robert . Zielinski State of Florida County of Lee t� Sworn to ands bscribe before me this d• e a. , 20 j Z1fL who is e-rson• •e n to me or who has provided as identification. f pNDA L B °�r,,� — Oes2°4F�;c9 % Notary Public, State of Florida •� Q G • j • • stn • •� •*� •1 111° 4• ,?B0Odic e d thN 4 Unde"' O Z. /• o 4 cT C. /,!T RAZ Construction LLC PO BOX 2186, FORT MYERS FL 33902/PH: 239-337-0003 EMAIL: RAZConstructionl @aol.com February 24, 2014 I, Robert A. Zielinski, Authorized Agent for RAZ Construction LLC has applied to Qualify RAZ Construction LLC in Collier County and do hereby attest to the fact that I am aware that I, Robert A. Zielinski, Authorized Agent for A - Z Masonry Inc. also Qualifies A-Z Masonry Inc. in Collier County. Ignature: Rob A. Zielinski State of Florida County of Lee Sworn to and subscribed before me this da • - V 0(1'oP , 20N by c� - Qf-\-- ,Zi��l n� ,t who is .-rsonally k • to me who has provided as i.enfification. �\1��111iH1lJll/��j� (pDA L.80 rrjr Q�.••............•.<4;3) • •109x1 i2r?o-�A Notary Public, State of Florida * • N • • �•� :*2 • #EE 211653 i� N �Q� . X9 •,; B .'Q 9 :y; ec d Utlinco •. ORIGINAL ( i191i? I' o BUILDING REVIEW AND PERMITTING CONTRACTOR LICENSING SECTION COLLIER COUNTY/CITY OF NAPLES /CITY OF MARCO ISLAND Contractors Licensing Board ATTACH(TAPE ON ALL SIDES)A Community Development&Environmental Services Division RECENT PHOTO OF QUALIFIER. 2800 North Horseshoe Drive PHOTO MUST BE FULL-FACED, Naples, Florida 34104 VIEW APPROX.2"x 2",A CLEAR Telephone: (941)403-2431 AND RECOGNIZABLE LIKENESS. Facsimile: (941)403-2345 APPLICATION TO QUALIFY SECOND ENTITY THIS FORM MUST BE COMPLETED IF YOU WISH TIO INITIATE OR CHANGE THE STATUS OF AN EXISTING LICENSE. READ ALL INSTRUCTIONS AND MAKE SURE YOU HAVE SIGNED WHERE INDICATED. TYPE OR PRINT IN INK. MAKE CHECKS PAYABLE TO THE COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS. ALL CHECKS MUST CLEARLY STATE APPLICANT'S NAME AND ADRESS. PLEASE ALLOW 2 -3 WEEKS FOR PROCESSING. FEE S1L1 u�X / 1. Applicant's Name (Licensee) O' LICENSE #f \, L (€ (��'�.D UNDER THE FEDERAL PRIVACY ACT, DISCLOSURE OF SOCIAL SECURITY NUMBERS IS VOLUNTARY UNLESS SPECIFICALLY REQUIRED BY FEDERAL STATUTE. IN THIS INSTANCE, SOCIAL SECURITY NUMBERS ARE MANDATORY PURSUANT TO TITLE 42 UNITED STATES CODE, SECTIONS 653 AND 654; AND SECTIONS 455.203(9), 409.2577, AND 409.2598, FLORIDA STATUTES. SOCIAL SECURITY NUMBERS ARE USED TO ALLOW EFFICIENT SCREENING OF APPLICANTS AND LICENSEES BY A TITLE IV-D CHILD SUPPORT AGENCY TO ASSURE COMPLIANCE WITH CHILD SUPPORT OBLIGATIONS. SOCIAL SECURITY NUMBERS MUST ALSO BE RECORDED ON ALL PROFESSIONAL AND OCCUPATIONAL LICENSE APPLICATIONS AND WILL BE USED FOR LICENSE IDENTIFICATION PURSUANT TO THE PERSONAL RESPONSIBILITY AND WORK OPPORTUNITY.RECONCILIATION ACT OF 1996(WELFARE REFORM ACT), 1.04 PUB.L. 193, SEC. 317. - - , _ :/ /� /` Place of Birth: (City)f Ci. (_I / (State) (Nation) (i Social Security Number Date of Birth SIX: /�Male Female ; RACE: (1)White_;(2)African-American; (3)Hispanic ;(4)Asian (5)Indian;(6)Other 2. Name of Business To Be Qualified: ' \7 C__0(--Ns-V(ut C l on �--�- Mailing Address: PC ox 2) t,(O l s FL_ 3Y1 O2 Street or P.O.Box City State Zip Street Address: COO\ 3—Q cy,Su-) *).()2, (" r_-1l`_c L 3 C I Street City ( State Zip Business Phone Number: ( 339 —°° 3 Federal ID Number:" 2-699 C I APPLICATION TO QUALIFY SECOND ENTITY 3. Applicant's (Licensee) Name: t_t� t (1 CtN 2,r*' ikn � Last First Middy Applicant's (Licensee) Official Mailing Address of Record: R o, 7)0y, 1 0ci n LTS �e� L 3510 2 Street City k County State Zip Street Address (if Post Office Box is listed above): 1 210 CkNeAr c ctSe� Ct. '��va. 35120 Street City County State Zip Home Phone (2.N ) (o 4- se Office Phone (23 ) 331-5 COO 4. VERIFICATION OF GENERAL LIABILITY INSURANCE and WORKERS' COMPENSATION (or exemption from Workers Law) INSURANCE (ATTACH A CERTIFICATE OF INSURANCE OR EXEMPTION. I HEREBY AFFIRM THAT I HAVE OBTAINED GENERAL LIABILITY AND PROPERTY DAMAGE INSURANCE IN THE AMOUNTS SET FORTH BELOW and workers' compensation insurance (unless exemption has been filed with and approved by the Bureau of Workers' Compensation compliance), for the safety and welfare of the public. I further affirm that I have met all continuing education requirements. I understand that it is my responsibility to maintain all documentation supporting this affirmation of eligibility. I affirm that these statements are true and correct and I recognize that providing false information may result in a FINE,SUSPENSION or REVOCATION of my contractor's license. �/� Rc\oul .'LICANT'S SI :TURE PRINT OR TYPE NAME DATE ' V, - a t3 f, ��i�`i kr ; f��a 't§ '4�}l'a- S+ St'421 � "i it ��A 1 � �i �� �1� ,� � �I�� A �. � � � � � � F �� 1 sM:�`"' �„ k-r-�� .. r ;* - III IIl �B ® d III 8 d Q e 3 � LT � �.rr vss� .ca -s �a q�� s' 1` ✓-rt.N {"s�. + , aK,.c .. TO FILE A NOTICE OF ELECTION TO BE EXEMPT from the provisions of the FLORIDA WORKERS' COMPENSATION LAW, contact your nearest Florida Department of Labor and Employment Security, Bureau of Workers' Compensation Compliance office to obtain foul'# BCM-250-T. 3 APPLICATION TO QUALIFY SECOND ENTITY 5. QUESTIONNAIRE-QUALIFYING A SECOND ENTITY THIS FORM MUST BE COMPLETED BY THE APPLICANT REQUESTING TO QUALIFY A SECOND ENTITY OR REQUESTING A CHANGE TO AN EXISTING SECOND ENTITY QUALIFICATION. THE APPLICANT AND PRESIDENTS (OR PARTNERS/OWNERS) OF ALL COMPANIES INVOLVED MUST SIGN WHERE INDICATED. PLEASE USE THIS SHEET. ONLY USE ADDITIONAL SHEETS IF NECESSARY. A. Explain why you wish to maintain your present license(s)while qualifying this additional business. ,,-) 1 Sh mO r n Uc ce 1 0 ;m k4v LW-L-- L\9 cv- ' C,Af fQJri --) C_C 1 ra c,-� V3k)..SCML, S AA--) wc-\.`. ek \oe under ' AN) busrne Tat j B. Has the proposed entity been previously qualified? If so, explain why the previous qualifier is no longer willing to continue to qualify this entity. C. If the proposed entity has been qualified within the last 12 months, list the last three jobs completed by the proposed entity. Include dates of completion, address, description of work, name of previous r qualifier and name of owner. c xo.Lx. .1 CcmQG&u j �- 1 ee •-1e1V4 r,� is no p(EV t CuS rill t�(t1 c 213,1 SEici'` c 4Ccrci, �kobrlolc(,, r U m C�r l�--v '1�-�S '1 c IP�uer (P�,�. �cem Lem l cod Tw1, i3o t t{ a) 2'L 9 r� (us 397A- J-k-zx-eor(d92. V�r F# ame.g 5Q' ,bl oc,►',/,".m c,4,,191,eb.d Tar., 2014 KoAs lk '2304 /Capa&cal ;,5Lob,blGU(, m creNl d .�e� 20►`} D. List the last three jobs completed by you under your existing license. Include date of completion. address,description of work,name of previous qualifier and name of owner. tl r 2- e9--V,U4-5; 303 Scud k d rooK lclxv_.)\I\lGQLS Z1O11`L 6-*"-"YO d -1 �s f szVi Ci-\?cese_ca_ l©}-gC,1 0325 r ek.ute„-s alb t s Corr mu,w�es M 'LOU'L 31(01 ■SuatJ Vcai e/5 2+ N I 0,i2. t n No peevlcTLs °e,,� iJ1carK Vererrn a w &S Slab, \oicCX.d 1 Am car V.1A Crn5-Puc up E. Do the business(s) ou presentlqualify and/or wish to qualify have any outstanding liens against them or against the property of consumers as a result of construction work or a contract they had with your firm? YES NO If yes,identify business and provide explanation. F. List principal suppliers for the past six months for the business you presently qualify. E 0.0)te T--2--as)-9 0. 21q, ES-)e.ro 33929 N-D S P 3435 -►'\Scn 'mkAfS 3591(a V ress �l�c� 2,0yr5 Tale B\vd, 6c;�raa 3 3 0 G. List principal suppliers for the past six months for the business you are applying to qualify. le✓ ; Palk* T-0. -CsA-ero 33c 2c) 3�3 Ste`, 1 , 3135 Y Son �� e � 0\-Alt-'r5 w4-re ss o U 2�L n j c 91 e.:S\vd y Gu4 ■ 33 SO 4 APPLICATION TO QUALIFY SECOND ENTITY H. List persons authorized (currently and in the past 6 weeks) to pull pelinits on your license(s). \Sec 1. How are you being paid by the business(s) you presently qualify (examples: salary, % of profits, etc.)? J. How will you be paid by the business you are applying to qualify? S Caal K. What percentage of ownership do you have in the present business(s) you are qualifying and what percentage of ownership will you have in the business you are attempting to qualify? 00 4)4) L. Do you (applicant) have check writing authority for the present and proposed entity? YES NO_X_ If yes, provide a letter from the bank. C_um pars' e_ M. List officers (or-partners, owners) of business you are applying to qualify and give title/position held. TtLzf L. 1� �S a, IN101 Y N. List officers (or partners, owners) of business you presently qualify and give title/position held. O. Do the business(s) you presently qualify and wish to qualify have any other licenses presently qualifying those businesses? YES X NO . If yes, list licensee's name, license number and address. L nrnc)eu \e,S t Lee_ c_u, s Z WCscr so kq,D CND rk o e--- Ll i,+l1 L\CWnSe. t" .94 P. Submit notarized statements signed by an authorized gent of the entity(s) you presently qualify and from an authorized agent of the proposed entity attesting to the fact that each is aware of what entity you presently qualify, and what entity you are requesting to qualify. S Croce 1"Lk j Cc: c&r x.-S . 5 APPLICATION TO QUALIFY SECOND ENTITY 6. FINANCIAL RESPONSIBILITY. All applicants/licensees must answer the questions below. If you answer "yes" to any of the questions, a written explanation is required. Additional documentation is also required, as indicated. If you are applying to qualify a corporation,partnership or other legal business entity, ALL OFFICERS OF THAT ENTITY MUST ALSO EXPLAIN IF ANY OF THE BELOW WOULD PERTAIN TO THEM. This would include the president, vice president, secretary, and/or partners or owner of the proprietorship. HAVE YOU, the business organization, or any of the above mentioned individuals in any capacity ever: YES NO Y A. Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial settlements? B. Had claims or lawsuits filed or unpaid or past due accounts by your creditors as a result of construction operations? C. Undertaken construction contracts or work which resulted in liens, suits or judgments being filed? _ "k, D. Had a lien filed against you by the U. S. Internal Revenue Service or Florida Corporate Tax Division? If "yes", you must attach a copy of the Notice of Lien, and any payment agreement, satisfaction, Release of Lien or other proof of payment. _ E. Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? F. Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" any disciplinary action by a state, county, or municipality? If "yes", you must attach a copy of any state, county, municipal or out-of-state disciplinary order or judgment. G. Filed for or been discharged in bankruptcy within the past five years? If "yes", you must attach a copy of the Discharge Order, Order Confirming Plan, or if a Corporate Chapter 7 case, a copy of the Notice of Commencement. H. Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years? NOTE: IF YOU, THE APPLICANT/LICENSEE, HAVE HAD A FELONY CONVICTION, PROOF THAT YOUR CIVIL RIGHTS HAVE BEEN RESTORED WILL BE REQUIRED PRIOR TO LICENSURE. NOTE: The Board requires any applicant/licensee who answers "yes" to any question contained in the Financial Responsibility Section of the Application to supply a complete explanation of the response, and include a statement detailing the steps taken by the licensee to prevent a recurrence of the circumstances leading to the conviction, discipline,judgment, bankruptcy, or other event leading to the response. You must include any proof of payment, satisfaction of liens,judgments and bankruptcy discharge papers in your submittal, if applicable. Applicants may be required to appear before the Application Review Committee to answer questions regarding such responses. 7. CREDIT REPORT (Reports that do not include the following information will not be acceptable) Reports for the present and proposed entities must be submitted (not more than six months old) from a nationally recognized credit- reporting agency and must be submitted before an additional license can be issued. If you are applying to qualify as an individual, the credit report must be on you. If you are applying to qualify a business organization,the credit report must be on the business organization. If your business is newly established,you will ALSO need to submit credit reports on the following: the newly formed business and the majority owners holding 25%or more interest PLUS letters from three construction related suppliers indicating that an account either exists or has been opened for the entity you are applying to qualify. A credit report is also required for the entity that you are presently qualifying. 6 APPLICATION TO QUALIFY SECOND ENTITY Make sure you give written authorization to the credit agency so they can accurately check your credit references. Federal, State,County (including all counties within the State of Florida)public records pertaining to judgments,bankruptcies,and tax liens must be searched and results noted on the credit report. The credit report must include a public records check of the home counties and all other counties where 25% or more of the contractor's work has been done over the last three years. (If public records reflect unsatisfied obligations, attach written explanation and legal documentation.) The credit report must reflect officers, partners, and proprietors and FEIN and Social Security numbers. Attach a credit report(s) from a nationally recognized credit-reporting agency to this application. If you are unable to receive the credit report, you may have a credit agency send the credit report directly to: Florida Construction Industry Licensing Board, 7960 Arlington Expressway, Suite 300,Jacksonville,Florida 32211-7467,and complete this statement: I have requested a credit report(s)on Date (PROPOSED ENTITY AND PRESENT ENTITY). to be sent directly from (NAME OF CREDIT REPORTING AGENCY) 8. CORPORATIONS — ATTACH A COPY of the current Annual Report Form filed with the Florida Secretary of State or, if your corporation is newly established, attach a copy of the Florida Certificate of Incorporation for the proposed and present entities, if applicable. All foreign (out of state) corporations must register with the Florida Secretary of State (850) 488-9000. 9. FICTITIOUS NAME — ATTACH A COPY of the recorded Fictitious Name Registration from the Division of Corporations; also submit a copy of the filed application or newspaper article for the proposed and present entities, if applicable. (This does not apply to corporations using their registered name.) 10. ORGANIZATIONAL RELATIONSHIPS — Do you qualify any business other than the business you are applying to qualify? YES )( NO (If "yes", what percentage of the business do you own (if any)? I o© %). Contact Board office for guidelines to qualify more than one business. Company Name: \_Z R`'\Q f 0. \.\.o I PhySice.A IQo l 5a\c.V-,scn' +. tt 202., Company Address: " F{- ANNier 1 FL- 33902_ C+ kle,is aL 3 GI D t Your License Number: C 913 11. PROOF OF CONTINUING EDUCATION IS REQUIRED when reactivating or reinstating a license. When reactivating or reinstating your license, you must attach a copy of your Certificate of Completion from a Board approved sponsor. You must provide proof of your continuing education hours, equal to those required of an active licensee, during the period of time your license was delinquent or inactive (beginning December of 1993). 7 AFFIDAVIT I, 'R U ,( ,- -1'e. 1ockl certify that the foregoing is true and correct to the best of my knowledge. AUTHORIZED OFFICOR THE FIRM STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 2- , 01 L4- 6\eta-4- ,-2 i 2.�1 n5 of �� C-6r\ 1.1 E) by (NAME OF OFFICER,TITLE/AGENT) (NAME OF CORPORATION) a \ (tf corporation, on behalf of the corporation. He/She has (STATE OR.PLACE OF CORPORATION) produced \r13,L43A)(--) as identification and did not take an oath. (TYPE OF IDENTIFICATION) 001111111q/y ,�\��o����NDA L.80/ zt 11,is. 0.4 O.(<:p ice / w�sperZl `cfo• *-• a'm: - SIGNATURE OF NOTARY . . ,� o' #EE 211653 `:d ecadedthd Ley:Qom, R\ cnda t3 \ei .o'•/y.�blic Unde ; • O �•. !�/*/,1jc, STATE°Isk\ ' (PRINT NAME OF NOTARY) 00/011100 NOTARY PUBLIC 8 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance 90-105, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he/she 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/she has full authority to supervise construction undertaken by himself/herself or such business or organization and that he/she 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. -10k,n4L2A APPLICANT(PLEASE PRINT) Okos\-aK- -;on NAME OF COMPANY SIGNATURE OF AP' CANT STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 2_120\ 1 H_( by (DATE) 6\0 k who has produced • �_ �I�. : • (NAME OF PERSON ACKNOWLEDGING) ( YPE OF IDENTI ICATION) as identification and who did not take an oath. �`�NDA L'B� 1 ,� 7471°mss, •VO�,�Qt 2 j �'�j• o cp • * SIGNATURE OF NOTARY SE* : ®•s : 2: #EE 211653 :�Q c3•••.',/ Bondedlho•��.'qv \ I oCCt L_ \e U (PRINT NAME OF NOTARY)NOTARY PUBLIC ) 9 RESOLUTION OF AUTHORIZATON WHEREAS 'RA L l.Ur15VAt LA:\Cr\ L.—C— proposes to . (Name of Business Entity) engage in contracting as 0..c eor a;\---■ c n in (Type of legal entity: corp.,partnership,etc. Collier County,Florida, according to Collier County Ordinance 99-45;and WHEREAS Pc Z C,()S ur.,-\—1 cXl lLLC, proposes to (Name of Business Entity) �7 qualify for a Certificate of Competency with 1a,c op f k t !. jQ 1. i Ins 1 (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned OW\QM of (1 1 6:1' (Officers, Owners,Partners) AZ.l (151 'uGi1 I LC hereby resolve and represent to the Collier County (Name of Business Entity) `' Contractors'Licensing Board that the qualifying agent,'® 1 f ,�`fL�k )S `t ,is active (Nine o Individual) in all matters connected with the contracting business ofC�t� , and (Name of Bu_s' ess ntity) We further resolve and represent that R ob` e.,(-}-v \. 1� \'(ls til is /� `_ (Names of Individual) legally empowered to act for�i\Z Ci`,(6V(L(C 10� � LC.. in all matters connected with its (Name of Business Entity) • contracting business, and has the authority to supervise construction undertaken by '4 A2-c_ . uC a, \LC. . (Name of Business Entity) ` DULY PASSED AND ADOPTED THIS 2_0 day ofk t�lfy, 20.H. (Officers,Partners,Owners—with 0,/, - ,,,ocuti- Designai underneath) Witness Witness Witness Corporate Seal(if Applicable) p Or Notary Public Certificate Sworn to and subscribed before me this2U 1't day of 0 ,20 1 by_a, : ,- .� 1 . 7A \Ic>1d0 L.1. 0\e v ' : Notary Public Name Printed ,�,�N1f11 1iillif���,J Notary Public Signature Commission Number FF ti l 5 ��'''(P �•B�4, . My Commission expires:)c -21-I(a \�C''.*OSSION -,∎.� ? ,pet 21, iO�.. •• o 0�' W. Z * • —.s • y: #EE 211653 :o . I- .2"u ticU��v. �-'� • COLLIER COUNTY GOVERNMENT CON.I.M NITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 - MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. - Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number (SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 1 19, Florida Statues. • 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 16 NP 12/01 02/24/14 11 : 03CT [SUBJECT] [SSN] [BIRTH DATE] ZIELINSKI, ROBERT A. `- [CURRENT ADDRESS] [DATE RPTD] 1109 PO BOX 1109, FORT MYERS FL. 33902 [FORMER ADDRESS] 18210 RIVER CHASE CT. , ALVA FL. 33920 12/01 1141 OCEAN DR. , SUMMERLAND KEY FL. 33042 M O D E L P R O F I L E ***FICO CLASSIC 04 SCORE +812 : 011, 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=0 COL=0 NEG=0 HSTNEG=0 TRD=10 RVL=4 INST=0 MTG=6 OPN=0 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $32 .3K $46. 9K $5332 $0 $ 89% MORTGAGE: $1 .0M $ $649K $0 $3544 TOTALS: $1.OM $46. 9K $654K $0 $3544 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 CHASE B 26QK001 5/83 $6999 111111111111 RO1 2/14A $14 . 8K $0 111111111111 I CREDIT CARD 2/14P $0 48 0/ 0/ 0 AMEX B 21WB001 12/96 $25.3K 111111111111 ROl 2/14A $32 . 1K $0 111111111111 I CREDIT CARD $5332 48 0/ 0/ 0 BK OF AMER B 4275002 4/04 $665K 360M2912 111111111111 M01 2/14A $0 111111111111 I CONVENTIONAL REAL $529K 48 0/ 0/ 0 BK OF AMER B 4275002 8/05 $171K 360M632 111111111111 MOl 2/14A $0 111111111111 I CONVENTIONAL REAL $119K 48 0/ 0/ 0 GECRB/JCP D 235058D 4/06 $140 111111111111 ROl 1/14A $2000 $0 111111111111 I CHARGE ACCOUNT 7/07C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 BK OF AMER B 4275002 7/03 $499K 180M 111111111111 M01 11/11A $0 111111111111 I CONVENTIONAL REAL 11/11C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 6331059 5/00 $322 RO1 5/09A $4000 $0 I CREDIT CARD 3/08C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 BK OF AMER B 6331062 10/03 $105K 300M740 111111111111 MO1 12/08A $0 111111111111 I CONVENTIONAL REAL 12/08C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 6331062 6/03 $225K 180M2149 11111111111 MOl 8/04A P CONVENTIONAL REAL 11 0/ 0/ 0 BK OF AMER B 6331062 7/01 $275K 360M2880 111111111111 MOl 5/04A $0 111X11111111 I FRD999684256 5/04C $0 CLOSED 30 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 2/24/14 ZNP6284423 (FLA) MERIT CREDIT C R E D I T R E P O R T S E R V I C E D BY : 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 CHASE BC26QK001 (800) 955-9900 P.O. BOX 15298 WILMINGTON DE. 19850 AMEX BC21WBOO1 (800) 874-2717 P.O. BOX 981537 EL PASO TX. 79998 BK OF AMER BM427S002 (800) 451-6362 4161 PIEDMONT PKWY GREENSBORO NC. 27410 GECRB/JCP DC235058D (866) 227-5213 PO BOX 965007 ORLANDO FL. 32896 BK OF AMER BC6331059 PO BOX 982235 EL PASO TX. 79998 BK OF AMER BM6331062 (800) 669-6607 4161 PIEDMONT PKWY GREENSBORO NC. 27410 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 . Premier Profile-A TO Z MASONRY,INC Subcode:970135 Ordered:02/24/2014 11:06:11 CST ', , Experian- Transaction Number:0500308078 #�} Search Inquiry:A-Z MASONRY INC/1601 JACKSON STREET SUITE 202/FORT A-,vorld insight MYERS/FL/33901/650249565 Model Description:Intelliscore Plus V2 Business Name Business Identification Number• A To Z t A.SONRY� 1N..0 844281474 Primary Address: 1601 JACKSON ST STE 202 Website: www.atozmasonry.com FORT MYERS, FL 33901-2968 Phone: (239)337-5000 Tax ID: 65-0249565 TOP Ri c E�asI l2oard Risk Scores and Credit Limit Recommendation Days Beyond Terms Derogatory Legal Fraud Alerts Intelliscore Plus Financial Stability Risk Company DBT Original Filings High Risk Alerts fla LOW RISK , LOW RISK 1 Score range:1 -100 percentile Industry DBT: 11 Credit Limit Recommendation:$18,100 TOP B.tiesss�Fa.GtS a , .✓..� '*rov ':5 .I.,a4..d'S:nk.t..,.. � v. ..,. w 1. ....�,.:= ..... F ... �.�'.J.n .-.. s........_' .. ,:... Founded in 2002,A to Z Masonry, Inc.is headquartered in Mt.Olive,FL. It is a masonry company specializing in residential and commercial projects.The company offers services such as full-mason fireplaces,saw cuts,stone works,straight lines,and arches. Years on File: 20(FILE ESTABLISHED 03/1994) SIC Code: CONCRETE WORK CONTRACTORS-1771 State of Incorporation: FL SPORTING&RECREATIONAL GOODS,SUPPLIES-5091 Date of Incorporation: 02/01/1991 NAICS Code: Business Type: Institutions-Profit Poured Concrete Foundation and Structure Contractors-238110 Contacts: TONY ZILINSKI-PRESIDENT Sporting and Recreational Goods and Supplies Merchant Wholesalers ROBERT ANTHONY ZIELINSKI -423910 Number of Employees: 35 Sales: $2,800,000 7,,-NP Commercial Fraud Shield =Evaluattion for A TO:.Z111ASONRY„INC;-1601 JACKSON ST STE 202,FORT MYERS-,FL33901 2968': Business Alerts Verification Triggers Active Business Indicator: Experian shows this business as active INACTIVE DOMESTIC CORPORATE FILING FOUND Possible OFAC Match: No OFAC match found Business Victim Statement: ;.3;-j No victim statement on file Credit Risk Score an&CreditLiimi#.Recommendatiion Credit Risk Score:Intelliscore Plus Current Intelliscore Plus Score: 99 Risk Class: I f Premier Profile-A TO Z MASONRY,INC 1/5 • , �.__.z.E ..0 m „F The risk class groups scores by risk into ranges of similar 99 performance.Range 5 is the highest risk,range 1 is the _. ..._ . lowest risk. High Low I • ( Risk r' Risk 0 10 25 50 75 7 00 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 Industry Risk Comparison > NUMBER OF RECENTLY ACTIVE COMMERCIAL ACCOUNTS 98%of businesses indicate a higher likelihood of severe delinquency. > RATIO OF TOTAL BAL TO TOTAL HIGH BAL ACROSS ALL COMM ACCTS > LENGTH OF TIME ON EXPERIAN'S FILE Quarterly Score Trends Quarterly Score Trends ao 100 go 83 80 70 68 60 The Quarterly Score Trends provide a view of the B0- likelihood of delinquency over the past 12 months for this 50 _ business.The trends will indicate if the score improved, remained stable,fluctuated or declined over the last 12 months. 30 10 o y � 0 - � .�..t� 4 btPy S� p T” 1'e!`�- Credit Risk Score:Financial Stability Risk . Current Financial Stability Risk Score: 92 Risk Class: 1 92 i High Low I The risk class groups scores by risk into ranges of similar t R.isi. . _ ._w ' Risk performance.Range 5 is the highest risk,range 1 is the 0 10 30 [, 117- lowest risk. This score predicts the likelihood of financial stability risk within the next 12 months. The score uses tradeiine and collections information,public filings as well as other variables to predict future risk. Higher scores indicate lower risk. Factors lowering the score Industry Risk Comparison NUMBER OF ACTIVE COMMERCIAL ACCOUNTS 91%of businesses indicate a higher likelihood of financial stability risk. > RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR > RISK ASSOCIATED WITH THE BUSINESS TYPE > BALANCE TO HIGH CREDIT RATIO FOR OTHER COMMERCIAL ACCOUNTS Credit Limit Recommendation Credit Limit Recommendation 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 $18,100 Plus.The recommendation is a guide.The final decision must be made based on your company's business policies. P-aXinertt a ct Legat Etlrb Sul ar h s; - _ Payment Performance Trade and Collection Balance Legal Filings Premier Profile-A TO S MASONRY, INC 2/5 - Current DBT: 0 Total trade and collection(5): $6,700 Bankruptcy: No I Predicted DBT as 04123/2014: 1 All trades(5): $6,700 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(3): $900 UCC filings: 0 Highest DBT Previous 5 Quarters: 0 6 month average: $500-$3,500 Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended: 64,600 Payments are stable Most frequent industry purchasing terms: NET 30,REVOLVE,CREDIT Industry Comparison Industry DBT Range Comparison DST Norms The current DBT of this business is 0.80%of businesses have a DBT range of 0-5. Ail industry: 9 DBT for this business: 0 Same industry: 11 Industry Payment Comparison Has paid sooner than 50%of similar businesses latillibitiaarilligrill i ' 1 DST Range 0-5 6-15 16+ TOP Payment Trending DBT Trends Monthly DBT Trends Quarterly DBT Trends ig - .ig- g - g - s- s - 5 - 13 - a 5 - 4 4-- 3- 3 - 1 - 1 - 411- ,0---., A .0,",.. ,a, 0,- 0 ... ..,.,.,,...,-;-, - , ,. ,,,-.......„ -4,---44-9a,--.Altz----4411:No----.41-1...„--,- ,,C4.1`7-5 sCI::3 AO-'Monthly Payment Trends Payment Trends Analysis Account Status CONCRETE WORK CONTRACTORS-1771 Days Beyond Terms y Date Reported Industr Business DBT Balance Cur 1-30 31-60 61-90 91+ Cur DBT CURRENT 84% 11 0 $900 100% JAN14 84% 11 0 $1,900 100% DEC13 84% 11 0 $500 100% NOV13 85% 11 0 $3,500 100% OCT13 84% 12 0 $1,400 100% SEP13 84% 11 0 $800 100% AUG13 85% 11 0 $1,200 100% Quarterly Payment Trends Account Status Payment History-Quarterly Averages Days Beyond Terms Premier Profile-A TO Z MASONRY,INC 3/5 Quarter Months DBT Balance Cur 1-30 31-60 61-90 91+ 1-67- 13 OCT-DEC 0 $1,800 100% - i Q3-13 JUL-SEP 0 $1.100 100% Q2-13 APR-JUN 0 $3,900 100% Q1 -13 JAN-MAR 0 3900 100% Q4-12 OCT-DEC 0 $1,500 100% TOP trade t?amen Surutrar ' •.._ . .,_ • Trade Line Type Lines Reported DBT Recent High Credit Balance Current 01-30 31-60 61-90 91+ Continuous 3 $6,800 $900 100% New 0 $0 Combined Trade 3 $6,800 $900 100% Additional 2 $11,100 55,800 100% Total Trade 5 $17,900 $6,700 100% To"1, Trade Payment New andrContinuousfy Reported Trade Details Payment Experiences Account Status (Trade Lines with an(")after the date are newly reported) Days Beyond T erms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Category Reported Sale Terms Credit BLDG MATRL 01/2014 01/2014 CREDIT $4.600 $400 100% OFFC SUPPL 02/2014 01/2014 CREDIT $1.100 $100 100% VVAREHOUSE 02/2014 01/2014 CREDIT $1,100 $400 100% TOP 0 Trades Payment Additional Trade Details_ Payment Experiences Account Status (Trade Lines with an(*)after the date are newly reported) ; Days Beyond Terms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Category Reported Sale Terms Credit ACCT SVCS 02/2012 VARIED $0 CRED CARD 02/2014 01/2014 REVOLVE $11,100 $5,800 100% TOP Additional Business Facts Corporate Registration THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA. State of Origin: FL Date of Incorporation: 02/01/1991 Current Status: Inactive Business Type: Institutions-Profit Charter Number: S29035 Agent: ZIELINSKI ROBERT A Agent Address: 1601 JACKSONST STE 202 FT MYERS,FL TOP fnquirie f x Summary of Inquiries Business FEB14 JAN14 DEC13 NOV13 OCT13 SEP13 AUG13 JUL13 JUN13 Category FINANCE 1 INSURANCE 1 Premier Profile-A TO Z MASONRY.INC 4/5 TEXTILES 1 Totals 1 1 i 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 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 2014.All rights reserved.Privacy oofcy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. Premier Profile-A TO Z MASONRY.INC 5/5 UMW Merit Credit 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: A-Z MASONRY INC FEDERAL ID: 65-0249565 CURRENT STATUS:ACTIVE BUSINESS PRINCIPAL(S): ROBERT ZIELINSKI TITLE: DIRECTOR DATE INCORPORATED: 06/02/1997 Feb 251402:16p 239-277-0167 2392770167 p.1 Premier Profile-RAZ CONSTRUCTION,LLC Subcode:970135 Ordered:02/25/2014 13:13:19 CST Experian- Transaction Number:C500310224 Search Inquiry:RAZ CONSTRUCTION:LLC`l601 JACKSON ST STE 202/FORT a..YCalr of insight fVYERS/FL133901/US1NiA/97 1 1 29906 Model Description: Intelliscore Plus V2 Business Name 114 Business Identification Number RAZ CONSTRUCTION, LLC 971 129906 Primary Address: 1601 JACKSON ST STE 202 FORT MYERS,FL 3390'-2968 T•?P Risk Dashboard Risk Scores and Credit Limit Recommendation Days Beyond Terms Derogatory Legal Fraud Alerts !n_elliscore?f us Financial Stabilty Risk Compan,,'CET Original Filings High Risk Alerts Score unavailable. Score unavailable, r Information on file not Information on file not DBT proven to predict serious proven to predict financal Unava,lablu � t , future, risk. stability risk- i Credit Limit Recommendation: N/A '•_•A AQ Business Facts Years on File: 1 (FILE ESTABLISHED 05/2013) State of Incorporation: FL Date of Incorporation: 04/2312013 Business Type: Profit Contacts: ROBERT ANTHONY ZIELINSKI-MANAGER Tan Commercial Fraud Shield Evaluation for: RAZ CONSTRUCTION,LLC,1601 JACKSON.ST STE 202,FORT MYERS,FL339Q1-2968 Business Alerts Verification Triggers - The primary Business Name.Address,and Active Business Indicator: Experian shows this business as active Phone Number on Exoerian File were reviewed •=-- for High Risk indicators,no Hich Risk indicatcrs were found. Possible OFAC Match: No OFAC ralc'l found Business Victim Statement: No victim statement on file credit Risk.Score,and Credit Limit Recommendation Credit Risk Score:Intelliscore Plus Current fntellisccre Plus Score: Score and Risk Class Unavailable(999) This score-predicts the likelihood of serious credit I f delinquencies for this business within the next 12 mcntYs. High n!' L'=': Tnis report does not irclude data elements stetis:icaliy __ pi==t proven to predict serious future delinquency.Therefore an Intelliscore Plus score cannot be calculated and the risk 2- 50 _- 100 class is ur.available. Credit Risk Score:Financial Stability Risk Premier Profile-RAZ CONSTRUCTION,LLC 1:3 Feb 2514 02:16p 239-277-0167 2392770167 p.2 Current Financial Stability Risk Score:Score and Risk Class Unavailable (999) This score predicts the likelihood of financial stability risk within the next 12 months.Information on file is not proper,to predict financial stability tisk.Therefore e , _.__ _ . F >l' Financial Stability Risk score cannot be created. 3 1_ 1,00 Credit Limit Recommendation Credit Limit Recommendation This recommendation compares this business against similar ousinesses in the Experian b.,siress No:available-Th s report does rot credit database.It is based on trade rfo'maticn,industry,age of business and the lnelliscore include the data elements needed to P us.The recommendation s a guide.The final decision must be made based on your company's create tie credit limit recommendation. business policies. ToP0, Payment and Legal.Filings Summary Payment Performance Trade and Collection Balance Legal Filings Current DST: Not Available Total trade and coilection CO): SO Bankruptcy: No Predicted DBT: N;A All trades 0): SO Tax Lien filings: 0 Judgment filings: 0 Monthly Average DBT: 0 AU collections(0): Se Sum of legal filings: SO Highest DBT Previous 6 Months: 0 Continuous trade(0): $0 UCC filings: C Highest DBT Previous 5 Quarters: 0 6 month average: NiA Cautionary UCC filings: Nc Payment Trend Indication: Highest credit amount extended: NiA Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms rot available industry Comparison Industry DBT Range Comparison The current DE'-of this business is Not Available. DST for this business: Not Available t 11 `]BT Range 0-5 15-15 151 iop ldditioiaal Business Facts Corporate Registration THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA. State of Origin: FL Date of incorporation: 04/23;2013 Current Status: Acl:ve Business Type: Profit Charter Number: _130000594 Agent: KNOTT GEORGE HESO Agent Address: KNOTT EBELINI HART FOR--NMYERS.FL 'CP 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 1-800-5204221, option#4 for more information. End of report 1 at 1 report Tire inrornation herein is furnished in confidence for your excl:uivc 1.,se far legitimate business purposes ano shall not be._producod.Neither Experian fnformntion Solutions,Inc.,nor!heir sources or distributors warrant such information nor shall they be iiabte ror your use or reliance upon ii. Experian 2014.All rights reser/ec_Privecr,41icy. Premier Proa:e-R/\Z CONSTRUCTION,LLC 2:3 Feb 2514 02:16p 239-277-0167 2392770167 p.3 • Experian and he Exoerian marks he-6n are service marks or registorcd t.-ademarks of=xperian. Pre-nier Profile-RAZ CONSTRUCTION,LLC 31 Feb 25 14 02:16p 239-277-0167 2392770167 p.4 • WINN TT Merit Credit 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: RAZ CONSTRUCTION LLC FEDERAL ID: 462699889 CURRENT STATUS:ACTIVE BUSINESS PRINCIPAL(S): ROBERT ZIELINSKI TITLE: MANAGER DATE INCORPORATED: 04/23/2013 AEM Business Banking Bank of erica-r• P.O.Box 15284 Customer service information Wilmington,DE 19850 'a) Customer service: 1.888.852.5000 HIPPlAM11114lh4011I4I1IIIIIIIIIr4hddir AF 0 075 257 423 001732 WW2 AT 0.406 bankofamerica.com A-Z MASONRY INC Bank of America, N.A. PO BOX 1109 P.O. Box 25118 FORT MYERS, FL 33902-1109 Tampa,FL 33622-5118 Your Full Analysis Business Checking for January 1, 2014 to January 31, 2014 Account number: A-Z MASONRY INC Account summary Beginning balance on January 1,2014 $236,301.95 #of deposits/credits:7 Deposits and other credits 409,774.09 #of withdrawals/debits:112 Withdrawals and other debits -17,912.01 #of days in cycle:31 Checks -368,502.21 Average ledger balance:$278,711.00 Service fees -26.84 Ending balance on January 31, 2014 $259,634.98 immel A-Z MASONRY INC I Account# I January 1,2014 to January 31,2014 IMPORTANT INFORMATION: BANK DEPOSIT ACCOUNTS Change of address- Please call us at the telephone number listed on the front of this statement to tell us about a change of address. Deposit agreement-When you opened your account,you received a deposit agreement and fee schedule and agreed that your account would be governed by the terms of these documents,as we may amend them from time to time. These documents are part of the contract for your deposit account and govern all transactions relating to your account, including all deposits and withdrawals. Copies of both the deposit agreement and fee schedule which contain the current version of the terms and conditions of your account relationship may be obtained at our banking centers. Electronic transfers: In case of errors or questions about your electronic transfers- If you think your statement or receipt is wrong or you need more information about an electronic transfer(e.g.,ATM transactions,direct deposits or withdrawals, point-of-sale transactions) on the statement or receipt,telephone or write us at the address and number listed on the front of this statement as soon as you can. We must hear from you no later than 60 days after we sent you the FIRST statement on which the error or problem appeared. - Tell us your name and account number. - Describe the error or transfer you are unsure about,and explain as clearly as you can why you believe there is an error or why you need more information. - Tell us the dollar amount of the suspected error. For consumer accounts used primarily for personal,family or household purposes,we will investigate your complaint and will correct any error promptly. If we take more than 10 business days(10 calendar days if you are a Massachusetts customer) (20 business days if you are a new customer, for electronic transfers occurring during the first 30 days after the first deposit is made to your account)to do this,we will credit your account for the amount you think is in error, so that you will have use of the money during the time it will take to complete our investigation. For other accounts,we investigate, and if we find we have made an error,we credit your account at the conclusion of our investigation. Reporting other problems-You must examine your statement carefully and promptly. You are in the best position to discover errors and unauthorized transactions on your account If you fail to notify us in writing of suspected problems or an unauthorized transaction within the time period specified in the deposit agreement(which periods are no more than 60 days after we make the statement available to you and in some cases are 30 days or less), we are not liable to you for, and you agree to not make a claim against us for the problems or unauthorized transactions. Direct deposits- If you have arranged to have direct deposits made to your account at least once every 60 days from the same person or company,you may call us at the telephone number listed on the front of this statement to find out if the deposit was made as scheduled. ©2013 Bank of America Corporation Bank of America,N.A. Member FDIC and 1121 Equal Housing Lender • ` � Your checking account Bank o erica A-Z MASONRY INC I Account# I January 1,2014 to January 31,2014 Deposits and other credits Date Transaction description Customer reference Bank reference Amount 01/03/14 Deposit -65.47 I NDN:56370383 CO 10:2721432917 TEL continued on the next page MINIM, A-Z MASONRY INC Account# "" • I I January 1,2014 to January 31,2014 ,,E� Withdrawals and other debits - continued Date Transaction description Customer reference Bank reference Amount 01/02/14 PAYCOR INC_ DES:SVC-PAYCOR -35.85 10:258087007607492 INDN:A-Z MASONRY CO 1D:4311299990 CCD continued on the next page MEIN . Your checking account Bank of America A-Z MASONRY INC I Account# I January 1,2014 to January 31,2014 Withdrawals and other debi't's - continued Date Transaction description Customer reference Bank reference Amount 01/23/14 PAYCOR INC. DES:Pay fund -10.00 10:176694671327925 INDN:A-Z MASONRY CO ID:6311299990 CCD Total withdrawals and other debits -$17,912.01 Checks Date Check# Bank reference Amount Date Check# Bank reference Amount 01/06 24193 -31.06 continued on the next page mime A-Z MASONRY INC I Account# I January 1,2014 to January 31,2014 Checks - continued Date Check# Bank reference Amount Date Check# Bank reference Amount 01/08 27789 -10,490.90 Total checks -$368,502.21 Total# of checks 86 * There is a gap in sequential check numbers Service fees Date Transaction description _ Amount 01/15/14 12/13 ACCT ANALYSIS FEE -26.84 Total service fees -$26.84 Note your Ending Balance already reflects the subtraction of Service Fees. Date Balance($) Date Balance($) Date Balance($) 01/01 236,301.95 01/03 321,823.49 01/07 289,596.75 01/02 230,189.58 01/06 295,997.34 01/08 221,967.92 continued on the next page • ° - Your checking, �cc ount o e 'nca ,�� A-Z MASONRY INC I Account# I January 1,2014 to January 31,2014 Daily ledger balances - continued Date Balance($) Date Balance($) Date Balance(5) 01/09 221,084.66 01/17 280,598.00 01/27 281,695.61 01/10 340,494.79 01/21 259,764.68 01/28 280,394.63 01/13 325,034.63 01/22 154,571.82 01/29 270,402.33 01/15 324,819.64 01/23 118,256.19 01/30 261,361.00 01/16 323,136.54 01/24 283,816.46 01/31 259,634.98 To help you BALANCE YOUR CHECKING ACCOUNT, print a copy of the"How to Balance Your Bank of America Merrill Lynch Account" page by visiting CashPro®University at cashproon line.bankofamerica.com. NMI ■ sus: A-Z MASONRY INC 1 Account# January 1,2014 to January 31,2014 :1! • • This page intentionally left blank • Business Banking P'% • BankofAmerica P.O.Box 15284 Customer service information Wilmington,DE 19850 S) Customer service: 1.888.852.5000 i.1111.11111.1111.111 1l.llluhl1lhlihl.11..,i.F.hl,1iniliiii AF 0 075 188 092 008689 ti802 AT 0.384 -* bankofamerica.com A-Z MASONRY INC Bank of America, N.A. PO BOX 1109 P.O. Box 25118 FORT MYERS, FL 33902-1109 Tampa,FL 33622-5118 Your Full Analysis Business Checking for December 1, 2013 to December 31, 2013 Account number: A-Z MASONRY INC Account summary 3eginning balance on December 1, 2013 $421,743.77 #of deposits/credits:6 Deposits and other credits 367,287.60 #of withdrawals/debits:123 Withdrawals and other debits -13,394.66 #of days in cycle:31 Checks -539.301.11 Average ledger balance:$291,120.53 Service fees -33.65 Ending balance on December 31, 2013 $236,301.95 Beginning January 1,2014,we will assess a new daily overdraft fee for each calendar day your account's end-of-day balance is negative, regardless of the type of debit item that created the overdraft.We will no longer charge the per-item fee for each item that overdraws your account however,a per-item fee will continue to be assessed for each non-sufficient funds item that is returned without payment. A-Z MASONRY INC 1 Account# 1 December 1,2013 to December 31,2013 • IMPORTANT F A I . • BANK DEPOSIT ACCOUNTS Change of address- Please call us at the telephone number listed on the front of this statement to tell us about a change of address. Deposit agreement-When you opened your account,you received a deposit agreement and fee schedule and agreed that your account would be governed by the terms of these documents, as we may amend them from time to time. These documents are part of the contract for your deposit account and govern all transactions relating to your account, including all deposits and withdrawals. Copies of both the deposit agreement and fee schedule which contain the current version of the terms and conditions of your account relationship may be obtained at our banking centers. Electronic transfers: in case of errors or questions about your electronic transfers- If you think your statement or receipt is wrong or you need more information about an electronic transfer(e.g.,ATM transactions,direct deposits or withdrawals, point-of-sale transactions) on the statement or receipt,telephone or write us at the address and number listed on the front of this statement as soon as you can. We must hear from you no later than 60 days after we sent you the FIRST statement on which the error or problem appeared. — Tell us your name and account number. — Describe the error or transfer you are unsure about,and explain as clearly as you can why you believe there is an error or why you need more information. — Tell us the dollar amount of the suspected error. For consumer accounts used primarily for personal, family or household purposes,we will investigate your complaint and will correct any error promptly. If we take more than 10 business days (10 calendar days if you are a Massachusetts customer) (20 business days if you are a new customer,for electronic transfers occurring during the first 30 days after the first deposit is made to your account)to do this,we will credit your account for the amount you think is in error,so that you will have use of th f_ money during the time it will take to complete our investigation. For other accounts,we investigate,and if we find we have made an error,we credit your account at the conclusion of our investigation. Reporting other problems-You must examine your statement carefully and promptly. You are in the best position to discover errors and unauthorized transactions on your account. If you fail to notify us in writing of suspected problems or an unauthorized transaction within the time period specified in the deposit agreement(which periods are no more than 60 days after we make the statement available to you and in some cases are 30 days or less),we are not liable to you for, and you agree to not make a claim against us for the problems or unauthorized transactions. Direct deposits- If you have arranged to have direct deposits made to your account at least once every 60 days from the same person or company,you may call us at the telephone number listed on the front of this statement to find out if the deposit was made as scheduled. ©2013 Bank of America Corporation Bank of America,N.A.Member FDIC and Equal Housing Lender • Your checking ac unt of America -'�R-Z MASONRY INC I Account# I December 1,2013 to December 31,2013 Deposits and other credits Date Transaction description Customer reference Bank reference Amount 12/06113 Deposit -223.39 INDN:ROBERT ZIELINSKI CO ID:1133133497 PPD continued on the next page Greater efficiency starts with an easy shift nkofA e y to web-based check deposits. MeernQ-Ly�srlr r Deposit checks electronically,right from your desktop,with Remote Deposit Service Online.Simply scan your checks using a bank-provided scanner to transmit the images and data to us online.Potential benefits may include faster access to cash with fewer trips to the bank. bankofamenca_com/remotedepositservice 1 0 • A-Z MASONRY INC I Account# I December 1,2013 to December 31,2013 'Withdrawals drawal and other debits - continued Date Transaction description Customer reference Bank reference Amount 12/09/13 LIBERTY MUTUAL DES:EFT PAYMMI 4-a-113 -2,037.45 ID:CF0002098509 INDN:A-Z MASONRY INC on-Uot CO ID:1362739571 CTX ADDITIONAL INFORMATION IS AVAILABLE FOR THIS PMT. CONTACT A TREASURY SALES OFFICER FOR ASSISTANCE. Total withdrawals and other debits -$13,394.66 Checks Date Check tt Bank reference Amount Date Check# Bank reference t Amount 12/09 X?6q 1 ( S -50521 continued on the next page 1. � , .. Your checking acco W America® ' -----"A-Z MASONRY INC I Account# December 1,2013 to December 31,2013 Checks - continued Date Check# Bank reference Amount Date Check# Bank reference Amount 12/09 24171 -12,432.34 continued on the next page A-Z MASONRY INC I Account# I December 1,2013 to December 31,2013 Checks - continued Date Check# Bank reference Amount Date Check# Bank reference Amount 12/20 27751 -4,685.50 Total checks -$539,301.11 Total# of checks 105 Y There is a gap in sequential check numbers Service fees Date Transaction description Amount 12/16/13 11/13 ACCT ANALYSIS FEE -33.65 Total service fees $33,65 Note your Ending Balance already reflects the subtraction of Service Fees. Daily ledger balances Date Balance($) Date Balance(S) Date Balance($) 12/01 421,743.77 12/11 226,291.58 12/20 311,563.81 12/02 405,282.66 12/12 225,350.14 12/23 213,037.11 12/03 405,117.82 12/13 285,503.45 12/24 212,799.54 12/04 380,404.68 12/16 275,564.59 12/26 192,677.37 12/05 377,173.64 12/17 303,784.13 12/27 272,399.09 12/06 344,479.85 12/18 299,865.04 12130 260,193.25 12/09 243,606.58 12/19 263,485.50 12/31 236,301.95 12/10 227,419.05 '' To help you BALANCE YOUR CHECKING ACCOUNT, print a copy of the"How to Balance Your Bank of America Merrill Lynch Account" page by visiting CashPro®University at cashproonline.bankofamerica.com. Business Banking ank o erica'' '.O.Box 15284 Customer service information Wilmington,DE 19850 Customer service: 1.888.8525000 lith1IIII1INnllliiillluhllP1119l 11"111IInhlnll*lhlllII AF 0 075 040 066 009304 #002 AT 0.384 . bankofamerica.com A-Z MASONRY INC - Bank of America, N.A. PO Box 1109 P.O. Box 25118 FORT MYERS,FL 33902-1109 Tampa,FL 33622-5118 Your Full Analysis Business Checking for November 1,2013 to November 30, 2013 Account number: Account summary Beginning balance on November 1 2013 $121,745.05 #of deposits/credits:9 eposits and other_credits __. -- 939,446.04 #of withdrawals/debits:130 Withdrawals and other debits 9,908.99 #of days in cycle:30 Checks -629,488.52 Average ledger balance:$365,109.80 Service fees -49.81 Ending balance on November 30, 2013 $421,743,77 A printable statement reconciliation page is available. You can print a copy of the "How to Balance Your Bank of America Merrill Lynch Account"page by visiting CashPro® University at cashproonline.bankofamerica.com.To have a copy mailed to you,call the client services number listed at the top of your statement. „ wry c-nF coFC.n nFI IVFRY P TYPE IMAGE I BC:)AX A-Z MASONRY INC I Account# November 1,2013 to November 30,2013 t , MPORTANT iR -- N: BANK DEPOSIT ACCOUNTS Change of address- Please call us at the telephone number listed on the front of this statement to tell us about a change of address. Deposit agreement-When you opened your account,you received a deposit agreement and fee schedule and agreed that your account would be governed by the terms of these documents,as we may amend them from time to time. These documents are part of the contract for your deposit account and govern all transactions relating to your account, including all deposits and withdrawals. Copies of both the deposit agreement and fee schedule which contain the current version of the terms and conditions of your account relationship may be obtained at our banking centers. Electronic transfers: In case of errors or questions about your electronic transfers- If you think your statement or receipt is wrong or you need more information about an electronic transfer(e.g.,ATM transactions,direct deposits or withdrawals, point-of-sale transactions)on the statement or receipt,telephone or write us at the address and number listed on the front of this statement as soon as you can. We must hear from you no later than 60 days after we sent you the FIRST statement on which the error or problem appeared. - Tell us your name and account number. - Describe the error or transfer you are unsure about,and explain as clearly as you can why you believe there is an error or why you need more information. - Tell us the dollar amount of the suspected error. For consumer accounts used primarily for personal,family or household purposes,we will investigate your complaint and will correct any error promptly. If we take more than 10 business days(10 calendar days if you are a Massachusetts customer) (20 business days if you are a new customer,for electronic transfers occurring during the first 30 days after the first deposit is made to your account)to do this,we will credit your account for the amount you think is in error,so that you will have use of the money during the time it will take to complete our investigation. For other accounts,we investigate,and if we find we have made an error,we credit your account at the conclusion of our investigation. Reporting other problems-You must examine your statement carefully and promptly. You are in the best position to discover errors and unauthorized transactions on your account If you fail to notify us in writing of suspected problems or an unauthorized transaction within the time period specified in the deposit agreement(which periods are no more than 60 days after we make the statement available to you and in some cases are 30 days or less),we are not liable to you for, and you agree to not make a claim against us for the problems or unauthorized transactions. Direct deposits- If you have arranged to have direct deposits made to your account at least once every 60 days from the same person or company,you may call us at the telephone number listed on the front of this statement to find out if the deposit was made as scheduled_ 2013 Bank of America Corporation Bank of America,N.A. Member FDIC and in Equal Housing Lender Dnan 7 of 1R Your checking account BankofAmerica _z MASONRY INC I Account# I November 1,2013 to November 30,2013 Deposits and other credits Date Transaction description Customer reference Bank reference Amount 11/01/13 DRHorton PMD DES:PAYMENT ID:75307 1,07336 ID:197103601396938 INDN:A-Z MASONRY CO ID:1311299990 CCD continued on the next page x Greater efficiency starts with an easy shift sankofAmerica- to web based check deposits. Memillyn`li Deposit checks electronically right from your desktop,with Remote Deposit Service Online.Simply scan your checks using a bank-provided scanner to transmit the images and data to us online.Potential benefits - x*ham may include faster access to cash with fewer trips to the bank. bankofamerica.com/remotedepositservice Page 3 of 18 . A-Z MASONRY INC I Account# 1 November 1,2013 to November 30,2013 = Withdrawals and other debits - continued Date Transaction description Customer reference Bank reference Amount 11/07/13 PAYCOR INC. DES:Pay fund -2,037.45 ID:CF0002073382 INDN:A-Z MASONRY INC g76,9/ CO ID:1362739571 CTX ADDITIONAL INFORMATION IS AVAILABLE FOR THIS PMT. CONTACT A TREASURY SALES OFFICER FOR ASSISTANCE. Total withdrawals and other debits -$9,908.99 Parse 4 of 18 * . ''1,7:P Your checking account Bank of erica A-Z MASONRY INC 1 Account# I November 1,2013 to November 30,2013 Checks Date Check# Bank reference Amount Date Check# Bank reference Amount 11/01 24125 -10,951.00 I continued on the next page V Da6a C nr 1 R A-Z MASONRY INC I Account# I November 1,2013 to November 30,2013 ' ° c - continued • Date Check# -94.93 Total checks -$629,488.52 Total #of checks 111 * There is a gap in sequential check numbers Service fees Date _ Transaction description Amount 11/15/13 10/13 ACCT ANALYSIS FEE -49.81 Total service fees $49.81 Note your Ending Balance already reflects the subtraction of Service Fees. Daily ledger balances Date Balance($) Date Balance(S) Date Balance(S) 11/01 361,594.00 11/13 317,926.19 11/21 351,120.95 11/04 324,262.23 11/14 316,699.20 11/22 290255.08 11/05 242,997.45 11/15 440,000.58 11/25 278,870.87 11/06 317,107.45 11/18 439,107.50 11/26 371,960.80 —11/07 315,341.44 11/19 477,209.69 11/27 321,406.66 11/08 426,325.71 11/20 425,842.11 11/29 421,743.77 11/12 314,355.68 ParspFnf1R Primary account number: • November 1,2013-November 30,2013 ■ Page 2 of 8 WELLS . FARGO • Platinum Business Services Package Activity summary Account number: Beginning balance on 11/1 $50,537.65 RAZ CONSTRUCTION LLC Deposits/Credits 35,125.45 Florida account terms and conditions apply Withdrawals/Debits - 53,249.40 For Direct Deposit and Automatic Payments use Ending balance on 11/30 $32,413.70 Routing Number(RTN): 063107513 For Wire Transfers use Average ledger balance this period $37,120.81 Routing Number(RTN): 121000248 Overdraft Protection Your account is linked to the following for Overdraft Protection: a Credit Card - interest summary Interest paid this statement $0.45 Average collected balance $35,954.14 Annual percentage yield earned 0.02% Interest earned this statement period $0.45 Interest paid this year $0.90 Transaction history Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance 11/1 10208 Cashed Check 278.59 g 11/1 10209 Check 793.05 o 11/1 10211 Check 662.89 ° 11/1 10219 Check 507.68 11/1 10212 Check 417.39 47,878.05 11/4 10218 Cashed Check 393.05 11/4 10220 Check 560.75 11/4 10215 Check 440.90 11/4 10225 Check 433.41 425.39 r. 11/4 10214 Check 11/4 10221 Check 373.67 11/4 10217 Check 367.38 11/4 10213 Check 348.06 11/4 10223 Check 348.05 11/4 10222 Check 333.38 11/4 10216 Check 312.55 11/4 10224 Check 297.22 43,244.24 11/5 Deposit 10,000.00 • 11/5 10189 Check 473.30 11/5 10227 Check 180.00 11/5 10210 Check 73.88 11/5 WF Bus Credit Auto Pay 131105 90225231560056 25.00 51,701.70 Zielinski,Robert 11/6 10205 Check 13,148.72 38,552.98 11/7 10206 Check 1,652.86 36,900.12 Wells Fargo Combined Statement of Accounts Primary account number: • November 1,2013-November 30,2013 • Page 1 of 8 WEILS FARGO 000770 1 AV 0.360 1256584 Questions? e t 11 l utn[t 1ht t Il l 1t Il[I[I 11111 i u.l I.L . t litlt 11 xRAZ CONSTRUCTION LLC Available by phone 24 hours a day,7 days a week: 1601 JACKSON ST STE 202 1-800-CALL-WELLS (1-800-225-5935) FORT MYERS FL 33901-2968 TTY: 1-800-877-4833 En espanol: 1-877-337-7454 Online:wellsfargo.com/biz Write: Wells Fargo Bank,N.A.(287) P.O.Box 6995 Portland,OR 97228-6995 n r Your Business and Wells Fargo Account options Applying for financing can seem like a numbers game of credit scores and A check mark in the box indicates you have these convenient financial statements.Find out what lenders are really looking for at services with your account. Go to wellsfarga.com/biz or call o wellsfargobusinessinsights.com/lenders. the number above if you have questions or if you would like to add new services. z z Business Online Banking 0 z Online Statements © z Business Bill Pay ❑ z z Business Spending Report IS z Overdraft Protection 12 z z z z 0 0 0 Summary of accounts 0 0 C.) CO Checking/Prepaid and Savings CO Ending balance Ending balance 8 0 Account Page Account number last statement this statement Platinum Business Services Package 2 119.01 144.02 �, Total deposit accounts $50,656.66 $32,557.72 Primary account number: • November 1,2013-November 30,2013 ■ Page 4 of 8 Li1S. • F' GO Transaction history (continued) Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance 11/27 10292 Check 370.95 11/27 10291 Check 346.66 11/27 10279 Check 345.39 11/27 10286 Check 333.95 11/27 10287 Check 328.99 11/27 10283 Check 326.22 11/27 10294 Check 323.54 11/27 10293 Check 311.68 35,375.49 11/29 to Florida act, Citrus B Payment 131126 41 681 624 Raz Construction LLC 2,113.00 11/29 10285 Check 455.52 11/29 10282 Check 393.72 11/29 Interest Payment 0.45 32,413.70 Ending balance on 11/30 32,413.70 Totals $35,125.45 $53,249.40 The Ending Daily Balance does not reflect any pending withdrawals or holds on deposited funds that may have been outstanding on your account when your transactions posted. If you had insufficient available funds when a transaction posted,fees may have been assessed. Summary of checks written(checks listed are also displayed in the preceding Transaction history) Number Date Amount Number Date Amount Number Date Amount 10189 11/5 473.30 10234 11/12 598.60 10262 11/22 345.40 10205* 11/6 13,148.72 10235 11/12 289.60 10263 11/22 793.06 10206 11/7 1,652.86 10236 11/12 393.70 10264 11/25 662.89 10208* 11/1 278.59 10237 11/8 419.15 10265 11/25 392.18 10209 11/1 793.05 10238 11/8 449.75 10266 11/25 265.97 10210 11/5 73.88 10239 11/12 596.91 10267 11/25 396.18 10211 11/1 662.89 10240 11/12 437.85 10268 11/25 426.28 10212 11/1 41739 10241 11/12 335.81 10269 11/25 312.55 10213 11/4 348.06 10242 11/12 372.98 10270 11/25 324.62 10214 11/4 425.39 10243 11/12 349.72 10271 11/25 368.17 0 0 10215 11/4 440.90 10244 11/12 310.30 10272 11/22 419.12 °' 0 10216 11/4 312.55 10245 11/15 249.35 10273 11/25 522.23 ^' 10217 11/4 367.38 10246 11/15 793.06 10274 11/25 301.65 10218 11/4 393.05 10247 11/15 662.88 10275 11/25 347.55 10219 11/1 507.68 10248 11/15 461.91 10276 11/25 307.53 10220 11/4 560.75 10249 11/18 388.56 10277 11/25 288.99 10221 11/4 373.67 10250 1-1/18 469.90 10278 11/25 358.78- 10222 11/4 333.38 10251 11/18 401.58 10279 11/27 345.39 10223 11/4 348.05 10252 11/18 355.34 10281* 11/26 662.89 10224 11/4 29712 10253 11/18 410.15 10282 11/29 393.72 10225 11/4 433.41 10254 11/21 333.39 10283 11/27 326.22 10227* 11/5 180.00 10255 11/15 449.75 10284 11/27 380.95 10228 11/8 345.39 10256 11/18 637.11 10285 11/29 455.52 10229 11/8 793.06 10257 11/18 400.69 10286 11/27 333.95 ` ;!} 10230 11/8 662.89 10258 11/18 393.34 10287 11/27 328.99 10231 11/8 444.86 10259 11/18 38856 10288 11/26 355.63 10232 11/12 372.98 10260 11/18 369.96 10289 11/26 403.80 10233 11/12 452.88 10261 11/18 383.87 10291* 11/27 346.66 Primary account number: • November 1,2013-November 30,2013 ■ Page 3 of 8 WELLS FAR G (, Transaction history (continued) Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance 11/8 10228 Cashed Check 345.39 11/8 10237 Cashed Check 419.15 11/8 10229 Check 793.06 11/8 10230 Check 662.89 11/8 10238 Check 449.75 11/8 10231 Check 444.86 33,785.02 11/12 10234 Check 598.60 11/12 10239 Check 596.91 11/12 10233 Check 452.88 11/12 10240 Check 437.85 11/12 10236 Check 393.70 11/12 10232 Check 372.98 11/12 10242 Check 372.98 11/12 10243 Check 349.72 11/12 10241 Check 335.81 11/12 10244 Check 310.30 11/12 10235 Check 289.60 29,273.69 n 11/13 Deposit 10,000.00 39,273.69 c 11/15 Recurring Transfer to Raz Construction LLC Business Market Rate 150.00 Savings Ref#Ope2Kvn6Wx xxxxxx8994 c 11/15 10245 Cashed Check 249.35 -I 11/15 10246 Check 793.06 0 11/15 10247 Check 662.88 o 11/15 10248 Check 461.91 o 11/15 10255 Check 449.75 36,506.74 11/18 Recurring Transfer From Raz Construction LI Business Market 125.00 z Rate Savings Ref#OpeSGxxmc2 xxxxxx8994 z 11/18 10256 Check 637.11 Z 11/18 10250 Check 469.90 z 11/18 10253 Check 410.15 z 11/18 10251 Check 401.58 z z 11/18 10257 Check 400.69 z 11/18 10258 Check 393.34 z 11/18 10249 Check 38856 0 11/18 10259 Check 388.56 0 11/18 10261 Check 383.87 11/18 10260 Check 369.96 N 11/18 10252 Check 355.34 32,032.68 0 11/20 Deposit 5,00.0.00 37,032.68 2 11/21 10254 Check 333.39 36,699.29 0 11/22 10262 Cashed Check 345.40 11/22 10263 Check 793.06 0 11/22 10272 Check 419.12 35,141.71 11/25 10264 Check 662.89 4> 11/25 -Cheek heck 522:23 A 11/25 10268 Check 426.28 11/25 10267 Check 396.18 11/25 10265 Check 392.18 11/25 10271 Check 368.17 11/25 10278 Check 358.78 11/25 10275 Check 347.55 11/25 10270 Check 324.62 11/25 10269 Check 312.55 11/25 10276 Check 307.53 11/25 10274 Check 301.65 11/25 10277 Check 288.99 11/25 10266 Check 265.97 29,866.14 11/26 Deposit 10,000.00 11/26 10288 Cashed Check 355.63 11/26 10281 Check 662.89 11/26 10289 Check 403.80 38,443.82 11/27 10264 Check 380.95 Primary account number: • November 1,2013-November 30,2013 ■ Page 6 of 8 WELLS- . 1 F Business Market Rate Savings Activity summary Account number: Beginning balance on 11/1 $119.01 RAZ CONSTRUCTION!LC Deposits/Credits 150.01 Florida account terms and conditions apply Withdrawals/Debits - 125.00 For Direct Deposit and Automatic Payments use Routing Number(RTN): 063107513 Ending balance on 11130 $144.02 For Wire Transfers use Average ledger balance this period $144.84 Routing Number(RTN): 121000248 Interest summary Interest paid this statement $0.01 Average collected balance $144.84 Annual percentage yield earned 0.08% Interest earned this statement period $0.01 Interest paid this year $0.02 Transaction history Deposits/ Withdrawals/ Ending daily Date Description Credits Debits balance 11/15 Recurring Transfer From Raz Construction LI Business Checking Ref 150.00 269.01 4lOpe2Kvn6Wx xxxxxx7777 11/18 *Recurring Transfer to Raz Construction LLC Business Checking Ref 125.00 144.01 llOpe5Gxxmc2 xxxxxx7777 11/29 ' Interest Payment 0.01 144.02 Ending balance on 11/30 144.02 0 Totals $150.01 $125.00 co The Ending Daily Balance does not reflect any pending withdrawals or holds on deposited hinds that may have been outstanding on your account when your co a transactions posted.If you had insufficient available funds when a transaction posted,fees may have been assessed. * Indicates transactions that count toward Federal Reserve Board Regulation D limits. Please refer to your Account Agreement for complete details of the federally-mandated transaction limits for savings accounts. Monthly service fee summary For a complete list of fees and detailed account information,please see the Wells Fargo Fee and Information Schedule and Account Agreement applicable to your account or talk to a banker.Go to wellsfargo.com/feefaq to find answers to common questions about the monthly service fee on your account. Fee period 11/01/2013-11/30/2013 Standard monthly service fee$6.00 You paid$0.00 How to avoid the monthly service fee Minimum required This fee period Have any ONE of the following account requirements • Average collected balance $500.00 $145.00 ❑ ` • Automatic transfer from an eligible Wells Fargo business checking account $10(100 $150.00 J 1 YCNC Primary account number: • November 1,2013-November 30,2013 is Page 5 of 8 'WELLS Summary of checks written (continued) Number Date Amount Number Date Amount Number Date Amount 10292 11/27 370.95 10293 11/27 311.68 10294 11/27 323.54 *Gap in check sequence. Monthly service fee summary For a complete list of fees and detailed account information,please see the Wells Fargo Fee and Information Schedule and Account Agreement applicable to your account or talk to a banker.Go to wellsfargo.comlfeefaq to find answers to common questions about the monthly service fee on your account. Fee period 11/01/2013-11/30/2013 Standard monthly service fee$30.00 You paid$0.00 How to avoid the monthly service fee(complete 1 AND 2) Minimum required This fee period 1)Have any ONE of the following account requirements • Average ledger balance $25,000.00 $37,121.00 [j • Combined balances in linked accounts,which may include $40,000.00 ❑ - Average ledger balances in business checking,savings,and time accounts - Most recent statement balances of:business credit card,Wells Fargo Express 0 Equity°and BusinessLine°lines of credit,Wells Fargo BusinessLoan°term loan o - Average daily balances from previous month in business PrimeLine`line of j credit and Business PrimeLoan"account,Wells Fargo Express Equity`,SBA,and c Equipment Express'loans x 2)Complete the package requirements ° c, • Have qualifying linked accounts or services in separate categories* 3 El o v *Includes Wells Fargo business accounts and services such as debit card,savings accounts,active Online Banking,credit card,loans and lines of credit. z WWI( z z z Account transaction fees summary z Units Excess Service charge per Total service z Service charge description Units used included units excess units($) charge($) z Transactions 98 400 0 0.50 0.00 z 0 Total service charges $0.00 0 0 A Al CO v 0 O W 0 O W 0 V EaDid you know that you can review your safe deposit box information through Wells Fargo Business Online Banking?Sign onto - t business onTinebanking al-Wellsfargo.com/biz and go to your account siJmmary page to review details. p Primary account number: • November 1,2013-November 30,2013 ■ Page 8 of 8 WELD F " O` General statement policies for Wells Fargo Bank Notice: Wells Fargo Bank,N.A.may furnish information about accounts You must describe the specific information that is inaccurate or in dispute belonging to individuals,including sole proprietorships,to consumer and the basis for any dispute with supporting documentation. In the case of reporting agencies. If this applies to you,you have the right to dispute the information that relates to an identity theft,you will need to provide us with accuracy of information that we have reported by writing to us at: Overdraft an identity theft report. Collections and Recovery,P.O.Box 5058,Portland,OR 97208-5058. Account Balance Calculation Worksheet Number Items Outstanding Amount 1. Use the following worksheet to calculate your overall account balance. 2. Go through your register and mark each check,withdrawal,ATM transaction,payment,deposit or other credit listed on your statement. Be sure that your register shows any interest paid into your account and any service charges,automatic payments or ATM transactions withdrawn from your account during this statement period. 3. Use the chart to the right to list any deposits,transfers to your account, outstanding checks,ATM withdrawals,ATM payments or any other withdrawals(including any from previous months)which are listed in � your register but not shown on your statement. I II ENTER A.The ending balance shown on your statement I I I � i ADD B. Any deposits listed in your register or transfers into your account which are not shown on your statement. + $ TOTAL $ j f � i 1 CALCULATE THE SUBTOTAL (Add Parts A and B) TOTALS � o SUBTRACT I 0 C. The total outstanding checks and I withdrawals from the chart above - $ CALCULATE THE ENDING BALANCE i I i (Part A+Part B-Part C) This amount should be the same I ( { as the current balance shown in your check register $ Total amount$ • O2010 Wells Wells Fargo Bank,N.A.All rights reserved.Member FDIC NMLSR ID 399801 Primary account number: • November 1,2013-November 30,2013 ■ Page 7 of 8 WET.T S. FARGO 1 IMPORTANT ACCOUNT INFORMATION Online and Telephone Transfers from a Savings Account May Be Declined Beginning December 11,2013,transfers from this savings account through online banking(including mobile and text)or by telephone may be declined for the remainder of the monthly statement period if the federal limit of six(6)transfers is reached.We are taking this step to help customers stay within the federal limit. As stated in your Account Agreement,most transfers from savings accounts are limited by Regulation D to six(6)per month including transfers for overdraft protection coverage,online banking,or by telephone(automated and banker assisted).If the limit is exceeded, an excess activity fee applies and the account may be converted to a checking account. There are no limits on transfers or withdrawals made in person at ATMs or Wells Fargo banking locations or on any types of deposits. If you have questions,please contact your local banker or call the phone number on the top of your statement. 0 C --I 0 0 0 GoV O z z z z z z z z z z z z z z z z O O O O v O O O O N ...____— - -____.. ..__ ._--- 01 Wells Fargo Combined Statement of Accounts LS Primary account number: • December 1,2013-December 31,2013 ■ Page 1 of 7 F GO. ry 028599 1 AV 0.360 1399682 Questions? 1I111IIi1IIIIIII1jlI1nILI14hrirplhillflii11,11 tilli1t1(ti`1i Available by phone 24 hours a day,7 days a week ' 1601 CONSTRUCTION ACKS ST S 202 1-800-CALL-WELLS (1-800-225-5935) �'•�'� 1 b01 JACKSON ST STE 202 TTY: 1-800-877-4833 FORT MYERS FL 33901-2968 En espanol: 1-877-337-7454 Online: wellsfargo.com/biz Write: Wells Fargo Bank,N.A.(287) P.O.Box 6995 Portland,OR 97228-6995 0 O 0 _r _r, Business and Wells Fargo Account options C I Acheckmarkintheboxindicatesyouhavetheseconvenient Getting ready for tax season can be a challenge!Creating a checklist,and services with your account. Go to wellsfargo.com/bizorcall ip preparing in advance will set you up for a successful meeting with your tax the number above if you have questions or if you would like m to add new services. z preparer.Remember to bring your deposit routing and account number when z Business Online Banking In accounts. preparing your taxes and you may be able to take advantage of using direct z z deposit for your tax refund into one of your Wells Fargo checking or savings Online Statements SI z z 0 z Business Bill Pay z z Business Spending Report 12 Overdraft Protection 0 zz z z z 0 0 e, 0 Your statement includes a"Monthly service ou fee summary"section that gives you the with the view of your checking or savings'acco unt roactively service feeethenthly service fee on your account.This section provides y view this g information our statement the monthly rl nservice ecurefo applicable,and the online banking sessionrby clicking f View Monthly Service Fee" n the left-hand 1 information on your you'd like your o navigation bar.If you'd like to schedule an account review or to learn about other accounts or services we offer,please contact Wells o Fargo at 1-800-225-5935 or visit your local Wells Fargo store. A 0. Summary of accounts Checking/Prepaid and Savings Ending balance Ending balance laststatemenT this statement Page Account number 24,939.09 Account 144.02 169.02 Business Market Rate Savings 5 $32,557 72 $25,108.11 Total deposit accounts Primary account number: • December 1,2013-December 31,2013 ■ Page 2 of 7 WELLS FARGO Platinum Business Services Package Activity summary Account number: Beginning balance on 12/1 $32,413.70 RAZ CONSTRUCTION LLC Deposits/Credits 21,125.12 Florida account terms and conditions apply Withdrawals/Debits - 28,599.73 For Direct Deposit and Automatic Payments use Ending balance on 12/31 S24,939.09 Routing Number(RTN):063107513 For Wire Transfers use Average ledger balance this period $28,175.29 Routing Number(RTN): 121000248 Overdraft Protection Your account is linked to the following for Overdraft Protection: IN Credit Card - XXXX-XXXX-XXXX- Interest summary interest paid this statement $0.12 Average collected balance $27,175.29 Annual percentage yield earned 0.01% Interest earned this statement period $0.12 Interest paid this year $1.02 Transaction history Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance 12/2 10290 Check 525.60 12/2 10295 Check 344.23 315 0 43.87 m c. 12/6 Deposit 5,000.00 12/6 10298 Cashed Check 27839 12/6 10280 Check 793.05 12/6 10300 Check 662.89 12/6 10310 Check 180.09 34,629.25 12/9 Florida Citrus B Payment 131205 43196028 Raz Construction LLC 2,004.00 12/9 First Insurance Wuspcustdr 131206 1800142 RazConstruction 790.36 LLC 12/9 10309 Check 395.03 12/9 10301 Check 322.54 12/9 10304 Check - 282.59 12/9 10308 Check 248.20 12/9 10305 Check 244.27 12/9 - 10303 Check 226.02 12/9 10314 Check — - 208.49 17 12/9 10311 Check 203_.... .._ __. _ .. --- _ ... . •. !� 12/9 - 10307 Check 193.93 �: 12/9 10312 Check 187.01 + 12/9 10313 Check 176.70 12/9 10306 Check 175.47 12/9 10302 Check 166.23 12/9 WF Bus Credit Auto Pay 131206 90225231560056 1528 28,789.96 Zielinski,Robert • 12/12 10299 Check 793.06 27,996.90 12/13 10316 Cashed Check 278.59 .Primary account number: • December 1,2013-December 31,2013 ■ Page 3 of 7 'WELLS, FARGO Transaction history (continued) Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance 12/13 10317 Check 793.06 12/13 10318 Check 662.88 12/13 10326 Check 377.94 12/13 10319 Check 335.23 25,549.20 12/16 Recurring Transfer to Raz Construction LLC Business Market Rate 150.00 Savings Ref#Ope2L5Hb4M xxxxxx8994 12/16 10327 Check 475.36 12/16 10322 Check 411.66 12/16 10321 Check 335.24 12/16 10328 Check 330.23 12/16 10323 Check 316.63 12/16 10324 Check 298.29 12/16 10330 Check 288.99 12/16 10320 Check 274.29 12/16 10329 Check 274.28 22,394.23 12/17 Recurring Transfer From Ra_Construction LI Business Market 125.00 22,519.23 Rate Savings Ref#Opexnmj2Vv xxxxxx8994 12/18 Deposit osit_ 10,000.00 Q __12/18 10331 Check 319.99 32,199.24 12/20 10332 Cashed Check 323.46 12/20 10333 Check 793.06 m 12/20 10334 Check 662.89 cv 12/20 10342 Check 373.17 co co co 12/20 10335 Check 337.77 29,708.89 12/23 10341 Cashed Check 225.45 Z 12/23 10325 Cashed Check 316.00 z -.. 12/23 10343 Check 438.56 z - _ $8 12/23 10338 Check 408.315.15 z 12/23 10347 Check 312.37 z 12/23 10337 Check 12/23 10344 Check 309.37 z 12/23 10339 Check 276.38 Z 12/23 10340 Check 274.17 z 12/23 10346 Check 263.99 N 12/23 10336 Check 255.58 0 12/23 10345 Check 255.58 26,057.41 °A 12/26 First Insurance Wuspcustdr 131224 1800142 Raz Construction 790.36 25,267.05 m 1�3+�4 LLC 12/27 10348 Cashed Check 263.97 o 12/27 10349 Check 793.05 CD ro 12/27 10350 Check edc 662. 9 12/27 10358 Check 440.21 0 12/27 10351 Check 377.94 22,728.99 0 12/30 Deposit 6,000.00 A 12/30 10359 Check 600.93 12/30 10354 Check 462.84 12/30 10355 Check 399.67 12/30 10353 Check 380.94 12/30 10363 Check 376.17 12/30 10360 Check 370.94 12/30 10356 Check 328,99 12/30 10361 Check 311.68 12/30 10352 Check 311.67 12/30 10362 Check 246.19 24,938.97 12/31 Interest Payment 0.12 24 939.09 Ending balance on 12/31 24,939.09 Totals $21,125.12 $28,599.73 The Ending Daily Balance does not reflect any pending withdrawals or holds on deposited funds that may have been outstanding on your account when your transactions posted.If you had insufficient available funds when a transaction posted,fees may have been assessed. Primary account number: • December 1,2013-December 31,2013 ■ Page 4 of 7 , WELLS ERGO; Summary of checks written(checks listed are also displayed in the preceding Transaction history) Number Date Amount Number Date Amount Number Date Amount 10280 12/6 793.05 10319 12/13 335.23 10341 12/23 225.45 10290• 12/2 525.60 10320 12/16 274.29 10342 12/20 373.17 10295* 12/2 344.23 10321 12/16 335.24 10343 12/23 438.56 10298* 12/6 278.59 10322 12/16 411.66 10344 12/23 309.37 10299 12/12 793.06 10323 12/16 316.63 10345 12/23 255.58 10300 12/6 662.89 10324 12/16 298.29 10346 12/23 263,99 10301 12/9 322.54 10325 12/23 316.00 10347 12/23 315.15 10302 12/9 166.23 10326 12/13 377.94 10348 12/27 263.97 10303 12/9 226.02 10327 12/16 475.36 10349 12/27 793.05 10304 12/9 282.59 10328 12/16 330.23 10350 12/27 662.89 10305 12/9 244.27 10329 12/16 274.28 10351 12/27 377.94 10306 12/9 175.47 10330 12/16 288.99 10352 12/30 311.67 10307 12/9 193.93 10331 12/18 319.99- 10353 12/30 380.94 10308 12/9 248.20 10332 12/20 323.46 10354 12/30 462.84 10309 12/9 395.03 10333 12/20 793.06 10355 12/30 399.67 10310 12/6 180.09 10334 12/20 662.89 10356 12/30 328.99 10311 12/9 203.17 10335 12/20 337.77 10358* 12/27 440.21 10312 12/9 187.01 10336 12/23 255.58 10359 12/30 600.93 10313 12/9 176.70 10337 12/23 312.37 10360 12/30 370.94 10314 12/9 208.49 10338 12/23 408.88 10361 12/30 311.68 10316* 12/13 278.59 10339 12/23 276.38 10362 12/30 246.19 10317 12/13 793.06 10340 12/23 274.17 10363 12/30 376.17 10318 12/13 662.88 *Gap in check sequence. Monthly service fee summary For a complete list of fees and detailed account information,please see the Wells Fargo Fee and Information Schedule and Account Agreement applicable to 1 your account or talk to a banker.Go to wellsfargo.com/feefaq to find answers to common questions about the monthly service fee on your account. o R c, Fee period 12/01/2013-12/31/2013 Standard monthly service fee$30.00 You paid$0.00 Now to avoid the monthly service fee(complete 1 AND 2) Minimum required This fee period 1)Have any ONE of the following account requirements • Average ledger balance $25,000.00 $28,175.00 la • Combined balances in linked accounts,which may include $40,000.00 El - Average ledger balances in business checking,savings,and time accounts - Most recent statement balances of:business credit card,Wells Fargo Express Equity°and BusinessLine°lines of credit,Wells Fargo BusinessLoan°term loan - Average daily balances from previous month in business PrimeLine*line of credit and Business PrimeLoan'°account,Wells Fargo Express Equity°,SBA,and Equipment Express'loans 2)Complete the package requirements • Have qualifying linked accounts or services in separate categories* 3 Q *Includes Wells Fargo business accounts and services such as debit card,savings accounts,active Online Banking,credit card,loans and lines of credit.YJ . Primary account number: • December 1,2013-December 31,2013 ■ Page 5 of 7 WELLS FRS' Account transaction fees summary Units Excess Service charge per Total service Service charge description Units used included units excess units($) charge($) Transactions 77 400 0 0.50 0.00 Total service charges $0.00 CaDid you know that you can review your safe deposit box information through Wells Fargo Business Online Banking?Sign on to business online banking at wellsfargo.com/biz and go to your account summary page to review details. ca o Business Market Rate Savings Activity summary Account number: N CO Beginning balance on 12/1 $144.02 RAZ CONSTRUCTION LLC (0 z Deposits/Credits 150.00 Florida account terms and conditions apply z Withdrawals/Debits - 125.00 For Direct Deposit and Automatic Payments use z Routing Number(RN):063107513 z Ending balance on 12/31 $169.02 z For Wire Transfers use z z Average ledger balance this period $160.95 Routing Number(RTN): 121000248 z z z z z v 0 Interest summary m o Interest paid this statement $0.00 A N Average collected balance $160.95 oa Annual percentage yield earned 0.00% o(0 Interest earned this statement period $0.00 j Interest paid this year $0.02 v-9 rn A rn •A Primary account number: • December 1,2013-December 31,2013 ■ Page 6 of 7 WELLS FARGO Transaction history Deposits! Withdrawals! Ending daily Date Description Credits Debits balance 12/16 Recurring Transfer From Raz Construction LI Business Checking Ref 150.00 294.02 #Ope2L5Hb4M xxxxxx7777 12/17 *Recurring Transfer to Raz Constructi on LLC Business Checking Ref 125.00 169.02 #Opexnmj2Vv xxxxxx7777 Ending balance on 12/21 169.02 Totals $150.00 $125.00 The Ending Daily Balance does not reflect any pending withdrawals or holds on deposited funds that may have been outstanding on your account when your transactions posted. if you had insufficient available funds when a transaction posted,fees may have been assessed. Indicates transactions that count toward Federal Reserve Board Regulation Dlimits. Please refer to your Account Agreement for complete details of the federally-mandated transaction limits for savings accounts. Monthly service fee summary For a complete list of fees and detailed account information,please see the Wells Fargo Fee and Information Schedule and Account Agreement applicable to your account or talk to a banker.Go to wellsfargo.com/feefaq to find answers to common questions about the monthly service fee on your account. Fee period 12/01/2013-12/31/2013 Standard monthly service fee$6.00 You paid$0.00 How to avoid the monthly service fee Minimum required This fee period Have any ONE of the following account requirements • Average collected balance $500.00 $161.00 0 • Automatic transfer from an eligible Wells Fargo business checking account $100.00 $150.00 El YCivC IMPORTANT ACCOUNT INFORMATION 0, CD Online and Telephone Transfers from a Savings Account May Be Declined Beginning December 11,2013,transfers from this savings account through online banking(including mobile and text)or by telephone may be declined for the remainder of the monthly statement period if the federal limit of six(6)transfers is reached.We are taking this step to help customers stay within the federal limit. As stated in your Account Agreement,most transfers from savings accounts are limited by Regulation D to six(6)per month including transfers for overdraft protection coverage,online banking,or by telephone(automated and banker assisted).If the limit is exceeded, an excess activity fee applies and the account may be converted to a checking account. There are no limits on transfers or withdrawals made in person at ATMs or Wells Fargo banking locations or on any types of deposits. If you have questions,please contact your local banker or call the phone number on the top of your statement. We want to let you know of the following fee change effective April 1,2014: -Collections-Domestic:Auto Draft-$25 per item If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. .Primaryaccount number: • December 1,2013-December 31,2013 ■ Page 7 of 7 WELLS . FARE:. General statement policies for Wells Fargo Bank ■Notice: Wells Fargo Bank,N.A.may furnish information about accounts You must describe the specific information that Is inaccurate or in dispute belonging to individuals,including sole proprietorships,to consumer and the basis for any dispute with supporting documentation, In the case of reporting agencies. If this applies to you,you have the right to dispute the information that relates to an identity theft,you will need to provide us with accuracy of information that we have reported by writing to us at: Overdraft an identity theft report. Collections and Recovery,P.O.Box 5058,Portland,OR 97208-5058. Account Balance Calculation Worksheet Number Items Outstanding Amount 1. Use the following worksheet to calculate your overall account balance. 1 1 2. Go through your register and mark each check,withdrawal,ATM ( - transaction,payment,deposit or other credit listed on your statement. Be sure that your register shows any interest paid into your account and -- - -- -- l any service charges,automatic payments or ATM transactions withdrawn _ _ _ from your account during this statement period. _ 3. Use the chart to the right to list any deposits,transfers to your account, 7.._ _outstanding chf-rks,ATMwithdrawals,ATM.payments-or any_other _ - —L._ L_ withdrawals(including any from previous months)which are listed in n a your register but not shown on your statement. 0 ENTER - -_ co A.The ending balance i ° _ - - ` N shown on your statement $ I -` CD m ADD z Z B. Any deposits listed in your $ register or transfers into $ z z your account which are not $ ` z shown on your statement. + $ _=- z z TOTAL $ I —_ z CALCULATE THE SUBTOTAL z z (Add Parts A and B) I � A - O TOTAL $ _ ` a 1 �° ra SUBTRACT -4 C. The total outstanding checks and -_ _ o co withdrawals from the chart above - $ = A CALCULATE THE ENDING BALANCE c (Part A+Part B Part C) -_ - - - - - - _ This amount should be the same �� i as the current balance shown in 4:.i your check register $ °" I - Total amount $ 02010 Wells Fargo Bank,NA All rights reserved.Member FDIC.NMLSR ID 399801 - Wells Fargo Combined Statement of Accounts .Primary account number: • January 1,2014-January 31,2014 • Page 1 of 8 "WELLS FAE.,G0 035332 1 AV 0.381 1613530 Hit uhiIuildilllIIl"II'III'111111 uill'IlhIlu11111II1II1Ih"I Questions? 4a' ` RAZ CONSTRUCTION LLC Available by phone 24 hours a day,7 days a week: tiLV 1601 JACKSON ST STE 202 1-800-CALL-WELLS (1-800-225-5935) FORT MYERS FL 33901-2968 TTY: 1-800-877-4833 En espanol: 1-877-337-7454 Online: wellsfargo.corn/biz Write: Wells Fargo Bank,N.A.(287) P.O.Box 6995 Portland,OR 97228-6995 0 0 Your Business and Wells Fargo Account options Getting ready for tax season can be a challenge!Creating a checklist,and A check mark in the box indicates you have these convenient c preparing in advance will set you up for a successful meeting with your tax services with your account. Go to wellsfargo.com/biz or coil preparer.Remember to bring your deposit routing and account number when the number above if you hove questions orif you would like N to add new services. Z preparing your taxes and you may be able to take advantage of using direct Z deposit for your tax refund into one of your Wells Fargo checking or savings Business Online Banking 0 z accounts. Online Statements © z Business Bill Pay Z Business Spending Report Q z Overdraft Protection 0 z z z z 0 o_ 0 0 Summary of accounts v a, Checking/Prepaid and Savings Ending balance Ending balance Account Page Account number last statement this statement 1=1 co Platinum Business Services-Package - 2 169.02 194.03 ° Total deposit accounts $25,108.11 536,270.38 Primary account number: • January 1,2014-January 31,2014 IN Page 2 of 8 WELLS ... FARGO Platinum Business Services Package Activity summary Account number: Beginning balance on 1/1 $24,939.09 RAZ CONSTRUCTION LLC Deposits/Credits 80,125.72 Florida account terms and conditions apply Withdrawals/Debits -68,988.46 For Direct Deposit and Automatic Payments use Ending balance on 1131 $36,076.35 Routing Number(RTN): 063107513 For Wire Transfers use Average ledger balance this period $41,792.33 Routing Number(RTN): 121000248 Overdraft Protection Your account is linked _ Interest summary Interest paid this statement $0.72 Average collected balance $40,824.59 Annual percentage yield earned 0.02% Interest earned this statement period $0.72 Interest paid this year $0.72 Total interest paid in 2013 $1.02 Transaction history Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance - ol 1/3 10368 Cashed Check 263.96 o 1/3 10369 Check 79406 1/3 10370 Check 664.89 1/3 10371 Check 422.20 1/3 10378 Check 363.63 22,430.35 1/6 10377 Cashed Check 346.93 1/6 - 10357 Cashed Check 35563 „„ 1/6 10379 Check 523.94 1/6 10374 Check 449.22 1/6 10373 Check 370.79 11//66 /6 10380 Check 361.79 1/6 10376 Check 337.77 . ,.. 1/6 10375 Check 325.79 1/6 10381 Check 320 00 1/6 10382 Check 309.08 1/6 10372 Check 249.34 1/6 10383 Check '� 225 00 . 0 ' 1/6 WF Bus Credit Auto Pa 14010690225231560056 78,236.74 Pay . Zielinski Robert 1/7 Deposit 10,000 00 28,236.74 1/10 10384 Cashed Check 263.9.8 1/10 10385 Check 794.05 1/10 10386 Check 664.88 1/10 10394 Check 430.66 26,083.17 1/13 10393 Cashed Check 364.32 - Primary account number: • January 1,2014-January 31,2014 • Page 3 of 8 WELLS • FARGO Transaction history (continued) Check Deposits! Withdrawals/ Ending daily Date Number Description Credits Debits balance 1/13 10389 Check 497.38 489.39 1/13 10387 Check .. . ......... .. .. .... . .. ...........1/13 _ 488.76 1/13 10395 Check _-.,__. . ,.._...,._ __�,....- -,_,-._ 1/13 10390 Check 478.45 ..:....__.... ...- . __-_-.. 1/13 10392 Check _.:, . ,:-:: � 436.47 377.43 1/13 10396 Check __.. 1/13 10391 Check 361.00 1/13 10388 Check 320.00 ..._w _.- .:.. .,,. _ .__.. 319.98 1/13 10397 Check .-.. _.. 1/13 10398 Check 293.60 _�_ , 167.47 21,488.92 1/13 10399 Check _....._.. ..____. _... _.._.. _ 1/15 Recurring Transfer to Raz Construction LLC Business Market Rate 150.00 Savings Ref#Opek3Nds4F xxxxxx8994 Florida 01_. 1 252.00 20,086.92 1/15 F Gtrus B Payment 140113 49631878 Raz Construction LLC 1/16 Deposit 50 000 00 1/16 �_ - Q°Po u - - 10 000.00 __.. 80 086.92 1/17 Recurring Transfer From Raz Construction LI Business Market 125.00 n Rate Savings Ref#O a 6M 203 x 0000(8994 ci 1/17 10401 Cashed Check 345.39 1/17 10403 Check 794.06 1/17 10404 Check _ _......_ 664.89 c 1/17 10412 Check 501.03 77 906.55 0 05 1/21 10411 Cashed Check 465. °' 1/21 10414 Check 682.32 N 1R1 10408 Check 537.96 T/21 10407 Check 517.24 1/21 10405 Check 510.23 474.51 z 1/21 10410 Check z __. __. ,._,451.35 z 1/21 10406 Check _._.._ __. __ _..._____ _ 1/21 10409 Check 442.20 425.76 z z 1/21 10415 Check _ .... ..___.... 416.62 z 1/21 _ 10416 Check _ ,..:. _. .:, .. .._.,_._. ...._ ... ,__,_,,,..,_., . _.. ... 39564 z 1/21 10417 Check °-° °° °'- 1/21 10418 Check 197.42 o 1/21 10413 Check 187.00 _ . 187.00 72 016.25 A° 1/21 10402 Check 1,817.41 70,198.84 w 1 /22 10365 Check "` 1/23 10366 Check 21 93820 48 26064 �.., ,, „_ _,.. _,,,.,.... . ti 1/24 10419 Cashed Check 166.23 - 1/24 10421 Check 794.06 IQ _.. UD 1/24 10430 Check ___.. 604.90 _... _... 1/24 10423 Check 523.48 - 1R4 10420 Check co -1/27 DFposit _10,000.00 c 431 60 45,740.37 448$7 1/27 10429 Cashed Check p _,.,,2 664 89 1/27 10422 Check 1/27 10426 Check 634.16 1/27 10425 Check 1/27 10428 Check 48517 1/27 10435 Check 475.85 .,. _.:.. ,, >::., 1/27 10427 Check 8 470.47 1/27 10424 Check 434 49 1/27 10431 Check 431 60 :,._,,,,,, 1/27 10434 Check 37422 1/27 10436 Check 314.32 50,171.29 1/27 10433 Check 298.55_.. _.__.. .... 1/28 10441 Check 10,545.98 39,612.19 1/29 70442 Check ,.,,_ .._.,.__ , .,...:.v_..._. ._. . . , 637.50 50 1/30 _..., 10439 Check _ _ ___ _ --. .- ....._.. ..... . 1/30 10440 Check 270.00 38,704.69 1,124.48 1/31 10438�Check _... _ __. __._.,_ ....._.-.._.._. 794.06 1/31 10445 Check Primary account number: • January 1,2014-January 31,2014 ■ Page 4 of 8 WELLS FARGO Transaction history (continued) Check Deposits/ Withdrawals/ Ending daily Date Number Description Credits Debits balance 1/31 10460 Check 456.01 1/31 10446 Check 254.51 1/31 Interest Payment 0.72 36,076.35 Ending balance on 1/31 36,076.35 Totals $80,125.72 $68,988.46 The Ending Daily Balance does not reflect any pending withdrawals or holds on deposited funds that may have been outstanding on your account when your transactions posted.ifyou had insufficient available funds when a transaction posted,fees may have been assessed. Summary of checks written(checks listed are also displayed in the preceding Transaction history) Number Date Amount Number Date Amount Number Date Amount 10357 1/6 355.63 10391 1/13 361.00 10418 1/21 197.42 10365* 1/22 1,817.41 10392 1/13 -"436.47 104-19 - 1/24 166.23 10366 1/23 21,938.20 10393 1/13 364.32 10420 1/24 431.60 10368* 1/3 263.96 10394 1/10 430.66 10421 1/24 794.06 10369 1/3 794.06 10395 1/13 488.76 10422 1/27 664.89 10370 1/3 664.89 10396 1/13 377.43 10423 1/24 523.48 10371 1/3 422.20 10397 1/13 319.98 10424 1/27 434.49 10372 1/6 249.34 10398 1/13 293.60 10425 1/27 531.49 10373 1/6 370.79 10399 1/13 167.47 10426 1/27 634.16 10374 1/6 449.22 10401* 1/17 345.39 10427 1/27 470.47 1 0375 1/6 325.79 10402 1/21 1 87.00 1 0428 1/27 485.17 10376 1/6 337.77 10403 1/17 794.06 10429 1/27 448.87 10377 1/6 346.93 10404 1/17 664.89 10430 1/24 604.90 10378 1/3 363.63 10405 1/21 510.23 10431 1/27 431.60 10379 1/6 528.94 10406 1/21 451.35 10433* 1/27 298.55 10380 1/6 361.79 10407 1/21 517.24 10434 1/27 379.22 10381 1/6 320.00 10408 1/21 537.96 10435 1/27 475.85 V 10382 1/6 309.08 10409 1/21 442.20 10436 1/27 314.32 o+ 'w 10383 1/6 213.33 10410 1/21 474.51 10438* 1/31 1,124.48 a, 10384 1/10 263.98 10411 1/21 465.05 10439 1/30 637.50 10385 1/10 794.05 10412 1/17 501.03 10440 1/30 270.00 10386 1/10 664.88 10413 1/21 187.00 10441 1/28 13.12 10387 1/13 489.39 10414 1/21 682.32 10442 1/29 10,545.98 10388 1/13 320.00 10415 1/21 425.76 10445-* 1/31 794.06 10389 1/13 497.38 10416 1/21 416.62 10446 1/31 254.51 10390 1/13 478.45 10417 1/21 395.64 10460* 1/31 456.01 Gap in check sequence. Monthly service fee summary For a complete list of fees and detailed account information,please see the Wells Fargo Fee and Information Schedule and Account Agreement applicable to = � Fee period 01/01/2014-01/31/2014 Standard monthly service fee$30.00 You paid$0.00 How to avoid the monthly service fee(complete 1 AND 2) Minimum required This fee period 1)Have any ONE of the following account requirements • Average ledger balance $25,000.00 $41,792.00 ✓r . Primavy account number: • January 1,2014-January 31,2014 • Page 5 of 8 WELLS_ FARGO Monthly service fee summary(continued) How to avoid the monthly service fee(complete 1 AND 2) Minimum required This fee period • Combined balances in linked accounts,which may include $40,000.00 0 - Average ledger balances in business checking,savings,and time accounts - Most recent statement balances of:business credit card,Wells Fargo Express Equity'and BusinessLine'lines of credit,Wells Fargo BusinessLoan'term loan - Average daily balances from previous month in business PrimeLine"line of credit and Business PrimeLoan'°account,Wells Fargo Express Equity',SBA,and Equipment Express'loans 2)Complete the package requirements • Have qualifying linked accounts or services in separate categories" 3 Q *Includes Wells Fargo business accounts and services such as debit card,savings accounts,active Online Banking,credit card,loans and lines of credit. WK/WK Account transaction fees summary Units—"" "- Excess Service charge per Total service Service charge description Units used included units excess units($) charge($) o o Transactions 88 400 0 0.50 0.00 o Total service charges $0.00 it c C c c 0 01 01 w w N z z z z z Z Z Ell Did you know that you can review your safe deposit box information through Wells Fargo Business Online Banking?Sign on to z business online banking at wellsfargo.com/biz and go to your account summary page to review details. z z z z z z z 0 0 IMPORTANT ACCOUNT INFORMATION I A We want to let you know of important upcoming changes to your Platinum Business Services Package. Effective April 7,2014,the monthly service fee for your account will increase to$4.0.This fee will be waived if you meet the package requirements and have any one of the following: CD -$25,000 average ledger balance A -$40,000 combined balance If you do not meet one of the balance requirements noted above,the monthly service fee will appear on your April monthly statement dated on or after April 7,2014.Monthly service fee details can be found in the"Monthly service fee summary"section of your statement. Also,effective April 7,2014,we are pleased to inform you that the following new and enhanced product features will be included each month on your account: -Up to 500 transactions per month at no charge,an increase of 100 transactions per month.The fee for transactions over S00 per month will remain unchanged at$0.50 each. -Up to$20,000 of cash deposited per month at no charge,an increase of$5,000 cash deposited per month.The fee for cash deposited over$20,000 per month will remain unchanged at$0.30 per$100 deposited. -No fee for stop payments -No fee for cashier's checks Primary account number: ■ January 1,2014-January 31,2014 ■ Page 6 of 8 WELLS FAO • -No fee for money orders -Waived ATM access fee for two domestic(U.S.)non-Wells Fargo ATM cash withdrawals* -No fee for two incoming domestic/internal wires Fee change effective April 1,2014: -Collections-Domestic:Auto Draft-$25 per item *Wells Fargo ATM access fee waived for two non-Wells Fargo ATM cash withdrawals from your primary checking account within the Platinum Package per statement cycle.ATM access fee for each additional non-Wells Fargo ATM cash withdrawal transaction will be assessed.Surcharges imposed by non-Wells Fargo ATM owners or operators may apply. If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. Business Market Rate Savings Activity summary Account number: Beginning balance on 1/1 $169.02 RAZ CONSTRUCTION LLC Deposits/Credits 150.01 Florida account terms and conditions apply Withdrawals/Debits - 125.00 For Direct Deposit and Automatic Payments use Ending balance on 1/31 $194.03 Routing Number(RTN):063107513 For Wire Transfers use Average ledger balance this period $190.79 Routing Number(RTN): 121000248 Interest summary Interest paid this statement $0.01 Average collected balance $190.79 Annual percentage yield earned 0.06% Interest earned this statement period $0.01 Interest paid this year $0.01 A Total interest paid in 2013 $0.02 Transaction history Deposits/ Withdrawals/ Ending daily Date Description Credits Debits balance 1/15 Recurring Transfer From Raz Construction LI Business Checking Ref 150.00 319.02 4tOpek3Nds4F xxxxxx7777 1/17 *Recurring Transfer to Raz Construction LLC Business Checking Ref 125.00 194.02 #Opeg6Mp2D3 xxxxxx7777 1/31 Interest Payment 0.01 194.03 Ending balance on 1/31 194.03 Totals $150.01 $125.00 The Ending Daily Balance does not reflect any pending withdrawals or holds on deposited funds that may have been outstanding on your account when your transactions posted. Ifyou had insufficient available funds when a transaction posted,fees may have been assessed. Indicates transactions that count toward Federal Reserve Board Regulation D limits.Please refer to your Account Agreement for complete details of the federally-mandated transaction limits for savings accounts. . Primary account number • January 1,2014-January 31,2014 • Page 7 of 8 WELLS • FARGO Monthly service fee summary For a complete list of fees and detailed account information,please see the Wells Fargo Fee and Information Schedule and Account Agreement applicable to your account or talk to a banker.Go to wellsfargo.com/feefaq to find answers to common questions about the monthly service fee on your account. Fee period 01/01/2014-01/31/2014 Standard monthly service fee$6.00 You paid$0.00 How to avoid the monthly service fee Minimum required This fee period Have any ONE of the following account requirements • Average collected balance $500.00 $191.00 ❑ • Automatic transfer from an eligible Wells Fargo business checking account $100.00 $150.00 Q YGYC IMPORTANT ACCOUNT INFORMATION O We want to let you know of the following fee change effective April 1,2014: Collections-Domestic:Auto Draft-$25 per item c If you have questions about these changes,or would like a complimentary financial review to ensure that you have the right accounts o to meet your financial goals,please contact your local banker or call the phone number listed at the top of your statement. w co Z Z z Z Z Z Z Z � Z v _0) Primary account number: ■ January 1,2014-January 31,2014 • Page 8 of 8 WELLS FARGO General statement policies for Wells Fargo Bank •Notice: Wells Fargo Bank,N.A.may furnish information about accounts You must describe the specific information that is inaccurate or in dispute belonging to individuals,including sole proprietorships,to consumer and the basis for any dispute with supporting documentation. In the case of reporting agencies. If this applies to you,you have the right to dispute the information that relates to an identity theft,you will need to provide us with accuracy of information that we have reported by writing to us at Overdraft an identity theft report. Collections and Recovery,P.O.Box 5058,Portland,OR 97208-5058. Account Balance Calculation Worksheet Number Items Outstanding II Amount 1. Use the following worksheet to calculate your overall account balance. 2. Go through your register and mark each check,withdrawal,ATM transaction,payment,deposit or other credit listed on your statement. Be sure that your register shows any interest paid into your account and any service charges,automatic payments or ATM transactions withdrawn from your account during this statement period. 3. Use the chart to the right to list any deposits,transfers to your account, outstanding checks,ATM withdrawals,ATM payments or any othc: withdrawals(including any from previous months)which are listed in your register but not shown on your statement. ENTER A.The ending balance shown on your statement $ ADD B. Any deposits listed in your $ register or transfers into $ i your account which are not $ I shown on your statement. + $ TOTAL $ CALCULATE THE SUBTOTAL I (Add Parts A and B) TOTAL $ _ V 01 SUBTRACT C. The total outstanding checks and withdrawals from the chart above - $ CALCULATE THE ENDING BALANCE (Part A+Part B-Part C) This amount should be the same r:= _ as the current balance shown in your check register $ I Total amount$ a,+F 52010 Wells Fargo Bank,NA.AII rights reserved.Member FDIC NMLSR ID 399801 COLLIER COUNTY ••• • :CERTIFICATE OF COMPETENCY. . CERTIFICATION INFOR11 AT1:ON 011:923. C.ertfcation Information: . •C'olli.er Co.u;nty.Board of County Cor�immissioners: • • . • • Date:.October 08;. 2013 .• . DBA: A MAS.Of RY, LNG: • . •ADDRESS' P O�BO 0.1109 , • FT. MYERS FL 33902 -. •PHONE_ 2393375000, : ;: . CELL: 23.985:1:9,13 FCC 2393341.374 , LICENSEE NBR :011;923_ QUI LIFI:ER: .. :R.OBERT A.ZIELINSK1 . • • • • • • TYPE` . CONCRETE.FORMING AND PI ACING CLASS:CODE`..:. 4060 - ISSUANCE NBR: 1.1.3:17 INS.URPNCE • ORI.GISSD.: • - EXPIRATION:- r. :.:General: •L�abih ,::.::;'•:.::: October 1.5;.1.990: :: September30,,201.4 Marc: 1 2014• Worker's Compensation : •.. March 19 2074: NOTE: It-rs the Qua[fef''s responsibility to.Steep all business, licensing and requirements.curren#. and'to provide;up=to:dafe> copies.for Collier:county...files. -This includes all insurance..ca.. . tes and-anychange ofad:dress::inforrrtation - = - _ County, • C.ntractor Licensing; ::..:• CONCRETE:.FORIMZNG:::AND•PLACING ` : : .• Cert.Nar�::• .: : - .;.Ex ,:..,. ..,• Status.:.• @9/3'6/201• Active • . _iA-'Z:•.MA ONRY,,I C r.. . .P.:.:;0_;.,B ) 1109 ,:-- ET":.'MYERSr:Fes, ,3302.x: Licensee Information . A . Description - Type. PropertyAlert Licensee Number Q/1317 Name ROBERT A. ZIELINSKI Type Contractor Status Open View Master Project View AR Activities Forthis Licensee Add a new person or business to Address Book Examination Results Add Exafm Result, Link ExarriTest Type Date of ExjamTest City Score receivedExarniTest result Show More FieCds, Fields Charge Exam Fee Ej Exam Code Sponsoring County Sponsorship App Date I ' 1Sponsorship Expiration Date 1 Testing Facility COLLIER COUNTY CERTIFICATE OF COMPETENCY • CERTIFICATION INFORMATION C11923 Certification Information Collier County Board of County Commissioners Date: October 08, 2013 DBA: A-Z MASONRY, INC. ADDRESS: P. O. BOX 1109 FT. MYERS, FL 33902 PHONE: 2393375000 CELL: 2398519131 FAX: 2393341374 LICENSEE NBR: C11923 QUALIFIER: ROBERT A. ZIELINSKI TYPE: MASONRY CONTR. CLASS CODE: 4250 ISSUANCE NBR: 11923 INSURANCE: ORIG ISSD: EXPIRATION: General Liability October 15, 1990 September 30, 2014 March 19, 2014 Worker's Compensation March 19, 2014 NOTE: It is the Qualifier's responsibility to keep all business, licensing and requirements current and to provide up to date copies for Collier county files. This includes all insurance certificates and any change of address information. Collier County * City of Marco * City of Naples Contractor Licensing MASONRY CONTR. Cert Nbr: Exp: Status: C11923 09/30/2014 Active A-Z MASONRY, INC. ROBERT A. ZIELINSKI P. 0. BOX 1109 FT. MYERS, FL 33902 Signed: Licengee Information Licensee Number t?I1423 — Description I Type I Property Alert Name ROBERT A. ZIELINSKI Type Contractor Status Open View Master Project View All Activities for this Licensee Add a new person or business to Address Book Examination Results Add Exam Result Link i Ex Test Ty-oe I Date of Ex rrirest I Cif I Score received I E m/Test result 07J19Stl LEE COUNTY €B47.130- [ Show More Fields I [ Hide or Clear Fields,] Charge Exam Fee Exam Code Sponsoring County Sponsorship App Date Sponsorship Expiration Date Testing Facility 1 . 2014 FLORIDA PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#P97000049464 Jan 15, 2014 Entity Name: A-Z MASONRY, INC. Secretary of State CC2751595009 Current Principal Place of Business: 1601 JACKSON ST SUITE#202 FT MYERS, FL 33901 Current Mailing Address: P.O. BOX 1109 FT MYERS, FL 33902 FEI Number: 65-0249565 Certificate of Status Desired: Yes Name and Address of Current Registered Agent: ZIELINSKI,ROBERT A 1601 JACKSON ST SUITE#202 FT MYERS,FL 33901 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : Title D Name ZIELINSKI, ROBERT A Address 1601 JACKSON ST, SUITE 202 City-State-Zip: FT MYERS FL 33901 1 hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the some legal effect as if made under oath;that lam an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:ROBERT A ZIELINSKI DIRECTOR 01/15/2014 Electronic Signature of Signing Officer/Director Detail Date Detail by Entity Name Page 1 of 2 • FLORIDA DEPARTMENT #{O'[F STATE yam" D ivISIQN O4 CORPORATIONS IONS �', Detail by Entity Name Florida Profit Corporation A-Z MASONRY, INC. Filing Information Document Number P97000049464 FEI/EIN Number 650249565 Date Filed 06/02/1997 State FL Status ACTIVE Principal Address 1601 JACKSON ST SUITE#202 FT MYERS, FL 33901 Mailing Address P.O. BOX 1109 FT MYERS, FL 33902 Changed: 01/18/2008 Registered Agent Name &Address ZIELINSKI, ROBERT A 1601 JACKSON ST SUITE#202 FT MYERS, FL 33901 Officer/Director Detail Name &Address Title D ZIELINSKI, ROBERT A 1601 JACKSON ST, SUITE 202 FT MYERS, FL 33901 Annual Reports Report Year Filed Date 2012 03/22/2012 2013 03/04/2013 2014 01/15/2014 hi+r.•//aoor-h rn d- ern/Tn rn.irc / '�rY+pro+i�r+Caorrh/CPOr�1�Rc�nTtTlatoiT/T+nti trT�T.ma/��mr_ ')/')(1P)n1ii 2014 FLORIDA LIMITED LIABILITY COMPANYANNUAL REPORT FILED DOCUMENT#L13000059471 Jan 25, 2014 Entity Name: RAZ CONSTRUCTION, LLC Secretary of State CC6953661702 Current Principal Place of Business: 1601 JACKSON STREET,SUITE 202 FORT MYERS, FL 33901 Current Mailing Address: PO BOX 2186 FORT MYERS, FL 33902 US FEI Number: 46-2699889 Certificate of Status Desired: Yes Name and Address of Current Registered Agent: KNOTT,GEORGE H ESQ KNOTT EBELINI HART 1625 HENDRY STREET,SUITE 301 FORT MYERS,FL 33901 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGR Name ZIELINSKI,ROBERT A Address 1601 JACKSON STREET,SUITE 202 City-State-Zip: FORT MYERS FL 33901 hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:ROBERT A ZIELINSKI MGR 01/25/2014 Electronic Signature of Signing Authorized Person(s)Detail Date Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS fiwitt,fz Detail by Entity Name Florida Limited Liability Company RAZ CONSTRUCTION, LLC Filing Information Document Number L13000059471 FEI/EIN Number 462699889 Date Filed 04/23/2013 State FL Status ACTIVE Principal Address 1601 JACKSON STREET, SUITE 202 FORT MYERS, FL 33901 Mailing Address PO BOX 2186 FORT MYERS, FL 33902 Changed: 01/25/2014 Registered Agent Name &Address KNOTT, GEORGE H, ESQ KNOTT EBELINI HART 1625 HENDRY STREET, SUITE 301 FORT MYERS, FL 33901 Authorized Person(s) Detail Name &Address Title MGR ZIELINSKI, ROBERT A 1601 JACKSON STREET, SUITE 202 FORT MYERS, FL 33901 Annual Reports Report Year Filed Date 2014 01/25/2014 Document Images httn•/ice arrh cnnlniv nrcr/Tnni1irAT/C nrnnratinnQaarrh/Caarr-hPPenitflatail/FntitcrNTarna/fl a 11 1 '7OOn/1111a r - J§ 1 '4 LIC2007-01976 azmas1601@aol.com renewa License Holder ROBERT A ZIELINSKI Name: Firm Name: A TO Z MASONRY INC Address: PO BOX 1109 FORT MYERS FL 33902 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in a safe place 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. Below 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.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity 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 ContractorLicensing @Leegov.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 LIC2007-01976 to ContractorLicensing @Leegov.com. Re:"renewal by email". Cutnere-- ----- -- --- LEE COUNTY Conditions of Certificate Conditions of Certificate CERTIFICATE OF COMPETENCY (239)5334895 Shall maintain required insurances on active Renewal due for active and inactive - certcates_ certificate each year in September. NAME:ROBERT A ZIELINSKI D/B/A A TO Z MASONRY INC Shall inform the Contractor Licensing Office of COMP.Na shall appear on all UCENSED FOR: Concrete Forming&Placing any Address or telephone#change_ advertisements including vehicles reflecting a business name. Shall only contract in D/B/A name as it COMP.NO.: CW 000062 appears on certificate.Board of Approval required on business name changes. NOT VALID AFTER:09130/2014 Signature of License Holder fa trbcrenarpt • r F_ r IN I LIC2007-01977 azmas1601taol.com renewa License Holder ROBERT A ZIELINSKI Name: Firm Name: A TO Z MASONRY INC Address: PO BOX 1109 FORT MYERS FL 33902 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in a safe place 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. Below 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.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity 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 ContractorLicensing @Leegov.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 LIC2007-01977 to ContractorLicensing @Leegov.com. Re: "renewal by email". Cut.Hece Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239)533.8895 Shall maintain required insurances on active Renewal due for active and inactive certificates.• certificate each year in September. NAME:ROBERT A ZIELINSKI D/B/A A TO Z MASONRY INC COMP.NO.shall appear on alt LICENSED FOR: Masonry Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone#change. a business name. Shall only contract in 0/B/A name as it appears on certificate.Board of Approval COMP.NO.: MA 000038 required on business name changes. NOT VALID AFTER:09/30/2014 Signature of License Holder fcntrbcren2rpt • • \ CHARLOTTE COUNTY LICENSING CERTIFICATE OF COMPETENCY —- NOT VALID AFTER 09/30/2015 Lic.Type: L CONC MASONRY DBA A Z MASONRY INC - : • Lic.Nbr: AAA008760 ROBERT ZIELINSKI PO BOX 1109 FORT MYERS FL 33902- • ( ( • • 4 i . III r()U. ism LIC2013-00621 azmas1601 Cr�aol.com License Holder ROBERT A ZIELINSKI Name: Firm Name: RAZ CONSTRUCTION LLC Address: PO BOX 2186 FORT MYERS FL 33902 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in a safe place 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. Below 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.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity 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 ContractorLicensing@Leegov.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 LIC2013-00621 to ContractorLicensing @Leegov.com. Re: "renewal by email". Cuutliere Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239)533-8895 Shall maintain required insurances on active Renewal due for active and inactive certificates_ certificate each year in September. NAME ROBERT A ZIELINSKI D/B/A RAZ CONSTRUCTION LLC COMP.NO.shall appear on all LICENSED FOR= Concrete Forming&Placing Shall inform the Contractor licensing Office of advertisements including vehicles reflecting any Address or telephone#change. a business name. Shall only contract in D/B/A name as it appears on certificate_Board of Approval COMP_NO_: CUV2013-00621 required on business name changes_ NOT VALID AFTER:09/30/2014 Signature of License Holder frntrlocren2rpt A i-z-s ILL (01 11 LIC2013-00622 azmas1601 aaol.com License Holder ROBERT A ZIELINSKI Name: Fino Name: RAZ CONSTRUCTION LLC Address: [P BPX 2186 FORT MYERS FL 33902 Thank you for assisting Lee County Contractor Licensing in their effort to'Go Green". Please keep this document/file in a safe place 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. Below 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.tee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity 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 ContractorLicensing @Leegov.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 LIC2013-00622 to ContractorLicensing @Leegov.com. Re: "renewal by email". Cut Here Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239) 895 Shall maintain required insurances on active Renewal due for active and inactive certificates_ certificate each year in September_ NAME:ROBERT A ZIELINSKI D/B/A RAZ CONSTRUCTION LLC COMP.NO.shall appear on all Shall inform the Contractor Licensing Office of LICENSED FOR: Masonry advertisements including vehicles reflecting any Address or telephone#change. a business name_ 2nd co Shall only contract in DIB/A name as it appears on certificate.Board of Approval COMP_NO.: MA13 00622 required on business name changes. NOT VALID AFTER:09/30/2014 Signature of License Holder roxnocrenZrpt Liceusme Information * Licensee Number C11923 _ Description Type Property Alert Name A-Z MASONRY, INC. -- - . Type | Contract i Contractor [ Status Active� ��o L�| View Master Project View All Activities for this Licensee Add a new person or business to Address Soak Insurance Add Insurance Link' Producer Type I Policy Number Effective Date I Expiration Date Limit 'ALANvvlLu4momASSOrI General Liability IG01100172900 03/19/2013 03/19/2014 2800008 --- FIVE COUNTY INSURANCE vvorkebcompensatio 8Fn13UB'2856C33'1 03/19/2013 83/19/2014 • Address Address line 2 { ' [----------'—_| A City/State/Zip | � | .0 ( Show More Fields 1 Hide or Clear Fields 1 Expiration processed [i Producer Phone Number 12394181100 A °® CERTIFICATE OF LIABILITY INSURANCE DATE ) _ 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 CONTACT Joyce Delisle NAME: y Alan Williams & Assoc Ins Agency Inc PHONE C ,: (239)418-1100 I F�A)OC No):(239)418-1164 13720-2 Ben C. Pratt! ADDRESS:..,-aoyce @awainsurance.com Six Mile Cypress Pkwy INSURER(S)AFFORDINGCOVERAGE NAIC# Ft.Myers FL 33912 INSuRERA:International Ins Co of s2267 INSURED INSURER B:PIMA 0018 RAZ Construction, LLC INSURERC: P.O. Box 2186 INSURERD: INSURER E: Fort Myers FL 33902 INSURER F: COVERAGES CERTIFICATE NUMBER:13/14 New REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD POUCY NUMBER (MM(DDIYYYY) (MM/DD/YYYY) GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(a occurrence) $ 100,000 A CLAIMS-MADE X OCCUR IG011002008-00 7/1/2013 7/1/2014 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 71 POLICY PRO- n $ JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I RETENTIONS $ B WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS. ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) 106-52559 7/1/2013 7/1/2019 EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 1,000-,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION (239)252-2469 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Contractor Licensing Board ACCORDANCE WITH THE POLICY PROVISIONS. 2800 North Horseshoe Dr Naples, FL 34104 AUTHORIZED REPRESENTATIVE Jeff Williams/CL10 - ..----- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnns 01 The enmmn name an`1 Inn^are rsnia*srsrl marts of ennm 1 Lee County Tax Collector's Office Page 1 of 3 Hello,Guest ```rlr, •C t r ±1 ;rt/ n: �'!r Home•FAQ•En Espanol•Contact Us•Printable Version• Search... GO in'crrrrtat,on Pr..pc,;t/Taxes Vett cles t Vessels Driver License Hunting& Fishing Local Business Taxes Pay Online Business Tax Account Information e: r ...� Business A TO Z MASONRY INC 1601 JACKSON ST STE 202 FT MYERS FL 33901 (239)337-5000 AL,ould 8903020 Description CONCRETE FORMING AND PLACING CONTRACTOR M ii Address PO BOX 1109 Fl MYERS FL 33902 Year Amount Account is paid current. Outstanding Balance Due as of 2/2612014 $0.00 Additional Options: Payments Made Change Mailing Address Cupyi tyi it v 2uu , Lee Quui ty Tax QuileLtui s 6111(.:e.r II i ly.ita iesei veil.- view aue rvueies-v,ew rayinent ru iues Sign In Access your Lee County Tax Collector account Need an Account? Create a Lee County Tax Collector account Why would I need an account? Taxpayer Portfolio Reprint Receipt View Cart Instructions Mass Tax Payments Search Real&Tangible Reprint Receipt Merchant Report Accounting Report View Cart Lee County Property Appraiser Local Business Tax Search 1httr■•//zzrzvzzr leetr rnm/cearrh detail acn`Iaernnnt=R4(l'(17(1R7SeariHTvne=(1CfT Jr 7/7(,/7014 Lee County Tax Collector's Office Page 1 of 2 • Hello,Guest 1\'lr LeeTL.Piicccu it IGr. r, , 4 r , as Home•FAQ•En Espanol•Contact Us•Printable Version• Search... ira c .,.«tic Pr op..'t r''axess Vehicles i Vearels Driver License Hunting&Fishing Local Business Taxes Pay Online ar c1• " ` Business Tax Account Information Se ew Search Business RAZ CONSTRUCTION LLC 1601 JACKSON ST STE 202 FT MYERS FL 33901 (239)337-5000 ,,u,w,,1 1400407 DAs,--ipaa„ CONCRETE FORMING AND PLACING CONTRACTOR Siaiiiiia Attdrebs PO BOX 2186 I-I MYBkS l-L 33Y02 year Amount Account is paid current. Outstanding Balance Due as of 2/26/2014 $0.00 Additional Options: Payments Made Change Mailing Address ■:',upyilylil v 2009, Lee Cuunty TdA Cullei,tur's vffh,c.All ilylds 1eseiveJ.-view Siie ruiii,ies-view nayir.eur ruiiaes 0 Sign In Access your Lee County Tax Collector account Need an Account? Create a Lee County Tax Collector account Why would I need an account? Taxpayer Portfolio Reprint Receipt View Cart Instructions M033 Tax Peymcnt3 Search Real&Tangible Reprint Receipt Merchant Report Accounting Report View Cart Lee County Property Appraiser Local Business Tax Search httn•/Rxnxnxw leptr rnm/cearrh detail acn7ar rnrnnt=14ll4R7R'SenrrhTvne=OCCT.Tr 7/7 F,/7(l1 d Feb 2S14O1:3Op A-Z Masonry, Inc. 239-334-1374 p.1 ~ ` � ~ ` . _ . .� . /� .`. THONY ziELINSKI -091A AEZTES`.- � amry,�no*,=��,"���u�'rxw° **���`�°� or- P0 consent'~.—_ _- - . ---- ----------- -- ----'--' - . • Jorge Ramirez 2795 43rd AVE NE Naples FL 34120 Collier County Contractor Licensing Board Dear Board Members And I'm submitting this application to you in order for me to get approved for a landscaping contractor license. I have met all the requirements for this license except showing two years of work at a licensed landscaping company.The experience and knowledge that I have gained from my father, Alfredo Ramirez, who has worked 20 years at Agro Turf a landscaping company here in Naples Florida. He has educated me and continues to this day on this trade. Along with my father my brother, Ricardo Alfredo Ramirez, had worked for Trugreen for an amount of 6 months. Ricardo Alfredo Ramirez has continued to assist me by having taken and passing his BMP exam and acquired his, Limited Commercial Fertilizer Applicator Certificate for which he is trained to use by his study's and Alfredo Ramirez in accordance with the state of Florida and the local ordinances of the city of Naples. If approved Alfredo Ramirez and Ricardo Alfredo Ramirez will be involved in this trade with me. Yours Sincerely Jorge Ramirez COLLIER COUNTY BUSINESS TAX RECEIPT $.71F -sfi APPLICATION 2800 N.Horseshoe Drive,Naples,FL 34104 _ ,,��_.t - ` Make Check Payable to Collier County Tax Collector Phone:239-252-2477 Fax: 239-643-4788 Website:www.colliertax.com CHECKLIST 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 - Ut r (6:-e t- L la) DBA NAME - ��G. 1�- Zet w.N C'A v^e. lb) BUSINESS OWNER OR QUALIFIER'S NAME- -3 ov,e �t-v i ;.c-7 2) PHYSICAL ADDRESS- _� (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - u. Yes No 3) BUSINESS MAILING ADDRESS- 2-755 (r:` ? 4 iy 3L4 () Street City 1� A Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS-47.761S 3r /61 e 5) TELEPHONE-Business: "OR— .1P-51c{t.I Home: 2:3 E;730---e3 tc 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- 3-- 8) OFFICE WITHIN CITY LIMITS OF NAPLES - I.- Yes_No If Yes,City License No. 9) S OCIAL SECURITY E�C CONDUCTED: 10) NUMBER OF EMPLOYEES-Including number of ownersNJ I 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 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'' Collier County Growth Management Division 2800 Horseshoe Drive N. Naples, FL 34104 239-252-2400 RECEIPT OF PAYMENT Receipt Number: 2014162485 Transaction Number: 2014-009604 Date Paid: 03/05/2014 Amount Due: $300.00 Payment Details: Payment Method Amount Paid Check Number Cash $300.00 Amount Paid: $300.00 Change / Overage: $0.00 Contact: GARCIA, JORGE RAMIREZ 2795 43RD AVE NE NAPLES , FL 34120 FEE DETAILS: Fee Description Reference Number Original Amount GL Account Fee Paid Contractor's License Abated CEUL20140001658 $300.00 $300.00 113-138900-321237 Citation Cashier Name: melissaalvarez Batch Number: 3638 Entered By: clements_k k GMD Operations & Regulator ageme Licensing Sec 2800 North Hors s lg Drive f , Naples, FL4 L 147' .( APPLICATION FO%44 COLLIER COUNTY/CITY OF NAPLES/CPI*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: ^1o,E 1/,' 4 6✓/✓C 6- Fiction Name/DBA: /_ Qualifier Name: c%n(4 MI"/ti//i?- Physical Address: 95 3,0 Aw NF //m'6tf' 31/20 (Number & Street) (City) (State) (Zip Code) Mailing Address: P. ?5- 15R.° n A/6- /(/Itt • 31/20 (Number & Street) (City) (State) (Zip Code) Telephone: .-1_ . C�° ` i cl. E-Mail: TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 `Specialty $205.00 Specialty trade: fh CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. Joy /`fT zeOgiligG9 4-GF/ Ao TZi-lie c4/a'7 74 /4= - 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 payand the reasons for the refusal to pay. Attach extra pages if needed. AFFIDAVIT / certify that the foregoing is true and correct to the best of my knowledge. Autho ed err-Ott"a'Firm STATE OF FLORIDA COUNTY OF (''c /I-1 The foregoing instrument as acknowledged before me this =� (. �f 'Ct "�.,'• ° ('f 1l (Date) By )C ) f of J(- f of)I YN(. =✓CI it,n (, 6-r Lit: (Name'io officer, title/agent) (Name of Corporation) ' a -Orr,<1,:�. Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced ►%;-i'V?r; ■ identification and did not take an oath. (Type of identification) NOTARY'S SEAL ;��""' `�; FOSTER RHEIN (SIGNATUR OTARY) t : Notary Public-State of Florida N� i '. My Comm.Expires Jul 29,2017 `•:;, E ps Commission#FF 40612 Page 2 of 4 QUALIFIER INFORMATION: Name: JO/ '! /Zilni/L - Address: 27 %S 43/zoo 4 /"v ' Ii'Aihre Fe 39/ze (Number& Street) (City) (State) (Zip Code) cz Telephone: L_ `7 '✓ - 1`"11 Date of Birth: ' S.S. #: 000-00- `( E-Mail: Driver's License: 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 4- .7.1--12-C, 9- (23) Oq Jr -vs- ' 4 c(4- (23,) 5 9'?-.�Z 3. Have you ever been convicted of a crime related to Contracting? (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 experience during the past ten years. ri- to/'r? /O Mkk/ -701(2-ate' 10. Statement of any formal training you have had in the area for which the application is made. ly°/'-Cr/vei //✓ Die` 74// J Page 3 of 4 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report March 4, 2014 Official Score Report: Candidate Information: Name—Jorge Ramirez Candidate#: 20871630R Testing Site: Ocala, FL Final Score Result: Tree Contractor Score: 86% (3/3/2014) Business Procedures Score: 52% (3/3/2014) Business Procedures Score: 82% (3/4/2014) These results represent the grade that has been achieved on the Tree Contractor & Business Procedures examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on March 4, 2014. If you have any further questions,please do not hesitate to contact us. Sincerely, P a E. Bowermeister President PO Box 831127 Ocala,Florida 34483-1127—Voice(352)369-GITS –Fax(352)387-2443 800 997 2129 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. APPLICANT(PLEASE PRINT) InkA/C4-#4 &r NAME OF COMPANY Sl f ■j; c;NT STATE OF FLORIDA, COUNTY OF L o i ii ey'' n z The foregoing instrument as acknowledged before me this a ` ' ' fc � j� �'��" (Date) By / nzt 1►"' - who has produced /_g. (Dame cif person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL _ " ,`- IGNATUR 40;Fp` E RHEIN _ 1S E OF 1�ARY) ( = : , . Wary Public-State of Florida 1 1 ' e�c My Comm.Expires Jul 29,2017 ',.;,o �d;�' Commission#FF 40612 Page 4 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. (4-` -- --------77' S `! T 'E OF APPLICANT ,J0f t,-4 ,^Jr—, ((I i' (.--L(_ BUSINESS NAME DATE BEFORE ME this day personally appeared �'�' Y FPem'ed c��'^t;r' �=-uitii,'re c who affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any ;ime he employees one or more persons he must obtain said Workmen's Compensation Insurance. ;TATE OF FLORIDA ,OUNTY OF ('c f i .)y'" r n 'he foregoing instrument was acknowledged before me this '> ' e;y f /2'1-t(;'0/ al if 7 (Date) y �� isit'v L.,C a t 7 Y' who has produced -' :"-vex' ( i` c�i 15C--; (name'of person acknowledging) (Type of identification) s identification and who did not take an oath. • SIGNATURE OF NOTARY P `i t NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) _ _ NOTARY PUBLIC ■ :A v 411;P FOSTER RHEIN * �� °" Notary Public-State of Florida 1 ,, Comm.Expires Jul 29,2017 4 ?"44? Commission#FF 40612 omirempigis IF VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: JO'- �-�^ Certificate Category Requested: > ( C Ty (M1V/J) 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: Title: films*lp ----- License Number(if applicable): Name of Business: --7/D ' 2 ' 4J4 7r //c' Business Address:/ ??/ Business Phone: ( '3 !) ZS3 �ZJ� The Applicant's years of experience from to The applicant's scope of work (specific duties)included: Additional Comments: Falsifying any information provided herein may subject your license to revocation. A. SE S(- �Cu CCG■ Signature J.6.V�/S' f/47ZCf�} Print Name: State of Florida County of. Collier C±r ( (�I I The oin instrument was acknowledged before me on this J day of . , t(L (A`t by (;2CtCt who is personally known to me or produced °IlliarlifintirliirZ as identification and who did not take an oath. ' e ii 14A ,,."_k..._ /5,/J r .;.',87";1,\I MAIN,HA AZIJCE?A GONZALEZ • ry ,: MY COMMISSION;iFFOF9860 Vt.'s? E na: Xi of S November 12.2017 (407)39153 r ::;a ,.,. a.-..^ rn Signature o otary AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, TW , am a resident of County, (State) and have resided here for more than five (5) years. During the last five years I have known otitri 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. ,���`�ak (Signature)�L✓ (Name) (-7-04- ci- (Address)21� � 3 vd Ave 'u Telephone)�.7.2jc 35`-'fl V1133 STATE OF FLORIDA COUNTY OF (�.�� The foregoing instrument was acknowledged before me this kiLeldin S� ZDI by (Date) �q �'?� who has produced FLb/f v r uunsf (name of person acknowledging) (Type of identification) as identification and who did not take an oath. r ;_ 4," MARTHA AZUCENA GONZALEZ / My COMMISSION#FF069860 /.�� ter !� �. L! r," STGNATUREO F NOTARY �,,�"��d,;.= EXPIRES November 12.2017 (407)398-0153 Floridardotary Set ice.COm / � IL.I " _ NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, -S , am a resident of - - _ County, (State) and have resided here for more than five (5) years. During the last five years I have known 33DiZF7s7 (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) SQS,f 4 O rC.i G- (Name) --S*es v S (Address) CM c 6 ! f" - <-; t�-•�-` A/i P l cC AO v .Lt it 6 Telephone) 1- cie. STATE OF FLORIDA COUNTY OF �-}� The foregoing instrument was acknowledged before me this Vah 't`` ' N by 3esuB C7arc(a who has produced FL-Driver` cer75 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. MARTHA AZUCENA GONZALEZ L � w MY COMMISSION#FF069860 SIGNATURE U NOTARY • - EXPIRES November 12,2017 (407)398-0153 FloridallotaryService.com i/u f a tiCt V Z 1 e z NOTARY'S SEAL (PRINT NAME OF NOT ARY) NOTARY PUBLIC , STATEMENT OF OWNERSHIP This certifies that I, JOB 1I! %' am a member or (APPLICANTS NAME) Managing member of Jf,W f1RN CA [ . (LIMITED LIABILITY COMPANY NAME) I own 100 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. (PRINT NAME) r a/� •PPLIC• . SIGNATIIRF) .--S— \c .. 1 Lt (DATE) COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 elf MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio,Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statues. iti (kV.% ^Volk eV•il eV.) eV* ^Volk 0 e�♦ t/Vo4 ♦ u1� ♦ ♦ t1Vrt ♦ ♦ 1104 ♦ 1410 ♦ it4, 4 1, , 14 To tt xl 14 0 tk KI A 0 14 0 bk I 0 4 • 0 AU le a 4 t,v +/) rir • A o t 0A� .• to V0 •Al . tt(40,7 .4 4`i) - 1 45 tu 0 1 0 rw: W ^O U a ♦ y w a) e iki V // cn- ... II bdib 1-) g .4 ic, e ei 4 .6. v oh g '4,0 14 15- 1 1 A.4414:, 41 Vcd c.4—i 1,4 ;4 i''5, cu g A w • ,. i:L.7--", ci) N fg ,.gt 0 c) 'i.-���A` - i w .-� '� . o o •�•'i 7) 4 1 ti ;...• k oli w =ci..) v) r�A4 i-e -- 0 0 .0 b- ...H. .. c ilr f..) 0 c::. O � o ' - M 1 g . . ....... v/i ,„ . .., a.), ri) I ›, ''-,,1 -8 15 tk V 0 4 : {4 .t, C� � � o � 7' c �A� � 04 V go 0 4 1) 8 v/p ; I:(vpf i O E o .- o ti res 4 1�A�t U o � zs .[►tel■I A tt • 4i0 A .. = cd _.,.-4 C A .' . C * ) fit V E-4 1-( cip L - 0 4 g *V; � � r1 Pi1 � 1 � 04 ♦ b 0 ♦ ♦ ti l r1 �♦ 0ACIINVarrf ♦Vi ♦�i Wm% x%12 p {r�A♦I,r �r��♦tur Ii•A • { 'e") {•4 kir {.,EJ• p • n CREDIT CIIEI( CONFIDENTIAL Individual Credit Report Name • RAMIREZ, JORGE Ordered By: RUSH Address : 2795 43RD AVENUE NE Customer : 9999-006 Received : 03/05/14 NAPLES, FL 34120 Completed : 03/05/14 Social # : Applicant: - Bill Amt : $85.00 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 Stet Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA 5/3 BANK CC AS AGREED 5467 11/13 10/07 0 CLOSED 0 REV 0000 00 Ri 48 A DLA=11/13 BK OF AMER AS AGREED 1086 02/14 09/06 1094 0 0 REV 0000 00 R1 48 A DLA=05/13 CAP ONE AS AGREED 02/14 03/07 1446 0 0 REV 0000 00 R1 48 A DLA=03/13 CHASE AS AGREED 02/14 07/08 3500 0 0 REV 0000 00 R1 48 A DLA=08/13 CHASE AS AGREED 01/14 01/09 101020 93327 0 805 0000 00 M1 48 A DLA=03/13 GECRB/TJXDC AS AGREED 02/14 02/14 0 0 0 REV 0000 00 R1 00 A DLA=02/14 GECRB/AMAZON AS AGREED 02/14 06/13 160 0 0 REV 0000 00 R1 08 A DLA=09/13 GECRB/CARECR AS AGREED 02/14 04/13 2421 0 0 REV 0000 00 R1 10 A DLA=08/13 GECRB/CARECR PD WAS 30 02/14 04/07 784 CLOSED 0 REV 0100 00 R1-* 48 A DLA=02/13 Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. -3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 CREDIT CHECK CONFIDENTIAL Name • RAMIREZ, JORGE Customer: 9999-006 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 Stet Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev EC_OA HSBC BANK AS AGREED 02/09 11/08 50 PAID 0 REV 0000 00 R1 02 A DLA=02/09 OCWEN LOAN AS AGREED 07/13 04/09 45000 CLOSED 0 0 0000 00 M1 48 A DLA=07/13 SEARS/CBNA AS AGREED 02/14 01/13 0 0 0 REV 0000 00 R1 13 A DLA=02/14 SEARS/CBNA AS AGREED 02/14 01/13 0 0 0 REV 0000 00 R1 13 A DLA=02/14 SHEFFIELD FN AS AGREED 09/13 08/09 6590 CLOSED 0 REV 0000 00 R1 48 A DLA=07/13 SHEFFIELD FN AS AGREED 08/13 10/12 8591 CLOSED 0 0 0000 00 I1 09 A DLA=08/13 SHEFFIELD FN AS AGREED 08/13 05/13 1662 CLOSED 0 0 0000 00 I1 03 A DLA=08/13 THD/CBNA AS AGREED THD/CBNA AS AGREED 02/14 06/13 68 0 0 REV 0000 00 Ri 07 A DLA=08/13 Total trade lines on this report: 18 PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS: CLEAR AS OF 03/05/14 . SOURCE (S) : EQUIFAX TRANSUNION INQUIRIES: Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. -3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561)616-5556 •CREDIT ChECKTM CONFIDENTIAL Name • RAMIREZ, JORGE Customer: 9999-006 Page: 3 INQUIRIES: 03/05/14 by CREDIT CHECK (TU) #00630273 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: 740 (scores range from 300 to 850) *** END OF REPORT *** This information is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. This personal report is furnished simply as an aid In determining the credit desirability of the applicant(s).It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. Ordered by: APPLICANT — SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 Detail by Entity Name Page 1 of 2 r FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS rt .. ° Detail by Entity Name Florida Limited Liability Company JORGE RAMIREZ LAWN CARE LLC Filing Information Document Number L14000037161 FEI/EIN Number NONE Date Filed 03/05/2014 State FL Status ACTIVE Effective Date 03/05/2014 Principal Address 2795 43RD AVE NE NAPLES, FL 34120 Mailing Address 2795 43RD AVE NE NAPLES, FL 34120 Registered Agent Name &Address RAMIREZ, JORGE 2795 43RD AVE NE NAPLES, FL 34120 Authorized Person(s) Detail Name & Address Title MGR RAMIREZ, JORGE 2795 43RD AVE NE NAPLES, FL 34120 Title MGR RAMIREZ, ALFREDO 2795 43RD AVE NE NAPLES, FL 34120 Title MGR RAMIREZ, RICARDO A 2795 43RD AVE NE NAPLES, FL 34120 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/flat-114... 3/5/2014 Detail by Entity Name Page 2 of 2 Title MGR RAMIREZ, LEONARDO 2795 43RD AVE NE NAZI S, FL 34dr2@ct Us E-Filing Services Document Searches Forms Help Annual Reports No Annual Reports Filed Document Images 03/05/2014 -- Florida Limited Liability View image in PDF format :'oo•:r:ant and ur:vacv Pniic:k-> Mate Fbrid,„ Department or State http://search.sunbi z.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/flat-114... 3/5/2014 Form 2553 Election by a Small Business Corporation (Under section 1362 of the Internal Revenue Code) (Rev.December 2013) •See Parts II and Ill on page 3. OMB No.1545-0123 Department of the Treasury ►You can fax this form to the IRS(see separate instructions). Internal Revenue Service ►Information about Form 2553 and its separate instructions is at www.lrs.gov/fo►m2554, Note. This election to be an S corporation can be accepted only if all the tests are met under Who May Elect in the instructions,all shareholders have signed the consent statement, an officer has signed below, and the exact name and address of the corporation(entity)and other required form information have been provided. Part I Election Information Name(see instructions) A Employer identification number JORGE RAMIREZ LAWN CARE LLC 46-4995477 Type Number,street,and room or suite no.(If a P.O.box,see instructions.) B Date incorporated or Print 2795 43RD AVE NE 03/5/2014 City or town,state,and ZIP code C State of incorporation NAPLES FL 34120 FLORIDA D Check the applicable box(es)if the corporation(entity),after applying for the EIN shown in A above,changed its ❑ name or 0 address E Election is to be effective for tax year beginning(month,day,year)(see instructions) • Caution.A corporation(entity)making the election for its first tax year in existence will usually enter the beginning date of a short tax year that begins on a date other than January 1. F Selected tax year: (1) 12 Calendar year (2) ❑ Fiscal year ending(month and day)• (3) ❑ 52-53-week year ending with reference to the month of December (4) ❑ 52-53-week year ending with reference to the month of• If box(2)or(4)is checked,complete Part II. G If more than 100 shareholders are listed for item J (see page 2), check this box if treating members of a family as one shareholder results in no more than 100 shareholders(see test 2 under Who May Elect in the instructions)• ❑ H Name and title of officer or legal representative who the IRS may call for more information I Telephone number of officer or legal representative JORGE RAMIREZ(MANAGER) If this S corporation election is being filed late,I declare that I had reasonable cause for not filing Form 2553 timely,and if this late election is being made by an entity eligible to elect to be treated as a corporation,I declare that I also had reasonable cause for not filing an entity classification election timely and that the representations listed in Part IV are true.See below for my explanation of the reasons the election or elections were not made on time and a description of my diligent actions to correct the mistake upon its discovery(see instructions). Under penalties of perjury,I declare that I have examined this election,including accompanying documents,and,to the best of my Sign knowledge and belief,the election contains all the relevant facts relating to the election,and such facts are true,correct,and complete. Here MANAGER Signature of officer Title Date For Paperwork Reduction Act Notice,see separate instructions, Cat.No.18629R Form 2553(Rev.12-2013) , : larida ',,... +,_. ,a, t►f,.IVER LICENSE CLASS E T-01• 4� :. x c ,& : iRh.UHREZ °218543RD AVE NE x NAPLES.FL 34120-0000 SEX-M S. . . IED:02i25-2009 rt Y' .t}c. •''» .EJ.FM $; 13-2017 r: - - u4CFp:01St-2012 -- e ?; SAFE DRIVER MOFORCYCLE'ALSb ` (*oration of a mote,vetscle constitutes consent to ry.sopiety test requeetl ty low a je w COLLIER COUNTY t, .) ' GROWTH MANAGEMENT DIVISION C! [ L, GIL/GO(/6J r 8 CITATION Pursuant to section 489.127.(3)(a).Florida Statutes,the undersigned hereby cenities that upon personal investigation,he/she has reasonable and probable grounds to believe that the person whose name appears below as issued to,did violate subsection 489.127.(1),Florida Statutes,and the Collier County Contractor's Licensing Ordinance No.2006-46(as may be amended)by committing the violation stated below. Month / Day nZ-7 Year • Time Cl M M Issued To J O r e fly_n1 Address a -7cf 5 4/3rd v _. N E City lVC2_f'if'S State FL, Zip Telephone o. I" _ l. Nl Vehicle Make/Type(if applicable) Year Color Tag No. `s 7,0 t iX r�� Jf r.�lhl'�-� /�c� F Location of Violation 4'44 T?rrar1571-c? 1,4) OPTIONS I have been informed of the violation for which I have been charged and elect the following option(Check one) I) ❑ I choose to pay the penalty of s1i'C'('), L'C. 2 t ❑ I choose not to pay the penalty,and will request in writing by cenitied mail or hand delivery an Administrative Hearing before the Contractor's Licensing Boar`d.. Description of ViolationuV n eDat,e V iolation Observed! 2 a) ❑ Falsely hold self or us mess am t t no ut Yfi7 as a licensee,certificate holder or registrant; h) ❑ Falsely impersonate a certificate holder or registrant; c) ❑ Present as his/her own the certificate or registration of another; d) ❑ Knowingly give false or forged evidence to the Board or a member thereof; e) ❑ Use or attempt to use a certificate or registration which has been suspended or revoked; 1))2"-'Engage in the business or act in the capacity of a contractor or advertise self or business organization as available to engage in the business or act in the capacity of a contractor without being duly registered or certified; g) ❑ Operate a business organization engaged in contracting after(60)days; h) ❑ Commence or perform work for which a building permit is required pursuant to an adopted state minimum building code or without such permit being in effect; ij ❑ Willfully or deliberately disregard or violate any Collier County ordinance relating to uncertified or unregistered contractors. A person or business organization operating on an inactive or suspended certificate, or registration,or operating beyond the scope of work or geographical scope of the registration,is not duly certified or registered. SIGNATURE(RECIPIENT) SIGNATURE(INVESTIGATOR) PRINT(RECIPIENTS NAME) P1 INT(INVESTIGAT('S NAME) Pursuant to 489.127, Florida Statutes, willful refusal to sign and accept this citation constitutes a misdemeanor of the second degree. punishable as provided in section 775.082 or 775.083 Florida Statutes. (SEE REVERSE FOR INSTRUCTIONS) .7 71ccc'/S69 lornaI : DRIVER LICENSE CLASS E RICARDO ALF REDO RAMIREZ-fARCIA 2796 43RD AVE NE NAPLES.PL 34120.0000 SEX: M H EC).O 7°2t 1 EXPO • t� � Jy:Nf A(IUt ot t(sari f COuo dfK nae:N to�y svtriay tqt rs@uirW by taw. * 1 f 4 a ! ■w . , � , f / /\ f k > y . >� \ i ,„ y ^ < /\ : )¢A ® {el q x .p3 - \ 0 k: (k[ dNI it z; m r z / / %f \r k 4Z ! f m 2 w » /11 , \��� \ To; Collier County Licensing Board 3/26/2014 My name is Russell Spokish, I have held a Cabinet Installers license for 13 years with good standing in Collier County without any complaints or fines. I am asking for reinstatement of my Cabinet Installers License so that I can get back to work and pay bills. The reason I let my license laps is because of the devastating recession causing me to close my business due to lack of work. My business was Royal Kitchens and most of my work was new construction so when the slow times came I had to close my business. My testing score was 9o%when I got my license and I am asking for waive of re testing because I have been working in the cabinet business here for the last 16 years. Cabinetry is the only trade that I know and I have been in the Cabinet Industry for over 3o years. Thank you for considering me as a licensed Installer in Collier County Florida. Russell Spokish 260168 street SW Naples FL 84105 239-300-9712 1 m y Florida nu .. DRIVER LICENSE CLASS E ALL; :: k *41° 1111111110.11110111116110 i P U SSELL GEORGE ....00°"U POi<1SH 2b01 68TH ST SW CDES Operation NAPL �" c1!5 Lic DOB !3�� SEX M ORIGINAL 2800 Svc exP - 20 Na REST ; ENDORSE. AP SAFE DRIVER MOTQ E A_SO COLLIER COUNTY/( Over 41 vo .:•t a moor vehicle,cangures eareent to any sabnety ee segLared by taw 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: �' �' U �/ �5 n Fiction Name/DBA: Qualifier Name: 9 5S e .'.\ 3 D �`� 1 3 h '`-1 � l Physical Address: H 'H �"1 � A �t ■ P \ `�' (2 i \_ Ku ) 6‘5( s (Number& Street) L' (City) AA (State) ((Zip Code) ft 3�103 Mailing Address: y`� ( \--TAI---t. 1 ik 1`--(1 NY N)0(4-1/2i �jv 1 re S (Number 86 Street) (MA 1✓APk, (State) (Zip Code) -l.34 1 Q1 Telephone: - ,1-300 r Cl/ 12— E-Mail: C Z■--)S S e_11 \... C A`N O.iv A pI-e.,0,-, torn TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 1 U Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 Specialty Specialty trade: CO()()1 t1`-t .'(''OC 1 On-kr. 2'6/2014 Reinstatement Fee= $205.00 Cl GE OF STATUS: C 175-37 j New License Fee- $205.00 2010-2013 Back Year Fees= $555.00 (�. Reinstatement ( ) Frord One Business to Another •Dincrem rev.m.n apnlc' Total=$965,00 Page 1of4 r w s 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. Martha Spokish President Russell Spokish Vice President 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. Royal Kitchens co. 4505 Taylor #18 & 19 Naples FL 34109 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. No debts AFFIDAVIT I, Russell Spokish certify that the foregoing is tr e and correc,to e be of y knowledge. ,..„4,,le,/ , Authorize 0 icer of he Firm STATE OF FLORIDA 0 i I COUNTY OF 6I\ie'r The foregoing instrument as acknowledged before me this IIV q"'l t,C) - t (Date) By Tit SSe. RPD i(t S1(1 of 1 1 (� 1 YlO [ cpec (Name of office, title/agent) (Name of Corporation) a Nir,,pieS no 4 t_AC\ Corporation on behalf of the corporation. State oi'Place of Corporation) He/She has produced LL')1(kCIe �.)� - identification and did not take an oath. (Type of identification) NOTARY'S SEAL JUDITN A.1i ;;ii \ _ ( /C,�(SIGNATURE OF Nl//('",,,W Bonded Through National Nets,Assn. QUALIFIER INFORMATION: Name: Russell Spokish Address: 2601 68 street SW Naples FL 34105 (Number& Street) (City) (State) (Zip Code) Telephone: 239 3 0 0 9 712 Date of Birth: S.S. #: 000-00-_ - E-Mail: russell @alnonaples .com Driver's License: 1. Type of Certificate of Competency for which application is made. Cabinet Installer 2. The names and telephone numbers of two persons who will know your whereabouts. Martha Spokish 239 293 1773 Ely Spokish 239 465 1220 3. Have you ever been convicted of a crime related to Contracting? NO (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? NO 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. NONE 9. List your business or work experience during the past ten years. President of Royal Kitchens co since 1996 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. Russell Spokish APPLICANT(PLEASE PRINT) Alno Naples Inc NAME O COMPAf�yY -^ i/ / i SIGNATURE OF APPL CANT STATE OF FLORIDA COUNTY OF Collier i\ The foregoing instrument as acknowledged before me this • Mci_kcc V\ _L LA (Date) ) By�v�SSe k` �b�cs� who has produced -L0V--koke,_ M.._ (Name of person acknowledging) (Type of identification) as identification and did not take an oath. '""":'", JUDITH A.TALAGA �' Nohry Public-State or Florida • f• My Comm.Expires Feb 19,2017 c. N'�' Co mmiesion 0 EE 876487 SQndsd Through Netbnst Nobly Aum. NOTARY'S SEAL • f L 7 d /7 SIGNATURE OF NOTARY) 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 Alno Naples BUSINESS NAME ` ,Lr' - C.)/'4/ DATE BEFORE ME this day personally appeared �k S. t° 1t o tSI� who affirms and says that he ias less than one employee and does not require Workmen's Compensation understands that at any ;ime he employees one or more persons he must obtain said Workmen's Compensation Insurance. ;TATE OF FLORIDA ;OUNTY OF �k `'r 'he foregoing instrument was acknowledged before me this i1 I Lf (Date) t I y t�.SS I� S 7c�k i S k who has produced �L or o (D L (name of person acknowledging) se of identification) s identifirntinn and who did not take an oath. 440* 4111 I a""+""w JUDITH A.TALAGA ' ` /1. /{ ti�Q(A_ --N, 4 Notary Public•State of Florida I L G L L ge• My Comm.Expires Feb 19,2017 Commission AF EE e7s487 SIG ATURE OF NOTARY n eoae. own Nolan/Through National National Assn. ( , ,i \ A ,t„ k, NOTARY'S SEAL (PRINT NAME OF NOTARY P it IC) NOTARY PUBLIC VERIFICATION, OF CJNSTRUCTIO'\ EXPERIENCE G`ID Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples,FL 34104 Russell Spokish Applicant's Name: Cabinet Installer Contractor 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 numbe-r of the pe on signing elow and verifying Applicants relevantexperience: Name: 10 / k'7E.S �.,/ •'� - Title: R6 fD License Number(if applicable): 6:R G 17 93g, Name of Business: 64 ,-/I itSr H1 2 tj/ _ 6-PO4A1 TIE , IC- • 3usiness Address: t%Wr 7 J ,AW Ai LA/Je• - Ai'9 /P S R 4/O'I 3usiness Phone2 / "7! 02 The Applicant's years of experience from / 1 t to _! 7" the applicant's scope of work(specific duties) included: e31RJ-T- e, jL 0e /l774 c7e) • kdditional Comments: -_Air r2,0e/L- . --7j- > - -, /2 ■alslfyfng any information provided herein may subject yuur license to revue to S: ature Print Name: Ser ' o Cortes tate of Florida :ounty of Collier day of 2,,.ci-___- y 7Qs-v'.0 e_ . who is personally known to me or produce, s identification and who did not take an ooh. -" �PIN s- '."�� ".''•�. Josur Si a ature of Not. • - - - s+. o= Notary Pubi Or 4.0 P�•h M Comm 8 B. JOSUE SOLIS 1 1,..4:, � a Notary Public•State of fta� i j t My Comm.Expires Jai 23,20110 _ .v-�w..I'.^Nr"y ( ''•',;f:';cif' Commission 0 FF$5542 0 VERIFICATION OF CONSTRUCTION EXPERIENCE ' GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: Russell Spokish Certificate Category Requested: Cabinet Installer Contractor 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: t �/ns L;.f Title: License Number(if applicable): C6 G f� CJ ��F Name of Business: !1 �72ki— A/0%7k / / 1-f / n c Business Address: 6 A- 7e/if Business Phone:Z y FL c The Applicant's years of experience from /9 to 2 t The applicant's scope of work (specific duties) included: ed— G F %/ //ems' Additional Comments: ,K! S Falsifying any information provided herein may subject your license to revocation. Signanrre Print Name: Christopher North state of Florida :aunty of Collier c_ ��C fhe foregoing instrument was acl:na+'Iedged before me on this =--� day of #"5"9 ��--} 2 C // " who is personally known to me or produced L bL (�/8 /9 is identification and 1010 did not take an oath. OLGA MORALES` ( Signatu•' of Nota 4 ;c, Notary Public -Slate of Florida '_•* t ; My Comm Expires Sep 9,2014 '•,,,F.o.►c,..s Commission# EE 24902 Bonded Through Natrona!notary Assn 'VERIFICATION OF CONSTRUCTION EXPERIENCE GJ'ID Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Russell Spokish Applicant's Name: v� Cabinet Installer Contractor 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: li Name: l A G1 t Title: (7C-Q.3i(1 �✓nt License Number(if applicable): (J`� dame of Business: 1Pt N U N ( -(D I I N C 3usiness Address: f y.N I �4 1 \+C( rY\ A-1' kx)C 1 €011---C 5 3usiness Phone:�bCC_N30- }R--The Applicant's years of experience from IGG4 to ")...0 19 the applicant's scope of work(specific duties)included: C ,'O I J..- CAINC1 rr LA_ JC. additional Comments: 'alsifying any information provided herein may subject your license to revocation. C-X a 3C0 l a Signature Martha Spokish Print Name: tate of Florida 'ounty of Collier r�( (�/\ t� �� i he foregoing instrument was acknowledged before me on this °�( -1 day of F 1 \CLtt -V 1 Li' y 1‘00 Is V-ASh who is personally know; - or produced L.C)L identification and whb did not take an oath. r �r i \ Signa re of Notary ,,,�`,',i'""'+. JUDITH A.TALAGA ( Notary Public.State of Florida t * My Comm.Expires Feb 19,2017 �; � SEE Commisston N EE 87$467 • - 4-41*Sosded Thr+t ionrd tin,4' AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER Christopher North , am a resident of Collier County, Florida (State) and have resided here for more than five (5)years. During the last five years I have known Russell Spokish (Applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) (Name) Christopher North (Address) 6"--2/ _ fl- A/C- Telephone) Z 2 �''r � ) 4'l 3_l� STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this GiJIL az 20l tby Ch(i54apher• k)61,(ji f L (Date) who has produced ', , `���' �- 8—zoi (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIGNA U'1'AHY NOTARY'S SEAL (PRI N• E OF NOTARY) NOTARY PUBLIC ,� yP,,B,, OLGA MORALES � ;: ° --,k ; Notary Public•State of Florida •; • •n My Comm.Expires Sep 9,2014 ;= Commission # FE 21902 �� •,,,, ;, Bonded Throug',N it oria'Vary Assn. 4 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I Servio Cortes , am a resident of Collier Florida County, (State) and have resided here for more than five (5)years. During the last five years I have known Russell Spokish -pplicant). I h. e ad the opportunity to observe his or her business and personal dealings and find h"• o �.er t e per. . of honesty, integrity and good character. , (Signature) e Ser Cortes (Name) (Address) ( r) SIJeIr , h `it ,A,.... if.* p Telephone)M ' 1 , ► J -I STATE OF FLORIDA COUNTY OF L The foregoing instrument was acknowledged before me this )`,� 2�1 by f (Date) JP_s v',C7 ��c k es who has produced as identification and who did not take an oath. AO dill ir4_ 11 I I I I� 1*'./ � NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC , 1 ....... `',..` �,��i�4 JOSUE SOLI$ % ,.,s - Notary Pubii•State of Flona. • My Comm.Expires Jan 23.2C r ,,,,,,, Commission*FF 85542 4 RES_ OLUTION OF AUTHORtZA TON WHEREAS Alno Naples Proposes to (Name Business Entity) ll engage in contracting as Cabinet Instaer (Type of legal entity:co in Collier County,Florida, �•�Partnership,etc. da according to Collier County Ordinance 2006-46,as amended;and WHEREAS Alno Naples (Name of Business Entity) proposes to qualify b ra Certificate of Competency with Russel Spokish (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: • Martha Spokish Russell Spokish We the undersigned' (Officers,Owners,Partners) of Alno Naples hereby resolve and represent to the Collier County (Name of Business Entity) Contractors'Licensing l3oard that the qualifying agent Russell Spokish ,is active in all maticrx Corneeted with the conracting business of (Name of Individual) �l.no Naples ,and We further resolve and represent that RussellfBpokishtity) is legally empowered to act for Al n o Naples s of Individual) in all matters connected with its (Name ofBusiness Entity) contracting business,and has the authority to supervise construction undertaken by Alno Naples (Name ofBusiness Entity) • DULY PASSED AND ADOPTED THIS 21 day of March 2 014 (Officers,Partn., • •ers—with .� t;�2e.� is G-e�eceLC e 2r ./ / / 'VVitnes '� i dr +/ I/ KA 2.E;.� kit.-L-L-e=e cc_c�,I.c-5 n 1 1 1Ct C J Witness . . Witness - Corporate Seal(if Applicable) ' No Or - i t Public Certificate Sworn to and subscribed before me this day of t�r� j� ,aL�qby f SSA 11 u CiSh cr)t4 1Yli. fflk , Y - . I (�� w�� &, E,t,,4't I_!'-,x;Lgtr /76''"7 IS ■, .� i i c c . Notary Public Name Printed :� „� Commission Number Notary P bli igna I • My Commission expires: " " KERAI L WILL • 'r= MY tXMAM1iss #EE 178347 EXPIRES:March 30,2018 • "•••• Banded ThruNotaryPublicUndertwbrs �r4P� 4 Alt 1 * 14#.- .. AMP4* 1 # 4 t ' ", 4 0.+Tj 0.1• .4#�•�y►•,rCw,,-*0 ••0.. 1• �•' �'�/m rt 04 te !41►• Ca EP4 ./-': ‘0:1)1 r+.—+-) ..,°, q ilig4.4 Alr C" cn E!') o C4 P 4,4100 ... „ o, 1or1 c) ,, P P CND x ®/ it 0 A/4 FA* ,.\. , g”: 5L F St-C/1 '-' -1-- S tti? ,-, ca., utti Ill i° ■ ta. i:ol "Old ; . C4 9 .4 3 ,--1... 0 !At * ttvorl g. --- g. 0 A� ti .. 1 tr A 2 . , :or4), 8 ::_1..., sq' &)t) ,T, ' 1 -7, e 4 , ; 1 ®il►r o 4.ca. CD x p u �f�`�i7111'+ r „ n a, 0 ILO 4 4 , a CD - � �W b , y 1�/.r3) �4 ��1 rt moo , o oak Or 0 a � 1�M� Oo ',� � 0 ›- PkI# 7. 401/No• 0 c!: ,t. (.9., /IA* .-3-, 0 ) tioz. : 04 V cn o A-40 IPO 0A IR tIk VP' A.14 . 1 1.4431,1. ,:) „- 1l/ � o � * ` ..r[�f iii 0i��i•. i 7. APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G12000070465 Fictitious Name to be Registered: ALNO NAPLES Mailing Address of Business: 2601 68 STREET SW NAPLES, FL 34105 Florida County of Principal Place of Business: COLLIER FILED FEI Number: Jul 15, 2012 Secretary of State Owner(s)of Fictitious Name: SPOKISH, MARTHA 2601 68 STREET SW NAPLES, FL 34105 US I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath and I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s. 817.155, Florida Statutes. MARTHA SPOKISH 07/15/2012 Electronic Signature(s) Date Certificate of Status Requested( ) Certified Copy Requested( ) State of Florida Department of State I certify from the records of this office that ALNO NAPLES, INC is a corporation organized under the laws of the State of Florida, filed on September 16, 2013. The document number of this corporation is P 13000077906. I further certify that said corporation has paid all fees due this office through December 31, 2014, that its most recent annual report/uniform business report was filed on March 24, 2014, and its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Twenty-fourth day of March, 2014 V-e4NVell!4" Secretary of State Authentication ID:CC9867542328 To authenticate this certificate,visit the following site,enter this ID,and then follow the instructions displayed. https://efile.sunbiz.orgicertauthver.html AK I ICLES OF INCORPORATION In compliance with Chapter 607 and/or Chapter 621,F.S.(Profit) ARTICLEI NAME r!LLD The name of the corporation shall be: AlnO Naples, Inc SE i `' F ;`f ,!. STATE ARTICLE II PRINCIPAL OFFICE �� Principal street address Mailing address dilnn. 3: 25 4444 Tamiami Trail North Suite 5 - Naples FL 34103 ARTICLE III PURPOSE Any and All Lawful Business The purpose for which the corporation is organized is: ARTICLE IV SHARES The number of shares of stock is: 100 ARTICLE V INITIAL OFFICERS AND/OR DIRECTORS Name and Title:Martha Spokish /President Name and Title: Russell Spokish/ VP Address 2601 68Th Street SW Address: 2601 68Th Street SW Naples FL 34105 Naples FL 34105 Name and Title: Name and Title: Address Address: Name and Title: Name and Title: Address Address: If this application contains incomplete or inaccurate information,it may cause a delay in the issuance of your exemption.An officer electing ar exemption under Chapter 440,Florida Statutes,is not entitled to benefits under this chapter. Section 1: APPLICANT INFORMATION *Name: Russell R Spokish 0*State Driver's License Number: or O*Florida Identification Number: Florida for information on obtaining a Florida Driver's License or Identification Card *Social Security Number(last four digits): 8873 *Date of Birth: Email Address: russell @alnonaples.com -The Division's purpose in collecting an email address is to communicate with the applicant regarding exemption related issues. Section 2; This section defaults to a Construction Industry Applicant.If you are in the non-construction industry,click on the radio button in order to select Non Construction Industry Applicant.The choice made below will determine which type of classification codes,either construction or non- construction,will appear in Section 3,Scope of Business or Trade. O CONSTRUCTION INDUSTRY APPLICANT ($50 FEE REQUIRED): *Please check the appropriate box to identify if you are an officer of a corporation or a member of a limited liability company. O Officer of a Corporation having at least 10%ownership VICE PRESIDENT .1 O Member of a Limited Liability Company(LLC)having at least 10%ownership O NON-CONSTRUCTION INDUSTRY APPLICANT (NO FEE REQUIRED): *Please check the appropriate box to identify if you are an officer of a corporation or a member of a limited liability company. O Officer of a Corporation: O Member of a Limited Liability Company(LLC)having at least 10%ownership Section 3: This section should be completed with information specific to your corporation or to the limited liability company in which you are a member. The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations.If you are unsure of the registered name, *Name of Corporation or LLC: ALNO NAPLES Inc. *FEIN:46-3711935 ____'..N ALNON-1 OP ID: QM :,4WO R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) a 03/25/2014 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: 239-261-6116 (cjA°NME"cT Karla P. Mendoza,CIC Dawson of Florida;Naples❑ 6609 callow Park Drive❑ Fax: 239 461 4803 (AtJ .0.239-280-3614 FA ,No): 239-261-2803 Naples,FL 34109❑ ADDRESS:KMendoza @DawsonCompanies.com Karla P.Mendoza INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Auto Owners Insurance 18988 INSURED ALNO Naples, lnc❑ INSURER B: Russell&Martha Spokish❑ 4444 Tamiami Trail N.,Ste 5❑ INSURER C: Naples,FL 34103 INSURER D: INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR'-- – -----– ---- UBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP POLICY (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 20115954 06/18/2013 06/18/2014 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 j GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY E T LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A ANY AUTO 20115954 06/18/2013 06/18/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X ; NON-OWNED I PROPERTY DAMAGE AUTOS (Per accident) $ $ UMBRELLA UAB i ;OOCCUR EACH OCCURRENCE $ EXCESS UAB1 CLAIMS-MADE -- AGGREGATE $ — DED ! RETENTION$ $ WORKERS COMPENSATION ( WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS_ ER . ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? IN/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below , I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Home Improvement Storefront - Retail/Resale Kitche cabinets including ❑i installation Li CERTIFICATE HOLDER CANCELLATION COLLI-D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractorsf i THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Licensing Borad❑ 2800 N Horseshoe Drive❑ Naples, FL 34104 AUTHORIZED REPRESENTATIVE /�" Mar 26 14 03:29p 239-277-0167 ,,,, 2392770167 p.2 )� Prepared By: Cry= Merit Credit ` �,tV (239) 277-3202 , !. \�,Y (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 AM 12/84 03/26/14 14 :29CT [SUBJECT] [SSN] [BIRTH DATE] SPOKISH, RUSSELL G. [ALSO KNOWN AS] LAROSA,RUSSELL [CURRENT ADDRESS] [DATE RPTD] 200 RED GATE TE. , CANTON 7. 30115 2/10 [FORMER ADDRESS] 7100 SABLE RIDGE LN. , NAPLES FL. 34109 9/03 5405 TAYLOR RD. , #18. NAPLES FL. 34109 [POSITION] [CURRENT EMPLOYER AND ADDRESS] [RPTD] [HIRE] ROYAL KITCHENS INC OWNER 6/04 10/96 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 O D E L P R O F I L E ***FICO CLASSIC 04 SCORE 4-597 : 038, 020, 010, 013 *** C R E D I T SUMMARY * * * T O T A L F I L E H I S T O R Y PR=1 COL=2 NEG=5 HSTNEG-L0 TRD=21 RVL=14 INST=4 MTG=2 OPN=1 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $7361 $11.0K $0 $0 100W OPEN: $310K $ $ $ 100W CLOSED W/BAL: $7094 $3546 $ TOTALS: $318K $1I1.0K $7094 $3546 $ P U B L I C R E C O R D SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5096155 11/12R $256K C CI 11SC1751 CIVIL JUDGMENT RBC BANK USA C O L L E C T I O N S SUBNAME SUBCODE ECtA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 3/12 $8618 CITIBANK SOUTH DAK 09B 2/14A $10.1K PLACED FOR COLLECTIO INVSTMTRTRVR Y 26HX001 I 5/12 $28.5K 12 WELLS FARGO 09B 34341682043104 12/13A $28.5K PLACED FOR COLLECT:O T R A D E S SURNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERI'IED CREDLIM PASTDUE ANT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLS /PD BALANCE REMARKS MO 30/60/90 Mar 26 14 03:29p 239-277-0167 2392770167 p.3 USAA SB B 3112046 10/09 $3860 R09 3/14A $4000 $1880 I CREDIT CARD 3/11F $3809 UNPAID BLNC CHRGD CFF USAA SB B 3112012 10/09 $3944 R09 3 44A $4000 $1666 I CREDIT CARD 3/I11F $3285 UNPAID BLNC CHRGD OFF TE{D/CBNA B 26H3005 4/101 $9258 R09 3/12A $7400 $0 I CHARGE ACCOUNT 12/10F $0 PORCH BY OTHER LENDER CHASE B 26QK001 9/48 $27.OK R09 6/11A $23 .7K $0 I CREDIT CARD 5/i1F $0 PURCH BY OTHER LENDER PNC MORTGAGE B 7484008 1/04 $590K 324M3473 111111111111 M02 2/i0A $0 1111111 C CONVENTIONAL REAL 2/IOC $0 CLOSED 19 0/ 0/ 0 GECRB/LOW L 235041G 11/00 $2492 111111:11111 RO1 3/14A $380 $0 111111111111 I CHARGE ACCOUNT 11/i1C $0 CLOSED 48 0/ 0/ 0 GECRB/Ht4DSGN B 9992684 9/04 $1864 111111111111 RO1 2/14A $5500 $0 111111111111 I CHARGE ACCOUNT 6/08C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 CAP1/SAKS D 2D0001 4/06 $2896 111111111111 ROl 12/1.3A $4000 $0 111111111111 I CHARGE ACCOUNT 4/09P $0 48 0/ 0/ 0 CHASE B 26QK001 5/04 $10 .8K 111111111111 RO1 11/13A $17 .3K $0 111:11111111 I FLEXIBLE SPENDING 12/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 SEARS/CBNA B 6256458 2/05 $393 111111111111 RO1 2/13A $4200 $0 111111111111 I CREDIT CARD 10/98C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 AMEX B 21WB001 9/ 8 $0 1111111111 ROl 9/]2A $500 $0 I CREDIT CARD 12/ BC $0 ACCT CLSD BY CONSUMER 46 0/ 0/ 0 MB FIN SVCS F 117Y003 9/ 7 $32.3K 60M647 X11111111111 I01 6/ 2A $0 111111111111 I AUTOMOBILE 6/i2C $0 CLOSED 48 0/ 0/ 0 TD BANK N.A. B 748M001 9/06 $16.5K 63M324 111111111111 I01 2/11A $0 111111111111 I RECREATIONAL MERC 2/I1C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 1597029 7/07 $9101 111111111111 RO1 6/10A $9400 $0 111111111111 I CREDIT CARD 2/ OC $0 ACCT CLSD BY CONSUMER 35 0/ 0/ 0 COMMUNITY BB B 1S5R002 1/14 $590K 324M 111111111111 MO1 Mar 26 14 03:29p 239-277-0167 2392770167 p.4 9003516 3/ 8A $0 111111111111 C REAL ESTATE-JUNIO 3/118C $0 PURCH BY OTHER LENDER 48 0/ 0/ 0 CCP+MUNITY BK B 1S5R002 G/pi $310K 1111X111'_111 001 900 4/06A 111111111X11 C 48 0/ 0/ 0 CAP ONE B 1DTV001 2/19 $6578 111111111111 RO1 9/ 5A $0 111111111111 I CREDIT CARD 9/ 5C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 GMAC Q 2592672 3/91 $20 .5K 60M396 111111111111 101 6/05A $0 111111111111 C AUTOMOBILE 6/05C $0 CLOSED 44 0/ 0/ 0 EXPO/03NA B 26H3004 6/ 4 $4465 11111111111 ROl 5/ 5A $7000 $0 I CHARGE ACCOUNT 2/05P $0 11 0/ 0/ 0 AMEX B 21WBOO1 6/04 $4155 1111111111 ROl 5/15A $3700 $0 I CREDIT CARD 4/05C $0 ACCT CLSD BY CONSUMER 10 0/ 0/ 0 PORSCHE CRD F 42UA193 8/11 $49. 9K 60M1010 1XX111111111 I01 6/04A $0 111111111111 C AUTOMOBILE 6/04C $0 CLOSED 33 0/ Q/ 0 I N Q U I R I E S DATE SUBCODE Si NAME TYPE AMOUNT 3/26/14 ZNP6284423 (FLA) MERIT CREDIT I C R E D I T R E P O R T S E R V I C E D BY : 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.transunioni1 com CREDITOR CONTACT INFORMATI N CHEROKEE ST ZP5086155 (404) 479-0541 990 NORTH ST CANTO GA. 30114 MIDLAND FUND YC36ET009 (800) 825-8131 8875 AFRO DR SAN DIEGO CA. 92.23 IN'VSTMTRTRVR YC26HX001 (916) 941-8865 45L1 GOLDEN FOOTHI EL DO O HILL CA. 95762 USAA SB BC3112046 (800) 922-9092 10750 MCDERMOTT SAN AITONIO TX. 78288 USAA SB BC3112012 10750 MC DERMOTT SAN TONIO TX. 78288 THD/CBNA BZ26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 CHASE BC26QK001 (800) 955-9900 P.O. BOX 15298 WILMINGTON DE. 19850 PNC MORTGAGE BM7484008 PO BOX 1820 DAYTON OH. 45401 GECRB/LOA7 LEI235041J (800) 444-1408 Mar 26 14 03:29p 239-277-0167 2392770167 p.5 PO BOX 956005 ORLANDO FL. 32896 GECRB/HMDSGN BC9992684 (866) 396-8254 C/O PO BOX 965036 ORLANDO FL. 32896 CAP1/SAKS DC2DQ3001 (800) 221-8340 PO BOX 10327 JACKS N MS. 39289 SEARS/CBNA BC6256458 PO BOX 6282 SIOUX FALLS SD. 57117 AMEX BC21W13001 (800) 874-2717 P.O. BOX 981537 EL PASO TX. 79998 MB FIN SVCS FA117Y003 P.O. BOX 961 ROANO{E TX. 76262 TD BANK N.A. BB748M001 (866) 246-0192 PO BOX 219 LEWISTON ME. 04243 BK OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 COMMUNITY BK BB1S5R002 (941) 649-1500 5150 TAMIAMI TRAIL NAPLES FL. 34103 CAP ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 GMAC QZ2592672 (800) 200-4622 P.O. BOX 380901 BLOOMINGTON MN. 55438 EXPO/CBNA BZ26H3004 PO BOX 6497 SIOUX FALLS SD. 57117 PORSCHE CRD FA42UA193 (800) 505-1041 980 HAMMOND DR ATLANTA GA. 30328 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 VERIFIF.T) FOR PINELLAS COUNTY. P LIC RECORDS LEARNED 1 SOURCES OF INFORMATION: T S 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. Mar 26 14 03:30p 239-277-0167 2392770167 p,6 i 1 1 Premier Profile-ROYAL KITCHENS CO . c-:.-, E,( : .•"':o Subcode:970135 Ordee 03/26/2014 14:30:25,CgFT i *I"�; Exrerian Transaction Number:C500349762 ,`, [. 1 o • e i'• Search Inquiry: ROYAL KITCHENS C0/5405 TAYLOR RD STE , IA) ' A world ofinsight 18/NAPLES/FL/34109/US/239-254-8888/736330420 '`l Model Description: Intelliscore Plus V2 f.-/ Business Name g Business Identification Number 73:6330.42Q Doing Business As: ROYAL KITCHENS Phone: (239)254-8888 Primary Address: 5405 TAYLOR RD STE 18 Tax ID: 59-3509752 NAPLES,FL 34109-1899 TOP 4•4i k ae h4ZD.ard Risk, cpres and Credit Limit Recommendati•n • - Days Beyond T:rms Derogatory Liitgai Fraud Alerts Intelliscore Pius Financial Stability'-isk Company DST Original Filings High Risk Alerts MEDIUM !j 'AEDIUN-HIGH DBT /1 f1 lJ 46 RISK 1 O i RISK Unavailable �j Score range:1 -100 percentile Credit Limit Recommendation:$3,300 TOP 4} Years on File. 16(FILE ESTABLISHED 02/1998) SIC Code: LUMBER&BUILDING MATERIALS DEALERS-5211 State of Incorporation: FL NAICS Code: Other Building Material Dealers-444190 Date of Incorporation: 03/08/1999 Business Type: Institutions-Profit Contacts: RUSSELL SPOKIS-1-PRESIDENT MARTHA SOPHIA SPOKISH-V CE PRESIDENT TOP '4 Commercial Fraud Shield f ualuetipq f o r,ROYAL..KITC11,EN CQ.o 541:14 TAYLOR I E3 ve la,MAPt»pc+.t Ii L3A1g9-'899 . Business • e' • Verification Ti-iggers The primary Business Name,Address,and Active Business indicator: r Experia shows this business as active Phone Number on Experian Flie were reviewed for High Risk indicators,no High Risk indicators were found. Possible OFAC Match: Ill No OF C match found Business Victim Statement: I No victi statement on file - O' core a5#P-r lft L.Ilt t i c " ziWion ., •. .: - -,. Credit RIsii Spore:Intellis-•re Plus ' Current Intelliscore Plus Score: 46 Risk Class: 3 1 46 IdiEDIUM€tiSf4 __I High Low The risk class groups scores by risk into ranges of similar Risk .;,ice:�,_. ,,:;,.•., Risk performance.Range 5 is the highest risk, range 1 is the lowest risk. 0 10 25 50 75 100 Premier Profile-ROYAL KITCHENS CO 1/3 Mar 26 14 03:31p 239-277-0167 2392770167 p.7 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 industry Risk Comparison > BALANCE OF AGED COMMERCIAL ACCOUNTS THAT ARE CURRENT 45%of businesses indicate a higher likelihood of severe delinquency. > RISK ASSOCIATED WITH THE COMPANY'S IND STRY > LOW NBR OF COMMERCIAL ACCTS RPTD WIT IN THE LAST 12 MOS Quarterly Score Trends Quarterly Score Trend -- -- lo0 r` g0 - 80 - 70 • • The Quarterly Score Trends provide a view of the 60 ' likelihood of delinquency over the past 12 months for this 50 45 45 . 45 business.The trends will indicate if the score Improved, 4Q. remained stable,fluctuated or declined over the last 12 months. r 20 10 _ Credit Risk Store: Financihl Stability Risk . Current Financial Stability Risk Score: 10 Risk Class:4 High ` »:Fa+eo,o l Low The risk class groups scores by risk into ranges of similar Risk: _ _ . Risk performance.Range 5 is the highest rsk,range 1 is the 0 3 i0 30 65 100 lowest risk. This score predicts the likelihood of financial stability rsk within the next 12 months. The score uses tradeline and collections information, ublic filings as well as other variables to predict future risk, Higher scores indicate ower risk. Factors lowering the score Industry Risk Comparison > NUMBER OF ACTIVE COMMERCIAL ACCOUNTS 9%of businesses indicate a higher likelihood of financial stability risk. > RISK ASSOCIATED WITH THE COMPANY'S INDLSTRY SECTOR > RISK ASSOCIATED WITH THE BUSINESS TYPE > EMPLOYEE SIZE OF BUSINESS Credit Limit iiecommendaifion Credit Limit Recommendation This recommendation compares this business against similar businesses in the Experian ousiness I credit database.It is based on trade information,industry,age of business and the Inteliiscore $3,300 Plus.The recommendation is a guide.The final decision must be made based on your company's business policies. TOP 0 ,Palm t R F!l% s 5liii n ar ....L,., , .. Payment Piriformance Trade and Collection Balance 1 Legal Filings : Current DBT: Not Available Total trade and collection (2); $0 Bankruptcy: No Predicted DBT: N/A All trades(2): $o 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(0): $0 UCC filings: 0 Highest DAT Previous 5 Quarters: 0 6 monh average: N/A Cautionary UCC filings: No Premier Profile-ROYAL KITCHENS CO 2/3 Mar 26 14 03:31p 239-277-0167 2392770167 p.8 Payment Trend Indication: Highe t credit amount extended: N/A Payment trend indicator not available Most f equent industry purchasing terms: In ustry purchasing terms not available Industry CPn?parison Industry DBT Range Comparison The current DBT of this business Is Not Available. DBT for this business: Not Available of businesses 80% 11910 DBT Range D-5 6-15 16+ TOP t l#1 :-.41_ 1.4011 l-trade DAtails Payment Experiences 'Account, tatus ('trade Lines vilth an(1 after the date are newly reported) Days Beyond Terms Business Date Last Payment; Recent High Balance Cur 1-30 31-60 6140 91+ Comments Category Reported Sale Terms Credit BANK 06!2013 CONTRCT $0 PRNTG&PUBL 1012012 VARIED $0 TOP.42$ Corporate ei9istration • THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA. State of Origin; FL Date of Incorporation: 03!08!1999 Current Status: Active Business Type: Institutions-Profit Charter Number: P990000233 Agent: SPOKISH RUSSELL Agent Address: 7100 SABLE RIDGE LANE NAPLES, FL TOP Ail 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 stre gthen and enhance the power of the information available for making sound credit decisions. Give credit wher• credit is due. Call 1-800-520-1221,option#4 for more information. End of report 1 of 1 report The information herein is furnished in confidence for your ex.lusive use for legitimate business purposes and shall not be reproduced Neither Experian Information Solutions, inc.,nor their sources or distributors arrant such information nor shall they be liable for your use or whence upon it. ©Experian 2014.All rights reserved.Privacy policy. Experian and the Experian marks herein are service marks o registered trademarks of Expenan. Premier Profile-ROYAL KITCHENS CO 3'3 Mar 26 1403:32p 239-277-0167 2392770167 p.9 TIT Brit Credit Fast, Accurate & Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNE /PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT T E COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OP INFORMATION; EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNT COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REG (DING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800-371-3346 OR 239-277-3202. COMPANY NAME: ROYAL KITCHENS CO FEDERAL ID: 59-3509752 CURRENT STATUS: INACTIVE PRINCIPAL(S): RUSSELL SPOKISH TITLE: PRESIDENT MARTHA SPOKISH TITLE:VICE PRESIDENT DATE INCORPORATED:03/08/1999 To Whom It May Concern, Bradley Garrod, president of Garrod Painting Inc., is requesting reinstatement of my Collier County Contracting License. I grew up in Collier County, and was sponsored through Collier County for initial acquisition of license. I moved out of the area to Charlotte County shortly after obtaining my license, but have always maintained a license in good standings with Charlotte County, City of Punta Gorda, and Lee County. I am requesting a renewal of my license in Collier County for the ability to bid and complete work in Collier County again. Please review the attached application as well as proper documentation for consideration of reinstatement. Thank you for your time, f\� Bradley Garrod President Garrod Painting Inc. ,ezpi - ot GMD 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: (1 7/�n/2-64-) /A./9 /&k.- Fiction Name/DBA: Qualifier Name: 732r'z)i Le / C7I)/2/2 , Physical Address: 4 Z.7 / 3 54- J o 2 r C) P) i _ 11_ (Number 86 Street) (City) (State) (Zip Code) ��c > C.' �jc1(1/0 / 2/ c/7 '7/e/c Mailing Address: k= (Number 8, Street) (City) (State) (Zip Code) Telephone: kill 74-=2) %Zr-C(:: _-) Q✓/O2 _..-nZi--C/4% (� 9 mat/ Goy TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 Specialty $205.00 Specialty trade: /CAI)/;u-/)A,q — c CHANGE OF STATUS: REINSTATEMENT FEE $205.00 (/) Reinstatement From One Business to Another 3 BACK YEARS FEES $555.00 RENEWAL WI LATE FEE $185.00 Page : of 4 TOTAL = $945.00 r 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. 6'J I-)/ V 6j)l2/2. ;13 /6'; L/ 1.---e&2 ( C/5 ��-'!,_%t n � qt/ 644 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. 6� ct24ec6 recce /A./( 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. A70 4h/J ha ve_. ho--) i (iC,c2-ec AFFIDAVIT 1, gJJ/ Q/ 6c(-(272-6 certify that the foregoing is true and correct to the best of my knowledge. / - /f/ Z\---- / Authorized Officer of the Firm STATE OF FLO A COUNTY OF 1L�,V�u The foregoing instrument as acknowledged before me this (31-1, };` -l7, of 7 917641:,,c< rr ,^ /(Date) l By r5Y-c j'i€+ \')Ci Viroel of 6( vnd f-C-21 A71 -A7 Pt( . (Name of officer, title/agent) (Name of Corpoftion) a 1-lo v f.),_ Corporation on behalf of the corporation. (State or Place of Corporation) yy He/She has produced ff"VS0a.,OLit J`ha.00 identification and did not take an oath. (Type ofentification) ' (.. \\\ R _, NOTARY'S SEAL Y 1 t _ t d,%I.tr:F. KA1 YNft Affrot 1 t ', : /A,\ t�I R.4.'(. 'I '' �� , MY COMMISSION#EE 173191 (SIGNATURE OF NOTARY) „, = EXP!RES.February 26,2010 e' tbnda0 Tin Deo Nary Servile 1 Page 2 of 4 QUALIFIER INFORMATION: Name: �/--12k_C_ Address: i 5 q(/ 17--(z l2( 5 l�I i ht/-2 c bib �C� G�` 3�C'67-_ (Number& Street) (City) (State) (Zip Code) Telephone: q41 5 ..,<_71-4s.7 Date of Birth: / S.S. 4: 000-00- /C)L /7 � / T � �� _� / 1. Type of Certificate of Competency for which application is made. ic1 U76C/7a 2. The names and telephone numbers of two persons who will know your whereabouts. C`/ L(Ce_l 0 /&/1 //6/ q5// u/J 6Y5 /e_i/57/7//) 5/ -eo✓q qc/l ( 7 (-17g 3. Have you ever been convicted of a crime related to Contracting? A/C (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? Al( 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. /1/0 C/,/�./.7J 1J.. .;? f7_�2 c3JJ c/ G%z ,/CL.(rcv r�G 9. List your business or work experience during the past ten years. /0//cf? /2cc/C /Z 10. Statement of any forma!training you have had in the area for which the application is made./ Page 3of4 CD-Plus Report ID No. Description Exam Date Score Location 12052 PAINTING 9/14/2002 76.7 VENICE 12053 BUSINESS AND LAW 9/14/2002 78 VENICE 12695 TILE & MARBLE 11/2/2002 NO SHOW - NAPLES Printed on :2/20/2014 4:02:20 PM Collier County CD-Plus for Windows 95/98/NT Page :1 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. APPLICANT(PLEASE PRINT) NAME OF COMPANY SIGNATURE OF APPLICANT STATE OF FLoAtpA COUNTY OF LAO Gr �i� fy The foregoing instrument as acknowledged before me this ( 14 _'/17ria` Al (Date) By j2` 1 C-G G4, V1 U' who has produced -ekSot 1 i (Name of person cknowledging) (Type of id tification) as identification and did not take an oath. NOTARY'S SEAL ll % ,>.. KATHRYN it ANTONEW.pRY P(B SiGNATLR OF NOTARY) MY COMMISSION#EE 173191 'ir.�°raQ EXPIRES:February 26,2016 -14 or:B.oe`O Bonded Thru Budget Hatay Services Page 4 of 4 AFFIDAVIT IT IS understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if [ 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. SIGNA'I'U°RE OF APPLICANT -6i)2 2G%/ /`'%?//)1/7-) e` BUSINESS NAME DATE EFORE ME this day personally appeared 4110 r iJ 6 4--ot,7c1 who affirms and says that he is less than one employee and does not require Workme•'s Compensation understands that at any ne he employees one or more persons he must obtain said Workmen's Compensation Insurance. 'ATE OF FLORIDA )LINTY OF .e foregoing instrument was acknowledged before me this c r[ J' 1-e1,-47.A4.7 ,}1/y (Date) r who has produced O t t /CM„-k-1 (name of prson acknowledging) I (Type of identification) identifinntinn nnrl who did not take an oath. v i : SI I. • OF NOT• •Y 41fr /II /11' ,'Leti NOTARY'S SEAL (P 'INT NI ME OF NOTARY PUBLIC) ►((nTt�r�Y# .A ONEILI NOTARY PUBLIC , MY COMMISSION#EE 173191 EXPIRES:February 26,2016 Bonded Thin Budget Notery Servitu 4 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER /Ce_ ii Ii/9 71012 L Z/ , am a resident of X1 2.05) C_ County, ro 2/dC' (State) and have resided here for more than five (5) years. )wring the last five years I have known a. 0 2i/ ,(, t•)017 d (Applicant). I have had he opportunity to observe his or her business and p sonal dealings and find him or her to be a person of Honesty, integrity and good character. (Signature).-O� ...4P-C.-4-' l A(Name) 6fr/7j g A-)/on_ _L/ � (Address) S7 L t- l�ba/ n Lai X4)/A Po/4 , - YYY')/ Telephone) go c3s-8 8.o`1 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this b• % / �.�'4 . - by Date) i n(. ii JJ fill', P/// who has produced '/"f d'1Ll/ (.1 ii 10._!1`1 (name of Verson acknowledging) (Type of id6ntification) as identification and who did not take an oath. pis► JENNIFERHU1JNG �' , hiti-Vq,:, l' f� MY COMMISSION#FF007100 SIGMA LOitt, Itl± OF t�'1ARY 7 EXPIRES:APR 11,2017 a Bonded through 1st State Insurance a NOTARY'S SEAL (PRINT NAME OF NOTAm NOTARY PUBLIC • 10 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER C/O.c c6 /C, - / �J���rs-- , am a resident of Cr/a/%c 2ounty, F/6)/-/dam (State) and have resided here for more than five (5) years- During the last five years I have known P),-- 607/n)-(1 applicant). I have had he opportunity to observe his or her business and person d1 dealings and find h'; or her to.•- a per :n of ionesty, integrity and good character. (Signature) _j A (Name) C/C7---JGZ/o i-7G,-k te0 (Address) Z,5i4C.; rpk_r'(+ rl( J2r)C.. 0 --Pu—(1-1Ct eorda. F S5Pg-3 Telephone) q4-/ g/5 (04(Gb STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this C`. by J (lap? L 64 rib GV who has produced (name of p rson acknowledging) (Type of identification) as identification and who did not take an oath. „ri{ S, J IRE OF N_ TARY i\6. , /4,10,)„,J,r'- NOTARY'S SEAL (PRINT N� JE OF NOTARY) NOTARY PUBLIC O�PaY.,Ueli KATHRYN V.AKTONEW tc* MY COMMISSION#EE 173191 * . }�= ,,._,-,,,p:^:<< EXPIRES:February 26,2016 „,6°r Bonded That Budget Notary So vacs 9 Qualifier Certification Information CDPK2307 ' Qualifier Certification Information Collier County Board of County Commissioners Printed on 2/19/201 9: 07 :38AM CD-Plus for Windows CERT NBR: 24414 QUALIFIER NBR: 23352 BRADLEY JOHN GARROD JR. CLASS CODE: 4270 PAINTING CONTR. STATE NBR: COUNTY COMP CARD: STATE EXP LIAR EXP WC EXP ORIG ISSD RENEWAL EXPIRES 1/8/2004 1/13/2003 9/30/2003 DBA: DI ABRUZZO PAINTING, INC. WC EXEMPT: Y OL EXEMPT: N ADDRESS: 4112 32ND AVENUE S.W. EXEMPT EXP DATE: 1/21/2005 CITY: NAPLES FL 34116- PHONE: (239) 348-7611 FAX: (239) 348-7611 NOTE: It is the qualifier' s responsibility to keep all business, licensing and requirements current and to provide up to date copies for Collier County files. This includes all insurance certificates and any change of address information. Collier County / City of Marco/ City of Naples Contractor Licensing PAINTING CONTR. Cert Nbr: 24414 Exp:9/30/2003 Status:CANCEL State Mir: Exp: DI ABRUZZO PAINTING. INC. BRADLEY JOHN GARROD JR. 4112 32ND AVENUE S.W. NAPLES FL 34116- Signed: ;VERIFICATION OF CONSTRUCTION EXPERIENCE :1 GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples, FL 34104 j pplicant's Name: YQC/ �!IG,//'Grj: )67(.6, e(12_11/2. ZLi /72 G . .:ertificate Category Requested: Jr_ ?�i / � -he Applicant is seeking a Collier County Certificate of Competency ht the trade indicated above. As part of the pplication 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 Corking as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). 'line served solely in a supen'isory or administrative role should be described, but may or may not be considered efficient to demonstrate required trade experience. The person verifying trade experience must provide the following iformation: 'ame, Title and license number of the person signing below and verifying Applicants relevant experience: ame: rQQ Ze �Q r�GGr f� y1 itle: Pry,./C&7") ' License Number(if applicable): ,12/71A 00/U//& ame of Business: (0 cce ice-/? -7-7� Zi7 ei usiness Address: z12-7/ -10 01 L Pc)2 / C'/?C 2/aV/ / _5.3gg) usiness Phone: 9-7//74-3-7ZID� The Applicant's years of experience from to he applicant's scope of work (specific duties) included: 1 2 0- i'1 "?Q f/ /( /) I O77c CO/1.2/)'2C,1 GL Gtl l��v CG7) C'/7 Ole (-2:_726z/ iditional Comments: �/L'.r t% ?� Al-(7,)! G±`":- ilsifying any information provided herein may subject your license to revocation. Signature /r',, Print Name: /nl00/6e- ,Q,=✓O 0E ite of Florida J runty of Collier e foregoing instrument was acknowledged before me on this (;' Clay o ��7 f ' t i J j rejr c-.4t 2 a who is personally knowrt\tn me r r foduced identification ad who did not take an oath. P, 01 )1At6f{ll= ,� MY COMMISSION#EE 1731x; Si nature of Notary EXPIRES:February 26,2018 ° -_ yri,ijThr,,Fxf7%'.iFas-y':e;v.'h,4e BUILDING DEPARTMENT CITY Y OF PUNTA GORDA BUILDING CITY OF PUNTA GORDA, FLORIDA DEPARTMENT CERTIFICATE OF COMPETENCY 326 W. MARION AVE. 941-575-3324, ext 1 BRADLEY J GARROD PUNTA GORDA, FL 33950 GARROD PAINTING INC 941-575-3324, ext 1 PO BOX 494410 e-mail: buildingdept©ci.punta-gorda.fl.us PORT CHARLOTTE FL 33949 CERT.#10-00009657 http://ci.punta-gorda.fl.us/depts/growthmgmt/building.html TYPE:PAINTING CONTRACTOR NOT VALID AFTER: September 30,2010 Expired or cancelled insurance automatically inactivates license BUILDING DEPARTMENT CITY OF PUNTA GORDA BUILDING DEPARTMENT CITY OF PUNTA GORDA,FLORIDA 326 W. MARION AVE. CERTIFICATE OF COMPETENCY 941-575-3324,ext 1 PUNTA GORDA, FL 33950 BRADLEY J GARROD 941-575-3324, ext 1 GARROD PAINTING INC e-mail: buildingdept@ci.punta-gorda.fl.us PO BOX 494410 PORT CHARLOTTE FL 33949 http://ci.punta-gorda.fl.usjdepts/growthmgmt/building.html CERT.#11-00009657 TYPE:PAINTING CONTRACTOR Expired or cancelled insurance automatically inactivates a license NOT VALID AFTER: September 30,2011 BUILDING DEPARTMENT CITY OF PUNTA GORDA BUILDING DEPARTMENT CITY OF PUNTA GORDA,FLORIDA 326 W. MARION AVE. CERTIFICATE OF COMPETENCY 941-575-3324,ext 1 PUNTA GORDA, FL 33950 BRADLEYJGARROD 941-575-3324, ext 1 GARROD PAINTING INC e-mail: buildingdept@ci.punta-gorda.fl.us PO BOX 494410 PORT CHARLOTTE FL 33949 http://ci.punta-gorda.fl.usideptsigrowttimmt_LI)ilding.html CERT.#12-00009657 TYPE:PAINTING CONTRACTOR Expired or cancelled insurance automatically inactivates a license NOT VALID AFTER: September 30,2012 . BUILDING DEPARTMENT CITY OF PUNTA GORDA BUILDING DEPARTMENT CITY OF PUNTA GORDA, FLORIDA. 326 W. MARION AVE. CERTIFICATE OF COMPETENCY PUNTA GORDA, FL 33950 941-575-3324,ext 1 BRADLEY J GARROD 941-575-3324, ext 1 GARROD PAINTING INC PO BOX 494410 PORT CHARLOTTE FL 33949 httn://ci.punta-gorda.fl.us/depts/growthmgmt/buildine.html CERT.#13-00009557 TYPE:PAINTING CONTRACTOR Expired or cancelled insurance automatically inactivates a license NOT VALID AFTER: September 30,2013 o. t.; ye } "s LUC2007-02772 Kathy Anionei i foarrodestimatir:gc yahoo.conn License Holder BRADLEY J GARROD - Name: Firm Name: GARROD PAINTING INC Address: PO BOX 494410 PORT CHARLOTTE FL 33949 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in.a safe place 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. Below 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.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity 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 ContractorLicensing @Leegov.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 ee effot 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 L!C2007 12772 to 4r� t .I c i I Re. s., ho -Y. / t U � 1 I i 7~i {i I�i,��.eCHL+�`.�.i,.v1 i f°',":c. :_ 3;':;" Conditions of Certificate LEE COUNTY i Conditions of Certificate CERTIFICATE OF COMPETENCY (239)533-8895 Shall maintain required insurances on active Renewal due for active and inactive certificates. certificate each year in September. NAME: BRADLEY J GARROD D/B/A GARROD PAINTING INC COMP. NO shalt appear on all Shall inform the Contractor Licensing Office of LICENSED FOR: Paintino Cntr advertisements includino vehicles retlectinc I any Address or telephone; change. a business name. Snail only connect in D;B/A name-as ii appears on cerdficate Board of Approve: COMP NO PT07-OZi7L required on business name changes NOT VALID AFTER: O5/3C/20'i44 Signature of License Holder icniriocren2in, 1°- t I , LIC2007-02772 License Holder BRADLEY J GARROD Name: Firm Name: GARROD PAINTING INC Address: PO BOX 494410 PORT CHARLOTTE FL 33949 Below 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.lee-county.com/dcd/contractorlicensing.htm -. In addition to this Certificate, it.is your responsiblity'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 do so by emailing your certificates to ContractorLicensing©Leegov.com. Our phone number is 239-533-8895 Please e-mail address and/or telephone changes to ContractorLicensing©Leegov.com cut Here Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239)533-6895 Shall maintain required insurances on active Renewal due for active and inactive certificates. certificate each year in September. NAME: BRADLEY J GARROD D/B/A GARROD PAINTING INC COMP. NO. shall appear on all LICENSED FOR Painting Cntr Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone//change a business name. Shall only contract in D/B/A name as it appears on certificate Board of Approval COMP. NO: PT0 -02172 required on business name changes. NOT VALID AFJER: 09/30/?01:1 ?signature of License Holder fcnirlocren2 rot BUILDING DEPARTMENT CITY OF PUNTA.GORDA BUILDING DEPARTMENT CITY OF PUNTA GORDA,FLORIDA 326 W. MARION AVE. CERTIFICATE OF COMPETENCY 41-575 3324,ext PUNTA GORDA, FL 33950 BRADLEY 1 GARROD 941-575-3324, ext GARROD PAINTING INC e-mail: buiidingdeptPci.punta-gorda.fl.us PO BOX 494410 PORT CHARLOTTE FL 33949 http://ci.punte-I?orda.fi.us/dePts/Rrcv✓thmRmtr/buiidinn.niml CERT.#14-00009657 TYPE:PAINTING CONTRACTOR Expired or cancelled insurance automatically inactivates a license NOT VALID AFTER: September 30,2014 CHARLOTTE COUNTY LICENSING • CERTIFICATE OF COMPETENCY ; ,' f ? - CHARLOTTE COUNTY LICENSING NOT VALID AFTER 09/30/2013 I! CERTIFICATE OF COMPETENCY � NOT VALID AFTER 09/30/2015 Lie.Type- L PAINTING ";■O' DEAL GARROD PAINTING INC I.ic.Type: L PAINTING Lic.Nbr AAA007 Ol l6 DBA GARROD PAINTING INC BRADLEY GARROD P O BX 494410 smw. Lio.Nbr: AAA 00]0l]6 PORT CHARLOTTE FL 33949- BRADLEY GARROD • P 0 BX 494410 sa,sco.a PORT CHARLOI lb FL 33949- • UULL1E.1-c'_ WUUN'TY GO VERNMFNI COMMUNITY DEVELOP KENT AND FNVRONNTNT AL SER VICES DIVISION 2800 N.Horseshoe Dr. • N p s.Florida 343=: e 239-403-2=00 e FAX 239-403-2334 :- I MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. - Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec, 2.1.1, all applicants are required to submit their social security number (SSN) for the following purposes: a) Assess applicant's ability to satisfy-creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119. Florida Statues and as may otherwise, be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Cliapter 119, Florida S nt+.yes_ • • N • SM CONFIDENTIAL Commercial Credit Report Company: GARROD PAINTING, INC . * Date: 12/23/13 Cust. No.: 9999 Address: 4271 JAMES STREET Price: $90 . 00 Ordered By: PORT CHARLOTTE, FLORIDA 33980 Page: 1 Telephone: (9 41) 743-7266 (X) Corporation PRINCIPALS: EIN: 03-0496688 PRESIDENT/VICE PRES/TREAS/SEC GARROD, BRADLEY, J. JR. Address: 1094 FERGUS LANE PUNTA GORDA, FLORIDA 33983 Social Security Number: - Stock Ownership: N/A Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: GARROD PAINTING, INC . was INCORPORATED in the county of COLLIER, state of FLORIDA, on 12/06, 2002 . The charter number is P02000129420 . The registered agent is GARROD, BRADLEY, J. JR. of 1094 FERGUS LANE, PUNTA GORDA, FLORIDA 33983 . Offices are LEASED from GARROD DRYWALL at $700 . 00 per month. The company employs . NET WORTH: ON FILE WITH STATE The company maintains banking relations with BANK OF AMERICA The officer handling the account is N/A - PORT CHARLOTTE, FLORIDA Reported for: APPLICANT - SEE NAME ABOVE Reported by: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 SM CONFIDENTIAL Commercial Credit Report Company: GARROD PAINTING, INC . * Date: 12/23/13 Cust. No.: 9999 Address: 4271 JAMES STREET Price: $90 . 00 Ordered By: PORT CHARLOTTE, FLORIDA 33980 Page: 2 PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF COUNTY, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: SEE BELOW*** *** Credit Profile *** Creditor Opened High Balance Rating SHERWIN WILLIAMS FAXED A&E PAINTS FAXED REMARKS: N/A = NOT APPLICABLE/NOT AVAILABLE * NAME CHANGE AMENDMENT FILED 06/02/03; OLD NAME WAS : DI ABRUZZO PAINTING, INC. A PUBLIC RECORDS SEARCH WAS CONDUCTED ON THIS NAME ALSO WITH THE FOLLOWING RESULTS : CLEAR AS OF 12/23/13 - SEVEN YEAR SEARCH. *** PUBLIC RECORDS SEARCH AS OF 12/23/13 IS AS FOLLOWS : (1) UCC FILING NO. 200901697956, 12/18/09, SECURED PARTY: SUNTRUST BANK COLLATERAL : ALL ASSETS, ACCOUNTS, FIXTURES AND CHATTEL PAPER INCLUDING PROCEEDS AND PRODUCTS EXPIRATION DATE : 12/18/14 END OF PUBLIC RECORDS SEARCH . REPORT WORKED BY RENEE END OF REPORT . This commercial report is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. SM . CHECK CONFIDENTIAL Individual Credit Report Name - GARROD, BRADLEY JOHN JR. f'( Ordered By: i( , t „, Customer : 9999 Address : 1094 FERGUS LANE ..,:,5 e, ' :, Received : 02/05/14 PUNTA GORDA, FL 33983 ;: .w „ G ................v.. •.... Completed . 02/05/14 Social # : Applicant : - Bill Amt : $60 . 00 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 Stet Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA 5/3 BANK CC AS AGREED 12/13 02/05 377 CLOSED 0 REV 0000 00 R1 48 A DLA=03/05 ALLY FINCL AS AGREED 01/14 08/10 22765 11153 0 378 0000 00 I1 40 C DLA=12/13 AM HONDA FIN AS AGREED 07/04 09/03 13647 CLOSED 0 0 0000 00 I1 09 P DLA=07/04 AMEX PD WAS 30 09/12 11/04 2375 PAID 0 0 0100 00 01-* 48 A DLA=09/12 AMEX AS AGREED 05/10 11/04 7283 PAID 0 REV 0000 00 R1 40 A DLA=02/09 BK OF AMER CUR WAS120 01/14 11/09 144340 128114 0 944 0502 08 M1-* 48 C DLA=01/14 BK OF AMER AS AGREED 12/09 08/08 142408 CLOSED 0 0 0000 00 M1 16 C DLA=12/09 CAP ONE AS AGREED 03/06 05/00 673 PAID 0 REV 0000 00 R1 48 A DLA=03/06 CHASE - CC AS AGREED 10/08 01/06 1500 PAID 0 REV 0000 00 R1 32 A DLA=03/08 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 Name • GARROD, BRADLEY JOHN JR. 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 Nos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA CITI AS AGREED 01/14 05/11 6866 6045 0 124 0000 00 R1 31 A DLA=01/14 FNB NAPLES AS AGREED 02/05 07/03 476 PAID 0 REV 0000 00 R1 18 A DLA=02/05 GECRB/DNKNDI AS AGREED 01/14 11/06 0 CLOSED 0 REV 0000 00 R1 48 A DLA=01/14 HARLEY DAVID AS AGREED 08/08 09/04 20273 CLOSED 0 0 0000 00 I1 45 A DLA=08/08 JAGUAR CRED AS AGREED 05/08 08/06 22618 CLOSED 0 0 0000 00 I1 21 A DLA=05/08 LAND ROVER AS AGREED 08/06 09/05 27444 CLOSED 0 0 0000 00 I1 11 A DLA=08/06 SEARS/CBNA AS AGREED 01/14 05/10 3806 3743 0 73 00 00 00 R1 43 A DLA=11/13 SUNCOAST CU AS AGREED 12/13 07/11 14472 7644 0 260 0000 00 I1 29 C DLA=12/13 SUNTRUST MTG FORECLOSURE 12/13 11/05 120000 0 0 0 01 01 24 M5-* 48 A DLA=08/11 Total trade lines on this report : 18 PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS : CLEAR AS OF 02/05/14 . SOURCE (S) : EQUIFAX TRANSUNION INQUIRIES: 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 CREDIT CHECK CONFIDENTIAL Name GARROD, BRADLEY JOHN JR. Customer : 9999 Page : 3 INQUIRIES: 02/05/14 by CREDIT CHECK (TU) #00630273 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 : 613 (scores range from 300 to 850) *** END OF REPORT *** This information is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. This personal report is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 • Detail by Entity Name Page 1 of 2 ao - 5 r'ki'#,p P'z' L n '' s easy S a `" is 5 fs FLORIDA DEPARTMENT of ' T:,'AT X I�vE ON .((yam■{ �j�]y{[y�� ���yyj '�{�}° b ISI ON ?M �7 OPR{, .R; A ON 3� �,..: 3.. ,, '3 k : `:' -'71�,P°.�, 4 .., r nra,�% air ,� ,:; '+?a&^k?�F .,H3 . s a,.< H ..N;Z�z.,win.s�+w✓,. u.;£.5R„ � Y-�,c;3�sy�K ,�� '"r" 'u:;�" "•� ��"" rl,,.,?� Detail by Entity Name Florida Profit Corporation GARROD PAINTING, INC. Filing Information Document Number P02000129420 FEI/EIN Number 030496688 Date Filed 12/06/2002 State FL Status ACTIVE Effective Date 12/05/2002 Last Event NAME CHANGE AMENDMENT Event Date Filed 06/02/2003 Event Effective Date NONE Principal Address 4271 JAMES STREET PORT CHARLOTTE, FL 33980 Changed: 06/15/2005 Mailing Address P.O. BOX 494410 PORT CHARLOTTE, FL 33949 Changed: 06/15/2005 Registered Agent Name & Address GARROD, BRADLEY JJR 1094 FERGUS LANE PUNTA GORDA, FL 33983 Name Changed: 04/28/2011 Address Changed: 04/28/2011 Officer/Director Detail Name &Address Title PVTS GARROD, BRADLEY JJR 1094 Fergus Lane Punta Gorda, FL 33983 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDe.tail/EntityName/dome-... 2/20/2014 ' Detail by Entity Name Page 2 of 2 . ` . Annual Reports Report Year Filed Date 2 O/2O �6mn Cnntamds^^ d�xingSan,iono Document Searches Forms Help �O12 O4/8O/2O12 2013 04/24/3013 Document Images 04/24/2013 ANNUAL REPORT View image in PDF format 04/30/2012 -- ANNUAL REPORT View image in PDF format 04/28/2011 -- ANNUAL REPORT View image in PDF format O4/22/2O1O — ANNUAL REPORT View image in PDF format O7/1O/2OO9 —ANNUAL REPORT View image in PDF format UG/18/2DO9 —ANNUAL REPORT View image in PDF format 04/22/2009 -- ANNUAL REPORT[ View image in POE format 04/08/2008 --ANNUAL REPORT View image in PDF format 03/26/2007 -- ANNUAL REPORT View image in PDF format O2/21/2OO8 — ANNUAL REPORT View image in PDF format OG/15/2OO5 —ANNUAL REPORT View image in PDF format 04/29/2004 -- ANNUAL REPORT View image in PDF format 06/09/2003 -- ANNUAL REPORT View image in PDF format 06/02/2003 -- Name Change View image in PDF format 12/06/2002 -- Domestic Profit View image in PDF format s^a�o,n^,.uaoen���°n'v,state hUn://ao8rch.ounbiz.org1oguiry/CorporntiooScorch/ScornhRcsnitDc1oil ome/dnrnp'... 2/20/2014 • 2009 FOR PROFIT CORPORATION AMENDED ANNUAL REPORT FILED Jul 10, 2009 DOCUMENT# P02000129420 Secretary of State Entity Name: GARROD PAINTING, INC. Current Principal Place of Business: New Principal Place of Business: 4271 JAMES STREET PORT CHARLOTTE, FL 33980 Current Mailing Address: New Mailing Address: P.O. BOX 494410 PORT CHARLOTTE, FL 33949 FEI Number:03-0496688 FEI Number Applied For( ) FEI Number Not Applicable( ) Certificate of Status Desired( ) Name and Address of Current Registered Agent: Name and Address of New Registered Agent: WOTITZKY, EDWARD L 223 TAYLOR STREET PUNTA GORDA, FL 33950 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date OFFICERS AND DIRECTORS: ADDITIONS/CHANGES TO OFFICERS AND DIRECTORS: Title: PT ( )Delete Title: PVTS (X)Change ( )Addition Name: GARROD,BRADLEY J JR Name: GARROD,BRADLEY J JR Address: 1094 FERGUS LANE Address: PO BOX 495218 City-St-Zip: PUNTA GORDA,FL 33983 City-St-Zip: PORT CHARLOTTE,FL 33949 Title: VPS (X)Delete Title: ( )Change ( )Addition Name: GARROD,BRENT A Name: Address: 3289 SW WILDCAT RUN ROAD Address: City-St-Zip: ARCADIA, FL 34266 City-St-Zip: I hereby certify that the information supplied with this filing does not qualify for the exemption stated in Chapter 119, Florida Statutes. I further certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes; and that my name appears above, or on an attachment with an address; with all other like empowered. SIGNATURE: BRADLEY GARROD PVTS 07/1012000 Electronic Signature of Signing Officer or Dirr otor Date w . (Requester's Name) 11110 1111 1 11111111111.11 :'1 (Address) 00001 196870 (Address) (CityfstratefZiplPhorce#) 06/02/03--01091----002 * 3S 00 0 PICK-UP WAIT 0 MAIL (Business Entity Name) (Document Number) Certified Copies Certificates of Status Special Instructions to Filing Officer: r f,: Office Use Only :" - 4//4 0?3 ---,--...'../ le,4,6 A,,.5.- 4 1 WOTITZKY, WOTITZKY, ROSS, GOLDMAN, STURGES �`' -' TUTTLE, P.A. ATTORNEYS AT LAW EDv,*ARD L wtrrrn2KY* ''.FLBAR WARD CY.DalTIED IIAL E WOTFIZPY*• REAL ESTATE LAWYER 223 TAYLOR STREET TELEPHONE(941)639-2171 WARBEN R ROSS°** *-FI.SUPREME COURT JASON B.GOIDMAN**`'* CEga RED CIRCUrr awn, PUNTA GORDA,FLORIDA 33450 ENGLEi rOOD(941)473-1700 NEST a FAMILY MEDIATOR. EIL W.STURGES.Ilt. 18501 MURD0aE CIRCLE,SUITE 501 FACSIM7.E: MELANIE H.TUTTLE an',can WCAL PORT CHARLOTTE,FLORIDA 33948 PUNTA GORDA(941)639-3617 DENNIS R WALLACE.D GOVERNMENT LAWYER PORT CHARLOTTE(941)627-1388 - FtANR_____1r_ "'"PL SUPREME COURT CERTIFIED CIRCUIT civ Please Reply to: WEB STTN• LEO WO17TZ.KY Ou www.woritzkyIaw,eorr* OF COUNSEL Punta Gorda May 12, 2003 FLORIDA DEPARTMENT OF STATE Division of Corporations Corporate Filings P.O. Box 6327 Tallahassee, FL 32314 Re: DiAbriizzo Painting, Inc. Gentlemen: Enclosed for filing please find Articles of Amendment to the Articles of Incorporation ofDiAbruzzo Painting, Inc. The amendment amends the name of the corporation and changes same from DiAbruzzo Painting, Lnc. to Garrod Painting, "Inc. Also enclosed please find our check in the sum of$35.00 as and for the corporate filing fee. We appreciate your consideration oft.ais matter. Very truly yours, Vv O'_'ITZKY,W jOT1 ZKY, ROSS, GOLDMAN, STURGES &TUT LE, P.A. z.../e,....„,..T By._ Edward L. Wotitzky ELW/ma Enc1. . • .- GASancly,C melon riarrod Statc.Lcr •. ES l\i LiS. _._✓ 1.940 PERSONAL ENTURY•WRONGFVL DE af Ea-LIISING HO.%1 NEGLECT-CIVIl _ITILA lCY- -i a,21,i ,.s.A' WF1 S S.TRUSTS&ESTATE PLANNLNG•PROBATE'6LIkttDLANS1-11?•CO:.`-ORATION lt FUNNIES LAW-i iNSSRDCTETsE:i.?IS•:WAIL':I.;r: RL7.1 ESTATE CLOSINGS'TITLE INSURANCE•REAL PROPERTY LAV'•CONDOMINIUM COMMUNITY ASSC'CJJSION L 5\'•ZONliNG.LAND 055 0 AL'*:_Lh;1Si RACOC LAW ARTICLES OF AMENDMENT TO THE ARTICLLS OF INCORPORATION OF Jo; DI AERUZZO PAINTING, INC. Pursuant to the provisions of Sections 607.1005 and 607.1006 of the Florida Statutes, the undersigned, being the sole incorporator and director of the corporation hereby adopts the following Arttples of Amendment to the Articles of Incorporation: 1. The current name of the corporation is Di Abruzzo Painting, Inc. 2. The Articles of Incorporation are hereby amended to change the name of the corporation to Garrod Painting, Inc. As a result, Article I of the Articles of Incorporation is hereby amended as follows: NAME: The name of the corporation is GARROD PA!NTfNG, INC., a Florida corporation 3. The amendment to the Articles of Incorporation was adopted on the 12th day of May, 2003. 4. The foregoing amendment was adopted by the incorporators and sole director of the corporation without shareholder action as no shares for this corporation have been issued, and, as a result, shareholder action was not required. IN WITNESS HEREOF,the undersigned hereby sets his hand and seal effective the 12th day of May, 2003, and hereby documents his approval of the foregoing Articles of Amendment to the Articles of I ncc rporation s heretofore set forth. Signed, Sealed and Delivered in the Presence of Efse tyk- rod,, Cla dio F ifaretti Villalobos, Pri d Name if First Iness Sol- orporator and Director ilk arteArif. t Printed Name of Second Witness STATE OF FLORIDA: COUNTY OF CHARLOTTE: The foregoing Articles of Amendment to Articles of Incorporation were acknowledged before me this./ day of May, 2003, by Claudio R. Bifaretti Viilalobos,the Sole Incorporator and Director of Dl ABRUZZO PAINTING, INC., a Florida corporation. He is prsonalIy, _known to mg or produced as identification, and did take an oath and deposed and stated the foregoing statements and matters are true and correct. • NiAtary Public Printed Namb of Notary Public My Commission Expires: CC..Ss-;, cf R Commission/Serial Number s,•o` Shirley A Coker h My Commission CC994598 15Cot R Expires January 18,2005 GASandytCarprtatlonlGarrod.Artides of Amendment il ., • ilt i1 f' r 1 'i lilliri (Requestor's Name) (Address) t. i. f 000009316340 (Address) (City/State/Zip/Phone ti) 1 c V CIE;;'liw'_.--Ll1l 07 .»-i,.il_lt '4*.tea. 5 0 PICK-UP 0 WAIT Q MAIL (Business entity Name) ECTsYE Dal (Document Number) Certified Copies Certificates of Status p rte, Special Instructions to Filing Officer: r�'' i `."'".4* • '-'-'' ' :4;‘-'4'- ^tip r `u i r ice Use Only TRANSMITTAL LETTER December 4th, 2002 To: Department of State Division of Corporations P.O. Box 6327 Tallahassee, FL 32314 DI ABRUZZO PAINTING, INC. Enclosed is an original and one copy of the articles of incorporation and a check in the amount of$78.75. This check covers the filing fee and Certified copy. Please mail the Certified copy to: Borro Tax Associates 3940 Radio Road Suite 103 Naples, Florida 34112 (239) 793-1040 We thank you for your assistance in this matter. Index to Articles of Incorporation: CORPORATE NAME: Page 1, Item I EFFECTIVE DATE/TERM: Page 1, Item II CAPITAL STOCK: Page 2, Item V INITIAL REGISTERED AGENT: Page 3, Item VI INITIAL OFFICERS: Page 3 Item VII DIRECTOR(s): Page 3 Item VIII INCORPORATOR(s): Page 4 Item XI ACKNOWLEDGMENT: Page 5 Bottom of page ARTICLES OF INCORPORATION r' '� doe' OF t' r DI ABRUZZO PAINTING, INC. d' ect The undersigned associates themselves for the purpose of`'for ng corporation for profit under Chapter 607, Florida Statutes, and rpeirt4y as follows : I. NAME: The name of the Corporation is DI ABRUZZO PAINTING, INC. II. TERM: The term of existence of the Corporation is perpetual. The corporation shall be deemed to have commenced its existence on DECEMBER 5TE, 2002. iftieggiWEIATE III. PURPOSE: The corporation is- organized for the purpose of owning, operating, governing, administering and managing any legal business including but not limited to residential and co Mercial painting contractor, or any other related service, wholesale and retail sales, installation, service, and any other legal business and to exercise all powers and discharge all responsibilities granted to it as a corporation under the laws of the State of Florida and these Articles of Incorporation and the laws of the United States. IV. POWERS: The powers of the Corporation shall include and be governed by the following provisions: 1 . The corporation shall have all of the common law and statutory powers of a corporation for profit which are not in conflict with the terms of these Articles, and in aridition, all the powers conferred by the Florida General Corporation Act upon a corporation. 2 . The corporation shall have all of the powers reasonably necessary to implement the powers of the corporation, including but not limited to: a. To have perpetual rucoession by its co.A.porate name. b. To have a carpore_te seal, which may be altered at pleasure, and to use the same by causing it, or a facsimile thereof, to be impressed, affixed, or in any other manner reproduced. c. To purchase, take, receive, lease or otherwise acquire, own, hold, improve, use, and otherwise deal in and with real or personal property or any interest therein, whenever situated. d. To sell, convey, mortgage, pledge, create a security interest in, lease, exchange, transfer, and otherwise dispose of all or any part of this property and assets. e. To lend money to, and use its credit to assist its officers and employees whenever, in the judgment of the directors of the corporation, such loan, guaranty, or a.sei.sta.nce may reasonably be expected to benefit the corporation. The loan, guaranty, or other assistance may he with 1 • VI. INITIAL REGISTERED OFFICE, INITIAL AGENT, PRINCIPAL OFFICE, AND ACCEPTANCE OF REGISTERED AGENT: The initial registered agent office is 4112 32nd Ave SW - Naples, FL 34116 and the name of its initial registered agent is Claudio R. Bifaretti Villalobbs . The initial principal office (and mailing address) of the corporation is 4112 32nd Ave SW - Naples, FL 34116. The undersigned, Claudio R. Bifaretti Villalobos, by signing these Articles, accepts the appointment as initial registered agent, and affirms that he is familiar with, and accepts the obligation of that position. VII. MANAGEMENT OF THE AFFAIRS OF TR1 CORPORATION-OFFICERS: The affairs of this corporation_shall be managed by its officers, subject, however, to the directions of the Board of Directors, except to the extent that the Directors shall have delegated the responsibility for such management under the provisions of these Articles and in accordance with the Bylaws . The officers of this corporation shall consist of a President, a Vice President, Secretary, and a Treasurer, -all of whom shall be elected by the Board of Directors according to the Bylaws of this corporation. The Directors may, if they desire, combine the Offices of Secretary and Treasurer and, in addition, provide for such other officers, agents, supervisory personnel or employees of the corporation as they shall see fit, none of which need be a member of the corporation. Commencing with the first annual meeting of the Board of Directors subsequent to incorporation, officers will be elected annually to hold office until the next annual meeting of the board of Directors or until their successors are elected and qualify. The names and addresses of the officers who are to serve until the first election by the Board of Directors are: NAME: JDDRESS: POSITION: Bradley J. Garrod Jr. 7950 Preserve Cir. ##824 PRESIDENT Naples,- FL 34119 Claudio R. Bifaretti Villalobof; 4112 32nd Ave SW SECRETARY Naples, FL 34116 TREASURER VIII. DIRECTOR(S) : There shall be ONE (1) director (s) of the corporation. The name (s) and address (es) of the initial board of director(s) who shall serve until the first election are: NAME: ADDRESS: Claudio R. Bifaretti Villalobos 4112 32nd Ave SW Naples, FL 34116 IX. REMOVAL OF OFFICERS AND DIRECTORS: The officers and directors may be removed prior to the expiration of their terms in accordance with the provisions of the Florida law applicable to corporations for profit, which provisions shall- control; however, if there shall not be applicable controlling provisions of law for the removal of officers or of directors, then the following shall apply: Any officer may be removed prior to the expiration of his term of office in the manner provided hereinafter, or in such manner as provided by the Bylaws ._ Any officer may also be removed for cause by a two-thirds (2/s) vote of the full Board of Directors at a meeting of Directors called at least in part for the purpose of considering such removal. Any director of this corporation may be removed with or without cause, and for any reason, upon a petition in writing of a majority of the stockholders of this corporation approved at a meeting of the stockholders called, at least in part, for this purpose, by a two-thirds (2/3) vote of the stockholders . The petition calling for the removal of such director shall set forth a time and place for the meeting of stockholders, and notice shall be given to all members of such special meeting of the stockholders at least ten (10) days prior to such meeting in the spanner provided in the Bylaws for the giving of notices of special meetings. At: any such meeting the director whose removal is sought shall be given the opportunity to be heard. X: INDEMNIFICATION OF OFFICERS AND DIRECTORS: Every director and every officer of the corporat:'.on shall be indemnified by the corporation against all liability and expenses, including counsel fees, reasonably incurred by or imposed upon him in connection with any proceedings to which he may be a party, or in which he may become involved, by reason of his being or having been an officer or director of the corporation, whether or not he is a director or officer at the time such liability or expenses are incurred, except in such cases wherein the director or officer is adjudged guilty of willful misfeasance or malfeasance in the performance of his duties; provided that in the event of any claim for reimbursement or indemnification hereunder based upon a settlement by the director or officer seeking such reimbursement or indemnification, the indemnification shall apply only if the Board of Directors approves such settlement and reimbursement as being in the interest of the corporation. The foregoing rights of indemnification shall be in addition to and not exclusive of all other rights to which such directors of officers may be entitled. — XI. INCORPORATORS) : The names and. addresses of the incorporator(s) are: NAME: ADDRESS: Claudio R. Bifaretti Villalobos 4112 32nd Ave SW Naples, FL 34116 r , R 1 XII. CONTRACTUAL RELATIONS: In the absence of fraud, no contract or other transaction between this corporation and any other person, firm, association, corporation or partnership shall be affected or invalidated by the fact that any officer or director of this corporation is pecuniarily or otherwise interested in, or is a director, member or officer of any such firm, association corporation or partnership, or is a party to or is pecuniarily or otherwise interested in such contract or other transaction, or is in any way connected with any person, firm, association, corporation, or partnership, that is interested therein, pecuniarily or otherwise. Any director may vote and be counted in determining the existence of a quorum at any meeting of the Board of Directors of this corporation for the purpose of authorizing such contract or transaction with like force and effect as if he or she were not so interested, or were not a director, member or officer of such other firm, association, corporation or partnership, providing that such director shall have disclosed to all other directors at or before the meeting, or all other directors shall otherwise know the facts of such relationship or interests of the director. In any and all events, a contract or transaction which is fair and reasonable as to this corporation at the time it is authorized by the board shall nevertheless be enforceable and neither void nor voidable. XIII. BYLAWS: The original Bylaws of this corporation shall be adopted by a majority vote of the Directors of the corporation. The Bylaws of this corporation may be amended, altered or rescinded by the Board of Directors only in the manner provided for in the Bylaws. XIV. AMENDMENT OF ARTICLES: If the provisions of statutory law of the State of Florida applicable to this corporation shall provide an exclusive method or methods for the amendment of -these Articles inconsistent with the provision hereinafter set forth, then the provisions of such law applicable to this corporation for the amendment of these Articles shall apply. Otherwise, when the provisions of statr:tory law applicable to the amendment of these Articles are not exclusive cr permit amendment by a process or processes set forth in the Articles, then these Articles of Incorporation may be amended from time to time by resolution adopted by a ma-iori.ty of the Board of Directors at any meeting of all the Directors of the corporation called, at least in part, to consider such amendment at which all of the directors are present. If law permits, the amendatory methods set forth in this Article shall be exclusive methods for amending. these Articles of Incorporation. The undersigned incorporator{s} hav A e'x c ted these Articles of Incorporation on the 4th day of December, 241 (I; 0 2.. Claudio R. Bifaretti illaLobos • 1 , • • 1 • ■ ' • • CERTIFICATE OF DESIGNATION OF REGISTERED AGENT/REGISTERED OFFICE PURSUANT TO THE PROVISIONS OF SECTION 607.0501 or 617-0501, FLORIDA STATUTES, THE UNDERSIGNED CORPORATION, ORGANIZED UNDER THE LAWS OF THE STATE OF FLORIDA, SUBMITS THE FOLLOWING STATEMENT IN DESIGNATING THE REGISTERED OFFICE/PEGISTERED AGENT, IN THE STATE OF FLORIDA. 1. The name of the corporation is: DI ABRUZZO PAINTING, INC. 2. The name and address of the registered agent and office is: Claudic R. Bifaretti Villa lobos 4112 32nd Ave SW Naples, FL 34116 _ Having been named as registered agent and to accept service of process for the above stated corporation at the place designated in this certificate, I hereby accept the appointment as registered agent and age to act in this capacity.I further agree to comply with the provisions of all statutes relating to the proper and complete perform,ance of my duties, and I am familia--_with and accept the obligations of my positi r/as re. -tered agent. ( ifi --1 C') (Signature) oc ...„'"A... r "7-1•-;:i- 3:h. 4' DIVISION OF CORPORATIONS, P.O. BOX 6327, TALLAHASSE&L 1314 -7,7 Eli A - ' . ' Jun 09, 2003 8:00 am J; .- 5/1 Secretary of State 2003 FOR PROFIT CORPORATION 05_1'1_2003 03 9O-,i 8 0116**-1 50.0 UNIFORM BUSINESS REPORT UBR DOCUMENT #P02000129420 1.EnptyName *."N.- DI ABFWZZO PAINTING,INC, •-t,...,F - :pmt::' Principal Putceet Business 1daUing Atld<ess 4112 32NIF AYE St 4112 3200 AVE SS 55047155 NAPLES,FL 34116 NAPLES.Ft. 34116 . . 2. Principal Fusco of Business a.Mastng Address silk Apt-S.etc_ suits.Apt s,etc. 0 cl+Eaa HERE»•MAKING CHANGES Ctty S State City 3 State 4.FE ntier Applied For ".Q 7..76- ti.J - - NotAppscettle M11111111111.1111111.11111 Cam s-Coral isle d stairs oereo 0 Foe onm 6.llama and Addraors at Donne Reglahlr.d Agent 7. tiro and Addreaa of Ntwr Rltlmt.d • Name -- -- `BtFARETti V1LLALOBOS;CLAUDIO R — _- — _ —_. — -- _ — - 4i 12 32ND AVE SW e D. es Aepl2D'e) NAPLES,Ft. 34178 ' • tiny FL . Wit. & The shwa famed er4ity suhratls tits stalemerd for fie purpose of changtns in registered odic*or registre443 agars,or WO.in the Stale d Fiat, a.I em!ardor pith,end swept the ub t9:lions of retysllred*Sera. stcNATURE ! svri..p,.wr«.:..d....a+,i.+.0.w.a.sift 1...*i • o.ori Ayi.r..t hi....'v..>.w.:w+«•.:m.:w ATE *AL r'. d y, ' " } r�C`-`+ � " �t o. Election Campaign Fbandng MOO May Be iii sl,sr4t- 1,6 tt�__�,,-� , a� . '+r,4 - - - Trust Funcitontbuton. - C1 Added 1oFoes io. OFFICERS AND DIRECTO114 11. ADDITIONS/CHANGES-TOOFF1+r£RSAND DIRECTORS IN 11 iris ' PD Diet tale ©Ctnarye D Adition rd itAtit GARROD,BRADLEY J JR - 3 nen Atottz 7960 PRESERVE C1R 9824 sti31 utsgss g cnY-sr-;c NAPLES.FL 34119 ca1.ss-ZIP SIRE STD D Delft lilt D dery 1=)Ad6tian g MA SWARM VlLLALC*OS,CI..AUDIO R Mai ' 51411 ototss 411232ND AVE SW lA Cm-Si-ZP NAPLES,FL 34116 txcr•st•Zrr 1rAE 0 Diet ' into a Ch3rgc a Mdton last nuAE sIIEn ADarlSa - deart,00r,tz __-crvr•al-z► ��---- — -- -- ' Cmar-26, _—. —__.-.-._._--..._-- ------.___ lit* - ----CI.Oetcu--_.-_ _MA_ __, 6 Cter* D xddaa Mid WigE sisal Atlt/MIS OM abbots trr(41-2P CITY.I.13P ilia a Writ Ida 0 Ctw p Adrian StaEEl AMISS ' SITEUNI Ess CrtY-St•ZP CitY-&1-Z1P mt.E D Deka lira D Charge ©sedition S iel M MUS SZIEFt AODALSS CPY-ST-It Ct1Y-S7-Zlr 12.1 hereby cdtl►y that the intim * 4:.•tO uM hang clan not quality for the exemption stated in Seeman 119.471SX?,Honda Slaw**.I lurN»r CerCfy slat the IMOrrns ion tndioated on this ropo,l or sup.r I r and&CC,ti die entl that try Sigrtanlre ShJI hav;:die sams ilgal sited as I1 made under oattt;fhai)am srt 7lhCM or Sock 1 i d the irpor*tton or the reoei 4 •t *0 m. • :. •• as regcired M Chap! 607,F orida statvlea and tl1M nair,e a{tpaers In block 10 M 9ocl 11 ti change*.a on an an+rirme d address emporerea. SIGNATURE: 1 fir.. / • Q7 {2 � 3 8- 4( 1 t r A CNATUR[ML rn'tnon arum d t%4•...,.<acRstn•:ip 4tatrol 'C , wm,f.o m e--.....__.._.. I • Form WI ig9 Request for Taxpayer Give form to the (Rev.October 2007) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service Narrja,,(as shown on your income,tax return) 67A22on 22i J r) l 6)(— aBusiness name,if different from above c D c Check appropriate box: ❑ Individual/Sole proprietor Corporation ❑ Partnership Exempt .'v ❑ Limited liability company.Enter the tax classification(D=disregarded entity,C=corporation,P=partnership)1► 1-1 p o ❑ payee Other(see instructions) ► c dress(number,street,and apt or suite no.) Requester's name and address(optional) 20 6ov OqL\L l C) cz,state,and ZIP code fn PO -\t `,_I k c 22 t k \ 2 f 1 List account number(s)here(optional) Mal rn Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box.The TiN provided must match the name given on Line 1 to avoid Social security number backup withholding. For Individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3. For other entities,It Is your employer identification number(EIN). If you do not have a number,see How to get a TIN on page 3. or Note.If the account is In more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. 22 &&) S- Mil Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer Identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all Interest or dividends,or(c)the iRS has notified me that i am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions, item 2 does not apply. For mortgage Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than Interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of Here U.S.person Date Ip Z/ ii) ��/ I J t General instructions Definition of a U.S. person. For federal tax purposes, you are considered a U.S.person if you are: Section references are to the Internal Revenue Code unless •An Individual who is a U.S. citizen or U.S.resident alien, otherwise noted. a A partnership, corporation,company, or association created or Purpose of Form organized in the United States or under the laws of the United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number(TIN) • An estate(other than a foreign estate),or to report, for example, income paid to you,real estate • A domestic trust(as defined in Regulations section transactions, mortgage interest you paid,acquisition or 301.7701-7). abandonment of secured property,cancellation of debt, or Special rules for partnerships.Partnerships that conduct a contributions you made to an IRA. trade or business in the United States are generally required to Use Form W-9 only if you are a U.S. person(including a pay a withholding tax on any foreign partners'share of income resident alien),to provide your correct TIN to the person from such business.Further, in certain cases where a Form W-9 requesting it(the requester)and,when applicable,to: has not been received,a partnership is required to presume that 1.Certify that the TIN you are giving is correct(or you are a partner is a foreign person,and pay the withholding tax. waiting for a number to be Issued), Therefore,if you are a U.S. person that is a partner in a 2. Certify that you are not subject to backup withholding,or partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable,you are also certifying that as a income. U.S. person,your allocable share of any partnership income from The person who gives Form W-9 to the partnership for a U.S.trade or business is not subject to the withholding tax on purposes of establishing its U.S.status and avoiding withholding foreign partners' share of effectively connected income. on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States is in the request your TIN,you must use the requester's form if it is following cases: substantially similar to this Form W-9. e The U.S. owner of a disregarded entity and not the eitiiy. Cat.No.10231X Form W-9 (Rev. 10-200-1) L_ I c. �r;it,t L=_ C�H L. k F 1L,! ' ` tELIS-.L [. A r C.;= 1 TIA <CE'ftTIFICATE 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 I, 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 NOME gran Soles I Work Comp Systems PHONE FAX ,,c 8 ArC,No,Et) 863-438-2710 1(A.;C Nb„863— 3 -271.1 } 711 MaiY Street, S T° #1 E-MAIL ADDRESS: Haines City, FL 33844 INSURER(S) AFFORDING COVERAGE NAIL# INSURER A - 1 INSURED Garrod Painting, Inc. INSURER B: 4271 James Street INSURER C. Port Charlotte, FL 33980 INSURER D: 941-743-7266 INSURER E: Star Insurance Company INSURER F_ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADDL SUBR PULIGY EFF POLICY EXP TYPE OF INSURANCE LTR ❑Jet mVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE I I OCCUR PREMISES Eat occurrence) S MED EXP(Any one person) S PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY I I JECT I I LOC PRODUCTS -COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY -CtJMEINEU SINGLE-UM-TT E (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) ` S UMBRELLA LIAB 1OCCUR EACH OCCURRENCE S - EXCESS LIRE I CLAIMS-MADE AGGREGATE S DED RETENTION S $ - WORKERS COMPENSATION A. X STATUTE 1 EE AND EMPLOYERS LIABILITY YIN ANY P�ROPRIETORIPAETNEPIEXECUTIVE E.L.EACH ACCIDENT „ 1 ,000,000 E OFFICEwmumER EXCLUDED? I N/A. I c (Mandatory in NH) WC 080199400 11/17/13 11/17/14 E.L.DISEASE-EA.EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below } E DISEASE-POLICY LIMIT } S 1 ,0 0 0,0 0 0 1 i 1 I i i u- i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES ;=.COED 101 Additional Remarks Schedule,may be attached if more space is required) 30 days written notice in the event of cancellation. Bradley Garrod is included in the Workers Comp. CERTIFICATE HOLDER CANCELLATION Collier County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Contractors Licensing Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ( 2800 N. HG.rse :h.:.E- 1-.:rive ACCORDANCE WITH THE POLICY PROVISIONS. AUTHC;.`ED R_P):ES I I0E --------------- C) IS06-2013 F C JI C'iRrl_II.',i i0 l: —ee ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD Proof of Coverage Page 1 of 1 4...4 JEFF ATWATER, CHIEF FINANCIAL OFFICER , ,, ,' FLORIDA DEPARTMENT OF FINANCIAL SERVICES Wit Home WC Databases (21,1) Home Exemption Detail Page This database was last updated Thursday,March 27,2014 12:14 AM. I.. Return to PreviouePaga,,,,,. Exemption Details burn. tele ElleeNye let Trerreselem OW E runnupliru Type —Bee, sese AnyWes Employer Name BRADLEY Click Here to View GARROD PR Jan 23 2013 Jan 23 2015 Construction Activities Listed on GARROD PANTING INC Exemption BRADLEY Click Here to View GARROD PR Feb 18 2011 Jan 23 2013 Construction Activities Listed on GARROD PAINTING INC Exemptron BRADLEY Click Here to View GARROD PR Mar 7 2009 Feb 18 2011 Construction Activities Listed on GARROD PAINTING INC Exemption Click Here to View GARROD BRADLEY PR Mar 8 2007 Mar 7 2009 Construction Activities Listed on GARROD PAINTING INC Exemption BRADLEY Click Here to View GARROD PR Feb 24 2005 Feb 24 2007 Construction Activities Listed on GARROD PAINTING INC Exemption BRADLEY Click Here to View GARROD GARROD PR Jan 17 2004 Jan 21 2005 Construction Activities Listed on PAINTING INC Exemption Click Here to View BRADLEY GARROD PR Jan 22 2003 Dec 31 2003 Construction Activities Listed on PAINTING INC GARROD Exemption BRADLEY Click Here to View GARROD GARROD SC Sep 5 2007 Sep 4 2009 Construction Activities Listed on STUCCO INC Exemption 'rerminatian may be through the revocation of the exemption.or expiration of the exemption. 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[ Q Da co v) era ; v , 0 e 2009/20.10 CHARLOTTE COUNTY LOCAL BUStNPSS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES September 30,2010 TYPE OF BUSINESS 001581 CONTRACTOR PAINTING&WALL COVERING NEW BUSINESS X RENEWAL SUPPLEMENTAL BUSINESS 4271 JAMES ST TRANSFER- ADDRESS PORT CHARLOTTE, FL 33980 ORIGINAL TAX 35.00 BUSINESS GARROD PAINTING INC NAME AMOUNT 35.00 PENALTY 0.00 OWNER BRAD GARROD MAILING PO BOX 494410 TOTAL 35.00 ADDRESS PORT CHARLOTTE, FL 33949 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED PAID-8014456.0001-0001 WEB 09/23/2009 35.00 F F L i s -tom L.-E — -`c. 12• 2009/2010 CHARLOTTE COUNTY ACCOUNT 5840 LOCAL BUSINESS TAX RECEIPT MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES September 30,2010 TYPE OF BUSINESS 001581 CONTRACTOR PAINTING&WALL COVERING NEW BUSINESS X RENEWAL SUPPLEMENTAL BUSINESS 4271 JAMES ST TRANSFER- ADDRESS PORT CHARLOTTE, FL 33980 ORIGINAL TAX 35.00 BUSINESS GARROD PAINTING INC • NAME • AMOUNT 35.00 PENALTY 0.00 OWNER BRAD GARROD MAILING PO BOX 494410 TOTAL 35.00 ADDRESS PORT CHARLOTTE,FL 33949 n7 i THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED PAID-8014456.0001-0001 1dE8 09/25/2009 35.00 Dear Business Owner: Your 2009-2010 Charlotte County Local Business Tax Receipt is attached above. Please detach the receipt and display it in a place that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition to any other license or certificate that may be required by law and does not signify compliance with zoning, health, or regulatory requirements.The Charlotte County Local Business Tax Receipt is non-regulatory and is not an endorsement of work quality. Your 2009-2010 Local Business Tax Receipt is valid from September 01,2009 through September 30,2010.Annual account notices are mailed in June to the address of record at that time.Any Changes to your Local Business Tax Account due to change of Business Name, Ownership, Physical Address or you are Closing your Business please contact our office at 941-743-1350 Vickie L. Potts Charlotte County Tax Collector 20101 2011 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2011 TYPE OF 1581 CONTRACTOR PAINTING&WALL COVERING(CONTRACTOR PAINTING&WALL C BUSINESS RENEWAL BUSINESS 4271 JAMES ST ADDRESS PORT CHARLOTTE, FL 33980 BUSINESS GARROD PAINTING INC NAME AMOUNT 35.00 PENALTY 0.00 OWNER BRAD GARROD TOTAL 35.00 MAILING PO BOX 494410 ADDRESS _- PORT CHARLOTTE, FL 33949 r TaL THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED - op— Paid 10/01/2010 Receipt # 898-00000007 35.00 -- Orh,tT ='=0- 1-: =p1 2010/ 2011 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2011 TYPE OF 1581 CONTRACTOR PAINTING&WALL COVERING(CONTRACTOR PAINTING&WALL RENEWAL BUSINESS 4271 JAMES ST ADDRESS PORT.CHARLOTTE, FL 33980 BUSINESS GARROD PAINTING INC NAME AMOUNT 35.00 PENALTY 0.00 OWNER BRAD GARROD TOTAL 35:00 MAILING PO BOX 494410 ADDRESS PORT CHARLOTTE, FL 33949 CiLuiLT TI-11S FOR BECOMES A RECEIPT ONLY VJtIEN'VA_IDATED . .-- Paid 10/01/2010 Receipt # 898-00000007 35.00 Dear Business Owner: Your 2010- 2011 Charlotte County Local Business Tax Receipt is attached above. Please detach the receipt and display it in a place that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition to any other license or certificate that may be required by law and does not signify compliance with zoning, health, or regulatory requirements.The Charlotte County Local Business Tax Receipt is non-regulatory and is not an endorsement of work quality. Your 2010 - 2011 Local Business Tax Receipt is valid from September 01. 2010 th:oligh SepternSei 30, 2011 Anima' cry ,: al, mailed in June to the address of record at that tulle.Any Changes to your Local BL!SI ess'Ca>:Acsouni due tr:onande ri"P; I;cc (V e.. Ownership. Physic Address or you rc Cl_osl you: E - ,-,. I lease unmoor i I. oh co ci 941-743_1300 VICKIE L. POTTS Charlotte County Tax Collector • 2011 / 2012 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2012 TYPE OF 1581 CONTRACTOR PAINTING&WALL COVERING(CONTRACTOR PAINTING&WALL C BUSINESS RENEWAL BUSINESS 4271 JAMES ST ADDRESS PORT CHARLOTTE, FL 33980 BUSINESS GARROD PAINTING INC NAME AMOUNT 35,00 PENALTY 0.00 OWNER BRAD GARROD TOTAL 35.00 MAILING PO BOX 494410 ADDRESS PORT CHARLOTTE,FL 33949 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED Paid 09/30/2011 Receipt # 899-00000972 35.00 2011 / 2012 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2012 TYPE OF 1581 CONTRACTOR PAINTING&WALL COVERING PAINTING&WALL O BUSINESS RENEWAL BUSINESS 4271 JAMES ST ADDRESS PORT CHARLOTTE,FL 33980 BUSINESS GARROD PAINTING INC NAME AMOUNT 35.00 PENALTY 0.00 OWNER BRAD GARROD TOTAL 35.00 MAILING PO BOX 494410 ADDRESS PORT CHARLOTTE,FL 33949 - THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED Paid 09/30/2012 Receipt # 899-00000972 33.00 Dear Business Owner: Your 2011 - 2012 Charlotte County Local Business Tax Receipt is attached above.Please detach the receipt and display it in a place that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition to any other license or certificate that may be required by law and does not signify compliance with zoning,health,or regulatory requirements.The Charlotte County Local Business Tax Receipt is non-regulatory and is not an endorsement of work quality. Your 2011 - 2012 Local Business Tax Receipt is valid from September 01, 2011 through September 30,2012 .Annual account notices are mailed in June to the address of record at that time.Any Changes to your Local Business Tax Account due to change of Business Name, Ownership,Physical Address or you are Closing your Business please contact our office at 941-743-1350 VICKIE L. POTTS Charlotte County Tax Collector a' ""• • 2012/ 2013 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT k.CCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE _. E °. SEFTE6ALEF.30 20'� 15c1 CON ;ACTOR PAINTING C V'.wLL COVERING(COi•.TRAC7OR P JNTINC V',OLL C FFN_ L L Ii.E CC. GARROD PAINTING INC 01.1 NAivlE :', -0.00 • OWNER BRAD GARROD TOTAL 35.00 MAILING PO BOX 494410 . _c C' !._ ADDRESS PORT CHARLOTTE,FL 33949 CLLH L" THE FORM BECOMES ES A RECEIPT ONLY WN VALIDATED E_- Paid 09/27/2012 Receipt 44 INT-00024331 35.001 a. 2012/ 2013 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 : - - MUST.BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER.30,2013 TYPE OF 1581 CONTRACTOR PAINTING&WALL COVERING(CONTRACTOR PAINTING&WALL CI BUSINESS RENEWAL BUSINESS 4271 JAMES ST ADDRESS PORT CHARLOTTE,FL .33980 BUSINESS GARROD PAINTING INC NAME . AMOUNT 35.00 PENALTY 0.00 OWNER BRAD GARROD TOTAL 35.00 MAILING PO.BOX 494410 ADDRESS PORT CHARLOTTE,FL 33949 POW CLaTiotte nyintiy Ta-x: THIS FORM BECOMES A.5E05157 ONLY WHEN VALIDATED Paid 09/27/2012 Receipt # INT-00024331 35.00 --- •- �. _..._ _.._ moo; :.i (1-1.0 .. Dear Business Owner: - • • Your 2012-2013 Charlotte County Local Business Tax Receipt is attached above.Please detach the receipt and display it in a pace: that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition,to any other license or certificate that may be required by law end does not signify compliance with zoning,health,or regulatory requirements.The Charlotte County Local Business Tax Receipt is non-regulatory and is not an endorsement of work quality. Your 2012 -2013 Local Business Tax Receipt is valid from September 01, 2012 through September 70,2013 ./annual accouni noticoE are mailed in June to the address of record at that time.Any Changes to your Local Business Tax Account due to change of Busine s• Name,Ownership. Physical Ac?dres or you are Closing your Business please contact our otiice at 941-743-1350 . VICKIE L. POTTS Charlotte County Tax Collector ' I w 2013/ 2014 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER.30,20114 TYPE OF 15011 CONTRACTOR PA RTING o WALL COVERIf�G C Iv I R,LCTOP.F , 1TI'A 0 'Y-AL E.J` NESS BUSINESS, CA,RV=D FAINTING NAME AMOUITT 38.00 PENALTY 0.00 OWNER BRAD GARROD ',TOTAL ; - -:._ 35.00 r. MAILING PO BOX 494410 ADDRESS PORT CHARLOTTE,FL 33949 i ' J C ,hc. THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED ,,,i.CT r. _ _ r_;;, .5 _,_L Paid 09/27/2013 Receipt # INT-00028283 35.00 s _ 2013/ 2014 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 5840 MUST BE DISPLAYED NA CONSFICUOUS PLACE EXPIRES SEPTEMBER 30,2014 TYPE OF 1581 CONTRACTOR PAINTING&WALL COVERING(CONTRACTOR PAINTING&WALL Ci BUSINESS P.ENEVdAL BUSINESS 4271 JAMES ST ADDRESS PORT CHARLOTTE,FL 33980 BUSINESS GARROD PAINTING INC NAME AMOUNT 35.00 PENALTY 0.00 OWNER BRAD:GARROD TOTAL 35.00 MAILING PO BOX 494410 ADDRESS:PORT CHARLOTTE,FL 33949 t ?O:t c DUI az: CO THIS FORM BECOMES RECEIPT ONLY'WHEN VALIDATED. ^1? .,C.,�01 ooe,not co..a:_rc Paid 09/27/2013 Receipt 4t INT-00028283 35•00 Chzriotte. ." is_339 _........2.c0/;:CALrr ; -(:i:0`,,M.:)=%".c'.-121. Dear Business Owner: Your 2013-2014 Charlotte County Local Business Tax Receipt is attached above.Please detach the receipt and display it in a place that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition to any other license or certificate that may be required by law and does not signify compliance with zoning,health,or regulatory requirements.The Charlotte County Local Business Tax Receipt is non-regulatory and is not an endorsement of work quality. Your 2013 -2014 Local Business Tax Receipt is valid from September 01, 2013 through September 30, 2014 .Annual account notices are • mailed in June to the address of record at that time.Any Changes to your Local Business Tax Account due to change of Business Name,Ownership, Physical Address or you are Closing your Business please contact our office at 941-743-1350 . VICKIE L. POTTS Charlotte County Tax Collector ee cou SJGGD3 -. ny Lee County Tax_ Co ecto , Tax CoT ector 2480 Thompson Street Fort Myers, Florida 33901 `rfatE of F,oi`am www.leetc.com Tel: 239.533.6000 Local Business Tax Account: 0804377 Dear Business Owner: Your 2013-2014 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 Detach and display bottom portion and keep upper portion for your records veeCOU�ty LEE COUNTY LOCAL BUSINESS TAX RECEIPT 2013 - 2014 Tax Col'eotor ACCOUNT NUMBER: 0804377 ACCOUNT EXPIRES SEPTEMBER 30, 2014 -te of FW' May engage in the business of: PAINTING CONTRACTOR Location 4271 JAMES ST PORT CHARLOTTE FL 33980 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY GARROD PAINTING INC GARROD BRADLEY J THIS IS NOT A DILL- DO NOT FIX P O BOX 494410 PORT CHARLOTTE FL 33949 PAID 336442-17-I-1 09.'27!2010 WEB EJ50.00 , , M I .. t4 _ ` ,4 3 , mod. 'f �. � ire ' I, �: a tr c,$SeH, t i.;_ . '# e , k 44.a 'fir � r February 28,2014 To Whom it may concern, I am writing this letter to request renewal of my Paving Block Contractors License. Since closing the company in 2011 due to the shift in the economy and financial difficulties which would no longer support working in the field, I changed my focus to pursuing my education,attending ITT Technical Institution. I have continued to maintain contact with a few paving block contractors and manufacturers in the area to stay current with knowledge and advances in the field.Through the support of Daniel Henthorne, I have continued to do pressure cleaning and maintenance for private homeowners and consequently, due to word of mouth advertising,found an increasing amount of requests for installation jobs. So it is with demand that I am requesting that you reinstate my license so that I might begin to work in the Paving business once again. It is my intention to provide quality work within the standards/regulations set down by Collier County to provide residents home improvements and maintenance that support the beauty of the landscape native to South Florida. Please consider my application seriously. Sincerely, e/./1/),6,(______________ 7 / - (- / Mikel Garrett Diehl ;,, "4:4---' co -teir Cicrisnty CDES Operations & Regulatory Management Licensing Section 87:1 lita,N. 2800 North Horseshoe Drive - f f ';3 i 4 - 1„:-) ■;), III --tit Naples, FL 34104 t — (7:_17,s, - 17)i U-7.) °,, 371) BY:„„ APPLICATION FOR "p r .._\J ; . .ci,, ci) ......... . .. 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:\-"4-\\Dc-■(9.C, \...y...„.acce, , 4 9c,,,- To k c41-.1a pet 17-Ine . Fiction Name/DBA: ____ Qualifier Name: rlk-A , V-,,7 il, (I-32) y. Physical Address: 14530 i stk ply c S(j) t\,41 ples ci 5q110 (Number& Street) . (City) (State) (Zip Code) Mailing Address: PO i3D0( Cap 104ples gi &Ltirra (Number & Street) ' (City) (State) (Zip Code) Telephone: a -t-n-t.a5 3 6 E-Mail: Ikk,„-.11._^ 'A .0 ; ' ,Caryl TYPE OF LICENSE: U General $230.00 U Electrician $230.00 U Building $230.00 LI Plumber $230.00 U Residential $230.00 U Air Cond. $230.00 U Mechanical $230.00 U Swimming Pool $230.00 U Roofing $230.00 La Specialty -, ,-, Specialty trade: Pc0)1 r 9 ,t,--1,31_ r.,,,?„ 3/6/2014 Reinstatement Fee= $205.00 CrGE OF STATUS: New License Fee=$205.00 (% Reinstatement ( From One Business to Another 2011-2013 Back Year Fees= $555.00 *Different fees may apply* Total=$965.00 Page 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. 45 50 154'' . SuJ 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. ¶'n4-C. f«- /A Rystis Inc 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, ¶'r ■Klti C� .o•'e 4 certify that the foregoing is true and correct to the best of my knowledge. fg,()(e,e-'9 Authorized Officer of the Firm STATE OF FLORIDA COUNTY OF O fL The foregoing instrument as acknowledged before me this 3\ AQtAI-1- (Date) (Name of officer, title/agent) n OZ ( g ) (Name of C�rporation) a Cx,i(0.9., Corporation on behalf of the corporation. (State or Place of Corporation) H has produced \• 0vfc.5\A,n identification and did not take an oath. (Type of identification) NOTARY'S SEAL NOTARY PUBLIC•STATE OF FLORIDA Donna Specie *VAA/j, , EE043482 (SIGNATU E OF NOTAR • Exr —s OV.27,2014 BoDmID TRR i :^.r cod LNG Ca,INC. Panes 9 of d QUALIFIER INFORMATION: Name: ‘..T\� a �', _ ©i tcrj Address: 4s 3o \S'-''` Vie. 51)3 3111110 (Number& Street) (City) State) (Zip Code) Telephone: __t -22r11-(63 Date of Birth: S.S. #: 000-00- E-Mail: '{1r\C,(Qj Q,k I�j ��rya;l , CO,,,- , Driver's License: J 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. , a - gii- saa rYA2e A 1 >!A a -g-fl-I Lit 3. Have you ever been convicted of a crime related to Contracting? (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? 1`k 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. RD(V2_ 9. List your business or work experience during the past ten years. 10. Statement of any formal training you have had in the area for which the application is made. e 4 )fl Cam. L.-Es ‘c) RcvO3 s U) .01nt.Th �eGtoiS bkock. Penn Z of A 'Licensee Information A Licensee Number Q29330 Description Type Property Alert Name NIIKEL GARRETT DIEHL Type Contractor Ell Status Open EI View Master Project View All Activities for this Licensee Add a new person or business to Address Book Examination Results A Add Exam Result Link Exam:Test Type Date of ExamiTest City Score received ExamiTest result A '...:.. INTERLOCKING PAVER 04728/2007 NAPLES 80.00 Pass ..L. BUSINESS &LAW 03/10/2007 GAINESVILLE 80.00 Pass .._ ..... BUSINESS &LAW 01/20/2007 F . PIERCE 68.00 Show More Fields .,. Hide or Clear Fields I Charge Exam Fee IiII Exam Code Sponsoring County Sponsorship App Date I — Sponsorship Expiration Date ' , Testing Facility ' 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. APPLICANT(PLEASE PRINT) 4-`oc"d v PGAtr V` ;nb tt�, NAME OF COMPANY 0,17( SIGNATURE OF APPLICANT STATE OF FLO3IDA COUNTY OF d Le. The foregoing Instrument as acknowledged before me this . I j Lt 4(Date) By ¶¶' \ p\ c,.�;-xal� a who has produced -4k. ■VpaS Le , (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL NOTARY P UBUC-STATE OF FLORIDA (SIGNATURE OO NOTARY) Donna Specie Commission#EE043482 „,,,•.''Expires: NOV.27,2014 BONDED TIIItU ATLANTIC BONDING CO.,INC. Page 4 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 tunes effective Workmen's Compensation Insurance it will result in the possible revocation of my . Certificate of Competency. fet), / . SIGNATURE OF APPLICANT tpc'kOa WASCC` 'r 1rr BUSINESS NAME 3\ LAaolt-i- DATE BEFORE ME this day personally appeared ¶ ■Wil co.Z; tLQ 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 4.1s1 The foregoing instrument was acknowledged before me this 3 1 a(D 1 L4 ( :ate) . - -by O 6,b i_A2 • who has produced CA•c■,)4e'v4TS i P Q - (name of person acknowledging) ( as identification and who did not take an oath. � SIGNATURE NOTARY-PUBLIC-STATE OF FLORIDA F NOTARY NOTARY SEAL Donna Specie " ,�=Commission. EE043482 • NOTARY PUBLIC -.„,,,,,,,.° Expires: NOV.27,2014 • BONDED THRU ATLANTIC BONDING CO.,INC. et Irt■ Vol■, itV•11;. 0 .-0,4 II i3etri )1 4 * #. t( i' * 0 11 4 * Xt ti 4111 i } torlfAll o 1. A 40 A. 0 *. KleA 75 al 7d #A t( 4 ) CO‘,4 < ,. .). A 40 04 "' 0 .N U � o ��- Aye•0 ° #A 4 o r 4-4 , 410 00 ii — .;: 2 it - `" ip otk ,-g ""Eitt 4•2 IA 4 7P., -/ I'' 0 . d OAtt r (1) 1 0 v] , b U AP V 0% 0 +-Lid - q(-2 ,6 :4 c,i' i-d 0 1,' ci-,7$e 4 4., 4 s'; tk VO 4 acs 1 z .� tk 4 �a . , y o a `,0,4 pip oat -ti 4 .5. 6. 2 r'''0 ,e2 0 0E11 , J vok NA 9 ' `-' ° r -o 7',:i �, . eiell N -4'-5 i 0 c n ..ti,1, fr4.0 44 _ / •y4 3 w ,-.' v -. a t PP pktlk [. OAK : tit V En H o 4 g :3:: q 1r # 1& # 444 . # 44 A-0 A 014 .E : 1 A t L/ 1►. .ovos ► t► Ali► * ► ,4lip- ,�rl►, V t*N11y 240 4e*0IMM,`[0*74, 0 1[I ,4 to _ v. 4 " 11 ATA 110 RESOLUTION OF AUTHORIZATON WHEREAS "Rotor f r.,\.trrY„n..a `D c . proposes to (Name of Business Entity) • engage in contracting as (9C'\OOrG1.-1' > in (Type of legal entity: corp.,partnership,etc. Collier County,Florida,according to Collier County Ordinance 2006-46, as amended;and OC■ d-C, U- S . g,, .� WHEREAS 'RG-er r E Gee I roc. proposes to (Name of Business Entity qualify for a Certificate of Competency with `M OkeQ, ,.O -eLQ (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned (7W tiNQ f of pr;tQ& RAp , (Officers,Owners,Partners) v-Zr 0.)&knARC .),u , eire, hereby resolve and represent to the Collier County (Name of Business Entity) ^ Contractors'Licensing Board that the qualifying agent, \ K.EX, • L)i-&Q- ,is active \ga e of ndiv'd 1 in all matters connected with the contracting business of � k Try, . ,and (Name of Business Entity) We further resolve and represent that ITN VA, G,. Oi Li is \, ,g tr��..,��,_ (Names of Individual) legally empowered to act for over�(`rYVI-4.e.rdvrt.t •T,ne . in all matters connected with its (Name of Business Entity) contracting business,and has the authority to supervise construction undertaken by Y7cs1 C94. \-Irec fD Gt V 9C11 Pr- rnairAe.r43tetz-..Trt (Name of Busines ntity) DULY PASSED AND ADOPTED THIS `S}. day of Mr—Lk at)14 (Officers,Partners,Owners—with Designation underneath)r.:)A)\. Witness to s Witness Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this 1114. day of m ,a)il-I by m &.C) LC. Notary Public Name Printed , Publi Signature Commission Number ',E03u' 1104 My Commission expires: 11 '1`so) NOTARY PUBLIC-STATE OF FLORIDA ' Donna Specie -~ Commission#EE043482 NFires: NOV.27,2014 BONDED Till-U.ATLANTIC BONDING Co.,INC. COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio,Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number (SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as. confidential and exempt under Chapter 119, Florida Statues. sM CREDIT CHECK CONFIDENT Commercial Credit Report Company: M & C FLORIDA PAVERS, INC. Date: 03/20/14 Cust. No.: 9999 Address: 6300 JANES LANE, #4 Price: $115 . 00 11771't tl PI Ordered By: RUSH NAPLES, FLORIDA 34109 °. Page: 1 Telephone: (234) 254-8600 (X) Corporation EIN: 65-1135621 PRINCIPALS: PRESIDENT/DIRECTOR DIEHL, MICHAEL D. Address: 4530 15TH AVENUE SOUTHWEST NAPLES, FLORIDA 34116 Social Security Number: - Stock Ownership: 10()% Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: M & C FLORIDA PAVERS, INC . was INCORPORATED in the county of COLLIER, state of FLORIDA, on 09/10, 2001 . The charter number is P01000089694 . The registered agent is DIEHL, MICHAEL D. of 6300 JANES LANE, #4, NAPLES, FLORIDA 34109 . Offices are RENTED from N/A at N/A per month. The company employs FIVE (5) . NET WORTH: ON FILE WITH STATE The company maintains banking relations with WELLS FARGO The officer handling the account is N/A - NAPLES, FLORIDA Reported for: APPLICANT - SEE NAME ABOVE Reported by: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL"-33409 . (561) 616-5556 SM CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: M & C FLORIDA PAVERS, INC. Date: 03/20/14 Oust. No.: 9999 Address: 6300 JANES LANE, #4 Price: $115 . 00 Ordered By: RUSH NAPLES, FLORIDA 34109 Page: 2 PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF COUNTY, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: SEE BELOW. *** *** Credit Profile *** Creditor Opened High Balance Rating N/A REMARKS: N/A = NOT APPLICABLE / NOT AVAILABLE ***PUBLIC RECORDS SEARCH AS OF 03/17/14 IS AS FOLLOWS : (1) STATE TAX LIEN FILED 01/23/13, $1, 037 . 59, BK4880PG2313, COLLER COUNTY CREDITOR: STATE OF FLORIDA (2) LAWSUIT FILED 07/26/07, CASE #2007CA2464, COLLIER COUNTY COURT PLAINTIFF: VIRGINIA L. SPENCER STILL PENDING (3) LAWSUIT FILED 08/20/07, CASE #2007SC2037, GLADES COUNTY COURT PLAINTIFF: FL PAVERS STILL PENDING (4) LAWSUIT FILED 10/02/09, CASE #09CC007459, LEE COUNTY COURT PLAINTIFF: GEICO INDEMNITY COMPANY STILL PENDING (5) LAWSUIT FILED 04/22/10, CASE #2010CA2686, COLLIER COUNTY COURT PLAINTIFF: SCP DISTRIBUTORS LLC STILL PENDING (6) LAWSUIT FILED 04/27/10, CASE #COWE10006538, BROWARD COUNTY COURT PLAINTIFF: HORNEXPRESS-GULF COAST INC STILL PENDING (7) LAWSUIT FILED 03/26/12, CASE #12CC001727, LEE COUNTY COURT PLAINTIFF: TRICIRCLE PAVERS INC STILL PENDING (8) LAWSUIT FILED 08/14/12, CASE #2012CC9128, DUVAL COUNTY COURT PLAINTIFF: TREMRON INC. STILL PENDING (9) JUDGMENT FILED 03/22/13, FILE #084078CA, COLLIER COUNTY COURT CREDITOR: S .T.D. ENTERPRISES OF NAPLES, INC. SM CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: M & C FLORIDA PAVERS, INC. Date: 03/20/14 Cust. No.: 9999 Address: 6300 JANES LANE, #4 Price: $115 . 00 Ordered By: RUSH NAPLES, FLORIDA 34109 Page: 3 END OF PUBLIC RECORDS SEARCH. REPORT WORKED BY NICOLE. END OF REPORT. V `�-e� �-'I. c-e e�SSitiv� 0 (�� tll- ie- This co mmercial report is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy of same,however,is rn no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. SM CREDIT CHECK CONFIDENTIAL Individual Credit Report Name • DIEHL, MIKEL G. Ordered By: RUSH Address : 4530 15TH AVENUE SW Customer : 9999 Received : 03/04/14 NAPLES, FL 34116 Completed : 03/04/14 Social #: Applicant . Bill Amt : $95.00 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 Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA BK OF AMER PD WAS 90 08/10 01/07 770 PAID 0 REV 07 03 03 R1-* 43 A DLA=08/10 FEDLOAN AS AGREED 12/13 11/11 6000 6672 0 0 0000 00 I1 24 A DLA=12/13 FEDLOAN AS AGREED 12/13 11/11 3500 3500 0 0 0000 00 11 24 A DLA=12/13 FEDLOAN AS AGREED 12/13 06/12 3500 3500 0 0 00 00 00 I1 17 A DLA=12/13 FEDLOAN AS AGREED 12/13 09/12 1000 1016 0 0 0000 00 I1 14 A DLA=12/13 FEDLOAN AS AGREED 12/13 06/12 4101 4400 0 0 0000 00 I1 17 A DLA=12/13 Total trade lines on this report: 6 PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS: CLEAR AS OF 03/04/14. SOURCE(S) : EQUIFAX TRANSUNION INQUIRIES: 03/04/14 by CREDIT CHECK (TU) #00630273 COMMENTS: Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. -3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561)616-5556 CREDIT cIIECIC CONFIDENTIAL Name • DIEHL, MIKEL G. Customer: 9999 Page: 2 COMMENTS: FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS. SAFESCAN/EQUIFAX, HAWK ALERT/TRANSUNION CHECKED FOR FRAUD. **** SEE BUSINESS REPORT ON: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. REPORT WORKED BY RENEE CREDIT SCORE: APPLICANT FICO SCORE: 674 (scores range from 300 to 850) *** END OF REPORT *** This information is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. This personal report is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. 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 CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. Date: 03/04/14 Gust. No.: 9999 Address: 4530 15TH AVENUE SW Price: $125.00 Ordered By: RUSH NAPLES, FLORIDA 34116 Page: 1 Telephone: (239) 877-6536 (X)Corporation PRINCIPALS: EIN: 27-1939392 PRESIDENT DIEHL, MIKEL G. Address: 4530 15TH AVENUE SW NAPLES, FLORIDA 34116 Social Security Number: • Stock Ownership: 100% Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. was INCORPORATED in the county of COLLIER, state of FLORIDA, on 02/16, 2010. The charter number is P10000014180 . The registered agent is DIEHL, MIKEL G. of 4530 15TH AVENUE SW, NAPLES, FLORIDA 34116 . Offices are OPERATED from APPLICANT'S RESIDENCE (HOME-BASED) at N/A per month. The company employs ONE ( 1 ) . NET WORTH: ON FILE WITH STATE The company maintains banking relations with WELLS FARGO The officer handling the account is N/A - NAPLES, FLORIDA Reported for: APPLICANT - DIEHL, MIKEL G. Reported by: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561)616-5556 SM CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. Date: 03/04/14 Cust. No.: 9999 Address: 4530 15TH AVENUE SW Price: $125 .00 Ordered By: RUSH NAPLES, FLORIDA 34116 Page: 2 PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF COUNTY, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: SEE BELOW*** *** Credit Profile *** Creditor Opened High Balance Rating GULF COAST PAVERS FAXED REMARKS: N/A = NOT APPLICABLE/NOT AVAILABLE *** PUBLIC RECORDS SEARCH AS OF 03/04/14 IS AS FOLLOWS: ( 1) LAWSUIT FILED 08/14/12, CASE #2012CC9128, DUVAL COUNTY/COUNTY COURT PLAINTIFF: TREMRON INC. STILL PENDING END OF PUBLIC RECORDS SEARCH. **** SEE INDIVIDUAL REPORT ON: DIEHL, MIKEL G. REPORT WORKED BY RENEE END OF REPORT. This commercial report is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable.• The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. Case 16-2012-CC-009128-XXXX-MA Department County CM! Division CC-G Case Status OPEN File Date 8/14/2012 Judge Name MITCHELL,SCOTT F. Parties Name/DOB/DL/ID# Race Type Address TREMON INC PLAINTIFF R FLORIDA HARDSCAPES&PAVER MAINTENANCE INC DEFENDANT M&C Florida Pavers Inc. DEFENDANT 7 , Diehl Mkel G DEFENDANT Attorneys Name Address Type Whiddon,Matthew Murray (redacted) Private Attorney Jacksonville,FL 322072269 Fees Date Description Assessed Paid Balance 08/15/2012 SUMMONS($10/ea) $10.00 $10.00 $0.00 08/15/2012 REFUNDCHECKFEE $0.00 $0.00 $0.00 08/15/2012 REFUNDCHECK $100.00 $100.00 $0.00 08/15/2012 CO/CLA1MS>$2500 3/1/2012 $300.00 $300.00 $0.00 08/15/2012 SUMvIONS($10/ea) $10.00 $10.00 $0.00 08/15/2012 SUMMONS($10/ea) $10.00 $10.00 $0.00 Dockets Line Count Effective ed Description Image 1 -- 8/1412012 COMPLAINT ON CONTRACT OR OTHER DEBT 8/15/2012 2 _- 8/14/2012 COVER SHEET 8/16/2012 3 -_ 8/14/2012 COMPLAINT 8/16/2012 4 -- 8/15/2012 CASE FEES PAID:$330.00 ON RECEIPT NUMBER 1638366 8/15/2012 5 8/15/2012 RECEIPT NUMBER 1638366 HAD A REFUND OF$100.00 AMOUNT SENT TO ERACLIDES,JOHNS,HALL,GELMAN,JOHANNESSEN& 8/15/2012 GOOD 6 -- 8/17/2012 SUMrvIONS ISSUED 8/17/2012 7 9/12/2012 NOTICE OF DESIGNATING PRRv1ARY EMAIL ADDRESS FOR THE SERVICE OF PLEADINGS AND PAPERS PURSUANT TO FLORIDA 9/26/2012 RULE OF JUDICIAL ADMINISTRATION 2.516 • I, 1/10/2013 8 1/23/2013 SUMMONS RETURNED NOT SERVED ON M&C FLORIDA PAVERS,INC.8/28112 9 -- 1/10/2013 SUMMONS RETURNED NOT SERVED ON MIKEL DIEHL 8/29/12 1/23/2013 10 -- 1/10/2013 SUMMONS RETURNED NOT SERVED ON FLORIDA HARDSCAPES&PAVER MAINTENANCE,INC.8/28/12 1/23/2013 11 -- M1712013 MOTION TO WITHDRAW 4/18/2013 A or\ (o.t (c. l t c > c<c r) LA 114A_C.Ae- Detail by Entity Name Page 1 of 2 FLORIDA DEpARTmENT F STATE i 4 DIVISION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation M & C FLORIDA PAVERS, INC. Filing Information Document Number P01000089694 FEI/EIN Number 651135621 Date Filed 09/10/2001 State FL Status INACTIVE Last Event ADMIN DISSOLUTION FOR ANNUAL REPORT Event Date Filed 09/23/2011 Event Effective Date NONE Principal Address 6300 JANES LANE #4 NAPLES, FL 34109 Changed: 04/01/2009 Mailing Address 6300 JANES LANE #4 NAPLES, FL 34109 Changed: 04/01/2009 Registered Agent Name & Address DIEHL, MIKE 6300 JANES LANE #4 NAPLES, FL 34109 Address Changed: 04/01/2009 Officer/Director Detail Name &Address Title PD DIEHL, MIKE 6300 JANES LANE#4 NAPLES, FL 34109 l.rrr/t,-,n„;rv/(`nrr,nratinncearch/cearchRecitltT)etail/FntitvName/domn-... 3/13/2014 ,^ Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2 2/2D ���o Contact l�pmngSomiceu Document Searches Forms Help 2OU9 04/01/2009 2010 02/12/2010 Document Images 02/12/2010 REPORT View image in PDF format 12/O8/2O09 — Of0OirResignation View image in PDF format 12/O8/2O09 — C)f/[}i/ Resignation View image in PDF format 11/18/2OU9 — (}f/Dir Resignation View image in PDF format O4/Q1/20O9 — ANNUAL REPORT View image in PDF format 04/O2/2OOO — ANNUAL REPORT View image in PDF format 04/16/2007 --ANNUAL REPORT View image in POF format 04/11/2006 --ANNUAL REPORT View image in PDF format 07/19/2005 -- ANNUAL REPORT View image in PDF forma 01/2 — ANNUAL REPORT View image in PDF forma 0O3 _ANNUAL REPORT View image in PDF forma DS/24/2OO2 — Amendment View image in PDF format 05/12/2002 -- ANNUAL REPORT View image in POF format 09/10/2001 -- Domestic Profit View image in PDF format om,,.umm'anu px"^mm:�e nn,�mpvo'or,u*", ms�� linn•//prnrc6 x,mhirorcy/lnonirv/Cornnratiun8eacch/ScorohBcmltDctni ... 3/13/2014 www.sunbiz.org - Department of State Page 1 of 1 FLORIDA P � .. � a Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return to List Fictitious Name Search Filing History (it DC,() I Submit Fictitious Name Detail Fictitious Name FLORIDA PAVERS Filing Information Registration Number 601267900221 Status EXPIRED Filed Date 09/25/2001 Expiration Date 12/31/2011 Current Owners 1 County COLLIER Total Pages 3 Events Filed 2 FEI/EIN Number NONE Mailing Address 6300 JANES LN.#4 NAPLES, FL 34109 Owner Information M &C FLORIDA PAVERS, INC. 6300 JANES LN.#4 NAPLES, FL 34109 FEI/EIN Number: 65-1135621 Document Number: P01000089694 Document Images 09/25/2001 -_REGISTRATION I View image in PDF format 04/0712009--CHANGE NAME/ADDRESS I View image in PDF format I 08/14/2006--RENEWAL I View image in PDF format I Prreviaus-on._List. Next oa.List Return to List Fictitious Name Search Filing History I Submit e ti;i)-tect its 1 Docarit_r t-t;t3ar t.:> r; P",F'u Services i Fauns i Hein i (2ttnvri'ht"ri and Ft:we:7 ittitiii.ties itte or F .r :0, D a't.1Wili Of State http://www.sunbiz.org/scripts/ficidet.exe?action=DETREG&docnum=G01267900221&rd... 3/13/2014 Dptail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF ATE DivIsION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. Filing Information Document Number P10000014180 FEI/EIN Number 271939392 Date Filed 02/16/2010 State FL Status ACTIVE Effective Date 03/01/2010 Principal Address 4530 15TH AVE. SW. NAPLES, FL 34116 Changed: 02/04/2013 Mailing Address PO BOX 990398 NAPLES, FL 34116 Changed: 02/04/2013 Registered Agent Name & Address DIEHL, MIKEL G 4530 15TH AVE. SW. NAPLES, FL 34116 Address Changed: 02/04/2013 Officer/Director Detail Name & Address Title P DIEHL, MIKEL G 4530 15TH AVE. SW. NAPLES, FL 34116 Annual Reports Report Year Filed Date 2012 01/08/2012 httn•//cParnh ciinhi 7_nru/Tnauirv/CornorationSearch/SearchResultDetail/EntityName/dome-... 3/13/2014 ^ ° Detail by Entity Name Page 2 of 2 2013 02/04/2013 2014 01/26/2014 Docurnent \ma°ea Home Contact Us e-Filing Services Document Searches Forms Help O1/26/2U14 —ANNUAL REPORT View image in PDF format 02/0412013 --ANNUAL REPORT View image in PDF format D1/08/2O12 — ANNUAL REPORT View image in PDF format O4/28/2O11 —ANNUAL REPORT View image in PDF format O2/1D/2O1O — Domestic Profit View image in PDF forma cmw"ommonu w*marmme n�da,Department o,�te litt"•//cror,li orci/Tnnnirv/CnrnnrutnnScoroh/Scuroh8L uultDe1ai ... 3/13/2014 I DEPART +rT OF THE TREASURY INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 02-19-2010 Employer Identification Number: 27-1939392 Form: SS-4 Number of this notice: CP 575 A FLORIDA HARDSCAPES & PAVER MAINTENANCE INC 6300 JANES IN STE 4 For assistance you may call us at: NAPNRR, FL 34109 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 (BIN) . We assigned you EIN 27-1939392. This BIN 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 BIN 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 BIN. 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 941 04/30/2010 Form 940 01/31/2011 Form 1120 03/15/2011 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 ELECTION: 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. s>r �kf'yk uG' (IRS USE ONLY) 575A 02-19-2010 FLOR 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 and Publication 4248, EFTPS (Brochure). If you need to make a deposit before you receive your Welcome Package, please visit an IRS taxpayer assistance center to obtain a Federal Tax Deposit Coupon, Form 8109-B. To locate the taxpayer assistance center nearest you, visit the IRS Web site at http://www.irs.gov/localcontacts/index.html. Note: You will not be able to obtain Form 8109-B by calling 1-800-829-TAXFORMS (1-800-829-3676) . 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 e-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. IMPORTANT REMINDERS: * 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. * Use this SIN 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 BIN, 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. Thank you for your cooperation. 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 CP 575 A correct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 02-19-2010 ( ) - EMPLOYER IDENTIFICATION NUMBER: 27-1939392 FORM: SS-4 NOBOD , DAN HENTHORNE PRECAST 5500 Taylor Road 239-594-7508 Naples, Florida 34109 239-594-7608 fax February 27, 2014 City of Naples 295 Riverside Circle Naples, FL 34102 To Whom It May Concern: Mr. Mikel Garrett Diehl has been installing, cleaning and sealing concrete brick pavers for Dan Henthorne Precast for the past 3 years. He has provided excellent installation services for our company. If you have any questions, please feel free to contact me at (239) 594-7508. Sincerely, da- * 1 Uk Dan R. entho`e Owner . a VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: NI v k d 6,—rc ,(II 1 Certificate Category Requested: t"t1,1 . + 13CL 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: I1 Li r, t " `' y"r l t c. --) i , rl Title: �` k.. .:.'`'tik v' License Number(if applicable): [q i•-",�S er ' ink Pre c (K a°1-Name of Business: �� (?�!l _/ Business Address: • ")/^)C) To ,.' 1 c �C.d r �'. �)t �a, R-- ` �t 1' Business Phone: °� 0. The Applicant's years of experience from to The applicant's scope of work (specific duties) included: Tk> 3-.=.s.i k i i f,;\., r I-° le=\,: a�. r)1. j ,' S,_ Additional Comments: Falsifying any information provided herein may subject your license to r o a io ■ r t Signature Print Name: ,i-x K. He r, %-,0 t el c state of Florida 2ounty of Collier // File re oing instrument was cknowled ed before me on this. da of ,y - v\who is personal] know, me or produced is identification and who did not take an oath. bon, ["tea \ ! Y"'eT V`t C'i iik_,, - Watt `•--k- Wendy S.Henthome ` fit' NOTARY PUBLIC Signaturef otary -+STATE OF FLORIDA w+�'•+", •*,;,e?Comm#EE105832 `40;E O Expires 6/23/2015 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER R I , am a resident of t, t l i County, • f\tx,;(9a (State) and have resided here for more than five (5) years. uring the last five years I have known \t01. G . 'N-tiQ_ (Applicant). I have had Le 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) u ' _ � (L , .. (Name) 11)10:t �� -�f iE.( t (Address) —f ► '� i UPC 54( Telephone) C )(1 111` 4 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this irt&` !k C)Li by h r (Bate) who has produced p2 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. a�+ Worl4V 5:kentheme LA—AP/7e elic ( i�tg f-2° L.k. NOTARY PUaLs SIGNATURE OF NOTARY p N t.j `rA i Orr FLO IDA Comm#E 406832 t ' Expires 6/23/2015 �t�rr 't C NOTARY'S SEAL (PRINT SAME OF NOTARY) NOTARY PUBLIC 10 �` FLORI-3 OP ID:RL '4`C..,°R°- CERTIFICATE OF LIABILITY DATE(rMl°DATYY) TY INSURANCE 03/05/2014 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 TH.. ‘2OLICIES 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 endorsament(s). PRODUCER CONTACT Progressive Insurance Agency P PHHONON E 2366 Pine 34109 Road (gyp ES Ead1: FAX Na): E MIN MSURERIBj AFFORDING COVERAGE NMI(.N INSURER A:Progressive Express Ins Co 10193 INSURED Florida Hardscapes dba INSURER a:Cypress Property&Cu Ins Co 10953 Florida Pavers,Inc _ 453015th Ave$W INSURER c Naples,FL 34116 INSURER D: INSURER E: MOWER F: I 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ',1 - '- .rr-Y;tLTR_ TYPE OF INSURANCE = AMA= POLICY NUMBER _( LINJTS GENERAL MINIM EACH OCCURRENCE S 100,000 B X COMMERCIAL GENERAL LI/marry GFL-1023441 04/24/2013 04/24/2014 s t EocswanD ost $ 100,000 CLAIMS-MADE I^i OCCUR MED EX(P(My one per) $ 6,000 PERSONAL a ADV INJURY S 100,000 GENERAL AGGREGATE S 200,000 GEN'LAGGREG'AT�E APPLIES PER: PRODUCTS-COMP/OP AGG $ 200,000 POLICY l 1IGT LOC $ AUTOAIOMtE LIABILITY ) N T A _ANY AUTO 08379915-0 01/04/2014 01104/2015 BODILY INJURY(Per parson) $ 10,000 AUTOS OWNED X SCHEDULED 20,000 AUTOS PROPERTY BODILY INJURY(Per accident) S HIRED AUTOS (PERACCIDEGE $ 10,000 _ $ UMBRELLA LA6 OCCUR EACH OCCURRENCE S _ EXCESS UAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS I WORKERS COMPENSATION WC STATU- ( OTH- AND EMPLOYERS'LABILITY TORY LIMITS! ER ANY PROPRIETORPARTPA:REXECUTIVE Y 1 N OFFICERIAIEMBIER EXCLUDED? n NIA EL.EACH ACCIDENT : N at pi In NH) yyee66 EL DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LEST I DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(Attach ACORD 101.Additional Racwli%Schelde.B more space le required) CERTIFICATE HOLDER CANCELLATION t COLLI-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractors ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Licensing Board 2800 N.Horseshoe Drive AUTHOR¢Ep REPRESENTATIVE �' Naples,FL 34104 Richard Larach 1 ®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD NOTICE OF ELECTION TO BE EXEMPT If this application contains incomplete or inaccurate information, it may cause a delay in the issuance of your exemption. An officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under this chapter. Section 1: APPLICANT INFORMATION First& Last Name: Mikel G Diehl State Driver's License Number: State ID Number: State: FL Date of Birth: Social Security Number(last four digits): 7141 Email Address: Mgdiehl13 @gmail.com Section 2: CONSTRUCTION INDUSTRY APPLICANT($50 FEE REQUIRED) Officer of a Corporation (Construction) Corporate Title: PRESIDENT Section 3: This section should be completed with information specific to your corporation or to the limited liability company in which you are a member. The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations. Name of Corporation or LLC: Florida hardscapes and paver maintenance FEIN: 27-1939392 IF YOU NEED TO APPLY FOR A FEIN,CLICK HERE Business Name (DBA): Phone: (239)877-6536 Applicant's Address of Record: 4530 15th ave sw City Naples State: FL Zip 34116 County: Collier Click on the arrow(s) next to the text box(s)to view a list of available Scope classifications/trades for the form type chosen in Section 2. Click on the appropriate scope to select. If you are unsure as to which classification/trade to choose, please contact your workers'compensation insurance carrier. If you do not have a workers'compensation insurance policy, contact the National Council on Compensation Insurance (NCCI) at 1-800-622-4123 option 5 to obtain a classification code. Scope 1: 05221 Concrete or Scope 2: Scope 3: Scope 4: Cement Work-Floors, Driveway Section 4: The corporation of which you are an officer or limited liability company of which you are a member must be registered and in 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 on file with the Florida Division of Corporations. P10000014180 Section 5: Pursuant to Chapter 489, F.S. (contractor licensing law), list certified or registered licenses related to the scope of business or trade listed in Section 3 held by the applicant, or the certified or registered license numbers held by the qualifier for the corporation or limited liability company listed on this application. The business name listed on the license MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations and on this Notice of Election to be Exempt. No DBPR License Listed This section is not applicable to my business Section 6: If you have submitted an electronic payment for this application,the transaction confirmation number is listed in the following space: Confirmation Number: 189839100 Application Number: E00200855 Section 7: N/A Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which this application applies? Name: FEIN Name: FEIN Name: FEIN Section 8: CONSTRUCTION INDUSTRY AND NON-CONSTRUCTION INDUSTRY LLC MEMBERS ONLY To be eligible for a construction industry exemption or a non-construction limited liability company exemption, an applicant must have the required ownership of the corporation or limited liability company. I am a shareholder owning at least ten percent(10%)of stock of the corporation listed on this application. Section 9: I certify that any employees of the corporation or members of the limited liability company listed in Section 3 are covered by workers'compensation insurance. Please identify the workers'compensation insurance carrier that covers any non-exempt employees. Carrier Name: My business does not have any non-exempt employees Section 10: 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 providing my name below, I attest that I have read, understand and acknowledge the foregoing notice. C. Acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any affiliated corporations as provided in Section 440.02, Florida Statutes. First Name: Mikel Last Name: Diehl Note:The Division has 30 days to review your application to determine if it meets the eligibility requirements for the issuance of an exemption.The Division will either issue a Certificate of Election to be Exempt or notify you that your application is incomplete. The Division reviews and processes exemption applications in the order they are received. Exemption information is reflected on the Proof of Coverage database the day following the issuance of the exemption. Visit the Division's website at http://www.myfloridacfo.com/wc to print your certificate. . i 10-06-2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * NON-CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. • EFFECTIVE DATE: .09/22/2011 EXPIRATION DATE: N/A' PERSON: DIEHL MIKEL G FEIN: 271939392 BUSINESS NAME AND ADDRESS: FLORIDA HARDSCAPES & PAVER MAINTENANCE INC P 0 BOX 990398 NAPLES FL 34116 SCOPES OF BUSINESS OR TRADE: p I- PRESSURE CLEANING j0 13 A. I`I Or'scia()INN)e .5 IMPORTANT: Pursuant to Chapter 440 . 05(141. F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate of election under this section may not recover beastits or compensation under this chapter. Pursuant to Chapter 440.05(121. F.S.. Certificates of election to be exempt... apply oily militia the scope of the business or trade listed on the notice of election to be exempt, Pursuant to Chapter 440.05(13), F.S.. Notices of election to be exempt sad certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice,or the issuance of the certificate. the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The depanmeal shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 • • PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE • STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES , DPASION OF WORKERS'COMPENSATION O F Pursuant to Chapter 440.05(14), F.S.. an officer of a corporation who NON-CONSTRUCTION INDUSTRY >.. {. elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA , L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW D chapter. EFFECTIVE 09/22/2011 EXPIRATION DATE: N/A Pursuant to Chapter 440.05(12). F.S.. Certificates of election to be PERSON: MIKEL G DIEHL H exempt.. apply only within the scope of the business or trade listed on FEIN 271939392 E the notice c' erection to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13). F.S.. Notices of election to be exempt FLORIDA HARDSCAPES `. ".WER MAiNT£a.rCE INC and certificates of election to be exempt shall be subject to revocation P 0 BOX 990399 - if. at any time after the filing of the notice or the issuance of the NAPLES. FL 34116 certificate, the person named on the notice or certificate no longer meets the requirements pf this section for issuai.,;e of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet t'e requirements of this I- PRESSURE CLE..N:ra: Section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your re: ird:-. • f- . . . . . N . 1 \ . . , . . \ • » » \ . \ \ } » ® . . :% / I . . . . t•,- -•,- ©,-.,,,,, 1..> .,. w . . : d • • COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION «Vim 2800 N.Horseshoe Drive,Naples,FL 34104 5vih!k cit ..•,~ ° Make Check Payable to Collier County Tax Collector :' v Phone:239-252-2477 Fax: 239-643-4788 Website:www.colliertax.com �oo'wE iRo CHECKLIST 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 - a(,►. r61Satetc) YCv LC 11\rm—kia-C (! la) DBA NAME - ��pc��dkr, lb) BUSINESS OWNER OR QUALIFIER'S NAME - N .VA:t.,tti 2) PHYSICAL ADDRESS - �"- r'+ 34.1i(0 (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - V Yes No 3) BUSINESS MAILING ADDRESS - 53o IS'"" N J✓J t 34 11 b Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- 1530 \Stk" S( Nc 34i 5) TELEPHONE -Business: a S9I—(463(o Home: , 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership 1� Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- o2 liIA 1 8) OFFICE WITHIN CITY LIMITS OF NAPLES- Yes L No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. 1)71 - *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: \(1 \ c ®R oc. re3 ee.krec S 10) NUMBER OF EMPLOYEES -Including number of owners: 11) FILL IN THE APPROPRIATE AREAS- a)Rental units(motel/hotel/apts.)Number of units: r 1N-4Q. b) Seating Capacity(rest./cafes,etc)Number of seats: Yun"Q c)Number of coin-operated machines owned by business or individual: n1NQ. 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 ARE T'UE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: // DATE: 3` 1 1 q (Owner and/or representative of business)TITLE: �, ****THIS LICENSE IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE**** SECTION A, B,AND C FOR OFFICE USE ONLY THIS SECTION TO BE FILLED OUT BY CONTRACTORS/BCC LICENSING BOARD SECTION A Classification of Contractor: County Certification Number: Department Supervisor Date: THIS SECTION TO BE COMPLETED BY PLANNING SERVICES SECTION B Business is an in-home occupation and the applicant has agreed to adhere to the requirements as set forth in the Collier County Zoning Ordinance. PROPERTY Business DOES COMPLY with the Collier County Zoning Ordinance. ZONED Signed: Title: Date: Comments: THIS SECTION TO BE COMPLETED BY THE HEALTH DEPARTMENT SECTION C Business DOES COMPLY with the local and/or State requirements. Signed: Title: Date: * In accordance with Florida Statute 205.0535(5), we require you to provide us with either a Federal Employer Identification Number(FEIN) or a Social Security number. • y Co -ter County 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 employees 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 3\, 1\ 14 ZONING CERTIFICATE#TC- APPLICANT'S NAME 'ci\% A G . �‘' PHONE: -� (�_ (q�3�o APPLICANT'S HOME ADDRESS 4S30 54'` Q.SW 3L4 l ( co TYPE OF BUSINESS TO BE CONDUCTED \C�SIr4,\.\G44o Os- \c kc-\\OC,'rb liCve(3 BUSINESS NAME(IF ANY) -\.p(�t \ re-C \ v- Ch\LQ.C- rr\CAr etti tf, crtV I, the undersigned, hereby affirm that 1 am the legal owner of the property at the above address or that l 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). 1 II APPLICANT SIGNATURE A /Of' DATE 3 11 1 1 L1 FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" wr I TO BE COMPLETED BY COUNTY STAFF ZONING: PROPERTY ID# DATE REVIEWED BY APPROVED HOLD DENIED COMMENTS/RESTRICTIONS: Must comply with Section 5.02.00 of the LDC ('see back of application). lax Collector Staff: Please forward a copy of issued certificate and receipt to Collier County Zoning Department. Daniel J. Haugen Contest of Citation 8650 Table of Contents El— Hearing Request (provided by Haugen) E2—Copy of Citation (provided by Haugen) E3—Confirmation of Hearing E4 & E5—County Case Detail Report E6 through E17—Contract Documents E18 through E21—Site Photos E22—Dealer in Appliances and Equipment for use of LP Gas, License Class Code 0602 E23 & E24—Florida Statute 527.01(12), in Appliances and Equipment for use of LP Gas E25 & E26—County Ord. 2006-46, as amended, Section 1.1 "Unlawful to without a Certificate of Competency' E27- County Ord. 2006-46, as amended, Section 1.6.1, Contractor Definition E28—County Ord. 2006-46, as amended, Section 1.6.1.3, Residential Contractor Definition E29 through E33—Previous Citation /Case File 3/24/2014 MAR 2 6 2614 To whom it may concern, I Daniel Haugen request an Administrative hearing before the Contractor's Licensing Board, in regards to Citation 08650. Thank you, Daniel Haugen CE COLLIER COUNTY GROWTH MANAGEMENT-DIVISION- i CITATION Pursuant to section 489.127.(3)(a).Florida Statutes,the undersigned hereby certifies that upon personal investigation,he/she has reasonable and probable grounds to believe that the person whose name appears below as issued to,did violate subsection 489.127.(1),Florida Statutes,and the Collier County Contractor's Licensing Ordinance No.2006-46(as may amended)by committing the violation } stated belo . I M Monthwar?.; Day Year !lime Issued To v fryiel tilf, r` Address , City -" State !" Zip ..}`S T n L 33; Race Sex I Het t Vehicle Make(Iype(if applicable) 1Year I Co or 'hag No. Location of Violation s' , OPTIONS I have been informed of the violation for which I have been charged and elect the - following option(Check one) 1) ❑ I choose to pay the penalty of$ s 2)jo I choose not to pay the penalty,and will request in writing by certifi a.' or hand delivery an At 6 6.6 ve Hearing before the Contractor's'jeer's'ig B.. Descrrption;of Violation ';, _y s V'o 4e,0 served ) i a) ❑ Falsely hold serf s:r bus', 'Lt., « , tri.fltdIderot,, b)b Falsely impersonate a certifi • 'of er or !. . 1 c) ❑ Pdsent as his/her own the certificate or registration of another; ' d)❑.Knowingly give false or forged evidence to the Board or a member thereof; 1 e) 0'Usetr attempt to use a certificate or registration which has been suspended or; revoked; f)/Engage in the business or act in the capacity of acontractor oradvertise self ' or business organization as available to engage in the,business or act in the I capacity of a contractor without being duly registered or certified; g)❑ Operate a business organization engaged in contracting after(60)days; to Commence orperform'Work forwhich abuildingpemrit is req riredPursuant to an adopted state minimum building code or without such perrnit being in effect i) ❑ Willfully ordeliberately disregard or violate any Collier County ordinance relating to uncertified or mregistered contractors. ' A person or business organization operating on an inactive suspended ended certificate, or registration,or operating beyond the scope of work or'_.=graphical scope of the i registration,is not did certified or registered.' 4111.714. mi. 1 SIGNATURE(RECIp SI p 'It- •.: I TIGATOR) PRINT(RECIPIENTS NAME) P I TIGATOR'S NAME } Pursuant to 489.127,Florida Statutes,willful refusal to sign and accept this citation. +. constitutes a misdemeanor of the second degree, punishable as provided in section 775.082 or 775.083 Florida Statutes. (SEE REVERSE FOR INSTRUCTIONS) RECIPIENT COPY El -® elc" C®u-prty Growth Management Division Planning & Regulation Operations Department Licensing Section March 26, 2014 Daniel A . Haugen 1989 Par Dr. Naples, FL.34120 RE: Contesting citations 08650 & 08651 Dear Mr. Haugen, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, April 16, 2014. 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 Since ly, Ale& ir Samantha Roe Customer Service Specialist Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 e3 Growth Management Division*Planning&Regulation*2800 North Horseshoe Drive*Naples,Florida 34104*239-252-2400*www.colliergov.net • Report Title: Code Case Details Date: 3/27/2014 9:20:23 AM Case Number: ceu120140005154 14 c 5 Case Number: CEUL20140005154 Status: Citation Case Type: Unlicensed Date&Time Entered: 3/13/2014 8:03:14 AM Priority: Normal Entered By: lanJackson Inspector: lanJackson Case Disposition: Unpaid Jurisdiction: City of Naples Origin: Complaint Detail Description: Complaint stating Daniel Haugen/Hot Concepts Fireplaces LLC contracting at 3005 Ft Charles Dr w/no license. Citation 8650 issued 3/18/14. Location Comments: 3005 Ft Charles Dr/folio 17210080007 Property 17210080007 Complainant Nelson, Rodney Violator Haugen, Daniel E' 1 Business Management& Budget Office Code Case Details Execution Date 3/27/2014 9:20:23 AM Desc .Assigned Required Completed Outcome Comments Preliminary Investigation lanJackson 3/12/2014 3/13/2014 Needs 3/12/14. Complaint stating unlicensed lnvestigatio contractor, Hot Concepts Fireplaces LLC/ n Daniel Haugen(300-4950/331-8303) contracting for construction at 3005 Ft Charles Dr. Found company to be operating w/Collier Wholesale Business Tax. Found that alleged violator had previously been cited for unlicensed advertising. 3/12/14.At location, no sign of alleged violator. 3/13/14. Spoke w/Gary Carlson ,who is builder/permit holder for new construction home at location. Obtained contract between Carlson Harris and Hot Concepts Fireplaces LLC. Found that Hot Concepts had contracted for construction of three fireplaces at location. Photos of fireplaces in case.Will address violation with Daniel Haugen, owner of Hot Concepts. 3/14/14. Several messages left for Haugen. 3/17/19. In reviewing contract,found that scope of work on constructing fireplaces as contracted includes multiple trades(masonry, mechanical). Established that residential Contractors License is minimum license required for contracted construction at this location. Investigation lanJackson 3/17/2014 3/19/2014 Citation 3/18/14. Met w/Daniel Haugen.Explained Required violation.With previous citation having been issued for unlicensed advertising to Haugen, $2000.00 citation issued.SWO for construction of fireplace at this location issued. Issue Citation (Licensing) lanJackson 3/19/2014 3/19/2014 Complete Citation Paid/Contested clements_k 4/2/2014 Pending Violation Description Status Entered Corrected " Amount Comments Unlicensed General Contracting Open 3/19/2014 $0 Title Reason Result Compliance Fine/Day Condition es." Business Management& Budget Office 2 Carlson & Harris General Contractors, Inc. Telephone(239)352-2460' 6017 Pine Ridge Road Suite#240 Naples,FL.34119 LHayes @Ca rlsonH a rris.com SUBCONTRACT AGREEMENT Subcontractor: Owner, Project Name and Location: Hot Concepts Fireplace Mr.and Mrs.Rob Stuckey 5585 Shirley Street Suite D 3005 Ft. Charles Drive Naples, FL 34109 Naples, FL 34102 Subcontract Price: Design Professional: $19,484.00 Kukk and Associates Plans and Specifications: Carlson& Harris Job No.: See Attached Exhibit "A" 26098 Scope of Work(Exhibit "B"): Carlson & Harris General Contractors, Inc.("Contractor") and Subcontractor agree that Subcontractor shall perform the scope of work set forth above subject to the following terms and conditions: CONTRACT DOCUMENTS: The Contract Documents applicable to this project are this Agreement,the drawings and specifications prepared for this project by the Design Professional,all addenda and all change orders,all of which are incorporated by reference into this Agreement. 2 MATERIALS AND SUPPLIES: All labor,materials and equipment furnished under this Agreement shall be in strict accordance with the Contract Documents. Where the Contract Documents describe work other than that specifically mentioned in this Agreement, then the Subcontractor shall perform the aggregate of all work specified in this Agreement and all.work described in.the Contract Documents which would be. reasonably inferred as being within the purview of the Subcontractor's work taking into consideration the type of project under construction the course of dealing and industry standards. 3. SUFFICIENCY OF WORK If Subcontractor at any time refuses or neglects to supply a sufficient number of properly skilled workmen or of materials of the proper quantity or quality or fails in any respect to prosecute the work with promptness and diligence,or fails in the. performance of the terms contained within this Agreement,Contractor reserves the right,three days after mailing a written notice to the Subcontractor,to make good such deficiency and to deduct the cost thereof from payment then or thereafter due the Subcontractor. This right shall be without any prejudice to any other remedies Contractor may have under this Agreement or under applicable Florida law. 4. PAYMENT: Contractor will pay Subcontractor the Contract Price as follows: A. INVOICES: All invoices must include reference to the Job Number,Name,Address,Scope of Work,Work completed to date and previous billings. B. TIME FOR MAKING PAYMENT: On or about the 10th day of each month Contractor will pay to Subcontractor a sum equal to 100%of the work completed by the Subcontractor during the previous month for which payment shall have been made to Contractor by Owner,(jlp)provided that the Subcontractor shall furnish to Contractor on or before the 25th day of each previous month,a statement of the Subcontractor's estimate of the work completed through the end of the month. The balance of the payment due will be made within 30 days after completion and final acceptance of the work by the architect and Carlson'Harris General Contractors,Inc.and payment by the Owner: 10%retainage will be held until completion of project. C. CONDITIONS PRECEDENT TO PAYMENT All lien releases,waivers of lien;affidavits and other documents which are required by the Contractor front the Subcontractor shall be delivered and the delivery of those documents shall be a specific condition precedent to payment by the Contractor to the Subcontractor. Final payment and all progress payment to be made under this Agreement are not due and owing and as express condition precedent,shall not be made unless(a) all work represented by the payment is accepted by Contractor,and(b)Contractor receives from Owner payment for the work for which Subcontractor payment is requested if a dispute arises between Subcontractor and Contractor,Contractor If may retain all payments Men due to Subcontractor as partial indemnification for any costs or damages Contractor may suffer by reason of Subcontractor's performance or failure to perform m accordance with this Agreement or applicable Florida law. 5. SHOP DRAWINGS. Subcontractor must forward seven copies of all required shop drawings to Contractor for the Design Professional's approval Subcontractor shall forward all required shop drawings to Contractor in sufficient time for Subcontractor to complete all work required within the time frame of the construction project and the schedule for completion of the work. No extension of time shall be granted by Contractor to Subcontractor for shop drawings either approved'by Contractor or re-submitted by Contractor to Subcontractor for revision where such approval or re-submission occurs within seven worktni,days Subcontractor shall submit shop drawings in sufficient time for Subcontractor to comply With its schedule of delivery and work,taking into account the seven working days afforded to Contractor for the approval of shop drawings. 6. INSURANCE If this Agreement requires Subcontractor to perform any services at the job site other than delivery of materials, Subcontractor agrees to furnish a certificate of insurance or evidence in fonts acceptable to the Contractor of the Subcontractor's insurance policies demonstrating that the Subcontractor carries public liability and property damage insurance,and Florida Worker's Compensation coverage as required by law with responsible insurance companies. Subcontractor or its carrier(s)must inform Contractor at least ten(10)days prior to the termination, cancellation or changes made in said insurance.coverage. Subcontractor agrees to carry insurance as follows: Public Liability 3500,000 Combined Single Limit each occurrence. and 5500,000 Combined Single Limit aggregate. Property Damage The general liability(bodily injury and property damage)must be on a comprehensive general liability form and must include,but not be limited to premises operations, explosions, collapse,and underground hazard coverage, products and completed operations coverage, contractual liability coverage,broad form property damage coverage,independent contractors coverage and personal injury coverage, Worker's Compensation Statutory Automobile Liability S500,000 each occurrence, and 3500,000 aggregate, Property Damage The automobile liability coverage must include owned;hired and non- owned vehicles. All Risk installation Floater 100%of the insurable value of the stored materials not on job site. The certificate of insurance should also sate'that"ii is agreed that cancellation of the above-stated coverages shall not be effective until thirty(30)days after a copy of the notice of such cancellation has been sent by certified mail to the Contractor." 7, SAFETY: See Exhibit"S" 8. WARRANTY: All labor,material and equipment furnished under this Agreement shall be guaranteed by the Subcontractor to the Contractor and Owner to be fit and sufficient for the purpose intended,and such labor,materials and equipment are guaranteed to be merchantable,of good material and workmanship,and free from defects,and Subcontractor agrees to replace without,charge to Contractor or Owner said labor,materials and equipment,or remedy any defects,latent or patent,not due to any ordinary wear and tear or due to improper use or maintenance,which may develop within one year from the date of acceptance by the Owner,or within the guarantee period set forth in the applicable plans and specifications,or statutes, whichever is longer. The warranties herein are in addition to those implied by law. Subcontractor agrees to replace any material and to correct any work deemed defective by the Contractor;Owner or Design Professional when requested to do so. This Agreement shall not operate as a waiver of any rights that the Contractor or Owner may have for breach of any warranty or guarantee or as election of remedies and is expressly agreed to be supplemental to all other express warranties and any warranties implied by law; 9, INDEMNiT'i Subcontractor agrees to indemnify and save harmless the Contractor and Owner,from any loss,expense,damage or injury(including attorneys fees),caused occasioned,directly or indirectly;by performance of or failure to perform this Agreement including,but not limited to the furnishing of or payment for permits,licenses or inspection fees the payment of royalty or license fees;the defense of suits or claims for infringement of patent rights;loss or damage arising from defective materials or workmanship any loss, damage or injury to persons(including employees)or to property. This indemnity shall be effective even if the loss or claim for which indemnification is sought shall have been caused,in part; by Contractor or Owner but shall not in any way be effective to hold Subcontractor responsible for the part of any loss,cost or expense caused by any person indemnified by this clause: 10. APPROVAL All material and equipment furnished under this Agreement shall be subject to the approval of the Owner,Owner's Design Professional and Contractor. Subcontractor shall furnish the required number of submittal data including but not limited to shop drawings,or samples for said approval. 11 is understood and agreed that Owner has the right to approve or disapprove the employment of Subcontractor and in the event that Owner does not approve Subcontractor,this Agreement shall become null and void. 11. TERMINATION: A. TERMINATION OF SUBCONTRACTOR:In the event the Subcontractor delays the progress of the work or the furnishing of material,or fails to comply with any schedule submitted to Subcontractor by Contractor,or fails in the performance of any of the provisions of this Contract files for bankruptcy or is involuntarily placed into bankruptcy,or becomes insolvent,or refuses or neglects to supply a sufficient number of properly skilled workmen,or refuses or neglects to supply a proper quantity or quality of materials called for under this Contract,or fails in any respect to prosecute the work with the promptness and diligence called for this Contract,or to fail in the performance of the terms and conditions found throughout this Contract, the Contractor shall have the right to cancel this Agreement three days after having mailed written notice to the Subcontractor at his last known address. In case of such termination,the Subcontractor'shall not be entitled to receive,any further payments under this Agreement until the performance of the Agreement has been completed,at which time,if the unpaid balance due Subcontractor exceeds the cost of completion,said amount shall be paid to Subcontractor,but if such expense incurred by the Contractor including all damage and cost incurred through the default of the Subcontractor shall exceed such unpaid balance, then Subcontractor shall be liable to Contractor for the excess sum. B. TERMINATION OF CONTRACTOR In the event of the termination of the Agreement between the Contractor and Owner, this Agreement shall also be terminated upon written notice of the Contractor to the Subcontractor,and Contractor shall only be liable for the labor and materials furnished up to the date of receipt of the written notice of termination. 12, ASSIGNMENT`: Subcontractor agrees that it will not assign this Contract,or any of the monies due it,or to become due hereunder,nor sublet any portion of the work without first obtaining written consent of Contractor. 13: TIME Time is of the essence of Ibis Contract.Notwithstanding any other provision of this Contract,should the Subcontractor for any reason fail to make deliveries as required hereunder to the satisfaction of the Owner,Design Professional,or Contractor,the Contractor shall be liberty to purchase the materials or obtain the labor from another source,and any excess in cost of same over the price herein provided shall be chargeable to and paid by the Subcontractor on demand. Should any delay on the part of the Subcontractor occasion loss,damage or expense including consequential damages to the Osne or to Contractor,the Subcontractor shall indemnify against such loss,damage or expense including attorney's fees as provided in paragraph 9. 14, CHANGES OR ALTERATIONS: No additions,deductions or changes shall be made in the work,nor shall there be any charges tot premium time,except upon wvriiten order of Contractor,which order shall specify the amount of additional compensation or credit to be applied to the amount of this Agreement and shall specify the additional time or savings in time attributable to the authorized change. 15. TITLE TO MATERIAL AND EQUIPMENT: The materials and equipment covered by this Contract,whether in a deliverable state or otherwise,shall remain the property of the Subcontractor until delivered to a designated site and actually received by the Contractor and/or stored on site or at such other location and in such condition as determined by the Contractor and any damage to the material and equipment or loss of any kind occasioned in transit or in storage where the storage is contrary to the instructions of Contractor shall be bonne by the Subcontractor notwithstanding the manner in which the goods are shipped or who pays the freight or other transportation costs. 16. SITE The Subcontractor shall clean up and remove from the premises all debris caused by the execution of the work or the furnishing of material, Upon failure to remove debris,Contractor may remove it and charge the cost to the Subcontractor, 17. LIENS: At the time of submitting applications for payment,the Subcontractor shall furnish all necessary lien waivers,affidavits or other documents required to keep the Owner's premises free from liens or claims for liens of all sub subcontractors,suppliers or laborers,''for all work for which the Subcontractor is then requesting payment. iI. TAXES: Subcontractor shall pay all sales,consumer,use and other similar taxes for the work or portions thereof provided by the Subcontractor which are legally enacted at the time this Agreement is signed,whether or not yet effective. Subcontractor shall also pay all other contributions;taxes or premiums which may be payable under federal or state unemployment insurance,law,worker's compensation law,and the Federal Social Security Act which taxes and assessments arise out of the performance of this Contract; 19. DISPUTE RESOLUTION AND PARTICIPATION AGREEMENT: The Subcontractor acknowledges and agrees that any controversy or claim arising out of or relating to this Contract,or the breach thereof shall be settled under the laws of the State of Florida. lithe Contractor is compelled into arbitration under the terms of its agreement with the Owner,Subcontractor agrees to participate in the arbitration for the purpose of resolving any dispute arising out of common or interrelated issues of fact or law: Subcontractor cannot compel the Contractor into arbitration under any such clause,but Contractor and Subcontractor may mutually agree to enter into binding arbitration to resolve any dispute at the time the disputes arises. Any litigation proceeding initiated under the terms of this Agreement may at the request of either party,be joined or consolidated with other litigation proceedings involving additional parties if the disputes arise out of common or interrelated factual occurrences. Both parties to this Agreement agree that if the other party becomes involved in litigation concerning the project which is the subject of this Contract,then the uninvolved party will participate in the litigation to the extent it involves questions of law or of fact which arise from or are related directly or indirectly to the performance of the terms of this Agreement by the party not involved in the litigation. The Subcontractor and Contractor agree to include a provision regarding dispute resolution identical io the one contained herein in all agreements with other contractors,subcontractors or suppliers. The parties further agree to contractually require the other contractors,subcontractors and suppliers to include identical dispute resolution provisions in all agreements that they may enter into for labor,materials or management to be furnished to the project; 20. ATTORNEI'S FEES: The parties to this Agreement agree that in the event that either party is required to enforce his legal rights under this Agreement or under applicable Florida law against the other,the prevailing party shall be entitled to reasonable attorneys fees and court costs regardless of whether an action is filed or the matter is resolved prior to an action being filed;and including all fees and costs associated with any appeal. 21, ENTIRE AGREEMENT; This Agreement and any documents referenced herein constitute the entire agreement between the Contractor and the Subcontractor. All prior representations,conversations,or preliminary negotiations shall be deemed to be merged in this document, and no changes will be considered or approved unless this Agreement is modified by an authorized representative of the Contractor in writing. 22 MISCELLANEOUS: All references in this agreement to"Subcontractor"shall mean the party sighing as"Subcontractor"and shall not be construed to omit any party providing labor,services,or materials pursuant to this agreement without regard to whether such party would traditionally be referred to as a subcontractor or as a material supplier. References to a party shall,include that party whether masculine,feminine,or neuter,singular or plural. CONTRACTOR CARLSON&HARRIS GENERAL CONTRACTORS,INC. 1 BY: 7/:-- TITLE: Vic President DATE: I/ `>lt' ,/'7 SUBCONTRACTOR: Hot Concepts Fireplaces (Name of Subcontractor) r BY 11 a 0 --- TITLE: of ®' 4r— aJka Wk.uc/yAA DATE: kt (-1 1 ..e.... • I ∎1111;1I ;! l'1,nI' :11111 '1 It l II It (ItI1'I;` I II, I'I.,I1 11,11 `.Iii ■ if ,trot. I, l rltr 14“1y_ r fit ,, ' 111 1,1 kit!. Art IiiIrt ttu,11 AO 00.1. Sl fti.. I MAN 15, 201 Al SI'I'I'. PLAN MAY 15, 21113 A2 Vo FLOOR PLAN A3 1"1' 1 1,(1(117 I'I.AN' MAY 15, 11►1 a MAY 15, 2013 A4 1" FLOOR REFLECTED( T1>1► CEILING PLAN MAY 15, 101;{ AS 2" FLOOR RI:F1.1:cTF.D CEILINC. PLAN MAY 15, 101 3 A(, ROOF PLAN MAY 15, 1013 A7 CARA{;E PLAN MAY 15. 1 013 All I)UOR SCHEDULE FIRST FLOUR MAY 15, 2013 A`) DOOR SCHEDULE SECOND FLOOR MAY 15, 2013 1 A 10 WINDOW SCHEDULE MAY 15, 201:; All FRONT, REAR AND 511)1-: H.I:VATIUN MAY 15, 201: A I2 SIDE ELEVATION DETAILS MAY 15, 2013 A 1 3 WALL SECTIONS MAY 15, 101:3 A 14 TYPICAL DETAILS MAY 15, 201:3 A IS INTERIOR ELEVATIONS MAY 15, 2013 • Structural: S I STRUCTURAL NOTES MAY 23, 201: 52 FOUNDATION PLAN MAY 23, 2013 S3 FOUNDATION PLAN MAY 23, 2(113 S4 1" FLOOR TIE BEAM MAY 23, 201: S5 1ST FLOOR TIE BEAM MAY 23, 2013 S6 2N1'FLOOR TIE BEAM MAY 23, 2013 S7 TYPICAL DETAIL SHEET MAY 23, 2013 S8 1ST FLOOR TIE BEAM P1 AN MAY 23, 2013 S9 1" FLOOR TIE BEAM PLAN MAY 23, 2013 S11) 1s1 FLOOR EPICORE NEGATIVE STEEL PLAN MAY 23, 2013 SI 1 2N" FLOOR TIE BEAM MAY 23, 2013 Si 2 FOUNDATION DETAII.S MAY 23, 2013 S13 FOUNDATION DETAILS MAY 23, 2013 S11 FOUNDATION DETAILS MAY 23,_2013 S15 FOUNDATION DETAILS MAY 23, 2013 S16 FOUNDATION DETAILS MAY 23, 2013 S17 FOUNDATION DETAILS MAY 23,2013 S18 FOUNDATION DETAILS MAY 23, 2013 S19 FOUNDATION DETAILS MAY 23, 2013 S20 FOUNDATION AND 1ST FLOOR DETAILS 69' MAY 23, 2013 S21 151 FLOOR DETAILS MAY 23, 2013 S22 TYPICAL DETAIL SHEET MAY 23, 2013 1 IpIIt(Iq! I t tt 0 t 4IV :R q11-1•1 MA1 10 :111 i I t o I 0,11 I INt, ti( III-I11I1 H MA1 II). :01 -` 1,1 (I ', 1 1(,11 1 INo ( III..11111,1..S MA1 11). ,011 I t 0 .1 I IOW! 0v0, t oN I ROI WIl iNt, I)1- 1 Ail ! MM 111 _'t+l -, H t t 0 `, 1 1101'1 1Ni,ANH H I li,l1'1 INo t oN I h tl .1 Nllt+ll ' MA1 10 .'111 I t 1 11k1. 1 1.1 VI ) 111.11"I INI. I'1 1117 MA) Ili , 111 H t `I ( I q\!1) 1.1 1'1.3 I li,11 I IN(' 1'I AN MA' I(I, ,'0 ► A11 I I IR`I I2V1•I AHHIO VIH H:O. (.Altl.l., (k H.I.H11()N1 MM. In :01 > AV <' ,,I.( ( NI) 1 i.v1.i AIIIJl( . VIDEO. s AF(I.I•. ,t II 11 1'III)NI' MM I0, .1o1 Mu't li,;ltut ill M(1 MI•:t HANICAL N))I'I AND S(:III.1)11LES MAY IIf, 201 .1 M l MECHANICAL NOTES AND CALCULATIONS MA1' 10, 2013 M,? I" FLOOR MECHANICAL. PLAN MAY 10, 201 3 M3 2N1' FI,(1t)11 MECIIANICAI. PLAN MAY 10, 2013 ElettFl(ii: E FLECTIUCAL NOTES AND SCHEDULE MAY 10, 201.; E2 I' 1 FLOOR 1:1,1•:(:'1'RI( Al. PLAN MAY 10, 21113 E.3 2N1' FLOOR HATTRICAL PLAN MAY 10, 201:i ' I:4 EI,ECTRI(:AL, CALCULATIONS AND NOTH MAY 10, 2013 I'Iucul)Ihg: H) NOTES AND SCHED111_,E MAY (O, 2(113 PO I SANITARY AND STORM DRAIN ISOMETRICS MAY 10, 2013 I'1 1S1 FLOOR SANITARY PLAN MAY 10, 2013 P2 lit FLOOR WATER SUPPLY PLAN MAY 10, 201:i P3 2N1' FLOOR PLUMBING PLAN MAY 10, 2013 P4 FLAT R001:STORM DRAINAGE PLAN MAY 10, 2013 7. 0.0 EXISTING CONDITION MAY 19, 2013 1.0 OVERALL SITE PLAN MAY 14,2013 1.1 FRONT SITE PLAN MAY 14, 2013 1.2 POOL GRADING PLAN MAY 14, 2013 l.3 POOL LAYOUT AND DIMENSION !'LAN MAY 14, 2013 1.4 GARDEN/-CABANA DECK PLAN MAY 14, 2013 1.5 SIDE YARD SECTIONS MAY 14, 2013 1.6 HARDSCAPE DETAILS MAY 14, 201 1.7 HARDSCAPE DETAILS MAY 14,2013 1.8 HARDSCAPE DETAILS MAY 14, 2013 Ei0 Exhibit B CONTRACT Page,- 1 -of I ,1, A ¢ its w r .f , 4t. 1.=i DATE: 06/18/2013 t SUBMITTED TO: Carlson Harris,do Dan Whewell " j o CO CEPTS ADDRESS: Stuckey Residence 3005 Pt.Charles Dr. CITY: Naples FIREPLACES STATE: FL DESIGN BUILD SERVICE REPAIR ZIP: 5585 Shirley Street suite D HOME PHONE: Naples,FL 34109 ALT.PHONE (239)300-4950 EMAIL: damicar}sonharris ni.nnail.cum contact @hotconceptsfireplaces.com PREPARED BY: Dan l O........m N.l w......arer..... .Fv®®®R.®.imc..BA,.....aw®a®smmlvroaQm®®®eo®...... .>ar...... .., Library Fireplace FIREPLACE:VENT FREE:ISOKERN Delivery and Installation according to manufacture and plan specifications of lsokem vent free fireplace A. Build base as needed to create proper finish height in accordance with plan specifications and elevations. B. Construct Isokern firebox/fireplace structure to manufacture and plan design specifications. Model:42"Vent Free C. Build firebox interior using firebrick D. Grout fire brick joints using mortar. Fire Brick Pattern:Herringbone Fire Brick color:Tan,Charcoal or Red Fire Brick Mortar color:Gray,Charcoal or white � IIII $3084.00 Additional Requirements:To be provided by separate contractor at additional cost not included in this proposal Gas line to fireplace location Electrical to fireplace control location �m sS�am�l®®..Mt..®wao�se�MIIie•®®®I�slmm®a®Mae��nowaa•1.®./..m®wrsM®aecwM®E..MI=aasiwrsr��,411M w MO e4lIN rt,a®I WORK DONE MEETS OR EXCEEDS ALL STATE,NATIONAL,AND NFPA CODES TOTAL $ 3084.00 AUTHORIZED SIGNATURE: _ '`'-' ` — REQUIRED DEPOSIT $ 1542.00 THIS PROPOSAL MAYBE WITHDRAWN IF NOT ACCEPTED WITHIN 30 DAYS BALANCE $ 1542.00 PAYMENT TO BE AS FOLLOWS:50%ON ACCEPTANCE BALANCE ON COMPLETION OR AS STATED fN"CUSTOMER A)XEPTANCE AGREE.MENf°OS RF VERSE SIDE 1 ACCEPTANCE OF CONTRACT t 1/ / 1 I AUTHORIZE THE ABOVE DESCRIBED 4RX UNDER THE TERMS ANO CONDITIONS I 'CUSTOMER ACCEPTANCE AGREEMENT' 1 1 / /2e SCHEDULED START DATE 1 SIGNATUR �. DATE: 2 1 r ir El( ` y - � Page- I -of 1 o' ?'1,:‘, .c,,:i: i DATE: 06/18/2013 „ t;' SUBMITTED TO: Carlson Harris c/o Dan Whewell y ADDRESS: Stuckey Residence 3005 Pt.Charles Dr. HST CONCEPTS CITY: Naples FIREPLACES STATE: FL DESIGN BUILD SERVICE REPAIR ZIP: 5585 Shirley Street suite D PHONE: Naples,FL 34109 ALT.PHONE (239)300-4950 EMAIL: danearlsonharristc iithiail etini contact@ hotconceptsfireplaces.com PREPARED BY: Dan m®v,®mrae®m.®�aR Rm YfO®�®m�RO�esmo.rm.a..�Na.®®..m0..a.v..w.m,a0va,m�r.s er0a.m..mnam.a��a...�erm...,.i.�®n.a�®es,ecrm,®® Great Room Fireplace FIREPLACE: VENTED:ISOKERN A. Build base as needed to create proper finish height in accordance with plan specifications and elevations. B. Construct Isokern firebox/fireplace structure to manufacture and plan design specifications. Model:42"Magnum C. Install required metal flue venting and termination according to plans and specs D. Build firebox interior using firebrick and refractory mortar E. Grout fire brick joints using mortar. Fire Brick Pattern:Herringbone 2"x 9" Fire Brick color:Tan,Charcoal or Red (physical samples available) Fire Brick Mortar color:Gray,Charcoal or white h +�`' '�'�''^"�4.4 $ 4i 4 Y 3 ,9 fi,"".A;ler4444'°141401041,ArtAu..4q.. 1- i-fe<7,-- , ,. ' ,,:,», ." $6954.00 Additional Requirements..To be provided by separate contractor at additional cost not included in this proposal Gas line to fireplace location Electrical to fireplace control location _O®Y...il1....W®!Q®01Y.R0—®®.OYbI.b......Y1l OYi®®—®Y6B.[®0r®I®®tR1Y../OIYCY!®®Y.O..Ai»Sas—d.Aif...l...r...■ WORK DONE MEETS OR EXCEEDS ALL STATE,NATIONAL.AND NFPA CODES ,TOTALS 6954.00 AUTHORIZED SIGNATURE: "' ^" REQUIRED DEPOSIT $ 3477.00 TIIISPROPOSAL MAY BE WITHDRAWN IF NOT ACCEPTED WITIHIN 30 DAYS BALANCE $ .3477.00 PAYMENT TO BE AS FOLLOWS:50%ON ACCEPTANCE BALANCE ON COMPLETION OR AS STATED IN"1 USTOMER AL cErERNcE m,REERirEr ON REVERSE SIDE F[t ACCEPTANCE OF CONTRACT 1 i', I AUTHORIZE THE ABOVE DESCRIBED'y1ORH UNDER THE TXRMO'CON NE IN"CUSTOMER ACCEPTANCE AGREEMENT" (' 1 / .- SCHEDULED START DATE 1. SIGNATUR ` � L •- , DATE:® 4e/ J ' EI2 (si, ' �CONTRpCT Page- l of I --IF "� "' 'm' DATE: 06/18/2013 SUBMITTED TO: Carlson Harris c/o Dan Whewell SHOTCONCEPTS CEPTS ADDRESS: Stuckey Residence-3005 Pt.Charles Dr. t/j j 1,e CITY: Naples FIREPLACES STATE: EL DESIGN BUILD SERVICE REPAIR ZIP: 5585 Shirley Street suite D PHONE: 239-250-9256 Naples,FL 34109 ALT.PHONE (239)300-4950 EMAIL: tlallcar1snl1auit a t,nl I]LLoin contact @hotconceptsfireplaces.com PREPARED BY: Dan irWele>®®ee q ei®®MI a We l®On MOIR=NM IMMOMNI m M ism 0eaaa ales CM e:MN MI km saRi MI WaM1A IMa ea no sw ow ma r mmecaw en mom=sma aria Ye am Al mea ism on dtl0� Lanai Fireplace FIREPLACE: ISOKERN: VENTED:OUTDOOR,See-Thru A. Build base as needed to create proper finish height in,accordance with plan specifications and elevations. B. Construct Isokern outdoor firebox/fireplace structure with see-thru two sided opening to manufacture and plan design specifications. Model:42"Standard See-Thru C. Install required metal flue venting and termination according to plans and specs D. Build firebox interior using firebrick and refractory mortar E. Grout fire brick joints using mortar. Fire Brick Pattern:Running Bond Fire Brick color:Tan,Charcoal or Red(physical samples available) Fire Brick Mortar color:Gray,Charcoal or white Ilgill ' 4 S - 3` s,* e e 55882.00 Additional Requirements:To be provided by separate contractor at additional cost not included,in this proposal Gas line to fireplace location Electrical to fireplace control location �lll___ir__al.. rail•alaAaaas®wse.aleal...ews®e iaarlmlla aat®m®Wnr>•®aenYMllelsa®®®......t.YaesrrrarWet. WORK DONE MEETS OR EXCEEDS ALL STATE,NATIONAL,AND NFPA CODES TOTAL $ 5882.00 AUTHORIZED SIGNATURE: '�' - REQUIRED DEPOSIT $ 2941.00 fins PROCOSAL MAY BE WITI1DRAWN IF NOT ACCEPTED IVITIIIN 30 DAy's BALANCE.$ 2941.00 PAYMENT TO BE AS FOLLOWS:50%ON ACCEPTANCE BALANCE ON COMPLETION OR AS STATED IN C1 STOMER ACLIPTANCB AOREEMENrONREVERSE SIDE, ;'` ACCEPTANCE OF CONTRACT 1 i; I AUTHORIZE THE ABOVE DESCRIBE RR UNDER THE TERM& DITIONS I USTOMER.ACCEPTANCE.AOREEMENT. I '' / I' SCHEDULED START DATE i SIGNATUR -. , - DATE: 2C1 1; £ f3 • a `l QNTRACT; Page- I -of 1 q % DATE: 09/16/2013 �; SUBMITTED TO: Carlson Harris c/o Dan Whewell HHOT 1 '��*� � ADDRESS: Stuckey Residence-305 Ft. Charles Dr. V�Co V4! L�l Jl CITY: Naples FIREPLACES STATE: FL DESIGN BUILD SERVICE REPAIR ZIP: 5450 Shirley Street suite A PHONE: 239-250-9256 Naples,FL 34109 ALT. PHONE (239)300-4950 EMAIL: dancarlsonliarristiitvmai Leon) _ contact @hotconceptsfireplaces.com PREPARED BY: Dan I:R100>Rw10000 V0®00000000iRYO[100 IMO=Si mi®®IYMAN i®®OKmiIOWrni9122i!®0®R•MI PM 1m 0111 YlYt MI i[idl 1110iiBp YAII®11IY OR9®®MO 411111I®.MEMOS®®IR WU FIREPIT: GAS:Burner Assembly and Control Valve Supply and install stainless steel burner support pan,stainless steel burner assembly,and automated control valve and ignition system. Installation according to design and manufacture's specifications. Valve: Fire By.Design AWEIS automated electronic ignition control valve Burner:FPK 24 Round Stainless Steel support pan and 18"multi ring stainless steel burner Media: Lava Stone or Fire Glass(Color TBD) $3564.00 Additional requirements:To be provided by separate contractor not included in this proposal Foundation/poured concrete structure Required shut off valves and gas line to location Electrical requirements for junction box and controls Low voltage wiring from control/transformer box to location _e dli.110®11000i00®Orar 0001111®/100 00 0110 0 010(W01RiIIRMI0!•001101®00aaa1 Rl®ON m01iIIIMI00011111100®M0000 M MEIN M MI NM N0 a 00.01000011..i•00M1 WORK DONE MEETS OR EXCEEDS ALL STATE,NATIONAL AND NFPA CODES TOTAL $ 3546.00 AUTHORIZED SIGNATURE: " -- = _. REQUIRED DEPOSIT $ 1773.00 THIS PROPOSAL MAY BE WIThDRAWN IF NOT ACCEPTED WITHIN.30 DAPS BALANCE $ 1773.00 PAYMENT TO BE AS FOLLOWS:50%ON ACCEPTANCE BALANCE ON COMPLETION OR AS SEATED N^CUSTOMER ACCEPTANCE AGRETME`T OS REVERSE SIDE `' ACCEPTANCE OF CONTRACT r: I AUTHORIZE THE ABOVE bESCRIDES.WORK UNDER THE TERMS b.CORD • IN`CUSTOMER ACCEPTANCE AGREEMENT'. I '' 9 t;' SCHEDULED START DATE r � SIGNATUR ,------7.-- .. DATE: j � I y �I1.1 Font, IN-9 Request for Taxpayer Give Form to the !Rev Auousf 2013; Identification Number and Certification requester-Do not Department of the Treasury send to the IRS. Internal Revenue Serene I.lamo as shown on your IN:ur'te lax return) Hot Concepts Fireplaces-LLC __ _ Bislness came/rhs•egardedenlfty name if dJi„wd from above , g'I---- a •CnEZrA 1GPrOUnat=_box for fcdern tax ch s,rcation- - -..�.. �� ..._.- Exemption;Isec rostructionlli r ❑Indntdu< / I proprietor ❑ Gnrporatton L C Corpn&a N. �j annt'si-yr ❑Trust/estate C n g Exempt payee code iif any( f u ra Unwed liability eompa^w Enter Rte Par classific.at'cm IC,C eorperalr r.S=S coginration.P nartde,hip)iv, D o„ Exemption FA rerlurt; E z ` cndv(1 any) 'F C Q. u ❑.Other(see inslrnr:UOns)h Artdns (number,street,and apt a suite no.( Requester's namr.andaddresc(optonal) ca n 5450 Shirley St Suite A _, City,state,and ZIP code o Cl) Naples,FL 34109 _ _ .. ...... _ti,__ List account number(s)here(optional) Part1x. Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the Na" me"line social security number --`1 to avoid backup withholding.For individuals,this is your social security number(SSN)-However,for a resident seen,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other TIN on page 3, Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose I Employer identification number number to enter, 1 Part II Certification t Under penalties of perjury.I certify that: 9 The number shown on this form is my correct taxpayer identification number for I am waiting for a number In be clued to me),arid 2. I ant not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Sen'ice(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)1lw IRS has notified me that I am no longer subject to backup withholding,and 3, I am a U.S.citizen or other U.S.person(defined below),and 4.The FATCA code(s)entered on this form(if any)indicating that tam exempt from FATCA reporting is correct. Certification instructions.You must,cross out item 2 above If you have been notified by the IRS that you are currently subject to backup Withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply-For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(iRA),and generally,payments other than interest and dividends;you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign Signature of r Here U.S-person► \ �'1 C Date I ( 1 1 General Instructions withholding tax on foreign partners`share of effectively connected income;and SeCGOnaeierence5 are to the Internal Revenue Code unless othorwlse notetl. 4-Certify.that FATCA code(s)endured on this form(if any)indicating that you are exempt morn the FATCA reporting,Incorrect. Future developments,The IRS has created a page on IRS.gov for information about Form W-9.at invw.its:govlw8.Information about any future developments Note.It you are a U.S.person and a requester requester's you a form other Man Form W-2 to request ourTW, t affecting Form W-9(such as legislation enacted after we release il)will be posted net your you mss!use the requester's form d it Is substantially on that page. similar to 1hls;Form W-9. Definition of a U.S,person.For federal tax purpose-c,you are considered a U.S. Purpose of Form person if you are: A person wrio is required to hie an inlonnatton return with the IRS must obtain your •An individual who is a US,duzenort).S.residentarien. correct taxpayer identification number(TIN)to report,for example,income paid.to •A partnership,corporation;company;or association created or organized in the you payments made to you in settlement of payment card and third party network United States or under the laws of the United States, I transactions.real estate transactions,mortgage interest you paid,acquisition or •Art estate(other than a foreign estate),or abandonment of secured property,cancellation of debt,or contributions you made man IRA •A domestic trust tar defined in Regulations section 301:7701-7), Use Form W-9 only It you are a U.S,person(including aresident alien);to Special rules for partnerships.Partnerships that conduct a trade or business.in when the United States are generally required to pay a withholding tea under section provide your correct 1114 to the person requesting it(the requester)and applicable;to 1441;on any foreign partners'share of effectively concocted taxable income from such busi I.Certify that the TIN you are giving is correct or you are waiting for a numb.. Hess Further,In cenarn cases whew a Foot W-9 has not been received, to be issued). the rules under section 1446 require aportnershtp to presume that it partner t5 a • foreign person;and pay the section 1 146 witnhotding tax.Therefore,If you are a 2 Certify that you are not subject to backup withholding„or U.S.person that is a partner in a partnership conducting a trade or business rn the United Stator,provide Form UJ 3.Claim exemption front backup withholding if you are a U.S.exempt payee.If 9 to the partnership to establish your U.S.status aoprCable,you are also certifying that as a U.S.person,your allocable share of and avoid suction 7446 withholding on your sham of partnership income any partnership income from a U.S.trade or business is not subject to the Cat No.t0231X Form W-9(Rev.6-7011) EIS- _ • A;c Q® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD1YYYY) L......----- 10/30/2013 I 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 poiicy(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 CONTACT Certificate Team____, _ Acentria, Inc.-Ft.Myers Office PHONE`" FAx 4091 Colonial Blvd tA1C.No.Ern239-939-1010 1Vic..Nei:239-939-7172 E-MAIL. Fort Myers FL 33966 ADDRESS:CedlficaieSQti>Bshayir.com _ .._.. „. ,� —__ INSURER(S)AFFORDING COVERAGE- ". _..._� -_ NAIC:p _ INSURER A:OHIO Casually Insurance Company_ ... /•0 INSURED INSURER B:TraveJe s Pr_ o,_nerty Casualty InsUran,,_ C• •. Hot Concepts Fireplaces LLC INSURER C:Nor h Pointe Insurance Company_�"".. _,_'774Q 5450 Shirley Street Suite A INSURER D Naples FL 34109 --- ______.._ __m ......- INSURER E: COVERAGES CERTIFICATE NUMBER:715173632 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 WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE,ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD SUBR POLICY EFF I POLICY EXP _...__ LTR I DM TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDO lYYYY) tMMIDD/YYW1. LIMITS C GENERAL.LIABILITY 3093002700 11/2/2013 11/212014: EACH OCCURRENCE 51000000 DAMAGE TO X COMMERCIAL:GENERAL LIABILITY PREMISES Ea occurrence) 5100000 _ T CLAIMS-MADE [x I OCCUR MED EXP.(Any one person) 55000 PERSONAL IL ADV INJURY $1000000 ■ GENERAL AGGREGATE 52000000 GEN'L AGGREGATE UMIT APPLIES PER, PRODUCTS.-COMP/OP AGG $2000000 I POLICY 7 JE d I LILOC I $ B AUTOMOBILE LIABILITY CUMUINEU 51Nt,LE LIMIT BA48243446 2l23/20t3 212320]4 IEa academl 51,0017,000 , X ANY AUTO BODILY INJURY(Per person) 5 ALL AUTOS NOD SCHEDULED BODILY INJURY(Per accident) S y NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) 5 S A X UMBRELLAUAB _OCCUR EU055053844 2/23/2013 2/23/2014 EACH OCCURRENCE :51,000,000 EXCESS MB CLAIMS-MADE AGGREGATE S OED I RETENTIONS 's :.. WORKERS:COMPENSATION WC;STATU- OTH-. AND EMPLOYERS'LIABILITY Y N •: I ANY PROPRIETORIPARTNER/EXECUTIVE I i I .NIA EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYE S It yes,describe under. DESCRIPTION OF OPERATIONS below .E.L DISEASE-POLICY LIMIT I S 1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Add,tlenal Remarks Schedule,It more spree IS required) Workers Compensation Exemption has been filed for Daniel J.Haugen i i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CARLSON HARRIS ACCORDANCE WITH THE POLICY PROVISIONS. 6017 PINE RIDGE RD#240 NAPLES FL. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 6/6 02-20-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS, COMPENSATION * * CERTIFICATE OF ELECTION TO RE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 02/2012012 EXPIRATION DATE: 02/19/2014 PERSON: HAUGEN DANIEL J FEIN: 378783368 BUSINESS NAME AND ADDRESS: • HOT CONCEPTS FIREPLACES LLC 1472 BIRDIE DR NAPLES FL 34120 SCOPES OF BUSINESS OR TRADE: 1- FIREPLACE INSTALL IMPONTANT: Pursuant to Chaplet 440 001141. f.S„ on Alike! di a torpor align who elects exemption liom this thnpler by"tiling p certificate of election under this rte cllna may not tertian benefit,or CoinsenSstinn under Ibis the pier. Putsunnl to-Chaplet.440.051121, F.S. Cavil It stns 01 electron In be .apply'only within 101 scope of the.business or Ind. listed on the notice of etecI+on to be "erupt. Pursuant to Chapter 440:051171; F.S,, Notices of election to be *-abate! end terriliceles of election to be *tempt the Ii. he sublet! Ia revougon N.a1 say lime eller the tiling al the notice m the issuance of the cerlillcate, the poison pooled on the notice or certificate no longer meets the.requirements_ol Infs section lot 9asuaace of a cert111nie. The department shalt revoke a cer1111tete *r soy lime for IsRire ol the person named on the certilltete to weal the t.g.iremenr of this Dolls,. QUESTIONS? (8501 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES -'I F DIVISION OF WORKERS'COMPENSATION Pursuant to Chapter 440.051191,. F.S., an officer of.a corporation who CONSTRUCTION INDUSTRY , *l elects exemption from this chapter by fling a certif icate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA It L. under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAWS i D chapter.. EFFECTIVE: 02/20/2012 EXPIRATION DATE( 02/12/2014 H Pursuant to Chapter 440.05(121, F.S., Certificates of election to be PERSON: DANIEL J HAUGEN exempt_ apply only within the scope of the business or trade listed on FEIN: 37 878 33E38 E the notice of election to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113h F.S., Notices of election to be exempt HOT CONCEPTS FIPEPLACES NC and certificates of election to be exempt shall be subject. to revocation 1477 DIROIE OR if, at any time after the filing of the notice or the issuance of the NAPLES, Ft Sa120 certificate, the person named On the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this • I- FIREPLACE INSTAL! section. QUESTIONS? (850} 413-1609 CUT HERE Carry bottom portion on the job, keep upper portion for your records, MC-252 CERTIFICATE OF ELECTION TO BE EXEMP1 REVISED 01-11 ` t ; i +: I I ',..'4'IA) • i ,.'i:.,',4,?,. ,, . 1 t \ g' - ((!(, ){ t .•1 4 ' ti� I k '. k ..,..,;51..1 F, 4 , ..11.'1".rs a '. .... r ♦ �/ )i - J�. ! s . �' ash"., },d yi s '. a § ,.:- n� t r1�,;rf �bk,-!`?.i.^e- t +4tx•t Jx.� tT, R'- ya;r f,.. 12 {: t is 1,''aa r , r i a" 't k' 'ba}(°�Z'� . ���q' • r v CY•P ,' ..4�"k. . - f''' P• 3 .8- _ 4. , • r'.. Y.n 1!' ••1S t. s,y • .4 r.t'6Z •( -pri, *` a' f ".•) •i : }° { W 'S .. ,.4 t � y,,.� rt.•%Z a 4.: ^s t�,°�; •h.f�'s•4v r.•�. t a k ".r'J�R-•.` � � r t + 7 e . , ^�., yl};:.,ie F:nN..i n n.41' .y n•r i ! a . r ' . ��= xJ i " e t SC 6t e t F � try ,' 1�# , ,`t ,fi o 4 .4 ''''''*;':'.4. ;� r � , '� � : � t.ir' , t i� r t. 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W . , L ... :5: • t_ + 1* • X1 ... • £ZI - Florida Department of Agriculture and Consumer Services Remit Payment Online at: ..,e-,201.90°f Division of Consumer Services wwwfl-ag-online.com 4°4 "/c�"�' Bureau of Liquefied Petroleum Gas Inspection -or- P?° l f Check or Money Order ljj payable to FDACS and remit with LI 04 ,,,r' � DEALER IN APPLIANCES AND EQUIPMENT form to: FOR USE OF LIQUEFIED PETROLEUM GAS (0602) FDACS ADAM H.PUTNAM LICENSE APPLICATION P.O Box 6700 Tallahassee„Florida 32314-6700 COMMISSIONER Sections 527.01(12)and 527.02,Florida Statutes Rule 5F-11.004,Florida Administrative Code License Application Fee: $75 fr m 7/1/13,,x3/31/14 $Serum 411114 09/31114 $:215f66-00714—3131115 No INSTRUCTIONS TO APPLY for the Dealer in Appliances and Equipment for Use of Liquefied Petroleum Gas (0602) license, fill this form out completely (PRINT OR TYPE) and return it with all attachments, including the license application fee, to the Bureau of LP Gas Inspection at the address in the upper right-hand corner. (See above dates for correct fee as required by s. 527.02, F.S.) SCOPE OF LICENSE: This license provides for the sale or lease of apparatus,appliances and equipment for the use of LP gas. This includes, but is not limited to, propane tanks, grills, ranges, ovens, water heaters, refrigerators, floor buffers, and similar equipment. NOTE: As a dealer in appliances and equipment for use of LP gas, it is your responsibility to assure your customers of a safe product by selling only those parts, appliances, or equipment that have been approved by a nationally recognized testing laboratory, pursuant to Chapter 527, F.S., and Rule 5F-11.001, F.A.C. BUSINESS NAME (NAME TO BE PRINTED ON LICENSE): Physical Address of Business(Address of location to be licensed): City County State Zip Code Telephone: Fax: Email Address(if any): Area Code( ) Area Code( ) COMPANY NAME (OWNER OF BUSINESS TO BE LICENSED): Company Mailing Address: City County State Zip Code Telephone: Fax: Email Address(if any): Area Code( ) Area Code( ) Questions should be directed to: The Bureau of LP Gas Inspection(850)921-1600 Org Code:42 10 11 01 000 EO:A2 Object Code:002102 £ ZZ FDACS-03513 Rev.02/14 Page 1 of 2 Chapter 527 Section 01 - 2012 Florida Statutes - The Florida Senate Page 1 of 2 The Florida Senate 2012 Florida Statutes Title XXXIII Chapter 527 SECTION 01 REGULATION OF TRADE, SALE OF LIQUEFIED PETROLEUM Definitions. COMMERCE,INVESTMENTS, GAS AND SOLICITATIONS Entire Chapter 527.01 Definitions.—As used in this chapter: (1) "Liquefied petroleum gas" means any material which is composed predominantly of any of the following hydrocarbons,or mixtures of the same:propane,propylene,butanes(normal butane or isobutane),and butylenes. (2) "Person"means any individual,firm,partnership,corporation,company,association,organization, or cooperative. (3) "Ultimate consumer" means the person last purchasing liquefied petroleum gas in its liquid or vapor state industrial,commercial,or domestic use. (4) "Department" means the Department of Agriculture and Consumer Services. (5) "Qualifier"means any person who has passed a competency examination administered by the department is employed by a licensed business in one or more of the following classifications: (a) Category I liquefied petroleum gas dealer. (b) Category II liquefied petroleum gas dispenser. (c) LP gas installer. (d) Specialty installer. (e) Requalifier of cylinders. (f) Fabricator,repairer,and tester of vehicles and cargo tanks. (g) Category IV liquefied petroleum gas dispensing unit operator and recreational vehicle servicer. (h) Category V liquefied petroleum gases dealer for industrial uses only. (6) "Category I liquefied petroleum gas dealer" means any person selling or offering to sell by delivery or at a stationary location any liquefied petroleum gas to the ultimate consumer for industrial,commercial,or domestic u any person leasing or offering to lease, or exchanging or offering to exchange,any apparatus,appliances,and equipment for the use of liquefied petroleum gas;any person installing,servicing,altering,or modifying apparatu piping,tubing, appliances,and equipment for the use of liquefied petroleum or natural gas;any person installing carburetion equipment;or any person requalifying cylinders. (7) "Category II liquefied petroleum gas dispenser" means any person engaging in the business of operating a liquefied petroleum gas dispensing unit for the purpose of serving liquid products to the ultimate consumer for industrial, commercial,or domestic use,and selling or offering to sell, or leasing or offering to lease,apparatus, appliances,and equipment for the use of liquefied petroleum gas, including maintaining a cylinder storage rack at licensed business location for the purpose of storing cylinders filled by the licensed business for sale or use at a lat, date. (8) "Category III liquefied petroleum gas cylinder exchange operator" means any person operating a storage facility used for the purpose of storing filled propane cylinders of not more than 43.5 pounds propane capacity or pounds water capacity,while awaiting sale to the ultimate consumer,or a facility used for the storage of empty or filled containers which have been offered for exchange. (9) "Category IV liquefied petroleum gas dispenser and recreational vehicle servicer" means any person enga in the business of operating a liquefied petroleum gas dispensing unit for the purpose of serving liquid product to £13 httn•//unznacflcanate cTnv/T awc/Ctat„tac/21112/cY7 Al 2hiion1 A Chapter 527 Section 01 - 2012 Florida Statutes - The Florida Senate Page 2 of 2 ultimate consumer for industrial,commercial, or domestic use, and selling or offering to sell, or leasing or offering lease,apparatus,appliances, and equipment for the use of liquefied petroleum gas, and whose services include the installation,service, or repair of recreational vehicle liquefied petroleum gas appliances and equipment. (10) "LP gas installer"means any person who is engaged in the liquefied petroleum gas business and whose services include the installation,servicing,altering,or modifying of apparatus,piping,tubing,tanks, and equipmE for the use of liquefied petroleum or natural gas and selling or offering to sell, or leasing or offering to lease, apparatus,appliances,and equipment for the use of liquefied petroleum or natural gas. (11) "Specialty installer"means any person involved in the installation, service,or repair of liquefied petroleui natural gas appliances and equipment,and selling or offering to sell,or leasing or offering to lease,apparatus, appliances, and equipment for the use of liquefied petroleum gas,whose activities are limited to specific types of appliances and equipment as designated by department rule. (12) "Dealer in appliances and equipment for use of liquefied petroleum gas" means any person selling or offe to sell,or leasing or offering to lease, apparatus,appliances, and equipment for the use of liquefied petroleum gas. (13) "Manufacturer of liquefied petroleum gas appliances and equipment" means any person in this state manufacturing and offering for sale or selling tanks,cylinders,or other containers and necessary appurtenances fc use in the storage,transportation,or delivery of such gas to the ultimate consumer,or manufacturing and offering sale or selling apparatus, appliances,and equipment for the use of liquefied petroleum gas to the ultimate consum (14) "Wholesaler" means any person,as defined by subsection(2),selling or offering to sell any liquefied petroleum gas for industrial,commercial,or domestic use to any person except the ultimate consumer. (15) "Requalifier of cylinders" means any person involved in the retesting,repair, qualifying, or requalifying c liquefied petroleum gas tanks or cylinders manufactured under specifications of the United States Department of Transportation or former Interstate Commerce Commission. (16) "Fabricator,repairer,and tester of vehicles and cargo tanks" means any person involved in the hydrostati testing, fabrication,repair, or requalifying of any motor vehicles or cargo tanks used for the transportation of liquE petroleum gases,when such tanks are permanently attached to or forming a part of the motor vehicle. (17) "Recreational vehicle"means a motor vehicle designed to provide temporary living quarters for recreatioi camping,or travel use,which has its own propulsion or is mounted on or towed by another motor vehicle. (18) "Pipeline system operator" means any person who owns or operates a liquefied petroleum gas pipeline system that is used to transmit liquefied petroleum gas from a common source to the ultimate customer and that serves 10 or more customers. (19) "Category V liquefied petroleum gases dealer for industrial uses only" means any person engaged in the business of filling,selling,and transporting liquefied petroleum gas containers for use in welding,forklifts, or othc industrial applications. History.-s.1,ch.24302,1947;s.11,ch.25035,1949;s.1,ch.57-174;s.1,ch.61-158;ss.13,35,ch.69-106;s.202,ch.71-377;s.3,ch.76-161 1,ch.77-457;ss.1,6,ch.80-390;ss.1,18,19,ch.81-175;ss.2,3,ch.81-318;ss.1,2,ch.82-6;s.124,ch.83-218;s.1,ch.86-69;ss.2,3,ch.87-39 ch.90-215;s.4,ch.91-429;s.1,ch.92-324;s.7,ch.93-142;ss.1,7,ch.93-248;s.1,ch.2000-269;s.23,ch.2001-63;s.1,di.2003-132. Note.-Former s.526.12. Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chamb, should be consulted for official purposes. Copyright © 2000- 2014 State of Florida. z I http://www.flsenate.gov/Laws/Statutes/2012/527.01 3/27/2014 ORDINANCE NO.2006-46 AN ORDINANCE AMENDING COLLIER COUNTY ORDINANCE NO. 90-105, AS AMENDED, THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD ORDINANCE;AMENDING SECTION 1.3.1 OWNER-BUILDERS,TO INCREASE THE MAXIMUM EXPENDITURE LIMIT TO $75,000, TO ALLOW FOR THE REPAIR OR REPLACEMENT OE_.CERTAIN ROOF SHINGLES AND TO PROVIDE FOR A DISCLOSURE STATEMENT; AMENDING SECTION 1.3.2 PUBLIC WORKS, EXEMPTING CERTAIN EMPLOYEES OF GOVERNMENTAL AGENCIES FROM THE REQUIREMENTS OF THIS ORDINANCE; AMENDING SECTIONS 1.6.1.1 THROUGH 1.63,48, REMOVING THE SPECIFIC TIME REQUIREMENTS FOR TESTING AND ADDING THAT TESTS BE APPROVED ACCORDING TO SECTION 2.6 OF THIS ORDINANCE; FURTHER AMENDING SECTION 1.6.2.11 STRIKING THE EXCLUSION OF LIQUID PETROLEUM GASES; FURTHER AMENDING SECTION 1.6.3.25, TO ADD REQUIREMENTS FOR NEW APPLICANTS FOR THIS LICENSE; FURTHR AMENDING SECTION 1.6.3.48 TO ADD REQUIREMENTS FOR NEW APPLICANTS FOR THIS LICENSE; AMENDING SECTION 2.5.4.6 ADDING MISSING LANGUAGE AT THE END OF THE PARAGRAPH;AMENDING SECTION 2.6 TO REFLECT THE RECOGNITION OF ADDITIONAL TESTING AGENCIES; AMENDING SECTION 2.11.2 ADDRESSING THE ISSUANCE OF TEMPORARY • LICENSES; ADDING SECTION 4.1.8.2,ADDRESSING FINANCIAL HARM CAUSED BY CONTRACTORS CAUSING CUSTOMERS TO SEEK A VARIANCE OR ADMINISTRATIVE REMEDY; AMENDING SECTION 43.2 ELIMINATING THE ADMINISTRATIVE FEE FOR COMPLAINANTS; AMENDING SECTION 4.3.5.1.(t), INCREASING MAXIMUM FINES TO TEN THOUSAND DOLLARS; PROVIDING FOR CONFLICT AND SEVERABILITY; PROVIDING FOR INCLUSION INTO THE CODE OF LAWS AND ORDINANCES; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS,certain provisions of this Ordinance are being amended at the discretion of the Board of County Commissions upon recommendations from staff, area contractors an I;the" general public. _{ NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF .COUNTY. COMMISSIONERS OF COLLIER COUNTY,FLORIDA that: - SECTION ONE: ORDINANCE NO. 90-105, AS AMENDED, IS HEREBY AMENDED AS FOLLOWS: PART ONE: CERTIFICATES OF COMPETENCY REQUIRED, 1.1. Unlawful to Contract without a Certificate of Competency. It shall be unlawful for any person,firm,partnership,corporation or other legal entity to: engage in any construction contracting business, advertise or represent himself/herself or a business organization as available to engage in any construction contracting business,or act in the capacity of a contractor or subcontractor for any of the trades listed in Section 1.6 of this Ordinance, within the unincorporated area of Collier County and the incorporated area within the boundaries of the City of Naples and within the City of Marco Island, without having first made application for and having been issued a current and valid Collier County/City Certificate of Competency or an applicable State Certified License. Nothing herein shall be construed to mean that there cannot be employees in a trade who are not qualified or certified within the definitions herein set forth if Words underlined are added;words sires-thr-eugh are deleted. such employees are employed by a licensed contractor who exercises supervision and control over said employees. Indicia of an employment relationship shall include the employer's regular payment of wages and compensation, RCA deductions, tax withholding and provision of Workers'Compensation to the employees,all as prescribed by law. 1.2. Building Permits. 1.2.1. No building permit shall be issued for the construction,alteration,or repair of any structure unless the applicant for the permit possesses a current Collier County/City Certificate of Competency, an applicable State Certified License, or is exempt from the operation of this Ordinance. 1.2.2. It shall be unlawful for any owner-builder to procure a building permit and to use said permit with the intent to aid or abet an unlicensed contractor to perform the permitted construction, alteration, or repair. Such conduct shall be punishable as a violation of this Ordinance and the permit and inspection shall be considered invalid for that portion of the construction related to the violation. 1.3. Exemptions. 1.3.1. Owner-Builders. The provisions of this Ordinance shall not apply to owners of property when acting as their own contractor and providing :. -:. :=• •••:- _ - _ . :. .-:• -• • . . . direct, onsite supervision themselves of all work not performed by licensed contractors: (a) When building or improving farm outbuildings or one-family or two-family residences on such property for the occupancy or use of such owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to exceed$75,000, on such property for the occupancy or use of such owners and not offered for sale or lease. In an action 2 Words slruekthr-eagli are deleted;words underlined are added. a-40 charges adopted by Resolution pursuant to Section 2.1.5 herein, and must submit an entire new application. If, as of the date of receipt by the County of said new application, three(3) years have passed since the date of his/her most recent examination that the individual passed to acquire the former Certificate,that individual must pass all then applicable testing requirements. If the request is to reactivate a dormant certificate, the re-testing requirement can be waived by staff if the applicant proves that he/she has been active in the trade in another jurisdiction,or has been active as an inspector or investigator in the trade,or for other valid reason that would render such re-testing superfluous. 1.5. Contractors'Identification Required on all Advertising Mediums. 1.5.1. All contractors licensed under the provisions of this Ordinance shall be required to firmly affix and/or to display the qualifier's Certificate of Competency Number and the "Doing Business As"Name on all advertising mediums used by the contractor,including but not limited to, contracts, brochures, business cards and vehicles used in their trade or business. The minimum height of each number or letter affixed to and displayed on vehicles shall be two (2) inches. 1.6. Definitions and Contractor Qualifications. 1.6.1. Contractor means the person who is qualified for and responsible for the entire project contracted for and,except for those herein exempted,the person who,for compensation, undertakes to, or submits a bid to, or does himself or by others, any or all of the following construct, repair, alter, remodel, add to, demolish, subtract from, or improve any building or structure, including related improvements to real estate, for others, or for resale to others, as hereinafter defined in Sections 1.6.1 through 1.6.3 of this Ordinance. 1.6.1.1. General Contractor requires forty-eight (48) months experience with a passing grade on ft-6446)46W an approved test and a twe-E4)-#tetif business and law test and means a contractor whose services are unlimited as to the type of work which he/she may do,except as provided in this Ordinance or in the Florida Statutes. NOTE: Also see Sect. 1.6.2. 1.6.1.2. Building Contractor requires forty-eight(48)months experience with a passing grade on a-six-(6)-ho an approved test and a t-W64-2-)-}te+if business and law test and means a contractor whose services are limited to construction of commercial buildings and single-dwelling or multiple-dwelling residential buildings, which commercial or residential buildings do not exceed three stories in height, and accessory use structures in connection therewith or a contractor whose services are limited to remodeling,repair,or improvement of any size building if the services do not affect the structural members of the building. NOTE: Also see Sect. 1.6.2. E Words arc deleted;words underlined are added. C�� 1.6.1.3. Residential Contractor requires forty-eight (48) months experience with a passing grade on a six (6) hour an approved test and a two (2) hour business and law test and means a contractor whose services are limited to construction, remodeling, repair, or improvement of one-family, two-family, or three-family residences not exceeding two stories in height and accessory use structures in connection therewith. NOTE: Also see Sect. 1.6.2. 1.6.1.4. Contractor qualifications for practice and restrictions. A general, building, or residential contractor shall not be required to subcontract the installation, or repair made under warranty, of wood shingles, wood shakes, asphalt or fiberglass shingle roofing materials on a new building of his own construction. Further, a general contractor on new site development work, site redevelopment work, mobile home parks, and commercial properties, shall not be required to subcontract the construction of the main sanitary sewer collection system, the storm water collection system, and the water distribution system, not including the continuation of utility lines from the mains to the buildings. Further, as to mobile home parks, the general contractor shall not be required to subcontract the continuation of utility lines from the mains, and the continuations are to be considered a part of the main sewer collection and main water distribution systems. However,no general,building or residential contractor state certified after 1973, shall act as, hold himself/herself out to be, or advertise himself/herself to be a roofing contractor unless he/she is certified or registered as a roofing contractor. 1.6.1.5. A general, building, or residential contractor, except as otherwise provided in this part, shall be responsible for any construction or alteration of a structural component of a building or structure, and any certified general contractor or certified underground utility and excavation contractor may perform clearing and grubbing, grading, excavation, and other site work for any construction project in the state. Any certified building contractor or certified residential contractor may perform clearing and grubbing, grading, excavation, and other site work for any construction project in this state,limited to the lot on which any specific building is located. 1.6.1.6. A general contractor shall not be required to subcontract structural swimming pool work. 1.6.2. Subcontracting; Subcontractors. A contractor shall subcontract the electrical, mechanical, plumbing, roofing, sheet metal, swimming pool, and air conditioning work for which a local examination for a Certificate of Competency or a license is required, unless such contractor holds a Certificate of Competency or license of the respective trade category, as required by the appropriate local authority. 1.6.2.1. Sheet Metal Contractor requires twenty-four (24) months experience and a passing grade on a three{3}.hour an approved test and a assin grade on a P g�' two-(-2}-hem business Words strus#-Elareugia are deleted;words underlined arc added. 1./� COP. Report Title: Code Case Details Date: 3/27/2014 9:12:33 AM Case Number: ceu120130007459 z Case Number: CEUL20130007459 Status: Closed Case Type: Unlicensed Date &Time Entered: 5/21/2013 11:40:03 AM Priority: Normal Entered By: webAnonymousUser Inspector: ReggieSmith Case Disposition: Unpaid Jurisdiction: Contractor's Licensing Origin: Public Portal Detail Description: UNLICENSED ADVERTISEMENT, HAUGEN, DANIEL,CITATION 7643, $300.00 "Unlicensed installation of masonry fireplaces and fire pits"WEB PORTAL COMPLAINT Location Comments: Hot Concepts fire places 5585 Shirley St Naples Fl. 239/300/4950 ig f , y nt ,i k t Bar l._ r r x n a MMa 3 Violator Haugen, Daniel eZq Business Management& Budget Office 1 Code Case Details Execution Date 3/27/2014 9:12:33 AM F�a§c��'a^ `I .,.r ara -` - r lam .� k E e .e ,rXFS€4Ma - S. «, F4: h e _ _ � . M 4 as g 4, $0244-1,444,4444444 Desc Assigned Required Completed Outcome Comments Preliminary Investigation ReggieSmith 5/21/2013 5/24/2013 Needs 05-24-13 RECEIVED CASE AND Investigatio RESEARCHED. FOUND WEBSITE n CONTAINING UNLICENSED ADVERTISING FOR INSTALLATION AND OR CONSTRUCTION OF GAS, ELECTRIC,AND MASONRY FIREPLACES AND CHIMNEYS. NO LICENSING FOUND FOR DANIEL HAUGEN,SOLE PROPRIETOR OF BUSINESS. COMPLAINT SUGGESTS WORK TAKEN PLACE; HOWEVER NO ADDRESS OR CONTACT INFORMATION WAS GIVEN. RS Cont. Investigation ReggieSmith 6/4/2013 6/4/2013 Complete 06-04-13 MADE TELEPHONE CONTACT WITH DANIEL HAUGEN,OWNER OF HOT CONCEPTS;SCHEDULED TO MEET IN OFFICE AT 0900 ON 06-05-13 TO REVIEW CASE AND COMPLAINT. RS Attach Picture(s) ReggieSmith 6/5/2013 6/5/2013 Complete ATTACHED SCANNED CITATION AND WEBSITE VIOLATION PAGE. RS Investigation ReggieSmith 6/5/2013 6/5/2013 Citation 06-05-13 MET WITH DANIEL HAUGEN AND Required ADVISED WEBSITE VIOLATION. ADVISED LICENSING REQUIRED FOR CLAIMED INSTALLATION OF FIREPLACE SERVICES. ADVISED LICENSING AVAILABILITY AND CORRECTION OF WEBSITE UNTIL LICENSING IS IN PLACE. ISSUED CITATION 7643, UNLICENSED ADVERTISEMENT,$300.00; HE SIGNED AND ACCEPTED HIS COPY. RS Issue Citation (Licensing) ReggieSmith 6/5/2013 6/5/2013 Complete ISSUED CITATION 7643, UNLICENSED ADVERTISEMENT,$300.00; HE SIGNED AND ACCEPTED HIS COPY. RS Citation Paid/Contested JenniferBlanc 6/19/2013 6/5/2013 Payment o Received 174ge A pest ��� Q�. x� � a a ? s, 6W s t�a . 4t4A ` �_ i�<.- .. f a :�ca a p'.. ,.. WiN 'rrr W`w.., ,. ....t ,,,,.a.ga. _ _ ills....,_ IO , a A, N:az ', ..,-. Violation Description Status Entered.' Corrected Amount Comments Unlicensed Advertisement Open 6/5/2013 $0 x - Title Reason Result Compliance'' Fine/Day Condition £30 Business Management& Budget Office 2 Hot Concepts Fireplaces Page 1 of 2 Brat Concepts Fireplaces DESIGN-BUILD-INSTALL-SERVICE-REPAIR Hot Concepts Fireplaces Home Services We Of fer Brands We Offer Traditional Fireplaces Modern Fireplaces. Outdoor Fireplaces Ethanol Fireplaces Electnc Fu'eplaces Outdoor kitchens Fireplace Doors CUSTOM Fire Features Fire Pits Testimonais Links A .I Location Contact lis Hot Concepts Fireplaces has over 20 years of fireplace experience.We can service or install any type of fireplace including custom fireplaces.Masonry,isokern,factory,electric, propane,natural gas,ethanol,modern,linear,fire pit,fire bowl,&outdoor fireplaces...we do it all! Serving Naples and surrounding areas. Contact Hot Concepts Fireplaces today at 239-300-4950V to speak with one of our friendly and helpful specialists,or browse our site for more information about our business. 31 httn://hotconceptsfireplaces.com/ 6/5/2013 04 X30©0 75/59 6 4 3 COLLIER COUNT BUILDING REVIEW& PERMITTING CITATION Pursuant to section 489.127.(3)(a),Florida Statues,the undersigned hereby certifies that upon personal investigation,he/she has reasonable and probable grounds to believe that the person whose name appears below,as Issued To,did violate Subsection 489 127(1),Florida Statutes, • and Collier county Contractor's Licensing Ordinance No.97-68(as may be amended from time to time)by committing the violation staled below. • Month 3-041...R.- Day Q ,IYear� Time dLt(� A M Issued To: N v)0 A.q 1,1 G�I,ln Address /V'7a? /V/1'-1 J //// • City q�CPS State Zip 3e,e3 Telephone No. Vehicle Make/Type(if applicable) Year 'Color .'Tag No. Location of Violation y 1 /f44 /X.' 7 OPTIONS. I have been_informed of the violation of which I have been charged and elect the following option(Check one) 1) LI I choose to pay the penalties.of S t on the Citation. 2) [� I choose not to pay the penalty and will requestin writing bycertifed mail or hand • delivery an Administrative Clearing before the Contactor's Licensing Board. Deseti.puun,ofViolation z /lam llateV (atiOn'Observed. eS'o?yJ a) Q Falsely hold self or business organization as a license,certificate holder or registrant; b) El Falsely impersonate a certificate holder or registrant; • • c) (] Present as his ownthe certificate or registration of another; d) o Knowingly give false or forged evidence`to the Board of a member thereof; e) o Use or attempt to use a certificate or registration which has been suspended:or rev ed; f) Engage in the business or act in the capacity of a contractor or advertise self or business organization as available to engage in the business or act l'capacity of a contractor without being dulyregisteied Decertified; g) 0 Operate a business organization engaged in contracting after(60)days following the termination of its only qualifying agent without designating another primary qualifying agent,except as provided in ss 489.119 and 489.1195,Florida Statues; h) ❑ Commence orperform wot'k for tvlui h abuildtng permit is required pursuant to an adopted state mmtntum building code without such permit being in effect or' • t.;. Willfully or deliberately disregard or vio[ate any Collier County Ordinance rclabng to uncertified or unregistyicd'contractors. A permui Or hiisirir.m Organization operating on an inactive.or silnpenrlrrl ificale ea • registration,or operating beyond the:scope of work or geographical scope of the registration,is not duly certified or registered. SIGNATURE(RECIP ) S1GNA1'UR NVESTIGATOR) PRINT(RECIPIENT'S NAME) PRINT 'ESTIGATOR'S NAME) Pursuant to 489.127,Florida Statues,willful refusal to sign end accept this citation constitutes a misdemeanor of the second degree,punishable as provided in section 775.082 or 775.083 Florida Statutes. (SE.F REVERSE FOR INSTRUCTIONS) COLLIER COUNTY CONTRACTORS LICENSE DEPARTMENT • Collier County Payment Slip (LC) Licensing Date: June 05, 2013 Contact: Haugen, Daniel 1472 Birdie Dr Naples, FL 34120 Licensing Issuance Number: FEES: 'Fee Description I Reference Number Amount 'Contractor's Lic. Citation (1st Offense) I CEUL20130007459 I $300.00 £33 Daniel J. Haugen Contest of Citation 8651 Table of Contents El—Hearing Request (provided by Haugen) E2—Copy of Citation (provided by Haugen) E3—Confirmation of Hearing E4 & E5—County Case Detail Report E6 through E10—Contract Documents E11—Site Photo E12—Dealer in Appliances and Equipment for use of LP Gas, License Class Code 0602 E13 & E14—Florida Statute 527.01(12), Dealer in Appliances and Equipment for use of LP Gas E15 & E16—County Ord. 2006-46, as amended, Section 1.1 "Unlawful to without a Certificate of Competency" E17- County Ord. 2006-46, as amended, Section 1.6.1, Contractor Definition E218—County Ord. 2006-46, as amended, Section 1.6.1.3, Residential Contractor Definition E19 through E23—Previous Citation /Case File 3/24/2014 MAR 2 ., 2014 IT BY: To whom it may concern, I Daniel Haugen request an Administrative hearing before the Contractor's Licensing Board, in regards to Citation 08651. Thank you, Daniel Haugen 1 j COLLIER COUNTY GROWTH MANAGEMENT.:DIVISION CITATION . Pursuant to section 409.127.(3)(a):Plotida 3tatutcs;•the undersigned ltet/b lkrdlies that upon ! ..personal investigation,he/she'has reasonableand probable grounds to believe that the person whose . pane appears below as issued to;did.violatesubsection489.127.(1);Florida Statutes;and the Collier County Contractor's Licensing Ordinance No,206.46(as may,be amended)by committing the violation stated below. Month r[ Da +/ Year Thiie !pM q 1 t Issued To U J l i Lf ti: Address ° () r.1 34.1.1/ l I. City 9f iy, f State t- i rYTatr u, ntGTyp ,, !- I 9 'i� e h a No I Date,f-,_nit Race Sex Hetght i Vehicle Make/lype(if applicable), rear lorf Tag No I Location of Violation j } ((,� t OP I NS . i 1 have`been ibforined'of the'violation for which I'have been charged and elect the' li following option(Check one) ',;,{r 6 i i 1) ❑ I choose to pay the penalty of$4.€/,!( , . 2)'j I choose not to pay the penalty,and will request in writing by certifi .mail or hand . i delivery an Administrative Hearing before the Contractor's Licensi g Bard. _ t Descn,Pt on of Violation F .,sr a ' ate V'latto ®bse YYe. if 4r �., R ay.❑ Falsely hold'e i u o t 'cen'�'�ee eettt ca "holder or € I registrant ,-' r, 1 : }� (4s, t _ i I.. b)'❑'Falsely iinpersona .a cert to fib der r g s : ,, ,.. i c) ❑ Present as his/her own the certificate or registration of another; ' d) ii Knowingly give false nr fnrged'evidence to the Board or a member thereof 1 e) ❑ Use or attempt tanse.a certificate or registration which.has been suspended or t ©yoked l) Engage td UAe buslrte4s utriact to llit;4apat tty of tr t,onliat,tur or advettise self or business organization as available to ,m enga e thefbusmess or act in the capacity of a contractor'withouf being`duly r gistered'or certified s g) ❑ Operate a besiness`organization engaged in conlraotu g after'(60)days; x I h)❑ Commence or perfonri ii tt&for which-a biiiidin permit is regnited piiiiiiant to j an adopted state minimum building code or:.without-such'perinit being in effect;. :a) ❑ Willfully'or deliberately disregard or violate any Collier County ordinance relating to uncertifiedor unregistered contractors. i. y A person or business organization operating on an inactiv o r suspended certificate I or registration,or operating beyond the scope of work o_raphtcal scope of the 1 i registration,is not duly certified or registered i( C _s f E SIGNATURIRECIpIENT) ` SIG A •E ; ' TIGATOR). . I • i e-r Cow vtty Growth Management Division Planning& Regulation Operations Department Licensing Section March 26, 2014 Daniel A . Haugen 1989 Par Dr. Naples, FL 34120 • RE: Contesting citations 08650 & 08651 Dear Mr. Haugen, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, April 16, 2014. • The meeting is held at 9:00am at the W. Harmon Turner Building (Bldg. F, Admin. Bldg.), 3299 Tamiami TrI. 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 Since-ly, a/U.1e4/1§4,J,L__ • Samantha Roe Customer Service Specialist Licensing/Operations 2800 North Horseshoe Drive { Naples, FL 34104 • E-3 Growth Management UIvrsron"t'lannulg&kegulation"`1N00 North Horteshoe Drive"Naples,Honda 34104"139-2 2-14UU'www.colhergov.net tergov.net Report Title: Code Case Details Date: 3/27/2014 9:18:29 AM Case Number: ceu120140005272 tom. -_.�a . r se t Case Number: CEUL20140005272 Status: Citation Case Type: Unlicensed Date&Time Entered: 3/14/2014 8:40:50 AM Priority: Normal Entered By: lanJackson Inspector: lanJackson Cosc Disposition: Unpaid Jurisdiction: City of Naples Origin: Complaint Detail Description: Emailed complaint stating Hot Concepts Fireplaces LLC contracting for construction at 620 Admiraty Parade with no license.Citation 8651 issued to Daniel Haugen Location Comments: 620 Admiralty Parade/folio 16811040007 #x ,, sx #,. ,��`� �s:sd t �1'� «r �_,:,�� � � .:�zs rj.�' �- �.�,�c'I�,�€..�r `�`v �- x z � -- 2"�--e- � � ds,� t:'"`� err -�.�'rc S,g .t t z3 is £ x x�2 2 aE,C a ` ,*� `s'.a t �.E .> ,7 f a.'. , S tc^7�t x`S',"a, S# - '�.f"2; F%/ Rs I$ x �� S C 1 2 1"� � � � � '��.°' Wy - fix.:- �E� '� � r,x. �» ,i.tx!..r.�sa iapl.L'.rr'.,.:wa.Jc..�M_a-.,..ti .is. vmtjri,,.gitVli s.� t3Pai*n..ka':;t ° l i.trWf: Nt dab. e q.q'Yt ,3 �»€r* 4. ,.z. � �v _ ..... .��a s .-e.., ,�, '� ;��.:..x-'�.i,.,,�wa �rs�.�...,,.,..,,.,rho�,,,,r n._„,7 Property 16811040007 {( 1 Y J ?1 mS oy 06x kn S A r R WoX F m r 5nitY is Violator Haugen, Daniel Business Management& Budget Office 1 Code Case Details Execution Date 3/27/2014 9:18:29 AM Avw-gge-"T £ �h t :nor _ . _.«�_ .SU....4+��_.�.,.c�-� Desc Assigned Required Completed Outcome Comments;. Preliminary Investigation lanJackson 3/14/2014 3/14/2014 Needs 3/13/14. Emailed complaint stating Hot Investigatio Concpets Fireplaces LLC/Daniel Haugen n (300-4950/331-8303)contracting for construction at 620 Admiralty Parade. 3/13/14.At location,found new construction home. BCB Homes builder/permit holder.On • site superintendent is Nick Maduro.Advised Maduro of complaint. Found that two fireplaces were partially constructed by a subcontractor of BCB Homes.This initial subcontractor agreement was then terminated.13C1i Homes then subcontracted Hot Concepts Fireplaces/Daniel Haugen to finish the fireplaces. Obtained contract from BCB Homes, Kim Levy 643-1004. Found that t Hot Concepts Fireplaces is operating with Collier County Business Tax for Wholesale Business. Found that contract contains construction items for which Hot Concepts is not licensed for(masonry at minimum).Will address violation w/Haugen. 3/14/14. Left several messages for Haugen. 3/14/14. In reviewing contract,found that contract includes minimum of two trades. Residential Contractors License,at minimum, required for execution of contract. Investigation lanJackson 3/17/2014 3/20/2014 Citation 3/18/14.Met w/Haugen.Explained violation. Required Issued citation 8651 for 2nd offense $2000.00. Issue Citation(Licensing) lanJackson 3/20/2014 3/20/2014 Complete Citation Paid/Contested clements_k 4/3/2014 Pending a i} t�. . dy fi t a T6W�r r : a�nr -� 3 °' J " ' w c s.�ai rt .�-�� ,7*41 _ k Violation Description 'Status Entered Corrected Amount Comments • Unlicensed General Contracting Open 3/20/2014 $0 Residential Contracting. t .C.`�".`'yfY` z3e r.'£` : t�_a "3�,. «i 't a,�r,� ,,q,; ,, I `,'.�a . "'' ..?A'�,? r. "{�,'f�M "i�¢i±3-.l,• '? _- .O.'�;.,t `' Y m.n,ate`` V . .�-4.�n'r'ros".x eny t'f .:.. " ��;�c€�. �s. .4 n. � ��x e3. r�.y't �_"§-,€.�` •.FF. ��'�,� -.'�`�.'ins* �§4`�a�'�.s.<��u �'�� ?^x �..,��is'q^s��.�`��€ r F"��'a, {�� � -,.� .F�'i*n`� u` :-r m :..a a, ir.Y :ku}a..,__,...:is..,...�.,it aiit ft... i� <Lare c�.G n.Y;� i..' 'X;,: 52Wiix�.:sf,',.u. .,v, g^ ";rtkAt e ..aG k..«�.r Atif5;�.# 4,r.iF�. Title Reason Result f Compliance Fine/Day Condition Business Management & Budget Office 2 • • . , I •: -• it,;': '1;if,:i'',l0' i ,, . ' • • ; i? i W - 4,:,i1 •i',11' ' 1 i ;'? i MU.: ':' ■ji;;; ,!•.,t. , . I • I 1.0, . :- a.?1, a•-•: . :0;K• j.4' ' AC-C3iR EP CERTIFICATE OFILIABILITYINSURANCE DATE(MMIDO/TYYY) —___L------•. 10/30/2013 THIS CERTIFICATE IS ISSUED AS..A MATTER OF INFORMATION-;ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR Nhd,ATIVEIY.AIVIpNDi,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OP INSURANCE DOES:NOT ICpt4STITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATETIOLDtR.. I IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED„Me pOlicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may reqiiirean endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).• -. . . - ' • • CONTACT PRODUCER • ' NAME: Certificate Team . : •!.. • Acentria,Inc.-FL Myers Office • a PHONE , EMI:239-939-1010 I FAX I(A/C,No:239-939-7172 • . . . • , • 4091 Colonial Blvd • E-MAIL Fort Myers FL 33966 , ,; i : Anoness:certificates@timshaw.com I : : : - 4 • INSURER(S)AFFORDING COVERAGE NAIC A • : . • ,.: a . • _ ______________ A: Lo_Casiblit4haFaLancgLaanaimay241:24_ INSURED ' 1 • ' 1- „ $'• INSURERBITrovelcr3 Property Casually insuran 38181 • . j. i.].. •t, P - . . Hot Concepts Fireplaces LLC ; ! : I.,...t .1, I !USURER c:North Pointe Insurance Company 27740 INS RER D • 5450 Shirley Street Suite A , ! !i! :; "I:' :il 1 b . , .. ;.„. ...„ :., ... , . Naples FL 34109 • •. (7, , , , i • 'I .!;• - !.:1 t:'!i i - :!!,' :i••0 INSURER F: COVERAGES :,CERTIFICATE NUMBER 1236926335. r REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCELISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOI IIREMENT„TOM OR CONDITION OF ANY CONTRACT OR OTIIER DOCUMENT WITII 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. r INSR AWL SUBR , r1• ! LTR TYPE OF INSURANCE : INSR WVD :. POLICY NUMB Eit.;':ir itrzolywiugigsrlyEXP LIMITS 1 C GENERAL LIABILITY , 3093062700 111 . 1 ■!Y!;- 11/2/2013 11/212014 1 • EACH OCCURRENCE $1000000 I DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY • 1:::: .t.,' le.' • PREMISES(Ea occurrence) $100000 i.- .14 1:•`• j CLAIMS MADE IX I OCCUR !!1 11 P-,• .• , • MED EXP An one person) $5000 • i' 11•!Ii• . Ai viir. . PERSONAL&ADV INJURY $1000000 I:1 ' •I!' 111i'l • .. GENERAL AGGREGATE 32000000 1:. I GENT.AGGREGATE LIMIT APPLIES PER 'i1 t: i PRODUCTS-COMP/OP ACT' $2000000 . i ;• ; •4■1, h 1. mum,nPR° ri LOC 17 ' !;': 1: .t ' a:Ii „I' i1 14' ! S B AUTOMOBILE LIABILITY :il BA4E64344, • '!f,`,;, N 4, 2/23/2613% 2/23/2014 •pahniNarGLL LIMIT 1 S1,000,000 ).. ": X ANY AUTO ::q . 1 _ , .,.,..,,•N ., ;I.? t. DODILY INJURY(NI Relate)) 5 • ALL OWNED —SCHEDULEA'. • , , , 1 a i:a. ') •11'1 I• BODILY INJURY(Per accidenl) $ AUTOS AUTOS ':j! • :, ': ?!.:: : 1 i. NON-OWNED• - ,,::- II .' • . Is,' 1 ,, PROPERTY DAMAGE S f HIRED AUTOS AUTOS ; . , . , : . ' :1'if: • ••''1,a.' :I k [(I:1 ,f_;( ,■-_,.. _ckfem) I-. I , ;,; .f ;;; A X UMBRELLA LIAB OCCUR• - . EV05005304 1.:••.• :T1 4i 2/23/2013: 2/23/2014 EACH OCCURRENCE 51,000,000 — " • . .f''t1 : ri!':1- 's • EXCESS LIAB CLAIMS MADE ' 1!: .11,:. ';: ':t 1i, 1.; AGGREGATE S . 1: DEO [RETENTIONS /1 :!.; 1•:'il ,.!: I'. • - S WORKERS COMPENSATION . :, /1 I I ' : !.' fl 1 1 1 ,. I WC STATU- ica i AND EMPLOYERS'UABILITY ri 1, 7..1 /TORY LIMITS - ANY PROPRIETOR/PARTNER/EXECUTNE r 1 ' ••• 1 /1 "; - 4 1 E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? I N/A ,) (Mandatory In NH) 1: • ‘i,':' •i• •1: ••. f- N .!. E.L.DISEASE-EA EMPLOYEE $ 1 •,iI, .1 j:I :' ataP i'.• I. 11 yes,describe under DESCRIPTION OF OPERATIONS below 1. ' 10., ,1! 4';.i!:: : ••" E.L.DISEASE-POLICY LIMIT $ t1 - 1 '', • '' '..'i/: '1'; 1 Ill I I. -i.:NI.I.'. • 1. 1 ..: . DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACoRolotAchillIonal RiiIrks Schedule,It more space Is required) Workers Compensation Exemption has been filed-for DanieliJ.Hatigen' . . • CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WITH REGARDS TO THE GENERAL LIABILITY COVERAGE SHOWN ABOVE IF REQUIRED BY WRITTEN CONTRACT SUBJECT TO THE TERMS,CONDITIONS AND EXCLUSIONS OF THE POLICY PER FORM NP1096 ATTACHED. . • t. . . . . . •" • • :, i.' I. I.; : ';' .r. i :-r I : , . - - , • • • 4. , I i' !,'';, . : ; .L 1, 1,, - , . .,I I• • • ,1 .I, .: , ,,, .. CERTIFICATE HOLDER I ' ., i t IiCACELLATION i 1 1 , , • .:: i: ;ii: ;, . afouLti,,,■NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ITI-IE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BCB HOMES . :,• : .; .:.,.• ;;. . : ACCORDANCE WITH THE POLICY PROVISIONS. 3696 ENTERPRISE AVE 5100 .. ' :,KP .,,-. ' . . : :- . • • ' NAPLES FL 34104 - • • ' : •■:. AUTHORIZED REPRESENTATIVE I r VA • : ,--i&e, :-;, . .- ., . .• . - , ION.©1088-2010 ACORD CORPORA I ION All rights reserved. . . . ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ei.„ • . __. ___ . . • . i COMMERCIAL GENERAL LIABILITY i It ,:i f ; , NPOIBB05IO THIS ENDORSEMENT CI'IAN,GES J5}—q POLI'CY. :PLEASE READ IT CAREFULLY. .• I'' AUT0MA '1C AIDD'ITiO 'AL INSUREDS This endorsement modifies insurance provided under the,following' . I' COMMERCIAL GENERAL LIABILITY COVERAGE FORM :. %. ,_ Except as provided below,ell other terms and conditions'of this policy i;entail'unchanged. The fallowing provision is added to(SECTION II):Who Is An Insured. . 4. Any entity you are required in a written contract to name as an insured.is an additinnal insured(hereinafter called additional insured),but: a. Only as respects contracts that were executed prior to the occurrence of"bodily injury',"property damage"or'personal and advertising injury",and b. Only with respect to liability for"bodily injury"."property damage"or"personal and advertising injury'caused,in whole or in part.by your acts or omissions or acts or omissions of those acting on:Veer behalf in connections with your premises,"your work"for the additional insured.or I j acts or omissions of the additional insured in connection with'the general supervision of"your work"to the extent set forth below: (1) The Limits of Insurance provided on behalf of the additional insured are nut greater than those required by such rnntrart. (2) All insuring agreements,exclusions and conditiods,of this policy apply. (3) In no event shall the coverages or Limit's'of Insurance in this Coverage Form be Increased by such contract. c. Except when required otherwise by contract.,?his insucapcd oes got apply,te: (1) "Bodily injury"or"property damage"occurring a(terf'�II work on theproject(other than service,maintenance or repairs)to be performed by or on behalf of the additional insureds)at the'site of the:covered operations has been completed;or (2) "Bodily injury"or"property damage"occurring after that portion of"your work"out of which the injury or damage arises has been put to Its Intended use by any person or organjzatien'athor than another contractor or subcontractor engaged iii perfu1 n11y uperatioux fur a principal as a part of the same gdoject, ` . (3) "Bodily injury"or"property damage"arising out of any act or omission of the additional insured(s)or any at their employees,other than the general supervision of work performed for the additional insured(s)by you. (4) "Property damage"to , if` i (a) Property owned,used or occupied by or rented to the additional insured(s); 1 (b) Prdrerty in the core,custody Or.'ccontrol-of the additional insured(s)or over which the additional insured(s)is for any purpose � , exr)P ising physicalcontrbh)pr rj1: ijt I (c) "Y t r work"for th�additional msured(s) t "!ii l' • 't (rd ,. ( , , ,.trriif ''''ti: d. With res ect J{'ol additional indureds fdho nt'o i rchiteots Ier ginee s orf strve ors•this insurance does not apply to"bodily injury.""property • P 't;tt. 4, } f Ft „, j J Y PP Y Y l Y' " P Y damage""persgnal injury or;adve.i. ipg r ji f y arisIti put of the rendering of or the failure to render any professional services by or for you. including: !,111,; ,v, •• , , ,'�l i. ; P,% ,tj. r I I.s , r, ,,,, : i.;t, , J (1) The prephring, appro4ing,or failing to•;prepare"or..apprdve maps,'drawings opinion% reports• surveys change orders, designs or f t •specifications;and ."'; ' : .'•J' ''j' t• i' , .. -,,,-.1 X11; .}}I I1,f (2) Su ervisor,inspection or engineering se vices.;. , :,i .,;r' ••O P Y p 9 9 i a�+' e. The insurance afforded by'this endorsement for thel,bene(it of'the additional insured shall be primary insurance,and any other insurance maintained by the additional insured shall be excess add non=contributory. f. 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I '• „. • , , • . ; • • • , • . , e......_ , i EXHIBIT"A" • SUBCONTRACTOR'S SCOPE OF WORK It is hereby agreed that absolutely NO change orders fir additional services performed Ivilhout the express PRIOR written OR email anln•owl by the Pro/ecl Manager will be considered regardless of its validifh.Subcontraeror nuts!get prior written approval .front the PROJECT MANAGER to get conmertsafe'd far ANY chemge orders.We have tils'cvissed this this arrangement prior to execution of this Contract and agree that if will be enforced WITHOUT EXCEPTION Furnish and deliver to the jobsite a complete FIREPLACE package as per Plans,BCB Specs, and as follows: 1. Includes remote controls and electronic ignition for Study and Outdoor Pavilion fireplaces. 2. includes firebrick as follows; a. designs as per Plans: -Outdoor Fireplace as per details 1 &2/0-2.3 with herringbone on walls and running bond on bottom, all on 2x9 (split brick) ii. Study Fireplace as per details 3/ID-1.7 with herringbone on walls and running bond on bottom, all on 2x9 (split brick) iii. Firebrick to be'BLACK" 3. includes Supply and install 30"Peterson Golden Oak designer gas log sets at BOTH fireplaces and as follows: a. vented burner assembly,grate,control valve,embers,lava rock,and log sot Model:R. II.Peterson 30"Stainless Sloe!045 burner with Electronic,Ignition and on/off remote b. vented burner assembly,grate,control valve,embers,lava rock,and log set Model:R.H.Peterson 30"045 burner with Electronic Ignition and on/off remote 4. includes(I)Emergency shutoff valve for each fireplace as per BCB Homes Specifications. ; 5. Include spark arrestors as needed at roof for code. 6. Includes FIREPLACE:ISOICERN:Repair existing • • Repairs or addition work required to correct damaged or improper installation. • Fill,as possible,open joints and voids missed during original installation • Correct,as possible,uneven seams facing lire box interior and where finish material will be affected • Drill holes in fire box wall for gas line 7. FIREPLACE:ISOKERN:FIRE BRICK:Into Existing a Supply and install Fire brick interior to existing Isokern fire box,as specified by manufacture and design specifications • Color:Charcoal • Pattern:Herringbone split 2 x 8 • Mortar Joints:Charcoal - € • $1500.00 8. FIREPLACE:iSOICERN:VENTING:TERMINATON,Custom • Supply and install custom designed and fabricated stainless steel spark arrestor/animal screen at the termination point,as.required to meet manufacture and code requirements. • (may require special equipment cost not included in price to complete installation)$385.00 BCB Supplementary Conditions&Specifications February 20,2012 Pagel;of I I Eq GENERAL.NOTES: 1. The manufacturer's standard form of warranty shall apply to all products. 2. Seven(7)sets of shop drawings. 3. Includes all required sales tax and delivery and unloading at the jobsite. 4: Includes all required permits. 5. No product will be ordered until final samples arc approved by BCB1-1. 6, The Subcontractor shall exercise proper and competent supervision at all times,including • • supervision of hoisting and loading.All required hoisting and scaffolding for loading,unloading, installing,stocking of materials and/ar equipment related to Work are included by Subcontractor,Therefore,the Subcontractor is responsible for safety related to hoisting, loading and installing of such Work. 7. The Subcontractor shall perform all Work in accordance with OSHA Requirements rind the General Contractors Safety Plan without exception.The Subcontractor is responsible to provide,install and maintain safety in relation to his Work 8. Subcontractor to Engineer,provide and install any&all structural support members required for systems to meet the requirements of the Contract Documents and all applicable codes and governing authorities. 9. Subcontractor is responsible for coordination of all equipment,and installations with other trades by means of shop drawings,interference drawings,mock-ups,coordination meetings,and field coordination prior to proceeding with Work. 10. All construction to comply with all applicable Building Codes. ■ 11. No production is to begin until after shop drawings and finish samples have been approved. i 12. Subcontractor is responsible for layout of all Work from control lines furnished by BCBH. Subcontractor responsible to install all Work plumb,straight,level and true to line,without i j warp or rack of frames and panels,anchored securely in place.Particular attention must be i made to line up system elements with the architectural building lines throughout. Subcontractor is responsible for field measuring all openings prior to fabrication. 13.Subcontractor to Engineer,provide and install any&all structural support members required for systems to meet the requirements of the Contract Documents and all applicable codes and governing tad hurt ieS. 14.It is hereby agreed that absolutely NO change orders for additional services performed without the express PRIOR written OR email approval by the Project Manager will be considered regardless ot'.its validity.Subcontractor must get prior written approval from the PROJECT MANAGER to get compensated for ANY change orders. We have discussed this arrangement prior to execution of this t Contract and agree that it will be enforced WITHOUT EXCEPTION s,. F.t.• Contract Axnoimf:$4949.00 ' i. r i i F I i i 4 • F • 4. t • F • uCU$upplcmcmary Condlituosaspciihcaliuu I'Wildly::0.2012 pnrr..SofII g id /,.��� �� ��; � .E•' � � '°` l „? . ✓ r^ `. 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".-r., '- _ r9 i • } t i E r . . i Florida Department of Agriculture and Consumer Services Remit PaymentOnlineat ,„soy eTCC4ci: Division of Consumer Services wwwn aq online con, Qs" �G Rureau of I igitefieci Petroleum Gas Inspection or w " 1.1:1 Check or Money Order paytable to FDA0 and remit tooth • �ks SE r DEALER IN APPLIANCES AND EQUIPMENT fQ Q p °NjE FOR USE OF LIQUEFIED PETROLEUM GAS (0602) f S Fi7A� , t o a ADAM H.PUTNAM LICENSE APPLICATION Po Box70© r Tallahasse COMMISSIONER e llond'a 3214.6700 Sections 527.01(12)and 527.02,Florida Statutes Rule 5F-11.004,Florida Administrative Code License Application Fee: ,K7f . /1 3 ....3„/3 trit,, magrammoyatv:-.,;.:_nl.calwriszorm INSTRUCTIONS TO APPLY for the Dealer in Appliances and Equipment for Use of Liquefied Petroleum Gas (0602) license, fill this form out completely (PRINT OR TYPE) and return it with all attachments, including the license application fee, to the Bureau of LP Gas Inspection at the address In the upper right-hand corner. (See above dates for correct tee as required by s. 527.02, F.S.) SCOPE OF LICENSE: This license provides for the sale or lease of apparatus,appliances and equipment for the use of LP gas. This includes, but is not limited to, propane tanks, grills, ranges, ovens, water heaters, refrigerators, floor buffers, and similar equipment. NOTE: As a dealer in appliances and equipment for use of LP gas, it is your responsibility to assure your customers of a safe product by selling only those parts, appliances, or equipment that have been approved by a nationally recognized testing laboratory, pursuant to Chapter 527, F.S., and Rule 5F-11.001, F.A.C. BUSINESS NAME(NAME TO BE PRINTED ON LICENSE): Physical Address of Business(Address of location to be licensed): City County State Zip Code Telephone: Fax: Email Address(if any): Area Code( ) Area Code( ) COMPANY NAME(OWNER OF BUSINESS TO BE LICENSED): Company Mailing Address: City County State Zip Codo Telephone: Fax: Email Address(if any): Area Code( ) Area Code( ) Questions should be directed to: The Bureau of LP Gas Inspection(850)921-1600 Org Code:42 10 11 01 000 EO:A2 Object Code:002102 FDACS-03513 Rev.02/14 Page 1 of 2 Chapter 527 Section 01 - 2012 Florida Statutes - The Florida Senate Page 1 of 2 The Florida Senate 2012 Florida Statutes Title XXXIII Chapter 527 SECTION 01 REGULATION OF TRADE, SALE OF LIQUEFIED PETROLEUM Definitions. COMMERCE,INVESTMENTS, GAS AND SOLICITATIONS Entire Chapter 527.01 Definitions.—As used in this chapter: (1) "Liquefied petroleum gas"means any material which is composed predominantly of any of the following hydrocarbons,or mixtures of the same:propane,propylene,butanes(normal butane or isobutane),and butylenes. (2) "Person"means any individual,firm,partnership,corporation,company,association,organization,or cooperative. (3) "Ultimate consumer"means the person last purchasing liquefied petroleum gas in its liquid or vapor state industrial,commercial,or domestic use. (4) "Department"means the Department of Agriculture and Consumer Services. (5) "Qualifier"means any person who has passed a competency examination administered by the department is employed by a licensed business in one or more of the following classifications: (a) Category I liquefied petroleum gas dealer. (b) Category II liquefied petroleum gas dispenser. (c) LP gas installer. (d) Specialty installer. (e) Requalifier of cylinders. (f) Fabricator,repairer,and tester of vehicles and cargo tanks. (g) Category IV liquefied petroleum gas dispensing unit operator and recreational vehicle servicer. (h) Category V liquefied petroleum gases dealer for industrial uses only. (6) "Category I liquefied petroleum gas dealer"means any person selling or offering to sell by delivery or at a . stationary location any liquefied petroleum gas to the ultimate consumer for industrial,commercial,or domestic u r ' any person leasing or offering to lease,or exchanging or offering to exchange,any apparatus,appliances,and equipment for the use of liquefied petroleum gas;any person installing,servicing,altering,or modifying apparatu piping,tubing,appliances,and equipment for the use of liquefied petroleum or natural gas;any person installing carburetion equipment;or any person requalifying cylinders. (7) "Category II liquefied petroleum gas dispenser"means any person engaging in the business of operating a liquefied petroleum gas dispensing unit for the purpose of serving liquid products to the ultimate consumer for industrial,commercial,or domestic use,and selling or offering to sell,or leasing or offering to lease,apparatus, appliances,and equipment for the use of liquefied petroleum gas,including maintaining a cylinder storage rack at licensed business location for the purpose of storing cylinders filled by the licensed business for sale nr use at a late date. (8) "Category III liquefied petroleum gas cylinder exchange operator"means any person operating a storage facility used for the purpose of storing filled propane cylinders of not more than 43.5 pounds propane capacity or pounds water capacity,while awaiting sale to the ultimate consumer,or a facility used for the storage of empty or filled containers which have been offered for exchange. (9) "Category IV liquefied petroleum gas dispenser and recreational vehicle servicer" means any person engq in the business of operating a liquefied petroleum gas dispensing unit for the purpose of serving liquid product to Chapter 527 Section 01 - 2012 Florida Statutes -The Florida Senate Page 2 of 2 ultimate consumer for industrial,commercial,or domestic use, and selling or offering to sell,or leasing or offering lease,apparatus,appliances,and equipment for the use of liquefied petroleum gas,and whose services include the installation,service,or repair of recreational vehicle liquefied petroleum gas appliances and equipment. (10) "LP gas installer"means any person who is engaged in the liquefied petroleum gas business and whose services include the installation,servicing,altering,or modifying of apparatus,piping,tubing,tanks,and equipmt for the use of liquefied petroleum or natural gas and selling or offering to sell,or leasing or offering to lease, apparatus,appliances,and equipment for the use of liquefied petroleum or natural gas. (11) "Specialty installer"means any person involved in the installation,service,or repair of liquefied petroleui natural gas appliances and equipment,and selling or offering to sell,or leasing or offering to lease,apparatus, appliances,and equipment for the use of liquefied petroleum gas,whose activities are limited to specific types of appliances and equipment as designated by department rule. (12) "'Dealer in appliances:and equipment for use of liquefied petroleum gas"means any person selling or offe to sell,or leasing or offering to lease,apparatus,appliances,and equipment for the use of liquefied petroleum gas: (13) "Manufacturer of liquefied petroleum gas appliances and equipment"means any person in this state manufacturing and offering for sale or selling tanks,cylinders,or other containers and necessary appurtenances fc use in the storage,transportation,or delivery of such gas to the ultimate consumer,or manufacturing and offering sale or selling apparatus,appliances, and equipment for the use of liquefied petroleum gas to the ultimate consum (14) "Wholesaler"means any person,as defined by subsection(2),selling or offering to sell any liquefied petroleum gas for industrial,commercial,or domestic use to any person except the ultimate consumer. (15) "Requalifier of cylinders"means any person involved in the retesting,repair,qualifying,or requalifying c liquefied petroleum gas tanks or cylinders manufactured under specifications of the United States Department of Transportation or former Interstate Commerce Commission, (16) "Fabricator,repairer,and tester of vehicles and cargo tanks"means any person involved in the hydrostati testing,fabrication,repair, or requalifying of any motor vehicles or cargo tanks used for the transportation of lique petroleum gases,when such tanks are permanently attached to or forming a part of the motor vehicle. (17) 'Recreational vehicle"means a motor vehicle designed to provide temporary living quarters for recreatioi camping,or travel use,which has its own propulsion or is mounted on or towed by another motor vehicle. (18) "Pipeline system operator"means any person who owns or operates a liquefied petroleum gas pipeline system that is used to transmit liquefied petroleum gas from a common source to the ultimate customer and that serves 10 or more customers. (19) "Category V liquefied petroleum gases dealer for industrial uses only"means any person engaged in the business of filling,selling,and transporting liquefied petroleum gas containers for use in welding,forklifts,or othc industrial applications. History.-s.1,ch.24302,1947;s.11,ch.25035,1949;s.1,ch.57-174;s.1,ch.61-158;ss.13,35,ch.69-106;s.202,ch.71-377;s.3,ch.76-16: z, 1,ch.77-457;ss.1,6,ch.80-390;ss.1,18,19,ch.81-175;ss.2,3,ch.81-318;ss.1,2,ch.82-6;s.124,ch.83-218;s.1,ch.86-69;ss.2,3,ch.87-39 ch.90-215;s.4,ch.91-429;s.1,ch.92-324;s.7,ch.93-142;ss.1,7,ch.93-248;s.1,ch.2000-269;s.23,ch.2001-63;s.1,ch.2003-132. Note.-Former s.526.12. Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chamb should be consulted for official purposes. Copyright v 2000- 20'14 State of Flux idd. V -.....10+,-.4-...4,-..-.1')(1111C'1'7 .i r1'7 r',n1 n ORDINANCE NO.2006-46 • AN ORDINANCE AMENDING COLLIER COUNTY ORDINANCE NO. 90-105, AS AMENDED, THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD ORDINANCE;AMENDING SECTION 13.1 OWNER-BUILDERS,TO INCREASE THE MAXIMUM EXPENDITURE LIMIT TO$75,000,TO ALLOW FOR THE REPAIR OR REPLACEMENT. OF. CERTAIN ROOF. SHINGLES WAND TO PROVIDE FOR A DISCLOSURE STATEMENT; AMENDING SECTION 13.2 PUBLIC WORKS, EXEMPTING CERTAIN EMPLOYEES OF GOVERNMENTAL AGENCIES FROM THE REQUIREMENTS OF THIS ORDINANCE; AMENDING SECTIONS 1.6.1.1 THROUGH 1.63.48, REMOVING THE SPECIFIC TIME REQUIREMENTS FOR TESTING AND ADDING THAT TESTS BE APPROVED ACCORDING TO SECTION 2.6 OF THIS ORDINANCE; FUR'T'HER AMENDING SECTION 1.6.2.11 STRIKING THE EXCLUSION OF LIQUID PETROLEUM GASES; FURTHER AMENDING SECTION 1.6.3.25, TO ADD REQUIREMENTS FOR NEW APPLICANTS FOR THIS LICENSE;FURTHR AMENDING SECTION 1.6.3.48 TO ADD REQUIREMENTS FOR NEW APPLICANTS FOR THIS LICENSE; AMENDING SECTION 2.5.4.6 ADDING MISSING LANGUAGE AT THE END OF THE PARAGRAPH;AMENDING SECTION 2.6 TO REFLECT THE RECOGNITION OF ADDITIONAL TESTING AGENCIES; AMENDING SECTION 2.11.2 ADDRESSING THE ISSUANCE OF TEMPORARY LICENSES;ADDING SECTION 4.1.8.2,ADDRESSING FINANCIAL HARM CAUSED BY CONTRACTORS CAUSING CUSTOMERS TO SEEK A VARIANCE OR ADMINISTRATIVE REMEDY; AMENDING SECTION 43.2 ELIMINATING THE ADMINISTRATIVE FEE FOR COMPLAINANTS; AMENDING SECTION 4.3.5.1.(f), INCREASING MAXIMUM FINES TO TEN THOUSAND DOLLARS; PROVIDING FOR CONFLICT AND SEVERABILITY; PROVIDING FOR INCLUSION INTO THE CODE OF LAWS AND ORDINANCES; AND PROVIDING FOR AN EF+'FECTIVE DATE. WHEREAS,certain provisions of this Ordinance ate being amended at the discretion of the Board of County Commissions upon recommendations from staff, area contractors anCd-.the` general public. r NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF=GOUM'Y' • COMMISSIONERS OF COLLIER COUNTY,FLORIDA that - SECTION ONE: ORDINANCE NO. 90-105, AS AMENDED, IS HEREBY AMENDED AS FOLLOWS: PART ONE: CERTIFICATES OF COMPETENCY REQUIRED. 1.1. Unlawful to Contract without a Certificate of Competency. It shall be unlawful for any person,firm,partnership,corporation or other legal entity to: engage in any construction contracting business, advertise or represent himself/herself or a business organization as available to engage in any construction contracting business,or act in the capacity of a contractor or subcontractor for any of the trades listed in Section 1.6 of this Ordinance, within the unincorporated area of Collier County and the incorporated area within the boundaries of the City of Naples and within the City of Marco Island, without having first made application for and having been issued a current and valid Collier County/City Certificate of Competency or an applicable State Certified License. Nothing herein shall be construed to mean that there cannot be employees in a trade who are not qualified nr r.ortified within the definitions heteiti act forth if -1- Words underlined are added;words struck-threugl,are deleted. I b� • such employees are employed by a licensed contractor who exercises supervision and control over said employees. Indicia of an employment relationship shall include the employer's regular payment of wages and compensation, FICA deductions, tax withholding and provision of Workers'Compensation to the employees,all as prescribed by law. 1.2. Building Permits. 1.2.1. No building permit shall be issued for the construction,alteration,or repair of any structure unless the applicant for the permit possesses a current Collier County/City Certificate of Competency, an applicable State Certified License, or is exempt from the operation of this Ordinance. 1.2.2. It shall be unlawful for any owner-builder to procure a building permit and to use said permit with the intent to aid or abet an unlicensed contractor to perform the permitted construction, alteration, or repair. Such conduct shall be punishable as a violation of this Ordinance and the permit and inspection shall be considered invalid for that portion of the construction related to the violation. 1.3. Exemptions. 1.3.1. Owner-Builders. The provisions of this Ordinance shall not apply to owners of property when acting as their own contractor and providing . • .. .. • - . • • . ' 'b • - • •••_ - - . mily—car twa.family residences-or • •• - - - - . ... -not to oxe i. :. ,... .. • the-eecopan - - -- . . . .. . .• .. .• . . • the construction of a one family or two family home -in any throe (3) year period. An•- L. .. .. ' • - • • • - - : • ••:. direct, onsite supervision themselves of all work not performed by licensed contractors: (a) When building or improving farm outbuildings or one-family or two-family residences on such property for the occupancy or use of such owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to exceed_75,000, on such property for,the oceu.pangy or use of such owners and not offered Cur sale or lease. In an action 2 Words n thr-emgh are deleted;words underlined ate added. f f) e1L charges adopted by Resolution pursuant to Section 2.1.5 herein, and must submit an entire new application. If,as of the date of receipt by the County of said new application, three(3)years have passed since the date of his/her most recent examination that the individual passed to acquire the former Certificate,that individual must pass all then applicable testing requirements. If the request is to reactivate a dormant certificate,the re-testing requirement can be waived by staff if the applicant proves that he/she has been active in the trade in another jurisdiction,or has been active as an inspector or investigator in the trade,or for other valid reason that would render such re-testing superfluous. 1.5. Contractors'Identification Required on all Advertising Mediums. 1.5.1. All contractors licensed under the provisions of this Ordinance shall be required to firmly affix and/or to display the qualifier's Certificate of Competency Number and the "Doing Business As"Name on all advertising mediums used by the contractor,including but not limited to, contracts, brochures, business cards aid vehicles used in their trade or business. The minimum height of each number or letter affixed to and displayed on vehicles shall be two(2) inches. 1.6. Definitions and Contractor Qualifications. 1.6.1. Contractor means the person who is qualified for and responsible for the entire project contracted for and,except for those herein exempted, the person who, for compensation, undertakes to, or submits a bid to, or does himself or by others, any or all of the following construct, repair, alter, remodel, add to, demolish, subtract from, or improve any building or structure, including related improvements to real estate, for others, or for resale to others, as hereinafter defined in Sections 1.6.1 through 1.6.3 of this Ordinance. 1.6.1.1. General Contractor requires forty-eight (48)months experience with a passing grade on a-six-(6)-heur an approved test and a two-(2)-l3euf business and law test and means a contractor whose services are unlimited as to the type of work which he/she may do,except as provided in this Ordinance or in the Florida Statutes. NOTE: Also see Sect. 1.6.2. 1.6.1.2. Building Contractor requires forty-eight(48)months experience with a passing grade on ams" , an approved test and a } �'e-42-}rate business and law test and means a contractor whose services are limited to construction of commercial buildings and single-dwelling or multiple-dwelling residential buildings, which commercial or residential buildings do not exceed three stories in height, and accessory use structures in connection therewith or a contractor whose services are limited to remodeling,repair,or improvement of any size building if the services do not affect the structural members of the building. NOTE: Also see Sect. 1.6.2. 6 Words stfask-threao are deleted;words underlined are added. 11 • 1.6.1.3. Residential Contractor requires forty-eight (48) months experience with a passing grade on a six (6)hour an approved test and a twe.-(2)-hot'business and law test and means a contractor whose services are. limited to construction, remodeling, repair, or improvement of one-family,two-family,or three-family residences not exceeding two stories in height and accessory use structures in connection therewith. NOTE: Also see Sect. 1.6.2. 1.6.1.4. Contractor qualifications for practice and restrictions. A general, building, or residential contractor shall not be required to subcontract the installation, or repair made under warranty, of wood shingles, wood shakes, asphalt or fiberglass shingle roofing materials on a new building of his own construction. Further, a general contractor on new site development work, site redevelopment work, mobile home parks, and commercial properties, shall not be required to subcontract the construction of the main sanitary sewer collection system,the storm water collection system, and the water distribution system, not including the continuation of utility lines from the mains to the buildings. Further, as to mobile home parks, the general contractor shall not be required to subcontract the continuation of utility lines from the mains, and the continuations are to be considered a part of the main sewer collection and main water distribution systems. However,no general, building or residential contractor state certified after 1973, shall act as, hold himself/herself out to he, or advertise himself/herself to be a roofing contractor unless he/she is certified or registered as a roofing contractor. 1.6.1.5. A general, building, or residential contractor, except as otherwise provided in this part, shall be responsible for any construction or alteration of a structural component of a building or structure, and any certified general contractor or certified underground utility and excavation contractor may perform clearing and f. g grubbing, grading, excavation, and other site '� work for any construction project in the state. Any certified building contractor or certified residential contractor may perform clearing and grubbing, grading, excavation, and other site work for any construction project in this state,limited to the lot on which any specific building is located. 1.6.1.6. A general contractor shall not be required to subcontract structural swimming pool work. • 1.6.2. Subcontracting; Subcontractors. A contractor shall subcontract the electrical, mechanical, plumbing, roofing, sheet metal, swimming pool, and air conditioning work for which a local examination for a Certificate of Competency or a license is required, unless such contractor holds a Certificate of Competency or license of the respective trade category, as required by the appropriate local authority. 1.6.2.1. Sheet Metal Contractor requires twenty-four (24) months experience and a passing grade on a-threes{ o*r naznrnvPri test and a passing grade on a two(2)hour business 7 Words strt-u are deleted;words undcrlimd aio added. or V/ I cAtergoalter. Report Title: Code Case Details Date: 3/27/2014 9:12:33 AM Case Number: ceu120130007459 a�r�"�t`t Alattialla*RWIa �� 113 �� ` ,. • Case Number: CEUL20130007459 Status: Closed Case Type: Unlicensed Date&Time Entered: 5/21/2013 11:40:03 AM Priority: Normal Entered By: webAnonymousUser Inspector: ReggieSmith Case Disposition: Unpaid Jurisdiction: Contractor's Licensing Origin: Public Portal Detail Description: UNLICENSED ADVERTISEMENT, HAUGEN,DANIEL,CITATION 7643,$300.00 "Unlicensed installation of masonry fireplaces and fire pits"WEB PORTAL COMPLAINT Location Comments: Hot Concepts fire places 5585 Shirley St Naples Fl.239/300/4950 yy 4n iii 'nom h A 1 - k l' L �rff ' W�' - W e.. � r n ��i '_ Violator Haugen, Daniel iq Business Management& Budget Office 1 • Code Case Details Execution Date 3/27/2014 9:12:33 AM Az ads rru �. Desc As�lgnetl Required Dgmpleted Outcome Pornments �3 Preliminary Investigation ReggieSmith 5/21/2013 5/24/2013 Needs 05-24-13 RECEIVED CASE AND Investigatio RESEARCHED. FOUND WEBSITE n CONTAINING UNLICENSED ADVERTISING FOR INSTALLATION AND OR CONSTRUCTION OF GAS, ELECTRIC,AND MASONRY FIREPLACES AND CHIMNEYS. NO LICENSING FOUND FOR DANIEL HAUGEN,SOLE PROPRIETOR OF BUSINESS. COMPLAINT SUGGESTS WORK TAKEN PLACE;HOWEVER NO • ADDRESS OR CONTACT INI-01MAI ION WAS GIVEN. RS Cont. Investigation ReggieSmith 6/4/2013 6/4/2013 Complete 06-04-13 MADE TELEPHONE CONTACT WITH DANIEL HAUGEN,OWNER OF HOT CONCEPTS;SCHEDULED TO MEET IN OFFICE AT 0900 ON 06-05-13 TO REVIEW CASE AND COMPLAINT. RS Attach Picture(s) ReggieSmith 6/5/2013 6/5/2013 Complete ATTACHED SCANNED CITATION AND WEBSITE VIOLATION PAGE. RS Investigation KeggieSmith 6/5/2013 6/5/2013 Citation 06-05-13 MET WITH DANIEL HAUGEN AND Required ADVISED WEBSITE VIOLATION. ADVISED LICENSING REQUIRED FOR CLAIMED INSTALLATION OF FIREPLACE SERVICES. ADVISED LICENSING AVAILABILITY AND CORRECTION OF WEBSITE UNTIL LICENSING IS IN PLACE. ISSUED CITATION 7643,UNLICENSED ADVERTISEMENT,$300.00;HE SIGNED AND ACCEPTED HIS COPY. RS Issue Citation(Licensing) ReggieSmith 6/5/2013 6/5/2013 Complete ISSUED CITATION 7643,UNLICENSED ADVERTISEMENT,$300.00;HE SIGNED AND ACCEPTED HIS COPY. RS l:` Citation Paid/Contested JenniferBlanc 6/19/2013 6/5/2013 Payment • o Received ViolationyDescription Status •Entered Corrected Amount Comments Unlicensed Advertisement Open 6/5/2013 $0 E 6 f� �` '��" ..., .��- � � }�� ; �. ._...» fi.� �'}`t' s -�'s' -,.i��-��� Title Reason is Result I Com liance I Fine/Da Condition fT .1• p l Y( I .. Business Management&Budget Office 2 Hot Concepts Fireplaces Page 1 of 2 Hot Concepts F�rep aces _ DESIGN-BUILD-INSTALL SERVICE-REPAIR /Lot Concepts Freptaces Home Services We Ultef Brands V.eOffer ' ` T�adnsonal Fi p ces • re la a . L > v re lac F s• OutdoorFireylaces 's ' 'i L•thaisot Fireplaces ,' �d�l1 .�.� '!,, FE K V J "6 44 .t '"'�' CONCEPTS .,., %K• ��: Electric Fireptaces s. Outdw�kitd,esu F.ircplace Doers " Fire Featur<s Fire Pits ' -- T¢ctimonals • • • Links Location 1• „ e t .^^': Contact Us e 6 t X. Hot Concepts Fireplaces has over 20 year s of fireplace experience.We can service or install any type of fireplace including custom fireplaces.Masonry,isokern,factory,electric, propane,natural gas,ethanol,modem,linear,fire pit,fire bowl,&outdoor fireplaces...we do it all! Serving Naples and surrounding areas. Contact Hot Concepts Fireplaces today at.239-300-4950(„,to speak with one of our friendly and helpful specialists,or browse our site for more information about our business. E z 1 4,++„•//hr.trnn s-,tefirpnlar`_pe r,.nm/ (/5/'t(112 I • • • c ort aog.1°6. 7. 5'.9 . COLLIER COUNTYN—° 7643 BUILDING REVIEW& PERMITTING • CITATION • Pursuant to section 489.127.(3)(a),Florida Statues,the undersigned hereby certifies that upon personal investigation,he/she has reasonable and probable grounds to believe that the person whose name appears below,as Issued To,did violate Subsection 489 1270),FI'orida Statutes, and Collier county Conuaetor's Licensing Ordinance No.97-68(as may be amended from time to time)by committing the violation stated below. q9 Month J!/L(x. 'Day 6 .. f Year/f• Time'V PM • Issued To: -6O7,vi0 "atl .�.� . Address /, '72 /'k p// City /'(P S' State AZ Zip J 7/a?c •lcicphone No.. l.0.�{as-0 r. . • Location of Violation •%•/ / / .. IO $ . I have been'itiforined of the violation cif w is . avc en charged and elect the following•• option(Check one) C➢0'" ' 1) 0 .I choose to pay the penaitics.of`$. .:---.X.-). on the Citation.. 2) 0 I choose not.to pay-the penalty and will request in writing by-certified mail or hand dclivcr.'an,1kdinhtisnutivi.IleatIng krone the Cunlrna■r'S I treating hoard. - . • Deseliktiun uCViulanon. Date V lation Observed 9 d?fit.'��J • (4.1. ,i/ion o a - a) ❑ Falsely hdld self or business organization'o t as a license,certificate holder or' registrant; b) o Falsely impersonate a certificate holder or registrant; • • c) 0 Present as his own'the certificate or regisliat on of another; ' •'' • d) IJ"Knowingly give false or forged'evidence to the Board 9f a member thereof; • e) 0 Use or attempt to use a certificate or'registrnfion which has been suspended or ; ....Eked; f) Engage in the business or act in the capacity of a contractor or advertise self or business organization as available to engage in the business or act. a eapPfi CCity of u i . crorifi 4Mar without being dilly rogiottiroii'tiri;citificd;° •••�. 1 g) [7 Operate a business organization engaged in contracting after(60)days • following the termination of its only qualifying agent without designating another primary I qualifying agent,except as provided in ss 489.119 and 489.1195,Florida Statues;, ' b) ❑"C',iiin"mcheKhr perform work for which a building'peimit is required pursuant to an 1 's • adopted stateminifrum building code,without such permit-beingin•eftecr bi'•'r'`` -''- i) O'Willfully'ordclibeiately'disregard'o}violatean'CollierCountyOrdinatice-relating•to f-,'' .uncertified or unrb ieh" 'contractors::•' `.".'•-''• ' .... A perxiin.Orlinsirnss Organization opci-itling on an inactive nr airipendrl certificate in .. 1 registration,or operating l/cyond the..scope of work or geographioal scope of 1tic E registration,is not duly certified or registered. ! l 111111111 , xi- //"/� r / 1 •SIGNATURE(RECIP • ) SIGNAfFUR-(INVESTIGATOR) ban axk,( i) ? � �i.��i -4i t PRINT(RECIPIENT'S WAME) PRINT grESTIGATOR'S NAME) • Pursuant to 489.127,Florida Statues,willful refusal to sign and nrrept this citation constitutes a misdemeanor of the second degree,punishable as provided in section 775.082 or 775.033 Florida Statutes. (SEE.R EVFRSE FOR.'INSTRUCTIONS). COLLIER COUNTY CONTRACTORS LICENSE DEPARTMENT • e-72--z_ • Collier County Payment Slip (LC) Licensing Date: June 05, 2013 Contact: Haugen, Daniel 1472 Birdie Dr Naples, FL 34120 Licensing Issuance Number: FEES: Fee Description I Reference Number Amount (Contractor's Lic. Citation (1st Offense) I CEUL20130007459 I $300.001 f,. I March 27, 2014 Collier County GMD Operations& Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, Florida 34104 RE:Adriano Cordero Application for Collier County/City of Naples/City of Marco I, Adriano Cordero am writing this letter of explanation in regards to my application for my License with Collier County GMD Operations and Regulatory Management, my current credit report shows that my credit score is lower than it needs to be to qualify. I have for the past years encountered some medical bills that were sent to collections which affected my credit score.There are no liens and Judgments against me and I am in the process of improving my situation with my creditors. I respectfully request the opportunity to receive my license in order to be able to meet my financial responsibilities and continue to improve my lifestyle for my family and enable me to work in Collier County. Sincerely, Adriano Cordero M ,f � Dr. Cordero Pediatric Office 1090 6th Ave. N. Naples, FL 34102 Tel. 239-213-9200 Fax 239-213-9205 March 27, 2014 Collier County GMB Operations & Regulations Management Licensing Section 2800 N. Horseshoe Dr. Naples, FL 34104 RE: Adriano Cordero Application for Collier County/City of Naples/City of Marco. I Nirka Cordero have personally known Adriano Cordero for 27 years, he is not only my brother in law he is also a good friend and a trustworthy individual, he has always been a very hard working individual and very responsible when it come to pay his debt. Unfortunately as many others citizens of this country he got hit very hard by our economy. When he first moved to Florida he was working for a painting company for almost 7 years, as the construction industry went down, he was laid off and came to work for our medical practice in our dispensing pharmacy. After 3 years and with the changes in the Medicaid Administration we were forced to close our pharmacy and I had to lay him off. As of today he is trying to his Painting Contractor license and to get back into the construction industry which is rapidly growing. Dr. Hector J. Cordero and I are willing to co-sign any loans in order to back him up economically in order for to fulfill his financial obligations. Sincerely; Hector J,Cordero, MD Nirka M. Cordero, Office Manager/Administrator �t GMD Operations & Regulatory Mana ment Licensing Section MAR 2 it 2014 P Pi 2800 North Horseshoe DriveRI.G.IN Naples, FL 34104 L 3 i 4 bfbt— / 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: A w`\ fit\ Exact Corporate/Business Name: C_G �.. Fiction Name/DBA: Qualifier Name: Ad/ i a n J Cif Id IT() Physical Address: �1�� \���.`�( =Lc� `a � j V_\ (Number & Street) (City) (State) (Zip Code) r Mailing Address: \VQ-rI- - �� 1. s_S r�� \0=Y\ (Number & Street) (City) (State) (Zip Code) Telephone:21°k- 222-4 -- E-Mail: I\ LO a `Z 0 C C tl.bc0,��.( TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 11 Specialty $205.00 Specialty trade: CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 QUALIFIER INFORMATION: Name: V- \'\ i) C_ -- CL--�� Address: 5 \A\ ` vv,AA *U V,c V-_- ; � 1 1 D\ (Number& Street) (City) (State) (Zip Code) Telephone: 2_1(� - .���-.?� - 'J \10 Date of Birth: --., S.S. #: 000- --( __ E-Mail: .3-.\s.i u CQRA- Ic 1 ,0\-i Driver's License: () 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. Ct-3c?— .W") ‘Z\ C--0V- k_ QI4—P\) '(). --C- ----Tk \ CI\\ *A--.\, (,_,O .A c-C,C-} '-:-iz_ („11.1c0 Se% -A% V7' 3. Have you ever been convicted of a crime related to Contracting? \\. (If yes attach extra sheet with explanation) 4, 7. Have you or any firms you have been associated with ever filed bankruptcy? I ( -k 1(7- 1i `j \) E Vx11 LI 8. List all debts you or any company( )associated with you refused or failed to pay and reasons why. Ni 9. List your business or work experience during the past ten years. -.:-__(j C.___ t., - -'\ IA\ .°A. t.k_ V\V_N\-\i\ CL, C),i\I\Q__c i' . CA)ia\V)0 10. Statement of any formal training you have had in the area for which the application is made. v.i R�Q V \ - V\* - Nv kse\ si:.) ,tit\ . ru j Page 3 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. 5\A\ 1\CcCtro,V-1 ._s QN k%z SV--- \ \\\CA\. \( (_,,t.A _ kb 0 S / 1-- ` `-- 0 'N Q L-P S , V L.-- , 7.) `'\ \1 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, Li N N b `- - -k��: certify that the foregoing is true and correct to the best of my knowledge. \ 1 Authorized Officer'of the Firm STATE OF FLORIDA COUNTY OF etiltK The foregoing instrument as acknowledged before me this I' '7 ` dilY D ab rJ 90 14 (Date) By Alb Q,t coo 0 03-;be�;:� of Eck-) s� S I L(Y1 1 1 f'S�' L L. L (Name of officer, title/agent) (Name of Corporation) a V Op,+6fl Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced h if C a Ltc_.. r7e_. identification and did not take an oath. (Type of identification) NOTARY'S SEAL L-R—e.-Ta P k_ --Aea ' ,N,a+ a RITA P.NASN (SIGNATURE OF NOTARY) '�",i.+ Notary Public-State of Florid* • ip s My Comm.Expires Jul 2,2017 �,,. Commission N FF 32$3$ 44` *MS Throu t N$Icn8 Notary Mkt. 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 APPLICAll a Sy , gfref, LAC . BUSINESS NAME f ! 4 of DATE BEFORE ME this day personally appeared P3 b R I C't f1 0 Ct1powho affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any ;ime he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA ;OUNTY OF .J. he foregoing instrument was acknowledged before me this / '/ LEA 0k Ma rch AO (Date) y r-rb Ocne C `b€C who has produced E`t J€_ Li d (name of person acknowledging) (Type of identification) s identification and who did not take an oath. P. v SIGNATURE OF NOTARY R Trt4 n S NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC— ,da RITA P.NASM Notary Public-Stan of Florida •f1:10 My Comm.Expires Jut 2.2017 Commission dr FF-"loSa Bonded Through National ilatary Asia. 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. APPLICANT(PLEASE PRINT) • ME OF COMPANY SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF Ck I I I CA The foregoing instrument as acknowledged before me this I'7 bny 0 !'fl 0t CC_k f.2fj j (Date) • By f icic no CC( IDEA-0 who has produced b P 1�ti� �S k i cam s c_. (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL RITA P.NASH (SIGNATURE OF NOTARY) • • `: Notary Public-State of Florida • My Comm.Expires Jul 2,2017 Commission#�FF 32$3$ ▪ A i Seeded Through Nriiof al Noll ellt. 11■ 1141■ — 4 —lifter 40-4110 Page 4 of 4 r � , STATEMENT OF OWNERSHIP This certifies that I, /Ih A (14nb0-,>€RD am a member or (APPLICANT'S NAME) r�rf LC - Managing member of e C`o $y 5*ni L� . (LIMITED LIABILITY COMPANY NAME) I own % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. i (PRINT NAME) _ SIGNATURE)(APPLICANT'S SIGNATRE) :« «�'� SAMANTHA LYNN ROE * * MY COMMISSION#EE 875238 N, ''!u''" EXPIRES:February 17,2017 I i Q (DATE) j/ 14-Of Roo° Bonded Thru Budget Notary Services RESOLUTION OF AUTHORIZATON WHEREAS � ��J� t-\1 r �'r proposes to C(Name of Business Entity) engage in contracting as in (Type of legal entity:corp.,partnership,etc. Collier County,Florida,according to Collier County Ordinance 2006-46,as amended;and WHEREAS 1-�� �j P \ -t proposes to (Name of usi ess Entity) qualify for a Certificate of Competency with Cc a1 6. (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned f-'. b of C�1 C>`f -V (Officers,Owners,Partners) `I hereby resolve and represent to the Collier County (Name of Business Entity) ^ \ Contractors'Licensing Board that the qualifying agent, \—. CC. >Q , is active (Name of ndividual) in all matters connected with the contracting business of \KO S\MA Q vl V h,\v-v I ,and fi (Name ofBusines ntity We further resolve and represent that t C —11\_;J 0 V_,& is (Names of Individual) legally empowered to act for Cv - 144 P,C YkI in all matters connected with its (Name of Business Entity) cout`ctiting Jusiipcs ,and has the‘authority to supervise construction undertaken by (Name of Business Entity) / DULY PASSED AND ADOPTED THIS ( 7 day of ilia f<•{�, (Officers,Partners,Owners-with OA f Designation underneath) Af Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this ! 1 day of ilk{ , •a?t:'1tf by Pcb 42 to 00 CO P - i A ?: t1Q.sl� %z_- . ` Notary Public Name P ''ted Notary Public Signature Commission Number - h My Commission expires: - 01)1.7 ��.14$4•,,� RITA P.NASH 's Notary Public-State of Florida My Comm.Expires Jul 2.2017 f Commission S FF 3213$ p■■■A``s Bonded Throw National Notary Arun. COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples,Florida 34104 • 239-403-2400 • FAX 239-403-2334 • MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 1 19, Florida Statues. • Licensee Information A Licensee Number Q26443 Description _ Type Property Alert Name ADRIANO CORDERO Type Contractor Status Open View Master Project View All Activities for this Licensee Add a new person or business to Address Book Examination Results A IAdd Exam Result Link l Ecarn/Test Type Date of ExanvTest_ City I Score received I ExarrdTest result BUSINESS &LAW 01/07/2006 NAPLES 78.00 Pass PAINTING 03115/2014 NAPLES 60 Fail i`_" PAINTING 03/15/2014 NAPLES 76 Pass Show More Fields. I i Hide or Clear Fields Charge Exam Fee[ Exam Code Sponsoring County Sponsorship App Date 1 T Sponsorship Expiration Date ! Testing Facility Mar20 1403:42p 239-2//-016/ L39L1/U1E�/ p.� -) Prepared BY• 4 ' : t t f[l F f I. Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 10/91 03/20/14 14 :43CT [SUBJECT] [SSN] [BIRTH DATE] CORDERO, ADRIANO JR. - [CURRENT ADDRESS] [DATE RPTD] 5171 HICKORY WOOD DR. , NAPLES FL. 34119 9/07 [FORMER ADDRESS] 3170 LA COSTA CI. , #203. NAPLES FL. 34105 6/06 2229 ARBOUR. WALK CI. , #715. NAPLES FL. 34109 M O D E L P R O F I L E ***FICO CLASSIC 04 SCORE +521 : 036, 013, 010, 018 *** 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=I. COL=6 NEG=4 HSTNEG=2-20 TRD=13 RVL=8 INST=2 MTG=2 OPN=1 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $4990 $21. 6K $0 $0 100% MORTGAGE: $362K $ $362K $0 $1208 CLOSED W/BAL: $166.51( $16.5K $ TOTALS: $367K $21.8K $379K $16.3K $1208 P U B L I C R E C O R D S SOURCE DATE LIAR ECOA COURT ASSETS PAID DOCKET## TYPE PLAINTIFF/ATTORNEY 2 5064304 11/09R C FE 3/11 925937 CHAPTER 13 BANKRUPTCY DISMISSED VALENCIA D RICHARD C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITO MOP ACCOUNT## VERIFIED BALAN REMARKS GULF CST COL Y 1X5L001 I 10/09 $122 MEDISAL 09B 3/14A $122 PLACED FOR COLLECTIO PORTFOLIO RC Y 1KSE003 I 2/10 $13 .2K FIA CARD SERVICES 09B 3/14A $13 .2K BANKRUPTCY DISMISSED AR RESOURCES Y 27GG001 I 12/08 $119 MEDICAL 09B 2/14A $119 PLACED FOR COLLECTIO AR RESOURCES Y 27GG001 I 12/08 $81 MEDICAL 09B 2/14A $81 PLACED FOR COLLECTIO MERCHANTSCOL Y 2057001 I 1/13 $109 10 FLORIDA POWER L 09B 1/14A $109 PLACED FOR COLLECTIO HWARFIELD Y 2AEWOO_ P 12/07 6/08F $1384 LA COSTA APARTMENT 09P 6/08A $0 PAID COLLECTION T R A D E S VERIFICATION OF CONSTRUCTION EtlW�X PERIENCE'S ��I E 1 �q. GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 �( Applicant's Name: V O s i i Certificate Category Req ested: -TQ (( ( / 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 p• •sense number o Ai- pers n signing below and verifying Applicants relevantexperience: r AM N Tir-1---- ame: �/ vim' ' U Title: FS) Licen Number(i applicable): /6/4114 Name of Business: g� 94 c 4.1 Business Address: 60 V 9 .00') - 2- 0.Business Phone:237 `�/p -9 /'/ The Applicant's years eerie ce from 2 009 to = c / y The applicant's scope of work s ecific duties included: pp p ( p ) t Additional Comments: 4 Pli? • W J /< U 1" LW_c/lea() i 4,—. A ) acs ES�� `� v �,, - 4 o 1m i t'-411 Falsifying an information provid herein may subject your license to rev,' . , A, , ,_ Sig at a ,,!� kV 1J2 I 14r- Z__._... Pr'�t Name: / 7 L��� State of Florida W County of Collier q The foregoing instrument w s acknowledged before me on this ` 7I day of ��r�-J') o / by /+Li(JQ_ f Oi)R I(eL1 C'Z. who is personally known to me or produced as identification and who did not take an oath. ge.94k Ai i 024 MTh P.NASH Signature of Notary r�,�n� A s Notary Public-State of Reticle ^'i+• My Comm.Expires Jul 2.2017 x.'1114 SINN nee*Woad Mara. \, . ate° ....,...: ..xt. ......:.:... .,. ..yva .., T..:.. .. ,. .,.. .�.:. .....:,....w. F NERIFICATION OF CONSTRUCTION EXPERIENCE ..emu GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 3plicant's Name: A bPi A ft Cc 1 Pejc"c' ;rtificate Category Requested: ?Qin ! 1 l ,e Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the )plication for this certificate the Applicant must verify their experience within this trade. You are being requested to •ovide information that will aid the Applicant in meeting this requirement. You should verify time of active experience )rking as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). me served solely in a supervisory or administrative role should be described, but may or may not be considered fficient to demonstrate required trade experience. The person verifying trade experience must provide the following formation: ime, Title and license number of the person signing below and verifying Applicants relevantexperience: tme: , 6F A : 9012.. , :le: j il,r~5s`DF e T License Number(if applicable): CC C '3 3_3/ tme of Business: 7r/w'PitC 4 e (__ c7,-c1`22 ALe WA .F- /t pi,."!6 isiness Address: g 2 G' 4,/<.imti c.l- a. I f lAPL C eI 34 Ct1 isiness Phone: 2 3`7 { 3/3' The Applicant's years of experience from cOO '( to ;20/1/ ie applicant's scope of work (specific duties) included: Iditional Comments: 7 d cr/ 7`it AE,. C'/Acs?v ANA /{r /443 c..--,s. 4t 7 1-1;/e , F FR' T tf 11% /7 j+ r , tri lI E /f/s5 Ti/f- s k � �c � r I S'/ r 'rife hi( /=`pFS F Isifying any information provided herein may subject your license to revocation. Signa re 7_ Print'Name: v o c ,q- / /r, ate of Florida unty of Collier e foregoing instrument was acknowledged before me on this /7 day of (Yea rch aC/cI E2t& 4. I! FEZ who is personally known to me or produced ,lbr x'r'c c e -91 - identification and who did not take an oath. 4-YL 761, //0 RITA P.NASN Signature of Notary :Oil Notary Public•SUN of Ronde• My Comm.Expos Jul 2.2017 �2 Commission•fF 32030 lorded NOW Assn. , VERIFICATION OF CONSTRUCTION EXPERIENCE'l GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: A_ yr A- 0 Co(J Certificate Category Requested: 'PA,--rA. -e7J7 (o4.21-?-4 C 4 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 nsee number of the person signing below and verifying Applicants relevantexperience: Name: A1' 1 A /P n7 ',v Title: i/• P License Number(if applicable): / 72 \Jame of Business: Rie.__s f cf_ p/¢-g ,,/,t//7,-;y S /12C 3usiness Address: 94 ..c.4.7 f/ /,1 , 3usiness Phone:2,:// "T5d l�-7,' The Applicant's years of experience from ,c;7a)6 to 2---% Elie applicant's scope of work (specific duties) included: ,_- // 2,...,2-2) .�'G ,4-. kdditional Comments: ralsifying any information provided herein may subject your license to revocatil • /ice_ _ ignature � �-�j� Print Name: ir7 ' A2'.. 2 tate of Florida :ounty of Collier he foregoing instrument was ack owledged before me on this 3) day of M 4 A C4 y 4 A -4I -"4 Alt-) who is personally known to me or produced -FL h'6,2„ob _ s identification and who did not take an oath. C.,"„ityl "" MELISSA ROSALI NARNEY Signature of Notary ■ ;O4,y,Y P`'e�,, 4 r �- Notary Public-State of Florida ( s-;:-;',,e,,,,„41•i My Comm.Expires Jan 8,2017 Commission 0 EE 850961 ,, of r� ; , 'i isP Bonded Through National Notary Assn. a� 41 —_ — — ! - - -N - A 1pha omega eimAfroleflon «,4 pi ./nut • 3784 Progress Ave Suite 104 Naples, Fl 34104 Ph.(239)261-4755 www.aocnaples.com 3/18/14 Attn:CILB Re:Adrianno Cordero To Whom it May Concern: Please accept this letter as my high recommendation for licensure of Adrianno Cordero. I can vouch for Mr. Cordero both personally and professionally. He has as always conducted himself with integrity and honesty. He has always shown the skill and professional responsibility necessary to perform on his own as a licensee. He has worked for me for many years as an employee of other painting firms that I have contracted with and has also worked for me as an employee. Please contact me if you have any questions, Michael J Wagner Jr '/7; /d1/ Alpha Omega Construction of Naples,Inc CBC1259125 Confidentiality Warning: This e-mail contains information intended only for the use of the individual or entity named above. If the reader of this e-mail is not the intended recipient or the employee or agent responsible for delivering it to the intended recipient, any dissemination, publication or copying of this e-mail is strictly prohibited.The sender does not accept any responsibility for any loss, disruption or damage to your data or computer system that may occur while using data contained in, or transmitted with,this e-mail. If you have received this e-mail in error, please immediately notify us by return e-mail. Thank you AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, _, am a resident of C a f(i County, l 0 r-t 06- (State) and have resided here for more than five (5) years. During the last five years I have known Adtrt &y o C✓eler0 applicant). I have had the opportunity to observe his or her business and personal dealings and find him or---r to be a person of honesty, integrity and good character. (Signature) 7: (Name) A s • • (Address)59 q 2 ;�( .51- P1-- SL J f Wiles 7L 3i//fo Telephone) 23q -- 60l-~ 400 l STATE OF FLORIDA COUNTY OF (V LU eg The instrument was acknowledged before me this S_.I -7 1 11- by fr'I del f�GIC'Z (Date) who has produced �L (name of person acknowledging) (Type of identification) as identification and who did not take an oath. 1 / I: SIGNA Eci?OTARY Ho(-r-e, Can NOTARY'S SEAL (PRINT NAME OF N�Y) NOTARY PUBLIC =?o`..'"v% MARIE D GONZPER MY COMMISSION#FF064894 °Noso.a?;.' EXPIRES November 2,2017 (407)398-0153 FloridallotaryService.com • + AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, IBC n As N , am a resident of Cr) t t t County, (2) (State) and have resided here for more than five (5) years. During the last five years I have known 1 Ck (}Q Cj"be_Ao 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. qq�� (Signature) R.. 16'' t2o k!--""k(Name) ► I Qom i1 t15 H if ` (Address) 3L /5 D J? 1/ 4 �� naPikt Telephone) 39 --A? - 6 Q 6 STATE OF FLORIDA COUNTY OF CO1--1-I The foregoing instrument was acknowledged before me this 8 1 —1- s q by R l zt 'P A1L - (Date) who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath. STGNATURr 0, OTARY ptita A NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC p„a- ; MARIE D GONZPER " MY COMMISSION#FF064894 '•' oF vo` EXPIRES November 2,2017 (407)398-0153 FloridallotarySerylcP.com (•k -1-( , ,,: ) a - -�,'c-/'6. `/ A�TCI CERTIFICATE OF LIABILITY INSURANCE DATE;2;;2x1°`4"' 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). CONTACT Melanie Conrad-Brooks PRODUCER NAME: _. PHONE F No.ExtI: 239-513-0555 AN,No): GULFCOAST INSURANCE CENTER ADDR ESS: melanieb©allstate.com ADDR 899 VANDERBILT BEACH RD#109 INSURER(S)AFFORDING COVERAGE NAtC 0 NAPLES,FL 34108 INSURER A: CYPRESS INSURED __ __. INSURER B: Eco System Paint LLC/Adrian Cordero INSURER c: 5171 Hickory Wood Drive INSURER D: __ NAPLES,FL 34119 INSURER S; „__ , INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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. ADD(.SUER -�— - POLICY EFF POLICY EXP IN TYPE OF INSURANCE INSR WVD POLICY NUMBER •JMM/DD/YYYYL(MM/DD/YYYYL. LIMITS GENERAL LIABILITY EACH OCCURRENCE $_. 100,000 DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea axon-once) S CLAIMS-MADE 1 X1 OCCUR MED EXP(Any one person) _ $ ,5,000 A 20P0040604-0 03/21/2014 03/21/2015 PERSONAL&ADV INJURY $ 100,000 GENERAL AGGREGATE $ 200,000 GEM%AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 100,000 —1 POLICY JFQT — LOC AUTOMOBILE UABILITY (ECOMBINED ISINGLE LIMIT $ ' ANY AUTO BODILY INJURY(Per person) $ - -- ALL OWNED SCHEDULED BODILY INJURY(Per acddent) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABIIJTY Y/N _IQRY I IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE 1 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractor Licensing Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 N Horseshoe Drive ACCORDANCE WITH THE POLICY PROVISIONS. Naples,FL 34104 AUTHORIZED REPRESENT IhE c':-2y” (77,i ACORD 25(2010/05) r. 019888''-2010 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD Welcome to One Time Pay 3/LO/14,8:11 PN a � Your one-time payment has been scheduled. Remit Information Exemption Fee: 50.00 Convenience Fee: 1.00 Business Name: Eco'System Paint Llc Applicant Name: Adriano Cordero Payment Confirmation-Please print for your records. Date&Time: Thu.Mar 20.2014 20:10:49 Name on Credit Card: Soraya Cordero Account Number: E00198379 Address Line 1: 5171 hickory wood dr Address Line 2: City,State,Zip: naples,fl 34119 Credit Card Account Number: ****2559 Payment Date: 03/21/2014 Payment Amount: $51.00 TOTAL PAYMENT: $51.00 Credit Card Auth: 101703 Transaction Confirmation: 188992406 print page Enter Email Address: adrianocordero @outlook.c 0 send confirmation Continue https://dimension2.princetonecom.com/otp/Fu ndingCCVerifyConfirm.do Page 1 of COLLIER COUNTY BUSINESS TAX RECEIPT QFTHES4 ' APPLICATION l --="' ! 9—, ,'rrn9 t °.W' ll�PS' �I • 4. 2800 N.Horseshoe Drive,Naples,FL 34104 r, os J Make Check Payable to: Collier County Tax Collector -,. Phone: 239-252-2477 Fax: 239-643-4788 Website:www.colliertax.com > o..,n® -,' CHECKLIST 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 - !-C O S� S �A \•-i )/DBA NAME - ' lb) BUSINESS OWNER OR QUALIFIER'S NAME - e__\�\\'0\k 1 Co ?---_C\_Q � 2) PHYSICAL ADDRESS - h VIA \ \-\C'�,2\\ �c, �c- .\ -Kl-c--,S (-\1 (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - Y Yes No 3) BUSINESS MAILING ADDRESS- \-A-\ ��\C\�'0 k.s^ VI- �� �_c) L ?L\1` Street City Zip• 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - S P 'N'1 -Q 5) TELEPHONE -Business: 7:3> c- 711:T - \ 23 Home: c'1 2 7 • 1 l 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- X Yes No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. � - ` '\` - *see back of application for explanation \ 9a) TYPE OF BUSINESS CONDUCTED: 10 / NUMBER OF EMPLOYEES -Including number of owners: 1". 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 1 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::`** . ' IR Co t eT County COLLIER COUNTY GOVERNMENT DEPT. OF ZONING& LAND DEVELOPMENT REVIEW WWVV.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 employees 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 7 –* -C'— Zc `(----� ZONING CERTIFICATE#TC- APPLICANT'S NAME C c-\V�J G C�33 . P K� PHONE: APPLICANTS HOME ADDRESS *- .�.lC �('' 1--- LL-b(, L \L + ���" Y ?< TYPE OF BUSINESS TO BE CONDUCTED V N K.1 ' r`-'' r C (`J G\C'��?L z- BUSINESS NAME(IF ANY) t Cl-16I c-)\/- \ "'\ V t Y` \ C Q I, the undersigned, hereby affirm that I am the legal owner of the property at the above address or that I 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 X DATE FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" ellIMMINIIIMIII0 k, TO BE COMPLETED BY COUNTY STAFF ZONING: PROPERTY ID# DATE REVIEWED BY APPROVED HOLD DENIED COMMENTS/RESTRICTIONS: Must comply with Section 5.02.00 of the LDC (see back of application). I ax Collector Staff: Please forward a copy of issued certificate and receipt to Collier County Zoning Department. J/LVILVIY i• v ua.a.�ayua � r � Y ' • Applications updated after 5:30 PM will be received by the Division the next business day. Please select which ID to search by: • *State Driver's License Number: or *Florida Identification Number: State Issued: Florida Driver's License: Last Name: CORDERO Enter Back E00198379 Adriano Cordero Eco'System Paint Lic Completed Successful View/Print Application Adriano Cordero Eco'System Paint Llc Completed Successful Print Exemption Certificate Print Exemption Certificate Wallet ADRIANO CORDERO ECO'SYSTEM PAINT LLC https://apps.fldfs.com/bocexempt/Search_Application.aspx#b 1/1 Hublar Lopez Rodriguez—D/B/A- Nian Construction Inc C.L.B. Case#2014-06 Table of Contents E-1 through E-2—Administrative Complaint E-3 through E-4—Case Summary E-5-through E-7- Formal Complaint E-8-Signed Notice of Hearing E-9-State of Florida, Department of Financial Services Division of Workers'Compensation Stop-Work Order, dated March 10th, 2014 E-10-Collier County Certificate of Competency E-11-through E-12-Corporation Detail E-13-History of the State of Florida, Department of Financial Services Division of Workers'Compensation Stop-Work Orders for Nian Construction E-14-through E-16-email from Insurance Agent E-17-through E19-Workers Compensation Proof of Coverage Page and Exemptions E-20-State of Florida, Department of Financial Services Division of Workers' Compensation Stop-Work Order, dated July 11th, 2013 E-21 through E23-Code Case Detail Report for CEMIS20130009795 and citation#7702 for 1st offense for failing to obtain Workers'Compensation coverage. E-24 through E-25-Code Case Detail Report for pending case CEMIS20140005028 E-26 through E-27- Florida Statute 440.10(1) (a) Liability for Compensation E-28 through E-30-Collier County Ordinance 90-15, as amended, Section 22.201(6) BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, V. Case Number: 2014-06 Hublar Lopez Rodriguez License Number: LCC20120004890/RB29003585 D/B/A—Nian Construction Inc Respondent. ADMINISTRATIVE COMPLAINT Collier County(County) files the Administrative Complaint against Hublar Lopez Rodriguez (Respondent), a Collier County licensed Registered Building Contractor( license# LCC20120004890/RB29003585),and states the following facts and allegations in support of the cited violations below: 1. The Respondent is currently licensed by Collier County as a Registered Building Contractor with License number LCC20120004890. 2. Under the provisions of Collier County Ordinance 90-105, as amended,Section 22-201,the following actions by a holder of a Collier County/City shall constitute misconduct and grounds for discipline pursuant to Section 22-202. a. On March 7th, 2014, it was discovered that, at an active construction jobsites at 2785 Linda Dr(Permit#PRBD20130613650), 2805 Linda Dr(PRBD20130613641) and 2837 Linda Dr (PRBD20130613638), Hublar Lopez Rodriguez, qualifier of Nian Construction, had employees performing construction without workers'compensation coverage, as required pursuant to Florida State Statute 440.10(1) (a). Said violation of the Florida State Statute 440.10(1) (a) constitutes a violation of Collier County Ordinance90-15, as amended,Section 22.201(6). This is the 2' violation concerning workers' compensation insurance for Nian Construction. b. 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. 3. Collier County brings the following charge in this formal complaint against the Respondent. COUNT I 4. Collier County Ordinance 90-105, as amended,Section 22.201(6) states "Disregards or violates, in the performance of his contracting business in the county, any of the building, safety, health, insurance or workers' compensation laws of the state or ordinances of this 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 WHEREFORE, in consideration of the foregoing,the Petitioner respectfully requests the Collier County Contractors' Licensing Board to find the Respondent guilty of the violations charged. Dated: March 21St, 2014 Signed: —' ' Collier County Contractors' Licensing Supervisor or Designee C.L.B. Case#2014-06 Hublar Lopez Rodriguez D/B/A: Nian Construction Inc A Collier County Registered Building Contractor: LCC20120004890 Violation of Collier County Ordinance 90-15, as amended, Sect: 22.201(6): Disregards or violates, in the performance of his contracting business in the county, any of the building, safety, health, insurance or workers' compensation laws of the state or ordinances of this county. On Wednesday March 10th, 2014, I received a call from Aysia Snodgrass who is a compliance investigator for the Florida Department of Financial Services, division of workers' compensation in regards to Nina Construction Inc jobsites that she was on March 7th, 2014. I met with Ms. Snodgrass at new construction jobsites on Linda Dr in the Bayshore area. All the jobs are permitted jobs by Nian Construction Inc. Ms. Snodgrass advised that when she was on site on March 7th, 2014 she observed work consisting of tile install, pavers install and soffit repair/work for jobsites at 2837, 2785 and 2805 Linda Dr. As per Inv. Snodgrass all workers claimed to be employees of Nian Construction and when she spoke to Mr. Antonio Brown (President of Nian) he confirmed that workers were employees and not subcontractors. Workers 'Compensation exemptions only for Mr. Brown and qualifier Hublar Lopez Rodriguez. Inv. Snodgrass supplied me with an email from Greg Roe from Roe Insurance which states "Aysia, please see attached signed and dated applications and screen shot below reflecting the time stamp of 3/7/2014 16:12 (412pm). The insured contacted me Friday about 2pm advising that he had neglected to send back his signed Work Comp applications and needed coverage ASAP due to WC Compliance inspection on his jobsite. I received the applications from him at 252pm and issued his policy and sent it to him at 302pm." A State of Florida, Department of Financial Services Division on Workers' Compensation stop work order was issued to Nian Construction Inc by Compliance Investigator Aysia Snodgrass on March 10th, 2014 for failing to obtain workers' compensation coverage for �-3 employees for jobsite date of March 7th, 2014. A Notice of Hearing for the Collier County Contractor Licensing Board was issued on March 11th, 2014 by Licensing Officer Thomas Keegan to Hublar Lopez Rodriguez for a second workers' compensation violation. Contractors' Licensing Board 2800 North Horseshoe Drive Naples, Fl. 34014 Complaint Number: 2014-06 Complainant:Any person that 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 copied of the complaint. Date: March 2152, 2014 Against: Contractor's name: Hublar Lopez Rodriguez Phone: 786-318-7836 Business name: Nian Construction Inc License number if known: LCC20120004890 Collier County Competency number: LCC20120004890 Contractor's business address: 6006 Radio Rd Naples, Fl Filed By: Name: Collier County Contractors' Licensing/Thomas Keegan Address: 2800 N. Horseshoe Dr Naples, FL 34104 Business phone:239-252-2468 Address where work done: 2/85, 2805 &283/ Linda Drive Naples, FL County: Collier Date of contract: N/A Date job started: N/A e-5 Date job completed or new home occupied: N/A Were there plans and specifications? N/A Is there a written contract? N/A If yes, amount of Contract? N/A Has Contractor been paid in full? N/A If Contractor has NOT been paid in full, what amount is paid? N/A Was a Building Permit obtained?Yes Building Permit number if known: PRBD20130613650(2785)/PRBD20130613641 (2805)/ PRBD20130613638 (2837) Have you communicated by letter with the licensee?Yes Date: March 11th, 2014 Do you have a reply? N/A 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): Section 22.201(6). Disregards or violates, in the performance of his contracting business in the county, any of the building, safety, health,and insurance or workers' compensation laws of the state or ordinances of this 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: On March 7th, 2014, it was discovered that, at active construction jobsites at 2785, 2805 and 2837 Linda Dr Naples, FL, Hublar Lopez Rodriguez, qualifier of Nian Construction, had employees performing construction without workers'compensation coverage, as required pursuant to Florida State Statute 440.10(1) (a). This is the 2nd violation concerning workers' compensation insurance for Nian Construction. (Complainant'. /1111.1r 6 State of: %' /< /C County of: (73/ / /rr Sworn to (or affirmed) and subscribed before me this f / day of p 0 cc '1 , 201 613 By I ;(m S (-c- fl (signature of person making statement). _ _Aar (signature of Notary Public) 4111W - Print,type or stamp name of Notary Publi • . , ■ M 1 G I CD Personally known or p roduced identification. \ccR6\A X5■44 0.0,-\ONtFF M18 ,VU C L` o,;• MV CAM NaN� ice= is •,n_a @�__... ' emseco00Boa s ltE of cs'O E-7 Collier County Growth Management Division / Planning and Regulation Operations Department/ Licensing Section Hand Delivered Date: March 11,2014 RE: Complaint filed against you by Collier County Contractor Licensing Department regarding a violation of disregarding or violating, in the performance of his contracting business in Collier County, any of the building, safety, health, insurance or Workers Compensation laws of the State of Florida or ordinances of this County on March 7`h, 2014 Dear: Hublar Lopez Rodriguez D/B/A-Nian Construction Inc 6006 Radio Rd Naples, FL 34104 A complaint has been filed against you by the above referenced individual. A hearing of this complaint will be held by the Contractors' Licensing Board on April 16th, 2014 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)4.1.6 of Ordinance#2002-21 the range of disciplinary sanctions which may be imposed are from an oral reprimand to a suspension or revocation of your Collier County Certificate#LCC20120004890 . Sincerely, Thom. - Licensing Compliance Officer j ■ Phone#239-252-2468 G'� STATE OF FLORIDA, DEPARTMENT OF FINANCIAL SERVICES • DIVISION OF WORKERS'COMPENSATION EMPLOYER NAME: NIAN CONSTRUCTION INC STOP-WORK ORDER No.: 14-085-D7 FEIN: 800868281 ISSUANCE DATE: 3/10/2014 EMPLOYER ADDRESS: 6006 RADIO RD CITY: NAPLES STATE: FL ZIP: 34104 WORKSITE POSTING ADDRESS: 2785 LINDA DR CITY: NAPLES STATE: FL ZIP: 34112 INDUSTRY OF EMPLOYER: • Construction O Non-Construction 0 Agriculture STOP-WORK ORDER Pursuant to Section 440.107, F.S.,the above-referenced Employer is hereby ORDERED TO CEASE ALL BUSINESS OPERATIONS FOR ALL WORKSITES IN THE STATE based on the following violation(s): ✓ Failure to secure the payment of workers'compensation in violation of sections 440.10(1),440.38(1), and 440.107(2) F. S., by: ✓ failing to obtain coverage that meets the requirements of Chapter 440, F. S., and the Insurance Code; materially understating or concealing payroll; materially misrepresenting or concealing employee duties so as to avoid proper classification for premium calculations; materially misrepresenting or concealing information pertinent to the computation and application of an experience rating modification factor. Failure to produce required business records within 5 business days in violation of section 440.107(7)(a), F.S. Failure to produce required documents within 3 business days in violation of section 440.05(11), F.S. THIS STOP-WORK ORDER MAY BE AMENDED TO INCLUDE ADDITIONAL VIOLATIONS AND SHALL REMAIN IN EFFECT UNTIL THE DIVISION ISSUES AN ORDER RELEASING THE STOP-WORK ORDER FOR ALL WORKSITES. CONDUCTING ANY BUSINESS OPERATIONS IN VIOLATION OF THIS STOP-WORK ORDER CONSTITUTES A FELONY OF THE THIRD DEGREE AND A PENALTY OF$1,000.00 PER DAY FOR EACH DAY OF VIOLATION SHALL BE ASSESSED. ORDER OF PENALTY ASSESSMENT: A penalty against the Employer is hereby ORDERED in an amount: ,/ Equal to 1.5 times the amount the employer would have paid in premium when applying approved manual rates to the employer's payroll during periods for which it failed to secure the payment of workers'compensation required by this chapter within the preceding 3-year period, or$1,000,whichever is greater. Section 440.107(7)(d), F.S. Up to$5,000 for each employee who the Employer misclassified as an independent contractor. Sections 440.10(1)(f)and 440.107(7)(f), F. S. The Stop-Work Order In this case shall remain in effect until the Division either(a),issues an order releasing the Stop-Work Order upon finding the employer has come into compliance with the coverage requirements of the Workers'Compensation law and paid the total penalty In full,or(b), Issues an Order of Conditional Release from Stop-Work Order pursuant to the employer coming into compliance with the coverage requirements of the Workers'Compensation law and entering into a Payment Agreement Schedule For Periodic Payment of Penalty. Please see the Notice of Rights on the reserve side that pertains to your rights regarding this action. CERTIFICATE OF SERVICE Pursuant to section 440.107(4), F.S., AYSIA SNODGRASS served a true copy of this Stop-Work Order: ✓ By posting at the Worksite: DATE: TIME: SERVER: ✓ By hand delivery: DATE: TIME: SERVER: By certified mail: DATE: TIME: ARTICLE: Rev 09/19/2012 9 COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION INFORMATION LCC20120004890 Certification Information Collier County Board of County Commissioners Date: January 24, 2014 DBA: Nian Construction Inc ADDRESS: 6006 Radio Rd Naples, FL 34104 PHONE: 786-318-7836 CELL: FAX: LICENSEE NBR: LCC20120004890 QUALIFIER: Lopez Rodriguez, Hublar TYPE: BUILDING CONTR.-REGISTERED CLASS CODE: 1100 STATE NBR: RB29003585 ISSUANCE NBR: 201200002273 STATE EXPIRATION: INSURANCE: ORIG ISSD: COUNTY EXPIRATION: August 31, 2015 General Liability December 11, 2012 September 30, 2014 March 26, 2014 Worker's Comp Exemption March 11, 2015 NOTE: It is the Qualifier's responsibility to keep all business, licensing and requirements current and to provide up to date copies for Collier county files. This includes all insurance certificates and any change of address information. Collier County * City of Marco * City of Naples Contractor Licensing BUILDING CONTR.-REGISTERED Cert Nbr: County Exp: Status: LCC2012000489 September 30, 2014 Active 0 State Nbr: State Exp: RB29003585 August 31, 2015 Nian Construction Inc Lopez Rodriguez, Hublar 6006 Radio Rd Naples, FL 34104 Signed: C-(D v 1 FLORIDA PA , MNT OF STATES ` DIVISION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation NIAN CONSTRUCTION INC Filing Information Document Number P12000096333 FEI/EIN Number 800868281 Date Filed 11/21/2012 State FL Status ACTIVE Principal Address 6006 RADIO RD NAPLES, FL 34104 Mailing Address 6006 RADIO RD NAPLES, FL 34104 Registered Agent Name & Address SPL INCOME TAX CORP 6006 RADIO RD NAPLES, FL 34104 Officer/Director Detail Name & Address Title P BROWN,ANTONIO 6006 RADIO RD NAPLES, FL 34104 Title VP LOPEZ RODRIGUEZ, HUBLAR 6006 RADIO RD NAPLES, FL 34104 Annual Reports Pi I http://search.sunbiz.org/Inq ui ry/CorporationSearch/SearchResultDetai I/EntityName/donp-p12000096333-6abcc8bc-0474-4b23-bf7c-907fc05e066d/ni an%20con... 1/2 .5/Z ULU 14 Detail eyLntityName Report Year Filed Date 2013 04/29/2013 Document Images 04/29/2013 --ANNUAL RE PORT View image in PDF format 11/21/2012 -- Domestic Profit View image in PDF format Cry-i0^` •=‘3,C; PRacy Policies State oft bibs,Deoaitmeo.t of http://search.sunbiz.org/Inq uiry/CorporationSearch/SearchResultDetail/EntityName/domp-p12000096333-6abcc8bc-0474-4b23-bf7c-907fc05e066d/nian%20con... 2/2 3/11/2014 stop vvorK uraers r ® fog t : ' a f x 'Yfr �€gr ttrR" s q C - onii .emu r -a gY P f JEFF ATi IATE RJ,CI1IE `I CIr OF I ER °� DLOr t. DI#' PMt'�';;MENT OF -FiT^�'► CIA.L;S R'i1ICES Stop-Work Orders This Database nas Last Updated:3/11/2014 12:12:09 AM You Searched for all Stop Work Orders like-nian- Your Search Found 2 Stop Work Orders 7/19/2013 anp4cts,er Bate Date: County City Bate Ended* }2e as on Name Served Reins bate ct"" NIAN FAILURE TO CONSTRUCTION COLLIER NAPLES 7/11/2013 7/19/2013 not reinstated OBTAIN INC COVERAGE NIAN FAILURE TO CONSTRUCTION COLLIER NAPLES 3/10/2014 not released not reinstated OBTAIN INC COVERAGE c,:mpl a,r has com,.ink)mrapiianac da:a.,...-s :k,:np,m5.zai0f1 _fx1.--Cfls( -' and crt(a-.t:_t„<ax-ric,dia payni:;,ni .1)1all i ::1r.; i! ,;a,paid tip.:n. ` em.l.t,el r<>-ems +a i rok l'3ymelv...\ort%Anent a:;the aa.J t.,: of €..ice tc Return to Query Form http:/Mww.myfloridacfo.comNVCAPPS/SWO/Emplist.asp 1/1 • KeeganThomas From: Greg Roe [greg @roeins.com] Sent: Monday, March 10, 2014 10:40 AM To: Aysia.Snodgrass @myfloridacfo.com Cc: ylang @bldrs.com; 'Linda Greenwald' Subject: RE: new policy confirmation Attachments: SKMBT_C20314030717020(3).pdf; Nian Construction New Work Comp Policy! Aysia, Please see attached signed and dated applications and screen shot below reflecting the time stamp of 3/7/2014 16:12. The insured contacted me Friday about 2pm advising that he had neglected to send back his signed Work Comp applications and needed coverage asap due to WC Compliance inspection on his jobsite. I received the applications from him at 2:52pm and issued his policy and sent it to him at 3:02pm (see attached email). 1 Sincerely, greq @roeins.com Cell: 813.263.8715 Office: 727-753-1020 Fax: 727-753-1021 http://vvvvw.Roeins.com Roe Insurance, Inc. 9851 State Road 54 New Port Richey, Fl. 34655 You cannot bind,alter or change coverage by sending an email.The information contained in this e-mail is privileged and confidential. The information contained in this email does not alter or amend coverage,nor does it constitute a policy,contract or legal evidence of insurance.This e-mail is only intended for the use of the individual or entity to which it is addressed and for the legitimate business purpose of Roe Insurance,Inc.Roe Insurance,Inc.shall not be responsible for any unauthorized use of this e-mail or any errors contained herein. If the reader of this message is not the intended recipient,or the employee or agent responsible for delivering the message to the intended recipient,you are hereby notified that any dissemination,distribution or copying of the communication is strictly prohibited. If you have received this email in error,please notify us Begin forwarded message: From:Yvette Lang<ylang@bldrs.com> Date: March 10, 2014 at 8:58:17 AM EDT To: Eddie Boshears<eboshears@bldrs.com> Cc: Linda Greenwald <IGreenwald@bldrs.com> Subject: FW: new policy confirmation Yvette Lang, MBA Builders Insurance Group Sr. Underwriter Asst. 678-309-4022 (direct) 678-322-1207 (fax) Toll Free 800-883-9305 ylang @bldrs.com From: Snodgrass, Aysia [mailto:Aysia.SnodgrassCamyfloridacfo.com] Sent: Monday, March 10, 2014 08:47 AM To: Yvette Lang Subject: new policy confirmation Importance: High Pursuant to "Florida State Statute 624.318(2)" , I am requesting information for a new policy written for Nian Construction Inc. Policy#WCV 0166090 00. I need a copy of the date/time stamped ACCORD application for coverage for an ongoing state investigation on this employer. Please respond this morning so the state can continue on with it's investigation/release of the employer. alpia Saadra(56 C166C9O DFS-Division of Workers'Compensation Bureau of Compliance 2295 Victoria Ave.,Suite 284 Fort Myers, FL 33901 Telephone:239-461-4077 VOIP:74077 c� 3 �' l J hops ,,�,•��.ams360 corn �., 7 ;. J 1 _ �. Vertafor Inc....( X � � ' Customer Cent,.. x IA Builders File Edit v ra Ufite_= Tcok: Heil; AMS3... ]AMS.... 0 1787... 41.1 ADP... i AUT , BC2... BenC... Bene. BIG Sunbiz Ff ... ElNew Activity ! ®New Suspense LLB eForms 1 c Doc36G Search S 3 6 0 . : .: Home Customer Bank Broker a Company Employee Vendor I Financial + Administration Custom^r. r' Tr•:- Documents 5,.7 `'. lain Co i r ,inc , '^ '" " ' '� '5� •r'�'Y`- Document File Name: SKMBT C20314030717020 Doc. Type: Extension: PDF Description: WC signed apps for BIG Received Date: 03/07/2014 16:12 Eastern Standard Time —Document Attrib File Size (Kb): 195 Reference #: 140307-211 F Compresse Storage Location: Database Index 1: r Encrypted Status: Processed Index 2: r Document Attac Processed Date: 03/07/2014 15:12 Security Class: Unrestricted I 17 Activity Eastern Standard Time r Notes Processed By: Gregory Roe r Vendor Invi r eForms Change Index Information View Attachmer Distribution Comments: j _ `_� j f 1001 ui k,uvclage rage 1 OI 1 JEFF,ATW;ATgLCHIEF FIN1LN TAL O FICER ` ter' µ FLORIDA DEPARTMENT OF'PINAN.CIAL'SERVICES WC Home WC Databases CFO[tome Locations Detail Page This database was last updated Sunday,March 30,2014 12:14 AM. Return to Employer Detail Page NIAN CONSTRUCTION INC Policy Number:WCV0166090 Cancellation Effective Effective at Street Address City State' Zip ; Number of Date 12:01 A M Employees Mar 7 2014 I Current I 6006 RADIO RD NAPLES FL f.884U 3 *Represents the total number of employees as reported by the insurance carder **Carriers were not required to report the total number of employees for policies issued prior to October 1,2009 Return to Search Page https://apps8.fldfs.com/proofofcoverage/LocationsDetail.aspx?PolicyID=WCV 0166090&... 3/31/2014 Report Viewer Page 1 of 1 3 45 1 11 -'Ib00% f' JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF.FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 4/1/2013 EXPIRATION DATE: 4/112015 PERSON: BROWN ANTONIO B FEIN: 800868281 BUSINESS NAME AND ADDRESS: NIAN CONSTRUCTION INC 6006 RADIO RD NAPLES FL 34104 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR Pursuant to Chapter 440.05(14)F.S,on officer or a corporation who elects exemption from this chapter by fling a cartikxte of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440 05(12),E.S.Certificates of election to be exempt..apply only within the scope gale business or trade toted on the notice of election to be exempt.Pursuant to Chapter 44,041U F.S..Notices of election to be exempt and certistates of election to be exempt seat be subject to reyocaton R.at any tkne atter the filing of the notice or the issuance of the eertifcate,the person named on the notice or certificate no longer meet,the requirements of this section for issuance of a certificate.The department shall revoke a oerbfxete at arty time for failure of the person named on the cdxxr.cale to meet the requirements of this section. DFS-F2-DWG252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?1850)413-1609 https://apps8.fldfs.comlcrreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6... 6/28/2013 • Report Viewer Page 1 of 1 ... 1 ...,.1. j'1 .1.1100% t.... • JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 3/11/2013 EXPIRATION DATE: 3/11/2015 PERSON: LOPEZ RODRIGUEZ HUBLAR FEIN: 800868281 BUSINESS NAME AND ADDRESS: NIAN CONSTRUCTION INC 6006 RADIO RD NAPLES FL 34104 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,as officer of a corporation who elects exemption from teas chapter by Ming a carofcataoh eroracn under Ois section may not recover benefits or compensation under rtes chapter.Pursuant to Chapter 440.05(12).F.S.,Cerdhacates of alection to be exempt,.apply ordy within the sops or the Lusinesa or trade;Mod on the note*oh elecaul to be exempt,Pursuant to Chapter 440 05(13),F.S„Hoboes of Cotton to be exempt and caru(catas of elecbo lo be exempt shall be subject toevora0 on it,.at any lune after the Ong of the nonce.or Ore issuance of the ceniflcate, Fie person named on the notice or cerhbrate no longer meets the r puiremens or this secton for issuance of a certificate.The department anal revoke a OFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 https://apps8.fldfs.comfcrreportv fewer/reportV iewer.aspx?data=kdvpginc9D7Q3 gH6TER6... 1/22/2014 STATE OF FLORIDA, DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION EMPLOYER NAME: NIAN CONSTRUCTION INC STOP-WORK ORDER No.: 13-167-D7 FEIN: 800868281 ISSUANCE DATE: 7/11/2013 EMPLOYER ADDRESS: 6006 RADIO RD CITY: NAPLES STATE: FL ZIP: 34104 WORKSITE POSTING ADDRESS: 3560 CORINTHIAN WAY CITY: NAPLES STATE: FL ZIP: 34105 INDUSTRY OF EMPLOYER: . Construction 0 Non-Construction 0 Agriculture STOP-WORK ORDER Pursuant to Section 440.107,F.S.,the above-referenced.Employer is hereby ORDERED TO CEASE ALL BUSINESS OPERATIONS FOR ALL WORKSITES IN THE STATE based on the following violation(s): ✓ Failure to secure the payment of workers'compensation in violation of sections 440.10(1),440.38(1),and 440.107(2)F S.,by ✓ failing to obtain coverage that meets the requirements of Chapter 440, F.S.,and the insurance Code; materially understating or concealing payroll; materially misrepresenting or concealing employee duties so as to avoid proper classification for premium calculations; materially misrepresenting or concealing information pertinent to the computation and application of an experience rating modification factor. Failure to produce required business records within 5 business days in violation of section 440.107(7)(a), F.S. Failure to produce required documents within 3 business days in violation of section 440.05(11.),F.S. THIS STOP-WORK ORDER MAY BE AMENDED TO INCLUDE ADDITIONAL VIOLATIONS AND SHALL REMAIN IN EFFECT UNTIL THE DIVISION ISSUES AN ORDER RELEASING THE STOP-WORK ORDER FOR ALL WORKSITES. CONDUCTING ANY BUSINESS OPERATIONS IN VIOLATION OF THIS STOP-WORK ORDER CONSTITUTES A FELONY OF THE THIRD DEGREE AND A PENALTY OF$1,000.00 PER DAY FOR EACH DAY OF VIOLATION SHALL BE ASSESSED. ORDER OF PENALTY ASSESSMENT: A penalty against the Employer is hereby ORDERED in an amount: ✓ Equal to 1.5 times the amount the employer would have paid in premium when applying approved manual rates to the employer's payroll during periods for which it failed to secure the payment of workers'compensation required by this chapter within the preceding 3-year period,or$1,000,whichever is greater. Section 440.107(7)(d), F.S. Up to$5,000 for each employee who the Employer miscassified as an independent contractor. Sections 440.10(1)(f)and 440.107(7)(f), P.S. The Stop-Work Order in this case shall remain in effect until the Division either(a), issues an order releasing the Stop-Work Order upon finding the employer has come into compliance with the coverage requirements of the Workers'Compensation law and paid the total penalty in full,or(b),issues an Order of Conditional Release from Stop Work Order pursuant to the employer coming into compliance with the coverage requirements of the Workers'Compensation law and entering into a Payment Agreement Schedule For Periodic Payment of Penalty. Please see the Notice of Rights on the reserve side that pertains to your rights regarding this action. CERTIFICATE OF SERVICE Pursuant to section 440.107(4), F.S., AYSIA SNODGRASS served a true copy of this Stop-Work Order: By posting at the Worksite: DATE: TIME: SERVER: By hand delivery: DATE: TIME: SERVER: By certified mail: DATE: TIME: ARTICLE: Rev 09/19/2012 tergov.net Report Title: Code Case Details Date: 3/11/2014 8:54:58 AM Case Number: cemis20130009795 r `: s s- is g rgike e_.i ti fiPti -Aa . Case Number: CEMIS20130009795 Status: Closed Case Type: Misconduct Date& Time Entered: 7/12/2013 9:30:48 AM Priority: Normal Entered By: lanJackson Inspector: lanJackson Case Disposition: Unpaid Jurisdiction: Contractor's Licensing Origin: Field Observation Detail Description: Citation 7702 to Hublar Lopez Rodriguez/Nian Construction, Inc.. Hired subcontractor w/no WC at 3560 Corinthian Way Location Comments: 3560 Corinthian Way/folio 27800003756 Property 27800003756 Contractor Lopez Rodriguez, Hublar eiak Business Management& Budget Office 1 • . Code Case Details Execution Date 3/11/2014 8:54:58 AM Vq ` i t a�i - .ISS E�'n i r '* : Desc -'Assigned Required Completed Outcome Comments Preliminary Investigation lanJackson 7/12/2013 7/12/2013 Citation 7/12/13.On 7/11/13, State Division of Required Financial Services,Aysia Snodgrass, issued State SWO to Corporation, Nian Construction, Inc., qualified by Hublar Lopez Rodriguez. Nian hired a subcontractor for drywall installation at 3560 Corinthian Way. Said subcontractor had no proof of WC coverage, violatin florida WC statute. Issue Citation(Licensing) lanJackson 7/12/2013 7/12/2013 Complete 7/12/13. Issued citation 7702 to qualifier for violating WC statute. Citation Paid/Contested consuelathom 7/26/2013 7/12/2013 Payment as Received Violation Description Status. Entered- Corrected Amount Comments Worker's Compensation Violation Open 7/12/2013 $0 Title Reason Result Compliance Fine/Day Condition Business Management& Budget Office 2 • COLLIER COUNTY— ( Q 2 BUILDING REVIEW& PERMITTING CITATION . Pursuant to section 489.127.(3)(a),Florida Statues,the undersigned hereby certifies that upon personal investigation,he/she has reasonable and probable grounds to believe that the person whose name appears below,as Issued To did violate Subsection 489 127(1),Florida Statutes, and Collier county Contractor's Licensing Ordinance No.97-68(as may be amended from time to time)by committing the violation stated below. /� Month Cay 1� I ear1-3 (Time r`' I� M/ M Issued To: ([ In/. ` i�"V Addres � I1 1r Itt / V 4 f City A bll fa State rl• Zip JI Tele.hon I. Race Sex Height Vehicle Make/Type(if applicable) Year Color Tag No. Location of Violation ,1414 uS(aj lair1 lam f OPTIONS'.; I have been informed of the violation of which!have been charged and elect the following option(Check one) 1) 0 1 choose to pay the penalties of$ i JV U on the Citation.. 2) 0.I choose not to pay the penalty and will request in writing by certified mail pr.hand delivery an Administrative Hearing.befor th Contractor's Licensing Board . Description of Violation 0:,0 f rt 4' Violation Observed I') 'I a) ❑ Falsely hold self or business org i t n out as a license,certificat hot er or ' registrant; b) []'Falsely impersonate a certificate holder or registrant; c) ❑ Present as his own the certificate or registration of another; d) ❑ Knowingly give false or forged evidence to the Board of a Member thereof; e) ❑ Use or attempt to use a certificate or registration which has been suspended or revoked; . 1) ❑ Engage in the business or act in the capacity of a contractor or advertise self or business organization as available to engage in the business or act in a capacity of a contractor without being duly registered or certified;' 8) ❑ Operate a business organization engaged in contracting after(60)days following the termination of its only qualifying agent without designating another primary qualifying agent,except as provided in ss 489.119 and 489.1195,Florida Statues; h) ❑'-Commence or perform Work for which a building permit is required pursuant to an ad pled state iunurnunt'building bode Without`such permit being in effect,or i) j�Willfully or deliberately disregard or violate any Collier County ordinance relating to /uncertified or unregistered contractors.., - A person or business organization operating on in Inac&e or suspended certificate Or registration,or ope in. :: and the scope of work or geographical scope of the registration,is not my e, ified or registered. i ii . /1 1 SIG. 'TORE '•ECIPIENT) SIGN I RE INVESTIGATOR) 0 ORD.,(i. (CPO> ..t.,„,t. IMild'ji,r '' . PRINT(RECIPIENT'Is NAME) P'INT(INVESTIGATOR'S NAME) Pursuant to 489.127,Florida Statues,willful refusal to sign and accept this citation constitutes a misdemeanor of the second degree,punishable as provided in section 775.082 or 775.083 Florida Statutes. (SEE REVERSE FOR INSTRUCTIONS) '27 669(900 3 731() COLLIER COUNTY CONTRACTORS LICENSE DEPARTMENT fergovmet Report Title: Code Case Details Date: 3/21/2014 10:06:34 AM Case Number: CEMIS20140005028 Ex___Vae;a....i k.., .,.= _ ,e.�.�-.AaA ..ee._..„. _ __ ,.0 _.. Case Number: CEMIS20140005028 Status: Refer to CLB Case Type: Misconduct Date&Time Entered: 3/11/2014 2:14:35 PM Priority: Normal Entered By: ThomasKeegan Inspector: ThomasKeegan Case Disposition: Case Pending Jurisdiction: Contractor's Licensing Origin: Complaint Detail Description: referal from state w/c-no insurance for employees -Nian Construction Location Comments: 2785 Linda Dr 2805 Linda Dr 2837 Linda Dr � I Property 55700280007 Contractor Nian Construction Inc Qualifier HUBLAR LOPEZ 670j4 Business Management& Budget Office 1 • Code Case Details Execution Date 3/21/2014 10:06:34 AM Desc Assigned Required Completed Outcome Comments Preliminary Investigation ThomasKeega 3/11/2014 3/12/2014 Needs 3/12/14-received call from Aysia Snodgrass n Investigatio (compliance investigator with division of n workers compensation)in regards to jobsites for Nian Construction she was at on Friday March 7th,2014... Met with Aysia at jobsites off Bayshore Dr-she stated that on 3/10/14 she observed work being done at 2785 Linda Dr,2805 Linda Dr,and 2837 Linda Or- consisting of tile work,pavers and roof/soffit repair. All workers stated to Aysia that they are employees for Nian Construction-Aysia then stated to me she called Antonio Brown (President of Nian)and that Mr. Brown did claim workers as employees-researched revealed that there was not a workers compensation policy for the employees-2 exemptions-1 for Mr. Brown and 1 for qualifier Hublar Rodriguez-A email from Gregory Roe from Roe Insurance shows that Mr.Brown contacted insurrance company about 2 pm on Friday advising that he had neglected to send back his signed work comp applications and needed coverage ASAP due to a Workers Compensation compliance inspection at his jobsites. Email attached to case-SWO issued by Aysia Snodgrass for failure to obtain workers compensation for employees-I meeti with qualifier Hublar Rodriguez and Antonio Brown on 3/11/14 at 900 and issued a NOH for the workers compensation violation-2nd offense-case to be heard 4/16/14 Investigation ThomasKeega 3/12/2014 3/12/2014 Refer to n CLB Schedule for CLB michaelossori 3/12/2014 Pending 0 Violation Description Status Entered Corrected Amount Comments Worker's Compensation Violation Open 3/11/2014 $0 2nd offense-2 swo issued by division of workers compensation u i s # b Sx}. e ?rte m wtr v R ha!F ir11 L t Title Reason Result Compliance Fine/Day Condition ac Business Management & Budget Office 2 Statutes & Constitution :View Statutes . Online Sunshine Page 1 of 2 Select Year: 2012 �Go, The 2012 Florida Statutes Title XXXI Chapter 440 View Entire Chapter LABOR WORKERS' COMPENSATION 440.10 Liability for compensation.— (1)(a) Every employer coming within the provisions of this chapter shalt be liable for, and shall secure, the payment to his or her employees, or any physician, surgeon, or pharmacist providing services under the provisions of s. 440.13, of the compensation payable under ss. 440.13, 440.15, and 440.16. Any contractor or subcontractor who engages in any public or private construction in the state shall secure and maintain compensation for his or her employees under this chapter as provided in s. 440.38. (b) In case a contractor sublets any part or parts of his or her contract work to a subcontractor or subcontractors, all of the employees of such contractor and subcontractor or subcontractors engaged on such contract work shall be deemed to be employed in one and the same business or establishment, and the contractor shall he liable for, and shall secure, the payment of compensation to all such employees, except to employees of a subcontractor who has secured such payment. (c) A contractor shall require a subcontractor to provide evidence of workers' compensation insurance. A subcontractor who is a corporation and has an officer who elects to be exempt as permitted under this chapter shall provide a copy of his or her certificate of exemption to the contractor. (d)1. If a contractor becomes liable for the payment of compensation to the employees of a subcontractor who has failed to secure such payment in violation of s. 440.38, the contractor or other third-party payor shall be entitled to recover from the subcontractor all benefits paid or payable plus interest unless the contractor and subcontractor have agreed in writing that the contractor will provide coverage. 2. If a contractor or third-party payor becomes liable for the payment of compensation to the corporate officer of a subcontractor who is engaged in the construction industry and has elected to be exempt from the provisions of this chapter, but whose election is invalid, the contractor or third-party may recover from the claimant or corporation all benefits paid or payable plus interest, unless the contractor and the subcontractor have agreed in writing that the contractor will provide coverage. (e) A subcontractor providing services in conjunction with a contractor on the same project or contract work is not liable for the payment of compensation to the employees-of another subcontractor or the contractor on such contract work and is protected by the exclusiveness-of-liability provisions of s. 440.1'1 from any action at taw or in admiralty on account of injury to an employee of another subcontractor, or of the contractor, provided that: 1. The subcontractor has secured workers' compensation insurance for its employees or the contractor has secured such insurance on behalf of the subcontractor and its employees in accordance with paragraph (b); and 2. The subcontractor's own gross negligence was not the major contributing cause of the injury. (f) If an employer fails to secure compensation as required by this chapter, the department shall assess against the employer a penalty not to exceed $5,000 for each employee of that employer who is �.+try•//umnv ran c+o+o 1 nc/C+o+„+An/in-1, , n 7A .4-o_n__.._Y- n._• _ ARTICLE V.BUILDING TRADES* Page 28 of36 r • competency card and as defined in this article or as restricted by the contractors' licensing board. (3) Abandoning a construction project in which he is engaged or under contract as a contractor. A project may be presumed abandoned if the contractor terminates the project without just cause, or fails to notify the owner in writing of termination of the contract and basis for same, or fails to perform work for 90 consecutive days without just cause and no said notice to the owner. (4) Diverting funds or property received for the execution of a specific contract project or operation or diverting funds earmarked for a specified purpose to any other use • whatsoever. (5) Departing from or disregarding in any material respect the plans or specifications of a construction job without the consent of the owner or his duly authorized representative. • (6) Disregards or violates, in the performance of his contracting business in the county, • any of the building, safety, health, insurance or workers'compensation laws of the state or ordinances of this county. (7) Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a certificate of competency under this article. (8) Committing mismanagement or misconduct in the practice of contracting that "` causes financial harm to a customer. Financial mismanagement or misconduct includes, but is not limited to, any of the following: i • a. The contractor fails to fulfill his contractual obligations to a customer because r of inability, refusal or neglect to pay all creditors for material furnished or work or services performed in the operation of the business for which he is licensed, f under any of the following circumstances: , i 1. Valid liens have been recorded against the property of a contractor's customer for supplies or services ordered by the contractor for the customer's job; the contractor has received funds from the customer to ' pay for the supplies or services; and the contractor hsr:; riot had the liens removed from the property, by payment or by bond, within 30 days after , the date of such liens; I 1. 2 I. . The contractor has abandoned a customer's job and the percentage of completion is less than the percentage of the total contract price paid to ' the contractor as of the time of abandonment, unless the contractor is entitled to retain such funds under the terms of the contract or refunds the excess funds within 30 days after the date the job is abandoned; 1 3. The contractor's job has been completed, and it is shown that the customer has had to pay more for the contracted job than the original contract price, as adjusted for subsequent change orders, unless such increase in cost was the result of circumstances beyond the control of the contractor, was the result of circumstances caused by the customer or was otherwise permitted by the terms of the contract between the i . contractor and the customer. 1 . ? t b. The contractor's job been completed, and it is shown that the customer has 1 incurred financial harm by having to seek a variance or other administrative remedy because of actions by the contractor. i (9) Performing any act which assists a person or entity in engaging in the prohibited unlicensed practice of contracting, if the licensed contractor knows or should have known that the person or entity was unlicensed. fg1 r,H.,•!/l;hro,•..7,,,,,,,,,,,,,,70..,,.,-.1.7�F..7F/rl,...[7:,..../1 nc'70/1/o cl,f t rn.a:.,._'1nnt AL. 1 It�in.,nn 1`11�LL v. utul)11v0 li<.iwi'F Page 27 of36 (i) Any individual who fails to renew his/her certificate of competency prior to December 31 of the year following its expiration shall thereby automatically have a certificate of competency that is null and void. To acquire a valid certificate from the county the individual must pay the then applicable full application fee in accordance with the schedule of fees and charges adopted by resolution pursuant to section 22-182(a)(4) herein, and must submit an entire new application. If, as of the date of receipt by the county of said new application, three years have passed since the date of his/her most recent examination that the individual passed to acquire the former certificate, that individual must pass all then applicable testing requirements. If the request is to reactivate a dormant certificate, the re-testing requirement can be waived by staff if the applicant proves that he/she has been active in the trade in another jurisdiction, or has been active as an inspector or investigator in the trade; or for other valid reason that would render such re-testing superfluous. (Ord. No. 90-105, § 1.4; Ord. No. 92-61, § 1; Ord. No. 94-34, § 1; Ord. No. 97-68, § 1, 10-28-97; Ord. No. 99-45, § 1.4-1.4.9, 6-8-99) Secs. 22-192--22-200. Reserved. DIVISION 3. STANDARDS OF CONDUCT AND DISCIPLINE* *State law references: Discipline of contractors, F.S. §§489.129, 489.533. Sec. 22-201. Misconduct--Collier County/city certificate of competency. The following actions by a holder of a Collier County/city certificate of competency shall constitute misconduct and grounds for discipline pursuant to section 22-202: (1) Knowingly combining or conspiring with an unlicensed contractor by allowing one's certificate of competency to be used by an unlicensed contractor with intent to evade the provisions of this article. When a licensed contractor acts as the qualifying agent for any firm without first making application under this article to represent said firm, such act shall constitute prima facie evidence of intent to evade the provisions of this article. When a certificate holder allows his certificate to be used by one or more companies without having any active participation in the operations, management, and control of such companies, such act constitutes prima fade evidence of an intent to evade the provisions of this article. Active participation requires job site supervision, knowledge of and participation in the business operations of the company, including all contractual matters. a. If any individual qualifying any business organization ceases to be affiliated with such business organization, he shall so inform the board. In addition if such individual is the only certified individual affiliated with the business organization, the business organization shall notify the board of the individual's termination and shall have no more than 60 days from the date of termination of the individual's affiliation with the business organization in which to affiliate with another person certified under the provisions of this article. In any event, the business organization shall not enter into any new contracts and may not engage in any new contracting until such time as a qualifying agent is employed. (2) Contracting to do any work outside of the scope of his competency as listed on his '14S http://library2.municode.com/default/DocView/10578/1/36/41?hilite=2006 46: 1/16/7(1(10 ARTICLE V. BUILDING TRADES* Page 28 of 36 • competency card and as defined in this article or as restricted by the contractors' licensing board. (3) Abandoning a construction project in which he is engaged or under contract as a contractor. A project may be presumed abandoned if the contractor terminates the project without just cause, or fails to notify the owner in writing of termination of the contract and basis for same, or fails to perform work for 90 consecutive days without just cause and no said notice to the owner. (4) Diverting funds or property received for the execution of a specific contract project or operation or diverting funds earmarked for a specified purpose to any other use whatsoever. (5) Departing from or disregarding in any material respect the plans or specifications of a construction job without the consent of the owner or his duly authorized representative. (6) Disregards or violates, in the performance of his contracting business in the county, any of the building, safety, health, insurance or workers' compensation laws of the state or ordinances of this county. (7) Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a certificate of competency under this article. (8) Committing mismanagement or misconduct in the practice of contracting that causes financial harm to a customer. Financial mismanagement or misconduct includes, but is not limited to, any of the following: a. The contractor fails to fulfill his contractual obligations to a customer because of inability, refusal or neglect to pay all creditors for material furnished or work or services performed in the operation of the business for which he is licensed, under any of the following circumstances: 1. Valid liens have been recorded against the property of a contractor's customer for supplies or services ordered by the contractor for the customer's job; the contractor has received funds from the customer to pay for the supplies or services; and the contractor has not had the liens removed from the property, by payment or by bond, within 30 days after the date of such liens; 2. The contractor has abandoned a customer's job and the percentage of completion is less than the percentage of the total contract price paid to the contractor as of the time of abandonment, unless the contractor is entitled to retain such funds under the terms of the contract or refunds the excess funds within 30 days after the date the job is abandoned; 3. The contractor's job has been completed, and it is shown that the customer has had to pay more for the contracted job than the original contract price, as adjusted for subsequent change orders, unless such increase in cost was the result of circumstances beyond the control of the contractor, was the result of circumstances caused by the customer, or was otherwise permitted by the terms of the contract between the contractor and the customer. b. The contractor's job been completed, and it is shown that the customer has incurred financial harm by having to seek a variance or other administrative remedy because of actions by the contractor. (9) Performing any act which assists a person or entity in engaging in the prohibited unlicensed practice of contracting, if the licensed contractor knows or should have known that the person or entity was unlicensed. ARTICLE V. BUILDING TRADES* Page 29 of 36 (10) Failing to promptly correct faulty workmanship or promptly replace faulty materials installed contrary to the provisions of the construction contract. Faulty workmanship means work that is not commenced, not continued, or not completed in accordance with all specifications of the applicable written agreement. Faulty workmanship includes any material flaw(s) in the quality and/or quantity of the unfinished work product, including any item that does not function properly as a part of the entire project. If there is no written agreement provision regarding the specific faulty workmanship issue, faulty workmanship exists if the work, process, product or part thereof does not meet generally accepted standards in Collier County in relation to the entire project. Faulty workmanship does not include matters of aesthetics unless the aesthetically related item clearly violates a written contract specification directly related thereto. (11) Failure to maintain at all times, with an insurance company authorized to do business in the state, the limits of liability and other categories of insurance as required by this article. (12) Failing to claim or refusing to accept certified mail directed to the contractor by the contractors'licensing board, or its designee. (13) Failing to maintain a current mailing address. (14) Failing to appear in person or through a duly authorized representative at any scheduled hearing on a complaint filed against the contractor. (15) Being convicted or found guilty, regardless of adjudication, of a crime in the county which directly relates to the practice of contracting or the ability to practice contracting. (16) Allowing another to take a qualifying examination on the applicant's behalf. (17) Engaging in contracting business in the county or the city when prohibited from doing so by the contractors' licensing board. (18) Proceeding on any job without obtaining applicable permits or inspections from the city building and zoning division or the county building review and permitting department. (19) Failing in any material respect to comply with the provisions of this article as a contractor or as a qualifying agent for a business entity engaging in contracting. (20) Signing a statement with respect to a project or contract falsely indicating that the work is bonded; falsely indicating that payment has been made for subcontracted work, labor, or materials which results in a financial loss to the owner, purchaser, or contractor; or falsely indicating that workers' compensation and public liability insurance are provided. (21) Failure of a qualifying agent for a firm/legal business entity to comply with the requirements set forth in F.S. §§489.119 and 489.1195. (22) Falsifying or misrepresenting any material fact to another person with the intent or for the purpose of engaging in the contracting business, providing materials or services, or soliciting business for an employer, as a contractor, or as an employee, regardless of any financial considoratlon. (23) Failing or refusing to provide proof of public liability and property damage insurance coverage and workers compensation insurance coverage. (24) Misconduct in the practice of contracting (see section 22-201.1 below). (Ord. No. 90-105, § 4.1; Ord. No. 92-61, § 4; Ord. No. 94-34, § 4; Ord. No. 97-68, § 1, 10-28-97; Ord. No. 99-45, § 4.1--4.1.24, 6-8-99) 6s. 3° �ttt •�n�}ra r< 7 mnr.i..-.�. ....«../,],..0..7-T.,,.[ •----/ti nc�O,, 1.41 elf •I