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CLB Agenda 10/15/2014 CONTRACTORS LICENSING BOARD Agenda October 15 , 2014 C o er County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA OCTOBER 15, 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: September 17, 2014 V. DISCUSSION: VI. NEW BUSINESS: (A) Orders of the Board (B) Tobias Simmons, Duane Thomas Marine Construction, LLC—Second entity application (C) Martin Selden, Asphalt Seal & Repair of SW Florida LLC- Second entity application (D) Yanira I. Tejada– Review of Credit. (E) Leonardo F. Alvarez, Leomar Cabinets, Inc. –Waiver of Exam(s)for Reinstatement VII. OLD BUSINESS: (A) Marius Pughiuc, Advanced Flooring of SW FL, Inc. Review of Credit Report(s) VIII. PUBLIC HEARINGS: IX. REPORTS: X. NEXT MEETING DATE: WEDNESDAY, DECEMBER 17, 2014 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 r p ,,,,,,,,r )._. ,__ - , , , . , i . BUILDING REVIEW AND P ERMITTING CONTRACTOR LICENSING SECTION COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO ISLAND Contractors Licensing Board Community Development&Environmental Services Division ATTACH(TAPE ON ALL SIDES)A 2800 North Horseshoe Drive RECENT PHOTO OF QUALIFIER. Naples, Florida 34104 PHOTO MUST BE FULL-FACED, 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 WIIERE 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 $ 1. Applicant's Name (Licensee) �b;'‘k s c,.....7 ,,. ‘4.,\_0�� LICENSE# (✓ C (So ().3 g 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 455.203 409.2577, 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), 104 PUB.L. 193,SEC.317. Place of Birth: (City) Ct Social Security Number Date of Birth (State) _ (Nation)_U SEX: V Male Female ; RACE: (1)White ;(2)African-American; 3 Hispanic ;(4) Asian (5)Indian;(6)Other 2. Name of Business To Be Qualified: -; R "_� 1 , 6 Mailing Address: E;i Street or P.O.Box City State Zip Street Address: Street City State Zip Business Phone Number: r i' ) { - (../1 i Federal ID Number: , i ) % r '"J / ," 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. c G S'P¢t t y K�D�:. 4! 7 cv l 9 cJ ."✓ Q.- p y[er-S (t(o S +�S' 3 4.-, U-'�l�5� 4-6 C'u r vs- -*4 r et yvl C ens t c'��l�c-(.3 `d C GZ ( ��a v 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. I 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 qualifier and name of owner. 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. .s`11=P 4 " i,( y L 11 ivi,,ez T110, d r- I3 s-s- ;15 IGt ri;: ((1 I v I `�j �,va th i e4. :y S t"` e/ :3 ' - (� l'"J i i t `5c o i-# e k.) -e '.) `1 1?q ci 5 i l q E. Do the business(s) you presently qualify 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. LEO t�,� jji0 r - o� s`I (.s. Aar rr my rs — L'33 - S3g G. List principal suppliers for the past six months for the business you are applying to qualify. CJ�51roa� ery,)Ivtt�„1(��1''ce.11 r-,n F.6/lap * (00)i 6-Trette,g' &)' b S ► &(,W Sj 4 APPLICATION TO QUALIFY SECOND ENTITY 3. Applicant's (Licensee)Name: 3 w, (C L . S Last First Middle Applicant's (Licensee) Official Mailing Address of Record: Street City County State Zip Street Address (if Post Office Box is listed above): Street City County State Zip Home Phone (9361 ) °t 7 6,4.//q Office Phone (ate) i f 4,2-CO 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 tiled 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. . /O / AS rr trim 5 APPLICANT'S SIGNATURE PRINT OR TYPE NAME DATE iy 3h CR _Jt .. kP''�Stl� l Il=� U94 b ✓l"Rl ��s.6nt 1F-1,,v'1 �&'3� si��.` ..E= !';''4/U rti:- � � 'y .� - _ 1}. '�'""'�:. '��`�"� i. " f�l_i �l f l *It '3�y -I IF try A,, -l-' 0 fi �a� 3 r^ay, y j,‘ 'iF 'T'�r -s r:��iw �s y-- t tr:t , �'k 3 .-., c ,- ...— ...., .. i -. g .. _ ..t i. ...,»X4.6 ... Y. .n !TA" 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 form#BCM-250-T. 3 ------ - --- -- APPLICATION TO QUALIFY SECOND ENTITY H. List persons authorized(currently and in the past 6 weeks)to pull permits on your license(s). I. How are you being paid by the business(s) you presently qualify (examples: salary, % of profits, etc.)? \Mr11 I. : ( <, J. How will you be paid by the business you are pplying to qualify? elnett< FAti,up)e-c<e-t d'-`‘ `116 67-e-e-fcsl'a 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? L. Do you(applicant) have check writing authority for the present and proposed entity? YES NO N If yes,provide a letter from the bank. M. List officers (or partners, owners) of business you are applying to qualify and give title/position held. ‘7)t:c -1-116114 //'f.0 r,t7-C 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 NO T . If yes, list licensee's name, license number and address. P. Submit notarized statements signed by an authorized agent 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. 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 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? X C. Undertaken construction contracts or work which resulted in liens, suits or judgments being filed? 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. YH. 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 AFFIDAVIT I, c9 ii) t \v V\ � (}}'� certify that the foregoing is true and correct to the best of my knowledge. AUTHORIZED OFFICER FOR THE FIRM -- STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this y ^/2"/� /� (DATE) by f'J//09 S �� ,�121( YJ of 42,rr�.g (NAME OF OFFICER,TITLE/AGENT) (NAME OF CORPORATION) a /6"wY2 d4 corporation, on behalf of the corporation. He/She has (STATE OR PLACE OF CORPORATION) produced 7)Y'i UP/s j* :f_.x cc—c: as identification and did not take an oath. (TYPE OF IDENTIFICATION) h'" NANCY A SCIOG /gab MY COMMISSION#FF133488 SIGNATU V OF NOS' RY EXPIRES June 17;2018 (ao7)398.0153 Florldallotery$eraice.corn (PRINT NAME OF NOTiAZY) 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. "r, 10,-4 ,, APPLICANT(PLEASE PRINT) / aalee C• NAME OF COMPANY SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this ll `�Z. "fV by (DATE) /G l-')/xJ S C e,1/m c)y1 S' who has produced 21)/7 e & G (NAME OF PERSON ACKNOWLEDGING) (TYPE OF IDENTIFICATION) as identification and who did not take an oath. _14fil ; NANCY A SCIOG MY COMMISSION#FF133488 SIGNATUR F NOTAR-Y gi ",:.', ..9,„:??!;/ EXPIRES June 17, 2018 (407)398-0153 FloridallotaryService.corn (�' ,' 77l/ (.52/C (PRINT NAME"OF NOTARY) NOTARY PUBLIC 9 COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2500 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 1":A 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. RESOLUTION OF AUTHORIZATON WHEREAS Jn.t, l 1101116 1'4444k e,(m sr proposes to ar}e of Busines ntity) engage in contracting as L i 1 WI� tit ( j / i I IT (d O in (Type of legal entity:corp.,partnership,etc. Collier County,Florida,accord..N..)1.-11 ng to Collier County Ordinance 99-45;and WHEREAS t, t c tY!c(a N C(ti Jut Pi.)()cue GIttriproposes to (Name of Business Entity) qualify for a Certificate of Competency with Tc710:4.S S:�, S (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned 1)�)c,. i It YYI L4 of (Officers,Owners,Partners) —17 ecru{c Y}1 r4,(1-4-1U (.1e. S/‘ hereby resolve and represent to the Collier County (Name of Business Entity) Contractors'Licensing Board that the qualifying agent, !r ,is active (Name of Individn l) in all matters connected with the contracting business of 'J o'i.s K:?'/J' M L:t a ,and (Name of Business Entity) We further resolve and represent that I S,'.,.; ch v' is p (Names of Individual) legally empowered to act for t Ju,. CAI I S-r in all matters connected with its (Name of Business Entity) c retracting business,and the aut ority to supervise construction undertaken by us c-Li. I}ta/YN.t-0 tt4 (Name of Business Entity) DULY PASSED AND ADOPTED THIS I +k day off f ,ZiJ . (Officers,Partners,Owners—with � � , � • �+•tion unde eath) 11 V`J `YY ►1G.t. 1 �.r.. ,/ J1 Witness cre Hess /AIL •it ` t I Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this IC., day of , ((v by ! . 1st, aid. ,U>u7/�Li L r PP''uu �� ..041101 Notary blic Name Printed 'otary 'ublic Signa e Commission Number 9''O My Commission expires: �,�p /?Joi$ °` a -_ NANCY A SCIOG "' MY COMMISSION#FF133488 EXPIRES June 17,oom 2018 of a,,,• 9®1)3Ga 0163 rtorIC$Note se ry c , • 9/18/2014 Detail by Entity Name FLORIDA DEPARTMENT OF STATE a a. A DIVISION O1: CORPORATIONS n ?; 4111- Y1. �— -� Detail by Entity Name Florida Limited Liability Company DUANE THOMAS MARINE CONSTRUCTION, LLC Filing Information Document Number L03000000532 FEI/EIN Number 760720731 Date Filed 01/07/2003 State FL Status ACTIVE Principal Address 296 ROCKHILL COURT MARCO ISLAND, FL 34145 Changed: 04/21/2004 Mailing Address 296 ROCKHILL COURT MARCO ISLAND, FL 34145 Changed: 04/21/2004 Registered Agent Name & Address THOMAS, DUANE 296 ROCK HILL COURT MARCO ISLAND, FL 34145 Authorized Person(s) Detail Name & Address Title MGR THOMAS, DUANE OJR 296 ROCKHILL COURT MARCO ISLAND, FL 34145 Annual Reports Report Year Filed Date 2011 03/21/2011 2012 04/27/2012 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/flat-103000000532-22284e88-a455-4b73-9e2c-e15481 e408ac/DUA.. 1/2 9/18/2014 Detail by Entity Name 2013 08/01/2013 Document Images 08/01/2013 -- ANNUAL REPORT View image in PDF format 04/27/2012 --ANNUAL REPORT View image in PDF format 03/21/2011 --ANNUAL REPORT View image in PDF format 04/30/2010 -- ANNUAL REPORT View image in PDF format 04/14/2009 -- ANNUAL REPORT View image in PDF format 04/30/2008 --ANNUAL REPORT View image in PDF format 03/29/2007 -- ANNUAL REPORT View image in PDF format 01/16/2006 -- ANNUAL REPORT View image in PDF format 02/09/2005 --ANNUAL REPORT View image in PDF format 04/21/2004 -- ANNUAL REPORT View image in PDF format 01/07/2003 -- Florida Limited Liability View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/flat-103000000532-22284e88-a455-4b73-9e2c-e15481 e408ac/DUA.. 212 9/18/2014 Detail by Entity Name FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation PRIME CONTRACTORS AND ASSOCIATES, INC. Filing Information Document Number P96000075862 FEI/EIN Number 593405426 Date Filed 09/10/1996 State FL Status ACTIVE Principal Address 909 San Marco Road MARCO ISLAND, FL 34145 Changed: 01/28/2013 Mailing Address 909 San Marco Road MARCO ISLAND, FL 34145 Changed: 01/28/2013 Registered Agent Name & Address SCHNEIDER, TODD E 909 San Marco Road MARCO ISLAND, FL 34145 Name Changed: 02/23/2009 Address Changed: 01/28/2013 Officer/Director Detail Name &Address Title PTSC SCHNEIDER, TODD E 909 San Marco Road MARCO ISLAND, FL 34145 Annual Reports http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/dome-p96000075862-6eb32c54-e3fd-40ce-b120-21 b670ab319f/pri... 1/2 9/18/2014 Detail by Entity Name Report Year Filed Date 2012 04/11/2012 2013 01/28/2013 2014 02/12/2014 Document Images 02/12/2014 --ANNUAL REPORT View image in PDF format 01/28/2013 --ANNUAL REPORT View image in PDF format 04/11/2012 --ANNUAL REPORT View image in PDF format 01/20/2011 --ANNUAL REPORT View image in PDF format 07/08/2010 --ANNUAL REPORT View image in PDF format 04/20/2009 --ANNUAL REPORT View image in PDF format 02/23/2009 -- Reg. Agent Change View image in PDF format 01/28/2009 -- Reg. Agent Resignation View image in PDF format 10/27/2008 -- Off/Dir Resignation View image in PDF format 02/07/2008 --ANNUAL REPORT View image in PDF format 01/14/2008 - ANNUAL REPORT View image in PDF format 01/16/2007 --ANNUAL REPORT View image in PDF format 01/16/2006 -- ANNUAL REPORT View image in PDF format 04/02/2005 --ANNUAL REPORT View image in PDF format 01/20/2004 --ANNUAL REPORT View image in PDF format 02/11/2003 --ANNUAL REPORT View image in PDF format 02/14/2002 --ANNUAL REPORT View image in PDF format 02/01/2001 --ANNUAL REPORT View image in PDF format 01/19/2000 --ANNUAL REPORT View image in PDF format 03/30/1999 -- ANNUAL REPORT View image in PDF format 04/01/1998 --ANNUAL REPORT View image in PDF format 01/16/1997 --ANNUAL REPORT View image in PDF format 09/10/1996 --DOCUMENTS PRIOR TO 1997 View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/dome-p96000075862-6eb32c54-e3fd-40ce-b120-21 b670ab319f/pri... 2/2 886 110th Ave.N.Suite#6,Naples,FL 34108 Phone:239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com BUSINESS CREDIT REPORT as of: 09/12/14 11:38 ET Duane Thomas Marine Construction, LLC Fed Tax ID#76-0720731 Address: 296 Rockhill CT Key Personnel: Thomas Duane Marco Island, FL 34145-3830 United States SIC Code: 1541-Contractors, Industrial Building, Phone: 239-642-0116 Wrhse Website: www.duanethomasmarine.net 1629-Heavy Construction, Nec Experian BIN: 943858147 NAICS Code: 236210-Industrial Building Agent: Thomas Duane Construction Agent 296 Rock Hill Court 237990 Other Heavy And Address: Marco Island, FL Civil Engineering Construction Business Type: Corporation Experian File January 2003 Established: Experian Years on File: 11 Years Years in Business: 12 Years Total Employees: 25 Sales: $2,600,000 Page 1 of 4 Filing Data Provided Florida by: Date of Incorporation: 01/07/2003 Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. Bankruptcies: 2 Liens: 4 Judgments Filed: 1 Collections: 3 Collection Filings Date Agency Agency Phone Status Closed j Amt Amt Comments Date Disputed I Collected ! 03/10 Johnson Morgan & Closed, 800-441-9550 03/10 $14,486 $0 White Bankruptcy $ 01/13 Altus Global Trade Uncollected 06/13 $6,544 $0 Diversified 07/10 Adjustment 763-783-2301 Open Account $1,294 $75 Service Collections Summary Status Number of Items Amt Disputed j Amt Collected Open Account 1 $1,294 $75 Uncollected 1 $6,544 $0 Closed, Bankruptcy 1 $14,486 $0 Page 2 of 4 Bankruptcies File Date: 02/01/2011 Filing Location: Us- Bankruptcy Court-Middle Tampa Legal Type: Bankruptcy Legal Action: Chapter 11 Discharged Document Number: 0917391 File Date: 08/07/2009 Filing Location: Us- Bankruptcy Court-Middle Tampa Legal Type: Bankruptcy Legal Action: Chapter 11 Document Number: 0917391 Judgment Filings, Date: 07/09/2009 Plaintiff: Triple 3 LLC Filing Location: Lee County Circuit Court Legal Type: Judgment Legal Action: Filed Document Number: 07CC6139 Liability Amount: $1,536 Tax Lien Filings Date: 07/24/2014 Owner: State Of Florida Filing Location: Collier County Circuit Court Legal Type: State Tax Legal Action: Released Document Number: 5011195 Liability Amount: $669 Description: Other Tax Date: 07/24/2014 Owner: State Of Florida Filing Location: Collier County Circuit Court Page 3 of 4 Legal Type: State Tax Legal Action: Released Document Number: 5011196 Liability Amount: $978 Description: Other Tax Date: 12/26/2013 Owner: State Of Florida Filing Location: Collier County Circuit Court Legal Type: State Tax Legal Action: Lien Document Number: 4927538 Liability Amount: $669 Description: Other Tax Date: 10/03/2011 Owner: State Of Florida Filing Location: Collier County Circuit Court Legal Type: State Tax Legal Action: Lien Document Number: 4612168 Liability Amount: $978 Description: Other Tax END OF REPORT Page 4 of 4 886 110th Ave. N.Suite#6,Naples,FL 34108 Phone:239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com BUSINESS CREDIT REPORT as of: 09/12/14 11:35 ET Prime Contractors and Associates, Inc. Fed Tax ID#59-3405426 Address: 888 Rose CT Key Personnel: Todd E Schneider Marco Island, FL 34145-2526 Mustafa Guvenc United States SIC Code: 8742-Management Phone: 239-394-4200 Consulting Services Website: apmglobal.com NAICS Code: 541611-Administrative Management And Experian BIN: 742441453 General Management Consulting Agent: Schneider Todd E Services Agent 888 Rose Court Business Type: Corporation Address: Marco Island, FL Experian June 1997 Also is (or has been) operating as: Experian Years on File: 17 Years Prime Contractors And Associates Inc Years in Business: More than 17 Years Apm Custom Homes Prime Contractors And Total Employees: 1 Associates, Inc Prime Contractors &Associates, Sales: $180,000 Inc Filing Data Provided Florida by: Page 1 of 2 Family Linkage: Date of Incorporation: 09/10/1996 Ultimate Prime Contractors &Associates, Parent Inc 888 Rose CT Marco Island, FL Branches/ Prime Contractors And Alternative Associates, Inc Locations 1845 San Marco Rd Ste 303 Marco Island, FL United States Prime Contractors And Associates, Inc 909 San Marco Rd Marco Island, FL United States Prime Contractors And Associates, Inc 939 Chalmer Dr Ste 2 Marco Island, FL United States Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. Bankruptcies: 0 Liens: 0 Judgments Filed: 0 Collections: 0 END OF REPORT Page 2 of 2 886 110th Ave. N.Suite#6,Naples, FL 34108 Phone:239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com PERSONAL CREDIT REPGTT(Compiled From National Records) <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> (I) P NP7771028 LICENSES ETC 16 NP 12/83 09/18/14 12:27CT <SUBJECT> <SSN> <BIRTH DATE> THOMAS, DUANNE 0. JR. <ALSO KNOWN AS> THOMAS,DUANE,OLIVER OTHOMAS,DUANE <CURRENT ADDRESS> <DATE RPTD> 296 ROCKHILL CT., MARCO ISLAND FL. 34145 9/00 <FORMER ADDRESS> 5 W. PELICAN ST., NAPLES FL. 34113 8/00 2619 PO BOX 2619, MARCO ISLAND FL. 34146 <CURRENT EMPLOYER AND ADDRESS> <RPTD> CUSTOM DOCK & REPAIR 9/94 M O D E L P R O F I L E ***FICO CLASSIC 08 SCORE +563 : SERIOUS DELINQUENCY, AND PUBLIC RECORD OR ***COLLECTION FILED; TOO FEW ACCOUNTS CURRENTLY PAID AS AGREED; NUMBER OF ***ACCOUNTS WITH DELINQUENCY; LENGTH OF TIME SINCE DEROGATORY PUBLIC RECORD ***OR COLLECTION IS TOO SHORT *** C R E D I T SUMMARY * * * T O T A L F I L E H I S T O R Y PR=9 COL=3 NEG=6 HSTNEG=5-76 TRD=18 RVL=12 INST=3 MTG=3 OPN=0 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $0 $300 $0 $0 100% MORTGAGE: $980K $ $545K $0 $2907 CLOSED W/BAL: $7899 $2545 $ TOTALS: $980K $300 $553K $2545 $2907 P U B L I C R E C O R D S PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS SOURCE DATE LIAB ECOA COURT ASSETS PAID DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064186 4/14R $1231 I RD 4973369 STATE TAX LIEN B5030P939 Z 5064186 12/13R $1273 I RD 4927542 STATE TAX LIEN B4995P128 Z 5064186 4/13R $26.3K I RD 4823980 FEDERAL TAX LIEN B4907P1655 Z 5064220 2/12R $37.7K I CI 10CA025897 CIVIL JUDGMENT CREDENTIAL LEASING COR Page 1 of 3 Z 5064186 11/11R $10.1K I RD 4624396 FEDERAL TAX LIEN B4734P2232 Z 5064186 6/10R $60.5K I CI 86865CA CIVIL JUDGMENT AMERICAN EXPRESS BANK Z 5064186 6/10R $349 I RD 7/14 4437581 RELEASE OF TAX LIEN B4573P146 Z 5064188 1/10R $8363 I CI 902284CC CIVIL JUDGMENT KELLY TRACTOR CO Z 5064207 7/09R $1536 I CI 7CC6139 CIVIL JUDGMENT TRIPLE J LLC C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS GULF CST COL Y 1X5L001 I 8/11 $105 MEDICAL O9B 9/14A $105 PLACED FOR COLLECTIO GULF CST COL Y 1X5L001 I 4/13 $83 MEDICAL O9B 9/14A $83 PLACED FOR COLLECTIO NCO FIN Y 73CJ021 I 5/12 6/14F $212 11 DIRECTV O9P 6/14A $0 PAID COLLECTION 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 CAP1/BOSE D 1DTV058 1/06 $2200 R09 4/11A $6000 $0 I CHARGE ACCOUNT 6/07F $1533 CLOSD BY CRDT GRANTOR BK OF AMER B 1597029 12/06 $2127 R09 3/11A $1000 $0 I CREDIT CARD 11/10F $0 PURCH BY OTHER LENDER THD/CBNA B 26H3005 7/02 $5484 R09 9/10A $5484 $1663 I CHARGE ACCOUNT 6/10F $5484 UNPAID BLNC CHRGD OFF DSNB MACYS D 2A5T001 1/07 R09 7/08A $882 I CHARGE ACCOUNT 5/08F $882 CLOSD BY CRDT GRANTOR CHASE B 617C042 12/06 $124K C9P 11/12A $125K $0 I HOME EQUITY LOAN 11/12F $0 SETTLED < FULL BLNC BAYVIEW LOAN F 27DB001 11/06 $980K 552M2907 10/11 111111111111 MOI 9/14A $0 $65.5 05 1111X1111111 I CONVENTIONAL REAL $545K 37 0/ 0/11 BK OF AMER B 427S002 11/06 $980K 360M5512 11/08 555555555555 MO1 6/11A $0 $22.0 05 55555X555555 Page 2 of 3 I CONVENTIONAL REAL 6/11C $0 TRNSFRD: OTHER LENDER 42 2/ 7/32 GMAC Q 2592768 4/06 $52.3K 60M1139 111122211111 101 3/10A $0 111111111111 C AUTOMOBILE 3/10C $0 CLOSED 47 3/ 0/ 0 BK OF AMER B 4275002 4/05 $287K 12/07 155555555555 COl 8/09A $288K $0 $26.2 05 55555555 I HOME EQUITY LOAN 7/09C $0 TRNSFRD: OTHER LENDER 20 0/ 0/19 CHASE B 26QK001 2/00 $6597 111111111111 ROl 6/09A $8600 $0 111111111111 I CREDIT CARD 2/06C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 GMAC Q 2592672 12/03 $35. 9K 60M812 111111122111 I01 12/08A $0 111111111111 C AUTOMOBILE 12/08C $0 CLOSED 48 2/ 0/ 0 BK OF AMER B 427S002 4/05 $400K 111111111111 CO1 11/06A $400K $0 1111 I HOME EQUITY LOAN 11/06C $0 ACCT CLSD BY CONSUMER 18 0/ 0/ 0 LITTON LOAN F 9823004 11/03 $476K 360M4668 111111111111 MO1 11/06A $0 111111111111 I CONVENTIONAL REAL 11/06C $0 CLOSED 24 0/ 0/ 0 CHASE B 701N136 3/00 $8917 111111111111 RO1 4/06A $10.5K $0 111111111111 I CREDIT CARD 2/06C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 GMAC Q 2592672 4/03 $10.4K 36M359 111111111111 101 1/06A $0 111111111111 I AUTOMOBILE 1/06C $0 CLOSED 32 0/ 0/ 0 5/3 BK FL B 21AV053 2/05 $0 11 RO1 7/05A $300 $0 I CREDIT CARD $0 2 0/ 0/ 0 CHASE B 701N138 11/00 $2441 111111111111 ROl 6/05A $2400 $0 111111111111 I CREDIT CARD 4/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CHASE B 26QK001 10/06 $8585 RUR 9/09A $7400 $0 I CREDIT CARD 11/08C $0 CHAPTER 7 BANKRUPTCY I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 9/18/14 PNP7771028 (FLA) LICENSES ETC END OF REPORT Page 3 of 3 9/18/2014 Detail by Entity Name FLORIDA DEPARTMENT OF STATE ti, DIVISION OF CORPORATIONS k 11 -' - ------> mss_:__._. Detail by Entity Name Florida Limited Liability Company MARCO ISLAND EQUIPMENT, LLC Filing Information Document Number L14000061654 FEI/EIN Number 46-5467844 Date Filed 04/15/2014 State FL Status ACTIVE Effective Date 04/15/2014 Principal Address 933 N. COLLIER BLVD MARCO ISLAND, FL 34145 Mailing Address 933 N. COLLIER BLVD MARCO ISLAND, FL 34145 Registered Agent Name &Address JAMES KARL & ASSOCIATES, P.A. 975 N. COLLIER BLVD MARCO ISLAND, FL 34145 Authorized Person(s) Detail Name & Address Title MGRM SCIOG, NANCY 933 N. COLLIER BLVD MARCO ISLAND, FL 34145 Annual Reports No Annual Reports Filed Document Images 04/15/2014 -- Florida Limited Liability View image in PDF format http://search.sunbiz.org/I nquiry/CorporationSearch/SearchResultDetail/EntityName/flal-114000061654-27f48101-5fd6-4500-8e31-2a69139e4958/marc... 1/2 9/18/2014 Detail by Entity Name http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/flat-114000061654-27f48101-5fd6-4500-8e31-2a69139e4958/marc... 2/2 • ******7************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Identity Theft Prevention Tips: *Centennial Bank will NEVER call and ask you for your Debit Card number or personal information. *Never give out your Debit Card number or personal information over the phone to anyone you do not know. *Immediately contact Centennial Bank if you mistakenly give our your Debit Card number or personal information to someone over the phone.(We can hot card your Debit Card and make you a new one same day!) *Monitor your account for unusual activity and if detected-contact the bank immediately. *** CHECKING *** 0900 NEW BUSINESS CK ACCOUNT NUMBER PREVIOUS STATEMENT BALANCE AS OF 04/30/14 773.94 PLUS 43 DEPOSITS AND OTHER CREDITS 441,293.91 LESS 443 CHECKS AND OTHER DEBITS 441, 022.09 LESS CYCLE SERVICE CHARGE 39.20 CURRENT STATEMENT BALANCE AS OF 05/31/14 1, 006.56 NUMBER OF DAYS IN THIS STATEMENT PERIOD 31 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 422 05/23 1,200.00 12956 05/21 2,098.09 13257 05/19 137.50 458* 05/08 2,100.00 12957 05/21 300.00 13258 05/16 136.50 10855* 05/06 1,000.00 12959* 05/20 1,100.00 13259 05/16 129.00 10856 05/06 1,000.00 12960 05/19 900.00 13260 05/16 25.00 "m111•111"" 12700* 05/07 350.00 12961 05/19 500.00 13261 05/19 25.00 12743* 05/13 1,500.00 12962 05/21 500.00 13262 05/19 82.50 12744 04/30 477.61 12963 05/20 340.00 13263 05/19 82.50 12745 05/05 1,100.00 12964 05/20 800.00 13264 05/23 3.75 12746 05/06 1,070.00 12965 05/21 1,053.00 13265 05/19 157.50 12747 05/06 200.00 12966 05/21 10,548.08 13266 05/19 3.50 12748 05/07 6,000.00 12967 05/21 300.00 13267 05/19 160.00 12749 05/12 1,000.00 12968 05/28 1,500.00 13268 05/19 128.00 12837* 05/02 500.00 12969 05/29 1,129.33 13269 05/19 31.18 12838 05/12 500.00 12970 05/22 500.00 13271* 05/19 184.02 12846* 04/30 1,343.34 12971 05/22 400.00 13272 05/19 74.35 12847 04/30 414.20 12972 05/28 300.00 13273 05/16 100.00 12848 05/14 677.34 12973 05/27 1,160.00 13274 05/16 297.00 12849 05/14 449.81 13198* 05/09 1,000.00 13276* 05/19 5.29 12902* 05/14 532.14 13221* 05/06 2,420.00 13277 05/20 8,026.91 12903 05/29 1,289.49 13250* 05/20 770.00 13278 05/19 1,882.00 12904 05/29 1,224.30 13251 05/15 5,000.00 13279 05/19 1,540.50 12950* 05/13 1,148.00 13252 05/19 2,138.50 13280 05/22 480.71 12951 05/16 400.00 13253 05/21 4, 980.94 13281 05/20 5,000.00 12952 05/14 238.03 13254 05/20 4,364.80 13282 05/21 102.75 12953 05/13 5,000.00 13255 05/19 165.00 13283 05/21 1,216.40 12955* 05/16 1,500.00 13256 05/19 100.00 13284 05/21 8,454.03 Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 2 of 35 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 13285 05/28 1,510.50 13344* 05/23 160.00 13392* 05/12 1,000.00 13286 05/27 300.00 13345 05/23 10.48 13393 05/13 4,629.97 13287 05/30 459.17 13346 05/27 72.00 13394 05/12 50.00 13288 05/22 21.56 13347 05/23 850.00 13395 05/12 250.00 13289 05/21 24,799.74 13348 05/29 722.25 13396 05/12 136.50 13290 05/21 75.00 13349 05/28 10,500.00 13397 05/12 162.50 13291 05/29 1,225.79 13350 05/05 2,569.32 13398 05/15 65.00 13292 05/21 7,500.00 13351 05/05 285.00 13399 05/12 115.00 13293 05/22 985.00 13352 05/05 237.50 13400 05/12 99.00 13294 05/22 3,000.00 13353 05/02 178.75 13402* 05/13 20.00 13295 05/28 1,500.00 13354 05/02 112.50 13403 05/12 74.25 13297* 05/30 115.71 13355 05/02 204.00 13404 05/12 25.00 13300* 05/27 53.00 13356 05/05 105.00 13405 05/14 342.50 13302* 05/29 81.67 13357 05/02 9.00 13406 05/12 82.50 13303 05/29 814.08 13358 05/02 140.00 13407 05/13 80.00 13304 05/28 2,907.21 13359 05/05 71.50 13408 05/14 120.00 13305 05/28 511.00 13360 05/05 350.00 13409 05/12 172.50 13306 05/28 440.00 13361 05/05 85.00 13410 05/12 31.50 13308* 05/29 565.37 13362 05/05 206.25 13411 05/13 60.38 13309 05/29 345.88 13363 05/05 12.38 13412 05/12 67.50 13311* 05/27 131.31 13364 05/06 63.25 13413 05/14 10.00 13315* 05/27 750.00 13365 05/12 90.75 13414 05/12 93.50 13316 05/28 5,693.41 13366 05/06 72.50 13415 05/09 105.00 13317 05/23 240.00 13367 05/06 48.00 13416 05/12 136.50 13318 05/23 100.00 13368 05/05 62.25 13417 05/13 62.50 13319 05/27 225.00 13369 05/05 675.00 13418 05/13 72.00 13320 05/23 71.50 13370 05/06 138.00 13419 05/14 40.00 13321 05/27 30.00 13371 05/16 4, 980.94 13421* 05/09 93.38 13322 05/23 156.00 13372 05/05 50.00 13422 05/12 132.00 13323 05/23 55.00 13373 05/14 6,787.08 13423 05/12 135.00 13324 05/27 89.25 13374 05/19 475.00 13424 05/12 300.00 13325 05/27 500.00 13375 05/14 489.72 13425 05/12 7.62 13326 05/27 80.00 13376 05/15 600.00 13426 05/12 31.22 13327 05/27 55.00 13377 05/14 1,113.00 13427 05/12 175.00 13329* 05/27 195.00 13378 05/05 297.00 13428 05/13 305.28 13330 05/27 7.00 13380* 05/09 189.74 13429 05/14 270.59 13331 05/28 46.00 13381 05/06 5,000.00 13430 05/19 805.00 13332 05/27 264.00 13382 05/08 77.00 13431 05/12 297.00 13333 05/28 168.00 13383 05/07 193.50 13432 05/14 175.50 13334 05/23 42.00 13384 05/08 270.00 13433 05/12 96.27 13336* 05/27 211.50 13385 05/08 270.00 13434 05/12 112.45 13337 05/23 10.38 13386 05/20 919.00 13435 05/14 20.00 13338 05/27 67.34 13387 05/08 202.50 13436 05/12 38.07 13339 05/27 33.81 13388 05/07 5,500.00 13437 05/12 94.22 13340 05/29 500.00 13389 05/22 12,295.18 13438 05/20 99.00 13342* 05/27 50.00 13390 05/15 1,000.00 13439 05/19 58.29 Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC IMAGES 269 296 ROCKHILL CT CYCLE-030 MARCO ISLAND FL 34145 Page 3 of 35 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 13440 05/20 1,500.00 13502* 05/06 32.00 13529 04/30 5, 500.00 13442* 05/14 7,500.00 13505* 05/08 147.31 13530 04/30 800.00 13443 05/16 300.00 13507* 04/30 500.00 13531 05/01 84.00 13444 05/16 1,200.00 13508 04/30 747.30 13532 05/01 4,800.00 13445 05/19 292.27 13510* 05/01 324.51 13533 05/05 300.00 13446 05/22 186.00 13511 05/05 1,420.00 13545* 05/05 809.19 13447 05/21 6,514.80 13512 05/01 2, 907.21 13547* 05/06 384.25 13448 05/19 52.99 13513 05/05 1,484.83 13548 05/05 50.00 13449 05/19 1,510.50 13514 04/30 750.00 13549 05/06 4,200.71 13482* 05/05 207.40 13515 05/07 990.04 13550 05/29 4,000.00 13490* 05/07 2,055.32 13522* 05/12 88.00 13551 05/29 100.00 13491 05/07 2,871.55 13527* 05/07 1,175.74 13578* 05/30 105.00 13492 04/30 500.00 13528 05/05 250.00 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 05/01 INTERNET XFER FROM 13,000.00 NUMBER 0000008774 05/01 DEPOSIT 10,800.00 05/01 OVERDRAFT FEE 270.00 ......... 05/01 INTERNET XFER TO 3,000.00 05/01 CKCD DEBIT 04/29 00:00 7.40 VERIZON WRLS P3385 01 NAPLE FL _ 05/01 CKCD DEBIT 04/30 00:00 11.14 ....■ AMAZON MKT PLACE PMTS AMZN C WA 05/01 CKCD DEBIT 04/30 00:00 33.89 SUNSHINE ACE MARCO MARCO IS FL 05/01 CKCD DEBIT 04/30 00:00 36.11 TOKYO INN JAPANESE STE MARC FL 05/01 CKCD DEBIT 04/29 00:00 44.48 MICCOSUKEE SRVCE PLA FORT L FL 05/01 CKCD DEBIT 04/30 00:00 57.13 MARCO BUILDING SUPPLY MARCO FL 05/01 CKCD DEBIT 05/01 00:00 108.18 AMAZON MKTPLACE PMTS AMZN C WA 05/01 CKCD DEBIT 04/30 00:00 213.34 FLORIDA PAINT DECOR MARCO I FL 05/02 INCOMING WIRE M. HEINZ 18,750.00 05/02 DEPOSIT 19,100.00 05/02 INTERNET XFER TO 10,000.00 Centennial Bank *******************EXCLUDE-Em i1 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKH[ L CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 4 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 05/02 INTERNET XFER TO 15,000.00 05/02 CKCD DEBIT 04/30 00:00 16.50 KELCO OF MARCO MARCO ISLAND FL 05/02 CKCD DEBIT 05/01 00:00 27.51 TEXACO 0303980 MARCO ISLAND FL 05/02 CKCD DEBIT 05/01 00:00 32.00 SILVERSPOT CINEMA 239 592 0 FL 05/02 CKCD DEBIT 05/01 00:00 50.64 TEXACO 0303980 MARCO ISLAND FL 05/02 CKCD DEBIT 05/01 00:00 225.29 FLORIDA PAINT DECOR MARCO I FL 05/05 DEPOSIT 6,393.00 05/05 Incoming Wire Fee for 05/04/14 15.00 05/05 WTHDRL DDA 05/04 21:01 400.00 615 E ELKCAM CIRCLE MARCO I FL 05/05 WTHDRL DDA 05/03 11:39 500.00 615 E ELKCAM CIRCLE MARCO I FL 05/05 POS DEBIT 05/05 10:30 2.09 SUNSHINE ACE HAR MARCO ISLA FL 05/05 POS DEBIT 05/03 10:30 4.22 SUNSHINE ACE HAR MARCO ISLA FL 05/05 POS DEBIT 05/04 15:49 8.78 EXXONMOBIL NAPLES FL 05/05 POS DEBIT 05/04 9:19 23.29 SUNSHINE ACE HAR MARCO ISLA FL 05/05 POS DEBIT 05/04 13:27 24.23 SUNSHINE ACE HAR MARCO ISLA FL 05/05 POS DEBIT 05/04 15:41 46.11 LOWE S 2261 NAPLES FL 05/05 CKCD DEBIT 05/02 00:00 50.81 CHEVRON 0357678 FORT LAUDER FL 05/05 CKCD DEBIT 05/04 00:00 59.80 JOEY S PIZZA PASTA H MARCO FL 05/05 CKCD DEBIT 05/03 00:00 62.70 PUBLIX 275 MARCO ISLAND FL 05/05 CKCD DEBIT 05/03 00:00 65.50 SUNSHINE ACE MARCO MARCO IS FL 05/05 CKCD DEBIT 05/03 00:00 76.12 PUBLIX 275 MARCO ISLAND FL 05/05 CKCD DEBIT 05/01 00:00 115.00 LA MIRANDA NAILS SPA MARCO FL 05/05 CKCD DEBIT 05/03 00:00 135.87 PLN PRICELINE HOTELS 800 65 CT 05/05 CKCD DEBIT 05/02 00:00 145.00 GRILL 66 BAR FORT LAUDERD FL Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 5 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 05/05 CKCD DEBIT 05/02 00:00 518.64 PAYPAL OLDEXCAVATI 40293577 CA 05/05 CKCD DEBIT 05/03 00:00 683.64 WEST MARINE 1304 NAPLES FL 05/06 CREDIT MEMO 300.00 05/06 INTERNET XFER FROM 15,000.00 NUMBER 0000002296 05/06 WTHDRL DDA 05/05 20:26 600.00 615 E ELKCAM CIRCLE MARCO I FL 05/06 POS DEBIT 05/06 13:51 18.49 SUNSHINE ACE HAR MARCO ISLA FL 05/06 CKCD DEBIT 05/03 00:00 3.18 HYATT PIER 66 RESORT FORT L FL 05/06 CKCD DEBIT 05/05 00:00 27.35 JOEY S PIZZA PASTA H MARCO FL 05/06 CKCD DEBIT 05/05 00:00 44.49 MARCO BUILDING SUPPLY MARCO FL 05/06 CKCD DEBIT 05/03 00:00 99.80 HYATT PIER 66 RESORT FORT L FL 05/06 CKCD DEBIT 05/05 00:00 1,000.00 PAYPAL SAPPERNELSO 40293577 CA 05/07 INTERNET XFER FROM 400.00 NUMBER 0000003344 05/07 INTERNET XFER FROM 400.00 NUMBER 0000003400 05/07 INTERNET XFER FROM 3,000.00 NUMBER 0000003312 05/07 INTERNET XFER FROM 7, 000.00 NUMBER 0000000178 05/07 POS DEBIT 05/07 16:03 10.05 SUNSHINE ACE HAR MARCO ISLA FL 05/07 CKCD DEBIT 05/05 00:00 83.10 TEXACO 0303980 MARCO ISLAND FL 05/07 CKCD DEBIT 05/06 00:00 113.73 PUBLIX 275 MARCO ISLAND FL 05/08 INTERNET XFER FROM 2,000.00 NUMBER 0000003436 05/08 INTERNET XFER FROM 2,500.00 NUMBER 0000006092 Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 6 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 05/08 INTERNET XFER FROM 5,500.00 NUMBER 0000003716 05/08 DEPOSIT 11,387.50 05/08 DEPOSIT 14,375.00 05/08 NSF FEE 30.00 05/08 OVERDRAFT FEE 90.00 05/08 AC-PROG EXPRESS -INS PREM 70.88 05/08 AC-NATIONAL GENERAL-PAYMENT 1,726.57 05/08 INTERNET XFER TO 16,000.00 05/08 CKCD DEBIT 05/07 00:00 25.50 SILVERSPOT CINEMA NAPLES FL 05/08 CKCD DEBIT 05/07 00:00 32.00 SILVERSPOT CINEMA 239 592 0 FL 05/09 DEPOSIT 12,594.00 05/09 WTHDRL DDA 05/08 20:29 300.00 615 E ELKCAM CIRCLE MARCO I FL 05/09 WTHDRL DDA 05/09 13:43 400.00 615 E ELKCAM CIRCLE MARCO I FL 05/09 INTERNET XFER TO 300.00 05/09 CKCD DEBIT 05/07 00:00 30.09 7 ELEVEN 25725 MARCO ISLAND FL 05/09 CKCD DEBIT 05/08 00:00 172.25 FLORIDA PAINT DECOR MARCO I FL 05/09 CKCD DEBIT 05/08 00:00 239.09 SUNSHINE ACE MARCO MARCO IS FL 05/12 INCOMING WIRE T. SWEEN 6,140.00 05/12 CKCD REFND 05/09 00:00 1.76 PAYPAL CDLOGIER 4029357733 CA 05/12 DEPOSIT 6,730.00 05/12 WTHDRL DDA 05/12 6:24 300.00 615 E ELKCAM CIRCLE MARCO I FL 05/12 WTHDRL DDA 05/11 9:40 600.00 615 E ELKCAM CIRCLE MARCO I FL 05/12 AC-Square Inc -140510B2 241.10 05/12 POS DEBIT 05/12 6:22 1.90 7 ELEVEN MARCO FL 05/12 CKCD DEBIT 05/11 00:00 3.99 APL APPLE ITUNES STORE 866 CA 05/12 CKCD DEBIT 04/18 00:00 5.18 PARADIES 101 Q02 FT MYERS FL 05/12 CKCD DEBIT 05/09 00:00 9.48 PAYPAL GAHOKA 4029357733 CA 05/12 CKCD DEBIT 05/10 00:00 10.06 • Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUNE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 7 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS EXXONMOBIL 97697536 NAPLES FL 05/12 CKCD DEBIT 05/09 00:00 11.74 PAYPAL CDLOGIER 4029357733 CA 05/12 CKCD DEBIT 05/09 00:00 11.74 PAYPAL DENISE768 4029357733 CA 05/12 CKCD DEBIT 05/09 00:00 14.00 PAYPAL CONGA7 4029357733 CA 05/12 CKCD DEBIT 05/09 00:00 14.99 PAYPAL CENTERSKY 4029357733 CA 05/12 CKCD DEBIT 05/09 00:00 15.99 PAYPAL DAVID FROST 40293577 CA 05/12 CKCD DEBIT 05/10 00:00 18.36 PUBLIX 275 MARCO ISLAND FL 05/12 CKCD DEBIT 05/09 00:00 29.59 PAYPAL CDLOGIER 4029357733 CA 05/12 CKCD DEBIT 05/09 00:00 29.64 SUNSHINE ACE MARCO MARCO IS FL 05/12 CKCD DEBIT 05/09 00:00 44.91 PAYPAL HUCKSTERSCL 40293577 CA 05/12 CKCD DEBIT 05/09 00:00 46.60 MARCO BUILDING SUPPLY MARCO FL 05/12 CKCD DEBIT 05/08 00:00 58.21 TEXACO 0303980 MARCO ISLAND FL 05/12 CKCD DEBIT 05/11 00:00 76.70 PINCHERS CRAB SHACK NAPLES FL 05/12 CKCD DEBIT 05/10 00:00 94.08 _ PUBLIX 275 MARCO ISLAND FL 05/13 DEPOSIT 3,000.00 05/13 Incoming Wire Fee for 05/12/14 15.00 05/13 WTHDRL DDA 05/13 17:42 400.00 615 E ELKCAM CIRCLE MARCO I FL 05/13 POS DEBIT 05/13 7:05 11.05 7 ELEVEN MARCO FL 05/14 INTERNET XFER FROM 6,000.00 NUMBER 0000004378 05/14 DEPOSIT 100.00 05/14 POS DEBIT 05/14 17:17 8.46 SUNSHINE ACE HAR MARCO ISLA FL 05/14 POS DEBIT 05/14 14:38 16.95 SUNSHINE ACE HAR MARCO ISLA FL 05/14 CKCD DEBIT 05/12 00:00 1.00 MAIN ST PARKING GARAGE FORT FL 05/14 CKCD DEBIT 05/12 00:00 2.00 MAIN ST PARKING GARAGE FORT FL 05/14 CKCD DEBIT 05/12 00:00 56.67 Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 8 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS TEXACO 0303980 MARCO ISLAND FL 05/15 INTERNET XFER FROM 2,000.00 NUMBER 0000005300 05/15 INTERNET XFER FROM 9,000.00 NUMBER 0000001618 05/15 CKCD DEBIT 05/13 00:00 18.52 ICHIBAN JAPANESE CHI FORT M FL 05/15 CKCD DEBIT 05/14 00:00 50.79 HIT INTERNA 2253040408 LA 05/15 CKCD DEBIT 05/14 00:00 95.89 HIT INTERNA 2253040408 LA 05/15 CKCD DEBIT 05/14 00:00 100.00 FDEP PAYMENT SYSTEM 0850245 FL 05/15 CKCD DEBIT 05/13 00:00 122.91 FTD AVAS FLOWERS MAHWAH NJ 05/15 CKCD DEBIT 05/14 00:00 188.73 FLORIDA PAINT DECOR MARCO I FL 05/16 CKCD DEBIT 05/15 00:00 518.50 UNITED 800 932 2732 TX 05/16 CKCD DEBIT 05/14 00:00 564.99 USHIP COM AUSTIN TX 05/19 INTERNET XFER FROM 10,000.00 NUMBER 0000010196 05/19 DEPOSIT 16,656.25 05/19 DEPOSIT 61,412.50 05/19 OVERDRAFT FEE 60.00 05/19 WTHDRL DDA 05/17 7:36 600.00 615 E ELKCAM CIRCLE MARCO I FL 05/19 POS DEBIT 05/19 18:31 22.31 XPRESS MART MARCO ISLAND FL 05/19 INTERNET XFER TO 25,000.00 05/19 INTERNET XFER TO 35,000.00 05/19 CKCD DEBIT 05/18 00:00 4.79 PAYPAL DTWELL99 4029357733 CA 05/19 CKCD DEBIT 05/18 00:00 6.87 PAYPAL MOONARSTORE 40293577 CA 05/19 CKCD DEBIT 05/18 00:00 10.35 PAYPAL SHOPPINGBRE 40293577 CA 05/19 CKCD DEBIT 05/18 00:00 10.98 PAYPAL YAAHEECOM 4029357733 CA 05/19 CKCD DEBIT 05/18 00:00 11.88 Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 9 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS PAYPAL ABCJEWELRYC 40293577 CA 05/19 CKCD DEBIT 05/18 00:00 14.58 PAYPAL WALSHOP810 402935773 CA 05/19 CKCD DEBIT 05/18 00:00 15.58 PAYPAL LIAO XINHUI 40293577 CA 05/19 CKCD DEBIT 05/18 00:00 20.51 PAYPAL QINGFANG201 40293577 CA 05/19 CKCD DEBIT 05/17 00:00 24.50 SILVERSPOT CINEMA NAPLES FL 05/19 CKCD DEBIT 05/18 00:00 27.80 PAYPAL RAOSHAOPING 40293577 CA 05/19 CKCD DEBIT 05/17 00:00 32.00 SILVERSPOT CINEMA 239 592 0 FL 05/19 CKCD DEBIT 05/18 00:00 35.50 PAYPAL BIZZYBE123 402935773 CA 05/19 CKCD DEBIT 05/17 00:00 42.97 TAVERN ON THE BAY NAPLES FL 05/19 CKCD DEBIT 05/15 00:00 47.67 TEXACO 0303980 MARCO ISLAND FL 05/19 CKCD DEBIT 05/17 00:00 60.00 BRAVO MERCATO NAPLES FL 05/19 CKCD DEBIT 05/15 00:00 100.00 DISH NETWORK ONE TIME 800 8 CO 05/19 CKCD DEBIT 05/16 00:00 172.25 FLORIDA PAINT DECOR MARCO I FL 05/19 CKCD DEBIT 05/17 00:00 176.49 MACY S EAST 822 NAPLES FL 05/19 CKCD DEBIT 05/16 00:00 195.55 PUBLIX 275 MARCO ISLAND FL 05/19 CKCD DEBIT 05/15 00:00 400.00 DISH NETWORK ONE TIME 800 8 CO 05/19 CKCD DEBIT 05/15 00:00 520.00 AMERICAN DALLAS TX 05/20 INCOMING WIRE GAGE 14,100.00 05/20 DEPOSIT 6,275.00 05/20 DEPOSIT 38,250.00 05/20 WTHDRL DDA 05/19 19:37 600.00 615 E ELKCAM CIRCLE MARCO I FL 05/20 AC-PROG SELECT INS -INS PREM 299.41 05/20 INTERNET XFER TO 25,000.00 05/20 CKCD DEBIT 05/19 00:00 45.32 JOEY S PIZZA PASTA H MARCO FL 05/21 INTERNET XFER FROM 24,000.00 NUMBER 0000002598 Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 10 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 05/21 INTERNET XFER FROM 25,000.00 NUMBER 0000002160 05/21 CKCD DEBIT 05/20 00:00 14.29 SUNSHINE ACE MARCO MARCO IS FL 05/21 CKCD DEBIT 05/20 00:00 38.00 SNOOK INN MARCO ISLAND FL 05/21 CKCD DEBIT 05/19 00:00 48.83 TEXACO 0303980 MARCO ISLAND FL 05/21 CKCD DEBIT 05/19 00:00 88.17 TEXACO 0303980 MARCO ISLAND FL 05/21 CKCD DEBIT 05/19 00:00 100.00 TEXACO 0303980 MARCO ISLAND FL 05/22 INTERNET XFER FROM 5,000.00 NUMBER 0000001956 05/22 INTERNET XFER FROM 5,000.00 NUMBER 0000002932 05/22 FOREIGN ATM FEE 2.00 1 AT 2.00 05/22 OVERDRAFT FEE 30.00 05/22 WTHDRL DDA 05/21 21:31 203.05 250 RACQUET CLUB ROAD WESTO FL 05/22 AC-COLLIER CLERK OF-ACH 100.26 05/22 POS DEBIT 05/21 20:00 48.37 SHELL SERVICE STATION NAPLE FL 05/22 CKCD DEBIT 05/20 00:00 11.65 XPRESS MART MARCO ISLAND FL 05/22 CKCD DEBIT 05/21 00:00 12.71 DUNKIN 349485 Q35 MARCO ISL FL 05/22 CKCD DEBIT 05/20 00:00 13.92 XPRESS MART MARCO ISLAND FL 05/22 CKCD DEBIT 05/21 00:00 152.45 SUNSHINE ACE MARCO MARCO IS FL 05/23 INTERNET XFER FROM 15,000.00 NUMBER 0000005464 05/23 OVERDRAFT FEE 30.00 05/23 WTHDRL DDA 05/22 21:05 500.00 615 E ELKCAM CIRCLE MARCO I FL 05/23 CKCD DEBIT 05/22 00:00 94.71 PLN PRICELINE HOTELS 800 65 CT 05/23 CKCD DEBIT 05/22 00:00 463.44 NEBS PRINT SUPPLIES 800 225 MA 05/27 INTERNET XFER FROM 1,000.00 • Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 11 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS NUMBER 0000000852 05/27 INTERNET XFER FROM 4,000.00 05/27 CKCD REFND 05/26 00:00 128.90 PLN PRICELINE HOTELS 800 65 CT 05/27 DEPOSIT 20,000.00 05/27 WTHDRL DDA 05/26 17:13 600.00 615 E ELKCAM CIRCLE MARCO I FL 05/27 POS DEBIT 05/27 17:27 9.49 WALGREENS MARCO ISLAND FL 05/27 POS DEBIT 05/26 12:01 10.05 SUNSHINE ACE HAR MARCO ISLA FL 05/27 CKCD DEBIT 05/26 00:00 5.60 MPA PARKING PAY BY PHO MIAM FL 05/27 CKCD DEBIT 05/25 00:00 6.00 GOGOAIR COM 877 350 0038 IL 05/27 CKCD DEBIT 05/23 00:00 6.00 GOGOAIR COM 877 350 0038 IL 05/27 CKCD DEBIT 05/23 00:00 9.95 GOGOAIR COM 877 350 0038 IL 05/27 CKCD DEBIT 05/25 00:00 18.32 EXXONMOBIL 47682976 MOUNT E NJ 05/27 CKCD DEBIT 05/23 00:00 18.92 SHELL OIL 575424870QPS NAPL FL �� 05/27 CKCD DEBIT 05/23 00:00 20.00 CASA BACARDI C10500601 FT M FL 05/27 CKCD DEBIT 05/23 00:00 21.06 RITTENHOUSE 1715 HOTEL PHIL PA 05/27 CKCD DEBIT 05/21 00:00 24.47 BONAVENTURE RESORT AND WEST FL 05/27 CKCD DEBIT 05/25 00:00 25.00 USAIRWAY PHILADELPHIA PA 05/27 CKCD DEBIT 05/23 00:00 27.00 USAIRWAY FORT MYERS FL 05/27 CKCD DEBIT 05/25 00:00 28.00 SW FLORIDA INTL AIRPOR FORT FL 05/27 CKCD DEBIT 05/23 00:00 31.52 FLORIDA PAINT DECOR MARCO I FL 05/27 CKCD DEBIT 05/23 00:00 34.00 PARKING 00425 ART ALLI 215 PA 05/27 CKCD DEBIT 05/25 00:00 70.00 APPLEBEES 96206149 MT LAURE NJ 05/27 CKCD DEBIT 05/26 00:00 94.75 PUBLIX 275 MARCO ISLAND FL Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE-030 Page 12 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 05/27 CKCD DEBIT 05/22 00:00 106.00 KELCO OF MARCO MARCO ISLAND FL 05/27 CKCD DEBIT 05/23 00:00 120.00 ROUGE 98 PHILADELPHIA PA 05/27 CKCD DEBIT 05/26 00:00 128.90 PLN PRICELINE HOTELS 800 65 CT 05/27 CKCD DEBIT 05/26 00:00 132.39 PLN PRICELINE HOTELS 800 65 CT 05/27 CKCD DEBIT 05/26 00:00 193.86 PLN PRICELINE HOTELS 800 65 CT 05/27 CKCD DEBIT 05/23 00:00 200.00 PROFESSIONAL DRY CLEAN MARC FL 05/27 CKCD DEBIT 05/25 00:00 398.00 AMERICAN DALLAS TX 05/28 INTERNET XFER FROM 10,000.00 NUMBER 0000002180 05/28 CKCD DEBIT 05/27 00:00 57.29 PUBLIX 275 MARCO ISLAND FL 05/28 CKCD DEBIT 05/26 00:00 64.95 7 ELEVEN 25725 MARCO ISLAND FL 05/28 CKCD DEBIT 05/27 00:00 103.80 SUNSHINE ACE MARCO MARCO IS FL 05/29 INTERNET XFER FROM 4,000.00 NUMBER 0000006916 05/29 WTHDRL DDA 05/29 10:13 500.00 615 E ELKCAM CIRCLE MARCO I FL 05/29 POS DEBIT 05/29 18:45 20.75 WALGREENS MARCO ISLAND FL 05/29 INTERNET XFER TO 400.00 05/29 CKCD DEBIT 05/28 00:00 41.85 SUNSHINE ACE MARCO MARCO IS FL 05/29 CKCD DEBIT 05/27 00:00 51.28 SHELL OIL 575424869QPS NAPL FL 05/29 CKCD DEBIT 05/27 00:00 84.24 TEXACO 0303980 MARCO ISLAND FL 05/29 CKCD DEBIT 05/28 00:00 237.00 DELTA DELTA COM CA 05/30 INTERNET XFER FROM 6,000.00 NUMBER 0000003134 05/30 SERVICE CHARGE 10.00 05/30 OVERDRAFT FEE 60.00 05/30 ISA FEE 05/28 00:00 .20 • Centennial Bank *******************EXCLUDE-Email 44890 0.2560 EX 0.000 05/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 269 MARCO ISLAND FL 34145 CYCLE,-030 Page 13 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS WESTJET 8380615216724 CALGA AB 05/30 ISA FEE 05/28 00:00 2.47 WESTJET 8382198559750 CALGA AB 05/30 POS DEBIT 05/30 12:44 11.59 WESTON BP FORT LAUDERDA FL 05/30 CKCD DEBIT 05/29 00:00 3.99 APL APPLE ITUNES STORE 866 CA 05/30 CKCD DEBIT 05/28 00:00 20.00 WESTJET 8380615216724 CALGA AB 05/30 CKCD DEBIT 05/28 00:00 199.24 USAIRWAY 800 428 4322 AZ 05/30 CKCD DEBIT 05/28 00:00 247.48 WESTJET 8382198559750 CALGA AB 05/31 CYCLE SERVICE CHARGE 39.20 BALANCE BY DATE DATE BALANCE DATE BALANCE DATE BALANCE DATE BALANCE 04/30 773.94 05/01 1,644.10 05/02 12,997.91 05/05 5,826.49 05/06 3,704.47 05/07 4,838.56- 05/08 9,882.18 05/09 19, 646.63 05/12 25,286.28 05/13 14,982.10 05/14 2,231.31 05/15 5, 989.47 05/16 4,162.46- 05/19 9,802.32 05/20 19,562.88 05/21 169.24- 05/22 8,612.10- 05/23 2,400.64 05/27 20,916.05 05/28 5,613.89 05/29 3,719.39- 05/30 1,045.76 05/31 1,006.56 *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Attention all Consumer Debit Card Holders: Effective 8/1/14 the following transaction limits will be in effect: PIN Based transactions 25 per day, Signature Based transactions 25 per day,$500 limit per day at ATMs,$1,500 per day Point of Sale transactions. Please be reminded to vigilantly review your statements to confirm all account activity and guard your debit card and PIN carefully. Some transactions could lead to overdraft and associated fees. Please discuss your Opt In election with your banker to ensure all transactions are covered by your Overdraft Privilege. *** CHECKING *** 0900 NEW BUSINESS CK ACCOUNT NUMBER PREVIOUS STATEMENT BALANCE AS OF 05/31/14 1,006.56 PLUS 40 DEPOSITS AND OTHER CREDITS 362,720.03 LESS 417 CHECKS AND OTHER DEBITS 347,904.94 LESS CYCLE SERVICE CHARGE 37.60 CURRENT STATEMENT BALANCE AS OF 06/30/14 15,784.05 NUMBER OF DAYS IN THIS STATEMENT PERIOD 30 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 10857 06/05 1,000.00 12986 06/10 1,201.00 13313 06/02 318.00 12701* 06/04 350.00 12987 06/13 675.00 13314 06/23 748.36 12738* 06/02 600.00 12988 06/16 500.00 13328* 06/09 210.00 12839* 06/09 500.00 12989 06/17 1,124.00 13335* 06/10 8.00 12905* 06/04 408.10 12990 06/19 300.00 13341* 06/02 500.00 12906 06/04 398.30 12992* 06/19 2,880.32 13552* 06/12 600.00 12907 06/06 489.72 12993 06/23 180.16 13553 06/11 1,113.00 12908 06/17 3,380.76 12994 06/23 461.10 13554 06/13 1,080.00 12909 06/19 3,152.33 12995 06/24 131.54 13556* 06/30 2, 907.21 12910 06/17 204.05 12996 06/25 207.33 13557 06/09 400.00 12911 06/17 265.27 12997 06/24 1,100.00 13558 06/11 269.10 _ 12912 06/17 822.40 12998 06/23 500.00 13559 06/04 747.30 12913 06/17 231.30 12999 06/27 500.00 13561* 06/23 50.00 12914 06/27 2,470.10 13001* 06/25 200.00 13562 06/11 1,049.00 12915 06/27 1,744.70 13003* 06/25 106.00 13563 06/11 7,538.57 12916 06/27 1,247.83 13004 06/25 1,500.00 13564 06/02 225.00 12917 06/27 1,557.87 13005 06/27 1,000.00 13565 06/03 3,511.53 12958* 06/03 546.36 13006 06/30 207.80 13566 06/02 131.17 12974* 05/30 1,500.00 13007 06/30 141.40 13569* 06/02 30.00 12975 06/06 1,716.25 13008 06/27 1,200.00 13571* 06/02 118.75 12977* 06/02 1,000.00 13009 06/30 906.63 13572 06/02 75.00 12978 06/03 900.00 13010 06/27 2,285.00 13573 06/09 7.50 12979 06/06 1,200.00 13012* 06/30 400.00 13574 06/02 30.00 12980 06/09 16,190.69 13296* 06/03 125.63 13575 06/03 37.38 12981 06/20 211.22 13298* 06/02 500.00 13576 06/13 88.00 12982 06/10 1,700.00 13301* 06/03 6,061.36 13580* 06/02 1, 985.00 12983 06/17 40.82 13307* 06/02 500.00 13581 06/12 1,197.92 12984 06/24 349.96 13310* 06/17 2,138.50 13582 06/02 61.74 12985 06/09 7,240.90 13312* 06/02 2,065.00 13583 06/02 18.00 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 2 of 35 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 13596* 06/03 5,000.00 13646 06/11 44.97 13696 06/16 10.00 13597 06/05 1,500.00 13647 06/16 475.00 13697 06/17 117.56 13599* 06/04 5,000.00 13648 06/12 1,798.00 13698 06/16 67.83 13600 06/05 387.50 13649 06/12 1,393.00 13699 06/16 31.27 13601 06/18 6,429.96 13650 06/12 445.30 13701* 06/25 495.00 13602 06/05 2,000.00 13651 06/10 1,010.00 13702 06/16 2,700.00 13603 06/10 750.00 13652 06/17 600.00 13703 06/24 820.24 13604 06/10 225.00 13653 06/11 736.25 13704 06/23 626.61 13606* 06/09 576.25 13655* 06/10 5,000.00 13705 06/23 805.00 13607 06/12 300.00 13656 06/11 50.00 13706 06/23 384.00 13609* 06/18 6,009.64 13657 06/11 2,031.49 13707 06/17 129.10 13610 06/10 42.43 13658 06/17 4,556.70 13708 06/17 5,500.00 13611 06/06 86.95 13659 06/11 79.54 13709 06/18 6,000.00 13612 06/10 4,293.20 13660 06/11 6,000.00 13710 06/25 1,500.00 13613 06/11 235.00 13661 06/12 446.50 13711 06/26 1, 584.31 13614 06/13 100.00 13662 06/12 576.25 13712 06/19 84.00 13615 06/11 33.20 13663 06/12 1,489.50 13713 06/24 81.67 13616 06/10 780.00 13664 06/13 1,500.00 13714 06/19 140.00 13617 06/09 1,000.00 13665 06/17 1,869.84 13715 06/19 3,500.00 13618 06/09 285.00 13666 06/12 3,000.00 13717* 06/30 1,200.00 13619 06/09 275.00 13668* 06/12 742.50 13718 06/23 175.00 13620 06/13 70.00 13669 06/16 242.44 13719 06/20 800.00 13621 06/09 30.00 13670 06/17 500.00 13720 06/24 4,495.67 13622 06/09 112.88 13672* 06/16 746.90 13721 06/20 285.00 13623 06/09 575.00 13673 06/17 98.00 13722 06/23 234.00 13624 06/09 25.00 13674 06/13 170.00 13723 06/23 70.00 13625 06/09 135.00 13675 06/25 292.27 13724 06/23 275.00 13626 06/09 41.25 13676 06/24 442.02 13725 06/24 80.00 13627 06/11 171.88 13677 06/24 692.19 13726 06/23 60.00 13628 06/13 115.50 13678 06/19 500.00 13727 06/24 31.50 13629 06/09 28.00 13679 06/17 4,549.01 13728 06/23 120.00 13630 06/11 140.00 13680 06/16 77.24 13729 06/24 57.75 13631 06/10 30.00 13681 06/16 270.00 13730 06/23 14.00 13632 06/11 222.00 13682 06/16 225.00 13731 06/24 106.25 13633 06/10 120.00 13683 06/16 39.00 13732 06/23 224.00 13634 06/12 135.00 13684 06/16 37.50 13733 06/25 222.00 13636* 06/06 90.00 13685 06/16 30.00 13734 06/23 88.00 13637 06/09 38.38 13686 06/16 77.63 13735 06/24 168.00 13638 06/09 4.74 13687 06/16 350.00 13736 06/20 124.50 13639 06/09 603.28 13688 06/17 45.00 13737 06/24 23.28 13640 06/10 41.31 13690* 06/18 217.29 13738 06/23 18.46 13641 06/09 4.93 13691 06/16 165.00 13739 06/23 14.86 13642 06/17 3,661.26 13692 06/17 81.25 13742* 06/30 500.00 13643 06/06 311.25 13693 06/17 140.00 13745* 06/30 559.03 13644 06/09 57.34 13694 06/13 246.00 13747* 06/24 863.00 13645 06/09 120.00 13695 06/23 50.00 13749* 06/26 131.31 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 3 of 35 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 13750 06/24 1,798.00 13764 06/27 6,559.28 13779 06/30 21.00 13751 06/30 1,022.00 13765 06/30 50.00 13780 06/27 87.50 13752 06/30 80.00 13768* 06/30 297.00 13781 06/30 77.00 13753 06/23 125.00 13769 06/30 29.25 13782 06/27 228.00 13754 06/24 39.96 13770 06/30 108.00 13783 06/30 240.00 13755 06/24 5,500.00 13771 06/30 84.00 13785* 06/30 332.00 13756 06/26 95.00 13772 06/30 117.88 13786 06/30 26.47 13757 06/27 95.00 13773 06/30 500.00 13787 06/30 23.28 13760* 06/24 2, 995.00 13774 06/30 97.50 13788 06/30 1,343.32 13761 06/25 6,000.00 13775 06/30 174.00 13795* 06/30 4,260.00 13762 06/25 21.36 13776 06/30 89.25 13763 06/26 1,500.00 13778* 06/30 168.75 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 06/02 INTERNET XFER FROM 2,500.00 NUMBER 0000014914 06/02 INTERNET XFER FROM 7,500.00 NUMBER 0000011212 06/02 AC-Square Inc -140531B2 1, 608.77 06/02 DEPOSIT 4,250.00 06/02 OVERDRAFT FEE 30.00 06/02 POS DEBIT 05/31 11:52 24.36 _ WALGREENS MARCO ISLAND FL 06/02 POS DEBIT 06/02 14:10 49.81 WALGREENS MARCO ISLAND FL 06/02 POS DEBIT 05/31 11:24 67.80 WALGREENS MARCO ISLAND FL 06/02 CKCD DEBIT 05/31 00:00 23.31 WALGREENS 5197 MARCO ISLAND FL 06/02 CKCD DEBIT 05/31 00:00 25.40 SUNSHINE ACE MARCO MARCO IS FL 06/02 CKCD DEBIT 05/30 00:00 45.32 JOEY S PIZZA PASTA H MARCO FL 06/02 CKCD DEBIT 05/30 00:00 48.31 TEXACO 0303980 MARCO ISLAND FL 06/02 CKCD DEBIT 05/30 00:00 65.37 SHELL OIL 575424869QPS NAPL FL 06/02 CKCD DEBIT 05/31 00:00 78.44 SCUBA MARCO MARCO ISLAND FL 06/02 CKCD DEBIT 05/29 00:00 80.00 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 4 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS MARRIOTTCRYSTALSHORES MARCO FL 06/03 DEPOSIT 13,000.00 06/03 POS DEBIT 06/03 12:20 16.90 SUNSHINE ACE HAR MARCO ISLA FL 06/03 POS DEBIT 06/03 11:03 33.88 SUNSHINE ACE HAR MARCO ISLA FL 06/03 INTERNET XFER TO 300.00 06/03 CKCD DEBIT 06/02 00:00 25.00 MARCO MEDICAL GROUP MARCO I FL 06/03 CKCD DEBIT 06/01 00:00 62.64 TROPIC CAY FORT LAUDERD FL 06/04 INTERNET XFER FROM 5,000.00 NUMBER 0000000416 06/04 POS DEBIT 06/04 9:27 7.94 WALGREENS MARCO ISLAND FL 06/04 INTERNET XFER TO 300.00 06/04 CKCD DEBIT 06/03 00:00 21.83 PUBLIX 275 MARCO ISLAND FL 06/04 CKCD DEBIT 06/02 00:00 37.05 PROGRESSIVE AUTO CENTE MARC FL 06/04 CKCD DEBIT 06/02 00:00 42.38 WIRELESS ZONE WZ737 MARCO I FL 06/04 CKCD DEBIT 06/02 00:00 47.94 MICCOSUKEE SRVCE PLA FORT L FL 06/04 CKCD DEBIT 06/03 00:00 55.18 SNOOK INN MARCO ISLAND FL 06/04 CKCD DEBIT 06/03 00:00 199.97 FLORIDA PAINT DECOR MARCO I FL 06/05 CREDIT MEMO 250.00 06/05 INTERNET XFER FROM 1,000.00 NUMBER 0000005118 06/05 DEPOSIT 3,420.00 06/05 DEPOSIT 7,500.00 06/05 DEPOSIT 27,584.01 06/05 OVERDRAFT FEE 30.00 06/05 WTHDRL DDA 06/05 8:07 40.00 615 E ELKCAM CIRCLE MARCO I FL 06/05 INTERNET XFER TO 1, 000.00 06/05 INTERNET XFER TO 6,500.00 06/05 CKCD DEBIT 06/04 00:00 29.12 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 5 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS SUNSHINE ACE MARCO MARCO IS FL 06/05 CKCD DEBIT 06/03 00:00 67.45 SHELL OIL 57544590805 BONIT FL 06/05 CKCD DEBIT 06/04 00:00 75.00 PINCHERS CRAB SHACK NAPLES FL 06/05 CKCD DEBIT 06/04 00:00 135.57 SCENTCHIPS AND MORE IN NAPL FL 06/05 CKCD DEBIT 06/04 00:00 204.61 SUNSHINE ACE MARCO MARCO IS FL 06/06 INTERNET XFER FROM 600.00 NUMBER 0000001782 06/06 DEPOSIT 8,000.00 06/06 DEPOSIT 11,798.70 06/06 WTHDRL DDA 06/05 19:54 200.00 615 E ELKCAM CIRCLE MARCO I FL 06/06 POS DEBIT 06/06 17:27 6.24 XPRESS MART MARCO ISLAND FL 06/06 INTERNET XFER TO 300.00 06/06 CKCD DEBIT 06/05 00:00 28.25 BREAKFAST PLUS MARCO ISLAND FL 06/06 CKCD DEBIT 06/04 00:00 50.00 MARRIOTTCRYSTALSHORES MARCO FL 06/06 CKCD DEBIT 06/05 00:00 68.35 PUBLIX 622 MARCO ISLAND FL 06/09 INCOMING WIRE GILL 7,562.50 06/09 WTHDRL DDA 06/07 11:05 300.00 615 E ELKCAM CIRCLE MARCO I FL 06/09 POS DEBIT 06/09 17:13 49.95 WALGREENS MARCO ISLAND FL 06/09 POS DEBIT 06/09 17:18 50.85 WALGREENS MARCO ISLAND FL 06/09 INTERNET XFER TO 25.00 06/09 CKCD DEBIT 06/07 00:00 7.99 PAYPAL LGSMARTWORL 40293577 CA 06/09 CKCD DEBIT 06/07 00:00 14.09 TEXACO 0303980 MARCO ISLAND FL 06/09 CKCD DEBIT 06/06 00:00 29.99 TAXEXCISE COM 866 2453918 TN 06/09 CKCD DEBIT 06/06 00:00 32.28 JOEY S PIZZA PASTA H MARCO FL 06/09 CKCD DEBIT 06/06 00:00 51.30 TEXACO 0303980 MARCO ISLAND FL 06/09 CKCD DEBIT 06/06 00:00 66.29 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 6 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS SHELL OIL 575424870QPS NAPL FL 06/09 CKCD DEBIT 06/06 00:00 81.35 TEXACO 0303980 MARCO ISLAND FL 06/09 CKCD DEBIT 06/08 00:00 131.15 PUBLIX 275 MARCO ISLAND FL 06/09 CKCD DEBIT 06/05 00:00 194.60 TROPIC CAY FORT LAUDERD FL 06/09 CKCD DEBIT 06/06 00:00 200.00 PROFESSIONAL DRY CLEAN MARC FL 06/10 DEPOSIT 13,715.60 06/10 Incoming Wire Fee for 06/09/14 15.00 06/10 STOP PAYMENT FEE 30.00 06/10 POS DEBIT 06/10 10:26 4.22 SUNSHINE ACE HAR MARCO ISLA FL 06/10 CKCD DEBIT 06/09 00:00 14.79 MARCO OFFICE SUPPLY MA MARC FL 06/10 CKCD DEBIT 06/09 00:00 191.31 DELTA DELTA COM CA 06/12 INTERNET XFER FROM 1,000.00 NUMBER 0000001556 06/12 INTERNET XFER FROM 1,200.00 NUMBER 0000002036 06/12 INTERNET XFER FROM 1,500.00 NUMBER 0000002044 06/12 AC-PROG EXPRESS -INS PREM 5,870.24 06/12 DEPOSIT 9,768.80 06/12 OVERDRAFT FEE 30.00 06/12 ISA FEE 06/11 00:00 2.88 DELTA 0062361829393 DORVAL QC 06/12 AC-NATIONAL GENERAL-PAYMENT 1,325.41 06/12 CKCD DEBIT 06/11 00:00 6.31 SUNSHINE ACE MARCO MARCO IS FL 06/12 CKCD DEBIT 06/11 00:00 8.46 SUNSHINE ACE MARCO MARCO IS FL 06/12 CKCD DEBIT 06/11 00:00 28.53 SUNSHINE ACE MARCO MARCO IS FL 06/12 CKCD DEBIT 06/11 00:00 32.97 SNOOK INN MARCO ISLAND FL 06/12 CKCD DEBIT 06/11 00:00 100.00 SNOOK INN MARCO ISLAND FL 06/12 CKCD DEBIT 06/11 00:00 190.15 SUNSHINE ACE MARCO MARCO IS FL 06/12 CKCD DEBIT 06/11 00:00 200.00 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 7 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS PROFESSIONAL DRY CLEAN MARC FL 06/12 CKCD DEBIT 06/11 00:00 288.11 DELTA 0062361829393 DORVAL QC 06/13 DEPOSIT 12,000.00 06/13 INTERNET XFER TO 200.00 06/13 CKCD DEBIT 06/12 00:00 9.95 GOGOAIR COM 877 350 0038 IL 06/13 CKCD DEBIT 06/12 00:00 25.00 DELTA FT MYERS FL 06/16 DEPOSIT 40,000.00 06/16 INTERNET XFER TO 19.00 06/16 INTERNET XFER TO 50.00 06/16 INTERNET XFER TO 100.00 06/16 INTERNET XFER TO 20,000.00 06/16 CKCD DEBIT 06/14 00:00 12.20 XPRESS MART MARCO ISLAND FL 06/16 CKCD DEBIT 06/15 00:00 15.89 SUNSHINE ACE MARCO MARCO IS FL 06/16 CKCD DEBIT 06/14 00:00 33.20 FLORIDA PAINT DECOR MARCO I FL 06/16 CKCD DEBIT 06/14 00:00 45.38 FLORIDA PAINT DECOR MARCO I FL 06/16 CKCD DEBIT 06/15 00:00 55.00 PINCHERS CRAB SHACK NAPLES FL 06/16 CKCD DEBIT 06/14 00:00 111 .62 PUBLIX 275 MARCO ISLAND FL 06/17 INTERNET XFER FROM 5,000.00 NUMBER 0000004004 06/17 AC-PROG SELECT INS -INS PREM 302.22 06/17 CKCD DEBIT 06/15 00:00 21.18 WEST MARINE 510 MARCO ISLAN FL 06/17 CKCD DEBIT 06/16 00:00 29.99 2CO COM NEWLIFE 08772940273 OH 06/17 CKCD DEBIT 06/16 00:00 81.82 SUNSHINE ACE MARCO MARCO IS FL 06/17 CKCD DEBIT 06/16 00:00 149.23 SUNSHINE ACE MARCO MARCO IS FL 06/18 INTERNET XFER FROM 1,000.00 NUMBER 0000002272 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 8 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 06/18 INTERNET XFER FROM 19,000.00 NUMBER 0000003538 06/18 DEPOSIT 6,237.66 06/18 OVERDRAFT FEE 30.00 06/18 AC-COLLIER CLERK OF-ACH 80.26 06/18 POS DEBIT 06/17 20:24 27.54 WALGREENS MARCO ISLAND FL 06/18 POS DEBIT 06/17 20:30 31.17 WALGREENS MARCO ISLAND FL 06/18 CKCD DEBIT 06/17 00:00 3.49 DUNKIN 310129 Q35 DANIA FL 06/18 CKCD DEBIT 06/16 00:00 303.27 DISH NETWORK ONE TIME 800 8 CO 06/19 INTERNET XFER FROM 5,000.00 NUMBER 0000001804 06/19 CKCD DEBIT 06/17 00:00 37.05 PROGRESSIVE AUTO CENTE MARC FL 06/19 CKCD DEBIT 06/17 00:00 49.57 MICCOSUKEE SERVICE PLA FORT FL 06/19 CKCD DEBIT 06/18 00:00 71.14 FLORIDA PAINT DECOR MARCO I FL 06/20 DEPOSIT 9,400.00 06/20 CKCD DEBIT 06/19 00:00 42.43 TOKYO INN JAPANESE STE MARC FL 06/20 CKCD DEBIT 06/19 00:00 118.34 SUNSHINE ACE MARCO MARCO IS FL 06/23 INCOMING WIRE FRED W MUNDIE JR 17,000.00 PA NUMBER 0000000255 06/23 DEPOSIT 10, 618.50 06/23 DEPOSIT 14,275.00 06/23 WTHDRL DDA 06/23 17:04 380.00 615 E ELKCAM CIRCLE MARCO I FL 06/23 INTERNET XFER TO 25,000.00 06/23 CKCD DEBIT 06/21 00:00 28.59 SUNSHINE ACE MARCO MARCO IS FL 06/23 CKCD DEBIT 06/21 00:00 34.02 FLORIDA PAINT DECOR MARCO I FL 06/23 CKCD DEBIT 06/19 00:00 38.12 TEXACO 0303980 MARCO ISLAND FL 06/23 CKCD DEBIT 06/20 00:00 39.17 JOEY S PIZZA PASTA H MARCO FL 06/23 CKCD DEBIT 06/21 00:00 42.63 Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 9 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS FLORIDA PAINT DECOR MARCO I FL 06/23 CKCD DEBIT 06/21 00:00 55.00 PINCHERS CRAB SHACK NAPLES FL 06/23 CKCD DEBIT 06/21 00:00 82.57 TEXACO 0303980 MARCO ISLAND FL 06/23 CKCD DEBIT 06/22 00:00 92.76 PUBLIX 275 MARCO ISLAND FL 06/23 CKCD DEBIT 06/21 00:00 143.00 PUBLIX 275 MARCO ISLAND FL 06/23 CKCD DEBIT 06/20 00:00 188.00 DELTA DELTA COM CA 06/23 CKCD DEBIT 06/21 00:00 200.00 PROFESSIONAL DRY CLEAN MARC FL 06/23 CKCD DEBIT 06/19 00:00 216.50 USAIRWAY 800 428 4322 AZ 06/23 CKCD DEBIT 06/19 00:00 269.00 SOUTHWES 800 435 9792 TX 06/24 INCOMING WIRE PINNACLE ISLAND 6,500.00 LLC NUMBER 0000000125 06/24 DEPOSIT 12,210.25 06/24 Incoming Wire Fee for 06/23/14 15.00 06/24 POS DEBIT 06/24 16:26 27.54 WALGREENS MARCO ISLAND FL 06/24 CKCD DEBIT 06/23 00:00 51.68 JOEY S PIZZA PASTA H MARCO FL 06/24 CKCD DEBIT 06/22 00:00 68.91 MICCOSUKEE SERVICE PLA FORT FL 06/24 CKCD DEBIT 06/23 00:00 105.70 PLN PRICELINE HOTELS 800 65 CT 06/25 DEPOSIT 15,000.00 06/25 Incoming Wire Fee for 06/24/14 15.00 06/25 WTHDRL DDA 06/25 15:49 300.00 615 E ELKCAM CIRCLE MARCO I FL 06/25 INTERNET XFER TO 200.00 06/25 CKCD DEBIT 06/24 00:00 19.68 PUBLIX 275 MARCO ISLAND FL 06/25 CKCD DEBIT 06/23 00:00 85.94 TEXACO 0303980 MARCO ISLAND FL 06/25 CKCD DEBIT 06/24 00:00 100.00 PINCHERS CRAB SHACK NAPLES FL 06/25 CKCD DEBIT 06/23 00:00 100.08 SHERATON HOTELS FT LAU DANI FL 06/25 CKCD DEBIT 06/24 00:00 186.34 FLORIDA PAINT DECOR MARCO I FL Centennial Bank *******************EXCLUDE-Email 35417 0.2560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHLLL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 10 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 06/26 ISA FEE 06/24 00:00 .39 WESTJET 8380615476739 CALGA AB 06/26 ISA FEE 06/24 00:00 4.25 WESTJET 8382199201476 CALGA AB 06/26 AC-Collier Tax -Collier 106.30 06/26 CKCD DEBIT 06/24 00:00 39.16 WESTJET 8380615476739 CALGA AB 06/26 CKCD DEBIT 06/25 00:00 179.83 FLORIDA PAINT DECOR MARCO I FL 06/26 CKCD DEBIT 06/25 00:00 256.47 BEBE COM 08002323100 CA 06/26 CKCD DEBIT 06/24 00:00 424.69 WESTJET 8382199201476 CALGA AB 06/26 CKCD DEBIT 06/24 00:00 922.00 B W EQUIPMENT CO FORT WAYNE IN 06/27 DEPOSIT 2, 600.00 06/27 DEPOSIT 6,500.00 06/27 DEPOSIT 13,000.00 06/27 WIRE TRANSACTION 770.00 06/27 WTHDRL DDA 06/27 16:40 600.00 615 E ELKCAM CIRCLE MARCO I FL 06/27 INTERNET XFER TO 300.00 06/27 INTERNET XFER TO 5,000.00 06/27 CKCD DEBIT 06/26 00:00 25.00 SNOOK INN MARCO ISLAND FL 06/27 CKCD DEBIT 06/26 00:00 29.67 SUNSHINE ACE MARCO MARCO IS FL 06/27 CKCD DEBIT 06/26 00:00 34.24 JOEY S PIZZA PASTA H MARCO FL 06/27 CKCD DEBIT 06/26 00:00 1,199.39 CEMEX CASH SALE 800 99CEMEX TX 06/30 DEPOSIT 8,750.00 06/30 DEPOSIT 24,000.00 06/30 SERVICE CHARGE 10.00 06/30 CYCLE SERVICE CHARGE 37.60 06/30 WTHDRL DDA 06/30 7:55 600.00 615 E ELKCAM CIRCLE MARCO I FL 06/30 WTHDRL DDA 06/30 10:17 600.00 615 E ELKCAM CIRCLE MARCO I FL 06/30 INTERNET XFER TO 500.00 06/30 INTERNET XFER TO 10,000.00 06/30 CKCD DEBIT 06/27 00:00 2.98 Centennial Bank *******************EXCLUDE-Email 35417 02560 EX 0.000 92 2 8578 06/30/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 283 MARCO ISLAND FL 34145 CYCLE-030 Page 11 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS MPA PARKING PAY BY PHO MIAM FL 06/30 CKCD DEBIT 06/29 00:00 17.00 SILVERSPOT CINEMA NAPLES FL 06/30 CKCD DEBIT 06/28 00:00 17.97 SUNSHINE ACE MARCO MARCO IS FL 06/30 CKCD DEBIT 06/29 00:00 27.35 JOEY S PIZZA PASTA H MARCO FL 06/30 CKCD DEBIT 06/29 00:00 29.25 SILVERSPOT CINEMA 239 592 0 FL 06/30 CKCD DEBIT 06/27 00:00 34.20 SUNPASS ACC14186158 888 865 FL 06/30 CKCD DEBIT 06/28 00:00 35.67 SNOOK INN MARCO ISLAND FL 06/30 CKCD DEBIT 06/27 00:00 50.00 SUNPASS ACC14186158 888 865 FL 06/30 CKCD DEBIT 06/29 00:00 60.00 PINCHERS CRAB SHACK NAPLES FL 06/30 CKCD DEBIT 06/29 00:00 77.79 EXXONMOBIL 97697536 NAPLES FL 06/30 CKCD DEBIT 06/27 00:00 87.83 TEXACO 0303980 MARCO ISLAND FL BALANCE BY DATE DATE BALANCE DATE BALANCE DATE BALANCE DATE BALANCE 05/31 1,006.56 06/01 493.44- 06/02 6, 669.55 06/03 3,048.87 06/04 432.88 06/05 27,217.64 06/06 43,069.33 06/09 20,935.85 06/10 19,195.19 06/11 518.81- 06/12 4,483.44 06/13 12,203.99 06/16 25,716.89 06/17 77.63 06/18 7,182.67 06/19 1,468.26 06/20 9,286.77 06/23 19,147.36 06/24 17,812.75 06/25 21,261.75 06/26 16,018.04 06/27 11,184.46 06/30 15,784.05 • *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 *** CHECKING *** 0900 BUSINESS CK ACCOUNT NUMBER PREVIOUS STATEMENT BALANCE AS OF 06/30/14 15,784.05 PLUS 53 DEPOSITS AND OTHER CREDITS 413,027.61 LESS 411 CHECKS AND OTHER DEBITS 427,930.71 LESS CYCLE SERVICE CHARGE 20.40 CURRENT STATEMENT BALANCE AS OF 07/31/14 860.55 NUMBER OF DAYS IN THIS STATEMENT PERIOD 31 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 605 07/03 1,000.00 13044 07/24 190.49 13798* 07/02 6,500.00 10858* 07/02 1,000.00 13047* 07/31 1,000.00 13799 07/07 1,442.95 12918* 07/17 1,020.25 13049* 07/25 1,800.00 13800 07/09 616.00 12919 07/17 177.29 13157* 07/17 575.58 13801 07/03 2,000.00 12976* 07/07 700.00 13158 07/17 226.16 13802 07/08 4,300.42 12991* 07/01 6,304.96 13159 07/17 63.44 13803 07/07 50.00 13000* 07/07 500.00 13160 07/17 897.45 13804 07/07 369.75 13011* 07/01 1,000.00 13161 07/17 262.80 13805 07/07 371.25 13013* 07/02 1,130.00 13162 07/17 39.11 13806 07/07 97.50 13014 07/07 345.99 13163 07/23 1, 652.81 13807 07/07 108.00 13016* 07/01 1,500.00 13164 07/17 306.08 13808 07/07 11.50 13017 07/01 5,506.78 13165 07/17 323.09 13809 07/07 350.00 13018 07/16 5,212.96 13167* 07/23 2,024.56 13810 07/09 10.00 13019 07/01 145.86 13560* 07/01 1,510.50 13811 07/08 10.50 13020 07/07 441.38 13568* 07/01 11,289.08 13812 07/08 15.00 13021 07/03 238.20 13577* 07/15 21.00 13813 07/07 123.75 13022 07/02 750.00 13579* 07/01 6,115.22 13814 07/07 14.00 13023 07/09 50.82 13689* 07/01 120.00 13815 07/08 168.75 13025* 07/08 500.00 13716* 07/03 75.00 13816 07/03 138.00 13026 07/08 500.00 13740* 07/02 125.63 13817 07/08 282.00 13027 07/08 1,198.00 13741 07/02 115.71 13818 07/08 32.00 13028 07/09 6,500.00 13743* 07/01 116.60 13819 07/03 217.88 13029 07/14 1,033.50 13744 07/02 5,284.51 13820 07/09 43.68 13030 07/11 1,500.00 13748* 07/03 500.00 13821 07/22 4.76 13031 07/14 377.74 13758* 07/07 1,136.03 13822 07/03 84.60 13032 07/11 362.02 13759 07/01 1,100.00 13823 07/07 103.59 13033 07/17 1,100.00 13766* 07/01 4,513.18 13824 07/07 23.73 13034 07/14 300.00 13777* 07/01 120.00 13825 07/10 213.46 13035 07/15 1,072.00 13784* 07/01 115.50 13826 07/16 6,827.61 13036 07/15 320.00 13789* 07/14 1,135.00 13827 07/14 825.00 13037 07/15 1,250.00 13790 07/08 5,742.59 13828 07/08 59.36 13038 07/16 68.15 13791 07/01 100.00 13829 07/17 305.16 13040* 07/21 1,000.00 13792 07/07 50.00 13830 07/17 432.00 13041 07/22 1,500.00 13793 07/03 1,484.83 13831 07/15 240.26 13042 07/22 1,074.00 13794 07/01 4,062.98 13832 07/22 425.00 13043 07/31 1,600.00 13796* 07/01 5,500.00 13833 07/21 791.48 Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 2 of 35 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 13834 07/16 371.00 13897* 07/15 160.00 13962 07/24 8,667.29 13836* 07/08 128.00 13898 07/16 1,576.64 13963 07/24 8,667.29 13837 07/22 120.00 13899 07/16 533.12 13964 07/22 5,000.00 13838 07/14 15.00 13900 07/15 5,000.00 13965 07/23 1,425.00 13839 07/09 160.00 13901 07/22 25.00 13966 07/23 6,094.47 13840 07/16 705.00 13902 07/25 13.00 13967 07/23 4,062.98 13841 07/15 50.00 13908* 07/21 350.00 13968 07/23 2,083.96 13842 07/17 1,113.00 13914* 07/17 6,500.00 13970* 07/23 2,083.96 13843 07/10 747.30 13917* 07/22 477.00 13971 07/23 8,125.96 13844 07/14 600.00 13918 07/17 1,500.00 13972 07/23 2,000.00 13845 07/09 6,094.47 13919 07/28 500.00 13974* 07/25 46.13 13846 07/09 7,856.19 13920 07/18 325.50 13975 07/23 6,500.00 13847 07/09 104.26 13921 07/21 283.50 13978* 07/25 779.63 13848 07/08 5,500.00 13922 07/21 3.25 13980* 07/24 1,500.00 13849 07/24 662.79 13923 07/21 40.63 13981 07/31 125.63 13850 07/11 625.00 13924 07/21 15.00 13983* 07/31 115.71 13851 07/10 2,000.00 13925 07/21 69.00 13985* 07/31 1,200.00 13852 07/11 1,245.00 13926 07/22 3,556.52 13986 07/29 3,678.19 13853 07/14 176.50 13927 07/22 344.50 13987 07/28 50.00 13854 07/24 2,034.33 13928 07/21 20.00 13989* 07/28 186.00 13855 07/24 2, 661.29 13930* 07/29 3.25 13990 07/28 297.00 13856 07/15 4,057.55 13931 07/21 550.00 13991 07/25 42.25 13857 07/15 156.00 13932 07/21 90.00 13992 07/25 121.88 13870* 07/14 46.50 13933 07/22 23.63 13993 07/29 5.00 13871 07/14 40.50 13934 07/22 232.00 13994 07/28 99.00 13872 07/14 100.00 13935 07/21 172.50 13995 07/28 11.50 13873 07/14 30.00 13936 07/21 173.25 13996 07/28 350.00 13874 07/22 16.00 13937 07/21 20.63 13997 07/29 17.50 13875 07/14 15.56 13938 07/22 81.25 13998 07/28 62.50 13876 07/15 36.36 13939 07/18 26.00 13999 07/30 136.00 13877 07/14 25.08 13940 07/22 67.50 14000 07/28 172.50 13878 07/14 6.36 13941 07/18 31.13 14001 07/28 10.50 13880* 07/15 2,138.50 13942 07/21 210.00 14002 07/29 25.00 13881 07/16 447.61 13943 07/21 116.21 14003 07/28 126.00 13882 07/28 710.00 13944 07/21 22.70 14004 07/28 18.00 13884* 07/16 233.38 13945 07/24 1,400.00 14006* 07/30 367.25 13885 07/24 2, 907.21 13950* 07/28 800.00 14008* 07/28 15.56 13886 07/17 300.00 13951 07/23 1,874.08 14009 07/28 508.67 13887 07/15 273.48 13952 07/24 791.48 14010 07/28 22.15 13888 07/14 50.00 13954* 07/28 116.60 14011 07/28 38.06 13889 07/16 1,180.84 13955 07/23 81.99 14012 07/28 47.05 13890 07/29 11,432.10 13956 07/25 332.37 14013 07/29 1,000.00 13891 07/16 1,356.80 13957 07/22 4.00 14016* 07/29 5,000.00 13892 07/15 2,400.00 13958 07/22 2,450.00 14017 07/30 50.00 13894* 07/11 48.00 13959 07/24 485.00 14018 07/30 1,000.00 13895 07/15 69.94 13961* 07/24 4,531.01 14020* 07/30 6,000.00 • Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCT.R-030 Page 3 of 35 CHECK TRANSACTIONS SERIAL DATE AMOUNT SERIAL DATE AMOUNT SERIAL DATE AMOUNT 14029* 07/31 71.27 14051* 07/29 1,074.00 14054* 07/31 500.00 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 07/01 INTERNET XFER FROM 25,000.00 NUMBER 0000002176 07/01 WIRE TRANSACTION 3,820.00 07/01 CKCD DEBIT 06/29 00:00 6.68 SECOND CUP NAPLES NAPLES FL 07/01 CKCD DEBIT 06/30 00:00 50.49 TEXACO 0303980 MARCO ISLAND FL 07/02 INTERNET XFER FROM 10,000.00 NUMBER 0000006030 07/02 INTERNET XFER FROM 15,000.00 07/02 CKCD REFND 07/01 00:00 137.94 PAYPAL BIZCOMASIAP 40293577 CA 07/02 CKCD REFND 06/30 00:00 750.00 MARY AND JIMMY BAIL BO NAPL FL 07/02 OVERDRAFT FEE 90.00 07/02 INTERNET XFER TO 50.00 07/02 CKCD DEBIT 07/01 00:00 3.99 APL ITUNES COM BILL 866 712 CA 07/02 CKCD DEBIT 07/02 00:00 5.50 SMART COMMUNICATIONS C 0941 FL 07/02 CKCD DEBIT 07/01 00:00 137.94 PAYPAL BIZCOMASIAP 40293577 CA 07/02 CKCD DEBIT 06/30 00:00 750.00 MARY AND JIMMY BAIL BO NAPL FL 07/03 DEPOSIT 2,400.00 07/03 DEPOSIT 14,475.00 07/03 OVERDRAFT FEE 30.00 07/03 POS DEBIT 07/03 11:02 4.01 SUNSHINE ACE HAR MARCO ISLA FL 07/03 CKCD DEBIT 07/02 00:00 50.00 SNOOK INN MARCO ISLAND FL 07/03 CKCD DEBIT 07/02 00:00 58.30 TRAFFIC COASTLAND MALL NAPL FL 07/03 CKCD DEBIT 07/02 00:00 104.94 Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION L,I.0 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 4 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS DILLARD S 216 COASTLAN NAPL FL 07/03 CKCD DEBIT 07/02 00:00 301.03 VICTORIA S SECRET 0412 NAPL FL 07/03 CKCD DEBIT 07/02 00:00 452.19 FERGUSON ENT 60 239 332 424 FL 07/07 AC-Square Inc -140704N2 9,384.47 07/07 FOREIGN ATM FEE 2.00 1 AT 2.00 07/07 WTHDRL DDA 07/03 20:44 203.00 FIFTH AVENUE SOUTH NAPLES FL 07/07 AC-NATIONAL GENERAL-PAYMENT 1,312.36 07/07 POS DEBIT 07/05 10:10 19.41 WALGREENS MARCO ISLAND FL 07/07 POS DEBIT 07/07 13:07 21.99 7 ELEVEN MARCO FL 07/07 POS DEBIT 07/05 9:50 22.62 7 ELEVEN MARCO FL 07/07 POS DEBIT 07/04 14:55 27.54 WALGREENS NAPLES FL 07/07 POS DEBIT 07/05 10:03 39.18 SUNSHINE ACE HAR MARCO ISLA FL 07/07 POS DEBIT 07/05 16:48 56.72 EXXONMOBIL NAPLES FL 07/07 POS DEBIT 07/05 15:33 123.57 WAL MART STORES NAPLES FL 07/07 POS DEBIT 07/05 16:02 181.73 WAL MART 3417 NAPLES FL 07/07 POS DEBIT 07/05 11:04 190.35 PUBLIX MARCO ISLAND FL 07/07 INTERNET XFER TO 180.00 07/07 INTERNET XFER TO 180.00 07/07 CKCD DEBIT 07/03 00:00 12.11 STARBUCKS 08454 NAPLE NAPLE FL 07/07 CKCD DEBIT 07/03 00:00 21.70 EXXONMOBIL 97697536 NAPLES FL 07/07 CKCD DEBIT 07/03 00:00 24.38 THE NAME GAME NAPLES FL 07/07 CKCD DEBIT 07/05 00:00 36.02 PINCHERS CRAB SHACK NAPLES FL 07/07 CKCD DEBIT 07/03 00:00 55.00 PINCHERS CRAB SHACK NAPLES FL 07/07 CKCD DEBIT 07/03 00:00 79.92 TEXACO 0303980 MARCO ISLAND FL 07/07 CKCD DEBIT 07/03 00:00 142.43 Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANF,THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 5 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS SUNSHINE ACE MARCO MARCO IS FL 07/07 CKCD DEBIT 07/04 00:00 963.06 MA GLOBAL 03366050040 NC 07/07 CKCD DEBIT 07/03 00:00 1,874.08 CEMEX CASH SALE 800 99CEMEX TX 07/08 INTERNET XFER FROM 5,000.00 NUMBER 0000001666 07/08 DEPOSIT 6,000.00 07/08 AC-PROG SELECT INS -INS PREM 322.37 07/08 POS DEBIT 07/08 17:36 12.71 SUNSHINE ACE HAR MARCO ISLA FL 07/08 CKCD DEBIT 07/07 00:00 12.99 APL ITUNES COM BILL 866 712 CA 07/08 CKCD DEBIT 07/07 00:00 37.58 JOEY S PIZZA PASTA H MARCO FL 07/09 INTERNET XFER FROM 5,000.00 NUMBER 0000003532 07/09 INTERNET XFER FROM 6,500.00 NUMBER 0000005180 07/09 OVERDRAFT FEE 30.00 07/09 CKCD DEBIT 07/07 00:00 21.93 TEXACO 0303980 MARCO ISLAND FL 07/09 CKCD DEBIT 07/08 00:00 22.78 SUNSHINE ACE MARCO MARCO IS FL 07/10 INTERNET XFER FROM 300.00 NUMBER 0000006170 07/10 INTERNET XFER FROM 2,500.00 NUMBER 0000006846 07/10 INTERNET XFER FROM 5,000.00 NUMBER 0000006470 07/10 AC-Square Inc -140710N2 9, 649.85 07/10 INCOMING WIRE PINNACLE ISLAND 25,000.00 LLC NUMBER 0000000253 07/10 OVERDRAFT FEE 60.00 07/10 CKCD DEBIT 07/09 00:00 21.39 SNOOK INN MARCO ISLAND FL 07/10 CKCD DEBIT 07/09 00:00 23.30 MARCO BUILDING SUPPLY MARCO FL 07/10 CKCD DEBIT 07/09 00:00 23.30 Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 6 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS MARCO BUILDING SUPPLY MARCO FL 07/10 CKCD DEBIT 07/09 00:00 52.94 GRC PROACTIV SOLUTION 800 2 CA 07/10 CKCD DEBIT 07/08 00:00 84.23 TEXACO 0303980 MARCO ISLAND FL 07/10 CKCD DEBIT 07/08 00:00 238.50 USAIRWAY 800 428 4322 AZ 07/11 DEPOSIT 6,200.00 07/11 DEPOSIT 8,593.75 07/11 Incoming Wire Fee for 07/10/14 15.00 07/11 POS DEBIT 07/11 18:22 21.99 7 ELEVEN MARCO FL 07/11 INTERNET XFER TO 15,000.00 07/11 INTERNET XFER TO 19,000.00 07/11 CKCD DEBIT 07/10 00:00 24.37 MARCO BUILDING SUPPLY MARCO FL 07/11 CKCD DEBIT 07/10 00:00 41.66 PUBLIX 275 MARCO ISLAND FL 07/11 CKCD DEBIT 07/09 00:00 62.08 SHELL OIL 575424869QPS NAPL FL 07/11 CKCD DEBIT 07/10 00:00 146.63 FLORIDA PAINT DECOR MARCO I FL 07/14 AC-Square Inc -140714N2 1,862.30 07/14 DEPOSIT 22,000.00 07/14 WTHDRL DDA 07/14 18:02 100.00 615 E ELKCAM CIRCLE MARCO I FL 07/14 WTHDRL DDA 07/14 18:03 500.00 615 E ELKCAM CIRCLE MARCO I FL 07/14 POS DEBIT 07/12 8:46 23.24 SUNSHINE ACE HAR MARCO ISLA FL 07/14 POS DEBIT 07/12 13:01 145.29 PUBLIX MARCO ISLAND FL 07/14 CKCD DEBIT 07/12 00:00 8.63 PAYPAL CHENZHENWEN 40293577 CA 07/14 CKCD DEBIT 07/12 00:00 13.25 SILVERSPOT CINEMA NAPLES FL 07/14 CKCD DEBIT 07/12 00:00 13.25 SILVERSPOT CINEMA NAPLES FL 07/14 CKCD DEBIT 07/12 00:00 15.50 SILVERSPOT CINEMA NAPLES FL 07/14 CKCD DEBIT 07/11 00:00 15.88 NAPA AUTO PARTS MARCO ISLAN FL 07/14 CKCD DEBIT 07/13 00:00 23.17 MARATHON PETR0125807 MARCO FL Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 7 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 07/14 CKCD DEBIT 07/11 00:00 81.05 TEXACO 0303980 MARCO ISLAND FL 07/14 CKCD DEBIT 07/11 00:00 172.25 FLORIDA PAINT DECOR MARCO I FL 07/14 CKCD DEBIT 07/11 00:00 192.16 SUNSHINE ACE MARCO MARCO IS FL 07/14 CKCD DEBIT 07/11 00:00 684.38 PAYPAL TCWCOMPUTER 40293577 CA 07/15 AC-Square Inc -140715N2 144.60 07/15 WTHDRL DDA 07/15 12:56 500.00 615 E ELKCAM CIRCLE MARCO I FL 07/15 CKCD DEBIT 07/15 00:00 45.92 AMAZON COM AMZN COM BIL WA 07/15 CKCD DEBIT 07/14 00:00 60.00 RIVERCHASE DERMATOLOGY MARC FL 07/16 INTERNET XFER FROM 10,000.00 NUMBER 0000003180 07/16 DEPOSIT 150.00 07/16 WTHDRL DDA 07/16 14:30 600.00 615 E ELKCAM CIRCLE MARCO I FL 07/16 AC-COLLIER CLERK OF-ACH 50.26 07/16 POS DEBIT 07/16 16:33 96.00 WALGREENS MARCO ISLAND FL 07/16 CKCD DEBIT 07/15 00:00 17.77 SUNSHINE ACE MARCO MARCO IS FL 07/16 CKCD DEBIT 07/16 00:00 25.90 AMAZON MKTPLACE PMTS AMZN C WA 07/16 CKCD DEBIT 07/14 00:00 38.36 TEXACO 0303980 MARCO ISLAND FL 07/16 CKCD DEBIT 07/15 00:00 79.21 PUBLIX 275 MARCO ISLAND FL 07/16 CKCD DEBIT 07/15 00:00 91.28 PLN PRICELINE HOTELS 800 65 CT 07/16 CKCD DEBIT 07/15 00:00 95.26 FLORIDA PAINT DECOR MARCO I FL 07/17 INTERNET XFER FROM 10,000.00 NUMBER 0000001374 07/17 INCOMING WIRE PINNACLE ISLAND 9,250.00 LLC NUMBER 0000000065 07/17 DEPOSIT 500.00 07/17 OVERDRAFT FEE 60.00 07/17 POS DEBIT 07/16 19:12 6.69 PUBLIX MARCO ISLAND FL Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 8 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 07/17 CKCD DEBIT 07/15 00:00 53.11 TEXACO 0303980 MARCO ISLAND FL 07/17 CKCD DEBIT 07/16 00:00 81.52 TEXACO 0303980 MARCO ISLAND FL 07/17 CKCD DEBIT 07/16 00:00 110.91 SUNSHINE ACE MARCO MARCO IS FL 07/17 CKCD DEBIT 07/16 00:00 113.57 SUNSHINE ACE MARCO MARCO IS FL 07/18 INTERNET XFER FROM 5,000.00 NUMBER 0000007908 07/18 DEPOSIT 5,000.00 07/18 DEPOSIT 5,000.00 07/18 Incoming Wire Fee for 07/17/14 15.00 07/18 OVERDRAFT FEE 30.00 07/18 WTHDRL DDA 07/18 9:50 300.00 615 E ELKCAM CIRCLE MARCO I FL 07/18 CKCD DEBIT 07/17 00:00 13.23 MARCO BUILDING SUPPLY MARCO FL 07/18 CKCD DEBIT 07/17 00:00 29.99 2C0 COM NEWLIFE 08772940273 OH 07/18 CKCD DEBIT 07/17 00:00 31.25 SILVERSPOT CINEMA 239 592 0 FL 07/18 CKCD DEBIT 07/17 00:00 43.89 SUNSHINE ACE MARCO MARCO IS FL 07/18 CKCD DEBIT 07/17 00:00 60.00 PINCHERS CRAB SHACK NAPLES FL 07/18 CKCD DEBIT 07/16 00:00 557.00 B W EQUIPMENT CO FORT WAYNE IN 07/21 DEPOSIT 7,125.00 07/21 DEPOSIT 38,750.00 07/21 WIRE TRANSACTION 1,020.00 07/21 WTHDRL DDA 07/19 11:18 600.00 615 E ELKCAM CIRCLE MARCO I FL 07/21 INTERNET 15,000.00 07/21 CKCD DEBIT 07/18 00:00 9.56 TEXACO 0303980 MARCO ISLAND FL 07/21 CKCD DEBIT 07/18 00:00 37.05 PROGRESSIVE AUTO CENTE MARC FL 07/21 CKCD DEBIT 07/17 00:00 65.53 SHELL OIL 575425144QPS BONI FL 07/21 CKCD DEBIT 07/20 00:00 66.63 SUN GAS BP QPS BOCA RATON FL Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 L MARCO ISLAND FL 34145 CYCLE-030 Page 9 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 07/21 CKCD DEBIT 07/19 00:00 70.12 JAZZIZ NIGHTLIFE BOCA RATON FL 07/21 CKCD DEBIT 07/18 00:00 103.91 WEST MARINE 1304 NAPLES FL 07/21 CKCD DEBIT 07/20 00:00 111.98 PLN PRICELINE HOTELS 800 65 CT 07/21 CKCD DEBIT 07/17 00:00 392.29 DISH NETWORK ONE TIME 800 8 CO 07/22 DEPOSIT 21,375.00 07/22 AC-ABC SUPPLY -BT0721 9,560.47 07/22 POS DEBIT 07/22 14:27 5.47 XPRESS MART MARCO ISLAND FL 07/22 POS DEBIT 07/21 20:58 89.97 WALGREENS MARCO ISLAND FL 07/22 INTERNET XFER TO 6,000.00 07/22 CKCD DEBIT 07/22 00:00 20.00 SUNPASS ACC14186158 888 865 FL 07/22 CKCD DEBIT 07/21 00:00 33.69 SUNSHINE ACE MARCO MARCO IS FL 07/22 CKCD DEBIT 07/21 00:00 47.22 WESTON BP QPS FORT LAUDERD FL 07/22 CKCD DEBIT 07/21 00:00 48.13 JOEY S PIZZA PASTA H MARCO FL 07/22 CKCD DEBIT 07/21 00:00 169.93 FLORIDA PAINT DECOR MARCO I FL 07/23 INTERNET XFER FROM 10,000.00 NUMBER 0000004406 07/23 AC-Square Inc -140723N2 482.35 07/23 DEPOSIT 9,000.00 07/23 CKCD DEBIT 07/22 00:00 6.85 AMAZON VIDEO ON DEMAND 866 WA 07/23 CKCD DEBIT 07/21 00:00 38.19 TEXACO 0303980 MARCO ISLAND FL 07/23 CKCD DEBIT 07/22 00:00 51.67 TEXACO 0303980 MARCO ISLAND FL 07/24 INTERNET XFER FROM 5,000.00 NUMBER 0000000624 07/24 INTERNET XFER FROM 5,000.00 NUMBER 0000006698 07/24 DEPOSIT 3,500.00 07/24 OVERDRAFT FEE 30.00 07/24 CKCD DEBIT 07/22 00:00 30.77 Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKH LL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 10 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS THE CRAZY FLAMINGO MARCO IS FL 07/24 CKCD DEBIT 07/23 00:00 78.59 PUBLIX 275 MARCO ISLAND FL 07/24 CKCD DEBIT 07/23 00:00 348.05 FLORIDA PAINT DECOR MARCO I FL 07/25 INTERNET XFER FROM 3,000.00 NUMBER 0000005178 07/25 INTERNET XFER FROM 15,000.00 NUMBER 0000002896 07/25 DEPOSIT 8,750.00 07/25 DEPOSIT 8,800.00 07/25 OVERDRAFT FEE 180.00 07/25 POS DEBIT 07/24 19:55 23.99 WALGREENS MARCO ISLAND FL 07/25 INTERNET XFER TO 300.00 07/25 CKCD DEBIT 07/23 00:00 5.00 MAIN ST PARKING GARAGE FORT FL 07/25 CKCD DEBIT 07/24 00:00 24.01 TOKYO INN JAPANESE STE MARC FL 07/25 CKCD DEBIT 07/24 00:00 40.00 MARCO MEDICAL GROUP MARCO I FL 07/25 CKCD DEBIT 07/23 00:00 80.01 TEXACO 0303980 MARCO ISLAND FL 07/25 CKCD DEBIT 07/24 00:00 100.00 APL ITUNES COM BILL 866 712 CA 07/25 CKCD DEBIT 07/24 00:00 182.84 FLORIDA PAINT DECOR MARCO I FL 07/28 RETURN OF OUTGOING WIRE 975.00 07/28 WTHDRL DDA 07/26 15:35 600.00 615 E ELKCAM CIRCLE MARCO I FL 07/28 AC-ABC SUPPLY -BT0725 7,917.98 07/28 POS DEBIT 07/26 15:43 39.21 WALGREENS MARCO ISLAND FL 07/28 POS DEBIT 07/26 13:11 49.30 SHELL SERVICE STATION NAPLE FL 07/28 CKCD DEBIT 07/25 00:00 8.00 AMAZON VIDEO ON DEMAND 866 WA 07/28 CKCD DEBIT 07/28 00:00 20.14 AMAZON MKTPLACE PMTS AMZN C WA 07/28 CKCD DEBIT 07/25 00:00 79.93 TEXACO 0303980 MARCO ISLAND FL 07/28 CKCD DEBIT 07/25 00:00 262.67 FLORIDA PAINT DECOR MARCO I FL Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC 296 ROCKHILL CT IMAGES 272 MARCO ISLAND FL 34145 CYCLE-030 Page 11 of 35 CHECKING ACCOUNT TRANSACTIONS DATE DESCRIPTION DEBITS CREDITS 07/29 DEPOSIT 3, 600.00 07/29 DEPOSIT 7,525.00 07/29 NSF FEE 30.00 07/29 OVERDRAFT FEE 780.00 07/29 INTERNET XFER TO 500.00 07/29 CKCD DEBIT 07/28 00:00 24.80 SUNSHINE ACE MARCO MARCO IS FL 07/29 CKCD DEBIT 07/28 00:00 212.67 SUNSHINE ACE MARCO MARCO IS FL 07/30 INTERNET XFER FROM 245.00 NUMBER 0000003360 07/30 INTERNET XFER FROM 500.00 NUMBER 0000001920 07/30 NSF/OD Fee Refund 720.00 07/30 INCOMING WIRE PINNACLE ISLAND 12,500.00 LLC NUMBER 0000000297 07/30 DEPOSIT 16,000.00 07/30 OVERDRAFT FEE 90.00 07/30 WTHDRL DDA 07/30 18:36 600.00 615 E ELKCAM CIRCLE MARCO I FL 07/30 INTERNET XFER TO 3,000.00 07/31 AC-Square Inc -140731N2 2,894.85 07/31 DEPOSIT 6,487.50 07/31 Incoming Wire Fee for 07/30/14 15.00 07/31 SERVICE CHARGE 10.00 07/31 CYCLE SERVICE CHARGE 20.40 07/31 INTERNET XFER TO 2,000.00 07/31 INTERNET XFER TO 3,000.00 07/31 CKCD DEBIT 07/29 00:00 55.00 OUTBACK 2026 NAPLES FL 07/31 CKCD DEBIT 07/29 00:00 76.69 7 ELEVEN 25725 MARCO ISLAND FL 07/31 CKCD DEBIT 07/30 00:00 242.49 FLORIDA PAINT DECOR MARCO I FL BALANCE BY DATE DATE BALANCE DATE BALANCE DATE BALANCE DATE BALANCE Centennial Bank *******************EXCLUDE-Email 45429 0.2560 EX 0.000 07/31/14 DUANE THOMAS MARINE CONSTRUCTION LLC IMAGES 272 296 ROCKHILL CT CYCLE-030 MARCO ISLAND FL 34145 Page 12 of 35 BALANCE BY DATE DATE BALANCE DATE BALANCE DATE BALANCE DATE BALANCE 06/30 15,784.05 07/01 12,213.78- 07/02 2,269.12- 07/03 7,866.90 07/07 5,242.78 07/08 2,579.49- 07/09 12,589.62- 07/10 26,395.81 07/11 3,097.81 07/14 20,195.32 07/15 2,488.91 07/16 6,968.24- 07/17 2,785.45- 07/18 10,751.56 07/21 26,221.34 07/22 16,220.30 07/23 2,403.83- 07/24 23,889.42- 07/25 7,589.47 07/28 4,553.85- 07/29 17,211.36- 07/30 1,510.39 07/31 860.55 RESOLUTION OF AUTHORIZATON WHEREAS proposes to (Name of Business Entity) engage in contracting as in (Type of legal entity:corp.,partnership,etc. Collier County,Florida,according to Collier County Ordinance 99-45;and WHEREAS proposes to (Name of Business Entity) qualify for a Certificate of Competency with (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned of (Officers,Owners,Partners) hereby resolve and represent to the Collier County (Name of Business Entity) Contractors'Licensing Board that the qualifying agent, ,is active (Name of Individual) in all matters connected with the contracting business of ,and (Name of Business Entity) We further resolve and represent that is (Names of Individual) legally empowered to act for 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: -M ( (q/i/62--'- Collier County / City of Naples / City of Marco Island Second Entity Qualification Guidelines * CO Vex CL 4tithribit o,k,'n[ � F rt,t!lc € I. c r E c E ' i- °%1,4t. Q� ;EA Ot F rtiT. r c- ' rPrc" 'eZ, e p'Ic r€;€ €qtr €� 1. A notarized statement signed by an authorized agent of the entity presently qualified as well as a notarized statement signed by an authorized agent of the proposed entity attesting to the fact that each is aware of what entity the licensee is presently qualifying and what entity the licensee is requesting to qualify. C.O flo..A,S 2. A credit report not more than-mold for the present and the proposed entity. If the proposed entity is newly formed(less than one year old), then a credit report shall also be required of its qualifier. 3. Proof that the licensee has been active in construction for the previous twelve months with the present entity. Applicant shall submit a list of up to three of the latest jobs completed including the date of completion, address, description of work, and the name of owner. (Use questionnaire) 4. If the proposed entity has previously been qualified (within the previous 12 months), a statement as to why the previous qualifier is no longer willing to qualify the entity. (Use questionnaire) 5. If the proposed entity has previously been qualified (within the previous 12 months), a list of the three jobs completed by the proposed entity within the last twelve months of qualification. Include the dates of completion, address, description of work, name of previous qualifier, and name of owner. (Use questionnaire) 6. A statement that there are no outstanding liens or judgments against the present entity or against the proposed entity, or against any consumer/consumers that are a result of construction performed by either the present entity or the proposed entity. If liens or judgments are present, an explanatory statement is required. (Use q uestiormaire) 7. Bank statements for the previous three months on both the present and the proposed entity (if applicable). 8. Verification of bank balance for each entity, for the same date, not to exceed three months prior to the scheduled hearing. r 9. Statements indicating the mariner of remuneration of the licensee for the present as well as the proposed entities. (Use questionnaire) 10. Statement showing the licensee's ownership in the present entity as well as ownership in the proposed entity. (Use questionnaire) Second Entity Qualification Guidelines continued 11. Application fee of 105.W W . Make check payable to the Collier County Board of County Commissioners. This fee is nonrefundable regardless of the outcome of the request for additional entity. If approved, the additional fee for the license will be according to the schedule adopted by the Board of County Commissioners. 12. A statement of need, from the licensee, for maintaining the present entity qualification while requesting to qualify an additional entity. (Use questionnaire) 13. A list of principal suppliers for the present and proposed entity. (Use questionnaire) 14. A list of persons authorized (currently as well as the previous six months) to pull permits for the licensee. (Use questionnaire) 15. A list of all officers in the present as well as in the proposed entity. (Use questionnaire) 16. A properly completed Application to Qualify a Second Entity. It should be noted that the qualifier must be responsible for and capable of supervising, directing, managing, and controlling both the contracting activities of the entity he/she now qualifies as well as the proposed entity. Managing of contracting activities includes the proper collection and disbursement of funds and the proper payment of subcontractors and suppliers. In addition, he/she must be responsible for and capable of the supervision, direction, management, and control of all entities for which he/she pulls permits. Geographical location of all entities involved must be so situated as to permit the aforementioned supervision, direction, management and control. The Board will consider the ownership, interest, status as a corporate officer or partner, check writing authority, and other factors as evidence of control of the entities. At the sole discretion and option of the Board, the Board may deem it a requirement that the qualifier be able to sign on checks relating to construction payables. ALL APPLICANTS MUST APPEAR BEFORE THE CONTRACTOR LICENSING BOARD FOR FINAL APROVAL r - c `� 6. e a B ,, c+• my A p c+s ' 0 i ILK t, f ic);\ e r (' [ �7y f c-A EdI P4 FL } Pr,�`. d`WC.p4C� '� E g " 4.1.,R 0P- G"3aq�c. k 6+K p. pt) w r • Martin Selden 12298 Isabella Dr. Bonita Springs, FL 34135 Cell: 239-269-4121 Fax: 239-947-2557 To Whom It May Concern, I Martin Selden am fully aware that I am attempting to qualify Asphalt Seal and Repair of SW Florida, LLC. To be able to asphalt sealcoat and stripe in Collier County. I am also the owner of Advanced Sweeping and Service Inc. a Collier licensed business. Asphalt Seal and Repair of SW Florida is a Florida Corporation that I have been working with for a while. They are the company that I sub contract to do all of my asphalt sealcoating. I in turn do all of Asphalt Seal and Repair of SW Florida's striping. They are a good, honest, company. This past year Scott Brady passed away. Scott was Asphalt Seal and Repair of SW Florida's qualifier in Collier County. I am happy to be the qualifier for Asphalt Seal and Repair of SW Florida in Collier County. I also qualify Asphalt Seal and Repair of SW Florida in Lee County. I presently qualify both Advanced Sweeping and Service Inc. and Asphalt Seal and Repair of SW Florida LLC. in Lee County. Marti Selden Vi(t \ i ovtdiL_ MAIbA I IAAVIDRA Notary P tt State o1 Florida Commission,FF 134309 ;'Ts' My comm.expires June 19,2018 • Martin Selden 12298 Isabella Dr. Bonita Springs, FL 34135 Cell: 239-269-4121 Fax: 239-947-2557 To Whom It May Concern, I Martin Selden am fully aware that I am qualifying Asphalt Seal and Repair of SW Florida, LLC. To be able to asphalt sealcoat and stripe I am also the owner of Advanced Sweeping and Service Inc. f/p176 / o/1,1 Martin Selden ■ cv4-&-- MAMA L SAAV!MA Notary PubNc,State of Florida Commission►FF 134309 My comm.expires June 19,2018 Q'a1t Sea/cf Professionals In: .� . • Asphalt Patching v" • Crack Sealing Q a� d�h 9 • Sealcoating Crack Sea September 10, 2014 Collier County Contractor Licensing Board 2800 Horseshoe Drive Naples, FL 34104 To Whom it May Concern: I am fully aware that Martin Selden is qualifying Asphalt Seal & Repair of SW Florida, LLC. Martin Selden is owner of Advance Sweeping and Service, Inc. a licensed parking area sweeping,seal coating and line striping company doing business in Collier County, Florida. Stephen K McLeod Member/Mana'-r 40000y. As. alt Seal & Rep, it of SW Florida (, 9/1 Lh4 Corporate Office: 2077 Enterprise Drive • De Pere, WI 54115 (920) 338-0130 • Fax (920) 338-0131 • Toll Free 800-879-7602 m ua y, „..., = .„,.,,,, IIII •e• ::: =----- BUILDING REVIEW AND PERMITTING CONTRAC - - ----- ,.T`. rr,rTTf1, COLLIER COUNTY/CITY OF NAPLES/CITY OF MA Contractors Licensing Board 1 A Community Development&Environmental Services Division R. 2800 North Horseshoe Drive iD, Naples, Florida 34104 . R Telephone: (941)403-2431 SS. 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 APPLICAN'T'S NAME AND ADRESS. PLEASE ALLOW 2 -3 WEEKS FOR PROCESSING. FEE $ 105• °G J 1. Applicant's Name (Licensee) tit�,,T;vx �j e1C6A LICENSE#(- O 1 1- 'QM') 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), 104 PUB.L. 193, SEC. 317. i � ' ° / / ; Place of Birth: (City) p0' r01-7. (State)/1 ■' (Nation) 14.5* Social Security Number Date of Birth SEX: dale_Female ! RACE: ( (1)White_;(2)African-American; (3)Hispanic_;(4)Asian (5)Indian;(6)Other ■ 2. Name of Business To Be Qualified: A-Spka, k Srui Ce R_epaxie■ ©5 tStL/ (loric& LAX, Mailing Address: 2,C2 k 4 E N Y'e r j i— i S -e, OR_ De Pe re. w.c j�t l c Street or P.O.Box City State Zip Street Address: Street City State Zip Business Phone Number: la, 1'7 Q- 6 6 0 Z Federal ID Number: Y1- _ • APPLICATION TO QUALIFY SECOND ENTITY 3. Applicant's (Licensee) Name: Se(61.0.‘ / -r,,n Last First Middle Applicant's (Licensee) Official Mailing Address of Record: )7A) 7A1C l s AAZ,-e(l a- 1) v2 [3 on i 74 Sp`; vi 9,5 L e r( 314 OS Street City County State Zip Street Address (if Post Office Box is listed above): SO - Street City County State Zip Home Phone (2 3°() z 6 q<'1 l - ► Office Phone (Z-31) 7 L 5 5 5 7 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. `� �I /v1 4 r 70 h c JC (1.0 b/l"Ll l`� AP'. I ANT'. SIGNATURE PRINT OR TYPE NAME DATE ,dpm E r Y fi T41 t C e t ( c . . s4 rF _ rdlt?i e �et�� E ytia R7� .3 t.+� �`\,; k),L' IL G' � &q�jE�}?C !� L LL.L E_E C:01.[... C LL l�':[ L4 FH ��;�L 2- kiLf N•G�tv�5��.tv( yhf� if � [ 4v t�$,� � �EI Lb� 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 form#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 additjonal business. p r,s--r kb us 1Ae5-5 ✓L V 4ae� 5-7--r i f 1 / _ 6,ec_e9,tc� -t us).i c c LAS; o CO 5 tocec ,h9 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. Li S , c ectT k 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 qualifier and name of owner. it,,aro-Yv Q4 ce- Kt-11y &"-- 7-ceJ"r ist 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. Q, ct 71 e.)14,0 E. Do the business(s) you presently qualify 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 )L If yes, identify business and provide explanation. F. List principal suppliers for the past six months for the business you presently qualify. 5 L4 ,r tN 1 n vl/ i it \a. -5 fa; kt 7 G. List principal suppliers for the past six months for the business you are applying to qualify. U 0 ✓l,4a..l it ks4 Pi r i c YI i l 4►tit f3 ct, 4 APPLICATION TO QUALIFY SECOND ENTITY H. List persons authorized(currently and in the past 6 weeks) to pull permits on your license(s). M cce 14, J&Cd n I. How are you being paid by the business(s) you presently qualify (examples: salary, % of profits, etc.)? lo.er� 74c�e J. How will you be paid by the business you are applying to qualify? arc fk.1C +,y c11e -V- 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? p reseAA7 tdoe7o 2 " ' l0 Iv L. Do you(applicant) have check writing authority for the present and proposed entity? YES ). NO If yes, provide a letter from the bank. M. List officers (or partners, owners) of business you are applying to qualify and give title/position held. S T e r ./14 . L Q Oci M 9 f 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 NO . If yes, list licensee's name, license number and address. P. Submit notarized statements signed by an authorized agent 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. 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 A. Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial settlements? .5( B. Had claims or lawsuits filed or unpaid or past due accounts by your creditors as a result of construction operations? K. C. Undertaken construction contracts or work which resulted in liens, suits or judgments being filed? 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. X. 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, it 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 yZ (If "yes", what percentage of the business do you own (if any)? %). Contact Board office for guidelines to qualify more than one business. Company Name: .41/444,Ce0"retie j 9—0e, J ► c,e. 6-10 p +� Company Address: if 2Z? . 154 f(4 OIL, c ra r (..?1( Your License Number: LGG p l 1 600 1747 47 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 08/28/2014 18:50 1-239-947-2557 PAGE 01 • ESOL ION A ,ORI TON SPHktT SF1-L or • P412 WHEREAS 4 'n�l1f tGw4 Ri 5k) Ft0r��oZ I- 1 t. C_ proposes to (Namcpf,Zusiness Entity) VVV engage in contracting as L C_ in (Type of legal entity:corp.,partnership, etc_ Collier County,Florida,according to Collier County Ordinance 2006-46,as amended;and WHEREAS.._mgig: -- Limit 111P-1 siiii ot- 71/21-i tic_ _,proposes to (Name of Business nti. ) ,•°l PI qualify for a Certificate of Competency with • fit S ' " etv (Name of Individual) . NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned j_14.117kil lEgALII ______.of A.,� �^ �� 0 (�rz , Owners,Partners) ( he�e�esolve and represent to the Collier County (Name of Business En ty) Contractors'Licensing Board that the qualifying agent,Ak 5PZ.4/F�,is active (Name of Individual) in all matters connected with the contacting business of A► r1' Sri Z l' SW FL and l L (Name of Business En:, ) We further resolve and represent that Mr .T Ai _p is (Names of Individual) legally empowered to act fort , 4 >f -A/ g'!.r' ,/� iv all matters connected with its (Name of Busines•entity) contractin busines ,and has the authority to supervise construction undertaken by 49P/14--4 t-4 f?,/SW!—toMt of`t-<� (Name of Bush ss Entity) j J DULY PASSED AND ADOPTED THIS--t t---day of i►.l ✓ " • (Officers,Partners,Owners-with '// • Designation underneath) w.o•s • 1 ''"Mor, %! ----.- ,�, Witness Catporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this /!o day of` fa/4_ _, 20/Y by .s he. /'YIc L re Notary Public Name Printed Notary P licSignatu Commission Number My Commission expires: /'5/Zoos AFFIDAVIT I, VIII � �.. lA (-0, 1,,.. eb certify that the foregoing g xs true and correct to the best of my knowledge. • .IHORT :. OFFICER FOR THE FIRM STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this � ;_ of!`MIi OF OFFICER,TITLE/.AGENT) (NAME OF CON a L- Le : corporation,on behalf of the corporation. He/She has (STATE OR.PLACE OF CORPORATION) produced GQ)f•.ye.cr, /Yu.vexs 1.4e.f ma-e. as identification and did not take an oath. (TYPE OF IDENTIFICATION) • SIGNATURE OF NOTARY (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT I, "6>/'W,il kCe(4 certify that the foregoing is true and correct to the best of my knowledge. li,k rilii-ey7 -/' i A i ORIZED OFFICER FOR THE FIRM STATE OF FLORIDA COUNTY OF xi(The foregoing instrument was acknowledged before me this m J2( c (1 � by �i- of /O�t/Gv. c -,a %p r 4°/4 S�'/'t�j'ce l NG� (NAME OF OF ER,TITLE/AGENT) (NAME of CORPORATION)/ a r( corporation, on behalf of the corporation. He/She has (STATE OR PLACE OF(CORPORATION) 'MOM�M A(Q as identification and did not take an oath. (TYPE s,,� ,a1,e •EOFNOT• R\ mcKro b Ca med L (PRINT NAME OF NOTARY) NOTARY PUBLIC i MAMA I SAAVIONA f oN Notary Pub a Stabr3Florida Oomxniss{on#FF 134309 my comm,expires Juno 19,2018 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. ,td r`ri n. 1e ((.14-v■ APPLICANT(PLEASE PRINT) `. �`j�, Sa/� ',� is LGL NA EOFC• 1P• ■ Y �� / / I - ./ SI 9 •TURE •F APPLICANT STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this J@ ` 340 I g ' by Mocr), (\eQ, who has odu ed .1 /r (NAME OF PERSON ACKNOWLEDGING) ( as identification and who did not take an oath. ii CA` t.i ' WI • SIG' A .UREOFN•T\•Y -DA.ok 6 . Co2a0Qco __ (p• 4i Z0 ■ •. a,- NOTAg al' C FP 194309 ,,.8' caw wiris Me it 2°18 9 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. advanced Sweeping From: Sheryl Mcleod <sheryl @asphaltsealandrepair.com> Sent: Tuesday, August 12, 2014 11:41 AM To: martin @cleanlotpros.com Subject: contracts 1-Owner/Address-Sorrento Villas 1400 Pompei Lane Naples, FL Contract Through-C & D Management Job Description- Seal coat and re-stripe all parking areas Completed-3-30-14 Price-$7,450.00 2-Owner/Address-The Verandas @ Kelly Greens 12521-61 Kelly Sands Way Ft. Myers, FL Contracted Through-Hayden &Associates Job Description-Seal coat and re-stripe parking areas and roadways Completed 4-12-14 Price-$7,234.00 3-Owner/Address-Perkins Restaurant 27941 Crown Lake Blvd. Bonita Springs, FL Job Description-asphalt repairs/patching, seal coat and re-stripe Completed 1-13-14 Price-$10,628.00 Sheryl McLeod Asphalt Seal & Repair 2077 Enterprise Dr. De Pere,WI 54115 sheryl @asphaltsealandrepair.com 800-879-7602 SerW c COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION INFORMATION Current C-e LCC20110001947 Certification Information Collier County Board of County Commissioners Date: September 10, 2014 DBA: Advanced Sweeping And Service Inc ADDRESS: 12298 Isabella Drive Bonita Spings, FL 34135 PHONE: 2399495550 CELL: 2392694121 FAX: 2399472557 LICENSEE NBR: QUALIFIER: Selden, Martin R. LCC20110001947 TYPE: SEAL AND STRIPING CONTR. CLASS CODE: 4350 ISSUANCE NBR: 201100001013 INSURANCE: ORIG ISSD: EXPIRATION: General Liability August 24, 2011 September 30, 2015 April 22, 2015 Worker's Comp Exemption August 08, 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 SEAL AND STRIPING CONTR. Cert Nbr: Exp: Status: LCC20110001947 09/30/2015 Active Advanced Sweeping And Service Inc Selden, Martin R. 12298 Isabella Drive Bonita Spings, FL 34135 Signed: • Detail by Entity Name Page 1 of 3 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation ADVANCED SWEEPING AND SERVICE INC. Corr €(\tctj Filing Information Document Number P08000106627 FEI/EIN Number N/A Date Filed 12/08/2008 State FL Status ACTIVE Effective Date 01/01/2009 Principal Address 12298 ISABELLA DR. BONITA SPRINGS, FL 34135 Mailing Address 12298 ISABELLA DR. BONITA SPRINGS, FL 34135 Registered Agent Name &Address SELDEN, MARTIN 12298 ISABELLA DR BONITA SPRINGS, FL 34135 Officer/Director Detail Name & Address Title P SELDEN, MARTIN 12298 ISABELLA DR. BONITA SPRINGS, FL 34135 Annual Reports Report Year Filed Date 2012 05/06/2012 2013 01/26/2013 2014 01/18/2014 Document Images 01/18/2014 -- ANNUAL REPORT View image in PDF format http://search.sunbiz.org/Inquiry/CorporationS earch/SearchResultDetail/EntityName/domp-... 9/1 0/20 1 4 Detail by Entity Name Page 2 of 3 01/26/2013 -- ANNUAL REPORT View image in PDF format 05/06/2012 -- ANNUAL REPORT View image in PDF format 04/13/2011 --ANNUAL REPORT View image in PDF format 01/13/2010 -- ANNUAL REPORT View image in PDF format 12/08/2008 -- Domestic Profit View image in PDF format Copyright and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/dome-... 9/10/2014 Detail by Entity Name Page 1 of 3 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS /inikz DIVISION CORPORATIONS Detail by Entity Name Foreign Limited Liability Company ASPHALT SEAL & REPAIR OF SW FLORIDA, LLC y 0 p,J -e �rt)-1' Filing Information Document Number M10000005754 FEI/EIN Number 274278974 Date Filed 12/27/2010 State WI Status ACTIVE Principal Address 10962 CALLAWAY GREENS COURT FORT MYERS, FL 33913 Mailing Address 10962 CALLAWAY GREENS COURT FORT MYERS, FL 33913 Registered Agent Name & Address MCLEOD, Stephen 10962 CALLAWAY GREENS COURT FORT MYERS, FL 33913 Name Changed: 03/17/2014 Authorized Person(s) Detail Name &Address Title MGR ASPHALT SEAL & REPAIR, INC. 2077 ENTERPRISE DRIVE DE PERE, WI 54115 Annual Reports Report Year Filed Date 2012 03/29/2012 2013 03/01/2013 2014 03/17/2014 Document Images http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/forl-m... 9/10/2014 Detail by Entity Name Page 2 of 3 03/17/2014 --ANNUAL REPORT View image in PDF format 03/01/2013 --ANNUAL REPORT View image in PDF format 03/29/2012 -- ANNUAL REPORT View image in PDF format 01/25/2011 --ANNUAL REPORT View image in PDF format 12/27/2010 -- Foreign Limited View image in PDF format Copyright and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/forl-m... 9/10/2014 Q,(‘att See/� Professionals In: Asphalt Seal & Repair of SW Florida • Asphalt Patching tct 10962 Callaway Greens Ct. Ft. Myers, FL 33913 Crack Sealing Adfc 4'° 800-879-7602 / Fax(239)-561-5921 • Sealcoating ��9•Crack s,,,-s• August 15, 2014 To Whom it May Concern; As of today August 15,2014,Asphalt Seal & Repair of SW Florida has no judgments or liens against us. We are in good standing with all creditors and/or vendors paid in full. I, e', S eryl i •er Asphalt Seal & Repair of SW Florida 2077 Enterprise Drive • De Pere, WI 54115 (920) 338-0130 • Fax (920) 338-0131 • Toll Free 800-879-7602 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 4/83 09/11/14 12:41CT [SUBJECT] FSSN] [BIRTH DATE] SELDEN, MARTIN R. [ALSO KNOWN AS] SELDIN,MARTIN,REX [CURRENT ADDRESS] [DATE RPTD] 12298 ISABELLA DR. , BONITA SPRINGS FL. 34135 8/08 [FORMER ADDRESS] 27293 PINECREST LN. , BONITA SPRINGS FL. 34135 8/07 [POSITION] [CURRENT EMPLOYER AND ADDRESS] [RPTD] SECURITY TRUST MORTG CORP PRESIDENT 12/07 [FORMER EMPLOYER AND ADDRESS] STERLING MORTGAGE 9/96 M O D E L P R O F I L E ***FICO CLASSIC 04 SCORE +696 : 040, 020 *** 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=3 NEG=0 HSTNEG=0 TRD=15 RVL=14 INST=0 MTG=1 OPN=0 INQ=5 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $18. 6K $40.2K $314 $0 $25 99% MORTGAGE: $320K $ $274K $0 $2149 TOTALS: $338K $40.2K $275K $0 $2174 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS GULF CST COL Y 1X5L001 I 2/11 $665 MEDICAL 09B 5621752 9/14A $665 PLACED FOR COLLECTIO REV REC CORP Y 42DF003 I 5/14 $651 MEDICAL 09B 4141363023 6/14A $651 PLACED FOR COLLECTIO CNVRGT HTHCR Y 439E001 I 9/13 $2759 MEDICAL 09B 20846978 10/13A $2759 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 SYNCB/SAMSDC B 235061D 1/14 $0 11111111 RO1 521333117021 9/14A $3500 $0 I CREDIT CARD 1/14P $0 8 0/ 0/ 0 SYNCB/JCP DC B 235060H 9/04 $0 111111111111 ROl 546680109232 8/14A $500 $0 111111111111 I CREDIT CARD 9/10C $0 CLOSED 48 0/ 0/ 0 CAP ONE B 1DTV001 9/03 $4074 111111111111 ROl 480213262884 8/14A $5000 $0 111111111111 I BUSINESS CREDIT C 10/09P $0 48 0/ 0/ 0 SYNCB/AMAZON D 235064K 8/13 $0 111111111111 RO1 604578103632 8/14A $1000 $0 I CHARGE ACCOUNT $0 12 0/ 0/ 0 SYNCB/LOW L 235041J 9/07 $703 111111111111 RO1 798192410579 8/14A $224 $0 111111111111 I CHARGE ACCOUNT 10/11C $0 CLOSED 48 0/ 0/ 0 CHASE B 26QK001 8/13 $578 MIN25 11111111111 RO1 464018208318 8/14A $1500 $0 I CREDIT CARD $314 11 0/ 0/ 0 FIFTH THIRD B 992S002 4/05 $320K 504M2149 111111111111 MOl 1190305 7/14A $0 111111111111 I CONVENTIONAL REAL $274K LOAN MOD NON GOVT 48 0/ 0/ 0 DISCOVERBANK B 9616003 6/87 $0 111111111111 RO1 601100425353 3/14A $2000 $0 11111111111 I CREDIT CARD 2/14C $0 ACCT CLSD BY CONSUMER 23 0/ 0/ 0 JARED J 722D64G 9/11 $0 111111111111 RO1 312790 9/13A $7000 $0 111111111111 I CHARGE ACCOUNT 9/13C $0 INACTIVE ACCOUNT 24 0/ 0/ 0 BK OF AMER B 1597029 3/00 $25 RO1 3437 9/13A $7000 $0 I CREDIT CARD 9/13C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 THD/CBNA B 26H3005 5/08 $352 111111111111 ROl 603532030804 2/13A $2501 $0 111111111111 I CHARGE ACCOUNT 12/11C $0 INACTIVE ACCOUNT 48 0/ 0/ 0 CRDT FIRST A 3835003 12/10 $457 1 RO1 69566 1/11A $2800 $0 I CHARGE ACCOUNT 1/11P $0 1 0/ 0/ 0 BK OF AMER B 1597029 4/98 $0 ROl 5203 3/09A $0 I FLEXIBLE SPENDING 3/09C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 FIA CS B 1597185 7/02 $13.5K 111111111X11 RO1 8222 9/08A $26.4K $0 111111111111 I CREDIT CARD 9/08P $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 AMEX B 21WBOO1 5/97 $0 111X11111111 RO1 043567252012317752 6/07A $11.6K $0 111111111111 I CREDIT CARD 6/07C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 9/11/14 ZNP6284423(FLA) MERIT CREDIT 9/04/14 ZLA4852358 (CAL) BOFA/LNDSF 8/25/14 ZCS0001208 (CNM) FDC 8/29/13 BNY5371284 (EAS) SYNCB/AMAZON 9/25/12 ZNJ0004048 (EAS) C B ASSO FIL 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 GULF CST COL YC1X5L001 (877) 827-4820 5630 MARQUESAS CIR SARASOTA FL. 34233 REV REC CORP YC42DF003 (865) 971-1300 PO BOX 50250 KNOXVILLE TN. 37950 CNVRGT HTHCR YC439E001 (866) 867-0179 124 SW ADAMS ST PEORIA IL. 61602 SYNCB/SAMSDC BC235061D (800) 964-1917 PO BOX 965005 ORLANDO FL. 32896 SYNCB/JCP DC BC235060H (866) 227-5213 PO BOX 965007 ORLANDO FL. 32896 CAP ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 SYNCB/AMAZON DZ235064K (866) 634-8379 PO BOX 965015 ORLANDO FL. 32896 SYNCB/LOW LH235041J (800) 444-1408 PO BOX 956005 ORLANDO FL. 32896 CHASE BC26QK001 (800) 955-9900 P.O. BOX 15298 WILMINGTON DE. 19850 FIFTH THIRD BM992S002 (513) 358-4801 5050 KINGSLEY DR CINCINATTI OH. 45263 DISCOVERBANK BC9616003 (800) 347-2683 POB 15316 WILMINGTON DE. 19850 JARED JA722D64G 375 GHENT RD AKRON OH. 44333 BK OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 THD/CBNA BZ26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 CRDT FIRST AZ3835003 (216) 362-5000 POB 81315 CLEVELAND OH. 44181 FIA CS BC1597185 (800) 421-2110 PO BOX 982238 EL PASO TX. 79998 AMEX BC21WBOO1 (800) 874-2717 P.O. BOX 981537 EL PASO TX. 79998 BOFA/LNDSF Z 4852358 (800) 447-1692 101 S MARENGO AVEN PASADENA CA. 91101 FDC Z 0001208 (970) 663-5700 5200 HAHNS PEAK DR LOVELAND CO. 80538 SYNCB/AMAZON B 5371284 (866) 634-8379 PO BOX 965015 ORLANDO FL. 32896 C B ASSO FIL Z 0004048 (800) 523-0233 PO BOX 509124 SAN DIEGO CA. 92150 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Aug 1814 09:39a 239-277-0167 2392770167 p.1 Premier Profile•ASPHALT SEAL&REPAIR OF SOUTHWEST FL Subcode:970135 • '• • Ordered:08!18/2014 08:30:24 CST I: Transaction Number.C500532349 ••••�.�Xp @�+ �� Search Inquiry:ASPHALT SEAL&REPAIR OF SW FLORIDA LLC/10962 CALLAWAY GREENS CT/FORT •A wi,rld of insight MYERS/FL/33913/274278974 Mode)Descriptionn:Intelliscore Plus V2 Business Name ASPHALT SEAL& REPAIR OF SOUTHWEST FL Bus 82 t 9lification Number 98827 7 59.882. Primary Address: 10962 CALLAWAY GREENS CT FORT MYERS,FL 33913.8134 TOP :Risk Dashboard:; . . Risk s-and Credit{;ittif f2eooittrilendatfo>t •Days Reya :..,.... .,. .....•. ... .. .... .. ... ... rut 7er'ms =Aerogatoty Lesiar, Keatrd.Ale � ' Intelliscore Plus Financial Stability Risk Company - - -• .• ..• ^ --� .- •,.;•��•,•• •.•�.`t • P�/ Original Filings High Risk Alerts Score unavailable. Score unavailable . Information on file not information on file not DST _ proven to predict serious proven to predict financial Unavailable 1 future risk. stability risk. • Credit Limit Reccmmendallon:NIA 7oP I, Business Facts • Years on File: 0(FILE ESTABLISHED 07/2014) TOP 4, 'Commercial Fraud Shield Evaluation for;ASPHALT SEAL&REPAIR OF SOUTHWEST FL,10962 CALLAWAY GREENS CT,FORT MYERS, FL33913.8134 • Bustrtassi43etts': •VerigeAttor Triggers Active Business indicator: ? Experian shows this business as active BUSINESS ADDRESS IDENTIFIED AS RESIDENTIAL Possible OFAC Match: c l No OFAC match found Business Victim Statement: �•r �O'` No victim statement on file I aY!Ch; Credit Risk Score and Credit Limit Recommendation Credit Risk Score inteltlsegre P1iis Current Intelliscore Plus Score:Score and Risk Class Unavailable(999) This score predicts the likelihood of serious credit High ,. delinquencies for th's business within the next 12 months. Risk y _ _ Low Lo •-_ ••-.• . .. ,, ,. �••--- � `�;, `�'�� Risk This report does not include data elements statistically proven to predict serious future delinquency.Therefore an 10 2'5 SR 75 700 Intelliscore Plus score carrot be calculated and the risk class is unavailable. Credit i:tiskSc upe:.FlpanclafStability Isk ;•. �' 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 an file is not proven to predict financial stability risk.Therefore a Premier Profi:e-ASPHALT SEAL&REPAIR OF SOUTHWEST FL ' it 2 Aug 1814 09:39a 239-277-0167 2392770167 p.2 Financial Stability Risk score cannot be created. Nigh Rixbe t.z 3 e mil.;J:.,v •`.5� + .e t.04'J x� Risk D 3 10 30 6.5 160 Credit t imIt Recotitrtten _-. .. datltin •- _• Credit Limit Recommendation This recommendation compares this business Not available-This report does not credit database.it is based on trade information,industry,age of business r and he 1 telliszo eness include the data elements needed to Plus.The recommendation is a guide.The final decision must be made based on your company's create the credit limit recommendation, business policies. Top 4) Payment and Legai Filings Summary Payn(eht•Performance ;.Trade and Collecllart Balanc ` Current DBT: hict Available Total trade and collection 0; ( ) $0 Bankruptcy: Predicted DBT -.,:.... "-� " -"-•• "" N�' N/A All trades(0): s0 Tax Lien filings: 0 Monthly Average DST: 0 All collections(0): Judgment filings: p Highest 081 Previous 6 Months: 0 Continuous trade(0): 0 Sum of legal filings: 30 $ Highest DST Previous 5 Quarters: 0 6 month average: g0 UCC filings: 0 N/A Cautionary UCC filings: No Payment Trend indication: Highest credit amount extended: N/A Payment[rend indicator not available Most frequent industry purchasing terms: industry purchasing terms not available Industry Comparison. Industry DST Range Comparison The current DST of this business is Not Available. DBT for this business: Not Available t_ DST Range 0-5 6-15 16•i- JJJ TOP 4) Experian prides itself on the depth and accuracy of the data maintained on out 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.Cali 1-800-520.1221,option#4 for more Information. End of report 1 of report The information herein is furnished in confidence for your exclusive use for legiwr.ale business purposes and shall not be reproduced Neither Experan fnfornrolion Solutions,inc.,nor their sources o-oisfrfoulors-warrant such information no,shall they be liable for your use orre5ance upon it. Experian 2014.Al!rights reserved,Privacy olicy- Evperien and the Experian marks herein are service marks_or registered trademarks of Experian, Premier Profile-ASPHALT SEAL&REPAIR OF SOUTHWEST FL 2/2 BMO 0 Harris Bank A part of BMO Financial Group BMO HARRIS BANK N.A. 35128 P.O. BOX 94033 PALATINE, IL 60094-4033 ACCOUNT NUMBER: Statement Period 06/01/14 TO 06/30/14 01 09145 IM0099002900000000 ASPHALT SEAL & REPAIR OF SW FLORIDA PAGE 1 OF 2 1/ 2 4185 OAKRIDGE CIR DE PERE WI 54115-9233 0 1000 IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR BMO HARRIS ACCOUNTS, PLEASE CALL US TOLL-FREE AT 1-888-340-2265. BMO HARRIS BANK(R) IS A TRADE NAME USED BY BMO HARRIS BANK N.A. MEMBER FDIC. EQUAL HOUSING LENDER. NMLS401052 VISIT US ONLINE AT WWW.BMOHARRIS.COM. CHECKING ACCOUNTS ESSENTIAL BUSINESS CM ASPHALT SEAL & REPAIR OF SW FLORIDA ACCOUNT NUMBER (Checking) DEPOSIT ACCOUNT SUMMARY Previous Balance as of May 31, 2014 6,174.29 1 Deposits (Plus) 5,000.00 5 Withdrawals (Minus) 805.05 Ending Balance as of June 30, 2014 10,369.24 Deposits and Other Credits Date Amount Description Jun 24 5,000.00 TELLER DEPOSIT Withdrawals and Other Debits Date Amount Description Jun 12 3.00 ACCT ANALYSIS SERV CHG Jun 24 62.34 ACH DEBIT WEB FPL DIRECT DEBIT ELEC PYMT Jun 24 214.71 ACH DEBIT WEB PROG EXPRESS INS PREM Checks by Serial Number Date Serial # Amount Date Serial # Amount Jun 13 1435 125.00 Jun 24 1437 * 400.00 * Indicates break in check sequence Daily Balance Summary Date Balance Date Balance May 31 6,174.29 Jun 13 6,046.29 Jun 12 6,171.29 Jun 24 10,369.24 FOR?AS30039 BMO el Harris Bank A part of BMO Financial Group BMO HARRIS BANK N.A. 35354 P.O. BOX 94033 PALATINE, IL 60094-4033 ACCOUNT NUMBER: Statement Period 07/01/14 TO 07/31/14 01 09145 IM0099002900000000 ASPHALT SEAL & REPAIR OF SW FLORIDA PAGE 1 OF 1 1/ 1 4185 OAKRIDGE CIR DE PERE 'WI 54115-9233 0 1000 IMPORTANT INFORMATION - FOR ALL DEPOSIT ACCOUNTS, EFFECTIVE SEPT. 1, 2014 THE DEPOSITED ITEM RETURNED FEE WILL INCREASE TO $12 EACH AND EFFECTIVE SEPT. 8, 201.4 THE CASHIER'S CHECK PURCHASE FEE WILL INCREASE TO $10. IF YOU HAVE QUESTIONS ABOUT THESE CHANGES, SPEAK WITH A BMO HARRIS BANKER. IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR BMO HARRIS ACCOUNTS, PLEASE CALL US TOLL-FREE AT 1-888-340-2265. BMO EARRI.S BANK(R) IS A TRADE NAME USED BY BMO HARRIS BANK N.A. MEMBER FDIC. EQUAL HOUSING LENDER. MLS401052 VISIT US ONLINE AT WWW.BMOHARRIS.COM. CHECKING ACCOUNTS ESSENTIAL BUSINESS CKG ASPHALT SEAL & REPAIR OF SW FLORIDA ACCOUNT NUMBER (Checking) DEPOSIT' ACCOUNT SUMMARY Previous Balance as of June 30, 202.4 10,369.24 1 Deposits (Plus) 2,541.67 2 Withdrawals (Minus) 1,248.50 Ending Balance as of July 31, 2014 11,662.41 Deposits and Other Credits Date Amount Description Jul 28 2,541.67 TELLER DEPOSIT Withdrawals and Other Debits Date Amount Description Jul 11 1,245.50 ACH DEBIT CCD Dex One Payment Jul 11 3.00 ACCT ANALYSIS SERV CHG Daily Balance Summary; Date Balance Date Balance Jun 30 10,369.24 Jul 28 11,662.41 Jul 11 9,120.74 FORM330039 BMO IM Harris Bank A part of BMO Financial Group BMO HARRIS BANK N.A. 34877 P.O. BOX 94033 PALATINE, IL 60094-4033 ACCOUNT NUMBER: Statement Period 08/01/14 TO 08/31/14 01 09145 IM0099002900000000 ASPHALT SEAL & REPAIR OF SW FLORIDA PAGE 1 OF 2 1/ 2 4185 OAKRIDGE CIR DE PERE WI 54115-9233 0 1100 IMPORTANT INFORMATION - FOR ALL DEPOSIT ACCOUNTS, EFFECTIVE SEPT. 1, 2014 THE DEPOSITED ITEM RETURNED FEE WILL INCREASE TO $12 EACH AND EFFECTIVE SEPT. 8, 2014 THE CASHIER'S CHECK PURCHASE FEE WILL INCREASE TO $10. IF YOU HAVE QUESTIONS ABOUT THESE CHANGES, SPEAK WITH A BMO HARRIS BANKER. IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR BMO HARRIS ACCOUNTS, PLEASE CALL US TOLL-FREE AT 1-888-340-2265. BMO HARRIS BANK(R) IS A TRADE NAME USED BY BMO HARRIS BANK N.A. MEMBER FDIC. EQUAL HOUSING LENDER. MLS401052 VISIT US ONLINE AT WWW.BMOHARRIS.COM. CHECKING ACCOUNTS ESSENTIAL BUSINESS CKG ASPHALT SEAL & REPAIR OF SW FLORIDA ACCOUNT NUMBER (Checking) DEPOSIT ACCOUNT SUMMARY Previous Balance as of July 31, 2014 11,662.41 6 Withdrawals (Minus) 9,315.49 Ending Balance as of August 31, 2014 2,346.92 Withdrawals and Other Debits Date Amount Description Aug 12 3.00 ACCT ANALYSIS SERV CHG Aug 21 133.53 ACH DEBIT WEB FPL DIRECT DEBIT ELEC PYMT Checks by Serial Number Date Serial #$ Amount Date Serial #k Amount Aug 01 1438 5,000.00 Aug 22 1441 305.00 Aug 25 1440 * 2,625.93 Aug 15 2899786 * 1,248.03 * Indicates break in check sequence Daily Balance Summary Date Balance Date Balance Jul 31 11,662.41 Aug 21 5,277.85 Aug 01 6,662.41 Aug 22 4,972.85 Aug 12 6,659.41 Aug 25 2,346.92 Aug 15 5,411.38 FORMG30039 . N IIF ±l i l��i 1 fi � l� � �i t � i �t �" !I, �::I� I JI 1 !' �r ��' '� � 0 1 I 9 I y Ei 11. 7 e , `� i i, ,lr. i ,, "i� e:r 7. 1 fig it'I I; I". :.f i` I..lli 1 �� P. ;1111' ,�l�f I��d�ll°�� :�U a C If : �1y ' Idf I � i , i 1I1, il.. ! :4. y 1 I I � 1 .I.1 r ,':j� lii4;Jlt �#' p i 4 s.l:$ t� i, l ,t ,l ..,1. t 4 1., Y�� Ii,. I �11, 14 li !+ 'SERVICiE!hCiil: ' Il �' ' i I 1 1 .yt g t: Subcode:970135 Ordered:08/19/2014 13:47:51 CST •CI:E)(t)erlafl Transaction Number.0500535010 • • • ' Search I ,uiry:ADVANCED SWEEPING&S/12298 ISABELLA DR/BONITA A WOdd Ca.ing t a n ci: -' "'f1,, a t Nw G l irk LI 1�� 1i(li i '� #� 3 •5 _ 33831 �h�k#�I f i ��. I ;� �� l i� ,f �� '� i�11�iR {� !l 1 li' ��: ,i��f i�, ;t'1 t F #',-J 6 l 1 X10 'toll or' =1 J ii.Yl ,I `I .f • :+ ' F w, i, ! I }t {' 1J e 1 I i� i ,..7." 6`W LP.. 1137 li .11.1011[111,� it I ' , a 1 s$1 1.1.,i I,�1'ii4 , .! diets li!I) EI 'I3.l x �ll ''t 1 ", it I 1 �,, !>li�ait):; ..�. tk, ,�� I1�Y k •Jig (, _ '� �L l is .._ I �. . .k� ,� lit nli ,:. R (I ', Business Name b Business Identification Number 1, F • ' I ADVANCED SWEEPING AND SERVICE INC. : -a� 898433831 l 14i::'• Ili 1,, Lev 11 , 16 itI r ,sl`au 1 t� I 11 , " t Ill 1 �a€ II Prt fy d ressr11229- ISABELLA DR f, Website:cleanlotpros,corn �. � •' �7 1;'•I...•:_,,: rP'' t 1 I� rill, 1 1111{ iC l> If! IIIII li iI ' 1 ' it ''0'•,I A•!GSl FL' 135 6431 Phone: (239)949-5550 lr J i � „1,,,,` ',`F .2 i 11 II II 11.1 tl[P•t • : 1 . 14'11 J it i,. ; `I9ft :� til 'I.� i II i .1'11'11 r .t t iJt l 0'�i ,s 11'1.11 .•I�#5a:1 l: 4i;;fl s9 �' 1' ,r la i; . : t v n.a �!h I. '1 . t T¢P 0 II' .• Ix4 6 oit 1 of Pis , a_:hboard { Fisk = . . III ! I, `: ' ' , II k• it 2 V �s� j7 i k l g. i 14 't Ii I 10 �i.i s..�tz .''',I ,'. :E�f+'y�yp�p iW '� 1, 1 161600 1 ,' T .`I Ifl 17 tit iY � r�,>' " I:.1.7,11,, llri11 Jc, ' } 4'I� !;i.lri: 1 ��_. y i*Oka; . ,i « bll� �`'': �I'i BLd.1. [�ySb a � -i,� r a t I' F I H � ?� YY Q, �$ji� . ��7 j`['-' � p 1 :� � �•. p 11 �R1ak Aldk ,.I: i k I' ' YI' �Y. r A �1 04-, 1!i ,;1. { 1 rtT 1F„ b'"jF t 1 '�'1'.i` �4i1 Iii lgt 1...41 ^ Vij t I t ! +� , I `{ 4 '1 S 112' ,i MEb JM HIGF(I �{ � � F u ?'! �li I ! T • i *?` fit h } 1 1 .i i i 1 �7 l p C 7 1� �' � f ! �... C F� I { 'J s It 1 � >� I g� 'I � � � � ' I � �, {', RISK k , ,x ¢ ` 4 1 ' ,, ! P„.iJ 1� i, � 3 . i, l e � rf � a1�� 311 1 �i1 1 3 evr�'�'��1 �ki M�1•{ L . 1 i I 1f :# L tr•i4• Score range:1 -100 percentile 1 relit Limit R_ecommendatlon:42,000 : l sin ..;Facts. Years on File: 5(FILE ESTABLISHED 01/2009) SIC Code: .HIGHWAY&STREET CONST,EXC.ELEV HWYS-1641. I' State of Incorporation: ` ` ' t FL NA.ICS Code:• Highway,Street,and Bridge Construction 23731I0: ` ' Date of Incorporation: 01/01/2009” Number of Employees: i r 91 Business Type: , : institutions-Proft Sales: 63 205,0001 Contacts: MARTIN J SELDEN-PRESIDENT • TOP 0^ '' Commercial Fraud Shield Evaluation tor: ADVANCED SWEEPING&SERVICE INC, 12298 ISABELLA DR, BONITA SPGS,FL34135-6431 a.. , 7 , as 'q. ' 't, yvkP Fa t"a "9 r->AA^.7fr,7 vh> ++ry !r>1,,, m ,.+. m °xl` h"" °+. �! >" L°5 �,q�qy � < � � i �a 7a`e R �fx N� t,1'' r 4�� oa 'Il,t-'X '.:7�9f Y57O,,i,e 4. �'��F.' ¢F�.00,.fC{ J.;e4.1e Ai.: fV t� -'194, 4zi iit.41-A. 9 # �{"r<4:freikr,,,,A:, S Active Business Indicator: VI, Experian shows this business as active BUSINESS ADDRESS IDENTIFIED AS• RESIDENTIAL Possible OFAC Match: li—al. No OFAC match found Business Victim Statement: • '1 No victim statement on file Credit Risk Score and Credit Limit x Current Intelliscore Plus Score: 16 Risk Class: 4 1�^ � 4 u r _.' .},=4 d J '. ce, ..., 4 r 4 a l u s y t y ,i y xt v � ( ME7117M HIGH RISK .4,:.17 1 � � ., 1 ��p " The risk class groups scores ores b risk into ranges es of similar � ; performance.Range 5 is the highest risk,range 1 is the . t''�1 1- lowest risk, 0' XO 0S,L 01 ' -z.H x`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 Premier Profile-ADVANCED SWEEPING 4 SERVICE INC 1/5 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 15%of businesses indicate a higher likelihood of severe delinquency. > NUMBER OF COMMERCIAL ACCOUNTS WITH NET 1-30 DAYS TERM > BALANCE OF COMMERCIAL ACCOUNTS AT WORST DELINQUENCY > NUMBER OF DEROGATORY COMMERCIAL LEGAL ITEMS Action or risk based on your company's specific score thresholds: MEDIUM-HIGH RISK ` A 5 Cr' j. 4 cO t, ii;: si trr 4 4 1p; �t > �r d 'f,r r #;,4t-: : " 'j ✓ .-- Quarterly Score Trends 100 ;g go y. ao 70 :-SztL . The Quarterly Score Trends provide a view of the 60 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 40 ;iTa E months. 30 ^' . . 10 i C fi.:, a.lit Oil OG 4 t d�4 P f .Pc? �P1.-01' gy 4. f. 4:.pAi �'5 44Gi;.4 .14\q 11 ,f,A e.`,''.!; J �L i-.. i,r I•{ » �NL tr f rf ,•tl,{ ;{y .1�"-:11.i ' '.1'r.A,4 `I :ir"., I /3," 1I ' ,�;, sY Zt2.. it, ,1,, I -.'",br 'ji"rM�, .-L 14 ;'-'l sky-,'j04 1 8 Ly:'srr r % i ,047Atjxe.',.ns, .. ,:;z'k ))I+1'1..�...,S.',.. `iAN.?., f.. €,. '�t• ,±,.',�.''`, ,ir:.,ptn;�W.11'tr.:,. ` fi ''A= ,1,0,2- -1,4 ,,-.,�� i."' •w,ye;!:.'..,•.$.;rr' „4..,,u.r. a .4,.VA.!, Current Financial Stability Risk Score: 18 Risk Class: 3 r; ir-. i.( *1+'{ ^ t• ,•'.• f .,n l 1 x , u -4 ; ,`i1xtI it Or a �i s �1r f r r it !L c x b ht-ry, ,� � Z t`"�/iit! The risk class groups scores by risk into ranges of similar performance.Range 5 is the highest risk,range 1 is the %11,,...44k1,0, lowest risk. } t 1 c a i% V ,.1' O'''1 4-01 @ X m. r..o,'.,,,.:;':-.L.''',.. ,% t'„,x . x , -aiw di . ,g. » ,1 .x, „ This score predicts the likelihood of financial stability risk within the next 12 months. The score uses tradeline and collections information,public filings as well as other variables to predict future risk.Higher scores indicate lower risk. Factors lowering the score Industry Risk Comparison > NUMBER OF ACTIVE COMMERCIAL ACCOUNTS 17%of businesses indicate a higher likelihood of financial stability risk. RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR PERCENT OF COMMERCIAL ACCOUNTS DELINQUENT > NUMBER OF COMMERCIAL DEROGATORY PUBLIC RECORDS ,• .... v ... .r rte.,-C ,� -4 7.. h t< 4 .> ..ma,"ems lee` -v.lr;axii%r `." 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 $2,000 Plus.The recommendation is a guide.The final decision must be made based on your company's business policies. Top Payment and Legal Filings Summary ... F c-„,,,, w, ' ,-i m ss ' : 6 , , , �.ew ' Y,.. ' , 4 7 3?A ,a fl x . , ,,,, ,,,,r ± .' - -, { rz , �h[1Ak �f , , 7� • 6 I +�. 1,,,,i.. P3" ,-61,4;, 4_f 4v 4 t .. , � , .,.}i �iai,K( �4 a ¢. or%:d49; tiFP i s3l LY �,dzic tf„ ' q Y, y } §�,,, � ':,- [,.,.,A,,- . , „, - 4 ,,• ,.,,,: Current DBT: 0 Total trade and collection(3): $100 Bankruptcy: No Predicted DBT: N/A All trades(3): $100 Tax Lien filings: 1 Judgment filings: 0 Monthly Average DBT: 1 All collections(0): $0 Sum of legal filings: $300 Premier Profile-ADVANCED SWEEPING d SERVICE INC 2/5 Highest DBT Previous 6 Months: 8 Continuous trade(2): $100 UCC filings: 0 Highest DBT Previous 5 Quarters: 4 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended: $200 Payment trend indicator not available Most frequent Industry purchasing terms: Industry purchasing terms not available y' .a., �.J lhiritr.1,,A S� -. y k� -,4..4,TA 44 l ";L,°>" ...�"_' r`fa'4 al "x}-" ♦T kA�+ yb r -:-,', r3 '.E ,,,, ,,.- - _ /��}p fl, �y 1. .., . .,c £xy .5i,YW?xa„a+..�.,. ...::+tP';c .� v��' ��€Y°� ?s��;� �f� to Y �`Y �::: Industry DBT Range Comparison The current DBT of this business is 0.80%of businesses have a DBT range of 0-5. DBT for this business: 0 Yid - r , J L� f^ J'. % of businesses _ft —% r F ti . � z . . ..a1 .Gu 1,,,,....-p.,-;,.,a .3. ,:, ;f ,.eg Top F,ZY. ent,Trending m,,•,.f.a v .._i*,4tF,4's.Ga.i 44-w. as.m ;� FAT. .- .., .... .. ., .. .., .. .._ .. .. Monthly DBT Trends Quarterly DBT Trends , 10 d 1a ei 9 6. . e e @ 8 - 9 Pd 3 5 '1's 1 -tea 1 .r4,4,40, 044,0,000,a,peckAttpso 000000, soo scco Aos AGM* so,o i s � e+�01ai”' r 4+t.d,<<t��.,,, ...•t,. +:w7 a.,'.'F A.,r7 t t5'r . ,r,: ,.. ., _ . 't. Payment Trends Analysis Account Status HIGHWAY&STREET CONST,EXC ELEV HWYS-1611 Days Beyond Terms Date Reported Industry Cur DBT Business DBT Balance Cur 1-30 31-60 61-90 91+ CURRENT N/A N/A 0 $100 99% 1% JUN14 86% 5 0 $100 99% 1% MAY14 86% 5 8 $200 49% 50% 1% APR14 85% 6 0 $100 97% 3% MAR14 87% 6 0 $100 97% 3% FEB14 — 87% 6 0 $100 99% 1% JAN14 85% 6 0 $100 99% 1% Aell.4 . ,,,,,, Gil c$L,'Y f,"Toe r rw,: k1 1:.. '}z'S'' L,# ,� �i ,{5�r'�LS ',lvS— Ust�L*•iS..�va-�' ,. rx3 (,�t : Apr! ti , - ,�e,f,J.m'. � t B�,. � l.<'� �'w;+ r' � y..e...>i .si �.. '�ti� � �.�......�' �, �` � � "_-�.' e 7ti ;.- ...`. s` 'tv"+u. n� ..� �t-. Account Status Payment History-Quarterly Averages Days Beyond Terms Quarter Months DBT Balance Cur 1-30 31-60 61-90 91+ Q2-14 APR-JUN 4 $100 74% 26% Q1 -14 JAN-MAR 0 <$100 99% 1% Premier Profile ADVANCED SWEEPING$SERVICE INC 3/5 • Q4-13 OCT-DEC 0 <$100 100% Q3- 13 JUL-SEP 0 <$100 100% Q2-13 APR-JUN 0 <$100 100% TOP 0 Trade Payment Summary Trade Line Type Lines Reported DBT Recent High Credit Balance Current 01-30 31-60 61-90 91+ Continuous 2 $200 $100 99% 1% New 0 } $0 1f �!;s , w•• , tip ;;;;.4-1. sb. r� .. Additional 1 p $0 t n s�+4.c ( "• ° fit.,. I s rs y�r �s, ,*,1=t s 4J$ i k r! r S I s E )h � �..�.t.K..^,._ TOP CO Trade Payment-New and Continuously Reported Trade Details ' a.nw�d � ,.s Fc 1 -4. s^x It i£� r '' y,.s €, 7 .7y,.;. y �,t r.. 'Cvy �ai^� 2 ._'I�hld-. t�F..�`W'se,��a:��.l �. >^r� ��e��" �� "4 � ...,r,_ ro,.h� .a �'c ;,�.,..� Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Cate.o Re.orted Sale Terms Credit PACKAGING 08/2014 NET 30 $0 CUST 2 YR PRNTG&PUBL 07/2014 VARIED $200 $100 99% 1% Top Trade Payment-Additional Trade Details 5 wig T AMA < ' reii -l .74 k n, S,-*-Y q 9�''�'ii ��i, e.: a ( ' j j ,�5 zi.1'�!. kZ.,�.> . k�� >?�' ��'t t�� :att ...a+��n.,� �; �y �, Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Cate.o Re.orted Sale Terms Credit GENERAL 11/2011 CONTRCT $0 TOP 0 Legal Filings Le {{ File Date Filing Type Status Amount Filing Number Jurisdiction 12/03/2012 State Tax Lien Filed $300 2012000263733 LEE COUNTY CIRCUIT COURT Filed by:STATE OF FLORIDA TOP 0 ddt�ona�Busirae s Facts sy rlr,.K A :rjrTk"'f�y�'& ! 'aa+TEtob rTere . t y �a 4 �s - ,. k t ?T$>f *+''7. * �°'3iF ? - "a 0:; ( LL S 1 1 c }a-TvrA 4 ! fi it t 3s}1 Y 4 JS F� 4 rf-A y�c M1 „'t! j�:�G � .u. �U �,�y� C � rc: � _ .R rs..n-:v. rft1:.5°^Y"�w 'ar ,k rrs,K,..s sti��c ,��.._. ,x... � 'x,. .d,,�J� .G.w a ar°f -.s." •v.A'^#�'r... '�t.lM'. THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA. State of Origin: FL Date of Incorporation: 01/01/2009 Current Status: Active Business Type: Institutions-Profit Charter Number: P080001066 Agent: SELDEN MARTIN Agent Address: 12298 ISABELLA DR BONITA SPRINGS,FL TOP 0 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 Premier Profile-ADVANCED SWEEPING&SERVICE INC 4/5 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 policy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. • Premier Profile-ADVANCED SWEEPING&SERVICE INC 515 Bus Platinum Privileges ,4•Bank of America' , p o.Box 15284 :wilnungton,DE19850 .. . Customer service information IIlIiIIIlIII1I114I1il11116Illi illnII_IipiIi911fh.IiIIilI"III. . • • 1 888.BUSINESS(1888.287.4637) :: Al' : O 076 693•104. 022733 1*0I AV 0.381'. bankofamerica.com' ' •• '.; P.O.:Box25118:.:•. ADVANCED SWEEPING'AND:SERVICE INC. . ' . Tampa;..F-.L 33622 5118 : . 12298 ISABELLA.DR •.. BONITA SPRINGS,FL 34135-6431.• : Your Business Fundamentals Checking Bus platinum:Privileges . .for July 1 2014.to July 31,•2014-- Account number: ADVANCED.SWEEPING AND SERVICE INC:_ . . Account summary . .: •.•Beginning balance on July 1,2014 •$10,43925 . .:#.ordeposits/credits:] .Deposits:and other credits .. • • 9;05..... 0 #of withdrawals/debits:9 Withdrawals and other.debits -7:95 #of items-previous cycle'.9•Checks • : : •.-2,952:85. .. .•days m Cycle:31,�. Service fees -40 Average:ledger balance:$17;662:05' ' Ending balance an.July 1.1, 2014 $16,533.45`.' 'Includes checks paid deposited l'tems&other debits • e-s A na eye •.4 *,III -4 �, .Start_earning cash back_today,simply: .. . . 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In the next month following redemption.For more information,please read the program terms of use at wwwbankofamerica.com/serviceagreement Bank of America NA Member FDIC. • . 02014 Bank of America Corporation ARM3JKNJ I AD-04-14-0084A . .' • • a Your checking account Banl�of Americ ADVANCED.SWEEPING AND SERVICE INC.. I • .1. July 1,2014.to July 31,2914 Deposits and other credits Date • Description; .. : Amount ,' 07/03/14 . Deposit 9,05500. Total deposits and:other.credits. •$9,055.00 ' Withdrawals:and other:•debits Date.. • Description Amount'• •07/03/14: • BANKCARD DES:MTOT•DISC.ID:524771000471149 •7.95 Total.withdrawals and other debits $795 Checks Date Check#: Amount Date ..Check:;# - Amount 07/01/14 .1144., -300.00 07/21/14.•• , 1148 -74.00 . 07/17/14 •.1145 : -88.25. 07/21/14 1.149.. . . -12334; • 07/21/14 . 1146.. • -2,050:95 07/21/14 1150 . 98.00 • 07/22/14 1147.. 138.41 07/24/1.4 , ...11.51 . 79.50. • : Total checks -$2;952.85 • Total.# of checks . .. • . • 8 Check Out the Bank.of America Small: Business Community it's a•convenient and complimentary online resource that.can help you grow your business. • • Read articles by experts �v •h5. Exchange ideas in real time with other peoplelilce you . •Access financial-tools-and much more Visit bankorannerica.com/sbc-today.: ,Life's.better when we're connected'" . AR4P3PGA A612-134391A I . . • Bus Platinum Privileges Bank of America' ' P:o.iingto,D Customer service Information Wilmibgtoa,D$i98G0 . . -� : - I it Ih I nil r I I I► a II Ih and'r I r_ 1 888.BUSINESS(1',888,28 .4637)..7• i 11; 1�I 11 .Ih 1.11111..mi. 11 1111 . l Il I . Al 0':•075 857 '982 023536 11.001--.AV-0:391. bankofamerlca:tom.; ,• Bank of America,'N.A: •• • • P.O..Box 25118 Tacripa, FL'33622 51.18 • ADVANCED SWEEPING AND SERVICE INC. • 12298ISABELLA DFT .. BONITA SPRINGS,'FL 341`35-6431.. . .• • • • Your Business Fundamentals Checking .. Bus.Plat num Privilege • for June 1;.20.14 to June 30,....2014.....- Account number:.: .`.•ADVANCED.SWEEPING•AND•SERVICE INC: • •r .•Account summary .•Beginning balance on June.1,2014 $8,747.99.. #of deposits/creditsr4. Deposits and other credits •• 8,601.55 7• #of withdrawals/debits:'S ••• Withdrawals and other debits -0.00 •.#of items-previous cycle':.0 ,• • Checks -6,91'0.29 #of days in cycle 30: ...Service fees. ..,• -0.00,• • Average ledgerbaiance::$13,59130• Ending.balance on:June 30;201.4 •• - :.$1.0,439.25 'includes cheeks potddeposited Items&otherdebi s. . - •, { . ",gg 4` , 0, 4 / /� r t Enrollment via Mobile app �g -r w Our free Mobile Banking App lets you not available on all devices. .• fN ab1 , >y • ..• •• . . ' Wireless fees may"apply. <f,•''fit v! ��► �^,� r„vt 1,Y �' 3F0i bank for your business on'the-go For the text message,• supported carriers include:•Vrz- irA f r. '� .Mobile Bankin ives you convenient and •secure: Alltel. AT&T, Cellular One , . 4 y �� Banking$ you T-Mobile, Vrcgin Mobile, lia •• 1 `� x • access• to your business accounts anytime;anywhere. us Cellular and Venaon • 1: f �f r Wireless: Text STOP to '''i*it ''si v`a A y • _ •Check balances 226526..to. cancel and• �,w �xv, '� y �r ,K*s . Pa bills. • text HELP to.226526 for w ' r r Locate.ATMs or. an. centers• heir, Bank of 'America,• ex � g N.A. Member. . FDIC. 02014 Bank of America ,� t Teat BizApip•to 22• and download your.free Corportation ��t� y • n � Mobile i nldn App today AR65HU7N 'I AD-03.14-0264A �!:r.:k9:.k.'3:cti�':h ,..-�'an;4 L..,y�M,r.`:.n .ww:...r..'� .. . ADVANCED SWEEPING•AND SERVICE INC. I .I 'June 1,2014 to June 30,2014 Service fees ......:Based upon:the•activity below;the:monthly fee'ori your Business.Fundamentals checking account.was waived for the statement period ending At least one of the following occurred . . . • O. :$250+In net new purchases on a'inked Business:debit card . .• ^ $250+in net new purchases`on a'linked Business credit card •. ••• . 53,000+•minimum daily balance.in primary checking.account : . $5,000+--average monthly balance in•primary checking account . . 0 $15,000+combined average monthly balance its linked business accounts • . A check mark indicates that you have qualified fora monthly fee waiver on the account based on your usage of these products or service's. For information on how to open a new product or to link an existing service.to your;account please call 1-888-BUSINESS:or _ visit bankofamerica:com/smalibusiness. .• ' .•• Daily ledger.balances . Date Balance($) Date . Balance(S) . Date, Balance(5)• :06/01. : 8,747.99 : :06/12 :15,734.47 - .•06/26-. .. . 9,85532•.06/04- : . . 13;705.99. • 06/16 15,660.47 06/27 .. 10,589.27.'"• 06110 16,61.5.99 ..06/25 .... 10,082.47. 06/30 - . .' .10,439.25 To help you BALANCE YOUR CHECKING ACCOUNT,visit•bankofamerica:com/statemenntbalance or the Statements and Documents'tab In-Online Banking for a printable version of the How to Balance Your Account Worksheet. • Your checking account Bankof America ADVANCED SWEEPING AND SERVICE INC. I I June'',2014.to June 30,2014 • Deposits and other credits . • .Date Description Amount .• :.06104/14 Deposit. '. 4,95$.00 .06/10/14 Deposit :. : 2,490.00 06/10/14 Deposit 420.00• 06/27/14 ' Intuit Payment 5.Des:lntuitpmts.Id:. 73355. Total deposits and other credits . 58;601.55 . . • Checks Gate Check/f. Amount Date. Check# Amount. 06/16/14 1139 . -74.00 06/26/14 1141 -226.75", 06/12/14 . 1140 881.52 06/30/14 , 1.143' 1 - 150.02 . . 06/25/14 .. `1140*. .; -5.578 00 Total checks -$6,910.29 Total#of checks` 5 ' There is a gap in sequential check numbers M.=t+ »$ "t`f dry �Yr e�' 41 § , ttrh R . 'c a`^ . ....^,. � �,'� fir-±, '+`"� - '` sc c t�,� +l�, s i !{ 4' 4-E,,,.--.1t, n a 4,1. ,s i .,- ^�.� , f ' t,4 tan �€ x `4 3 �` 4 , c-...' FMS ,a t' � .--'� 'A +, +rGe �t -. 3, :> m,• '5 :, �. ,,,11-„,.." x 5 bmay; is 4 ; Kkifii Ayye �new,�,,c,��los r. a k,a %� "i4si;.'€ `- & di▪"F^` a r5 l nd them ai3�� r,. ,- l r.1i. _� . ,' �' . °�k` x:7' :. w . t�''�� yyni� *,x2; � t�••w.cc.�,c .r�wy �� ,� �f-s fir' �''� t�'o St`s +��c.�. y.�. £ _ I "�' �,44'1v' t a tie r-.:x ' ,`��' f'a. 5n 5-'*se ~in,'r &:-,.- ., �' „,- 5 gx .'.,=3 ' a...7'4-..,'ss` ,-.. '�$' „.� .',,. •3`,_°4. .-{'. ^" ,:=�;� 'fic- ' -'7r x tea. t, t Bankof•America• ►! . . t aP.O.Box 15284. Customer service information • 6,...1.888.BUSINESS(1.888.2874637)nlr 1I 111 ul�lllnl I n till I Ils i iI t (�.l IIli�.nit I il �.� .• = Al '0 075 994 642 006406 US01 AV'0.391'' ..bankofamerica.com' .. � i w , i s - i _ . iiii Bank of America.N.A 1.: 25118_ f, Tampa;FE 3362251.18. . . ' . . • ADVANCED SWEEPING AND SERVICE INC: • 12298 ISABELLA DR ._. '. . . . ' `'BONITA'SPRINGS,-F1;:34135-6431 •• ,1 -, • .137. . ._ Your Busine*s Fundamentals Checking for May 19,2014 to May 31;2014 ' Account number: ADVANCED SWEEPING AND SERVICE INC. . . :i' .. Account summary Beginning balance on May T9;2014 - ti SOW #of deposits/credits:2 Deposits.and other.credits.. .• 8,816.99 a #of withdrawals/debits:l . .Withdrawals and other debits - •=0.00 #.of items-previous cycle?.0.. . Checks -0,00 •#of days in cycle 13 • Service fees • -69.00 Average ledger balance$6,158:53 • Ending balance on May 31;2014 $8,747.99 • 'Includes checks'paid deposited items&other debits' • 'a 1 � t Go paperless. .. f:.' � `f } ? +�, :�� . •.Your secure paperless statements look just like your paper copies � h r Get email reminders that link right to your statements for easy access ,� 1 s� � :View,download and print your business statements anytime . '4:` e f*, .� , '' To switch in just a few •clicks, log in to Small.Business Banking ,�5 • }#- • at bankofamerica.com/smalibusiness •. S 7 '..14.'E �a 14 .4 ,,,;: `•' Bank of America,NA Member FDIC®2014 Bank of America corporation: ARPJ49RE I AD-021#031$A:. i ADVANCED SWEEPING'AND SERVICE iNC. I.'. •I.'July 1;2014 to July 31,2014.... . `: Service fees . Based upon the activity below,the monthly,fee.on your Business.Fundamentals checking accountrwas.waived•for the.statement period'ending • 06/30114: . At least.one of the following occurred. 0 $250±in net new purchases.on a linked Business debit card 4: $250±innet new purchases on a linked Business credit card • • •.y• .. :•$3,000+minimum daily balance in primary checking account. .. • • .. . lif $5,000+average monthly balance in primary checking account O 515,000+combined.average monthly balance in linked business accounts . A check mark indicates that you have qualified fora monthly fee waiver on the•account based on your usage of these products or•: :.services. For information on how to open a.new product or:to link an existing service to your.account-•please.call..1-888-BUSINESS or visit•bankofamerica.com/smallbusiness • . • . - . • • .• Daily ledger balances •Date Balance(S) Date Balance(5) •.Date .. .Balance(5). . 07/01. 10,139.25 ., 07/17. 19,098.05 `07/22 :. `. .16,612.95' :. 07/03 .19;186:30 07/21.. 1.6,751.36 07/24.... .16,533.45 ..• . I. . . ..TO help you BALANCE YOUR•CHECKING ACCOUNT;visit bankofamerica.com/statementbalance or the Statements and Documents tab .•. in Online Banking for a priritable version of the Flow to Balance Your Account Worksheet' • .•• • • • • • Bank of America ... Your checking.account.'. ' "•ADVANCED SWEEPING AND SERVICE INC. I .I M ,ay 19 2014 to May:31,2014 •. .. . .. ,: Deposits.and.other. •credits ' Date Description Amount .•05/19/14....• Agent Assisted Transfer From Chk 3058 Confirmation#2651650613. • • • •• • '5,000.00 :•05/28/14!.• Agent Assisted Transfer From Chk 3058.Confirmation#4228831485 . • • • .•3;816.99' •• ."....total deposits and other credits: • •• : .• • : $8;816.99 •: • 'Service fees. • .. • ••••.... . ;Date Transaction description Arrant' 05/28/14 CHECk ORDER00075.DES:FEE: • 10:11051393871 • ••_69.00.. . Total service fees ... . . • . $.69.00':. '.•• • ••I Noeyour.Ending.Balance..alteady.reflects.the.subtraction.:of Service.Fees. .. . Daily ledger.bala:nces .•.: Date .:.. . . . Balance i$).• • •Date '' Balance($) ' ..Date • Balance(S).' • 05/19 . : • : . .5,000.00 -: •5/28 . .. •': - • 8.,816.99 . '.0529 - 8.747.99 • ler. : To help you BALANCE YOUR•CHECKING ACCOUNT,-visit bankofamerica:com/statementbalance or the Statements and Documents tab. . . .• in Online Banking for a printable version.of the How to:Balance Your Account.Worksheet.: . . . . . . .Get your exclusive Inc.guide.:. • .. . • : , "Build; Buy or Ally:.Growth Strategies:sfor Business".:•" .. . i Simply visit th.e.Bank•of America Small.Business Community to download your - •• : ter free copy and learn how you can accelerate the growth of your busIness. • .• "' < While • you're • there,access •financial tools,exchange ideas with other:small business • . owners and much more: • : .. .:: . • Free download: Go tobankofamerica.com/sbc today 1I1C... . . . Inc.is a registered trademark of Mansueto Ventures LLC fully kensed and Bank of America Corporation has written permissionalowing • . usage to publish,Bank of America;NA Member FDIC 02014 Bank of America Corporation .ARIXG6LF i AD-132-14-0316A . 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' • • .1 . , .. . . .3' q,. •' • . • , •. .. • • • • . ; . , ! • • . • • ., ACA ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ke..-■---` 09/11/2014 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 CONTACT NAME: John Hoffman Bay Insurance Agency, Inc. (A/CNo.EXi$ 920-339-8262 FAX Bay 920-339-8294 3136 Holmgren Way E-MAIL P.O. Box 28077 ADDRESS: ccampbell @bayinsagency.com Green Bay, WI 54324-0077 NSURER(S)AFFOROINGCOVERAGE _ NAIC# INSURER A: Society Insurance INSURED 920-338-0130 INSURER 6 Asphalt Seal & Repair , Inc. INSURERC: Asphalt Seal & Repair of SW Flcda, ITC INSURER D: 2077 Enterprise Dr De Pere, WI 54115 INSURERS: _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 SUBI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I INSR WYD POLICY NUMBER I LMMIDD/YYYY) IMMIODIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 15 1,000,000 TO A COMMERCIAL GENERAL LIABILITY X CBP473408 04/01/2014 04/01/2015 PS( RENTED PRREMIEMI ESES(Eagccun-ence) $ 100,000 I CLAIMS-MADE X OCCUR MED EXP(Any one person) S 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 7 POLICY I I PRO- JECT X LOC S AUTOMOBLE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 A ANY AUTO X CAP473409 04/01/2014 04/01/2015 BODILY INJURY(Per person) 5 X ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS ( ent) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS (Per accident) Ih n P:LV,:•Ez.., I w« fi z 1$ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,000 A EXCESS LIAB CLAIMS-MADE UXL473430 04/01/2014 04/01/2015 AGGREGATE s 3,000, 000 I DED RETENTION S $ WORKERS COMPENSATION IX TORYTATUS I DEB_ AND EMPLOYERS'LIABILITY_ Y I N A OFFICER/MEMBER BBREAR EXCLUDED? CUTIVE N N!A EL.EACH ACCIDENT s 100,000 WC473429 04/01/2014 04/01/2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 100, 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 500,000 coop 250/ coil 500 ded. A Physical Damage- auto X CAP473409 04/01/2014 04/01/2015 DESCRPTION OF OPERATORS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Martin Selden is included on Workers Compensation Policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Contractors Licensing Board ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N Horseshoe Dr Naples, FL 34104 AUTHOR¢ED REPRESENTATIVE I 94)A ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 1003555 LOC#: A cORD® ADDITIONAL REMARKS SCHEDULE Page of AGENCY . . . . NAMED INSURED Bay Insurance Agency, Inc. Asphalt Seal & Repair , Inc. POLICY NUMBER Asphalt Seal & Repair of SW F]. 2077 Enterprise Dr De Pere, WI 54115 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance COVERAGES CERTIFICATE NUMBER: ILTR I I A SCI yyvQ I REVISION NUMBER: TYPE OF INSURANCE POLICY NUMBER l{MIODI )!LMMID LIMfTS 10,000 A E & 0 X CBP473408 04/01/2014 04/01/2015 I I ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • " 000 v:Z19, ATWATER '2Ef: NANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION • **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW ' L.,...,NSIR12TION INDUSTRY EXEMPTION its that the individual listed below has elected to be exempt from Florida Workers'Compensation law. r..DA1F: 8/27/2013 EXPIRATION DATE: 8/27/2015 Pt. ziON:. SELDEN MARTIN 2038242'78 NAME AND ADDRESS: 'ANGEL)SWEEPING AND !SABEL LA DR. T.! SI,RINGS EL. 34135 BUSINESS OR TRADE: NC&SHOP :ONS •140.0(14),F.S.,an officer of a corporation who elects exemption from this chapter by tiling a certificate of election under this section into; ...:impensatoil under this coupler.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt..apply only within the.sc.npi. traue listed on the notice of election to be exempt Pursuant to Chapter 440.05(14 F.S.,Notices of election to be exempt and certificates of soot shell 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 insets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the jilt:certificate to meat the requirements of this section. t:•••;.!") `1:ERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTION:5?(1.10t!, ',1:1-1 Florida s.. .0 sr, ' COL CLASS B I; MARTIN R l 4s .n. ,SE'LDEN ',- mss" 98 ISABELLA DR '' - -e !TAS' - ,.. t -r.= ti--,::::,--. t.<. t s•� R. Oueranon of a motor i tWER, -wi0i'ORCYCLE ALBt """'� txntWUtes consent to any sob iety fast agtvad by law i Yanira Tejada 1885 47th Ave NE Naples, Fl 34120 September 24, 2014 Dear Sir or Madam, Subject: Application for Landscaping Restricted license I am writing to provide explanation of my credit report obtained by your office in connection to my landscaping restricted license application. My credit is poor because I was going through a rough financial time the last couple of year. My source of income was greatly reduced and I could not keep up with my payments. Large part of my income went into paying my mortgage and keeping my house. I could not keep up with my credit cards payments so I did not pay them. Unfortunately, I was unable to continue to keep paying my house and it went into foreclosure. All this time I was trying to sell my house on short sale so at least I would not have a foreclosure on my credit. I just sold it on short sale on September 5th, 2014 so now I can concentrate on working with the other credit companies to come to a payment agreement or a payoff amount. I had a tax lien but that is all paid. Also a dispute with a insurance company , that is all paid. Target put a lien and that was also resolved when I did the short sale on the house. I have attached a copy of the insurance and the tax lien matter concluded. I know and understand that that is not the only things on my credit, I need to go through it all and call the companies and figure what I owe them. Please understand and take into account that foremost on my mind was my house and now since it just recently was resolved I am just trying to start again. I am requesting the Landscaping license so that I can work in Collier county with all the needed permits, licenses and insurances. Then when I have all my paperwork in order, hopefully I can start working and work towards my goal of having a clean credit and a better financial future. Thank you, 'ra Tejad LAW OFFICES GARY KORNFIELD,P.A. EMERALD HILLS EXECUTIVE PLAZA 4601 Sheridan Street,Suite 222 Hollywood.Florida.33021 Gary Komfield Admitted to Practice Broward (954)241-0440 in Florida and Pennsylvania Facsimile (954)241-0441 September 3, 2008 Yanira I. Tejada 3715 39'Avenue NE Naples, FL 34120 Re: Seminole Casualty Insurance Company a/s/o Cruz vs. Trejada and Pena Our Claim No. : S0602164 Date of Accident • February 16, 2006 Our File No. • 08-270 Dear Ms. Tejada: Enclosed herewith is the recorded Satisfaction of Judgment. This maybe used to reinstate your driving privileges. Your insurance company paid the claim in full. This matter is concluded. Sincerely yours, LAW OFFI .6'r ;, • ► p" MELD, P.A. B � G. Kornfield, Esquire GK/ci t f_y flU! RE T.= wif i Department of the Treasury Notice CP39 Lt ) Internal Revenue Service Tax Year 2006 IRS PO Box 621501 Notice date June 11,2012 Atlanta, GA 30362-1501 Social Security number To contact us Phone 1-800-829-0922 Your Caller ID 307916 053988.976920.0241.004 1 AT 0.374 643 11111IIhl1IIIII I"1111IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiJIIII,II Page 1 of 2 YANIRA I TEJADA t 3715 39TH AVE NE F,tr NAPLES FL 34120-7546 053988 We applied a 2011 overpayment to tax you owe for 2006 Amount due: $0.00 We applied the $1,010.27 overpayment Billing Summary from your 2011 tax return to the amount Amount owed on 2006 tax return owed on the tax return you filed in 2006. $1,010.27 As a result, the amount you owe for 2006 Overpayment applied from 2011 -$1,010.27 Amount ount due is $0.00. $0.00 What you need to do You don't need to respond to this notice. Continued on back... 6r YANIRA I TEJADA Notice CP39 V 3715 39TH AVE NE NAPLES FL 34120-7546 Notice date 1 re 11, 201 IRSSocial Security numbe !!iII rr,; ,, If your address has changed, please call 1-800-829-0922 or visit www.irs.gov.fti~, mcir,,,„0,,,,.,.....„ II II I ❑ Please check here if you've included any correspondence.Write your Social Security number(154-90-0720), the tax year(2006), and the form number(1040)on any Contact information correspondence. -1 a.m. 7 a.m. p.m. r i p.m. Primary phone Best time to call Secondary phone Best time to call INTERNAL REVENUE SERVICE KANSAS CITY, MO 64999-0204 slinl'II,I,tI,IIII,,,,III I MIIIIIIIIIII1111.111itllh.,ll,l 1549 00720 KO TEJA 30 ❑ 200612 iff# GMD Operations & Regulatory Management Licensing Section A Il c' 2800 North Horseshoe Drive Naples, FL 34104 2 O I 3 ` Q 1 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: krG4tc<. \a rms / o4 P/ôrtla.. , t 11. a �t1'gav :€ri ,z Fiction Name/DBA: Qualifier Name: a j/N 1.( --re-135CL Physical Address: 18B5- 91.14 , et es - . 30 Z O (Number 86 Street) City) (State) (Zip Code) Mailing Address: t§ 1045 K. it 2 31 N4Plec 't2. 2'//o r (Number 85 Street) P (City) (State) (Zip Code) Telephone: 3Y8 `1( E-Mail: paro-dt - 1.-VL- �4-o t•C c wt 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 ❑ S ' ming Pool $230.00 ❑ Roofing $230.00 I Specialty $205 00 1 G Specialty trade: &a f,, 1 e$t . • JY CHANGE OF STATUS: ( ). Reinstatement ( ) From One Business to Another -_ (. ) Dormant License to Active Page 1 of 4 • t 1. The names,titles, home address and phone numbers of all Officers/Managing Members of the Firm. Ae3c3Avb kt.c_o 1 1 l W.V.?)ti‘AK PC( Oct,le fi 3 V!20, �3Yd �� t LA 1 e��d�. , 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. A/MA t 12+1)410 , ■,D3V, 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. R . AFFIDAVIT I, IC10 I I O -a—certify that the foregoing is true and correct to the best of my knowledge. kJ ` ./ Authorize fficer of the Firm STATE OF FLORIDA (� COUNTY OF eo/Li e-2 The foregoing instrument as acknowledged before me this Sep m L e r ),p 20 i ``t (Date) j' By tflrr, �� CAO of ?0,,,r-cotise Land SC� r J b,-P " a-IUA (Name of officer,•le/agent) • (Name of Corporation) a A 12A fJ..1\ Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced 1)11 Ve1r'5 `A CQY\Se._ identification and did not take an oath. (Type of identification) NOTARY'S SEAL •:; ,,t Bye: EDIS A AREVALO (SIGNA OF NOTARY) .i"= MY COMMISSION#FF005369 -'+)itf,.P°'• EXPIRES April 4,2017 ''.FOF fl0+�• P (407)398-0153 Flor!dallotaryServlce.cOm Page 2 of 4 QUALIFIER INFORMATION: Name: 3eLA I RA.. Address: l g � (-11 iv e_ 4 ts ç(. 3412-6 (Number& Street) (City) (State) (Zip Code) Telephone: !i J"( 3`i J`( b Date of Birth: S.S. #: 000-00- E-Mail: i o.,i S 8'c ac!•C.6Yi� Driver's License: ► 1. Type of Certificate of Competency for which application is made. • 1r&viScAY9 1 yn Yes - 2. The names and telephone numbers of two persons who will know your whereabouts. kf jahA, 1QLLL) t 239 (6.)-s-cittel TJcu . , 2_39 a0l�7� 3. Have you ever been convicted of a crime related to Contracting? /06 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? 0.1 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. •�Mr ct ; , Cry p,� • t ry F-1/ e:ti-4 i r Z r• et- .1"241/ck 10. Statement of any formal training you have had in th areafor which the application is made. + C SS PeiGiotett "/tty„/tee-etcfe Page 3 of 4 • mss♦t 1 , • AFFIDAVIT _ ,--,••.` _• ....---- —7—r-- -- ----. . The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. • 1(& id - s. 9PLlCANT(PLEAS ibfit loødccá, AME OFCOMPANY ICZ014062'" • A S NATURE • / PLICANT STATE OF FLO DA , COUNTY OF Q-01‘1 P Nl' The foregoing instrument as acknowledged before me this Stp 1.2-r I D rh -l%l q • (Date) By ;x\1 (C TQ C&0 -- who has produced b r‘ Iexc L .yes (Na a of person acknowteging) (Type of identification) as identification and did not take an oath. • NOTARY'S SEAL ED IS A AREVALO (SIGNAT OF NOTARY) :'• fat .`� MY COMMISSION#FF005369 `��'°P' EXPIRES April 4,2017 ''�FOF ie`` p (407)398-0153 FloridallotarySerVICe.com Page 4 of 4 • Licensee bifennatiost - • ;„. Licensee Number Q17635 Description Type Property Alert Name IYANIRA I TEJADA Type .CprtractQL_____ - • . Status Open View Master Project View AM Activities for this Licensee Add a new person or business to Address Book Examination Results -..4„ Result Link Exam/Test Type Date of Exam/Test City Score received pplairest result BUSINESS AND LAW 07/12/1997 NAPLES 75.50 TREE CONTRACTOR 03/03/2007 NAPLES .76.40 ......... ..... . . TREE CONTRACTOR 02/10/2007 FT.LAUDERDALE-BROWARD C 57.00 [ .Show More fields ( Hide or Clear Fields Charge Exam Fee a Exam Code I Sponsoring County ) Sponsorship App Date I Sponsorship Expiration Date ! TestiNF4OilitY I „ --.41P-4P11"-aPer*F..."441401"--41111$0111"AtiVis'=111,4g, • - alte — ,m■ 11. :f• • S.7, •.40.04111*- 4111.$14%"..70011145i. " .4.14010010.04., 4.'r" • 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 >ossible revocation of my Certificate of Competency. r S NATURE OF •('PLICANT �� .A.:r - %/ - it. 1'I Or— :USINESS NAME • 41 I ct) (i DATE EFORE ME this day personally appeared LA 0,-N11 Y7n TY G'td t affirms arms and says that he >s less than one employee and does not requir Workmea's Com nsation understands that at any ne he employees one or more persons he must obtain said Workmen's Compensation Insurance. 'ATE OF FLORIDA )LINTY OF Le foregoing instrument was acknowledged before me this �G t.A {,`33c_r- 10-12-0) (Date) Gum∎"Cc -'I -G� � � .- who has produced ' b r 1 V Q 1�5 CQ.c�C ame of person ac nowledging) (Type of identification) ` identification and who did not take an oath. 411IW 41\ 410 • SIGNATURE • OTARY /C NOTARY'S SEAL ,rared _ tiNU (PRINT_NAME OF NOTARY PUBLIC) NOTARY PUBLIC ' EDIS A AREVALO t. 2 MY COMMISSION#FF005369 o? EXPIRES April 4,2017 • (407).398-0153 FlorldallotaryService.com . + I ' 4 • t RIFICATION OF CONSTRUCTION.EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section _.. _-_ 2800 N.Horseshoe Drive Naples,FL 34104 - --- ,pplicant's Name: I 1 t "re • 'ertificate Category Requested: INC) sr&l pt /�c-i/ he Applicant is seeking a Collier County Certificate of Competency in 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 rovide information that will aid the Applicant in meeting this requirement. You should verify time of active experience 'orking as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). ime served solely in a supervisory 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 (formation: ame, Title and license number of the Jpe�rson signing below and verifying Applicants relevant experience: ame: a�1& 19[ 4 V itle: T License Number(if applicable): /0 O 3 7'9 9 Put41•ame of Business: • kith 1 ii ,leitDi GQ , „dye__ • k / d &pi 's' usiness Address: `'2vS � � .N= SW/ 1a 4 4 Neu-,. -'l. 331'13 usiness Phone:23gt13 6,(0 The Applicant's years of experience from to9 i he applicant's scope of work(specific duties) included: 1\1\aI a∎Y C A cj 6-4C) % 447/^5�(Jtc_A . 'S. ,J ,,r1.,lt1it31 ( air Llw- `) rtn�45 planks' 1041ex .11 Li • a CcUc)h p1'0in fr.P WtC t iditional Comments: ilitik,f o1.l1/ tabU✓ g 1145 Cam+-yek_ rlsifying any information provided herein may subject your license to revocation. atvvtist_ gtrtit , Signature Print Name: Af fcik ) ate of Florida )unty of Collier , le foregoing instrument was acknavledged before me on this 1O` ]day of \04-1, .Q0 I Li A\ 1v.t�. i A*0 who is personally known to me or produc (vC-Y5 (..;C .w1 S-e_ identification and who did not take an oath. Signature of No • ---_ �r '\ EDIS A AREVALO 11,l��,. o• MY'COMMISSION#FF005369 — — '''orw?,• EXPIRES April 4,2017 (407)398-0153 Florid allotaryService.com • 3 VERIFICATION OF CONSTRUCTION EXPERIENCE:, GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples,FL 34104 Applicant's Name: _. A 1 I. e. ,! t a Certificate Catego ; • quested: _ l�, •'• I ALI \ "J'1 L44 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: -o5_ v _ -3 Title: \ ('QCLSIX.'t'e- s(,V 4 1(License Number(if applicable): C G) C I S/ AS- < Name of Business: DVV1 ^�. W 1n6 c*\o Y 6 4 60u- We6+--CI0 flLt 1 -' Business Address: e i r)* 5+' S Vi 1 M Ck tA-e-S -0- 340/ �,,�,�y,� a-S3-o3i i Business Phone:23�i t[�Y.t� The Applicant's years of experience from �13 to ��y� The applicant's scope of work(specific duties)included: i rL n114 �" ' ; • ' AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER r`. "' }-t ■ 4hD►t,9 l 5i?11 it) , am a resident of ac,/(1 .e...-K County, Oil JA (State) and have resided here for more than five (5) years. )uring the last five years I have known (1.ini rt.. TP ti�.LYC�. (Applicant). I have had he opportunity to observe his or her busin s and personal dealings and find him or her to be a person of tonesty, integrity and good character. r (Signature) °�i /J%t / iC.-- (Name) 4 0-1 1- ivy 44/US°I i/J c (Address) ) 6( J /& d C 4,Im tk Cie. . NJ 4p a s' I-7. 3 yHii' Telephone) .239 (900 ' SO✓ O • v STATE OF FLORIDA y t COUNTY OF ,,,,...p„. ,'. .:.,... .�,. The foregoing instrument was acknowledged before me this csi-- - ' )04 201 y by • (Date) +� 40,tn o I i ! t7 who has produced `ljnift4 L,c2 ,,mac (name of-erson acknowledging) (Type of identification) as identification and who did not take an oath. ...._. 5.... ... (....)\--D • SIGNATURE OF OT SAS f ev-L NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC '.0 A,4(.6 ED6S A AREVALO ' MY COMMISSION#FF005369 ,o F FLP o,;,' EXPIRES April 4,2017 O (407)398-0153 FtorldallotaryService.corn 0 t t ' :: tntit rumem W145 acknowledged b tF'!"minFx 1 ' + _.L.i 7 ,,.. 10 Z 0_4V 0A. o*♦iV/A 04V/11. 04 V0A 04��11A 04V01 t a . 1 .� 1 ._ 1 1l IV II a •0� � •�. s�•�.T s�•�.T sD.•�.T s'••�. s'•. 0 r. .-.k.-� : 11,01 VAA 2: ' 410 0.01 AD '--, 0 H 1 0*4,1.. iik ♦� � t* ° qy 0 40 i sa•►.••l O r•-••a(®- +M At 2, • al. )--+) o p FIA or)-t 4 NO. t 0 OZ 1 0 0 up ,--t .-, LI \ ,.,-..741 t tk"Ma c CD ►�0. ink L/`. j - �9 ��. N �` O csi CA 1 c< r� A -401-.--• 5,-,\'' _ ; -`-, 0 z O 2- 11,1, P „. #A1z. (_4:._' e . 4r.♦, n .3 CA F ', CA S n ,� till a �A� 0 - BCD < 4) ,.. VI/.V, - CD ,� ¢; ,�AI •psi•►•-a 3, o CD a °`; a a►® N . CIQ (c? `5'. Alio: 4 cp CD 0�k�♦7 o o r,� 01 Cr r * #At ,, . ,,, gAtk . it +� q r�■�*� A. . ter► ..m. � � t 0 + ltL # 1 . 1 )(4 # 4 & J 4 ' L mss: . .7AZ� A7A 0 A A oA ■d %Iw o*�0 1t0 A 40 4t0 44 0 1 0 OVA kW tt0 e4110 �0*74 4.0 Sep 11 14 02:36p 239-277-0167 2392770167 P2 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 7/97 09/11/14 13:08CT [SUBJECT] 1SSN1 [ [ALSO KNOWN AS] TEJADA,YANIS,I [CURRENT ADDRESS] [DATE RPTD] 3715 NE. 39TH AV., NAPLES FL. 34120 10/05 [FORMER ADDRESS] 2571 N. WILSON BV., NAPLES FL. 34120 3715 N. 39TH AVE NE 2571 WILSON BV., NAPLES FL. 34120 [CURRENT EMPLOYER AND ADDRESS) [RPTD] YEM DRYWALL INC NAPLES FL 3/02 [FORMER EMPLOYER AND ADDRESS] VERTEZ DRYWALL - PARTNER 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 * * * A L E R T * * ***FICO CLASSIC 04 ALERT: SCORE +509 : 038, 013, 010, 020 *** IN ADDITION ***TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=3 COL=5 NEG=10 HSTNEG=4-98 TRD=19 RVL=11 INST=2 MTG=6 OPN=0 INQ=4 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $392 $500 $0 $0 100% MORTGAGE: $466K $ $486K $65.0K $2805 CLOSED W/BAL: $13.01( $7014 TOTALS: $466K $500 $499K $72.0K $2805 P U B L I C R E C O R D S SOURCE DATE LIAB ECOA COURT ASSETS PAID DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064186 4/10R $4179 I CI 10118SC CIVIL JUDGMENT TARGET NATIONAL BANK Z 5064186 9/09R $5748 I RD 6/12 4340019 PAID FEDERAL TAX LIEN B4490P1859 Z 5064186 4/08R $6926 C CI 62726CC CIVIL JUDGMENT SEMINOLE CASUALTY INSU 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 10/13 $3589 CITIBANK SOUTH DAK 09B 8561447386 8/14A $3589 PLACED FOR COLLECTIO Sep 11.1402.36p 239-277-0167 2392770167 p.3 MIDLAND FUND Y 36E1009 I 1/12 8546202337 53673 CITIFINANCIAL 09B 8/14A $5829 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 5/12 $3693 CHASE BANK USA N A 09B 8550134420 8/14A $3693 PLACED FOR COLLECTIO PORTFOLIO RC V 1KSE003 I 3/09 4862367128801448 $1152 CAPITAL ONE BANK U 09$ 8/14A $1151 PLACED FOR COLLECTIO FST NAT COLL Y 2C8C001 I 3/13 47300374 $211 12 DIRECTV 09B 4/13A $211 PLACED FOR COLLECTIO TRADES SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 MOP ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS TARGET/TD D 1ZX5002 8/04 $4179 MO 30/60/90 435237670351 8/14A $3600 R @9 I CREDIT CARD $4179 4/09F $4179 CLOSD BY CRDT GRANTOR SWISS COLONY D 4534003 11/08 $91 71261766 10/134 R09 I CHARGE ACCOUNT 7/09F U45 / $91 UNPAID BLNC CHRGD OFF THD/CBNA B 26H3005 4/05 $2896 603532017054 6/11A $3200 R09 I CHARGE ACCOUNT 11/08F $2896 UNPAID BLNC CHRGD OFF CHASE B 26QK001 9/06 $4368 418587439659 3/09A $3263 $0 R09 I CREDIT CARD 10/08F $0 PURCH BY OTHER LENDER CAP ONE B 1DTV001 1/05 $1136 486236712880 3/09A $500 $0 R09 I SLDTO PORTFOLIO R 3/09F $0 PURCH BY OTHER LENDER BK OF AMER B 1597029 12/07 $5870 9214 2/09A $5000 R09 I CREDIT CARD $1357 11/08F $5870 CLOSD BY CRDT GRANTOR OCWEN LOAN B 813P004 9/05 $280K 360M1509 11/13 55555555 M05 7190341516 7/14A $65.0K I CONVENTIONAL REAL $65.5 05 $298K 8 0/ 0/ 8 ()NEWEST BANK B 4784001 9/05 $280K 360M15@9 4/08 555555555555 MO5 6683001493265 11/134 $0 $8867 05 555555555555 I CONVENTIONAL REAL 11/13C $0 TRNSFRD: OTHER LENDER 48 0/ 0/47 SAXON MTG F 3324006 9/05 $70.0K 360M729 1/09 555555XX5555 M05 6242000548996 1/12A $0 I SECOND MORTGAGE 1/12C $0 TRNSFRD: OTHER OLENDER 5385550/50/ 34 HOMEQ F 1B6F123 9/05 $70.0K 360M729 5/08 555554332111 M05 693032497 10/08A $0 $2916 05 1111111117.11 Y SECOND MORTGAGE 10/08C $0 TRNSFRD: OTHER LENDER 26 1/ 2/ 6 ZALE/CBNA J 215G001 4/07 $2510 603525106906 B/14A $560 111111111111 R01 I CHARGE ACCOUNT 3/09C $0 111111111111 $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 WFHM B 821E004 3/05 $186K 360M1296 10/08 111111111111 M01 Sep 11 1402.36p 239-277-0167 2392770167 p.4 7090197391949 8/14A $0 $6882 05 111111111111 C FHA REAL ESTATE M $187K 48 0/ 0/ 0 WESTLAKE FIN F 1T9Q001 8/10 $11.5K 45M402 111111111111 I01 1709468 1/14A $0 111111111111 I AUTOMOBILE 1/14C $0 CLOSED 39 0/ 0/ 0 ALLY FINCL F 259237L 9/06 $38.7K 60M645 111111111111 I01 29909297510 9/10A $0 111111111111 I AUTOMOBILE 9/10C $0 CLOSED 46 0/ 0/ 0 TARGET N.B. D 6476004 8/04 $424 111111111111 R01 29803 1/10A $500 $0 111111111111 I CHARGE ACCOUNT 10/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 AQUA FINANCE F 36VD001 10/05 $1263 X40 040 3/09A 111111111111 R01 2 @0 I LINE OF CREDIT 3/09C $0 ACCT CLSD BY CONSUMER 1411110/10/ 0 CHASE B 26QK 004 4/05 $940 111111111111 R01 426605030000 1/07A $588 $0 111111111 I CREDIT CARD 11/06C $0 CLOSD BY CRDT GRANTOR 21 0/ 0/ 0 CB/NPRTNWS C 1NZ8090 9/04 $392 111111111111 R01 585637338379 11/06A $509 $0 111111111111 I CHARGE ACCOUNT 10/06P $0 26 0/ 0/ 0 GMAC MORT. F 2672002 9/05 $70.0K 360M729 11 M01 292041697 5/06A $0 I SECOND MORTGAGE 5/06C $0 TRNSFRD: OTHER LENDER 4 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 9/11/14 ZNP6284423(FLA) MERIT CREDIT 9/27/13 BPT3541542(WAS) MAB&T RETAIL 9/27/13 NDY1263431(DAY) 5YNC6 1/18/13 ZMI0651860(FLA) PREMIUM CB C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 2 BALDWIN PLACE P.O. 80X 1000,CHESTER, PA. 19022 800-888-4213 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION COLLIER CIR ZP5064186 (941) 774-8800 3301 TAMIAMI TRL E NAPLES FL. 34101 MIDLAND FUND YC36ET009 (844) 236-1959 8875 AERO DR SAN DIEGO CA. 92123 PORTFOLIO RC YCIKSE003 (800) 772-1413 287 INDEPENDENCE VIRGINIA BEACH VA. 23462 FST NAT COLL YC2CBC801 (800) 824-6191 610 WALTHAM WAY SPARKS NV. 89434 TARGET/TD DZ1ZXS002 PO BOX 673 MINNEAPOLIS MN. 55440 SWISS COLONY D24534803 1112 7TH AVE MONROE WI. 53566 THD/CBNA BZ26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 Sep 11 1402:36p 239-277-0167 2392770167 p.5 CHASE BC26QK001 P.O. BOX 15298 WILMINGTON DE. 19850 (800) 955-9900 CAP ONE BC1DTV001 POB 30281 SALT LAKE CITY UT. 84130 (800) 955 707@ 8K OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 OCWEN LOAN BM813P004 1661 WORTHINGTON R WEST PALM BEAC FL. 33409 (561) 682-8000 ONEWEST BANK 884784001 6900 BEATRICE FSB KALAMAZOO MI. 49009 (800) 781-7399 SAXON MTG FM3324006 PO BOX 161489 FORT WORTH TX. 76161 (817) 215-7200 HOMEQ FM1B6F123 P.O. BOX 13716 SACRAMENTO CA. 95853 (877) 867 7378 ZALE/CBNA 3A2156001 PO BOX 6497 SIOUX FALLS SD. 57117 WFHM BM82TE004 7255 BAYMEADOWS WA DES MOINES IA. 50306 (800) 288-3212 WESTLAKE FIN FS1T9Q001 4751 WILSHIRE BVLD LOS ANGELES CA. 90010 (323) 692-8800 ALLY FINCL FA259237L (888) 925-2559 P.O. BOX 380901 BLOOMINGTON MN. 55438 TARGET N.8. DC6476004 PC BOX 673 MINNEAPOLIS MN. 55440 AQUA FINANCE FZ36VD001 1 CORPORATE COVE WAUSAU WI. 54401 (715) 848-5425 CHASE BC26QK004 P.O. BOX 15298 WILMINGTON DE. 19850 (800) 955-9900 CB/NPRTNWS CW1NZ8090 PO BOX 182789 COLUMBUS OH. 43218 GMAC MORT. FM2672002 (800) 766-4622 3451 HAMMOND AVE WATERLOO IA. 50704 MAB&T RETAIL B 3541542 216 W 2ND ST DIXON MO. 65459 SYNCB N 1263431 C/O PO BOX 965037 ORLANDO FL. 32896 (866) 419 4096 PREMIUM CB Z 0651860 2412 NW 87 PLACE DORAL (800) 322-8825 FL. 33172 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 3 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. Electronic Articles of Incorporation FILED 74768 FILED For September 09, 2014 Sec. Of State nhaney PARADISE LANDSCAPING OF FLORIDA. INC The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: PARADISE LANDSCAPING OF FLORIDA, INC Article II The principal place of business address: 1885 47TH AVE NE NAPLES. FL. US 34120 The mailing address of the corporation is: P.O. BOX 112831 NAPLES. FL. US 34108 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 100 Article V The name and Florida street address of the registered agent is: YANIRA TEJADA 1885 47TH AVE NE NAPLES. FL. 34120 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: YANIRA TEJADA P14000074768 FILED Article VI September 09, 2014 Sec. Of State The name and address of the incorporator is: nhaney YANIRA TEJADA 1885 47TH AVE NE NAPLES, FL. 34120 Electronic Signature of Incorporator: Y_ANIRA TEJADA I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are true. 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, F.S. I understand the requirement to file an annual report between January i st and May 1st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or directors) of the corporation is/are: Title: P ALEJANDRO RICO CASTANEDA 1885 47TH AVE NE NAPLES, FL. 34120 Title: VP YANIRA TEJADA 1885 47TH AVE NE NAPLES, FL. 34120 Article VIII The effective date for this corporation shall be: 09108/2014 6 ACOR 0 (MMIDDIYYYI� �•o" CERTIFICATE OF LIABILITY INSURANCE DATE 09/15/14 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 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 NAME: All Casualty Insurance of Naples ((A/C.No.Ext): (239)348-7779 _ FAx(NC.No): (239)348-7713 5425 Golden Gate Pkwy. Suite#6-E E-MAIL_ADDRESS: ol.com Jl4pRESS: oliviains@aol.com Naples, FL 34116 INSURER(S)AFFORDING COVERAGE NAIC0 � Phone (239)348-7779 Fax (239)348-7713 INSURER A: ASCENDANT INSURANCE CO INSURED INSURER B: PARADISE LANDSCAPING OF FLORIDA 0 INSURERC: I 1885 47TH AVE NE INSURER D: NAPLES,FL 34120 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 ADD SUER POLICY EFF POLICY EXP I LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS — I ■ I GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 1 DAMAGE TO RENTED I © COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000.00 i A El El CLAIMS-MADE El OCCUR GL-45560-0 MED EXP(Any one person) $ 5,000.00 09/15/2014 09/15/2015 ❑ PERSONAL BADVINJURY $ 1,000,000.00 ❑ _ GENERAL AGGREGATE $ 2,000,000.00 GEM_AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS-COMP/OP AGG $ 1,000,000.00 n POLICY ❑ PRO- ❑ LOC _ I $ JECT AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT (Ea accident) $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OOVWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS r accident D— ❑ 1 $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ I ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑-DED ❑ RETENTIONS --- - $ WORKERS COMPENSATION ❑WC STATU- ❑OTH- AND EMPLOYERS'LIABILITY Y/N —LOB ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE• $ If yes,describe under l o ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT' $ I ; DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more apace is required) i i LANDSCAPING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COLLIER COUNTY THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LICENSING SECTION �a 2800 HORSESHOE DR /1 AUTHORIZED REPRE TATIVE f NAPLES,FL 34104 1988-2 0 A •RD C•RPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name a • ogo are registered marks of ACORD NOTICE OF ELECTION TO BE EXEMPT Please thoroughly read the instructions before completing this application. Print legibly in each data entry field. If this application contains incomplete or inaccurate information or if the handwriting is not legible,it may cause a delay in the issuance of your exemption. SECTION 1: Applicant Name(please print): &Vint' o -----1 R. Applicant's social security number: / Applicant's E-mail address(optional): eat' f 1-FL Q Q._0 1.ccAt"-... SECTION 2: I am applying for exemption as a(You must check only one box in this section): CONSTRUCTION INDUSTRY($50 FEE REQUIRED)-The Division will accept a money order or a cashier's check made payable to the DFS WC ADMINISTRATION TRUST FUND. ❑ Officer of a Corporation(Title): -OR- ❑ Member of a Limited Liability Company(LLC) NON-CONSTRUCTION INDUSTRY.(T5O k'EE REQUIRED) e Officer of a Corporation (Title): V fif/ ) An officer electing an exemption under Chapter 440,Florida Statutes is not entitled to benefits under this chapter. SECTION 3. The corporation of which you are an officer or the limited liability company of which you are a member must be registered and in an active status with the Florida Division of Corporations.Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with the Florida Division of Corporations. List the document number(document number Town your Annual Report) file with the Florida Division of Corporations. (( SECTION 4. This exemption application applies only to the person signing the application,the Corporation/LLC that is listed below,and the scope of business or trade,listed: Name of Corporation orLLC:PQfO4f t dSCo Pt -of W 4aA f4Ac. FEIN: ill'/7/1/S1/1 AS REGISTERED WITH THE FLORIDA DIVISION OF CORPORATIONS 7 Business Name: phone: ( ) IF APPT ICARLE-LIST FICTITIOUS N4➢IR D K E DOING BUSJNFSS AS(DRA):.Ai SO KNOWN AS N SM (AKA)Applicant's Address of Record: L BS C c'1"'l Avg_ aU INCLUDE AP_4RTMEAT OR SUITE NUMBER City: fJSgiAeS State:'�L. Zip: 3Y/2_0 County: Cd/I et"' Scope of Business or Trade: 1.Letilltiatii/L5 2. 3. 4. SECTION 5. List all certified or registered licenses issued pursuant to Chapter 489,F.S.held by the applicant,or the certified or registered license numbers held by the qualifier for the corporation or LLC listed on this application of which the applicant is a corporate officer: SECTION 6. If you have submitted an electronic payment for this application,write the transaction confirmation number in the following space: SECTION 7. Are you affiliated with any corporation(including LLC)other than the corporation(including LLC)to which this application applies? 0Yes2'No IF YES,PLEASE LIST THE NAME(s)AND FEIN(s)OF THE AFFILIATED CORPORATION(s)OR LLC(s): NAME: FEIN: SECTION S. Tf your corporation or LLC is engaged in the construction industry,you must provide the required proof of ownership in the corporation or LLC. A. To be eligible for a construction industry exemption as an officer of a corporation,the applicant must be a shareholder, owning at least 10%of the stock of the corporation. A COPY OF A STOCK CERTIFICATE EVIDENCING TAE REQUIRED OWNERSHIP MUST BE ATTACHED. B. To be eligible for a construction industry exemption as a member of a limited liability company,the applicant must confirm ownership of at least 10%of the company. THE REQUIRED OWNERSHIP MAY BE ESTABLISHED BY PRODUCTION OF DOCUMENTATION REFLECTING THE REQUIRED OWNERSHIP,OR BY SUBMITTING A STATEMENT ATTESTING TO THE REQUIRED OWNERSHIP. THIS APPLICATION iS CONTINUED ON PAGE 2 DWC 250,NOTICE OF ELECTION TO BE EXEMPT—REVISED 12/08;RULE 69L-6.009,F.A.C. NOTICE OF ELECTION TO BE EXEMPT—Page 2 SECTION 9. FRAUD NOTICE A. Any person who,knowingly and with intent to injure,defraud,or deceive the department or any employer or employee,insurance company or any other person,files a notice of election to be exempt containing any false or misleading information is guilty of a felony of the third degree. B. Attestation of applicant-By signing below,I agest that I have read,understand and acknowledge the foregoing notice. ta,, /yJ SIGNATURE OF APPLICANT SECTION 10.You must identify the workers' compensation insurance carrier that covers any non-exempt employees of your business. Carrier Name: AFFIDAVIT OF APPLICANT: I hereby certify that the information contained herein is true and correct to the best of my knowledge and belief;that this election does not exceed exemption limits for corporate officers,including any affiliated corpor.tions as prov.•ed in §441.02 Florida Statutes. 01 - 15' '�{) ��,t` . 1 APPL! NT'S SIGNATURE DATE SIGNED ,. (� k NOT•R ' STATE OF FLORIDA,COUNTY OF l�fer �, o.Y , l`"C � ' r..• - '<: EDIS A AREVALO Sworn to and subscribed before me this '} day of t Xp . , 2c i y ,bye. : '!I MY COMMISSION#FF005369 Personally Known O. ;'aced I4 entifi•.tion Au Type of Identification ProducedDL :D.i EXPIRES April 4,2017 NOTARY SIGNATU''. i II My Commission Expires ow)3!!•!153 FloridallotaryServke.com Please mail or submit your completed app/..: ion,application fee,and any required attachments to The Division of Workers'Compensation at the district office nearest your place of business. STATE USE ONLY Effective/Issue Date: 2295 Victoria Avenue,Suite 163 921 North Davis Street 401 NW 2^" Avenue Expiration Date: Ft.Myers,FL 33901 Building B,Suite#250 Suite#321,South Tower Telephone(239)461-4006 Jacksonville,FL 32209 Miami FL 33128 Telephone(904)798-5806 Telephone(305)536-0306 Control Number: 610 E.Burgess Road Pensacola,FL 32504-6320 400 West Robinson Street TALLAHASSEE SUBMITTERS Telephone(850)453-7804 Roan#512,North Tower Postmark Date: Orlando FL 32801 Walk-in submissions: 3111 S.Dixie Highway,Suite#123 Telephone(407)835-4406 or 2012 Capital Circle SE West Palm Beach FL 33405 (407)245.0896 Suite#102,Hartman Bldg. Telephone(561)837-5716 Tallahassee FL 32399-2161 Payment Number 1313 N.Tampa Street,Suite#503 499 Northwest 70th Ave.,Suite#116 Telephone(850)413-1609 Tampa FL 33602 Plantation FL 33317 Received Date: Telephone(813)221-65C6 Telephone(954)321-2906 Mail in submissions: 200 East Gaines Street Live Oak Business Center Tallahassee FL 32399-4228 1111 NE 25th Ave.,Suite#403 5969 Cattlemen Lane Telephone(850)413-1609 Ocala FL 34470 Sarasota FL 34232 Telephone(352)369-2806 Telephone(941)329-1120 The collection of the social security number on this form is specifically authorized by Section 440.05(3), Florida Statutes. The social security number will be used as a unique identifier in Division of Workers' Compensation database systems for individuals who have applied for and/or been issued a certificate of election to be exempt. It will also be used to identify information and documents in those database systems regarding individuals who have applied for and/or been issued a certificate of election to be exempt for internal agency tracking purposes and for purposes of responding to both public records requests and subpoenas that require production of specified documents. The social security number may also be used for any other purpose specifically required or authorized by state or federal law." DWC 250,NOTICE OF ELECTION TO BE EXEMPT—REVISED 12/08;RULE 69L-6.009,F.A.C. DEPARTMENT OF THE TREASURY 13-"INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 09-10-2014 Employer Identification Number: 47-1794847 Form: Number of this notice: CP 575 A PARADISE LANDSCAPING OF FLORIDA PO BOX 112831 --� NAPLES, FL 34108 For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 47-1794847. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 941 01/31/2015 Form 940 01/31/2015 Form 1120 03/15/2015 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. DRIVER LICESE CLASS - YANtRA 1MEG' TEJADA 1885 47TH AVE NE fu€ .w2-1a-2019 Yx *-'• .f' DR`" • or 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 il'10-.I I II ZONING CERTIFICATE#TC- APPLICAN ' NAME H IJ T S NAME �t/1�� e PHONE: APPLICANT'S HOME DRESS l ` t CIA_A-12. �S f� n 1€5- .pl. 3!i 2-O TYPE OF BUSINESS TO BE CONDUCTED LQ .sc441 `�{' BUSINESS NAME(IF ANY) Ttarad {tIJ' tcc&p(/ 0-f �'cti'id I, the undersigned, hereby affirm that I am the legalowner of th property at the above d P Y. address or that 1 have the legal right to conduct the business described above at this address by virtue of my leasehold interest in this property, and that I have read, understood, and agree to abide by the provisions of LDC Section 5.02.00 "Home Occupations"(see back of application). APPLICANT SIGNATURE DATE FEE: $ 0CHECKS PAY LE TO: "C LIER COUNTY TAX COLLECTOR" 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). Tax Collector Staff: Pie.ase forward a copy of issued certificate and receipt to Collier County Zoning Department. COLLIER COUNTY BUSINESS TAX RECEIPT oFT> S Ai APPLICATION ��I 2800 N.Horseshoe Drive,Naples,FL 34104 jl,� . ;mod Make Check Payable to Collier County Tax Collector �!'` -" Phone: 239-252-2477 Fax: 239-643-4788 Website: www.colliertax.com 'y?oo ip`.' ' 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 7-71) ) CORPORATE NAME - Q„ • a e.. • 1• _ ,i ■ di, •i!•_k N 1°--1-a) DBA NAME - al lb) BUSINESS OWNER OR QUALIFIER'S NAME - A 11/431 au., �G,tiver 2) PHYSICAL ADDRESS - 168 S 4 Vt 4tl AV it)r_, (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - V Yes No 3) BUSINESS MAILING ADDRESS - TP �x I -3 f Nck IeS -ff. 3//ate . Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- Ig'XS Lig all p Ai 5) TELEPHONE -Business:239 1.-8-171 3 Co (' Home: 2 3&j k S t/re 6) LEGAL FORM OF BUSINESS: Sole Proprietorship, Partnership !/Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- ql p Q"(2a1 8) OFFICE WITHIN CITY LIMITS OF NAPLES- Yes ti No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. - - - *see back of application for explanation pa) TYPE OF BUSINESS CONDUCTED: LaJVISC6,10 111_01 6), !UMBER OF EMPLOYEES-Including number of owners: 2.-. 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 HE BEST OF MY KNOWLEDGE. �( xxxAPPLICANT'S SIGNATURE: j�I DATE: 4 440 ^��/ (Owner and/or representative of business ITLE: / / ****THIS LICENSE IS ON-REFUNDABL FOR BUSINESS STATED ABOVE* L0MAR C A S I N E T S September 25, 2014 To The County of Collier, I Leonardo Alvarez owner of Leomar cabinets Inc, would like to inform through this letter that I didn't renew my contractors license because; I left the country to start a new project in a different country, due to not enough work for my business. I tried keeping my contractor license active by paying the Lee County license and the Cape Coral license. I would like you, Collier County to accept my forgiveness for not keep paying my license in your county. I didn't have the right information back then, if not I would it paid all my fees. Thank you for you valuable time and thank you for the new opportunity. Any question please call me at 239-878-5618 cell. Thank you. /�I Satcerele, Leonardo Alvarez Owner Leomar Cabinets Inc. Leomar Cabinets INC. P.O BOX 152663 Cape Coral Fl.33915 T: (239)878-561a E:info a leomarcabinets.com W:www leomarcabin• . n CDES Operations & Regulatory Management Licensing Section 1.1 2800 North Horseshoe Drive Naples, FL 34104 ) 11(`"i`7 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/B uuineus Namc: L. ( (,('��\n Ck ; T2C1 C� Fiction Name/DBA: Qualifier Name: 1— c?(.:)(\(Lx-c-) U `r--. A( 1C�.� Physical Address: 21 11 cc( (} .S C06 (Number& Street) (City) (State) (Zip P Code) Mailing Address: `P_U _3O ( LG6 Ci e �v(� L � 3396 (Number 86 Street) (City) (State) (Zip Code) Telephone: L 3Cl 7b. S616 E-Mail: X11?cU* Ge-C?rnc rC Ctb 1 ne t 5-Co <' TYPE OF LICENSE: $230.00 Li General ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 U Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑:Swimminc Pon! $230.00 ❑ Roofing $230.00 L Sp � 9/25/2014 Reinstatement Fee=$205.0O Specialty trade: ( Z�')In �' ' ( ': ;`� ! .jj ,�. ( 2 Back year Fees=$370.00 2014-15 Rene«al Fee= `6125.00 `Different tees may apdv` total=$700.00 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. NGtr Lc, L i�€ 4( pe — V;CC ?ce ick 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. wo 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 Leo c cc (\(Uc to Z certify that the foregoing is true and correct to the best of m knowledge. • • - % icer o e Firm STATE OF FLORIDA COUNTY OF The foregoing Instrument as acknowledged before me this Se,p --/etc ? .. Zvi 4/ (Date) By L��O�tl4 nC - L t/q 2 I-'? of r 6/19A2- (4 //'`t?3 /f✓ L (Name of officer, title/agent) (Name of Corporation) a A._0(2'O .A Corporation on behalf of the corporation. (State or Place of Corporation) He/She has-produced L 7C identification and did not take an oath. Type of identification) NOTARY'S S �'�"'•`l% LANCE L. GOERNOT �'" •' ',s, � � '•+ MY COMMISSION#EE 843385 1 , � � EXPIRES:January 6,2017 1, (SIGNATURE OF NOTARY) Page 2 of 4 QUALIFIER INFORMATION: Name: Le o n c4 AL)ck e Z_ Address: 2 7 q 1 ct TS+ J-- �?�� /`� � 3cl/6 (Number& Street) (City) (State) (Zip Code) Telephone: .Z 39 - &1e —s6 s j Date of Birth: S.S. #: 000-00- E-Mail: ;AS-0 Le0cnaC cstb I r1 e Co on Driver's License: 1. Type of Certificate of Competency for which application is made. CCc 1y« k Anci /1/11l w0 2. The names and telephone numbers of two persons who will know your whereabouts. OM) vW1 (1kr 2M- 560 -9170 cIc,rc\ s 707 - Lirt-10 3. Have you ever been convicted of a crime related to Contracting? ( 0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? •(10 8. List all debts you or a(((��nyc�ompany(s)associated with you refused or failed to pay and reasons why. �l we(j� `Q 9. List your business or work experience during the past ten years. + (Al 6iite + � �\ � L\ If l(Ct �(J YIY� 10. Statement of any formal training you have had in the area for which the application is made. / I- (\ Page 3 of 4 e , • 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. Leofica<3 (vcre L APPLICANT(PLEASE PRINT) L.QU,rna< ( a1in12., °) a- C NAME OF COMPANY J SIGNA- OF AP ICANT STATE OF FLORIDA COUNTY OF L E� The foregoing Instrument as acknowledged before me this 5t,›-Zr-,14 1-4., Zcyq (Date) By t eU,VAAOd /L 44,2( — who has produced Pc /,C_ (Name of person acknowledging) (Type of identification) as identification and did not take an oath. �`"�"'„' LANCE L. GOERNDT MY NOTARY'S SEAL ;tit COMMISSION#EE 843385 EXPIRES:January 6,2017 (SIGNATURE OF NOTARY) 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. SIGNAk • •_-.. - T_- BUSINESS NAME 0T - lam ` -^ I / 1 DATE 3EFORE ME this day personally appeared YOnQ r c() ��`UGtI t'Z who affirms and says that he Las 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 FL DA 'OUNI`Y O Q l I i er he foregoing instrument was acknowledged before me this q 12 [D / / y ,-� �-, (Date) `sir(?rdu l': R/rn cezwho has produced 1-2-4L- (name of person acknowledging) (Type of identification) identifirntinn nnFl who did not take an oath. (SIGNAT E OF OTARY NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) •�0.�.:°e� JENNIFERBUNCO NOTARY PUBLIC r� u. c MV COMMISSION M FF 085144 EXPIRES:February 10,2018 } n1 \oe Bo dThre Budget NOV Servkes qTF OF F�� 4 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER ) 2.4/let_ gaili _, am a resident of Le County, F 10 l C1.G (State) and have resided here for more than five (5) years. During the last five ears I have known Leona-ka-0 �Q'roZ g Y applicant). I have had the opportunity to observe his or her business and personal deal ngs and find him or her to be a person of honesty, integrity and good character. - !1 r n (Signature)c'% ' A+vl (Name) 4A-0° /N Ceerel-44Q 4/"4T (Address) /3v27-2-1 ""/"" '')9 f , ?3 5O3 Telephone) (934 447/e77 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this —51 1Ji '4,* 26,/O'Yby (Date) 40 Ai 1/41. ,-e4A) who has produced (..Qc. (name of person acknowledging) (Type of identification) as identification and who did not take an oath. LANCE L. GOERNDT �= MY COMMISSION#EE 843385 ! St NATURE OF NOTARY .ti o,"ilop' EXPIRES.January 6,2017 ?'' 14pece I NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC 9 Q ev•A v rve, f• v•At f Itv•it p Ar, ttor# , # toritt ;,# ):40 4 *: ):10/0�•-.[►+1�►•-t►+.�.• .'/11 `- { U • • # )441 # 1441 ti1 � r .. t ArAtik sir )j �A� • elk V Q ♦lit 0 dak V (-4 -c, 1.) ioss O r •`.0, a A� •(÷_i i E \ L WO o n� \r v V ' u °' U , tool VOli ..c v 4 All Iliet , '-+5-' (1) 2t-- .4?-5) a) g 4;, te-, oAtt : Is i.4 • O —c 0 4-4 ... ' ' \ ° 04 110 +-) , , 0 ' gi' .'- . . 0 03 ti> liffP • w C.// 1g Cd ' .4 •COQ' ' , c+-, I ��r z ,s_., t ..___2 „, *� o._, ,__n, ,.. E g ___ L, v) -c2 0 -2 >, t pf A)4 : n 4400 !it `✓ C U .` O X17 c,-, (I) U 2 Ve OD ti:411 7i 0 ,_, •-on. ra r414'i' '") cci;rar4. " t4_, ,, ,____, .h, ,..Q) - N U 2 �s � t ° o 48 VP' ° toA .E _ _ .a ° `♦boy one-'4; Ilk yo ttvo 4 t 4,Il 40-1111 0 ICE4 +.49". )%1r4+0.rit\l%+4PArt• elb0.4 411. ..)::11 tk 04404 04 # 4 II # 4 *:14 ).4 * AOAd 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. - . .a . . . . (JSfICrdit 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 SEPTEMBER 26, 2014 BUSINESS CREDIT REPORT LEOMAR CABINETS, INC. FED TAX ID#: 20-5084655 FILED: 6-20-2006 2797 FIRST ST, FORT MYERS FL 33916 CORPORATE OFFICERS OFFICE SSN LEONARDO ALVAREZ P - FINANCIAL RECORDS CREDITOR/BANK TYPE OF HIGH RET PAST ACCOUNT NUMBER ACCOUNT OPENED BALANCE LIMIT CHECKS DUE NOT PROVIDED 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: NO RECORDS FOUND ELEMENTS SEARCHED: LEOMAR CABINETS, INC. FED TAX ID#: 20-5084655 2797 FIRST ST, FORT MYERS FL 33916 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 1 OF BUSINESS CREDIT REPORT (JSfI Credit Bureau Credit Reporting Fs Collections 8546 W Homosassa Trl Ste 4, Homosassa FL 34448 Phone 352-628-2580 • 888-474-2270 • Fax 866-588-3604 SEPTEMBER 26, 2014 PERSONAL CREDIT REPORT(COMPILED FROM NATIONAL RECORDS) [SUBJECT] [SSN] [BIRTH DATE] ALVAREZ, LEONARDO F. - [ALSO KNOWN AS] ALVAREZ,LEO, F [CURRENT ADDRESS] [DATE RPTD] 2797 1ST ST. , #1404 . FORT MYERS FL. 33916 8/10 [FORMER ADDRESS] 152663 PO BOX 152663, CAPE CORAL FL. 33915 3/08 1922 NE. 3RD ST. , CAPE CORAL FL. 33909 [POSITION] [CURRENT EMPLOYER AND ADDRESS] [VERF] [RPTD] LEDMAR CABINETS PRESIDENT 10/08 12/08 [FORMER EMPLOYER AND ADDRESS] LEOMAR CABINETS INC PRESIDENT 3/07 4/08 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 * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +578 : 038, 013, 010, 020 *** IN ADDITION ***TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=0 COL=3 NEG=2 HSTNEG=4-32 TRD=11 RVL=6 INST=5 MTG=0 OPN=0 INQ=3 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $572 $420 $26 $0 $25 94% INSTALLMENT: $14.6K $ $14 .4K $0 $433 CLOSED W/BAL: $3746 $0 $451 TOTALS: $15.1K $420 $18 .1K $0 $909 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS DIVERSIFIED Y 2BAF001 I 4/14 6/14F $149 11 COMCAST 09P 23374975 6/14A $0 PAID COLLECTION AFNI Y 96ER007 I 12/09 4/10F $101 10 CENTURYLINK 09P 1026144478 4/10A $0 SETTLED [ FULL BLNC CRD PRT ASSO Y 4326001 I 4/08 9/08F $65 COMCAST FORMERLY T 09P 1467582248 9/08A $0 PAID COLLECTION USA CREDIT BUREAU • • • PAGE 1 OF PERSONAL CREDIT REPORT 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 FRD MOTOR CR F 3796761 10/06 $28.1K 78M426 I09 41670258 5/13A $0 C AUTOMOBILE 12/12F $3473 UNPAID BLNC CHRGD OFF MARKONE FIN F 2BA2001 11/08 $9704 48M311 I9P 300127666 2/11A $0 C AUTOMOBILE 2/11F $0 PAID/WAS A CHARGE OFF SYNCB/AMEAGL C 235051N 8/08 $104 111111111111 R01 604410061054 9/14A $124 $0 111111111111 I CHARGE ACCOUNT 12/10C $0 CLOSED 48 0/ 0/ 0 CREDITONEBNK B 54MR013 4/13 $654 MIN25 2/14 132115543211 R01 444796222712 9/14A $300 $0 $130 05 32111 I CREDIT CARD 1/14C $273 CLOSD BY CRDT GRANTOR 17 3/ 3/ 3 CAP ONE B 1DTV001 3/13 $433 MIN25 121111211211 R01 517805794900 9/14A $300 $0 12111 I CREDIT CARD $26 17 4/ 0/ 0 AMER CR ACPT F 2CZ9001 5/14 $14 .6K 66M433 111 I01 47200137059281001 8/14A $0 I AUTOMOBILE $14 .4K 3 0/ 0/ 0 ZALE/CBNA J 215G001 10/08 $80 111111111111 R01 603525111617 2/13A $500 $0 111111111111 I CHARGE ACCOUNT 2/10C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 CB/EXPRESS C 8349001 7/08 $139 3/09 121113211111 R01 32728 9/09A $120 $0 03 1 I CHARGE ACCOUNT 7/09P $0 13 2/ 1/ 0 INTLHOM PROD H 133E005 10/07 $2600 36M98 7/08 555555543255 I01 20017097570024850 8/09A $0 $510 05 5432111111 I INSTALLMENT SALES 8/09C $0 CLOSED 22 2/ 2/12 CITI B 282E001 6/98 111111111111 R01 422398014969 9/07A $2620 $0 11 I CREDIT CARD 2/06C $0 CLOSD BY CRDT GRANTOR 14 0/ 0/ 0 PRIMUS FINAN F 3796006 5/99 $17.8K 74M330 111111111111 I01 20300774 7/05A $0 111111111111 C AUTOMOBILE 7/05C $0 CLOSED 24 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 9/26/14 ZNF1034779 (FLA) COLLIERCOUNT 5/12/14 ACH9698604 (CHI) FORT MYERS T 3/06/13 BPC2699824 (NTL) CAP ONE 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: USA CREDIT BUREAU • • • PAGE 2 OF PERSONAL CREDIT REPORT NO RECORDS FOUND ELEMENTS SEARCHED: LEONA.RDO ALVAREZ 2797 FIRST ST, FORT MYERS FL 33916 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 3 OF PERSONAL CREDIT REPORT Certified-Copy I certify the attached is a true and correct copy of the Articles of Incorporation of LEOMAR CABINETS, INC., a Florida corporation, filed electronically on June 20, 2006, as shown by the records of this office. I further certify that this is an electronically transmitted certificate authorized by section 15.16, Florida Statutes, and authenticated by the code noted below. The document number of this corporation is P06000084137. Authentication Code: 060622083558-000076398340#1 Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Twenty Second day of June, 2006 ":504:7-"rA-;", , 4 „,,k1.-*, 4%. ,:,. .,; -i i"4+ fir -b y,-. 'l Ft -c } y JI,r fix` 57"- 4:11,A.:^ -7: c,.: • tbue M. Cobb cob vivo.- exretMrp at §htate i J Electronic Articles of Incorporation PO6000084137 For FILED June. Ofstate6 LEOMAR CABINETS, INC. jshivers The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: LEOMAR CABINETS, INC. Article II The principal place of business address: 1002 SE 12TH TER APT. D CAPE CORAL, FL. US 33990 The mailing address of the corporation is: 1002 SE 12TH TER APT. D CAPE CORAL, FL. US 33990 Article III The purpose for which this corporation is organized is: CABINET BUILDING, INSTALLATION, AND SERVICE. Article IV The number of shares the corporation is authorized to issue is: 100 Article V The name and Florida street address of the registered agent is: LEONARDO F ALVAREZ 1002 SE 12TH TER APT. D CAPE CORAL, FL. 33990 I certify that I am familiar with and accept the responsibilities of P06000084137 registered agent. FILED June 20 2006 Registered Agent Signature: LEONARDO F. ALVAREZ chive s Mate Article VI The name and address of the incorporator is: LEONARDO F. ALVAREZ 1002 SE 12TH TER APT. D CAPE CORAL, FL 33990 Incorporator Signature: LEONARDO F. ALVAREZ Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P LEONARDO F ALVAREZ 1002 SE 12TH TER, APT. D CAPE CORAL, FL. 33990 US Detail by Entity Name Page 1 of 2 -1441""4"r-." `: ►� xp� ,"W «ice �.:��y'*_� FLORIDA STATE DEPARTMENT OF STAT �}IVISION. OF. CORFORATIONS""°°" �� .e` ' z ' � � . . Cdr' Detail by Entity Name Florida Profit Corporation LEOMAR CABINETS, INC. Filing Information Document Number P06000084137 FEI/EIN Number 205084655 Date Filed 06/20/2006 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 09/28/2009 Event Effective Date NONE Principal Address 2797 FIRST STREET 1404 FORT MYERS, FL 33916 Changed: 04/20/2012 Mailing Address P.O BOX 152663 CAPE CORAL, FL 33915 Changed: 04/29/2008 Registered Agent Name & Address ALVAREZ, LEONARDO F 2797 FIRST STRET FORT MYERS, FL 33916 Address Changed: 04/20/2012 Officer/Director Detail Name & Address Title P ALVAREZ, LEONARDO F 2797 FIRST STREET FORT MYERS, FL 33916 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/domp-... 9/26/2014 Detail by Entity Name Page 2 of 2 Title VP REALPE, MARTHA L 2797 FIRST STREET FORT MYERS, FL 33916 Annual Reports Report Year Filed Date 2012 04/20/2012 2013 05/15/2013 2014 04/13/2014 Document Images 04/13/2014 --ANNUAL REPORT View image in PDF format 05/15/2013 -- ANNUAL REPORT View image in PDF format 04/20/2012 -- ANNUAL REPORT View image in PDF format 04/26/2011 -- ANNUAL REPORT View image in PDF format 04/30/2010 -- ANNUAL REPORT View image in PDF format 09/28/2009 -- Amendment View image in PDF format 04/29/2009 --ANNUAL REPORT View image in PDF format 04/29/2008 --ANNUAL REPORT View image in PDF format 04/30/2007 -- ANNUAL REPORT View image in PDF format 06/20/2006 -- Domestic Profit View image in PDF format 3lld Pn vaof Policies date or f iorida,Depart went of>tat:e http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/EntityName/domp-... 9/26/2014 AC'cn 1:7 OP ID:XH 4....,_,..- CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) 08/06/2014 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:239-542-1533 CONTACT Dawson of Florida;Cape Coral NAME: Amanda Dvorak Dawson of Florida dba Fax:239-542-5527 (A"0 No,Ext):239-205-1544 FAx 3501 Del Prado Blvd.Suite 204 EMAIL (Arc,No): 239-542-5527 Cape Coral, FL 33904 ADDRESS:advorak @dawsoncompanies.com Joseph C.Brickner PRODUCER LEOMA-2 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIL# INSURED LeomarCabinets,Inc. INSURER A:Southern Owner's Insurance Co. P 0 Box 152663 10190 Cape Coral,FL 33915 INSURER B:Auto Owners Insurance 18988 INSURER C: 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 —ADDL SUER LTR TYPE OF INSURANCE' INSR WVD POLICY NUMBER JMM DD�YLMM/DD//YYYYYJ UMITS GENERAL LIABILITY ' EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 2073492314 09/23/2014 09/23/2015 PREMISES(a occurrence) $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person)_ $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: � LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X FR AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT B X ANY AUTO 4856481700 09/23/2014 09/23/2015 (Ea accident) $ 300,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS PROPERTY DAMAGE $ (Per accident) $ X NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE — AGGREGATE $ _ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION - $ AND EMPLOYERS'LIABILITY WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N TORY LIMITS ER OFFICER/MEMBER EXCLUDED? N!A E.L.EACH ACCIDENT $ (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION • COLLI-A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractors THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Licensing Board Development Services Center AUTHORIZED REPRESENTATIVE 2800 Horseshoe Dr N Naples, FL 34104 -iYXlu.e� = L I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD /01 stoz„ ��oower 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: 9/26/2014 EXPIRATION DATE: 9/25/2016 PERSON: ALVAREZ LEONARDO F FEIN: 205084655 BUSINESS NAME AND ADDRESS: LEOMAR CABINETS INC P.O BOX 152663 CAPE CORAL FL 33915 SCOPES OF BUSINESS OR TRADE: CERAMIC TILE, INDOOR CARPENTRY FLOOR COVERING STONE, MA INSTALLATION OF CA INSTALLATION-R 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 CITY OF v 9A ► p�. <OR10P CITY OP 1 City of Cape Coral Certificate of Competency 10852 Date Issued: 09/19/2014 CABINET& MILLWORK INSTALL ALVAREZ LEONARDO LEOMAR CABINETS INC Expiration Date: 09/30/2016 L Detach and post bottom portion CITY OF CAPE CORAL CERTIFICATE OF COMPETENCY City of Cape Coral -- 1015 Cultural Park Blvd -- Cape Coral Florida 33990 -- (239) 574-0430 This Certificate expires September 30, 2016 Visit Our Website at www.capecoral.net Certificate #: 10852 Location: PO BOX 152663 CITY OF Classification: Business Phone: (239) 878-5618 SPECIALTY State License: t� �Qv CABINET & MILLWORK INSTALL 9A O ALVAREZ LEONARDO -<0Ros% LEOMAR CABINETS INC Date Issued: 09/19/2014 PO BOX 152663 Amount: $ 150.00 CAPE CORAL. FL 33909 CITY OF 0 v Q 4. '<OR09' 611♦ OF 1 City of Cape Coral Certificate of Competency 10852 Date Issued: 09/23/2013 CABINET & MILLWORK INSTALL ALVAREZ LEONARDO LEOMAR CABINETS INC Expiration Date: 09/30/2014 Detach and post bottom portion CITY OF CAPE CORAL CERTIFICATE OF COMPETENCY City of Cape Coral -- 1015 Cultural Park Blvd -- Cape Coral Florida 33990 -- (239) 574-0430 This Certificate expires September 30, 2014 Visit Our Website at www.capecoral.net Certificate #: 10852 Location: PO BOX 152663 CITY OF Classification: Business Phone: (239) 878-5618 SPECIALTY State License: 0 � (t" CABINET & MILLWORK INSTALL ALVAREZ LEONARDO 't<oRoP LEOMAR CABINETS INC Date Issued: 09/23/2013 PO BOX 152663 Amount: $ 75.00 CAPE CORAL. FL 33909 • CITY OF 4ge O� k, c1T` City of Cape Coral 14 O'r Certificate of Competency 10852 Date Issued: 09/25/2012 CABINET&MILLWORK INSTALL ALVAREZ LEONARDO LEOMAR CABINETS INC Expiration Date: 09/30/2013 Detach and post bottom portion CITY OF CAPE CORAL CERTIFICATE OF COMPETENCY City of Cape Coral -- 1015 Cultural Park Blvd-- Cape Coral Florida 33990 -- (239) 574-0430 This Certificate expires September 30, 2013 Visit Our Website at www.capecoral.net Certificate #: 10852 Location: PO BOX 152663 CITY OF Classification: Business Phone: (239) 878-5618 SPECIALTY State License: A �Qr CABINET& MILLWORK INSTALL ALVAREZ LEONARDO LEOMAR CABINETS INC Date Issued: 09/25/2012 PO BOX 152663 Amount: $ 75.00 CAPE CORAL. FL 33909 LEE COUNTY LIC2010-00364 leomarcabinetshotmail.com renewal License Holder LEONARDO ALVAREZ Name: Firm Name: LEOMAR CABINETS INC Address: PO BOX 152663 CAPE CORAL FL 33915 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 Unincorporated 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 LIC2010-00364 to ContractorLicensing @Leegov.com. Re: "renewal by email". Cut.l tere 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: LEONARDO ALVAREZ D/B/A LEOMAR CABINETS INC COMP. NO. shall appear on all LICENSED FOR: Cabinet&Millwork 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 C610-00364 required on business name changes. NOT VALID AFT r. • ' •.a,15 igna ur '—ix �`^'• fcntrlocren2.rpt LEE COUNTY LIC2010-00364 leomarcabinets(a�hotmail.com renewal License Holder LEONARDO ALVAREZ Name: Firm Name: LEOMAR CABINETS INC Address: PO BOX 152663 CAPE CORAL FL 33915 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 LIC2010-00364 to ContractorLicensing @Leegov.com. Re: "renewal by email". Cut Here 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: LEONARDO ALVAREZ D/B/A LEOMAR CABINETS INC COMP. NO. shall appear on all LICENSED FOR: Cabinet&Millwork 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.: C610-00364 -equired on business name changes. NOT VALID AFTER:09/30/2014 Signature of License Holder fcntrlocren2.rpt (CITY D F "T` °' City of Cape Coral Business Tax Receipt A 4 i* BT15-64667 Issue Date: 09/19/2014 Q CARPETS/RUGS (INSTALLATIO DBA: LEOMAR CABINETS INC ORO Owner Name: ALVAREZ LEONARDO Expiration Date: 09/30/2015 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9-72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the public and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 10% for the month of October, plus an additional 5% for each month thereafter. The total delinquency penalty shall not exceed25% of the tax. A 25% penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities, nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Business Tax Receipts are available for purchase on July 1st. If you need to transfer your Business Tax Receipt due to a change of business name, ownership, location or closing your business, please contact our office at 239-574-0430 to obtain the proper information. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT#: BT15-64667 City of Cape Coral -- 1015 Cultural Park Blvd --Cape Coral Florida 33990-- (239) 574-0430 This Receipt expires September 30, 2015 Visit our website at: www.capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. -THIS TAX IS NON REFUNDABLE - Location: 1922 NE 3RD ST Number of Employees: Business Phone: (239) 878-5618 CITY OF Classification CARPETS/RUGS (INSTALLATIO HOME BUSINESS PAID ON 60628 - Qv LAMINATE FLOORING •p Off. A<OR10P LEOMAR CABINETS INC ALVAREZ LEONARDO Classification Code: 161A PO BOX 152663 CAPE CORAL, FL 33909 Issued Date: 09/19/2014 Amount $55.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state,county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. CITY OF City of Cape Coral Business Tax Receipt � 4 0 .9 q"Q' BT15-60628 Issue Date: 09/19/2014 Q HOME BUSINESS ONLY <oR+oP DBA: LEOMAR CABINETS INC Owner Name: ALVAREZ LEONARDO Expiration Date: 09/30/2015 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9-72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the public and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 10% for the month of October, plus an additional 5% for each month thereafter. The total delinquency penalty shall not exceed 25% of the tax. A 25% penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities, nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Business Tax Receipts are available for purchase on July 1st. If you need to transfer your Business Tax Receipt due to a change of business name, ownership, location or closing your business, please contact our office at 239-5740430 to obtain the proper information. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT#: BT15-60628 City of Cape Coral -- 1015 Cultural Park Blvd --Cape Coral Florida 33990 -- (239) 574-0430 This Receipt expires September 30, 2015 Visit our website at: www.capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. -THIS TAX IS NON REFUNDABLE - Location: 1922 NE 3RD ST Number of Employees: Business Phone: (239) 878-5618 CITY OF Classification HOME BUSINESS ONLY Q <OR\OP LEOMAR CABINETS INC ALVAREZ LEONARDO P 0 BOX 152663 Classification Code: 999 CAPE CORAL, FL 33915 Issued Date: 09/19/2014 Amount • $15.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state,county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. i .- 0,-' t CITY' O F a" °' City of Cape Coral •o „, Business Tax Receipt V ; 4.q. BT14-64667 Issue Date: 09/23/2013 `Q CARPETS/RUGS (INSTALLATIO <oRo DBA: LEOMAR CABINETS INC Owner Name: ALVAREZ LEONARDO Expiration Date: 09/30/2014 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9-72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the public and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 10% for the month of October,plus an additional 5% for each month thereafter. The total delinquency penalty shall not exceed 25% of the tax. A 25%penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities, nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Business Tax Receipts are available for purchase on July 1st. If you need to transfer your Business Tax Receipt due to a change of business name, ownership, location or closing your business, please contact our office at 239-574-0430 to obtain the proper information. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT#: BT14-64667 City of Cape Coral -- 1015 Cultural Park Blvd --Cape Coral Florida 33990—(239) 574-0430 This Receipt expires September 30, 2014 Visit our website at: www.capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. -THIS TAX IS NON REFUNDABLE- Location: 1922 NE 3RD ST Number of Employees: Business Phone: (239) 878-5618 CITY OF Classification CARPETS/RUGS (INSTALLATIO HOME BUSINESS PAID ON 60628- Nillelir LAMINATE FLOORING '<OR10P LEOMAR CABINETS INC ALVAREZ LEONARDO Classification Code: 161A PO BOX 152663 Issued Date: 09/23/2013 CAPE CORAL, FL 33909 $ Amount $55.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state,county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. CITY OF "" °' City of Cape Coral ) Business Tax Receipt 5.. 0 v �Q' BT14-60628 Issue Date: 09/23/2013 0 *., Q HOME BUSINESS ONLY DBA: LEOMAR CABINETS INC '<og 0P Owner Name: ALVAREZ LEONARDO Expiration Date: 09/30/2014 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9-72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the public and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 10% for the month of October,plus an additional 5%for each month thereafter. The total delinquency penalty shall not exceed 25% of the tax. A 25% penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities,nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Business Tax Receipts are available for purchase on July 1st. If you need to transfer your Business Tax Receipt due to a change of business name, ownership, location or closing your business, please contact our office at 239-574-0430 to obtain the proper information. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT#: BT14-60628 City of Cape Coral -- 1015 Cultural Park Blvd --Cape Coral Florida 33990 --(239) 574-0430 This Receipt expires September 30, 2014 Visit our website at: www.capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. -THIS TAX IS NON REFUNDABLE- Location: 1922 NE 3RD ST Number of Employees: Business Phone: (239) 878-5618 CITY O F Classification HOME BUSINESS ONLY O :O O� kh <OR10P LEOMAR CABINETS INC ALVAREZ LEONARDO P 0 BOX 152663 Classification Code: 999 CAPE CORAL, FL 33915 Issued Date: 09/23/2013 Amount $15.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state,county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. CITY O F """ °' City of Cape Coral ' Business Tax Receipt 0 -.N Y BT13-64667 Issue Date: 09/25/2012 CARPETS/RUGS(INSTALLATIO <OR10P DBA: LEOMAR CABINETS INC Owner Name: ALVAREZ LEONARDO Expiration Date: 09/30/2013 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9-72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the public and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 10%for the month of October,plus an additional 5%for each month thereafter. The total delinquency penalty shall not exceed 25% of the tax. A 25%penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state,county, or cities,nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Business Tax Receipts are available for purchase on July 1st. If you need to transfer your Business Tax Receipt due to a change of business name, ownership, location or closing your business, please contact our office at 239-574-0430 to obtain the proper information. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT#: BT13-64667 City of Cape Coral-- 1015 Cultural Park Blvd —Cape Coral Florida 33990 --(239) 574-0430 This Receipt expires September 30, 2013 Visit our website at: www.capecoral.net I DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. I THIS TAX IS NON REFUNDABLE- Location: 1922 NE 3RD ST Number of Employees: Business Phone: (239) 878-5618 CITY OF Classification R /R ( SA HOME CA BUSINESS PETS UGS PAID INTALL ON 09 TIO 60628 - LAMINATE FLOORING LEOMAR CABINETS INC ALVAREZ LEONARDO PO BOX 152663 Classification Code: 161A CAPE CORAL, FL 33909 Issued Date: 09/25/2012 Amount $55.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state,county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. ' CITY O F "" OF City of Cape Coral jiro' • Business Tax Receipt «.r4 0 v BT13-60628 Issue Date: 09/25/2012 943 HOME BUSINESS ONLY DBA: LEOMAR CABINETS INC <ORto Owner Name: ALVAREZ LEONARDO Expiration Date: 09/30/2013 THIS RECEIPT IS FURNISHED PURSUANT TO FLORIDA STATE STATUTES, CHAPTER 205 AND CITY OF CAPE CORAL ORDINANCE 9-72 AS AMENDED The law requires this receipt to be displayed conspicuously at the place of business so that it is open to the view of the public and available for inspection. Payment is due each year by September 30th. Payment after September 30th is delinquent and subject to a penalty of 10% for the month of October,plus an additional 5%for each month thereafter. The total delinquency penalty shall not exceed25% of the tax. A 25%penalty is imposed on any person engaged in any new business, occupation or profession without first paying a Cape Coral Business Tax. This receipt is for a business tax only. It does not permit the person/business to violate any existing regulatory or zoning laws of the state, county, or cities,nor does it exempt the business from licenses or permits that may be required by law. This receipt does not assure quality of work. Business Tax Receipts are available for purchase on July 1st. If you need to transfer your Business Tax Receipt due to a change of business name, ownership, location or closing your business, please contact our office at 239-574-0430 to obtain the proper information. Detach and post bottom portion CITY OF CAPE CORAL BUSINESS TAX RECEIPT RECEIPT#: BT13-60628 City of Cape Coral -- 1015 Cultural Park Blvd —Cape Coral Florida 33990—(239) 574-0430 This Receipt expires September 30, 2013 Visit our website at: www.capecoral.net DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. -THIS TAX IS NON REFUNDABLE- Location: 1922 NE 3RD ST Number of Employees: Business Phone: (239) 878-5618 CITY OF Classification tHOME BUSINESS ONLY 94341011111P: °<oR\OP LEOMAR CABINETS INC ALVAREZ LEONARDO P 0 BOX 152663 Classification Code: 999 CAPE CORAL, FL 33915 Issued Date: 09/25/2012 Amount $15.00 This document is a business tax only. This is not certification that licensee is qualified. It does not permit the licensee to violate any existing regulatory zoning laws of the state,county or cities nor does it exempt the licensee from other taxes or permits that may be required by law. 03ecoUho. Lee County Tax Collector Tax Co for 2480 Thompson Street Fort Myers, Florida 33901 spare of F`ot`aa www.leetc.com Tel: (239) 533-6000 Local Business Tax Account: 0701311 Dear Business Owner: Your 2012-2013 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. t °4'r-°.1444 Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records \eeCoony LEE COUNTY LOCAL BUSINESS TAX RECEIPT raxCo.' 4 for 2012 - 2013 ACCOUNT NUMBER: 0701311 ACCOUNT EXPIRES SEPTEMBER 30, 2013 stare of so'`a� May engage in the business of: Location CABINET/MILLWORK CONTRACTOR 1922 NE 3RD ST CAPE CORAL FL 33909 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY LEOMAR CABINETS INC ALVAREZ LEONARDO THIS IS NOT A BILL-DO NOT PAY PO BOX 152663 CAPE CORAL FL 33915 PAID 317072-3-1 09/25/12 04:07:46 JBS1 $50.00 • « \ ° < } t ' ` ° \\ : §� : JI ii i}�, ' : r $ §■~R § }§ - » . � y . ay. \ ^ .\ •>«© ». : > • } $, 7. fly 2, . J« ; } Filing# 18628764 Electronically Filed 09/24/2014 03:27:27 PM IN THE COUNTY COURT IN AND FOR MIAMI-DADE COUNTY FLORIDA CIVIL DIVISION Case No. : 14-13631-CC-23 Ascendant Commercial Insurance, Inc. , Plaintiff, VOLUNTARY DISMISSAL v. MCM Tile & Marble, Inc. , Defendant . Plaintiff, Ascendant Commercial Insurance, Inc. , voluntarily dismisses its Complaint against Defendant, MCM Tile & Marble, Inc. , with prejudice. I hereby certify that a true and correct copy of this Voluntary Dismissal was furnished by e-mail on September 23, 2014 to: MCM Tile & Marble, Inc. , Marius Pughiuc, Registered Agent, 15579 Marcello Circle , Naples , F1 34110 ; luann@ fiveszaraccountingservices .com. CORINNE B. ROSNER, P.A. Attorney for Plaintiff Corinne @floridacollectionslaw. com 1755 North University Drive Pembroke Pines, Florida 33024 Phone: (954) 577-7700 Fax: (954) 424-0500 By: Cu ' NNE ' . ROSNER FLORIDA BAR NO. : 864099 Page 1 C.5158/ September 23, 2014 . w MCM Tile and Marble Inc July 31, 2014 Board of County Commissioners Collier County License Office 3299 Tamiami Trail E Naples,FL 34112 To whom it may concern: I would like to transfer my license from my previous company,MCM Tile&Marble Inc, to my current business,Advanced Flooring of SW FL Inc. I have closed down the company MCM Tile&Marble Inc due to a worker's compensation audit that was filed erroneously and we are currently in the process of appeal,which has caused the outstanding debt to go into collections. I am currently working with the worker's comp insurance office to correct the audit, and adjust the balance due. Sincerely, Marius Pughiuc President 15579 Marcello Circle, Naples, FL 34110 Telephone: (239) 645-1606 Page 1 le-r C.4:31,414.ty 11)C et5Sfik, \ ` ES Operations & Regulatory Management 1.00 �= Licensing Section t ' 2 \� A < 2800 Noi- h Horseshoe Drive i' - Naples, FL 34104 1)14"c:1103- 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: •4t V tiCe 00 /r/ C).-/ Jai--/ C_ m Fiction Nae/DBA: /.\/� / - Qualifier Name: C-1(t u.5 1^LI �1 Physical Address: ? 1'9-RC_'f C C/i � : /, -j/ ' !f// - (Number & Street) Ci ( ty) (State) (Zip Code) Mailing Address: (Number & Street) (City) (State) (Zip Code) Telephone: L E-Mail:oVa vi C( Cif. C004! t( at P, 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 D/Swimming Pool $230.00 ❑ Roofing $230.00 Specialty $205.00 Specialty trade: Ti 'Ala rbLe..- CHANGE OF STATUS: ( 1F(Are Vi U L -..7"3 0,0 j- ) Reinstatement (- rom One Business to Another ( ) Dormant License to Active Page 1 of 4 / (La 4 67( Jo/7 t°f (/41 ?tica/( 7;z& tiorZe i‘iee ouid °c .a•-s Qco STATE OF FLORIDA COUNTY OF CO 11 o TIC instrument wa ,,cknowled•ed before me this day of jt1t; 1U1�t by 9.1-0.0 Uet (name of person owl0dgingl. V,, - ' • ��:•:.`ekt. SAMANTHA LYNN ROE (Si '-) re y r'ublic-State of Florida) * _ * MY COMMISSION#EE 875239 4 EXPIRES:February 17,2017 S(',A M V(` AN +„. ,00 Bonded lin Budget Navy Ssrvices (Print,Type. Name o Notary ) Personally Known OR Produced Identification Type of Identification Produced 17;l-71P / figeNglf31 JUL 222014 NI BY: QUALIFIER INFORMATION: 1 1/n 1/ ` C-40ei1`io6 v- o M e l 0,9PfuS W.,164 !(ic Address: bli NO - • c Y . 0 .)&S 't 3 /l o (Number&Street) (City) (State) (Zip Code) Telephoner IA"g-{7-- 160(../ Date of Birth: S.S. #: 000-00- - - E-Mail: i'1,( u511 i tic cc ca.s-1. Ke . Driver's License:- , 1. Type of Certificate of Competency for which application is made. 1 D` UVOU �-P 2. The names and telephone numbers of two persons who will know your whereabouts. 7&V�=- Cis o -€- . - - • - 70 .7-- cc D 5- I/00 Q e-e__ 7701.1-- -6- --,,g 3 - a57 1 ' c .`Z 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? 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. ore 0 reS -C„GZ„..„, ' . �� -e e �D tc. -- ,KP cle 9. List your business or work experience during the past ten years. �( ifs,: IL '.. f• Qal� . i/ P r ' Col ■ /- 6-Ac. /ii—Pic 10. Statement of any formal training you have had in the area for which the application is made. Y0 G1 t''' Page 3 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. f`'1rl‘6 ( 'tS 410/0C c, — 64°51gOG 15-579 i fig t2Ct L L o C//2_ ?gE S/ C"1•/l •14-pks qa - y (f0 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. Mc 11 'It Cc ' c� 6tIpkiz 6Lc t vk( 9_ Mc ,ELI _H t N(ScS /krC ,, - not/�c SIB-- L j iic 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. J` r-c�O3-� cc a ?o 1 P- ac 4 7eoteoAD mac., r e 0, \_0/\ i vo r-c-Q = &I-o ck AFFIDAVIT I,7 /1+j2 f u S TUG' 41 tiCcertify that the foregoing is true and corr= 'o the best of my knowledge. NO ;7.rized Officer of the Firm STATE OF FLORI A j2, COUNTY OF (T/c '� The foregoing instrument as acknowledged before me this -f/..2// / (Date) By � > / 7 L of J✓L,✓c_—co- I_cazi ✓C7 r�,- S//r-� 1�./C (Name of officer, title/agent) (Name of Corporation) a c. c-e-,= . J, Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced t=4_ ,.-->e_— identification and did not take an oath. (Type of identification) 011111111111//// NOTARY'S SEAL \\�� ,AVSCO SU �� / ._<c4;.•' ,SSIOryF•.. -- .•OD Byer/B 'Ai•• ' r — � .a •Ss 2 9 •. 4 4 °�u' • * (SIGNATURE OF NOTARY) • y y: 1FF 030924 4,;git S .9 � 1/11tfittottQk' 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. /P l(i • faC/ift"C APPLICANT(PLEASE PRINT) tI,N v iv r e #A, a c,P.,yG 1 cvt/.1 :t NAME OF COMP' "Y AI SIGNA'S 'FOF APPLICANT STATE OF FLORIDA COUNTY OF C,.,,_:_,,.-f< The foregoing instrument as acknowledged before me this 7A2/.)‘' (Date) By =f�=-t , '- C. who has produced A=z_,›c:_ (Naive of person acknowledging) (Type of identification) 41440:01 111 as identification and did no I v, � �\\G\.• .4�bi ��x..., \sSl0NE,to•. '% • ��•pr�ber 16?) % Z•: OWN :4( r- - _ cn NOTARY'S SEAL • �•� •t- .* • !F O2 24 4, " f • 0"4-••.�.gPub, .•'Pc (SIGNATURE OF NOTARY) I, / 311 PUBLIC 1• i```ce 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. SIGN.`! •E OF APPLICANT V/4-0C ey,f itc /-4c BUSINESS NAME .7 - 1/1-/ DATE BEFORE ME this day personally appeared ,4-,=7 �v.�.�'' C affirms arms and says that he has less than one employee and does not req e Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged bofore me this '1`407'� (Date) by 4 —S f=t '-'.- who has produced ,? (name of person acknowledging) (Type of identification) as identifientinn nn- who did not take an oath. QP�G\S.. SU�Fti��i k Nssiolve•. �� SIGNATURE OF NOTARY` • ober is riO� • � �. -4 N • *' - .a..-.(C , S '_. 5 . NOTARY'S SEMI* : •• = (PRINT NAME OF NOTARY PUBLIC) •. 4FF 030924 ��ozs tN . e NOTARY PUBLIC 4 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, MA-Le- l-- -1-1111/4-3414 , am a resident of `-QL.0 Or- County, NAIL-ES. 44-04-1 M (State) and have resided here for more than five (5) years. During the last five years I have known IAA/II-11).S PV C--4IOC applic: `I have had the opportunity to observe his or her business and personal dealings and find him or her .e a p- :on of honesty, integrity and good character. (Signature) 1140.1......Aor■-■''' (Name) -1 E L. 1 r_ (Address) Lit • N *1"GILT (LA Hog Telephone) ` 4-f ' (G(3 STATE OF FLORIDA COUNTY OF _( The foregoing instrument was acknowledged before me this JULf ZZ1 ?-4)1 4 by (�I a,, , , ..--- ate) UUJX--i L �—-"J�t"l�f art (e- who has producedOl�1�1 (name of person acknowledging) (Type of ide- gf :don) as identification and who did not take an oath. Nulic ate of Fionaa Olga otary J P ZapparbStotli ! W- .o` My Comm,uion EE082427 •� ' '� r N�� •Y for no Expires 04/12/2015 / / {� l D - ZobeITNie 4.4.1 l y) NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC 9 ICI A VP 0Ik 04 110 0)ti t . ; ;411-iirtt �04,000 imiNfi-ill � � 4 tl yjr A.;ilk -41.0 44 . A 4 c,. . -4 vito 0 „ ct ›, *0 oil, 4 u rq ,. .,, . ,9 tOIN:3"a4 t Oki 't "8, c+-4 '—'' p, -+. ,0 A 4) P ; /4 0 1.f, �� p o bV" •< ►r Z+ l ; �, a j ,'±',. a) ,,,c,,,) • A I! Q Q r .*47 14 o ' : f :I r-Xriaillzk wie4 ^ � O ' `3 f.' ' kri gi- ( -. , 6 E 0 f.E: 8 ct.n)..., I F t Olk >•447 1 1 "c' ( w M et ''CJ 0 'F�' -4 ' i' p j C p c I C1 0 Aug 04 -0 4 Ct- 0 '66. 0 ,LICkl .2 V ID 40,1114 S -11"-j - o v4 -ci ›, T 74 irk u � ` o � '4 la CO;A bk ype o t o 16 ciai :-,.c . 4 e4(4E)1 tli y o •:‘ N OAS 0111. - - O of i imf,* H y cn H 0 g �♦/� .b,V0 140 •)4 Irl -li/ •[► .>••11 ∎0∎•<1 T . • fit► . •∎ . t ` r , „► s A • r#0, pA� b 0 vt `to r[/A4 fi /,A40 r0440 r[/A4 t4/` 40 __ COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 "411:1t1 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 Flprotecting gtyos r SSN and once collected,will be maintained as confidential and exempt under Chapt 9, • 886 110th Ave. N.Suite#6,Naples,FL 34108 API Phone:239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com PERSONAL CREDIT REPORT(Compiled From National Records) <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> (I) P NP7771028 LICENSES ETC 16 NP 1/04 07/21/14 14: 54CT <SUBJECT> <SSN> <BIRTH DATE> PUGHIUC, MARIUS - <CURRENT ADDRESS> <DATE RPTD> 15579 MARCELLO CI . , NAPLES FL. 34110 10/13 <FORMER ADDRESS> 17373 FUCHSIA RD. , FORT MYERS FL. 33967 2/05 7905 OAK ST. , TAYLOR MI. 48180 <POSITION> <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> MCM TILE & MARBLE 5/08 4/08 <FORMER EMPLOYER AND ADDRESS> TILE & MARBLE SUPERVISOR 9/07 9/07 M O D E L P R O F I L E ***FICO CLASSIC 08 SCORE +630 : SERIOUS DELINQUENCY; TOO FEW ACCOUNTS ***CURRENTLY PAID AS AGREED; PROPORTION OF LOAN BALANCES TO LOAN AMOUNTS IS ***TOO HIGH; NUMBER OF ACCOUNTS WITH DELINQUENCY *** 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 PUBUC RECORDS HAVE BEEN SEARCHED AT THE COUNTY,STATE AND FEDERAL LEVELS PR=0 COL=0 NEG=4 HSTNEG=4-93 TRD=21 RVL=12 INST=3 MTG=6 OPN=0 INQ=2 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $1099 $1150 $319 $0 $60 72% CLOSED W/BAL: $39.4K $39.4K $ TOTALS: $1099 $1150 $39.8K $39.4K $60 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 BK OF AMER B 6331204 7/07 $27.2K 12M M09 6/14A $39.4K I CONVENTIONAL REAL 4/11F $39.4K UNPAID BLNC CHRGD OFF CITI B 64DB002 8/05 $10.8K R9P 1/14A $9880 $0 I FLEXIBLE SPENDING 6/12F $0 SETTLED < FULL BLNC BK OF AMER B 427S002 3/07 $236K 360M 5/09 555555555555 M05 10/13A $0 $5832 05 555555555555 I FRD423747843 1001 10/13C $0 FORECLOSURE,CLTRL SLD 48 0/ 0/48 Page 1 of 3 BK OF AMER B 427S002 7/07 $218K 360M 5/09 555555555555 M05 4/11A $0 $4820 05 555555555554 I CONVENTIONAL REAL 4/11C $0 FORECLOSURE,CLTRL SLD 44 1/ 1/24 CREDITONEBNK B 54MR013 6/13 $531 MIN25 111111111111 RO1 7/14A $650 $0 I CREDIT CARD $37 12 0/ 0/ 0 5/3 BANK CC B 21AV061 4/13 $568 MIN35 111111111111 RO1 6/14A $500 $0 11 I CREDIT CARD $282 14 0/ 0/ 0 TOYOTA MTR Q 4176318 4/08 $44 .5K 72M752 112121111111 I01 3/14A $0 112111111111 I AUTOMOBILE 3/14C $0 CLOSED 48 3/ 0/ 0 5/3 BANK CC B 21AV061 10/07 $0 111111111111 RO1 11/13A $7000 $0 111111111111 I CREDIT CARD 12/07C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CHASE B 26QK001 12/03 $2997 111111111111 RO1 11/13A $3000 $0 111111111111 I CREDIT CARD 11/06C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 BK OF AMER B 6331059 3/05 $2937 XXXXXXXXX1XX RO1 7/11A $500 $0 XXXXXXXX1111 I CREDIT CARD 3/11C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 BK OF AMER B 427S002 3/07 $29. 6K 300M243 5/09 555555555555 MO1 6/10A $0 $974 05 543211111111 I CONVENTIONAL REAL 6/10C $0 TRNSFRD: OTHER LENDER 37 1/ 1/14 SUNTRUST BK B 423A027 1/06 $12 .8K 48M315 111111111111 I01 1/10A $0 111111111111 S BUSINESS 1/10C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 6331059 5/06 $90 11 RO1 5/09A $7500 $0 I CREDIT CARD 1/09C $0 ACCT CLSD BY CONSUMER 35 0/ 0/ 0 TD AUTO FIN F 624C139 7/04 $13.5K 60M XX1111111111 I01 2/09A $0 111111111111 I AUTOMOBILE 2/09C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 6331213 11/05 $60.3K 111111111111 CO1 4/07A $75.0K $0 1111 I HOME EQUITY LOAN 3/07C $0 ACCT CLSD BY CONSUMER 16 0/ 0/ 0 SPS F 1SRM001 1/05 $187K 360M1744 111111111111 MO1 4/07A $0 XXXXX1111 I CONVENTIONAL REAL 4/07C $0 CLOSED 21 0/ 0/ 0 CHASE B 701N134 7/05 $0 111111111111 RO1 12/06A $1000 $0 1111 I CREDIT CARD 11/06C $0 ACCT CLSD BY CONSUMER 16 0/ 0/ 0 CHASE B 701N134 6/04 $844 111111111111 RO1 Page 2 of 3 11/06A $1800 $0 111111111111 I CREDIT CARD 11/06C $0 ACCT CLSD BY CONSUMER 28 0/ 0/ 0 FST PREMIER B 41PF016 8/04 $251 111111111111 R01 2/06A $300 $0 111111 I CREDIT CARD 10/05C $0 ACCT CLSD BY CONSUMER 18 0/ 0/ 0 CHASE B 26QK004 10/04 $394 111111111111 RO1 11/05A $400 $0 I CREDIT CARD 8/05C $0 ACCT CLSD BY CONSUMER 12 0/ 0/ 0 MASTER FIN F 1TTR001 1/05 $187K 360M1351 1 M01 5/05A $0 I CONVENTIONAL REAL 5/05C $0 TRNSFRD: OTHER LENDER 1 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 7/21/14 PNP7771028 (FLA) LICENSES ETC 4/08/13 ACH0210186 (CHI) LEXUS OF NAP END OF REPORT 1 I Page 3 of 3 886 110th Ave. N. Suite#6, Naples, FL 34108 I Phone:239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com BUSINESS CREDIT REPORT as of: 07/22/14 13:03 ET MCM TILE & MARBLE, INC. Fed Tax ID#20-4107612 Address: 15579 Marcello Or Business Type: Corporation Naples, FL 34110-2836 Experian File January 2006 United States Established: Phone: 239-645-1606 Experian Years on File: 8 Years Years in Business: More than 8 Years Experian BIN: 987937896 Also is (or has been) operating as: MCM Tile & Marble, Inc Heritage Flooring Of SW Florida MCM Tile & Marble, Inc Family Linkage: Ultimate MCM Tile & Marble Inc Parent 15579 Marcello Cir Naples, FL Branches / MCM Tile & Marble Inc Alternative 17373 Fuchsia Rd Locations Fort Myers, FL United States Page 1 of 2 Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. Bankruptcies: 0 Liens: 0 Judgments Filed: 0 Collections: 1 Collection Filings Rack_19_148 Date Agency Agency Phone Status Closed Amt Amt !Comments Date I Disputed Collected Revenue Open 03/14 800-467-4064 $6,825 $0 Systems Inc Account Collections Summary 8_ck_to top Status Number of Items Amt Disputed Amt Collected Open Account 1 $6,825 $0 END OF REPORT Page 2 of 2 Electronic Articles of Incorporation PLED 4000049084 For June 043_2014 Sec. Of state mdickey ADVANCED FLOORING OF SW FL, INC. The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: ADVANCED FLOORING OF SW FL, INC. Article II The principal place of business address: • 15579 MARCELLO CIRCLE NAPLES, FL. 34110 The mailing address of the corporation is: 15579 MARCELLO CIRCLE NAPLES, FL. 34110 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 100 Article V The name and Florida street address of the registered agent is: MARIUS PUGHIUC 15579 MARCELLO CIRCLE NAPLES, FL. 34110 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: MARIUS PUGHIUC F LED 049084 f tte Article VI Sec 04 2014 mdickey The name and address of the incorporator is: MARIUS PUGHIUC 15579 MARCELLO CIRCLE NAPLES, FL 34110 Electronic Signature of Incorporator: MARIUS PUGHIUC I am the incorporator submitting these Articles eodf Incorporation d�affirm stated herein a true. I am aware that false information submitted document third degree felony as provided for in s.817.155, F.S. I understand ro � o �report between January 1st and May 1st in the calendar year rsg e � � h year thereafter to maintain"active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P MARIUS PUGHIUC 15579 MARCELLO CIRCLE NAPLES, FL. 34110 Article VIII The effective date for this corporation shall be: 06/04/2014 • Detail by Entity Name Page 1 of "L FLORIDA DEPARTMENT OF STATE DIVISION O C ORPOR_ NO\S Detail by Entity Name Florida Profit Corporation ADVANCED FLOORING OF SW FL, INC. • Filing Information Document Number P14000049084 FEI/EIN Number NONE Date Filed 06/04/2014 State FL - Status ACTIVE Effective Date 06/04/2014 Principal Address 15579 MARCELLO CIRCLE NAPLES, FL 34110 Mailing Address 15579 MARCELLO CIRCLE NAPLES, FL 34110 Registered Agent Name &Address PUGHIUC, MARIUS 15579 MARCELLO CIRCLE NAPLES, FL 34110 Officer/Director Detail Name &Address Title P PUGHIUC, MARIUS 15579 MARCELLO CIRCLE NAPLES, FL 34110 Annual Reports No Annual Reports Filed Document Images 06/04/2014-- Domestic Profit View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/S earchResultDetaiUEntityName/dome-... 6/10/2014 r DEPARTMENT OF THE TREASURY i' ii 1Ri./INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 06-04-2014 Employer Identification Number: 47-1017979 Form: SS-4 Number of this notice: CP 575 A ADVANCE FLOORING OF SW FL INC u may call us at: LUANN THOMAS For assistance yo 2170 KEARNEY AVE 1-800-829-4933 NAPLES, FL 34117 IF YOU WRITE, ATTACH �NOTICE. STUB AT THE END OF THIS WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 47-1017979. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. i important When filing tax documents, payments, and related correspondence, it is very that you use your EIN and complete name and address exactly as shown Above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you please be make assigned more using Ethe information is not correct off stub and return it to shown us. above, please make the correction Based on the information received from you or your representative, you must file 1 the following form(s) by the date(s) shown. Form 1120 03/15/2015 you can call us at � If you have questions about the form(s) or the due date(s) shown, youtcan If you our annual accounting period (tax year) , see Publication 538, the phone number or write to us at the address shown at the top need help in determining y Accounting periods and Methods. information u or your We tative. Itu s not allegalldetermination ofyour ttax classification, and is not representative. It is not a legal your tax classification, you may binding on the IRS. If you want a legal determination of in Revenue Procedure reg4e1t a private letter ruling from the IRS under the guidelines year at issue) .Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure byefiling Form 8832, Entity Certain tax classification elections can be requested 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 on must made isrincluded in the corporation must a Small Business Corporation. instructions for Form 2553, Election by (IRS USE ONLY) 575A 06-04-2014 ADVA B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042) , excise taxes (Form 720) , or income taxes (Form 1120) , you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-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. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write tc us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is ADVA. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. • • • (IRS USE ONLY) 575A 06-04-2014 ADVA B 9999999999 SS-4 Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please CP 575 A correct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 06-04-2014 ( ) _ EMPLOYER IDENTIFICATION NUMBER: 47-1017979 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE ADVANCE FLOORING OF SW FL INC CINCINNATI OH 45999-0023 % LUANN THOMAS u'nI.IuIIuIiIn1 2170 KEARNEY AVE NAPLES, FL 34117 -'�--" Cr£ I DATE(MM/DDIYYYY) ACOREP CERTIFICATE OF LIABILITY INSURANCE 07/18/2014 THIS ERTIFICATE 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 NAME: CUSTOMER SERVICE INTEGRAL UNDERWRITERS CORP PHONE FAX No):8777455560 PHONE E Euq: 2393043200 PO BOX 990337 E-MAIL SS: JhamandezOintegralund.com NAPLES FL 34116 INSURER(S)AFFORDING COVERAGE NAICI INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER B: FRANK WINSTON CRUM INSURANCE CO _— ADVANCED FLOORING OF SW FL, INC INSURER C: ——— 15579 MARCELLO CIR NAPLES,FL 34110 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 TYPE OF INSURANCE ADOL SUBR POLICY EFF MMI '!i MI POLICY EXP LIMITS LIR INSR WVD POLICY NUMBER ( DD/YYYYI (MDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE M RENTED X COMMERCIAL GENERAL LIABILITY (� (� CLAIMS MADE X OCCUR PREMISES(Ea occurrence) $ 100.000 " i " MED EXP(Any one person) $5,000 j A X DEDUCTIBLE$500 1 0185FL00061047 07/17/2014 07/17/2015 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 L.GEM_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000.000 S X I POLICY JE LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO ,BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PR–OPERTY DAMAGE $ HIRED AUTOS —AUTOS (Per accident) PIP 10.000 UMBRELLA LIMB OCCUR r r EACH OCCURRENCE $ I 1 —EXCESS LIAB CLAIMS-MADE AGGREGATE $ COVERAGE S DED RETENTION S WORKERS COMPENSATION X TORY OMITS X T AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N ['. FAFL141450 07/17/2014 07/17/2015 _E.L.EACH ACCIDENT $ 1.000.000 B (Mandatory In NR EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEES 1,000,000 If IM anddtory Ln and E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION describe under DESCRIPTION OF OPERATIONS below . ET- i DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) TILE FLOOR INSTALLATION CONTRACTOR CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY CONTRACTOR LICENSING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2800 N HORSESHOE DR #400 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NAPLES FL 34104 ACCORDANCE WITH THE POLICY PROVISIONS. FAX: 2392522469 AUTHORIZED REPRESENTATIVE ,t JULIO HERNANDEZ 4/l}\ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD y? . \ \\ \.' >. : + ± . �, . . . . yam.. . . . . � . . . < \ � «. � : » . « . ,y . _a#/ COLLIER COUNTY BUSINESS TAX RECEIPT j APPLICATION EF' " 1 C./ 2800 N.Horseshoe Drive,Naples,FL 34104 � *Make Check Payable to: Collier County Tax Collector �+ Phone:239-252-2477 Fax:239-643-4788 Website:www.colliertax.com cop wE:is' 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 Cl... CORPORATE NAME- 1 116 01 N ,.. --I'iC'. DBA NAME- A A lb) BUSINESS OWNER OR QUALIFIER'S NAME - i I (U S I C 2) PHYSICAL ADDRESS- 155-471 GI' • 11/4/4-?6,c- F( 3 Le t t c (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE- Yes No J. 3) BUSINESS MAILING ADDRESS-1 J il is .,ez.“A P_1 Q I� S 3`711 0 Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- 5) TELEPHONE-Business: ,23q Cif 5 I 60 Home: ,...,,.!..0.04., 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporatio LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- 0$`'U . i T-4-- 8) OFFICE WITHIN CITY LIMITS OF NAPLES -_Yes_No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. - - I n - O 1 1_ *see back of appl' 'on f explanation 9a) TYPE OF BUSINESS CONDUCTED: T 1 Ur- oc I h� 0Y) 0) NUMBER OF EMPLOYEES-Including number of owners: 3 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**** 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. Collier County LAND USE AND Zf,Mli,t . ; .11FICAT HOM;1 t%UZi `i.,$5 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 applica t is the person in whose name the Business Tax Receipt will be issued, and the applicant's signature mu appear on this form. Verification as property owner or lessee in the form of a Valid Florida's Driver License,' or lorida Identification Card and/or copy of valid lease agreement is required. ��r r e�..,1.- A cl r�e c. APPLICATION DATE 7/I /14. ZONING CERTIFICATE# APPLICANT'S PHONE C it S 1 6 0 4. Business Tax Lic# APPLICANT'S NAME /14P/f U S r-?c.t 6/1/uC- APPLICANT'S HOME ADDRESS i 5579 hir=}P_C LK, 0 C 14 . 4S -�L34'n 0 TYPE OF BUSINESS TO BE CONDUCTED //Le I j I.ipk.C. 0 A BUSINESS NAME(IF ANY) A-LL/4 tkicg. t T.00 et 61 G s Qe1 T- fL i 1\C 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 abov. at this address by virtue of my leasehold interest in this property, and that I have read, understood, and agree to abid: iy the provisions of LDC Section 5.02.00 "Home Occupations"(see back of application). APPLICANT SIGNATURE VPA al DATE 7/9-a-1/4 Aw-opy ,I)DE NO: 11 ROMZ FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" 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). Tax Collector Staff: Clerks Initials Horseshoe Greentree Please forward a copy of issued certificate and receipt to the Collier County Zoning Services. 5-24-2011 5.02.00 HOME OCCUPATIONS 5.02.01 Applicability Home occupations shall be allowed in any zoning district which permits residential dwellings as a permitted use. 5.02.02 Allowable Home Occupation Uses There shall be no retail sale of materials, goods, or products from the premises. 5.02.03 Standards The home occupation shall be clearly incidental to the use of the dwelling for dwelling purposes. The existence of the home occupation shall not change the character of the dwelling. A. An allowable home occupation shall be conducted by an occupant of the dwelling. B. There shall be no on-site or off-site advertising signs. C. The use shall not generate more traffic than would be associated with the allowable residential use. D. There shall be no receiving of goods or materials other than normal delivery by the U.S. Postal Service or similar carrier. E. Parking or storage of commercial vehicles or equipment shall be allowable only in compliance with the requirements for commercial vehicles in the County Code. F. The on-site use of any equipment or materials shall not create or produce excessive noise, obnoxious fumes, dust, or smoke. G. The on-site use of any equipment or tools shall not create any amount of vibration or electrical disturbance. H. No on-site use or storage of any hazardous material shall be kept in such an amount as to be potentially dangerous to persons or property outside the confines of the home occupation. There shall be no outside storage of goods or products, except plants. Where plants are stored, no more than fifty(50) percent of the total square footage of the lot may be used for plant storage. J. A home occupation shall be subject to all applicable County occupational licenses and other business taxes.