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CLB Agenda 02/18/2015 Co er County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA FEBRUARY 18, 2015 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: January 21, 2015 V. DISCUSSION: VI. NEW BUSINESS: (A) Orders of the Board (B) Paul E. Heaton, Kyle's Finish Carpentry, Inc.-Waiver of Exam(s) (C) Teodor Danilov, Custom Flooring Design Inc—Review Of Credit (D) Abel Arredondo, Superior Woodworking, Inc.-Waiver of Exam(s) (E) Josue Briceno, Innovative Glass &Window, LLC- Review of Application VII. OLD BUSINESS: (A) Luis Escobar—Review of probation. VIII. PUBLIC HEARINGS: IX. REPORTS: X. NEXT MEETING DATE: WEDNESDAY, MARCH 18, 2015 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 CONTRACTORS' LICENSING TENTATIVE BOARD SCHEDULE YEAR 2015 January 21St February 18th March 18th April 15th May 20th June 17th July 15th August 19th September 16th October 21St November 18th December 16th January 21,2015 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING January 21, 2015 Naples, Florida LET IT BE REMEMBERED, that the Collier County Contractors' Licensing Board, having conducted business herein, met on this date at 9:00 AM in REGULAR SESSION in Administrative Building "F," 3rd Floor, Collier County Government Complex, Naples, Florida, with the following Members present: Chairman: Patrick White Members: Michael Boyd Ronald Donino Terry Jerulle Richard Joslin Kyle Lantz Gary McNally Robert Meister Excused: Thomas Lykos, Vice Chair ALSO PRESENT: Michael Ossorio — Supervisor, Contractors' Licensing Office Kevin Noell, Esq. —Assistant County Attorney James F. Morey, Esq. —Attorney for the Contractors' Licensing Board Ian Jackson— Collier County Licensing Compliance Officer 1 January 21,2015 Any person who decides to appeal a decision of this Board will need a record of the proceedings and may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the Appeal is to be based. I. ROLL CALL: Chairman Patrick White called the meeting to order at 9:00 AM and read the procedures to be followed to appeal a decision of the Board. Roll call was taken and a quorum was established; eight voting members were present. II. AGENDA—ADDITIONS, DELETIONS, OR CHANGES: (None) III. APPROVAL OF AGENDA: Kyle Lantz moved to approve the Agenda as submitted. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. IV. APPROVAL OF MINUTES—DECEMBER 17,2014: Richard Joslin moved to approve the Minutes of the December 17, 2014 meeting as submitted. Gary McNally offered a Second in support of the Motion. Carried unanimously, 8—0. V. DISCUSSION: (None) VI. NEW BUSINESS: A. Orders of the Board Richard Joslin moved to approve authorizing the Chairman to sign the Orders of the Board. Ronald Donino offered a Second in support of the motion. Carried unanimously, 8— 0. (Note: With reference to the cases heard under Section VI, "New Business,"the individual(s) who testified were first sworn in by the Attorney for the Board.) B. John E. Griffith, Sr. —Contesting Citation Citation: #08724 ("Unlicensed Contracting") Date Issued: November 17, 2014 Fine: $2,000.00 (2nd Offense) Description of Violation: Engage in the business or act in the capacity of a Contractor, or advertise self or business organization as available to engage in the business of, or act in the capacity of a Contractor, without being duly registered or certified. 2 January 21,2015 John E. Griffith, Sr., was present and represented by his attorney, Adam J. Oosterbaan, Esq. Attorney Oosterbaan presented the Respondent's "Case in Chief" Opening Argument: • A violation may not have occurred since the work that was performed did not require a license. • Mr. Griffith acted in good faith because he believed he had been licensed to perform the work and did, in fact, obtain his license. Elizabeth Lynn Kosmerl testified on behalf of the Respondent. • She and Mr. Griffith have been business associates for over 10 years and they went into business together approximately one year ago. • She is the Qualifier for the business. • She processes all paperwork for the business. • She is licensed in Florida and holds two licenses: Residential Building Contractor (1986) and Residential Pool Contractor(1999). • She and her husband had established a corporation, "Blue Aqua Pools," and John Griffith had established a handyman service. • They decided to merge the two with the handyman service working under the corporation. • She submitted the paperwork for the d/b/a and fictitious name search; submitted application and fee ($50) required for Form: DBPR CILB-23 to change a business name. • Her intent was to use her Residential Building Contractor's license and not her Residential Pool Contractor's license. • Sunbiz showed the D/B/A went through and was "active." • In April, she received notification from the Department of Business and Professional Regulation ("DBPR") informing her that she had not submitted an application nor paid the required fee. • She re-submitted the previous paperwork and again paid the $50 fee. o Her error: She did not understand that the DBPR wanted new paperwork to be submitted for the Pool Contractor's license. • It was not until the incident occurred that she became aware of her error. • She faxed in a corrected application for the Pool Contractor's license on November 18, 2014 and it was approved the same day. • She has worked in Sarasota, the City of Fort Myers, Lee County, and the City of Naples for the past 20+years. Attorney Oosterbaan asked Ms. Kosmerl if the intention was for Mr. Griffith to work under the Pool Contractor's license. Ms. Kosmerl stated the Pool Contractor's license has been dormant and it was the intention for Mr. Griffith to work under the Building Contractor's license. She called the State to obtain information concerning how to solve the problem. 3 January 21,2015 She identified the first application (Building Contractor's license) which had been submitted to the DBPR on February 11, 2014. The second application (again for the Building Contractor's license) was submitted in April, 2014. The third application— for the Pool Contractor's license—was submitted in November, 2014. The three applications were accepted and admitted into evidence as Respondent's Exhibits "1," "2,"and "3." Attorney Oosterbaan questioned the Witness: Q. Did you believe that Mr. Griffith was, in fact, licensed during this process? A. Yes, sir, I did. Chairman White directed a comment to Attorney Oosterbaan: "You stated earlier that the Respondent was properly licensed based upon what the Witness had done for her license. Could you clarify that, please? Attorney Oosterbaan: Ms. Kosmerl was licensed. Mr. Griffith, under "John's Handyman Service," was going to work under her Building Contractor's license. The State required that Mr. Griffith also be included under the Pool Contractor's license. Kyle Lantz asked the Witness if she maintains liability insurance for the handyman service and the response was, "Yes." John E. Griffith, Sr. responded to Mr. Lantz's questions: Q. When did you obtain the insurance coverage? A. I have a$1M liability insurance policy for John's Handyman Service and John's Carpentry ... the new policy for this year will be issued for two million dollars. Q. And it has no reference to "Blue Aqua Pools"? A. No. It was noted only the fictitious name was covered and the policy was initially issued on January 17th—Mr. Griffith stated he has maintained coverage for the past 20 years. There was no Workers' Compensation Insurance coverage because Mr. Griffith is exempt—he works alone. Q. Are you an officer of"Blue Aqua Pools"? A. I guess I am. It was noted if a building permit had been pulled the issues would have been discovered earlier and could have been corrected at that time. Chairman White stated it was important to the Board to learn of the corrective actions taken by the Respondent prior to the Hearing. Michael Ossorio clarified the license for the Pool Contractor was not issued until November 25, 2014; when the Citation was issued on November 17, 2014, the company was in violation 4 January 21,2015 Attorney Oosterbaan questioned John E. Griffith: Q. At the time you performed work for Eva Bowen, did you believe that you were licensed? A. Yes, absolutely. On February 11th we sent in our first money for our first application and I got a license number. Then on March 26, 2014, the fictitious name ran in the newspaper and we sent that to the State. I had no reason to not believe that I was licensed. I did everything they asked me to do—I sent it in—I sent the fees in, and I was off and running. Chairman White asked Mr. Griffith to identify the license that he believed he held. A. I thought I was qualified through her license—the State license—for the Building Contractor's license. The information that we sent in to the State—I thought that was all wrapped up. Once they got the fictitious name that I had filed for in the newspaper and they got our application, I thought it was done and ready. Chairman White summarized: • You believed that you [John Griffith] were working lawfully under the license of the General Contractor, Elizabeth Kosmerl. • All matters pertaining to the d/b/a—the fictitious name—were properly licensed through"Blue Aqua" with her as the CBC (Certified Building Contractor). A. Yes, sir, that's correct. Chairman White continued: Q. When you entered into any contracts, was that also your belief? A. There were no contracts—there was never a contract signed. Q. When you entered into what you believed was an agreement --- A. Yes. My hands shake really bad when I start to write so a friend at the Pro Desk at Home Depot prepared a list of items that I was going to do and I signed it. Yes, this is what I'm going to do for $2,500 and I gave it to Mrs. Bowen. Nothing was ever said. Q. And that was done in the name of John's Handyman? A. I think we did, yes, I believe we did. When asked to produce a copy of the list, Mr. Griffith stated Mrs. Bowen possessed the only copy. Regarding County's Exhibit E-14 and 15: A. These are the list of projects that needed to complete all of her work on the home. This was what she needed. This was not contracted—there was never an agreement. All I did was simply put this together to show her how much the stuff was and I got prices from Home Depot—what the stuff was and what I needed down to buy the stuff—and to do the work. So I gave her a whole list. 5 January 21,2015 Attorney Oosterbaan asked Mr. Griffith if the 2-page list had anything to do with what he had agreed with Ms. Bowen to do. A. No, it did not. Q. That's an additional thing ... A. It's an additional, yes. Q. Was it ever agreed to—that list—between you and Ms. Bowen? A. No, it wasn't. All I did was to call her up because we were running out of what we had to do —I called her and gave her the list—one at a time—of stuff we need to do to finish the job. She said, "I'll get back with you." I think it was two days later that she called me and said I was fired. So I figured that the stuff was too pricey for her and she wanted to go somewhere else. And that was it. There was never nothing agreed to, to do anything other than the $2,500 worth of demolition. Q. What was your agreement with Ms. Bowen? What was the work that you discussed at Home Depot—what was the Scope of Work you were going to perform? A. We were going to haul away trash from the yard; take down the wood paneling inside the unit; take out all the insulation because she wanted blown-in insulation which we would do ... and that was it ... take out the appliances. Strip the place out was what our job was to do. Q. Except for any studs or load --- A. Right, exactly. Q. ... bearing structure? A. Right, no. Q. So that was what you both agreed on? A. Yes. Q. That was the Scope of Work? A. Yes. John Griffith reiterated he did not possess a copy of the agreement concerning the agreed Scope of Work ... the only copy of the document was given to Ms. Bowen. Kyle Lantz questioned Mr. Griffith: Q. The list that we have on Exhibit E-14 and 15 ... who wrote that? A. My friend, Lisa Smith. Q. Is it safe to assume that it was a bid or proposal for work that you A. ... was going to do. Q. It wasn't accepted but it was a bid? A. It was a bid to do this work, yes. Richard Joslin: Q. It appears that they were all itemized, according to what you were going to do for her? A. Yes, yes. Q. One of the items on E-15 was that you were going to haul away all of the debris ... which is what you said you did. Was that part of the work? A. I didn't haul away any debris ... I was supposed to haul all the debris that was left outside. When we got there to do the work, the people who had lived there before 6 January 21,2015 left all of their debris inside. In order to do the work, I had to haul it. So I hauled two loads out of the inside of the building. I had not got all of the stuff from the outside hauled yet. She seemed to think that I should have hauled it all. But that wasn't the agreement. So when she decided that I should haul it all, I stopped hauling any of it because the two loads from the inside the house that I hauled would have made up for the two loads that were outside. I just quit. Terry Jerulle: Q. This proposal on E-15, did you receive any money for any of these items? A. No, sir. Q. When you said you were hired initially to do the demolition on the interior of the home ... A. Yes. Q. ... did you get a demolition penult? A. They said I didn't need one because it was a manufactured home. Q. Who said you didn't need one? A. She did [indicating Eva Bowen], Mrs. Bowen did. Q. But you're the Contractor, correct? A. Yes. Q. Does the Contractor ask the client if he needs a permit or does the Contractor ask the County? A. I asked her, "Can you give me a legal description of this property so I can get a permit to do this work?" She said, "You don't need one for the interior ...." (over-speaking between the two ...) Chairman White advised Mr. Griffith to wait to respond until the entire question had been asked. Terry Jerulle: Q. The question was: Did you ask the County if you needed a demolition permit? A. No, I did not. The reason why I did not was because Mrs. Bowen said she has lived in manufactured homes for a long time and a permit was not needed to remove anything from the inside of the unit—according to the State. So that's what I went by. She did live in a mobile home in Jacksonville so I presumed she knew what she was talking about. Kyle Lantz: Q. Was this a mobile home or a manufactured home? A. It was a manufactured home, I believe. Q. Different from a mobile home? A. It was a double-wide—I don't know what the definition is but ... they rolled it in on wheels. Michael Ossorio clarified the County did not require a building permit nor did it issue a Citation to Mr. Griffith for not obtaining a building permit. The Building Official reviewed the information and the evidence, and determined a building permit was not required. 7 January 21, 2015 Richard Joslin: Q. You had previously mentioned that you had a Workers' Comp exemption form? A. Sure. Q. When was it dated? A. August 31, 2010. Q. You don't have a current exemption form? A. In this letter, it said that I don't need another one—it's good forever as long as I don't go out and hire a bunch of people. Q. Are you exempt because you hold a handyman's license? A. No, I'm exempt because I don't have any employees and I own the company. Kyle Lantz confirmed that a Workers' Comp exemption is good forever for anything other than the construction industry. When an exemption is applied for the d/b/a under the Building Contractor's license, the exemption will have a two-year limit. John Griffith: Anything that I have to do, I'll do. The Respondent's "Case in Chief"was concluded. Respondent's Argument(defense): Attorney Oosterbaan referred the Board to Florida Statute 489.532, "Contracts entered into by Unlicensed Contractors unenforceable:" (1)(a) For purposes of this Section, if a State license is not required for the Scope of Work to be performed under the contract, the individual performing that work is not considered unlicensed. Attorney Oosterbaan stated: • The Statute was the basis of his argument, i.e., whether or not a license was required under the circumstances, concerning what was "agreed" or to use the legal term, "contracted." • Even though Mr. Griffith acknowledged that even an oral agreement can be a contract, his agreement and the work that was actually performed was work that required removing paneling and such which he didn't believe enters into the definition under the "Definitions" section of Florida Statutes 489.105: (3) For the purposes of regulation under this part, the term "demolish"applies only to demolition of steel tanks more than 50 feet in height; towers more than 50 feet in height; other structures more than 50 feet in height; and all buildings or residences. • He did not believe it was "demolition" in the sense of tearing down the whole building; it was just the removal of some of the interior. That may be why a permit was not required—but he was not sure. • He submitted that he was not sure a license was, indeed, required. • The other document referred to as County's Exhibit E-14 and 15 was work that was not agreed upon and, therefore, does not fit the definition of a "contract" because there was no `meeting of the minds' as to the performance of that work. And the work was not performed under that document. 8 January 21,2015 • In examining the law, he did not find a Statute that indicated the mere proposal of work in the future would constitute unlicensed contracting. • As to the ``good faith" argument, he believed all efforts were made and the testimony indicated there was a good faith belief on the part of Mr. Griffith that he was, indeed, licensed to do the work that he was going to be perforning. • Both he and Ms. Kosmerl did all the necessary steps as quickly as possible to satisfy the license requirements. Attorney Oosterbaan concluded: • As for leniency in light of his arguments, he did not think it was a situation where Mr. Griffith, as an individual, was trying to ignore the law or side- step the law and not act according to what was required to do the work that he is doing. In the end, he did obtain a proper license. Kyle Lantz requested the Board's attorney, John Morey, to explain the definition of a "Contractor" under Florida Statutes, 489.105 Attorney Morey suggested reviewing Section 22-16, "Definitions and Contractor Qualifications," under the governing Code for the Board and Collier County." Contracting means, except as exempted in this part, engaging in business as a Contractor and includes, but is not limited to, performance of any of the acts as set forth in Subsection (3) which define the types of Contractors. The attempted sale of contracting services and the negotiation or bid for a contract on these services also constitutes contracting. Attorney Morey explained the last sentence meant not merely performing the work but also attempting to perform the work and making a bid to perform the work falls within the definition of"contracting" under Collier County's Code. Kyle Lantz asked if the State adhered to the same definition and if there were any disparities between the two definitions. Florida Statutes, Section 489.105, "Definitions:" "Contractor" means the person who is qualified for, and is only responsible for, the project contracted for and means, except as exempted in this part, the person who, for compensation, undertakes to, submits a bid to, or does himself/herself or by others construct, repair, alter, remodel, add to, demolish, subtract from, or improve any building or structure ..." Attorney Morey stated the relevant language in Section 489.105 was: "... undertakes to, submits a bid to, or does by himself/herself or by others ..." to actually do those things. Submitting a bid was referenced in the definition of"Contracting." 9 January 21, 2015 Kyle Lantz asked if County's Exhibit E-14 and 15 constituted"contracting." Attorney Morey explained it was "engaging in the business of a Contractor." If the Board determined that the document presented was a bid(or proposal), submitting a bid would fall under the definition of"Contracting." Both Florida Statutes and the Collier County Code included submitting a bid for work and services in their respective Definitions. Mr. Lantz asked if a license would be required to present a bid or proposal, regardless of whether or not it was accepted and work was done. The response from Attorney Morey was, "Correct." The County presented its "Case in Chief." Michael Ossorio referenced Citation#08724 (County's Exhibit E-3) which he issued on November 17, 2014. The amount of the fine was $2,000 since it was a second offense for unlicensed contracting. Eva Bowen testified on behalf of the County. Michael Ossorio asked Ms. Bowen to describe how she found John's Handyman Service and explain County's Exhibit E-14 and 15 to the Board. Eva Bowen stated: • She had lived in Jacksonville, FL for 29 years. • She moved to Naples, FL and bought a property in May, 2014. • She found an ad on Craig's List for a Licensed Contractor and called Mr. Griffith. • Mr. Griffith confirmed that he was a Licensed Building Contractor in Collier as well as in the State of Florida. He stated he would be happy to perform the work that she required. • She closed on the purchase of the manufactured home on May 2, 2014 and met Mr. Griffith at the property. They discussed in detail the work to be done,how long it would take to accomplish, and the cost for same. • The first agreement, "a Contract," was for $2,500; Mr. Griffith agreed to demolish everything on the inside the manufactured home and the outside, and—at his own expense -- to haul it away. • Mr. Griffith started his work on the manufactured home on May 2nd while she returned to Jacksonville; he started to remove the wooden panels, sheet rock, windows and opened the walls. He removed the ceiling panels. He also removed the floors because the plumbing was to be checked. • Mr. Griffith called almost every day with a report of his progress. • Every day beginning on May 2nd, she asked Mr. Griffith if he was a licensed Contractor or General Contractor or Building Contractor and also asked to see his license. • He never produced any documentation—he did not fax nor did her email anything to her as she had repeatedly requested. He ignored her requests for six days while assuring her, during their conversation, that he was licensed. 10 January 21,2015 • She stated she is a widow and used her life savings to buy the property in Collier County and she became scared that something [bad] could happen. She repeated she wanted a licensed Contractor to work on her property. • She stated she trusted him but was still very nervous because he was not cooperating concerning verifying his Contractor's license. • After six days, she returned to the area to review the progress and told Mr. Griffith if he could not produce his license, he would be fired. • She confirmed she asked him to remove the walls and replace with new sheetrock, to remove the insulation, and the studs, to replace the window, to raise the ceiling, to replace the doors and the floors. He was more than happy to do it. • When she returned, she stated that he had done a"horrible job and it was very devastating" for her. Michael Ossorio asked the Witness when she had received the proposal from John Griffith (County's Exhibit E-14 and 15). She replied while they had discussed the items over the phone on several occasions, she did not receive the itemized document until later in May. She confirmed she did not accept his list because he was unable to prove that he was a licensed Contractor. The County concluded its "Case in Chief." Cross-Examination of Eva Bowen by Attorney Oosterbaan: Q. Ms. Bowen, you agreed on a price with Mr. Griffith for the work that he was going to perform, is that correct? A. Yes. Q. Part of that was to make a deposit of$1,000 and pay the balance at completion? A. No. Q. It was sent to you in a writing that was attached to the "Statement of Claim" in a Small Claims Court action undertaken by Mr. Griffith, as the Plaintiff For the record, the Case Number was 14-SC-757. Chairman White caution Attorney Oosterbaan that Ms. Bowen had not testified to the new information he presented. Attorney Oosterbaan replied that he would show the relevance, especially with reference to Ms. Bowen's claim that she not aware of any licensing issues. Cross Examination continued: Q. Isn't it a fact that during the Court case which occurred after the performance of the work, you never made any mention to the Court of any licensing issues? A. That's incorrect and you weren't present during the Court hearing. In front of the Judge and many witnesses during the Court hearing, I asked why Mr. Griffith never produced any license before he was fired. I asked him over and over again. Furthermore, Mr. Griffith never got any deposit money from me because after I came and saw what happened to my home, I fired him. Why would he lie about it? 11 January 21,2015 Q. Did you agree during the Court case that you did owe Mr. Griffith $1,500 for the balance of the work that he performed? A. No, sir, I did not give him $1,500. I gave him $1,000 as a separation check and said told him to leave since he didn't have a license and she didn't want him working on her home. He accepted it with the understanding that the check was payment in full. I don't want anything to do with him. Q. In that Court case, was there a final judgment against you to pay the balance of the $1,500 plus Court costs? A. Yes. Of course because Mr. Griffith insisted in front of the Judge that he was a licensed Contractor. He testified under oath to the Judge that he was a licensed Contractor but he never provided any license. The Cross Examination was concluded. Kyle Lantz asked Attorney Morey to explain the Board's options. Attorney Morey: • If a person who was issued a Citation contests the Citation and shows that the Citation was invalid, or that the violation had been corrected prior to appearing before the enforcement or licensing board, the enforcement or licensing board may dismiss the Citation unless the violation is irreparable or irreversible. • If the Contractors' Licensing Board decided not to dismiss the Citation, it could not reduce the amount of the civil penalty imposed by the Citation but the Board could enhance it based on the following factors: o The gravity of the violation; o Any actions taken by the violator to correct the violation; o Previous violations committed by the violator. • Amount of maximum penalty: up to $2,500 Michael Ossorio asked if it was possible to uphold the Citation while dismissing only the civil penalty. Attorney Morey noted the language in the Ordinance was specific: if the Board found that a violation existed, it could either uphold the civil penalty imposed or enhance it. He was not sure if a penalty could be reduced; but the Citation, along with the penalty, could be dismissed by the Board. Kyle Lantz asked the penalty would be reduced if a license was either applied for or obtained prior to a hearing. Michael Ossorio explained a civil penalty would be reduced to $300 if a Respondent came into compliance with 45 days from the date a Citation had been issued, but only for a first offense. He noted the Respondent had been cited previously. Terry Jerulle moved to approve upholding Citation #8724as issued and maintain the civil penalty at $2,000 since the Respondent came into compliance. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8— 0. 12 January 21,2015 Kyle Lantz directed his comments to Elizabeth Kosmerl and John Griffith: • One of the goals of the Board was to bring violators into compliance. • You have moved closer to compliance by moving the license into the new company's name. • That's one step of ten. There are a number of other things that must be done: o The bid doesn't have a license on it; o The Workers' Comp isn't correct; o The liability insurance isn't correct; o You don't have the proper business tax receipt. • You stated if you had pulled a Building Permit, you might have found out you were in violation but it's not the Building Department's job nor is it the Board's job to tell you that you are doing something wrong. • You have an attorney to consult. • My recommendation: ask your attorney to follow through so you are in compliance but you must be in charge of your own business. • As the Qualifier, you are responsible for the business—that the bids are correct, that the contracts are right, that the insurance is right—that everything is right. • You have put yourself and your license on the line. • There are a lot of steps besides obtaining a fictitious name. • If you keep going the way you are going, you'll be back in here and subject to another fine. • What I've seen from this is a totally mismanaged company by a Qualifier who is totally ineffective and not doing her job to make sure that everything is right. • You have been licensed for 20+ years and if you don't know the regulations by now, it's time to go back to class and learn them. Chairman White directed his comments to John Griffith: • You do not hold a license and should not tell others that you are licensed. • It is the business entity that you are working for that is licensed. BREAK: 10:15 AM RECONVENED: 10:25 AM C. Bruce Fleugeman— Contesting Citation (d/b/a "A Fireplace") Citation: #09052 ("Unlicensed Mechanical Contracting") Date Issued: November 18, 2014 Fine: $1,000.00 Description of Violation: Engage in the business or act in the capacity of a Contractor, or advertise self or business organization as available to engage in the business of or act in the capacity of a Contractor, without being duly registered or certified. 13 January 21, 2015 Bruce Fluegeman: • He is the owner and manager of"Naples—A Fireplace Company" doing business as "A Fireplace." • The purpose: to sell factory-made, prefabricated, metal, insulated fireplaces along with the systems that the manufacturers built to vent the fireplaces that require venting. • The company has been in business for 17 years. • The company has never had a complaint or a Citation or lawsuit or any dis- satisfied customers. • He requested that the Board dismiss the Citation issued to his company for Unlicensed Mechanical Contracting, i.e., installing a fireplace and a flue system. • A builder(Phil Steiner) was contracted by a homeowner (Linda Fink) to install a fireplace and flue system. • On September 17, 1913, Phil Steiner came to my office and claimed to be a builder/remodeler. He wanted to buy a fireplace and the venting equipment for a job that he was doing and said that he would install the equipment. • He paid a deposit of$1,500 and the materials were ordered. • Mr. Steiner called the office during the summer of 2014, and stated he did not have the manpower to necessary to install the fireplace and flue system. He asked if we could assist him with the job. • We agreed and the job was completed within a month. • The final installment of our bill was paid by the homeowner. • In November, 2014, we were informed by Ian Jackson, Licensing Compliance Officer, that a complaint had been filed by the homeowner against Mr. Steiner. • During Mr. Jackson's investigation of the builder and the subcontractors, it was determined that my company had been in violation of the County's requirement that a Mechanical license or an HVAC license was necessary in order to install a metal flue pipe on a wood-burning fireplace. • The theory: the fireplace and the flue system are considered as part of the home's ventilation system. • As a result of the interpretation by the County and the City of Naples, only a licensed Mechanical Contractor or licensed HVAC Contractor could install the system. • When the company was started 17 years ago, he inquired with the State, Collier County and the City of Naples concerning which licenses were required to sell the fireplaces which were designated as "decorative appliances." • At the time, he was told that no specific licenses were required. • For 17 years he operated his business and was never told by anyone that any type of license was required other than to install the materials according to the manufacturer's specifications and installation manual instructions which had been approved by several nationally sanctioned testing organizations such as the Underwriters Laboratories ("UL") and the American National Standards Institute ("ANSI"). • During the past 17 years, the fireplaces that we have sold and installed have been installed in accordance with the manufacturer's specifications. 14 January 21, 2015 • We received no communication from the County or the City or the State that a license was required for us to connect a flue pipe on a wood-burning fireplace and no warning as to a Citation if, in fact, a license was required. • We did not know a license was required. • The product is a metal pre-fabricated fireplace with a metal flue system which is sold by the manufacturer as a total system. We are provided with the flue pipe— flue system— and the instructions to install it. • The product complies with the federal and State building codes that oversee fireplaces and flue systems. • He requested the Board to dismiss the Citation since it is the first and only one that we have ever had. • He assured the County and the Board that he has taken steps to avoid any violation in the future by not installing wood-burning fireplaces with flue systems and installing ourselves. • The company will only sell and deliver the product to the homeowner or builder. • We have turned down two or three jobs to install the wood-burning fireplaces since November. • It is a hardship for my business to do this but wood-burning fireplaces are a small part of our business. The majority of the fireplaces are electric or gas- fired. Chairman White asked if licenses were required to install the electric or gas-fired fireplaces. A. The fireplaces are regulated by the State of Florida's Department of Agriculture which requires an LP/Gas License for any connection made to a gas line. He recently found out about the requirement; he applied to the Department of Agriculture and paid the fee for a Class "C" License. He is waiting for a date to take the required exam. Q. My question and concern goes to the venting of the burnt gases. How is that different for a fireplace that is wood-burning versus a gas fireplace? You have taken some action to correct and not repeat the violation which is pertinent for the Board to understand. You would contract to install a gas fireplace but how is that different from the installation of a wood-burning fireplace. A. A wood-burning fireplace and a gas fireplace is that a wood-burning fireplace must be vented vertically through the roof using an approved metal flue system which is insulated and has proper clearances from any combustible material. There are three types of gas fireplaces, the only one which must be ventilated through the roof. The second is called a"direct vent" and can be ventilated to the outside through a side wall of the home. The third type which is the most prevalent in Southwest Florida is called an "unvented or vent-free" gas fireplace and does not require any venting at all. This fireplace burns relative hot and re-burns the exhaust gas that comes off of the fire. Q. Are you saying you would agree to install only the second and third of those types? A. The majority of what we install are the vent-less gas fireplaces and electric fireplaces. 15 January 21,2015 Michael Ossorio referenced County's Exhibit E-9 ("Collier County Business Tax Receipt") and requested that Mr. Fluegeman read the classification description to the Board. A. Code 03900001 —Description: Retail Sales Ian Jackson, Licensing Compliance Officer, presented the County's case. Tom Szempruch, Plans Examiner—Building Department, City of Naples, was called as a Witness to testify on behalf of the County. Ian Jackson questioned the Witness: Q. Mr. Szempruch, could we have your name and position with the City, please? A. Tom Szempruch. I work for the City of Naples as a Mechanical and Plumbing Inspector in Plan Review. My license number is PX2538BN4522. Officer Jackson referenced Collier County Exhibit E-15, i.e., Section 1.6.2.3 of County Ordinance #2006-46. Q. Does the flue system constitute a ventilation system as described in Section 1.6.2.3? A. Yes. Q. Also regulated by the Florida Building Code? A. Yes. Kyle Lantz questioned the Witness: Q. We are stating that a Mechanical Contractor's license is required to install the flue system—correct? A. Correct. Q. Can an HVAC—A or B Contractor do it or does it have to be specifically "mechanical"? A. No., either A or B. Q. But not a plumber? A. Correct. Q. But a plumber could do the gas ... A. ... connection and, if he is licensed, run the gas lines. Q. But they could do the venting of the gas if it were a vented system? A. No. Q. So they could vent a water heater but they couldn't vent a fireplace? A. I don't know if they are allowed to vent a water heater by Code. That would be something that Mike Ossorio would have to address. Terry Jerulle: Q. The venting of the fireplace—does that require an inspection from the County or the City? A. The Florida Building Code requires an inspection. Q. Then it requires a permit? A. Correct, and we inspect it under the mechanical permit. 16 January 21,2015 Chairman White asked the Witness if permits had been applied for in the case before the Board. A. I do not know anything about that—I don't do those inspections. Ian Jackson noted a peunit had been issued for a substantial remodel of the home and stated he assumed that, under the permit, any mechanical aspect of the plans—and part of the Plan Review for this substantial remodel. Chairman White asked Mr. Jackson if he knew who pulled the permit. A. Originally, a third party pulled the peiniit. The primary Contractor was unlicensed and cited. Q. And the permit puller? A. The permit puller had been contracted specifically for that by the homeowner. She hired a licensed Contractor to get a permit and hired an unlicensed Contractor to do the work, or to contract for the work and hire Subcontractors. Q. And it was that unlicensed Contractor that the subcontractor, Mr. Fluegeman, performed? A. The initial payment to "A Fireplace" was paid by the unlicensed Contractor and the balance was paid for by the homeowner. Kyle Lantz asked Mr. Jackson if a Mechanical Contractor had been assigned to the permit and the response was, "Yes, on the permit, as there was electrical and plumbing." Ian Jackson referred to County's Exhibit E-8, the "Contract," and acknowledgement by Mr. Fluegeman that he agreed to assist in the installation of the equipment. His testimony established he had contracted for the installation without being licensed. The County concluded its Case. Richard Joslin questioned the Respondent, Bruce Fluegeman: Q. You have a retail sales company— correct? A. Our company is in the business of selling fireplaces through the retail business and also to builders. Q. But, basically, a retail establishment? A. Yes. Q. You have clearly said through your testimony that you were unlicensed to install this particular fireplace? You needed a Mechanical License to do what you did to continue the contract. A. As I understand it, to sell the product, we do not need a specific license other than the business license from the County. Q. That is correct. A. But I recently learned that to install the flue system, we do need a license. I just learned that. Q. Through your testimony, you are admitting that you did install this particular system on this particular home? A. We did install the flue system and the fireplace. 17 January 21, 2015 Ronald Donino remembered that approximately one year earlier, the same situation was presented to the Board. He stated it appeared that, in the past, the requirement was not enforced for a Mechanical Contractor to install the duct work or the flue system but it seems the requirement is being enforced. Gary McNally moved to approve upholding Citation #09052 as issued. Chairman White offered a Second in support of the motion. Discussion: Terry Jerulle directed his question to Michael Ossorio: Q. The gentleman has been in business for 17 years. Has this Code been enforced for seventeen years? A. I can tell you the definition in Section 489 has not changed. The business tax receipt noted an "open date" of December, 2011 so I don't know if he has been in business for 17 years but the definition has not changed in decades. Chairman White noted the Respondent had adjusted his business practice as it was probably not cost effective to pursue a Mechanical or HVAC license. He outlined his reasons for not requesting an enhancement of the fine: • The Respondent had applied for and was waiting to take the test for an LP/Gas Class "C" License through the Department of Agriculture prior to the hearing to be compliant with the requirement to install a gas fireplace. • Regarding the "Gravity of the Violation"—there was no indication that the installment had not passed inspection. Kyle Lantz directed his question to Michael Ossorio: Q. I don't think you answered Terry's question. You said the Code has been the same. But he asked if it has been enforced the same? What I gathered from the last case and possibly from the case before the Board is that it may not have been enforced. That is relevant to me ... has it been enforced? A. We have issued Citations in the past but the Board only sees a few. In the majority of cases, they come into compliance through abatement or they pay the Citation. If you are asking if we have issued Citations for ventilation systems, of course we have. The Board has seen a couple within the past six months or past year that have petitioned the Board. Every violator is encouraged to petition the Board if they so choose. Q. Are you saying he was lucky for 17 years? It's not like—nobody ever said anything and then, a year ago, it started being enforced? Chairman White noted there was no testimony that there was any other instance where they have installed any flue system without the proper license. Kyle Lantz: But the law has been enforced—is what Michael is saying—it's not a new enforcement. They have been enforcing it consistently—The County didn't suddenly change—it has been consistent in its enforcement. Michael Ossorio: We try to apply the Ordinance as we see it. There is no "selective enforcement" here. 18 January 21,2015 It was noted the Citation was a first offense for the Respondent. If he had pursued obtaining a Mechanical or HVAC license versus changing the business practice, the fine would have been reduced to $300. Chairman White called for a vote on the motion to uphold the Citation and the fine at $1,000. The motion carried unanimously, 8—0. D. Debora Roos —Reinstatement of License (d/b/a: Roos Bros., Inc.) Debora Roos: • Requested the Board reinstate her Irrigation License. • She has been working as an Irrigation Contractor in Lee County since 2004. • Her license was originally in Collier County but she lived in Lee County and was not doing that much business in Collier County after two of her contractors when out of business. • The license was allowed to lapse in 2006. • There is more opportunity to work in Collier County and contractors have requested they do so. • She has maintained her Continuing Education requirement for Arborculture, and Lawn and Ornamental Pest control through the Florida Department of Agriculture and the University of Florida. Chairman White asked Michael Ossorio why the case was brought before the Board. A. If a license is allowed to lapse, the Applicant for reinstatement must retake the exam within three years unless they petition the Board. If the Board finds, through testimony, that taking the exam is superfluous to doing their work. The application of Ms. Roos shows that she has been current in Lee and other Counties for landscaping and irrigation. Michael Ossorio stated the County has no objection to the Board granting her request for a Waiver of the testing requirement. She will pay the last three years of back fees before a license would be issued. Debora Roos noted the backl fees amount of approximately $760 which she agreed to pay. Terry Jerulle moved to approve the application for reinstatement of Debora Roos' license without requiring retesting. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8—0. VII. OLD BUSINESS: (None) VIII. PUBLIC HEARINGS: (None) 19 January 21,2015 IX. REPORTS: • Michael Ossorio noted there was a posting on the website to hire a Licensing Compliance Officer on a temporary basis. He stated the position was for full-time work but without any benefits. X. NEXT MEETING DATE: Wednesday, February 18, 2015 BCC Chambers, 3rd Floor—Administrative Building "F," Government Complex, 3301 E. Tamiami Trail,Naples, FL There being no further business for the good of the County, the meeting was adjourned by the order of the Chairman at 11:17 AM. COLLIER COUNTY CONTRACTORS' LICENSING BOARD PATRICK WHITE, Chairman The Minutes were approved by the Board/Committee Chair on , 2015, "as submitted" F 1 OR "as amended" F 1. 20 To Collier county contractor licensing board From Paul E. Heaton Pertaining to the reinstatement of my collier county contractors license I am asking the board to reinstate my contractors license without re-testing. I have been in this trade since 1985 and have become a very reputable highly skilled finish carpenter/custom cabinet builder installer. I am not a handyman starting out, I am not a plumber, electrician, roofer, tile man. I am not a so called jack of all trades, nor do I wish to be. Just a highly skilled finish carpenter that wants to do what I do best. I started in this business in Ohio at a very young age and in the mid 80s I started my own small company doing finish carpentry work and that is what I have been doing from then to this present day. I moved to Naples FL. In April 2005. I purchased all necessary books, paid all fees due, tested and became a licensed, incorporated, insured contractor in collier county. Followed all rules and restrictions and was doing well until the crash that affected myself and many others. I was fortunate enough to have work to return to in Ohio in August 2006.Oporating under my Ohio corporation Kyle construction inc. Established in 1985 as Quality crafts carpentry. In 2007 the depression has affected the Ohio work force drastically and I was forced into the decision of filing for bankruptcy as you will see in my credit report. We have just returned to Naples in May 2014 and would like to make Naples our permanent residence. After returning I have realized that without my license it is very difficult to find work in my trade that pays a livable wage. Therefore due to my experience in this trade I am asking the board to please consider waiving the test and allowing me to reinstate my contractors license. This will be an S- corporation operating under the Florida registered name Kyle's finish carpentry inc. I will be the sole proprietor with no partners or other parties involved. Thank you Paul E. Heaton I have enclosed my resume for references and a little work history about myself I will turn 51 in April and with my new physical limits, and wear and tear over the years from doing what I do I would like you to know what I am looking for. I am not looking to start a big business with employees, I am only interested in being able to conduct business and do what I do legally in Collier county. I am a very honest trustworthy man that feels I have paid my dues to this trade and deserves to earn a livable wage doing the services I will be offering. Doing small jobs, helping and guiding residents that like to do the work them selves but need someone with the proper tools and knowledge. You will not see me bidding on complete trim jobs, which is what I have been doing for so many years. I will be looking for small light weight jobs that the big companies don't want. I am not looking for that pot of gold anymore,just trying to make a livable wage legally. With my new permanent injuries ( 2 torn rotator cuffs) it is going to be very difficult to find work that pays a livable wage in today's economy. Yes I know my limitations and my capabilities what I can and can't do, now to apply for a job and tell the employer my limitations no one is going to hire me. I am aware of all fees and cost to reinstate my license and will abide by all rules and regulations as per state and county. Your consideration for my license re instatement would be greatly appreciated Thank you Paul E. Heaton Paul E. Heaton 44 Sonderhen dr. Naples FL. 34114 Cell 216-287-5068 pheaton111496@gmail.com Objective To be a team player/leader using my many finish carpentry skills. More than 28 years experience in high end finish carpentry, design, on site build and install, new construction, residential and commercial remodeling. Crew leader Minor plumbing, electrical, and painting skills. Custom cabinet building/installations Complete interior trim, install, replace, repair Commercial carpentry. Heavy equipment operator.bulldozers, backhoes, bobcats, track hoes and trucks Own tools and reliable transportation. Photo portfolio of past projects I have been in the construction field most of my life. And have completed a variety of task. I am a very neat , clean respectable person. I take pride in my workmanship and believe a happy team player is a happy team worker. Work history For the past 28 yrs. I have been a self employed carpenter. Although my specialty is high end finish carpentry/cabinet design and build I am capable of many other skills as listed above. Your consideration for this position would be greatly appreciated. Thank you and have a wonderful day. References Joseph S. Fazekas Dan Ritosa 216-382-0177 Rinos woodworking shop Present client Present client 440-567-6507 Chris Parker Mark Murphy LLC Absolute roofing client The Parkerbilt corp. 216-337-9672 239-572-0001 Mike Harris Friend/client 10 years 330-577-6147 THANK YOU PAUL E.HEATON Ca ie-Y Go uYtty IM 5 137Til JAN 28 2015 GMD Operations & Regulatory Management Licensing Section BY, 2800 North Horseshoe Drive olc7 5 Naples, FL 34104 J 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: A L E S F 1 I-)/SH ?AtePECJi 2y; r C. Fiction Name/DBA: Qualifier Name: PC\J-1 E - P� Physical Address: LP /S 0^)DE:2J# r' p1e, /Mac FL, 3/0111 (Number & Street) (City) (State) (Zip Code) Mailing Address: y 4 SO/-"O HCN D/? /V AioLgS FL, 31f//L( (Number & Street) (City) (State) (Zip Code) Telephone: 9-- b -��' I L'' ` ` / —5 J E-Mail: Fff£°1-0A� 1 f( L((1"/E-(�� i-1r� .L1J, TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing n $230.00 CI Specialty $205.00 Specialty trade: Cabo i ylstit7( �• 7/15/2014 Reinstatement Fee=$205.00 CI ANGE OF STATUS: 3 Back year fees= 5555.00 (�//) Reinstatement ( ) From One Business to Another 2014-15 Renewal Fee=$125.00 'DiITerent fees may aapIv' Total=$885.00 1 to C D p( �, 07.131) Page 1 of 4 �.'4 rent few Z4-10711 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. P40L x.frJEfi1op3 / L S IOL.N' yL/ Uo,vdE2HE ©re'.. ft)AIL- 3 }!L, `3 4//1 q ,9-/6- - 7 5.06V 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. fl yt.- (:.i_V it,,;%2°e l 04, N�/ 3.ist 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. i✓U \J AFFIDAVIT I, PAO� k... //F/for.) certify that the foregoing is true al e correct to the best of my knowledge. 'I Authorized Officer of the Firm STATE OF FLORIDA( 11 COUNTY OF The foregoing instrument as acknowledged before me this / 1 )1---)4.---: (Date) / --�- By �1 (Ll vi 1-1,7,44, of ki-j te—. 3 Yk 64c7, C t) -Ll�c. (Name of officer, title/agent) (Name of Corporation) a '41)'1 , Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced et ' t?L5 )1 ci✓1X' identification and did not take an oath. (Type of identification) NOTARY'S SEAL „ , ,, / , __. /),A,t ”'", GINA M LOSifiACCO •IGN4 TURE +1 N ARY) d - 'Z: Notary Public. State of Florida • ,V ' M, Co, ■n Expires Oct 15 20!F ( emission M f 134591 Page 2 of 4 QUALIFIER INFORMATION: Name: Pi) E, -Iro t Address: yy SrO,'UDL2t-/t A DR, ,/i)l)pL 6 FL , 3101i/ (Number& Street) (City) (State) (Zip Code) Telephone: 0--/6- .-e`7 6-0 6k Date of Birth: y// /641 S.S. #: 000-00 / E-Mail: Ph E' el 1oh/i/y 16 6q7.N7,4/6.ear- Driver's License: 1. Type of Certificate of Competency for which application is made. CiV?i,v�? //1-1 /5/-f /'PE7-r-i%2V .A.i/LLu..)(2,€/1- 'N.r>e)/ 1 T/0, 2. The names and telephone numbers of two persons who will know your whereabouts. ZH1 /Si/A/L HtA7o/,-i 330) - z/61 - 033a / yLE / ti 70 ,9- /6 — 33 1 ` L-) 3 0 3- 3. Have you ever been convicted of a crime related to Contracting? /t/0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? >'6i 8. ist all debts you or any company(s) associated with you refused or failed to pay and reasons why. r-1 p n 7 6 0(.L 1 6i.2F D e7 L'42 OS , u,1_, AApL oyEt, 1 DL 't 4 5/u 9. List your business or work experience during the past ten years. r-l."...)i,9i Gt I3 /vrel /,-t law()R f> (-Y-6!.A/- /icC:- 1'4.-,S%,9/4 T/ 0 ', 10. '.tatement of any formal training you have had in the area for which the application is made. tj y /z5 , .4S ,4 i/,v/S i (1470G N 7(/',9/3/Ai l Po,- iz Page 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. Pool- E. H A TO/ APPLICANT (PLEASE PRINT) IS'y ES r/it•1SH :At'ep lyre/ NAME • COMPANY SIGNATURE OF APPLICANT STATE OF FLORID/9(1 /1 COUNTY OF (( ky The foregoing instrument as acknowledged betore me this / (Dat By (1-64 1 �`' ' who has produced G Y I fir , (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL ,� /1L. 6/- (&;,?. "',`; GINA M. LOSTRACCO (SIGNAT - •F NOTA ) • �l�• s Notary Public-Stale of Florida �•4( My Comm. Expires Oct 15. 2016 Commission # FF 1345C6 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. ,/lf2 SIGNATURE OF APPLICANT Ky t 6$ I sit (I At IDE 1"iC BUSINESS NAME / //fir //5 DATE BEFORE ME this day personally appeared )-4qA dr) who affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLO II�A COUNTY OF di I D�r The foregoing instrument was acknowledged before me this 146 6 // _) `J(DA.te_) by /� ft�c �` who has produced C� ✓1 vY5 I; (name of person acknowledging) (Type of identification) as identification and who did not take an oath. /'/G / �'�� SIGN 'U E OF NOTARY /l 'ATI NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC ... GINA M.LOSTRACCO • t ^Notary Public -State of Florida 1 �i,; 1y Comm Expires Oct 15 2018 Cnmm-st.nn a Fr 11Ic-r 4 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER 1, CN2■sroPlt.et M. P4LC t , am a resident of eD«iEa County, riot'Na (State) and have resided here for more than five (5) years. During the last five years I have known P4vi. E. PE61O) (Applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) 1,/// (Name) eNal5rOPNE.7M. Atvg-4, Jot (Address) Tr (Address) C.7. /tJ4puS , r� vista Telephone) 23i-S72'COO I STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this / G>/' -,.,) /' I by / ( ate) f' �' (f"'"?---."--- .c-.. G- �f'i S ' � ��" � ��'��`" who has produced /� �C (name of p rson acknowledging) (Type of identification) as identification and who did not take an oath. ("--------; Y P ` __�_, C..» p °°r, DASHIEL BLANCO �Z-�, t y,,l = MY COMMISSION#FF065166 'SI�NATUR OF NOTA Y ! r '''"e,,, ,,` EXPIRES November 3. 2017 r! (407)398.0153 Florida NotaryService.com - _ ; NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC IVERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: AUL c- J7(r4?dJ Certiticate Category Requested: rNtSkte0 (ARA�'x►ta."( e 61tvtr -4-Ncmtech The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker (e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the person signing below and verifying Applicants relevantexperience: Name: H013TOONc& A. I'Art/Cg/R Title: PQeS Licensee Number(if applicable): C(3C. I2S�.5ti8 Name of Business: 146 f AtJeF�4vie.T co., L te... 4► oz Business Address: S79.7 e dRSfi NE CT, Business Phone: 219-S72-000 I The Applicant's years of experience from ��I' 1 c /1 to .20/ r The applicant's scope of work (specific duties) included: !-1 4C 4 SPECTS 64-7 roJISNED eA APiwrRY r/Z4A4I:ad/ LAif0Ear2Yl evgtotit 6vit,ir - INS' ,11412 Uv,cotoc, , TtIM rivet 2 S?Ao if44-5) WINnoto Sj w 000 Ftoo2,,U4 . Additional Comments: D'Atlt. HAS 00,6 wna,c POt ME fHE PAST 19 `?C4L . FINO AWL Re-SPotosi6c6 4r.,0 An' eXCGU.ENT C44.96P)tV2 . Falsifying any information provided herein may subject your license to revocation. / ,' Signature Pint Name: / ICS JD/# r L / " ,ofrbee State of Florida County of Collier , The of e_om� insru ent was acknowledged before me on this f' day of c C \,l.L,,C' C.'1 C' ° by �-f'‘''".')' <Li 4' 13 ,. �, (,',( :.,,,srvho is personally known to me or p , duced V-c N 11\:,\----f- L;---f t-<\c.t--` , \ , identification and who did not take an oath. '�1 as n Y ,w DASHIEL BLANCO Sianaitrr o -Notary MY COMMISSION #FF065166 `"° "0Rt`,? EXPIRES November 3 2017 {407)398-0153 FloridallotaryService.c0m gli Qualifier c=r I LE. e°=:, ; Qualifier No First Name Middle Name Last Name Postfix I 27525 P4UL [E. 1HEATON 1------- �_ Detail Addresses Associated Tables I Update Info 1 .F ■ 1 [ID No. Description Exam Date Score Location Sponsor . a 1 Certificates 1 Examinations m _ =..: �-.._ ..,.-..__. -- --_._.._._,rte. =r-� _�� __...�.. 1 Record(s)- Examinations Thursday, Jan 08, 2015 01:18 PM STATEMENT OF OWNERSHIP This certifies that I, pc (> 1_ F. /1 / 10' -1 am a member or (APPLICANT'S NAME) Managing member of }sYLF F/f✓%sH Lt4/ef'E-/,-)7.2y fNC. . (LIMITED LIABILITY COMPANY NAME) I own /0 d % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. (PRINT NAME) ,7„; • (APPLICANT'S SIGNATURE.) / '< (DATE) 8bo-617-63131 9/16/2014 1 : 27 : 41 PM PAGE 1/001 Fax Server 0,4*W&I September 16, 2014 FLORIDA DEPARTMENT OF STATE Division of Corporations KYLE'S FINISH CARPENTRY, INC. 44 SONDERHEN DRIVE NAPLES, FL 34114 Qualification documents for KYLE CONSTRUCTION, INC. doing business in Florida as KYLE'S FINISH CARPENTRY, INC. were filed on September 15, 2014 and assigned document number F14000003894 . Please refer to this number whenever corresponding with this office. Your corporation is now authorized to transact business in Florida. This document was electronically received and filed under FAX audit number H14000216481. To maintain "active" status with the Division of Corporations, an annual report must be filed yearly between January 1st and May 1st beginning in the year following the file date or effective date indicated above. If the annual report is not filed by May 1st, a $400 late fee will be added. A Federal Employer Identification Number (FEI/EIN) will be required when this report is filed. Apply today with the IRS online at: https: //sa.www4 . irs.gov/modiein/individual/index. jsp. Please notify this office if the corporate address changes. Should you have any questions regarding this matter, please contact this office at (850) 245-6052 . Claretha Golden Regulatory Specialist II New Filing Section Division of Corporations Letter Number: 114A00019805 P.O BOX 6327—Tallahassee, Florida 32314 UNITED STATES OF AMERICA STATE OF OHIO OFFICE OF THE SECRETARY OF STATE I, Jon Rusted, do hereby certib, that I am the duly elected, qualified and present acting Secretary of State for the State of Ohio, and as such have custody of the records of Ohio and Foreign business entities; that said records show KYLE CONSTRUCTION, INC., an Ohio corporation, Charter No. CP12100, having its principal location in Maple Hts., County of Cuyahoga, was incorporated on March 16, 1998 and is currently in GOOD STANDING upon the records of this office. Witness my hand and the seal of the "ils4�"��E:T<1�j Secretary of State at Columbus, ()Ili() I . , ` ►1��.0i..`''` this 15th clay of September, ,a.D. ..: 2014. `t is.`t""'�'i`^ h(74.46&"/,.:- 0......, 4 k.. .,,, -&-a-1,■ ,-% Ohio Secretary of State Validation Number: 201425801341 H 11 uo0 ' APPLICATION BY FOREIGN C'ORPORXTION FOR AUTHORIZATION TO TRANSACT BUSINESS IN FLORIDA CO:IIPLLAVC'E iT7TH.SEC'TION 60".150 . FLORIDA STAPTES. THE FOLLOiTT: GLSSLB1IITTED TO REGISTER A FOREIGN CORPORATION TO TR-I VSA CT BE TS'INE.SS IN THE STATE OF FLORIDA. KYLE CONSTRUCTION, INC. 1. (Enter name of corporation: must include "INCORPORATED.- "COMPANY.- "CORPORATION_.. "Inc.." "Co.." "Corp." "Inc." "Co." or"Corp.") Kyle's Finish Carpentry, Inc. tIf name unavailable in Florida.enter alternate corporate name adopted for the purpose of nansactirfa business in Florida Ohio 34-1870176 Stare or country under the law of winch it is incorporated) tFE1 number. if applicable) 3/16/1998 Perp_ etual 4. �. 'Date of incorporation) Duration: Year corp. will cease to exist or'perpetual'') Upon Qualification. 6. (Date first transacted business in Florida. if prior to re.eistrationl (SEE SECTIONS 607.1`01 & 60--15U_.F.S.. to determine penalty liabihtr) 44 Sonderhen Drive, Naples, Florida 34114 )Principal office address) 44 Sonderhen Drive,Naples, Florida 34114 Current mailing address All lawful business S. Purposes) of corporation authorized in home state Of Corllitry To be carried out in state of Florida i 9. Name and street address of Florida registered agent: i P.(1). Box NOT acceptable) Name: Paul E. Heaton 44 Sonderhen Drive Office Address: Naples 34114 . Florida (City) (Zip code) 10. Registered agent's acceptance: Having been lift)11ed as registered agent and to accept service of process for the above stated corporation at the place designated in this application, I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relative to the proper and complete peifori►►ance of my dl/lies, and I(lm familiar with and accept the obligations of ml'position as registered agent. (thil zi i Re_i>rered a_e1rt', si_rrature i I I .Att icliecl CCititieate of ex1,tcn e duly alltileilticated. not 111010 than 00 +.lav pmioi to delrveiv of this application to the Depait111elit of State. i)w" the Secietatv Of Stare at otlmai official ha':1112 C11htodV of corpaiate records in the ltlli,rlictic'11 under the law at which it is incorporated. 7// i)i,r /' ms's'/ :.3 i��()'}/ '70' / 7 ' ' `` ' L� 12. T. xue` and bu;be* odJessesn[officers and o/ Jju�nv,� A. DIRECTORS Chairman: Address: Vice Chairman: Address: Paul E Heaton Director: 44 Sonderhen Drive Naples,Florida 34114 Address: Director: Address. B. OFFICERS Paul F. 1-Icaton E�es/Jeu/: 44 Svndcrhoo Drive,Naples, Florida orn 34114 u ^a , u Paul F. Ileaton Vice p`esuuu: 44 Sonderhen Drive Naples,Florida m ^^ c*: � Pnu| E Heaton Secretary: � 44 Sonderhen Drive, Naples, Florida 34114 Addke`s. Paul F. ||ruoo Tuu^un^c AJdc,,s 44800durhcn Drive, Naples, Florida]4| |4 NOTE: If necess . ou may attach i cesi . ou niav attach an addendum to the application additional officers and ocJirecr"u jo-t13 / Sienantie of Director or Officer The uUiccc/u . ecKnv.2u/u2 tins doctuneiit and who is listed in number 12 above' nLbouu that the facts stated herein ale nue and that he or she is 1,,vare that false infoimation ;Omitted in a doonnent to the Department of State constitutes a |hu1dc:arre felony as provided for iu ��S�- |�� [5. Paul E. Ucuu , President | i Typed"/ pinned name and c^ynury,(yu`"u /�� 'l/ .' / /�/� ` ' ^ "' _. Detail by Entity Name Page 1 of 2 Lt. .y ,.F',i::'"G`.'�PFi.+M:ue11S "�fi. '..a.SCMiet a'°Iif.` �;3i4'.'6. ',.„A�.«�,.�',£ 'k"�`21FidC. .'y'�alZ9tlF.7`..'#' 5. V ,`�A,•.,,+ , t . +LORI A D&PARTMENT OP S�TAT$ 14 -, .aG �� sratas xa�ssaa acswva W �xxart at . n r,: t i ri� ruv s IVISIQ. 01 cQRPt RA IU1MS o' :1/4 d r Detail by Entity Name Foreign Profit Corporation KYLE'S FINISH CARPENTRY, INC. Cross Reference Name KYLE CONSTRUCTION, INC. Filing Information Document Number F14000003894 FEI/EIN Number 341870176 Date Filed 09/15/2014 State OH Status ACTIVE Principal Address 44 SONDERHEN DRIVE NAPLES, FL 34114 Mailing Address 44 SONDERHEN DRIVE NAPLES, FL 34114 Registered Agent Name & Address HEATON, PAUL E 44 SONDERHEN DRIVE NAPLES, FL 34114 Officer/Director Detail Name & Address Title PVST HEATON, PAUL E 44 SONDERHEN DRIVE NAPLES, FL 34114 Annual Reports No Annual Reports Filed Document Images 09/15/2014 _ Foreign Profit f View image in PDF format 1 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail'?inquirytype=Entity... 1/8/2015 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE „e IMPORTANT STATE OF FLORIDA il°�=w Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation 1 who elects exemption from this chapter by filing a certificate of DEPARTMENT OF FINANCIAL SERVICES � t��;€�-,; � '. sin• P election under this section may not recover benefits or DIVISION OF WORKERS' COMPENSATION • 4 ....1:!" = • F compensation under this chapter. CONSTRUCTION INDUSTRY EXEMPTION 0 CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to WORKERS'COMPENSATION LAW D be exempt...apply only within the scope of the business or trade EFFECTIVE DATE: 11/4/2014 EXPIRATION DATE: 11/3/2016 listed on the notice of election to be exempt. PERSON: HEATON PAUL E H Pursuant to Chapter 440.05(13),F.S., Notices of election to be FEIN: 341870176 E exempt and certificates of election to be exempt shall be BUSINESS NAME AND ADDRESS: ,R subject to revocation if,at any time after the filing of the notice KYLE'S FINISH CARPENTRY INC E or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this I section for issuance of a certificate.The department shall revoke 44 SONDERHEN DR, a certificate at any time for failure of the person named on the NAPLES FL 34114 certificate to meet the requirements of this section. 1 SCOPES OF BUSINESS OR TRA CARPENTRY INSTALLATION OF CA DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 Detail by Entity Name Page 2 of 2 http://search.sunbiz.org/Inquiry/CorporationSeareh/SearchResultDetail?inquirytype—Entity... 1/8/2015 ------• rtD DATE(MM/DD/YYYY) ACORIJ CERTIFICATE OF LIABILITY INSURANCE 11.......--" 1/27/2015 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: JACOBS INSURANCE SERVICES LLC PHONE FAX INCA°.Extl (A/C,_N1_ 12644 TAMIAMI TRAIL E EMAIL ADDRESS: NAPLES FL 34113 INSURER(5)AFFORDING COVERAGE I—_ NAIC# (239)908-6855 (239)234-5205 INSURER A: FEDERATED NATIONAL 1 INSURED INSURER B:KYLES FINISH CARPENTRY, INC. I INSURER C: INSURER D: 44 SONDERHEN DRIVE - INSURER E NAPLES, FL 34114 t-- INSURER F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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 ADDLjSUBR j POLICY EFF POLICY EXP LIMITS LTR GENERAL LIABILITY E OF INSURANCE W INSR POLICY NUMBER (MM/DD/YYY ) (MMIDD/YYYY)i EACH OCCURRENCE $$1,000,000 _. 1 CLAIMS-MADE OCCUR DAMAGE TO RENTED ✓ 'COMMERCIAL GL-0000026166-00 01/28/2015 PREMISESLEaoccurrencee)--- $$100,000 COMMERCIAL GENERAL LIABILITY I _ 01/28/2016 I MED EXP(Any one person) $$5,000 ---{ PERSONAL&ADV INJURY I_$$1,000,000 I GENERAL AGGREGATE $ $_2000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $_$21000,000 POLICY PRO- LOC $ J i I ( , COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY TY I � (Eaaccidentl ---.... % S ANY AUTO ; BODILY INJURY(Per person) $ ( 1i ALL OWNED I- —1 SCHEDULED AUTOS L AUTOS BODILY INJURY(Per accident) $ NON-OWNED I PROPERTY DAMAGE $ �� HIRED AUTOS AUTOS ;-LPer accidentl___ 1 , 1 I I $ OCCUR EACH OCCURRENCE $ EXCESS ABAB I CLAIMS-MADE, I AGGREGATE $ r- - ---- I DED 1 --_ ... --- --....... 1 RETENTION$ I $ AND WORKERS COMPENSATION EMPLOYERS'LI A LIABILITY OBY LIMITS___ LER._ AND EMPLOYERS'LIABILITY - - -ANY PROPRIETOR/PARTNER/EXECUTIVE El,EACH ACCIDENT 10TH-1 $ OFFICER/MEMBER EXCLUDED? YIN N I A - - --_-- -_-__-- If M1ESCRIPTION OF OPERATIONS below I, I E.L.DISEASE-POLICY LIMIT $ . I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) THIS IS AN ADDITONAL INSURED CABINET AND MILLWORK INSTALLATIONS CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY CONTRACTOR LICENSING BOARD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N HORSESHOE DR NAPLES, FL 34104 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I t ,fir ; • Cpl2ier County I City of Marco/ City of 7 ..:? n m ;�V �., P CABINET T23 fr , P .urt Nbr:2$362 Exp:4/30/2 ''01 +' dtus:ACTIS�^ ` 4EATD*F ;; F' c 44 SONDEiCNEN DR :"fate Nbr: Exp xr ,i to ' '.NAPLES,PL.34z1J-mac RYLES FINISH CAIi TRY PAUL E. HEAT01�'� � ��."��a t'�'re1 '?� SEi?�Y3t G{-,�.2¢+!#tN#;" 3 56 HENDERSON DR 04t02f3 NAPLES ' ' #e �%3 4 4- t Signed: o 1 ~re _ " L LEE COUNTY' ' CERTIFICATE OF COMPETENCY (239)344-5895 NAME:PAUL E HEATON D/B/A KYLES FINISH CARPENTRY INC LICENSED FOR: Finish Carpentry Cntr COMP. NO.: F11105-00689 N MALID !3012006 i gignature of License Holder File Number: 350301413 y `/ Date Issued: 01/19/2015 TransUnion.. -Begin Credit Report- Personal Information You have been on our files since 04/01/1984 SSN: Date of Birth: Names Reported: PAUL E.HEATON Addresses Reported: Address Date Reported Address Date Reported 44 SONDERHEN,NAPLES,FL 34114 05/17/2005 8770 WADSWORTH RD,WINDHAM,OH 44288-9750 56 HENDERSON DR,NAPLES,FL 34114-8232 09/26/2005 Telephone Numbers Reported: (330)326-1223 (330)326-1250 (216)287-5068 Employment Data Reported: Employer Name Date Verified Position KYLE CONSTRUCTION 06/14/2004 OPERATOR SELF EMPLOYED 01/30/2004 CARPTER HELLIOTT CORP DBA Q 11/01/1997 QUALITY CRAFT CARPENTRY 03/01/1993 public Records OHIO FEDERAL COURT-AKR Docket#: 750576 (2 5 MAIN ST,AKRON,01-144308,(330)252-6100) Date Filed: 02/28/2007 Type: CHAPTER 7 BANKRUPTCY DISCHARGED Court Type: Federal District Date Paid: 06/25/2007 Responsibility: Individual Debt Plaintiff Attorney:C BAILEY CLEGG Date Updated: 06/26/2007 Estimated month and year that this item will be removed:01/2017 - Account Inforrnat oo .. „ Typically,creditors report any changes made to your account information manth(y.This means that some accounts listed below may not reflect the most recent activity until the creditor's next reporting This information may include things such as balances,payments,dates,remarks,ratings,,;etc.The key(s)below are provided to help you understand some of the account Information that could be reported Rating Key Some creditors report the timeliness of your payments each month in relation to your agreement with them. The ratings in the key below describe the payments that may be reported by your creditors.Any rating that is shaded indicates that it is considered adverse, Please note:Some but not all of these ratings may be present in your credit report N R X OK 30 fJ 9ft 12 'CQ -VS 1R :C [FC.I - Not Reported j: Unknown Current 30 days late 6Q days late 90 days tate 120+, d d ay s Collection sVatunta urrendety r I Repossession Charge Off Foreclosure' g Adverse Accounts O OCWEN LOAN SVCG LLC#719506**** (1661 WORTHINGTON RD,STE 100,WEST PALM BEACH,FL 33409,(561)682-8000) Date Opened: 05/05/2003 Balance: $0 Pay Status: >Account Included in Bankruptcy( Responsibility: Individual Account Date Updated: 03/31/2014 Date Closed:03/31/2014 Account Type: Mortgage Account Last Payment Made: 03/04/2010 Loan Type: CONVENTIONAL REAL ESTATE MTG High Balance: $148,000 Remarks:>CHAPTER 7 BANKRUPTCY(;CLOSED Estimated month and year that this item will be removed:02/2021 Satisfactory Accounts CAPITAL ONE/YAMAHA#17664190038**** (P 0 BOX 30253,SALT LAKE CITY,UT 84130-0253,(800)695-6950) Date Opened: 03/03/2003 Balance: $0 Pay Status: Current;Paid or Paying as Agreed Responsibility:Joint Account Date Updated: 07/12/2007 Terms: Paid Monthly Account Type: Revolving Account High Balance: $0 = Loan Type: CHARGE ACCOUNT =—..- Remarks:ACCOUNT CLOSED BY CONSUMER 1 06/2007 1 05/2007 1 04/2007 03/2007 1 02/2007 1 01/2007 12/2006 11/2006 ! 10/2006 1 09/2006 08/2006 07/2006 AMMO „- Rating , OK II OK;t , OK OK 11. OK 1(OK 1 OK 1( I OK 11 ` OK i OK OK I L OK To dispute online go to: http:J/transunion.com/disputeonline P 460L0-002 01219-1011058 04/1 rage: 1 01 3 Consumer Credit Report for PAUL E.HEATON File Number:350301413 Date Issued:01/19/2015 06/2006 05/2006 04/2006 03/2006 02/2006 1 01/2006 12/2005 11/2005 10/2005 ! 09/2005 08/2005 07/2005 Rating I OK 1 [ OK roK-] Toil [ 0KI r01—(-1 [OKl [010 [Oid [OK] [Oil [ OK 1 1 06/2005 05/2005 1 04/2005 03/2005 02/2005 01/2005 12/2004 11/2004 10/2004 09/2004 08/2004 07/2004 Rating 1 1 OK] [ OK 1 [OK] 1 :111 [OK-] [ OK1 j [ OK] [01(1 [OK] rOK] [OK] 1 OK 1 06/200 05/2004104/2004 03/2004 02/200101/2001112/200111/2003 10/2003[09/2003108/2001 07/2003 06/2003105/2003 04/200 03/20031 Rating ] I OK 1 J OK] LOK]�_roc [OK 1 Lots] 1 OK] [ OK [ lox] 1 OK 1 [ OK I 1OK 1 [ OK] 1 rOK] [ OK ] [OK 1 SYNCB/JC PENNEY# ***(PO BOX 965007,ORLANDO,FL 32896-5007,(866)227-5213) Date Opened: 12/13/1999 Balance: $0 Pay Status: Current;Paid or Paying as Agreed Responsibility:Individual Account Date Updated: 12/25/2014 Terms: Paid Monthly Account Type: Revolving Account Payment Received: $0 Date Closed: 03/13/2005 Loan Type: CHARGE ACCOUNT High Balance: $0 Credit Limit: $200 Remarks:CLOSED BY CREDIT GRANTOR;CLOSED 11/2014 10/2014 1 09/2014 08/2014 1 07/2014 06/2014 05/2014 04/2014 03/2014 1 02/2014 1 01/2014 12/2013 Rating [ 0K1 [OK I 1 OK [ 1 OK] 1 OK] [ 011 [—OK 11 LOK 1 [OK] [ OK (] roc [ OK 1 11/2013 10/2013 09/2013 1 08/2013 07/2013 06/2013 1 05/2013 04/2013 03/2013 02/2013 01/2013 12/2012 Rating 1 [ OK 1[ 1 OK] [OK7 [OK] roc rOKI 1 OK [ [ OK] I OK] 1 OK]( [ OK] I OK ] 11/2012 1 10/2012 09/2012 1 08/2012 07/2012 06/2012 I 05/2012 1 04/2012 03/2012 02/2012 01/2012 12/2011 Rating I [ OK 1[ , OK 1 I , 01]1 (OK 1 i � [ 010 OK] [OK ] [ OK] 1-01(1 [OK]] [OK] [ OK] 11/2011 10/2011109/2011 08/2011107/2011106/2011105/2011104/2011103/2011102/2011 01/2011112/2010,111/201 10/201 09/201d 08/2010 Rating [01] I [ OK 1 [ OK 1 1 OK 1 ( [O K-] [OK [ [ OK 1 I OK] I O K [ [ OK] [ OK 1 1 011 [ OK 10K I [ [No rOK 07/201 06/2010105/20101 04/201 03/2010102/201 01/2010112/2009 11/200 10/2009109/2009108/2009107/2009106/2009 05/200 04/200 Rating [OK]l 1 OK ] [OK 1 [ OK 1! [OK ] [OK] [OK [ 1 [ OK 1 I OK 1 1 OK-I 1 OK1 1 OK] [01 1 1 OK 1 _[_OK [ [-OK 1 I 03/2009102/2009 01/2009(12/200 11J200 10/200 09/2008108/200807/2008106/200 05/2008104/200 03/200 02/200 Rating [OK 1 [ [ 01( 11101( 111 OK 1 1 OK]8] [ OK I [ OK ( ( OK] 1 [ OK] I IOC� F01] [ roK1 [-Oki (-OK 1 SYNCB/JCPENNEY# Balance: $0 Pay Status: Current;Paid or Paying as Agreed Responsibility:Individual Account Date Updated: 12/26/2014 Terms: Paid Monthly Account Type: Revolving Account Payment Received: $0 Date Closed: 04/05/2007 Loan Type: CREDIT CARD Last Payment Made:06/05/2005 Date Paid: 06/05/2005 High Balance: $1,047 Credit Limit: $7,250 Remarks:CLOSED BY CREDIT GRANTOR;CLOSED 11/2014 10/2014 i 09/2014 , 08/2014 07/2014 06/2014 1 05/2014 04/2014 03/2014 , 02/2014 01/2014 12/2013 Rating I OK 1 [OK 1 ro 1 1 OK] [ OK 1 [OK[t [ OK] [ OK] 1 OK I [ OK [ OK] 1 OK II 11/2013 10/2013 09/2013 08/2013 07/2013 1 06/2013 05/2013 04/2013 03/2013 02/2013 01/2013 12/2012 Rating 1 OK] [ OK I I OK ]] 1 OK[ 1 01(11 1 OK] 1 OK 1 1 011 1 OK] [OK] 1 OK] 1 OK I{ 11/2012 1 10/2012 1 09/2012 1 08/2012 1 07/2012 06/2012 1 05/2012 04/2012 03/2012 02/2012 1 01/2012 1 12/2011 I Rating [ OK]l [ OK]I 1 OK 11 [ OK 1! [OK] [OK [1 1 OK]1 [ OK]] [OK_] [ OK][ 1 OK[[_. [OK ] 11/2011 10/2011109/2011108/2011 07/201 06/2011105/2011 04/2011 03/201 02/2011 01/201 12/201 11/2010110/2010109/2010108/20101 Rating j OK 1 1 OK 1 I OK 1 1 I OK] 1 I OK 1 [ OK I I [-OK] [ ] OK] 11 OK][ [ OK] [OK 1 I [ OK] [OK ] 1 r 01(] I [01(1 1 1 OK 1 07/20101 06/2010105/2010,04/2010i 03/2011 02/2011,01/2010 121200. 11/200 10/2009 09/2009 08/200 07/200 06/2009 05/2009 04/200 Rating I OK_1 t OK] [OK1 I 1 OK] [ [OK] I [ OK 1 [_OK 1 [ OK ] [ OK 1 [_OK 1 I I OK] 1 OK 1 I OK 151 03/200 02/2009101/2009 12/200811/200 10/2008 09/200 08/2008107/200 06/2008 05/200 04/2008 03/200 02/200 Rating ,_[OK] 1 1 OK] ] [01(111 OK] 1 1 OK] [ 1, OK1 [ 1 OK 1 I 1-OK 1 1 O K_] I OK I 1 OK J [ OK] [ OK ] [ [OK 1 US BANK# *** (425 WALNUT ST,CINCINNATI,OH 45202-3923,(800)8/9-1397) Date Opened: 01/05/2004 Balance: $0 Pay Status: Current;Paid or Paying as Agreed Responsibility:Joint Account Date Updated: 04/30/2005 Terms: $193 per month,paid Monthly for Account Type: Installment Account Payment Received: $193 36 months Loan Type: SECURED Last Payment Made:04/08/2005 Date Closed: 04/30/2005 High Balance: $5,698 1 03/2005 1 02J2005 01/2005 1 12/2004 11/2004 1 10/2004 J 09/2004 08/2004 1 07/2004 I 06/2004 1 05/2004 04/2004 Rating i. I OK OK 1 I OK j] [ OK] 1 OK] [ OK]1 i OK 1 [OK I 1 ( O K i L I OK 'i I OK] 1 OK 1 1 03/2004 1 02/2004 Rating 1 [ OK'1 I OK 1 I Promotional Inquiries PROGRESSIVE INSURANCE(PO BOX 43258,RICHMOND HEIG,OH 44123,(216)732-3038) Requested On: 12/09/2014 To dispute online go to: http://transunion.com jdisputeonline P 460L0-002 01219-1011059 05/10 Page: 3 of 3 Consumer Credit Report for PAUL E.HEATON File Number:350301413 Date Issued:01/19/2015 MERRICK BANK(10705 S JORDAN GATEWAY,SUITE 200,SOUTH JORDAN,UT 84095,(800)253-2322) Requested On:09/02/2014,03/05/2014 THE HARTFORD(8 FARM SPRINGS RD,FARMINGTON,CT 06032-2526,(888)413-8970) Requested On:08/15/2014 WEBBANK/FINGERHUT(6250 RIDGEWOOD ROA,SAINT CLOUD,MN 56303,(866)734-0342) Requested On:04/10/2014 Acc O un R� 4e lntuire5 PAUL HEATON via KARMA/TRANSUNION INTERAC(100 CROSS STREET,SAN LUIS OBISP,CA 93401,(805)782-8282) Permissible Purpose:CONSUMER REQUEST Requested On:01/16/2015 ALLSTATE(1819 ELECTRIC RD,ROANOKE,VA 24018,(800)255-7828) Permissible Purpose:INSURANCE UNDERWRITING Requested On:12/08/2014 ALLSTATE(1819 ELECTRIC RD,ROANOKE,VA 24018,(800)255-7828) Permissible Purpose:INSURANCE UNDERWRITING Requested On:12/08/2014 FIFTH THIRD BANK(5050 KINGSLEY DR,MD#1MOC2N,CINCINNATI,OH 45263,(513)358-6299) Requested On:11/11/2014 CONSUMERINFO via CONSUMER INFO.COM(P0 BOX 2390,ALLEN.TX 75013,(877)481-6826) Permissible Purpose:CONSUMER REQUEST Requested On:10/21/2014 ALLSTATE(1819 ELECTRIC RD,ROANOKE,VA 24018,(800)255-7828) Permissible Purpose:INSURANCE UNDERWRITING Requested On:05/20/2013 ONEWEST BANK FSB via ONEWEST BANK(155 NORTH LAKE AVE,PASADENA,CA 91101,(877)/41-9378) Permissible Purpose:CREDIT TRANSACTION Requested On:03/18/2013 -End of Credit Report- Should you wish to contact TransUnion, you may do so, Online: To dispute information contained in your credit report,please visit:www.transunion.com/disputeonline For answers to general questions,please visit:www.transunion.com o By Mail: $ TransUnion Consumer Relations P.O.Box 2000 Chester,PA 19022-2000 By Phone: (800)916-8800 You may contact us between the hours of 8:00 a.m.and 11:00 p.m.Eastern Time,Monday through Friday,except major holidays. — For all correspondence,please have your TransUnion file number available(located at the top of this report). To dispute online go to: http:jjtransunion.comjdisp_uteonline TrartsUnion Personal Credit Score PAUL E.HEATON YOUR CREDIT$CART W : Your.Score&Grade Store&Grade Range Where You Rank Score — 990 *a.:- 100% 672 A. Grade 50% r• DYou are here j 700 i71,`.' - 600 You are here S Created on F 501 0% 01/19/2015 Based on your TransUnion credit report,this is a The numerical score ranges from 990 to 501 Your credit ranks higher than 19%of the nation's depiction of your creditworthiness. equaling grade ranges from A to F. population. About your TransUnion Personal Credit Score Your TransUnion Personal Credit Score is displayed above,and was calculated with the VantageScore credit scoring formula.Your credit score is a snapshot of the contents of your credit report at the time the score was calculated.Using objective,impartial formulas to translate the contents of your credit report into a 3-digit score enables lenders to evaluate your application for credit in a fast,fair and more objective manner.Remember,we constantly update the information contained in your credit report,so your TransUnion Personal Credit Score only represents the score a lender would receive if they requested it today. Summary Given that you have low credit score,it will be hard for you to obtain new credit.Additionally,lenders almost certainly will require you to make a large deposit or down payment.Prepare yourself to pay high fees and interest rates,and do not expect to receive a high loan amount.It may be difficult for you to qualify for any credit cards as well.If you do qualify for a credit card,you will probably have a very low credit limit with extremely high interest rates.To increase your borrowing power and credit score,you may prove that you are creditworthy by always paying your bills on time.Your credit score can see dramatic improvements over time. Factors that impact your score 1„ There Is a bankruptcy on your credit report. . :: Negative records,such as a bankruptcy,.can substantially impact yrL r credit 2. None of your real estate accounts show a credit amount. Lenders may be able to better evaluate your creditworthiness if there is more information about your accounts on your credit report. 3..None of your revolving accounts show a credit amount. Lenders;ray be able to,better evatLate your craditworth ness if to re,is,mgre information ap t yput,accounts an ysrt,r credit report. ,. 4. None of your installment accounts show a credit amount. Lenders may be able to better evaluate your creditworthiness if there is more information about your accounts on your credit report. Answers About Credit Scores •How are credit scores used? A credit score is just one of several factors a company usually uses when deciding to extend credit,give insurance coverage or provide financial services to you.A variety of other factors will be considered,such as length of employment,income or previous experience with you.Depending on what you are applying for, different companies weigh each of these factors differently.By using a credit score,they can evaluate your application quickly,fairly and consistently. •How can I improve my credit score? A credit score is a snapshot of the contents of your credit report at the time it was calculated.Long-term,responsible credit behavior is the most effective way to improve future scores.Pay bills on time,lower balances and use credit wisely to improve your score over time.You should also review your credit report to ensure it is accurate. •Now do inquiries affect my credit score? o When your credit is checked by a business for the purpose of an application a'hard inquiry'appears on your credit report.These inquiries can affect your credit ° score;and typically they have only a small impact.Delinquencies,balances owed,and the length of time you have used credit are all more important.Inquiries have a greater impact if you have a limited credit history. Additional Information The TransUnion Personal Credit Score is provided to help you better understand how lenders view your credit report.It is not an endorsement or a determination of your qualification for a loan.The VantageScore credit scoring model was used for this Score Analysis and is not necessarily the same scoring model that may be used by a lender.The resulting credit score may not be identical in every respect to any consumer credit score produced by any other company.Any credit information that has not yet been reported to TransUnion will not be reflected in your consumer disclosure or score.Also,some items disputed directly with creditors are not incorporated in the assessment of your credit score. P 460L0-002 01219-1011056 02/14 Jan 28 15.02:23p 2392770167 p.2 Premier Profile-KYLE CONSTRUCTION INC • .. • Subcode: 970135 ■• • Ordered:01/2812015 13:20:01 CST •; :: Exn1erian- Transaction Number. C500718370 .ta■■ Search Inquiry:KYLE CONSTRUCTION,INC./WINDHAM/OH/44288/341870176 • A wor.ld&irrsight Model Description: Intelliscore Plus V2 Business Name Business identification Number KYLE CONSTRUCTION INC 752115580 Primary Address:8770 WADSWORTH RD Phone: (330)326-1223 WINDHAM,OH 44288-9750 TOP 0 Risk Dashboard • FCts145rsvrek#tstf Credi#L1ftEt C9tnrnendafiort •flays BByond:Terms Derogati4r3+Leg#tG -F txd-A#ett Intelliscore Plus Financial&ability Risk Company DBT Original Filings High Risk Alerts It'll HIGH RISK HIGH RISK DBT Unavailable iii 1 Score range: 1 -100 percentile r Credit Limit Recommendation:$1,100 TOP 0 Business Facts • Years on File: 16(FILE ESTABLISHED 0411999) SIC Code: CONSTRUCTION,SINGLE-FAMILY HOUSES-1521 NAICS Code: New Single-Family Housing Construction(except For-Sale Builders)- 236115 Number of Employees: Sales: $77,000 TOP 0 Commercial Fraud Shield Evaluation far:KYLE CONSTRUCTION INC,8770 WADSWORTH RD,WINDHAM,OH44288-9750 %1 Bti[stnesa � _ -�r ._.• _ , .. _... ... --- - - ... _.. it'erlf�cg#)'an`frLgges- , � : - Active Business Indicator: to Experian shows this business as inactive BUSINESS ADDRESS IDENTIFIED AS RESIDENTIAL Possible OFAC Match: 40 No OFAC match found Business Victim Statement: i No victim statement on file TOP 0 Credit Risk Score and Credit Limit Recommendation Cred�C-Risioaxc lns;]Usco plus Current Intelliscore Plus Score: 2 Risk Class: 5 ".;.,.HIGH 'RISK:: j High Lori ( Risk The risk class groups scores by risk into ranges of similar . .__.... P.isk performance. Range 5 is the highest risk,range 1 is the k 0 10 25 50 75 100 lowest risk. This score predicts the likelihood of serious credit delinquencies for this business within the next 12 months.Payment history and public record along with other variables are used to predict future risk.Higher scores indicate lower risk. Premier Profile-KYLE CONSTRUCTION INC 1/3 Jan 28 15'02:23p 2392770167 p.3 Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms not available Industry ompaneoti industry DBT Range Comparison The current DBT of this business is Not Available. DBT for this business: Not Available ffftlS"itlS51L"S » .1%_. DBT Range 0-5 6-15 16+ TOP Trade Payment-Additional Trade Details yme t Experlanc s kccoUnt Stags • f frat#e LThes with alt '}after 1l a date arB newly repoltedi bays 3eyottd terms Business Date Last Payment Recent High Category Reported Sale Terms Credit Balance Cur 1-30 31-60 61-90 91+ Comments CREL CARD 03/2012 REVOLVE $10,000 $10,000 100% CHARGE OFF TOP 0 • Legal Filings ban ptcjt File Date Filing Type Status Filing Number Jurisdiction 06125;2007 Chapter 7 Discharged 0750576 U.S. BANKRUPTCY COURT-NORTHERN AKRON 0212812007 Chapter' Filed 0750576 U.S.BANKRUPTCY COURT-NORTHERN AKRON 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 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 2015-All rights reserved.Pri s._ra licv. Experian and the Experian marks herein are service marks or registered trademarks of Experian. 3i 3 Premier Profile-KYLE CONSTRUCTION INC Jan 28 1502.23p 2392770167 p.4 VIEW Merit Credit Fast, Accurate &Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: _1_ SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800-371-3348 OR 239-277-3202. COMPANY NAME: KYLE CONSTRUCTION, INC FEDERAL ID: 341870176 CURRENT STATUS: ACTIVE PRINCIPAL(S): PAUL E. HEATON TITLE: PRESIDENT DATE INCORPORATED:09/15/2014 Cotiiey County 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 Business Tax Receipt 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. Y. r� C 1�_p r� APPLICATION DATE ` ZONING CERTIFICATE# APPLICANT'S PHONE �n/G" b 7 ._ (j 6 Business Tax Lic# APPLICANT'S NAME !'ALE- E, 1'1 -4"TQ,. APPLICANT'S HOME ADDRESS £/y 504414) ,et/E,v Cie- N11,OLES /-L- .J y//y TYPE OF BUSINESS TO BE CONDUCTED £ L?/-'L7 `-, 1/LL Lv CiaK .z%1-''S-T4 CZ 1.97'20-'-',S BUSINESS NAME (IF ANY) 15 y GES it-/n/SS/`/ e M of f2E,I1y . N 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 above at this address by virtue of my leasehold interest in this property, and that I have read, understood, and agree to abid by the provisions of LDC Section 5.02.00 "Home Occupations" (see back of application). /APPLICANT SIGNATURE DATE CODE 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 Li Greentree L_] T_'t ,3 _ *or-4-1rd .1 cony of issued certificate and receipt to the Collier. County Zoning Services. 5-24-2011 COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION e40yr 2800 N. Horseshoe Drive,Naples, FL 34104 l r Make Check Payable to Collier County Tax Collector Phone: 239-252-2477 Fax: 239-643-4788 Website: www.colliertax.com CHECKLIST Copy of Articles of Incorporation and/or Fictitious letter Yellow Fire Compliance(list of fire district phone number from the State stating that your business name is on file. enclosed) (850-245-6052 or 6058) www.sunbiz.org Copy of Marco Zoning Certificate.(239-389-5000) Copy of State license from Department of Business and Professional(850-487-1395)or Department of Health. Completed Zoning application with appropriate fee made payable (850-488-0595) to:Board of County Commissioners.(239-252-5603) Copy of City Business Tax Receipt.(239-213-1800) Completed Business Tax Receipt application with appropriate fee made payable to:Collier County Tax Collector.(239-252-2477) Copy of Motor Vehicle Repair Registration Certificate from Department of Agriculture.(800-435-7352) Other: Copy of Health inspection from Department of Hotels and Please contact the Property Appraiser's office at 239-252-8145 Restaurants(850-487-1395)or Department of Agriculture. regarding tangible tax. (800-435-7352) CHECK ONE: Date: Original Application Classification Transfer of License # Code Number - - Renewal of License # License Amount 1) CORPORATE NAME - 11- y L Lis F1 1St( e__A!�Pretri/P)' la) DBA NAME - lb) BUSINESS OWNER OR QUALIFIER'S NAME - pig UC- E. H-/1A%a &/ 2) PHYSICALADDRESS - a1 o,v12 eHE= fL, (No P.O. Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - Yes No 3) BUSINESS MAILING ADDRESS - Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- qySo,1,V'L-ezf/eA'h f .till PLL:S 11,3 lillg 5) TELEPHONE - Business: t9-/6" 347-5-06? Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation LTC LL.P 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 8) OFFICE WITHIN CITY LIMITS OF NAPLES - Yes No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. 3L/ - /g70/ 1 C7 *see hack of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: 6 fietvEr/441 LU %,,Q, .is it's-T/9 14?97/ U'^''S 10) NUMBER OF EMPLOYEES - Including number of owners: 1 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- Mttst have photo copy of state license if state licensed and certified t',i1)ER PEN,1I.IIFS OF PERJURY, t DECLARE TIL11 111AVE RFAI) i'IlE l'O1ZE(;OING l)OCL\I[N I' \NI) [`61:1 1. I FACTS °- FAfl;l) EN I f Ain': 11ZU[; 1.0 flit: [tl'N I r ov IV k O\VI.E1)Gl?. xxxAPPI.ICAN F'S SIGNATURE: I)A7'E: (() ■ncr and/or representative of business)TITLE: _ ••*'*THIS LICENSE IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE* ** RESOLUTION OF AUTHORIZATON WHEREAS fl Y LE S Fu-/ H (".F r'i°6^L4-?Y/ proposes to (Name of Business Entity) engage in contracting as c!O P J24) f/of" in (Type of legal entity: corp.,partnership, etc. Collier County, Florida, according to Collier County Ordinance 2006-46, as amended; and WHEREAS ifYLES F0.A--i/SH ,nief Eitii/P% i E. proposes to (Name of Business Entity) qualify for a Certificate of Competency with bI U G /1 q7-o r`°'' (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned' . • F3 t t-1,s/g a' of r Officers,Owners, Partners) if 'I LL 5 F I'-'S N (!4 f%k,Air i yr' %iereby resolve and represent to the Collier County (Name of Business Entity) Contractors' Licensing Board that the qualifying agent,P('I(9 L If. NG A'T O j"v , is active (Name of Individual) in all matters connected with the contracting business of N% c.5 N,N/Si-(M f-fr.A4/?Y,and (Name of Business Entity) We further resolve and represent that f-)ff,'(>- E. /fib li %u',' ' is (Names of Individual) legally empowered to act for 1SYLL5 {' l i'- /5 'l (1-A(ex)Er'rty in all matters connected with its (Name of Business Entity) contracting business and has the authority to supervise construction undertaken by hY1-CS' F/;LIr�N d± ('Nut-t(eY . (Name of Business Entity) DULY PASSED AND ADOPTED THIS / day of „re.,•ill Y,) J/$., (Officers,Partners,Owners-with s i e Designation underneath) .' itn• s Witness Witness Corporate Seal(if Applicable) •r Notary Public Certificate l � � Swor to and subscribed before me this l day of / by � � 't', 9 (, n � t.fin -) j'�1-- r 1 a �Z`i "4i6C•-�-� yy� Notary Public Name Printed Nota 4 r'C r n.ture /: j g Commission Number - D 6 () My Commission expires: ' 5)/�r R 4 ,°"" GINA M.LOSTRACCO • .';,\7. .I Notary Public.Stale of Flori0a r My Comm Expires Oct ,1 �ptn Curimissinn a f( i z January 30, 2015 To whom it may concern: I Teodor Danilov have attached documentation for my tile and marble contractor and floor covering license. You will see a credit report indicating a score of 509. I am currently working with a company called Lexington Law to clean up my credit report. I was able to increase my credit score to 543. I expect to have a significant increase within the next 2 to 4 months. I don't have any bankruptcy or have any collection agencies trying to collect. I only had some late payments and an error with a finance company that I have been working on fixing. In 12 years I have never been arrested or have had any traffic tickets. Thank you very much for your consideration. Sincerely, Teodor Danilov rpi cio L � frzi// GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Qi� ° � Naples, FL 34104 ` l , ( AP ,_ �Q ION FOR COLLIER COUN ' OF�}NAPLES/CITY OF MARCO ??%k FIflM INSTRUCTIONS: This applicati must be ty..eey, riiten 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: C(J 3%ONI Iii 6 6 T'? A/ j// '. Fiction Name/DBA: Qualifier Name: '76O6CW, bA N L Physical iicrss:LO RA CT 7 34 1 ( Q - 0'00v (Number 86 Street) (City) (State) (Zip Code) Mailing Address: . 01 .>")k o 2 2 —°N(T A {�f21 (�G �7 +-L , - (Number 86 Street) (City) (State) (Zip Code) Telephone: 23 TrO cSS R E-Mail: 18Ob1? _ AANlit ai 91 °' 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 Li Swimming Pool $230.00 ❑ Roofing 41, $230.00 !_I Specialty $205.00 ) J Specialty trade: +'Love (oV e i sI G C40,1/4/7e A e i R t 46t I Q. S- ■-L c:. v 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. i&;0602 it_vv /O6 IxOQA Q7 N1PLt✓ Ft- (icy 23q 710 '3'SL5 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. k` 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 , OW xi ILO,/ certify that the foregoing is true an• cor ec, to the best of my knowledge. 4da 'at Authorized Officer of the Firm STATE OF FLORIDA j COUNTY OF The foregoing instrument as acknowledged before me this IIZ '12 P2 / ��/ Date) By / �i 'r / Gi Ili Uv !/?L/ of ,57� fia, (Name of officer, title/ gent) (Name of Cor ration) • a Corporation on behalf of the corporation. (Sta a or Place of Corporation) He/She has produced `7 v identification and did not take an oath. (Type of identification) NOTARY" = 01110101NA GARCIA Notary Mlle,State of Florida Cpormig&#EE 833595 "^!' My comm.expires Sept.9,2016 (SIGNATURE OF NOTARY) Page 2 of 4 QUALIFIER INFORMATION: Name: f O.0 N hl 1 LO`✓ Address: !017 I KO1A I 1 ) ?L 3 L ■ ( Q ° C O (Number& Street) (City) (State) (Zip Code) Telephone: 236) -1S,R5 Date of Birth: 03 J C e ( 1 c Gr S.S. #: 000-00- E-maik-recpyoz p Driver's License: b 541 " a°- Ql - Gig-0 1. Type of Certificate of Competency for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. -0,1■1 � ; M\01‘-k CO U 29 .-4 04 -o ff iyi 2\ R1ct 3. Have you ever been convicted of a crime related to Contracting? N / A (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? N ! A 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. N/A 9. List your business or work experience during the past ten years. Z/®OQ LOVE/211O 10. Statement of any formal training you have had in the area for which the application is made. :)(/ / Page 3 of 4 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report October 31, 2014 Official Score Report: Candidate Information: Name—Teodor Danilov Candidate# 00670980D Testing Site: Ocala, FL Final Score Result: Tile and Marble Contractor Score: 76% (10/28/2014) Business Procedures Score: 78% These results represent the grade that has been achieved on the Tile and Marble Contractor and the Business Procedures examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on October 31, 2014. If you have any further questions, please do not hesitate to contact us. Sincerely, Jay E. Bowermeister President PO Box 831127 Ocala,Florida 34483-1127—Voice(352)369-GITS –Fax(352)387-2443 800 997 2129 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. I-�E oe n 1)■\1LO`/ APPLICANT(PLEASE PRINT) C-0 570M O G b'e5■GN1 1 ■oe NAME OF COMPANY II SIGNATURE OF APPLICANT' STATE OF FLORIDA s��" COUNTY OF The foregoing instrument as acknowledged before me this /.2 � (DDaatte) j� 7 By phi/ ` who has produced (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL Id/ (SIGNATURE OF NOTARY) r A OIOROINA GARCIA f ,;.'` Notary Public,State of Florida Commission#EE 833595 My comm.expires Sept.9,2018 Page 4 of 4 AFFIDAVIT IT IS understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. SIGNATURE OF APPL 'ANT C U ` ►O \ 13:1_00 \4e, S(G). e BUSINESS NAME 12 Xoa ) zc 14 DATE BEFORE ME this day personally appeared ,le%G7�'�OCDGry/a v who affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this /C by 42 r %l �U f Date ard ) y c1� who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath. 41`_ a GEORGINA GARCIA IGNAT E OF NOTARY A Notary Public,State of Florida Commission#EE 833595 My comm.expires Sept.9,2016 NO (PRINT E OF NOTARY PUBLIC) NOTARY PUBLIC 4 VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: '-U a d r U(\1 UV Certificate Category Requested: The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to )rovide 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). rime 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 nformation: Fame; Title and license number Doff the person signing below and\erifying Applicants relevant experience:K flame: O` Q� Ue(Y\ v .\ itle: 0 U.-AN e (' License Number(if applicable): C C?C. \ 5 0 '199-5 lame of Business: SwF C_O(\S#-C u c y r L LC_ ;usiness Address: a 89 40 C\c 1 1 t ,usiness Phone: aYi.94S- t S aO The Applicant's years of experience from OS 'aU 1 to a Jaoi1/4-1 he applicant's scope of work (specific duties) included: F OUf CV IC\ cx \C) \ 11 \(1O,C �J�e S Cie WOOd 0,0 d CAC ae# , Svy-Qt� ■Sec\ s��e v\-e c\ �- orc�c3,r'�zec \(\Ska1k0- otn . dditional Comments: '6 \ cx0Ac t C7 ��otci- -c-Cooc\ Cc.),IP&"\"(0v> 0;0 0,ssvcr QL) c--orveC u O Co\ty\ re\\--\ so.V■s�.e 6 alsifying any information provided herein may subject your license to revocation. _ ,f Signature Print Name: O\o KUe(MO ate of Florida aunty of Collier ie foregoing instrument was acknowledged before me_on this 021t da of Z)ec— t ON O\o * K.utonorve_N who is personally known to me rpreeluced ldetTfificafio'n and who did not take an oath. aajcziy.._) Signature of Notary ' •, ` MY COMMISSION 147709 a EXPIRES:August 4,2018 AO/ Bonded Thry Notary rw lMdorMAeR 8 .. _ VERIFICATION OF CONSTRUCTION EXPERIENCE„ GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: -r-E DJ E)iZ /q lel (,' certificate Category Requested: i ;�j��,g t� L'k f, r i L- ) v Cam. 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 )rovide 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). rime served solely in a supervisory or administrative role should be described, but may or may not be considered ;ufficient to demonstrate required trade experience. The person verifying trade experience must provide the following nformation: 'lame, Title and license number of the person signing below and\erifying Applicants relevant experience: ame: Dot 1 frii OH e itle: jz, `5c j E y License Number(if applicable): Z lame of Business: riObEt r't- N }-12,P)j e 144. usiness Address: 'S S OVV NA—PL-6-3 f 3 cm usiness Phone: 219 t fowl--U€ 3 0 The Applicant's years of experience from to he applicant's scope of work (specific duties) included: /7 'i 1,LC 111,f2I e. ft eetiEit-t-14-6 dditional Comments: 1'OQl P6a-Lj© alsifying any information provided herein may subject your license to revocation. Lie Signature e/ lv tki c k { Print Name: ate of Florida Runty of Collier )� iFo regog,instront was cknowledged before me on this day of /Joe-) d� �� 9J /�+p ! G who is personally known to me or produced 1-/144-00 L, identification and who did not take an oath. o�ra.. : DENISE K MORRIS Signature of Notary =Notary Public•State of Florida Commission#FF 92047 "'f of f,S$ My Comm.Exp,February 11,2018 8 E v . III • • 1 . I II 1 D. . . 1 GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: / eoJ 0 ( bf 10 )/ PP �/}� Certificate Category Requested: ��/1° J /'/ or 1/e . The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name,Title and license number of the person signing below and verifying Applicants relevantexperience: Name: NGifi0Jiy/ai 4 Title: O )/'2(1 License Number(if applicable): L eC 01 3000 1S70 Name of Business: fen?,c arl C t / ( , r 72 V ._.y�a V i A Na e fi� .....? -1/0 Business Address: / / Yie-x7/ Business Phone(47) DI.L ` T.2/7 The Applicant's years of experience from °l to c0# The applicant's scope of wor (specific duties)included: /✓O ,(C-1- 5 i Na7lie9 ili-e k--'-; n 14)4-620 i (-Pif0 4.-7--c-ri �j , d Additional Comments: �k�'� )/e�� \�0(� 4 L��'/I �.' � yCt �(�e5 � C -7,10 v)Y e/ f c/a //0ei Falsifying any information provided herein may subject your license to revocation. f� Print Name: /'/Oft cJ r /a U State of Florida / County of Collier (,�,, The foregoing instrument was acknowledged before me on this �gday o °AA(/O' by c,Yl awl 1 I IQ,O who is personally known to me • . educed • ''/,k N,t 1-2ALA ..1 1 ■ as identification and who tlid not take an oath. \‘‘ \P' BO /io R u attire of N.� : ' °mm.Expires • June 9,2018 : No.FF 130823 Bonded through Cn� Wells Farga Q.. OF FLOQ;`-,N. AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, f`0. KVet(Y\61e , am a resident of CU\\ I ec County, F aC cA a (State) and have resided here for more than five (5) years. During the last five years I have known _re odOC Qar \oV applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) (Name) O\Q c Kvec�nrhe (Address) • Sa`M moo, \eS ( L 3y 11 c Telephone) a 340 - 53`1 S STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this la • a• 0,019 by O\o \ roo (Date) who has produced F�-. �c wcc s L■cer se (name of person acknowledging) (Type of identification) as identification and who did not take an oath. • SIGNATURE OF NOTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC r Pyh PATRICIA A.ISON MY COMMISSION NFF147709 EXPIRES:August 4,2018 Bonded Thru Notary Public Underwriters AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I On ria �'/ J ( /Q(/ , am a resident of CO (/P' COW-7/7 0J _ + l County, �d ll dQ (State) and have resided here for more than five (5) years. During the last five years I have known / c-619 0( 6e;t410•( applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) (Name) Oaf(`a r(a 16 C,f •• (Address) Wi7 /-61/0/ 6, Nb ins 1 fit (3 -//O Telephone c-2 ) c)2„_‘ STATE OF FLORIDA COUNTY OF ,,�` The foregoing instrument was acknowledged before me this 2q NOS 196 2O)11-by � ,(Date) -m' K/\� ot(\ylow who has produced .ortda LY M.V9 UQ,V1 P, (name of person acknowledging) (Type of identification) as identification and who Q 1 u t y) an oath. %.•� PNA g p /i,� _ 4160 yt • My Comm.Expires; ITTATURE • i�� June 9,2018 No.FF 13089 Van°, tb ofal t. Bonded throu h i � gq..JJ 1 NOTARY'S Ste, Wells Fargo' : Q- (PRINT NAME OF NOTARY) ■� NOTARY PUBLIC OF F\-- ,,o` 41 RESOLUTION OF AUTHORIZATON WHEREAS QUb,d1") LTI.co 1iNG thai Xl )X(Qoposes to (Name v usiness Entity) engage in contracting as C o PO 1/0 i•-/ in (Type of legal entity:corp.,partnership,etc. Collier County,Florida,according to Collier County Ordinance 2006-46,as amended;and WHEREASC(UJIOP1 ;2: i22i)JJCa 1 i jf,/C, INC proposes to (Name of Business Entity qualify for a Certificate of Competency with TED ED 60 AA N)L©V (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned ONNGQ of (Officers,Owners,Partners) I C}t�i L 1�•`2 ��C� to 1 1.1 C , hereby resolve and represent to the Collier County (Name of Business Entity) ,��©� �Au I�� Contractors'Licensing Board that the qualifying agent, ,is active (Name of Individual) in all matters connected with the contracting business off s i oi' i -►=LOO6).1 1#1'it44 and f (Name of Busin ss Entity), We further resolve and represent that / EOAOC AN ILOV is _ (Names of Individual) legally empowered to act for CUSTOM --L.(O& i 1-4 blEt-016Xtin all matters connected with its (Name of Business Entity) contracting business,and has the authority to supervise construction undertaken by �i� J■!t (Name of Business Entity) DULY PASSED AND ADOPTED THIS 0 3 day of N C'/, G.14 (Officers,Partners,0*el,;rs—with Desi_•. ti sk,unde ' . 4/41 Witness fitness tipe‘ Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this Z day ofiC ,,,20Yr by a, (iO tea) (aIu4.2 y r/. Notaryublic Name Printed N∎to I'ublic Signature Commission Number ee $33 SclS My Commission expires: .7t " 41v_ e� GEORGINA GARCIA $ Notary Public,State of Florida Commission#EE 833595 My comm.expires Sept.9,2016 COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 ate, MEMORANDUM DATE: November 29,2007 TO: AppIicant'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. 13 886 110th Ave. N. Suite#6, Naples, FL 34108 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 10/07 01/30/15 08 :28CT <SUBJECT> <SSN> <BIRTH DATE> DANILOV, TEODOR - <CURRENT ADDRESS> <DATE RPTD> 1014 PO BOX 1014, ESTERO FL. 33929 1/13 <FORMER ADDRESS> 5223 CEDARBEND DR. , #4 . FORT MYERS FL. 33919 12/11 7621 WINGED FOOT DR. , FORT MYERS FL. 33967 <POSITION> <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> • SARMIS MARBLE TILE OWNER 7/11 7/11 S P E C I A L M E S S A G E S ***ID MISMATCH 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 08 ALERT: SCORE +543 : SERIOUS DELINQUENCY; TOO FEW ***ACCOUNTS CURRENTLY PAID AS AGREED; PROPORTION OF BALANCES TO CREDIT ***LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER REVOLVING ACCOUNTS; NUMBER ***OF ACCOUNTS WITH DELINQUENCY *** 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 PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY,STATE AND FEDERAL LEVELS PR=0 COL=0 NEG=2 HSTNEG=1-1 TRD=3 RVL=3 INST=0 MTG=0 OPN=0 INQ=4 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE CLOSED W/BAL: $4682 $2873 $ TOTALS : $ $ $4682 $2873 $ 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 1597029 10/07 $2368 R09 1/15A $2000 $559 I CREDIT CARD 5/14F $2368 UNPAID BLNC CHRGD OFF BBY/CBNA H 292F021 5/08 $2314 R09 1/15A $1400 $2314 I CHARGE ACCOUNT 11/12F $2314 ACCT INFO DSP BY CSMR CAP1/BSTBY D 1DTV057 5/08 $2229 XXXXXXXX2111 ROl Page 1 of 2 9/13A $1400 $0 111111111111 SLDTO CITI 11/12C $0 ACCT INFO DSP BY CSMR 48 1/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 1/30/15 PNP7771028 (FLA) LICENSES ETC 12/19/14 PNP7771028 (FLA) LICENSES ETC 11/17/14 ZNP6284423 (FLA) MERIT CREDIT 3/24/13 NDY1263431 (DAY) SYNCB 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 REPORT (Compiled From National Records) <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> (I) P NP7771028 LICENSES ETC 16 NP 10/07 12/19/14 14 :28CT <SUBJECT> <SSN> <BIRTH DATE> DANILOV, TEODOR - <CURRENT ADDRESS> <DATE RPTD> 1014 PO BOX 1014, ESTERO FL. 33929 1/13 <FORMER ADDRESS> 5223 CEDARBEND DR. , #4 . FORT MYERS FL. 33919 12/11 7621 WINGED FOOT DR. , FORT MYERS FL. 33967 <POSITION> <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> SARMIS MARBLE TILE OWNER 7/11 7/11 S P E C I A L M E S S A G E S ***ID MISMATCH 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 08 ALERT: SCORE +509 : SERIOUS DELINQUENCY; TOO FEW ***ACCOUNTS CURRENTLY PAID AS AGREED; PROPORTION OF BALANCES TO CREDIT ***LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER REVOLVING ACCOUNTS; NUMBER ***OF ACCOUNTS WITH DELINQUENCY *** 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 PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS PR=0 COL=0 NEG=4 HSTNEG=1-6 TRD=4 RVL=4 INST=0 MTG=0 OPN=0 INQ=3 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE CLOSED W/BAL: $5436 $3627 $ TOTALS: $ $ $5436 $3627 $ T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CAP ONE B 1DTV001 4/08 $818 R09 12/14A $750 $754 I CREDIT CARD 10/14F $754 CLOSD BY CRDT GRANTOR BBY/CBNA H 292F021 5/08 $2314 R09 11/14A $1400 $2314 I CHARGE ACCOUNT 11/12F $2314 UNPAID BLNC CHRGD OFF Page 1 of 2 BK OF AMER B 1597029 10/07 $2368 R09 9/14A $2000 $559 I CREDIT CARD 5/14F $2368 CLOSD BY CRDT GRANTOR CAP1/BSTBY D 1DTV057 5/08 $2229 8/13 543211113211 R05 9/13A $1400 $0 $105 05 111111111111 I CHARGE ACCOUNT 11/12C $0 PURCH BY OTHER LENDER 48 2/ 2/ 2 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 12/19/14 PNP7771028 (FLA) LICENSES ETC 11/17/14 ZNP6284423 (FLA) MERIT CREDIT 3/24/13 NDY1263431 (DAY) SYNCB END OF REPORT Page 2 of 2 Page 2 of 2 menu mrc '13 at eau we ROW AIM sac tans sin e¢t mew at '14 at sac mwa inure stn an eus at on fi Eqx NONE REPORTED CAPt/BSTBY More about this account> Translinion Experian Equifax Account 1 s " 169661-701696'""` CoordAioae Trauastared Clvmad Ted red Balance: SID S0 SO Types Change account Charge account Charge account Pay S1mrs: Late 120 Gaups Lae 112 ms's 123 Days Two-Year payment Whey Legend» Tra"stini" ea Et ila Ea 12 221 la CO ELI saa ern men ea '12 res mme:ear mmei smm set ale sac acv mew mac '13 ne numb awe rase sus as arcs Experian filA El 112i ;:a,= EA Ca cur mar re '12 at text awe mast lust,tsr.curs at en amp tae '13 as max amt raw ant JUL ass Sea Equifax stn e¢m nee mac '12 at use at true use at moos SEo-ems ma''mac '13 is WM we wri ant.wa saw BK OF AMER More about this account>> TransUnion Experian Equifax •Accaa&6: 4264287993801-1 • •Coat ore Derogatory Derogatory Derogatory Bad: $25331 $2358 52358' Type. Credit Carat Cleat Cab Pay Stabs: Cd ff Two-Year payment history Legend>> TransUnion Experian El tail ElaCI CI IlOil Mil US CA 1212 1 Eat i.;..a Q1101 la err toe mad '13 r e um ore um rte aaa st16 at scm team'arc '14 at con an e919 awe at ens N Equifaxaa sir era new at •13 at tsar ante burr sus ax. tats sea ea tie.mac '14 mt$tort non awe.con JUL sus installment Accounts:Accounts comprised of feted terms with regular payments INDI CR More about this account>> TransUnion Experian Equifax Account t 209"* Canada= Paid Balance: S0 Type; Auto Loan Pay Status: Current Two-Year payment history Legend» 1 TransUnion NONE REFORM') Experian BONE RB ZY® Equifax •I2 at raver are was eat sum ace aaw en ntmr mac '13 at apse an tam.amt aw ass in ma teae ea Public NONE REER.TED itngmrieS Crertator Name Bale at coq try ererht Bureau LEXISNEXIS 1111(012 3113 Eapuidax AT&T SRVS 090116 13 Eafuiitas TDWCRE DIT 03/2420113 E.@+an/as SYNCB 032423113 Tnamslbaron TO RETAIL CARD°,Sp' RORICE 03111 1/2311;8 dram BOFA!ILNDSE 1268/23132 Espuifiaac `BOEAILND 125'2012 Expmen FA/tLN r 321202032 Tramst bens 1CrecTitw Contacts 1CrecitorName Address Phone Number I TO RETAIL CARD SERVICE 1600 MACARTIiUR BLVD 201-818-4000 IMIAINWANN.)07430 CAP1tBSTBY 26525 N RIVERWOODS BLVD IVETTAWAAL 60045 CAP ONE P3 BOX 85620 DWI-AIL-ONLY , MIOMMO IDVA 23285 BOFAtI.NDSF 35 N!LAKE AVE 830-047-1692 PASADENA CA 91101 BK OF AMER PO BOx 68:235 EL PASOTX 79998 BBY4CBNA 50 NORTIWWEST POINT ROAD ELK GROVE VILLAGEIL 60007 httDS: / ULSCo ens_com/OT'Pmt d Wehniex hw;tlisnhivCenter// inn afin9i ehTnike 1 1//1 11/7111 J. /R Page 1 of 2 Credit Retorts Nir xem esei 110 2114((Th s nepolrt its armailtable wail December 10 21)44) D i'ersonal Information dunks:Personal Information I Summary I Account iiistorl / TransUnion Experian. Equifax CREDIT RII3FORT IMEE 1111152ID14 11UM32514 nT90:2014 MIME 1153131155 1531illOr TEDIDIOR mvtULOE TEODOR DP.fIfr!Ov AILS)MfiliO6rr9 AS: t 112114111E OF leitilmltt: 11957 rte; nor l CURRENT WEATITRES& 1311145731511/5111114 Fe lsax,1111141 P®E K 11014 fE5111E5/35L 33515214 MEM 31e29 . i 03=13 1. PKEVE2liS ADDRESS: 32234 SZDISCEDVEtlit9t1111,VA CMARBENG3 DR C52 !FORT IG?'9i.'®W.. 13L, l,Jtmi,4 FORT MYERS FL. ICIR 3, 711".AaTt51 33319 FtCI RT 1415255 F?L, '113 332411 EMPLOYER: SitAltillIS 0314`RR1 E TEE snWRJASPlitFwk4B,g MOD 0720111 TILE /Consumer Statement Transunion: NCt4E,gREP1311531 Experian: Now 1RispoAFirmi l Equifax: WINE REPORTED iiS u m m a ry ^Back to Top TransUnion Experian Equifax TOTAL AC4X*HWFS: 4 4 4 OWN ACCOUNTS: 0 0 1 CLOSED A .3141St 4 4 3 DELINCILIENT: 11 1 2 DEROGATORY: 3 3 1 BALANCE: 3343133 $5436-31 smek3.00 i PAY1ItffrS: ED 00 513330 5911313 P111IC 0 0 0 INCIIMMES12 years 2 2 4 Account History ^Back to Top p SAt-a-gllarace mle.mlg et pour parietal&Maury Ca a,- lr ca. us WI IMP rIJ! 30 d4•n - 1Q' 3044,.__ E 204es 15.134.97 743.7; W-.POcr.rs,nn r.-,Ikcun7 O5er� VnI.nOM am<a1 1e[! -✓,< lec3 I.ce ✓341✓• F>nc[:n,W,, 4h.'ta.v'F Revolving Accontrow AccoarittS olden arm eg&rrrerrall itennm CAP ONE More about this account> TransUnion Experian Equifax Account N: COB" Balance: ST54 3754 3/332 Type Crete Canal Cheat Cant Cleat Card Pay 9x415: Cmf1tertt"mirelivxttpeslfi CailerderrOtarsenif Lire TO Days Two-Year 1paynme*history Legend>a Transunion fd r.,t'e..b EA OR ®® me. 113 RE..337?so.MOW zunY.149 on SE sea MOW us '14 WM Wm.9 k.4,07-so 7406 s.on ier - `Equifax --�. test TOW 4017.3474 Na s s®so nun roc .13 ta$,na,09.rna•S.Kart-P. tom 9.on one eac '14 r®lam BBY/CBNA More about this account» TransUnion Experian Equifax Accorm[i_ " . Contitin= Derogatory Derogatory Balance: S2314 $2314 Type: Charge account Charge account Pay Status: ColtecconiChargeo4 Collectial'Cha eofi I Two-Year payment history Legend 0> Trans Union Experian 11111111111S111111131111111111312111®®®13111I httDS:lltiu.Sec a -COtnAMT.Mdllet Wela lge.Xili eldlletDisnlal°Cellie ribeVin._dt 0Weh7Teike__._ 11/1 OP!f l 4 /61 Member Home-ScoreSense.com Page I of 1 WC.r'KS FAQ Centactris Welcome. mm Eia,7;l-t, Your Member iD: Home Alerts Credit My Account Learning Center Monitoring Active my credit 0 Alerts-Oft ( View Report ) Latest Credit Scores How To:Top 5 Your Credit Rating: 1. Learn the Basics 593 FAIR Ui7,-Se7sta-dir:3 op:Chad;Recap. Understandno sour Grunt Scores 605 4041111... ei 350 4M 650 SW 550 SOS 650 700 75 SW ins 2. Avc:d Credit Pitfalls inese cornmon cfehlit mis,ps 3. Protect Your ide^tity Smart tips for you and your fami,. 549 You are unEkely to qualfy for a ban vnth an attractive interest rate more 4. Keep Your Family Safe ImocCant safety tips for you and vopr kids ScoreTraelcer ScoreCast Dispute Center 5. Use ScoreSense Features Get the most from your membership =tout Contact Us FAO Terms&Condticns Privacy Policy ''72014 ScoreSense.com At rights reserver: 2 https://membersi.seoresense.eomidashboard 11 J(11,01 4 x A t 1t it V 1h: #fit ll : t jtO - ow �t o x lif. ;1;10 4 4ti : 0 _ _ ' _ ; - - f ; . 4. .<.- 0 r : ** Ato Ill ∎1 0 ¶+j sik z� o -5 �� " 4* xtA ii -8 Q o o/ , la 444 t.•1 a) �U► o cn y '-.' En i► 414; v 4� y o } z N 2 I Q Q 4L. o - cd g ti � o ire -4 RI �jt t� ,' 7 0 11 I# /ii a) m 0 ,D 4 1, /44 . .1-5 . , ,,-5, , i ,„ -5'.--4 '' '' #A+17. 4 ' r---*--'''' 7 .7cj 7-.> ° 6 C\J 3 .2 AU WO ii. ' Z. '"°. r) -- ° p M civ3 ,g' 8 (" 0 .-- -1" cz Vein% 0 ',3`lif cD w Z cd "Z/ Q u 174 2 V 0 > ��1e r �, 4 �, ® � o I c,d v 2 PAL 1 V It- 0 t, i (9, •44 1St 9 1- s v 01 'Ci Q4 a 2 t /=o It% 0 -4-4c.) 0 a, 0 4-' -*- a a) � 4 10 ilk it, tkyg o t 8 c+-( :7: .-4 (8 Uy 0 ;re ‘1,4**: _ iv On bk Ark tit la st,:tqg -: 0 '54. 4 2 -0 ,..414 H 4,440 4.a.••• , . ,xj■Etil !°- )414- pf -4404.• )::( 441. )::k- 0 4, _403, 0:4 ' 24: Aq.4 , ' :)..,:k '4., ter s '44rr A - 1° ' . A ' 9.-**4"11b,'1,40--Albk 4 ::;rf ti -' -'/ ' AA 4 0,04.......0..........6.- 040` 0.4 0 t41,44 -t47440 Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OP STATE }; DIVISION OF CORPORATIONS 'fink: Detail by Entity Name Florida Profit Corporation CUSTOM FLOORING DESIGN INC Filing Information Document Number P14000090809 FEI/EIN Number NONE Date Filed 11/06/2014 State FL Status ACTIVE Effective Date 11/03/2014 Principal Address 1015 IXORA CT NAPLES, FL 34110 Mailing Address P.O. BOX 368125 BONITA SPRINGS, FL 34136 Registered Agent Name & Address DANILOV, TEODOR 1015 IXORA CT. NAPLES, FL 34110 Officer/Director Detail Name &Address Title P DANILOV, TEODOR 1015 IXORA CT NAPLES, FL 34110 Annual Reports No Annual Reports Filed Document Images 11/06/2014 -- Domestic Profit View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/30/2015 7 2 Detail by Entity Name Page 2 of 2 Co vright and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/30/2015 2 ?� Electronic Articles of Incorporation E P14000090809 FILD For November 06, 2014 Sec. Of State msolomon CUSTOM FLOORLNG DESIGN INC The tmdersi.ted 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: CUSTOM FLOORLNG DESIGN INC Article II The principal place of business address: 1015 IXORA CT NAPLES, FL. 34110 The mailing address sf the corporation is: P.O. BOX 368125 BONITA SPRINGS, FL. 34136 Article III The purpose for winch this corporation is organized is: ANY AND ALL LAWFUL BUSINESS_ Article IV The number of shares the corporation is authorized to issue is: 1 Article V The'riame and Florida street address of the registered agent is: TEODOR DANILOV 1015 IXORA CT. NAPLES, FL. 34110 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: TEODOR DANILOV P14000090809 FILED November 06, 2014 Article VI Sec. Of State The name and address of the incorporator is: msolomon lEODOR DANILOV 1015 IXORA CT NAPLES, FL. 34110 Electronic Signature of Incorporator: TEODOR DANILOV 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 1st and May 1st in the calendar year following formation of iii7s corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P TEODOR DANILOV 1015 IXORA CT NAPLES, FL. 34110 US Article VIII The effective date for this corporation shall be: 11103/2014 2 Certified Copy I certify the attached is a true and correct copy of the Articles of Incorporation of CUSTOM FLOORING DESIGN INC a Florida corporation, filed electronically on November 06,2014 effective November 03,2014.,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 P14000090809. Authentication Code: 141107122511-200266114732#1 Given under my hand and the Great Seal of the State of Florida at Tallahassee,the Capital,this the Seventh day of November,2014 ars irtlY :tios lel Ileigiff coo-ift betretarp of &tate 27 irl,m,v SS-4 Application for Employer Identification Number i• GYIS 11.t. to- ay 2.31% rut'use hir erePte Vers.crePurafices,ParblerstiPs,trusts,estates,churches, E" goerement agencies,111X6a111 Waal entities,certain irefivicluals,and others.) ova-amen a 7.0391,17r 47-2280498 Re. ■ See separate instrucidons for each One. In Keep a copy for your records. 1 Legal Flane et sanity Oper arses for whom the BIN is being requested Custom Flooring Design Inc 2 Trade more of business different turn name en foe 11 3 Beano adreinistatan trustm,'none or rare ea I Ta 4a %tale*address @SINIZ,apt,see no.and street or PM.ban 5a Street address(if Efitteres6 A,. nut erne a PLO box) ; P.O.box 368125 1015 Ixora ct "OZ1 flo 4h City,.snap.and Z code g kiefign,see irstreenfor* ,,51) City,state,and Z .mzfe fit foreign see raani=tiorsl '16 Bonita Springs,Florida,34136 Naples,Florida,34110 6 Carty end state where prim-pet business Fs larated >4 county,Florida 7a Name cf',Froolrairle party 17b SSN(FM,or EIN Teodor Danilov 1 769 8a Is Iris appication for a*dead Fattifty=roam XLC$',ror I 8b If 8a is'Yes,'erter the somber,of a foreign equivalent)? El Yes No members . ac if 8a is`‘Yes,"was the LLC ogroisned in She United States? 1---5 Yes No 9a Type of entity(check only one be*Carrion.If 8.2 is"Yes,"see the instructions for the correct box to deck. L7: Sole troprietor(SSINt Estete(SSN of decedent) El Partnership D Plan administrator(TIN) • Corporator tenter tom neenter to be Ned)I.Form 1120 D Trust(TM of grantor) O Personal service corporation 0 National Guard U Stateflocal government El Church or clarch-cortmlied organization 0 Farmers'cooperative 0 Federal govemmentkridary D Other[metope organization(specify) In D FEW Indsan tribal governments/enterprises O Other(specify)In Group Exemption Number(GEN)if any In 9b If a corporation, name the state or foreign country State Foreign country applicable)where incorporated Florida 10 Reason for applying(check only one box) D Banking purpose(specify purpose)lin 1 Started new business(specify type)In D Changed type of organization(specify new type)In Construction Purchased going business D Hired employees(Check the box and see line 13) 0 Created a trust(specify type) * • Compliance with IRS withholding regulations D Created a pension plan(specify type)In D Other(specify)In 11 Date business started or acquired(month,day,year).See instructions. 12 Closing month of accounting year December 11/07/2014 !,14 ff you expect your employment tax Nobility to be$1,000 13 Highest number of employees expected in the next 12 moths(enter-0-if none). I or less in a fad calendar year and awe to file Form 944 annuany instead of Fore 941 quarterly,check here. If no employees expected,skip the 14. (Your employment tax liability gererally win be$1,000 Agricultural Household Other or less if you expect to pay$4,000 or less in total wages.)if you do riot check this box,you must file FOrrTh 941 tor every quarter. 0 15 Fast date wages or ancesnies were paid(exonth day,year).Note.If applicant is a withholding aged,enter date income will first be paid to nonresident dens(fflung11%day.year) 16 Check one box that best desotaes the principal minty of your business. El Heath can&social assistance D Wholesale-agent/broker • Carstnonfon El Rota&tent g ID Transportation&warelnoushg H Aocreamodatien&food samba El Wholesale-other 0 Beta Reef estate El Magrarfacoeing 0 Finance&insurance D Other(specify) 17 Urnicalle principal the of merchandise sold,specific construction work done,products produced,or services provided. Construction Work 18 Has the applicant entity shown on the 1 ever applied for and received an BN? Yes No If"Yes, write previous EN here In Compete oils settee selv d you sent to authorize the named inffeithei to else Iva aft's en and answer questions about the connietice of this loan. Third Designee's name Designee's telephone number(include area code) Party Nicole Ramirez(93012413) ( 888 ) 629-9001 Designee Address and ZIP code Designee's fax number(include area code) 2800 Biscayne Blvd STE 200,Miami,FL 33139 ( 888 ) 593-2328 Under penalties of perjury.I declare that I have examined this appicahon,and to the best of my knowledge and belief,it is true,correct,and complete. Appicant's telephone number(rnclude area code) Name and title(type or print dearly) Teodor Danilov,Principal Officer ( 239 ) 770-3585 Applicant's fax number(include area code) Signature* Date In ( For Privacy Act and Paperwork Reduction Act Notice,see separate instructions. Cat.No.16055N Form SS-4 (Rev.1-2010) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/24/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVFI Y AMFNn FXTFND OR Al TFR TI-F CnVFRA(:F AFFnPnFr) RY 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. !l;!POpTANT: !f the cer+ifira+o r=rlarr i• .. A nnrrrnr.r Al 1■ICI rr=n +he n1L7.resi rn c+r,o M.frnrcpri If SUBROGATION IS WAIVED,subject to d.,...... ..n„F.. .4G 4..ar.4 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Weems Insurance of Naples,Inc P HONE Ext).(239)775-8705 FAX (239)775-8576 - unn 2661 South Airport noau Suite o icy ao�iiess susanL/weenrsnrswaucG.wrrwnswit.trec < Naples FL 34112 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: CYPRESS PROPERTY&CASUALTY INSURANC INSURED INSURER B: Custom Flooring Design Inc INSURER C: PO Box 368125 INSURER D: Bonita Springs,FL 34136 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 CERTIF!CAT MAY pc !eC” r nn Mona T!!r-n r mnM _ .,r EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $100,000 A I CLAIMS-MADE I X I OCCUR PRM RENTED PREMMI ESES S((Ea occurrence) $100,000 20P0071072-0 07/24/2014 07/24/2015 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $100,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $200,000 X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $200,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under --- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) FAX:252-2469 CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY CONTRACTORS LICENSING BOARD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 N HORSESHOE DRIVE ACCORDANCE WITH THE POLICY PROVISIONS. NAPLES,FL 34104 AUTH IZED REPRE NTATIVE I _ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are gistered marks of ACORD Z W .•' JEFF ATVVATER 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*t CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers Compensation law. EFFECTIVE DATE: 11/17/2014 EXPIRATION DATE: 11/16/2016 PERSON: DANILOV TEODOR FEIN: 472280498 BUSINESS NAME AND ADDRESS: CUSTOM FLOORING DESIGN 1015 IXORA CT. NAPLES FL 34110 SCOPES OF BUSINESS OR TRADE: CERAMIC TILE, INDOOR STONE, MA 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 frade Wad 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 tower meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF Fl FCTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 1 +,.... [ A• A k> mt■ ,p,.�,,.,?.>,p L� TY'PoOdMreYMSP *MAbY'1M` ° 3 0 COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION EV'. ilaC •4.9 ta. kd, l UF-th �=gi 2800 N.Horseshoe Drive,Naples,FL 34104 L. Make Check Payable to: Collier County Tax Collector Phone: 239-252-2477 Fax: 239-643-4788 Website:www.colliertax.com MoD WEta CHECKLIST Copy of Articles of Incorporation and/or Fictitious letter Yellow Fire Compliance(list of fire district phone number from the State stating that your business name is on file. enclosed) (850-245-6052 or 6058) www.sunbiz.org Copy of Marco Zoning Certificate.(239-389-5000) Copy of State license from Department of Business and Professional(850-487-1395)or Department of Health. Completed Zoning application with appropriate fee made payable (850-488-0595) to:Board of County Commissioners.(239-252-5603) Copy of City Business Tax Receipt.(239-213-1800) Completed Business Tax Receipt application with appropriate fee made payable to:Collier County Tax Collector.(239-252-2477) Copy of Motor Vehicle Repair Registration Certificate from Department of Agriculture.(800-435-7352) Other: Copy of Health inspection from Department of Hotels and Please contact the Property Appraiser's office at 239-252-8145 Restaurants(850-487-1395)or Department of Agriculture. regarding tangible tax. (800-435-7352) CHECK ONE: Date: Original Application Classification Transfer of License# Code Number - - Renewal of License # License Amount 1) CORPORATE NAME - Cub-rom o 1 N C: t.e�j‘‘G1■ 11 JC la) DBA NAME - lb) BUSINESS OWNER OR QUALIFIER'S NAME - .7-67060k, 'AN ILA 2) PHYSICAL ADDRESS - `1O15 vXQQ.A C i i\�� L 34 110 - o©oo (No P.O.Box allowed) f 2a) IS RESIDENCE USED AS AN OFFICE - " Yes No 3) BUSINESS MAILING ADDRESS- 0 BOX 'SC \25 bur.61- 5'. it l Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - 5) TELEPHONE- Business: 2 -11 O - 3'J S 5 Home: 239 T 39 O 3`3 X `5 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - O3 N 0 2.01A 8) OFFICE WITHIN CITY LIMITS OF NAPLES - Yes No If Yes,City License No. 9) SOCIAL SECURITY` 41 - 2_2_8 1 8 *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: f \3r CO iQfv''t 10) NUMBER OF EMPLOYEES -Including number of owners: I 11) FILL IN THE APPROPRIATE AREAS - a)Rental units(motel/hotel/apts.)Number of units: b) Seating Capacity(rest./cafes,etc)Number of seats: c)Number of coin-operated machines owned by business or individual: 12) STATE LICENSE OR CERTIFICATION NUMBER- Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE T' E TO E BEST OF MY KNOWLEDGE. DATE: IZ Q 2 4 xxxAPPLICANT'S SIGNATURE: (Owner and/or representative of business)TITLE: O` / 1•l 64Q) ****THIS LICENSE IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE**** COLLIER COUNTY BUSINESS TAX RECEIPT ,v uSi APPLICATION • f,* 2800 N.Horseshoe Drive,Naples,FL 34104 Make Check Payable to Collier Counts Tax Collector - 'i Phone:239-252-2477 Fax:239-643-4788 Website:www.colliertax.com v1D CHECKLIST l.' 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) w ww.sunbizorg 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. (300-435-7352) CHECK ONE: Date: Original Application Classification • Transfer of License# Code Number - - ___ Renewal of License# License Amount 1) CORPORATE NAME - C(.1 COPT ,ciA16 la) DBA NAME - ib) BUSINESS OWNER OR QUALIFIER'S NAME - 'TE®1LoP, 6641t1-.DV 2) PHYSICAL ADDRESS- 015 XO 2A l_-i N A � 34(\ O - c c cs o (No P.O.Box allowed) V/ 2a) IS RESIDENCE USED AS AN OFFICE- V Yes No 3) BUSINESS MAILING ADDRESS- O 60X 3(03(2.5 5omi c-p, 341 G Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- IOi5 iN,0 5) TELEPHONE- Business: 2 9-17O - Home239 no 35& 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership ' Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- NOV 2 0/L) 8) OFFICE WITHIN CITY LIMITS OF NAPLES-IL Yes_No If Yes,City License No. 9) SOCIAL SFr"' NO. or FEDERAL (EMPLOYER IDENTIFICATION NO. - 4-1 - 2 Gam.80498 *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: 1-I\ , 11/4.-1(-i Y 10) NUMBER OF EMPLOYEES-Including number of owners: f 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. RI TRUE I) THE BEST OF MY KNOWLEDGE. �� f xxxAPPLICANT'S SIGNATURE: .w�' `'' ' DATE: /2 02 '1 y (Owner and'or representative of business)TITLE: b r✓et **"*THIS LICENSE IS NON-REFUNDABLE FOR BUSLNESS STATED ABOVE**** `32 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: 33 Cover Letter for Superior Woodworking, Inc. By Abel Arredondo At the end of 2007 when the economy took a down fall and new construction nearly died, I was forced to take a salary job as a service/progect manager for Palm Bay Kitchens. A few months later they let the remaining licensed installers go and I found myself doing all the installations and service for the company as an employee. Unfortunately, I was not aware that I could pay to have my licence inactive. I simply thought I could renew my licence any time I needed it. Three years later I tried to renew my licence and was told that I needed to retest. This discouraged me and I did not to try to reinstate my licence. Since I have let my licence go I have worked for : Palm Bay Kitchens which later bought Naples Custom Cabinets and Designer Closets. I worked for this company for 3 years, the company shut down in January 2012. After that I worked for Grand Woodworking,LLC. I was their sole installer and service man for them from July 2012 to January 26, 2015. Due to a business dispute between partners the company is being dismantled. Now I would like to reinstate my installation licence for operating my own business, since I have work offers from the most prestigious cabinet shops in town, Artisan and Guild, AlliKriste, Rufino and others. Having my licence reinstated will give me the opportunity to serve these business with my expertise in cabinet installation. CDES Operations & Regulatory Management Licensing Section. 2800 North Horseshoe Drive Naples, FL 34104 Q/,--©'67 ? APPLICATION FOR COLLIER COUNTY/CITY Ok t LE S/CITY OF MARCO 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: S U Ii1Q,6 vV W0 (,( L • Fiction Name/DBA: Qualifier Name: i&be] AYreec If• Physical Address: I q 05 SE 23"t PL. &&2,Grf(QQ 1 L 339cl 0 (Number 86 Street) � (City) (State) (Zip Code) Mailing Address: ) `I`U 5 J E 23(a -PL L• C Q.O (O-Q FL- SY190 (Number 86 Street) (t ity) . (State) (Zip Code n n �" yy�� Code) Telephone: 2q 1 1 1 3_ fj E-Mail: r11�Q I F X-�rac�r (1'IOCI l•L' TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00. g U 5230.00 U. Residential $230.00 1/13/2015 Reinstatement Fee=$205.00 ❑ Mechanical $230.00 ❑ New License Fee= $205.00 ❑ Roofing $230.00 [T� 3 Year Fees=$555.00 /' *Different fees may apply* Total=$965.00 Specialty trade: CCU bi',n a+ iY S-fc . contr. . C GE OF STATUS(/ Prf_,v`u Cn •�-Jr -6 t) ) Reinstatement From One Business (, ) to Another ( ) Dormant License to Active Pagel of 4 QUALIFIER INFORMATION: Name: JbQ.l r ctona 6 5�(_ Address: )y 01") c, z rd ?L . 110. & �. 3 33 qc C� (Number& Street) (City) (State) (Zip Code) Telephone: 2 Yq ` VI( 3 — 6639 Date of Birth: s.s. #: E-Mail: AbQA f x+,014.-iQ3ma t .cam Driver's License: . J 1. Type of Certificate of Competency for which application is made. \ l i c2 t YISzA- n 4-aA t 61-c 1•o-r t t (( war k- 2. The names and telephone numbers of two persons who will know your whereabouts. Z cua. Los ia' 23q - 5 (no - I�7y 1..�.i YYQdond.O 23' - LQ 0 3 - 55 l.Q 3. Have you ever been convicted of a crime related to Contracting? r\-0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? n,b 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. sin a t o Q QQ¢,rsamtst,(2: t Cards j -dteall , , 014%S E I 1 W o at i v o(C.S0 £e on om col • i2 i yv . 41\s LAn L , a n� r ,- 9. List your business or work experience during the past ten years. Tai {3a, Ki#ck n ti 5a41t £ lo co 3 R.is na _ - SonaeorevAomCu.b;na52no3 ThIfyleetal t i - 4B2.4,11 APIale 200%- 2b12, (}r. Wo &u>crkt rinc, 20(2- 20 IS 2.0 10. Statement of any formal training you have had in the area for which the application is made. (ral►( IrhA-a,Ue 6.64-0V1 t.b Lr r hkt+t)rn0k02- o Q ral'IL i'�1aeh� Vn■ Wol incQ. '7n�us1 r S 1 � Q • z rope had my ow-c, b v-s g f a'm 2603- 260`g Page 3 of 4 • 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. P A f gckr I 0...5c1) (�03 6 6%1 1 0 5 5 . 2 1��. C TzLQ, Fc. 3& o � 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. c i(rr Cus iDm Ca In�.tS , t'n c.. 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. .51e SS 1 ( Q) 1&SanctQ.. CY2dit e&rdS , rfQdtCJ Qxl y ors SZ. . 818.56115: b : t 1 b 1 1 1 RV t i `L rN• ,\s : . i „ ►1. Anna -I- . ol]'{Ti-\ AFFIDAVIT I, Mae Ar(Qd6flia 1(. certify that the foregoing is true and correct to the best of my knowledge. Aerie Authorized Officer of the Firm STATE OF FLORIDA /t 14, �� COUNTY OF L— The foregoing instrument as acknowledged before me this ditsaM (4-4 C-,J 30 c710/S^ (Dot / By Pi/ _ r. G�D►o GCco of Lzr ��O r l�J D o CXI�J�' i l�t� (Name of officer, title/agent) 1 (Name of Corporation) 0 a 0 f --- Corporation on behalf of the corporation. (State or Place of Corporation) He/She has-produced�•-- Q{i v . Lr ' C.4,,k 4-Q-identification and did not take an oath. (Type of identification) NOTARY'S S RUOINA G.RUCI -?o ,`�:; Notary Public-State of Florida ` / / _ 1 ( I. •, My Comm.Expires Feb 5,2018` C--r ■ Commission M FF 089465 '•:f 1 (SIG ATURE OF NOTAR ( '' Bonded Through Natiorol Notary w w----T Page 2 of 4 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, c teal Asti,/ , am a resident of C1 0- County, -- I 0(lt .k (State) and have resided here for more than five (5) years. During the last five years I have known V-12 _Q l L((0 (1.(4liX(.5- applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) ZM&-(%5(Pi-( (Name) J 6..(& Los le, r (Address) 1625- I E 3(e Taf(QCft eCcra Telephone) 239 ,6(QO r 1G-7q STATE OF FLORIDA COUNTY OF _ The foregoing instrument was acknowledged before me this lat• � 661 y (D�at�) 3( �,. --- �— who has produced (na e of person acknowled . g) (Type of identification) as identification and who did not take an oath. ) r C dpATURE OF NOTARY an-et `h i n c c f d NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC ;,.!;;t'P',B,,, JANET KINCAID Notary Public-State of Florida (;:, r: My Comm.Expires Apr 30,2017 'r ` c Commission�EE 863651 '�i�,lip;�G,� Bonded Through National Notary As c, 9 AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all tirnes effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. Iege SIGNATU'E OF APPLICANT SiLge,«V1 W a6dw du►UNESS NAME �( • /(30/0 DATE BEFORE ME this day personally appeared Lei. ilrr"e-4 o,7Q who affirms and says that he has less than one employee and does not require Workmen's Compensation and understands that at any time he employs one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA., / COUNTY OF Loll' €+ ' The foregoing instrument was acknowledged before me this n - byA//�� (Date) b / fdodo �'¢ who has produced L rJ 'vP1t_ Le. c_e_ (name of person acknowledging) (Type of Identification) as identification and who did not take an oath. • < �'^'iy,6 RUDINA G.RUCI ` " ' •r° `�•% Notary Public•Stete of Florida SIGNATU'E OF NOTARY NOTARY SEAL 4 N • My Comm.Expires Feb 5,2011 A ;,F��,P,• Commission#FF 019165 7 NOTAR PUBLIC 9onded Through National Natty Assn. • 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\(cQddand0 fir. APPLICANT(PLEASE PRINT) )u, Uu� awa,(1Ail O ,rthC. . NAM OF COMPANY SIGNATU E OF APPLICANT STATE OF FLORIDA /i ,�� COUNTY OF ( 0/// The foregoing instrument as acknowledged before me this /12t () war L.2 O O/S (Date) By / ( / p,f�c,O who has produced �— cJ / V`e...r" (Name of person acknowledging) (Type of identification) as identification and did not take an oath. 4104, ccFFAA RUDINA G.RUCI ' ;1 sNbterY-Public-Stale of Florida • ? My Comm.Expires Feb 5,2015 . .: "'' a Commission#FF 089465 %F� :P NatianSWWI km (SIGN. URE OF NOTARY) . , Bonded Through Page 4 of 4 STATEMENT OF OWNERSHIP This certifies that I, Abd -A6V61-1C(0 am a member or � (APPLICANTS NAME) Managing member of 1op.ext oY Q W � i Ind- . (LIMITED LIABILITY COMPANY NAME) I own 160 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. AbA Ayoknk lc (PRINT NAME) (APPLICANT'S SIGNATURE) 130,/5 (DATE) Ca A ditt OA c "4 .. - Arlb * tik‘Pf 40 .• 11‘,Xt 4,■* 11:LVP 4A4 qVP1 41- 4 111145.1( 4 * lailP # 11 - ® }t tS1 # t 4# t 4 # U4 0 tt4 * � 0.. o.1•. •�.0 A Ilk .11 A tk it If �Hlm• �' 0...--1. O +,00(.0-rl 11.-t 21' ■-4• )-t f-D., ---. q 0 gAtk Zit to A 0 0 cil 0 CD y 44 40 Vir 4 * OA I:1 g (4 g: 5 R U)c, s . ' ) E-.Tc4 b. le n CD Olt 410 i� ' P . 00 )"""t g ----- 0 p-- a "") cp 41/ 1F:0 t -ti L E 0 d CD x ° a §1$ ® . go 2 �� 0 0 -i k o c , ' /Illk V D c cn 4) 0 et. ;21-) ° ° ;_ ° ‘ lit■ S o ll S P. i P L'i 'Al 0-' ‘r♦04 - a. CD 5 o. o dam . 0 a � ®iAlf,a 3-_, oo . o 0 o .Or f Co♦♦ C. o a •• or,v p o , C= �� ► I.410 +� 0 4 to AA V s; 11,yo )7,y# 4 ';,„, 0A;wil /14 .,14 r:( 4 ... tik ):14 .,.. 14 # 4 ,,, t, 04 .. 11 ,-.4.14 ---, ‘,1411°,,, ,daN 0,74A,14.+0%-iti,N 07ArtN+0,17+0.4 eau** 4; .1.214,1114)y Entity Name Page 1 of 2 ,z7Frr. 4‘, ‘111•121',.., .R., F ORIDA EPARTM S ENT OF TAT DivlSoN, OF C081°RAr1°NS Detail by Entity Name Florida Profit Corporatjon SUPERIOR WOODWORKING,INC. fling information Document Number P15000006424 FEI/EIN Number NONE Date Filed 01/20/2015 State FL Status ACTIVE Effective Date 01/20/2015 Principal Address 1405 S.E. 23RD PLACE CAPE CORAL, FL 33990 flailing Address 1405 S.E. 23RD PLACE CAPE CORAL, FL 33990 Registered Agent Name &Address ARREDONDO, ABEL, JR. 1405 S.E. 23RD PLACE CAPE CORAL, FL 33990 Officer/Director Detail Name&Address Title P ARREDONDO, ABEL, JR. 1405 S.E. 23RD PLACE CAPE CORAL, FL 33990 Annual Reports No Annual Reports Filed Document images 01/20,'2015 Domestic Profit L View image in PDF format ] Electronic Articles of Incorporation F1 5000006424 For January 20, 2015 Sec. Of State msolomon SUPERIOR WOODWORKING,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: SUPERIOR WOODWORKING,INC. Article II The principal place of business address: 1405 S.E. 23RD PLACE CAPE CORAL, FL. US 33990 The mailing address of the corporation is: 1405 S.E. 23RD PLACE CAPE CORAL, FL. US 33990 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: ABEL ARREDONDO JR. 1405 S.E. 23RD PLACE CAPE CORAL, FL. 33990 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: ABEL ARREDONDO JR. P15000006424 FILED Article VI January 20 2015 Sec. Of State The name and address of the incorporator is: msolomon ABEL ARREDONDO JR. 1405 S.E. 23RD PLACE CAPE CORA,FL. 33990 Electronic Signature of Incorporator: ABEL ARREDONDO JR. 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 1st 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 director(s) of the corporation is/are: Title: P ABEL ARREDONDO JR. 1405 S.E. 23RD PLACE CAPE CORAL, FL. 33990 US Article VIII The effective date for this corporation shall be: 01/20/2015 $A DEPARTMENT OF 7:E TREASURY f� 1" INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 01-26-2015 Employer Identification Number: 47-2902842 Form: SS-4 Number of this notice: CP 575 A SUPERIOR WOODWORKING INC 1405 SE 23RD PL CAPE CORAL, FL 33990 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 47-2902842. 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 frcm you or your representative, you must file the following form(s) by the date(s) shown. Form 1120 03/15/2016 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. DIr,402l[ WICI `Cil 11 will GMI Operations &Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: 4r L /4 R ,AarJP o Certificate Category Requested: The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement.You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time-served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name,Title and license number of the person signing below and verifying Applicants relevantexperience: Name: 96(2_,E'r7-- Ft 4 Title: PA-tr17-WriV 7Fv'iGrtl v-'` t4' gs'' License Number(if applicable): Al/A---&Pi1te\/a` ,v' e,i,01'4) Name of Business: 1d,L*G A-/ I-i 1C 1tAI #04-1f7-' Business Address: /6-i a 174-4-z,E F WA-y A/4-1044v FL-- ZiLO9 Business Phone: 4,231:?..)-90-'aZ/3..r The Applicant's years of experience from Q2002 to /01. The applicant's scope of work (specific duties)included: fkase•n>. a 3 1$ d 1 L (,+/O a mil' CJ ✓!5-Cc",771-44 r ✓L�L,C6V, L' Z i s1—y ;A/. 1-4/4 V Ci/ rrvA J44-- . Fog, tom/T "At' Win/ �4 , /A(, 3/ 3-,: A D�--A9 i t�FI� C A' W' ,r 4avo ,t-c -a-,,,/ 54.rnt, °&. - I Additional Comments: f4-6 L /uts 1L Gf'Ld t G„4„411.4 a''tE�,, ,a-Wg21/Z.u0•vC$c� /of/✓'774£ j 2. t!( .(1 £Q. /'d tA A1. /,5 ,4 , NliOW 1:9 47 l;7-74 Ec, A? Falsifying any information provided herein may subject your license to revocation. GR--64T" 47-14- Si ztur Print Name: 84--7-7-- tit 7 V9 State of Florida County of Collier The fore_j g ins e as acknowledged before me on this / day of _ �C 1 by ) re( who is personally known to me or produced t h0 7 20 D b 7-j.c:DO2 as identification and who did not take an oath. 0. 4 Signature of No 'j r","'",, ,',;, YURIMA MEJIAS Notary Public-State of Florida Ji4,4.4 My Comm.Expires Jun 7,2015 • oF,,A•s' Commission#EE 875377 VERIFICATION OF CONSTRUCTION EXPERIENCE Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: /" e/ ,AVRepo 4/ Certificate Category Requested: The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name,Title and license number of the person signing below and verifying Applicants relevantexperience: Name: /Lid Title: ©1Nf\_?f License Number(if applicable): Name of Business: G-( d �✓ijf.�/pfl'L' Business Address: 9-3q5 1resc• ./F'e-ir / Business Phone:23I 3 The Applicant's years of experience from lb,h(we„i 0/ /�to ` ci'Y`e..✓l The applicant's scope of work(specific duties) included: I i • ) of ik* O.• a►■ ; + m.t l wac � 1�C 1:$�;.,� PU,�,l �� - >1�, e. -I s, fit,,H i n s Clgtoi tholc41° f,m) <i' -4Y , OC Q 3 :e -t?c'kkc rciI r'111,,kork,S Additional Comments: i I k 4`/f J 1t9, *--61 ► naknc.ilL6 I 92\ i \2 0A.<2.4 v6.,4 e91 ‘JZYy 4e .t .: Falsifying any information provided herein mis y subje t your license to revocation. Signature -Print Name: /V-e-i/ State of Florida County of Collier The foregoing instrument was acknowledged before me • STS day of a1 by f,.1 I L- H 2 who is p•rsonally known to e or produced as identification and who did not take an oath. Sige re of Notary e Notary Public State of Florida James Skowronski My Commission EE 177586 pip. Expires 03/08/2016 A`c„_°R°® CERTIFICATE OF LIABILITY INSURANCE DATE oD 5) 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 NAMEACT Customer Service Department Gaslamp Insurance Services, Inc. faa%E:dl, (619)229-3854 IIFa/c.Nol, 3234 Grey Hawk Ct. CDR ;Certificate @premieragencyservices.corn INSURER(S)AFFORDING COVERAGE NAIC N Carlsbad CA 92010 INSURERA:United Specialty Ins Co. 12537. INSURED INSURER B: Superior Woodworking Inc INSURER C: 1405 SE 23rd INSURERD: INSURER E: Cape Coral FL 33990 INSURERF: COVERAGES CERTIFICATE NUMBER:GL Master 14-15 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. 1LLTTRR TYPE OF INSURANCE ANSR SUER VNn POLICY NUMBER (MWDONYTYI l (YYYY) LIMITS GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 50,000 A X CLAIMS-MADE OCCUR SII1008D02715 1/27/2015 1/27/2016 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE OMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,000 l n POLICY n jF O- 1----i LOC $ AUTOMOBILE UABILIIY COMBINED SINGLE LIMIT (Ea accident) _$ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS ^ AUTOS (Per accldere( $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ l $ WORKERS COMPENSATION I WCY I IAMBS I 10TH- AND AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT $ OFFICEFAMEMBER EXCLUDED? I N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ (I yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space is required) Verification of Coverage *Subject to all policy terms, exclusions and conditions* CERTIFICATE HOLDER CANCELLATION (239)252-2469 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Licensing Department 2800 N. Horseshoe Drive Naples, FL 34104 AUTHORIZED REPRESENTATNE P Salvagio/KATIE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION `CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW' CONSTRUCTION INDUSTRY EXEMPTION rims certl es:hat the Individuai Isted below has elected to be exempt from F!ccda Workers Compensation Iaw EFFECTIVE DATE: 1;28.'2015 EXPIRATION DATE: 27'201' PERSON: ARREDONDO ABEL FEIN: 472902542 BUSINESS NAME AND ADDRESS: SUPERIOR WOOD+NO'RKING INC 145 SE 23RD PLACE CAPE CORAL FL 33990 SCOPES OF BUSINESS OR TRADE: CARPENTRY NOC 44C'J:%'4, `r ar:t;'cac Cf.3"v1CCr41 or-hro S Cli Cter ly 17, ,are of_ea,gn anle°t _,Sci.Ii r ,?Cwe,gene+,1, >.ensa a '�.n:+l f„ ;3�tet ns_arr'r api:,;4... .,,:+.,3' F S -..ac'CCtes+_a.achcn:r ce erer,;.r rl Cty "o",y .v t r :r e SC-4e:It the toso.eSS Cl traCe'steal Or,I■n'lICe C iie..t Cnl h:6e Cxe,T'G: acr5u3^i!„...r.azter 44,7;5 1 tr ? Cct ces u{a..er,„+.°r!I^@ e--.tier to 7e exefrpl :.ac L1e S t .t ti'evcCCI IU 1 3:CO, rre age 'F.!d^g O ,le r.J!Ce C. :re-s5„aci a rt t^.e'ei'd.Ca1e c tIC nJ.'CC no or e ^Ve l$I' :fCu.!erne"l5 rt!" SC:..1,10.. S_,"a re,f 3-._I''t'.c;e -•••a:le_drtrinel't 5r-a!'Ct"•rea LI I✓v c: ? ER'F GATE OF Et ECT.:iN Ti E ".1F:REV SED.. LJL I.ST QNS :TSJ,G+". '.309 886 110th Ave. N.Suite#6,Naples,FL 34108 Phone:239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com BUSINESS CREDIT REPORT as of: 02/02/15 09:19 ET Superior Custom Cabinet,Inc. Fed Tax ID#52-2407694 Address: 1622 SE 21st Ter Business Type: Corporation Cape Coral, FL 33990-4715 United States Experian File April 2010 Established: Experian BIN: 930565402 Experian Years on File: 5 Years Agent: Arredondo Abel J Years in Business: More than 5 Years Agent 1622 SE 21ST Terr Filing Data Provided Address: Cape Coral, FL Florida by: Date of Incorporation: 10/31/2003 Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. /Bankruptcies: 0 /Liens: 0 /Judgments Filed: 0 /Collections: 0 END OF REPORT Page 1 of 1 1/28/15 Full Credit Report I Credit Karma Credit 0 Karma. 1 a Reported as of Jan 22,2015 abet arredondo's Credit Report Provided by msUnlon Overview Your Credit Score Account Mix Credit Cards 13 5 9 4. Real Estate 1 _9 Auto 2 s � Credit Rating Poor t`3a 0 5 , zwagyands Other Loans 1 Total Accounts 17 Personal Information Names Reported Dispute Details ABEL M ARREDONDO Found something incorrect on your report? MARTINEZ,ABEL,A Learn more about how to dispute items on your credit report. Addresses Reported 1205 NE 7TH PL F$ ers Belle My CAPE CORAL,FL T:Q Lehigh Acres Ca 33909 Cape 4"Cor r Coral ® 1622 SE 21ST TE Bon to Springs CAPE CORAL,FL Northytaples 33990 Naples W t 475 E GOLDEN GATE BV I Evergrades wrldl,f r f ttirv1" NAPLES,FL Map r Report a map error 34120 Employment Information Employer Reported Date Reported DESIGNER ABEL ARREDO Nov 8,2011 SUPERIOR CUSTOM CABINET Mar 31,2006 1-These Approval Odds represent Credit Karma's estimation of how likely you are to be approved for a product based on a comparison of your profile with data ahout Credit Karma members who have been approved for the product in the past(if available).There is no guarantee that you will be approved by the lender or that credit will be extended to you. Accounts Account Name Account Type Open Date Status Balance 1/28/15 Full Credit Report I Credit Karma DISCOVERBANK 8 Credit Card Jun29,2003 Closed $5,101 No Missed Payments Account Details Payment History Last Reported Dec 15,2014 No payment history has been reported by this creditor. Creditor Name DISCOVERBANK Credit Utilization* •134.24`0 Account Type Credit Card Account Status Closed-Derogatory Creditor Contact Details Opened Date Jun 29,2003 DISCOVER FINANCIAL SERVI Closed Date Nov 30,2009 PO BOX 1 531 6 15316 WILMINGTON,DE Limit $3,800 19850 Term _ (800)341-2683 Monthly Payment $0 Dispute Details Responsibility Individual Found something incorrect on your report? Balance $5,101 Learn more about how to dispute items on your credit report. Highest Balance 55,101 Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment Jul 12,2009 Amount Past Due $5,101 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Profit and loss write- off 1/28/15 Full Credit Report I Credit Karma BK WEST 0 Other Mar 31,2006 Closed $13,516 No Missed Payments Account Details Payment History Last Reported May 30,2014 No payment history has been reported by this creditor. Creditor Name BK WEST Creditor Contact Details Account Type Recreational Merchandise BANK OF THE WEST 1450 TREAT BV Account Status Closed-Derogatory WALNUT CREEK,CA Opened Date Mar 31,2006 94596 (800)827-7500 Closed Date Mar 25,2009 Limit _ Dispute Details Term 144 Months Found something incorrect on your report? Monthly Payment $0 l earn more about how to dispute items on your credit report. Responsibility Individual Balance $13,516 Highest Balance $17,413 Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment Aug 16,2010 Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Profit and loss write- of f 1/28/15 Full Credit Report I Credit Karma CHASE f Credit Card Sep 05,2001 Closed S4,629 No Missed Payments Account Details Payment History Last Reported Nov 03,2013 No payment history has been reported by this creditor. Creditor Name CHASE Credit Utilization* •115.73% Account Type Credit Card Account Status Closed-Derogatory Creditor Contact Details Opened Date Sep 05,2001 CHASE BANK USA NA Closed Date Aug 03,2009 PO BOX 1 5298 15298 Limit $4,000 WILMINGTON,DE 19850 Term (800)432-3117 Monthly Payment $0 Dispute Details Responsibility Individual Balance $4,629 Found something incorrect on your report? Learn more about how to dispute items on your credit report. Highest Balance $7,480 Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment Nov 06,2008 Amount Past Due $4,629 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Canceled by credit grantor 1/28/15 Full Credit Report I Credit Karma CHASE 8 Credit Card Jun 30,2005 Closed $5,030 No Missed Payments Account Details Payment History Last Reported Oct 29,2013 No payment history has been reported by this creditor. Creditor Name CHASE Credit Utilization* •109.35% Account Type Credit Card Account Status Closed-Derogatory Creditor Contact Details Opened Date Jun 30,2005 CHASE BANK USA NA Closed Date Jul 29,2009 PO BOX 1 5298 15298 Limit $4,600 WILMINGTON,DE 19850 Term (800)432-3117 Monthly Payment $0 Dispute Details Responsibility Individual Balance $5,030 Found something incorrect on your report? Leath mole about how to dispute items on your credit report. Highest Balance $7,114 Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment Nov 25,2008 Amount Past Due $5,030 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Canceled by credit grantor 1/28/15 FtlI Credit Report I Credit Karma THD/CBNA Credit Card Jan 26,2004 Closed $0 No Missed Payments Account Details Payment History Last Reported Jan 07,2013 No payment history has been reported by this creditor. Creditor Name THD/CBNA Credit Utilization* 0.00% Account Type Charge Account Account Status Closed-Derogatory Creditor Contact Details Opened Date Jan 26,2004 THE HOME DEPOT/CBNA Closed Date Oct 05,2009 PO BOX 6497 6497 Limit $2,200 SIOUX FALLS,SD 57117 Term — Monthly Payment $0 Dispute Details Responsibility Individual Found something incorrect on your report? Balance $0 Learn more about how to dispute items on your credit report. Highest Balance $2,639 Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment Jun 22,2009 Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Purchased by another lender 1/28115 Full Credit Report Credit Karma CITIFINANCIA s Credit Card Feb 01,2007 Closed $0 No Missed Payments Account Details Payment History Last Reported Mar 24,2010 No payment history has been reported by this creditor. Creditor Name CITIFINANCIA Credit Utilization* N/A Account Type Charge Account No credit limit reported Account Status Closed-Derogatory Opened Date Feb 01,2007 Creditor Contact Details Closed Date Jul31,2009 CITIFINANCIAL Limit — 605 MUNN ROAD C/S CARE DEPT FORT MILL,SC Term 29715 Monthly Payment $0 (800)922-6235 Responsibility Individual Dispute Details Balance $0 Found something incorrect on your report? Highest Balance $5,782 Learn more about how to dispute items on your credit report. Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment — Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Purchased by another lender 1/28115 Full Credit Report I Credit Karma B K OF AMER l Credit Card May 21,2003 Closed $2,217 No Missed Payments Account Details Payment History Last Reported Apr 30,2009 No payment history has been reported by this creditor. Creditor Name BK OF AMER Credit Utilization* `147.80 i Account Type Credit Card Account Status Closed-Derogatory Creditor Contact Details Opened Date May 21,2003 BANK OF AMERICA Closed Date Dec 22,2008 p0 BOX 982238 982238 Limit $1,500 EL PASO,TX 79998 Term (800)421-2110 Monthly Payment $0 Dispute Details Responsibility Individual Balance $2,217 Found something incorrect on your report? Leal more about how to dispute items on your credit report. Highest Balance $2,217 Payment Status Collection/Charge-Off Worst Payment Status Unknown Date of Last Payment Jan 24,2009 Amount Past Due $678 Times 30/60/90 Days Late 0/0/0 Remarks Charged off as bad debt Canceled by credit grantor 1/28/15 Full Credit Report I Credit Karma CHASE A© Mortgage Mar 01,2004 Closed SO 10 Missed Payments Account Details Payment History Last Reported Dec 15,2009 2009 ?:";®®®®® ®®®® 2008®®®®®®®®®®®® Creditor Name CHASE 2007®®®®®®®®®® Account Type Conventional Real 2006®®®®®®®®®®®in Estate Mortgage 2005 Account Status Closed-Derogatory J F M A M J J A S O N D Opened Date Mar 01,2004 30-59 Days Late CI 60-89 Days Late Closed Date Dec 15,2009 90-719 Days Late Limit — ® 120-149 Days Late Term 360 Months Unknown Monthly Payment $1,517 Creditor Contact Details Responsibility Joint CHASE Balance $0 PO BOX 24696 24696 COLUMBUS,OH Highest Balance $169,750 43224 Payment Status 120-149 Days Late (800)848-9136 Worst Payment Status 120-149 Days Late Dispute Details Date of Last Payment Nov 01,2008 Found something incorrect on your report? Amount Past Due SO Learn more about how to dispute items on your credit report. Times 30/60/90 Days Late 1/1/8 Remarks Foreclosure redeemed SYNCB/CHEVRO n Credit Card Oct 18,2003 Closed 50 No Missed Payments Account Details Payment History Last Reported Jan 14,2015 2014®®®®®®®®®®®® 2013®®®®®®®®®®®® Creditor Name SYNCB/CHEVRO 2012111111111111111111611111111111511111111111111111 Account Type Charge Account 2011®®®®®®®®®®®® Account Status Closed J F M A M J J A S O N D Opened Date Oct 18,2003 Credit Utilization* 0.00% Closed Date Mar 29,2008 Limit $600 Creditor Contact Details Term — Monthly Payment $p SYNCB/CHEVRON PLCC PO BOX 965015 965015 Responsibility Individual ORLANDO,FL Balance $o 32896 (800)243-8766 Highest Balance $o Payment Status Current Dispute Details Worst Payment Status Current Found something incorrect on your report? Date of Last Payment — LL,arn more about how to dispute items on your credit report. Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Closed 1/28/15 Full Credit Report Credit Karma SEARS/CBNA 8 Credit Card Oct 29,2000 Closed $0 No Missed Payments Account Details Payment History Last Reported Jan 06,2015 2014®®®®®®®®®®®® 2013®®®®®®®®®®®® Creditor Name SEARS/CBNA 2012®®®®®®®®®®®® Account Type Charge Account 2011®®®®®®®®®®®® J F M A M J J A S O N D Account Status Closed-Paid Opened Date Oct 29,2000 Credit Utilization 0.00% Closed Date May 12,2008 Limit $250 Creditor Contact Details Term — Monthly Payment $0 SEARS/CBNA PO BOX 6282 6282 Responsibility Individual SIOUX FALLS,SD Balance $0 57117 Highest Balance $445 Dispute Details Payment Status Current Found something incorrect on your report? Worst Payment Status Current L.earn rnore about how to dispute items on your credit report. Date of Last Payment Jun 02,2005 Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Canceled by credit grantor 1/28/15 Full Credit Report I Credit Karma SST/SYNOVUS 8 Credit Card Dec 03,2004 Closed $0 No Missed Payments Account Details Payment History Last Reported Sep 21,2009 Zoos 515151®®515151 2006 615161515151515151515151 Creditor Name SST/SYNOVUS 2007 516151615151616161615161 Account Type Credit Card 2006 515151615161515151515161 Account Status Closed-Paid 2005 51515151 J F M A M J J A S O N D Opened Date Dec 03,2004 Closed Date Nov 16,2006 Credit Utilization* 0.00% Limit $2,530 Term Creditor Contact Details Monthly Payment $0 SST/SYNOVUS Responsibility Individual 4315 PICKETT Balance $0 SAINT JOSEPH,MO 64503 Highest Balance $3,090 (800)789-8001 Payment Status Current Dispute Details Worst Payment Status Current Date of Last Payment Aug 31,2005 Found something incorrect on your report? Learn more about how to dispute items on your credit report. Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Account closed by consumer CAP1/BSTBY 8 Credit Card Jul 25,2004 Closed $0 No Missed Payments Account Details Payment History Last Reported Jul 28,2009 zoos 515151515151 2008 515151515151515151515151 Creditor Name CAP1/BSTBY P007 6161®®®5151515151 Account Type Charge Account 2006 515151515151516151515161 Account Status Closed-Paid 2005 515151515151 J F M A M J J A S O N D Opened Date Jul25,2004 Unknown Closed Date Feb 21,2009 Limit $1,400 Credit Utilization* 0.00% Term — Monthly Payment $0 Creditor Contact Details Responsibility Joint CAPITAL ONE/BEST BUY Balance $0 PO BOX 30253 30253 SALT LAKE CITY,UT Highest Balance $1,403 84130 Payment Status Current (800)695-6950 Worst Payment Status Current Dispute Details Date of Last Payment Mar 27,2006 Found something incorrect on your report? Amount Past Due $0 earn more about how to dispute items on your credit report. Times 30/60/90 Days Late 0/0/0 Remarks Closed 1/28/15 Full Credit Report I Credit Karma CITI r Credit Card Nov 14,1999 Closed $0 No Missed Payments Account Details Payment History Last Reported Aug 08,2007 2007®®®®®®® 2006®®®®®®®®®®®® Creditor Name CITI 2005®®®®®®®®®®®® Account Type Credit Card 2004®®®®®®®®®®®® Account Status Closed-Paid 2003 ®®®®® J F M A M J J A S O N D Opened Date Nov 14,1999 Closed Date Apr 18,2007 Credit Utilization* 0.00% Limit $3,410 Term Creditor Contact Details Monthly Payment $0 CITICARDS CBNA Responsibility Individual PO BOX 6497 6497 CREDIT BUREAU DISP Balance $0 SIOUX FALLS,SD 57117 Highest Balance $0 (800)533-5600 Payment Status Current Dispute Details Worst Payment Status Current Date of Last Payment May 24,2007 Found something incorrect on your report? Learn more about how to dispute items on your credit report. Amount Past Due $o Times 30/60/90 Days Late 0/0/0 Remarks Account closed by consumer FRD MOTOR CR '* Auto Aug 20,2005 Closed $0 No Missed Payments Account Details Payment History Last Reported May 12,2007 2007®®®® 2006®®®®®®®®®®®® Creditor Name FRD MOTOR CR 2005 ®®®®® Account Type Automobile J F M A M J J A S O N D Account Status Closed Opened Date Aug 20,2005 Creditor Contact Details Closed Date May 12,2007 FORD MOTOR CREDIT PO BOX 542000 542000 Limit OMAHA,NE Term 60 Months 68154 Monthly Payment $609 (800)727-7000 Responsibility Individual Dispute Details Balance $0 Found something incorrect on your report, Highest Balance $29,330 Learn more about how to dispute items on your credit report. Payment Status Current Worst Payment Status Current Date of Last Payment May 12,2007 Amount Past Due $0 Times 30/50/90 Days Late 0/0/0 Remarks Closed 1128/15 Full Credit Report I Credit Karma CAP ONE 8 Credit Card Nov 28,2001 Closed $0 No Missed Payments Account Details Payment History Last Reported Apr 20,2007 2007®i®i® 2006®®i®®®®®®®®®® Creditor Name CAP ONE 2005 ®®®® Account Type Credit Card J F M A M J J A S O N D Account Status Closed-Paid Opened Date Nov 28,2001 Credit Utilization* N/A Closed Date Apr 20,2007 No credit limit reported Limit Creditor Contact Details Term — Monthly Payment $0 CAPITAL ONE BANK USA NA PO BOX 30281 30281 Responsibility Individual SALT LAKE CITY,UT Balance $0 84130 (800)955-7070 Highest Balance $530 Payment Status Current Dispute Details Worst Payment Status Current Found something incorrect on your report? Date of Last Payment Jan 08,2007 Lean more about how to dispute items on your credit report. Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Account closed by consumer 1/28/15 Full Credit Report Credit Karma CHASE 18 Credit Card Dec 03,2004 Closed $0 No Missed Payments Account Details Payment History Last Reported Feb 21,2006 20061E 2o05®ll!®NIMI®NI®®NININI Creditor Name CHASE 2004 Account Type Credit Card J F M A M J J A S O N D Account Status Closed Opened Date Dec 03,2004 Credit Utilization* 0.00% Closed Date — Limit $2,500 Creditor Contact Details Term — CHASE BNK-FRMLY PRVD/WAM Monthly Payment $0 0 BANK ONE CARD SERV 2500 WESTFIELD DRI ELGIN,IL Responsibility Individual 60124 Balance $0 Dispute Details Highest Balance $3,090 Payment Status Current Found something incorrect on your report? Learn more about how to dispute items on your credit report. Worst Payment Status Current Date of Last Payment Aug 31,2005 Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Account closed by consumer FRD MOTOR CR ki Auto Jun 16,2001 Closed $0 No Missed Payments Account Details Payment History Last Reported Aug 25,2005 2005 E®®®®®® 2004 MINI®®MININI®®®NIMI Creditor Name FRD MOTOR CR 2003 MINIl®®MIIiNINI®®NI® Account Type Automobile 2002 NININI NINININININININI Account Status Closed 2001 MINI®® J F M A M J J A S O N D Opened Date Jun 16,2001 Unknown Closed Date Aug 25,2005 Limit — Creditor Contact Details Term 72 Months FORD MOTOR CREDIT Monthly Payment $519 PO BOX 542000 542000 OMAHA,NE Responsibility Joint 68154 Balance $0 (800)727-7000 Highest Balance $25,248 Dispute Details Payment Status Current Found something incorrect on your report? Worst Payment Status Current Learn more about how to dispute items on your credit report. Date of Last Payment Aug 25,2005 Amount Past Due $0 Times 30/60/90 Days Late 0/0/0 Remarks Closed 1/28/15 Full Credit Report l Credit Karma *Calculated using reported balance and credit limit on account. Credit Inquiries Creditor Name Inquiry Date Removed By* Type MIAMI CAR CR May 5,2014 Jun2016 Automotive Creditor Contact Details Dispute Details MIAMICARCREDI/MIAMICARCR Found something incorrect on your report? MIAMI,FL 33169 I earn more about how to dispute items on your credit report. (440)317-0010 MIAMI CAR CR May 4,2014 Jun2016 Automotive Creditor Contact Details Dispute Details MIAMICARCREDI/MIAMICARCR Found something incorrect on your report? MIAMI,FL 33169 I earn more about how to dispute items on your credit report. (440)317-0010 *Estimated based on the date of your inquiry and an assumed 2 year expiration period. Collections Agency Original Creditor Open Date Status Balance CAVALRY PORT 08 GE MONEY BANK Feb 20,2013 Open $296 Account Details Creditor Contact Details Last Reported Jan 12,2015 CAVALRY PORTFOLIO SERVIC 500 SUMMIT LAKE DR 400 Collection Agency CAVALRY PORT VALHALLA.NY 10595 Original Creditor 08 GE MONEY BANK (800)501-0909 Status Open Dispute Details Opened Date Feb 20,2013 Closed Date — Found something incorrect on your report? Learn more about how to dispute items on your credit report. Responsibility Individual Balance $296 High Balance $268 Remarks Placed for collection 1/28/15 Full Credit Report I Credit Karma MIDLAND FUND CITIBANK SOUTH Dec 27,2012 Open $3,258 DAKOTA N A Account Details Creditor Contact Details Last Reported Jan 12,2015 MIDLAND FUNDING LLC 8875 AERO DR 200 Collection Agency MIDLAND FUND SAN DIEGO,CA Onginal Creditor CITIBANK SOUTH 92123 DAKOTA N A (844)236-1959 Status Open Dispute Details Opened Date Dec 27,2012 Found something incorrect on your report'? Closed Date — Learn more about how to dispute items on your credit report. Responsibility Individual Balance $3,258 High Balance $2,639 Remarks Placed for collection PORTFOLIO RC CITIFINANCIAL INC Mar 30,2010 Open $6,317 Account Details Creditor Contact Details Last Reported Jan 08,2015 PORTFOLIO RECOVERY 287 INDEPENDENCE Collection Agency PORTFOLIO RC VIRGINIA BEACH,VA Original Creditor CITIFINANCIAL INC 23462 (800)772-1413 Status Open Opened Date Mar 30,2010 Dispute Details Closed Date — Found something incorrect on your report? Responsibility Individual Learn more about how to dispute items on your credit report. Balance $6,317 High Balance $5,783 Remarks Placed for collection PORTFOLIO RC HSBC BANK NEVADA Nov 20,2009 Open $7,396 NA Account Details Creditor Contact Details Last Reported Jan 08,2015 PORTFOLIO RECOVERY 287 INDEPENDENCE Collection Agency PORTFOLIO RC VIRGINIA BEACH,VA Original Creditor HSBC BANK NEVADA N 23462 A (800)772-1413 Status Open Dispute Details Opened Date Nov 20,2009 Found something incorrect on your report? Closed Date — Learn more about how to dispute items on your credit report. Responsibility Individual Balance $7,396 High Balance $6,574 Remarks Placed for collection 1/28/15 Full Credit Report I Credit Karma CBE GROUP 01 DIRECTV QUAD May 27,2012 Open $454 Account Details Creditor Contact Details Last Reported Nov 16,2014 THE CBE GROUP INC-FORMER 131 TOWER PARK DRI PO BOX 900 Collection Agency CBE GROUP WATERLOO,IA Onginal Creditor 01 DIRECTV QUAD 50704 (319)226-5173 Status Open Opened Date May 27,2012 Dispute Details Closed Date — Found something incorrect on your report? Responsibility Individual Learn more about how to dispute items on your credit report. Balance $454 High Balance $454 Remarks Placed for collection PIN CRED SER 12 CHASE BANK Jan 24,2011 Open $4,765 Account Details Creditor Contact Details Last Reported May 24,2014 PINNACLE CREDIT SERVICES PO BOX 5617 5617 Collection Agency PIN CRED SER HOPKINS,MN Original Creditor 12 CHASE BANK 55343 (952)939-8100 Status Open Opened Date Jan 24,2011 Dispute Details Closed Date Found something incorrect on your report? Responsibility Individual Learn more about how to dispute items on your credit report. Balance $4,765 High Balance $3,642 Remarks Placed for collection EOS CCA 10 AT T MOBILITY Aug 13,2012 Open $261 Account Details Creditor Contact Details Last Reported May 23,2014 EOS CCA PO BOX 981008 981008 Collection Agency EOS CCA BOSTON,MA Original Creditor 10 AT T MOBILITY 02298 (855)711-5165 Status Open Opened Date Aug 13,2012 Dispute Details Closed Date — Found something incorrect on your report? Responsibility Individual I earn mere about how to dispute items on your credit report. Balance $261 High Balance $221 Remarks Placed for collection 1/2 8/15 Full Credit Report I Credit Karma AFN I 10 VERIZON Nov 29,2011 Open $661 WIRELESS Account Details Creditor Contact Details Last Reported Apr 22,2012 AFNI PO BOX 3097 3097 Collection Agency AFNI BLOOMINGTON,IL Original Creditor 10 VERIZON 61702 WIRELESS (800)371-3645 Status Open Dispute Details Opened Date Nov 29,2011 Found something incorrect on your report? Closed Date — Learn more about how to dispute items on your credit report. Responsibility Individual Balance $661 High Balance $661 Remarks Placed for collection Public Records 0 As of Jan 22,2015,you had no public records on your credit report. How to Read Your Credit Report Your full credit report is divided into five important sections: Personal and Employment Information This section contains names,addresses and employers included on your credit report.This sort of information is added to your report after its been used on credit applications.Review this section for any information you don't recognize. Accounts This section contains details on each credit account on your credit report,including both open and closed accounts.Details include payment history,current status and reported balances.Review this section to ensure that your lenders have been properly reporting your activity,and to look for any accounts that you didn't open. p Credit Inquiries 1445 U:fle 4.11 fq 0 i1 f• CDL - ARMOCINDO.Nt "L- Vali! - = = , - .......41.111-e4ovegiutes consent to Inv sabnaV N.( W . Grovs tIi 1ianageinCnt 1)ivi ion Planning & Regulation Operations Department Li(CfSin ;Section February 4, 2015 Josue Briceno Innovative Glass & Window, LLC 226 Homestead Rd S Unit B Lehigh Acres, FL 33936 RE: Review of Application Mr. Briceno, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, February 18, 2015. The meeting is held at 9:00am at the W. Harmon Turner Building (Bldg. F, Admin. Bldg.), 3299 Tamiami Trl. E., Naples, FL in the Commissioner's Meeting Room on the 3rd floor. If you have any questions or concerns, please call (239) 252-2431. Sincerely, Samantha Roe Customer Service Specialist Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 Growth tv1anauernent Oiv,Oon'Planning K:(tes uL+tion'2000 North Horseshoe Oirio-N7ple;,1'lo,da 34104'130 252 2400 v.,,s coil' o,t.rrot GreenbergJoann From: OssorioMichael Sent: Wednesday, February 04, 2015 10:43 AM To: GreenbergJoann Subject: FW: Insurance From: Sheri Briceno [mailto:sheriOigwllc.net] Sent: Wednesday, February 04, 2015 1:33 PM To: OssorioMichael Subject: Insurance Sir, I am one of the owners of Innovative Glass&Window and I am also the one who gathered up all the paperwork for Josue Briceno to submit to Collier County for him to obtain licensure in your County. He is always out in the field and I am the one who handles all of the administrative tasks for the company(taxes, licensing, insurance, etc). Regarding the issue with the insurance information I am the one who provided the Insurance Certificates not Mr. Briceno. He just turned in what I gave him. Please bear with me as I give you a brief history of what has gone on with my company, I feel it might help you to understand why I panicked. We moved here from Miami to start a better life and opened Innovative Glass& Railing in 2012, with multiple partners.We had a glass division (myself&Josue and a railing division— our ex partner)We were running everything legitimately, taxes, insurances, licensing. Near the end of 2013,we were involved in a large railing project on a condominium that was run by our former partner. During the course of that project we found this partner doing side work,ordering materials"for this project" but actually working elsewhere. When we were contacted by the contractor&found out he hadn't been doing the work,we had to hire another company to finish this project and we lost 23+thousand dollars trying to honor this contract on our own rather than just backing out and leaving this contractor in a bind. That is a huge hit for a small company and we have been trying to recover ever since.We had to take out business loans,we still owe several vendors, but rather than just closing completely and filing for bankruptcy we wanted to make good on everyone we owe. We shutdown the railing division, moved to a much smaller warehouse in Lehigh, changed our name and have been trying our very best to move forward and pay off the old debts created by that situation, But it's been extremely hard on us. Late nights working,weeks with no pay, sleepless nights worrying,health issues,family issues,just complete devastation.We've felt like giving up so many times.And, I know none of this excuses my actions, just wanted you to understand my state of mind. I had been in the process of trying to research and reinstate our insurances which severe lack of funds had prevented me from having in place for a short period but this licensing situation in Collier County came up so quickly and I just panicked when I was gathering up the paperwork. (our Liability should be bound by this afternoon and our Workers Comp by later today or tomorrow) I know it might not seem like it now, but my intent was never to defraud anyone,out of fear I just panicked and made a very poor decision. We really are honest, hardworking people.We try to give back to our local community by inviting people to church, providing people in trouble with very low costs or sometimes even free donated work if we are able to help. We are just people trying to pay back our debts, support our families and desperately trying to recover from a terrible situation. I am hoping both you and the board of Collier County can at least take these things in to consideration when reviewing our case. Thank you for your time!! 1 i1ll1ovt! 8 18ss windos1ttC Colossians r, 3 Snarl$rleona Office Manager Innovative Glass and Window,LLC 226 Homestead Rd S unit B Lehigh Acres,FL 33936 (239)303-9316 Office (239)303-9365 Fax www.igwllc,net CONFIDENTIAL NOTICE rh,,, s.l e.a!rsui wan ny ,.t-a:h,n,_ br,'i,,ly, ,to i,.info: icra that <.ror,i,deorial,praadeaead,or of hera;0,e fro c aana.t[you tP e of a i.,,o ar .:antt , t.ed:[_pout, i){l a ac_fi,d,t ihote.100 Gr utih e We e?9r aosral inforrrt<al:ee in any way rttiie.r than We luteudad "dudldd sri, .; , ,t3nnso)C ;:defi.itinE i^:_t.G. ireended rreapenr,you re E=errhy notified tie t any , t,' .r i N.i,. :4.h i 3..rPwa,Ur 0,0 0i„.n,^Wounatra, rultamed al 0a attar ued to t h e,, i a a i l� `,f€Ita t Y ' C)1 f1.41`ycz O haver real th,0 rail in 0.1(01 rae ei.,,l r r ,hiy ih i teleiThone,,:We hununar ra.;aard ahov0,aad+ d dtrie'tt has em al and e;ry et ,,:hrnx r t, 'hot,r.,dnE.wintUU,or s,riri; Under Florida€aw. -mail addresl..ms are public records_If you do not want your e-mail address released in response to a punk.records request.do not send e!cctr into clad to tU e.outity Instead,contact this(Ace by teloarboora or in:,,Wing 2 o e-r ounty GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive go 5 - C" - c Naples, FL 34104 c9CJ ) 3— 3 $ APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: (, Q Exact Corporate/Business Name:in/W EdltWe 6('1cc W��1�/'md Fiction Name/DBA: / v it Qualifier Name: 'NW°U f' $ritn a Physical Address: 4a7°1 J +inVia1"6d ' OM)* a CIACill ��s cl 3313 (Number & Street) (City) (State) (Zip Code) Mailing Address: 5FW (Number & Street) (City) (State) (Zip Code) Telephone @2&303-9'3 )6 E-Mail:%(61 {Jj LL•C TYPE OF LICENSE: U General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 U Plumber $230.00 U Residential $230.00 U Air Cond. $230.00 ❑ Mechanical $230.00 U Swimming Pool $230.00 U Roofing $230.00 Specialty $205.00 Specialty trade: 1 CHANGE OF STATUS: 1t ,,' i { ) 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. Ste' \E n -36 ceno 'c" i 4te tJ 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years(ex. Held a license for or been a partner). Attach extra pages if needed. 3. List all debts you or any company(s)associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. 1\1° Q8 AFFIDAVIT u 0s14E ' GeNto certify that the foregoing is true and correct to the best of my knowledge. Th,V■4 alive..Gle,S5otnd Wthd&3 Li Authorized Officer of the Firm STATE OF FLORIDA COUNTY OF The foregoing instrument as acknowledged before me this (Date) By 06- 62/eC rJ6, of X-N O(/1171 614 ".r !/t iv2M (Name of officer, title/agent) (Name of Corporation) a Pa ,,/l Corporation on behalf of the corporation. (State or Place of Corporation) Os% 9'31' 7y' Y/' He/She has produced F -I t'i Licei.)34 identification and did not take an oath. (Type of identification) NOTARY'S SEAL J.DMIfNE JARRETr (714 ekica, 71 +YCOMMISSICN#FF0242 (SIGNAT RE OF NOTARY) EXPIRES:June 8,2017 (1A: 13(1�" Bonded Tin Notary Pubic ElndeatxFtt Page 2 of 4 QUALIFIER INFORMATION: Name: jcug Bfl ( VO Address: V f K1 5 ` 't 61Y4`e 1 1# orK t' t a- (Number& Street) (Ci t?ty) (State) (Zip Code) Telephone(?)1) D 314-6°6 Date of Birth:09.101# 1991-1 S.S. #: 000-00-r„-- =f- • 3 © (9 E-Mail: & 1 0„ L 1., • Nei-, Driver's Licenser 6 a 5 ti 3? . .5 24 q Q 1. Type of Certificate of Competency for which application is made. 6 lc,c .!t' '` .067, i NI' c. ,- #- ,c ' - , 2. The names and telephone numbers of two per ons who will know your whereabouts. Siles 1C6r(Ceno -i''Z S <6 35 — Q ti 1 Mci r 0 VcCct r.2...--Ca3s $ 3S - 2.4gc 3. Have you ever been convicted of a crime related to Contracting? NI V 0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? P4 C 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. NO NJ 9. List your business or work experience during the past ten years. maf 2 1: RW (:. , `. , ,� `` ` i ,\ `i_ y1 ti� t �.( . 10. Statement of any formal training you have had in the area for which the application is made. P61--'- C i { d le&it z— Page 3 of 4 Lee County Sotd wesi Tiorfht BOARD OF COUNTY COMMISSIONERS John E Manning Distract One Cecil L.Pendergrass District Tno Larry Kker February 02,2015 District Three Shan Hammon D stract Four COLLIER COUNTY CON RA I • L•' Frank Mann 2800 N I-10RSESHO Opp District Five NAPLES, Fl 42 Roger Desjarlais County Manager Richard Wii.Wasrh County Attorney Donna Mare Cotlns Hearing Examiner LETTER OF RECIPROCITY This letter is to verify that JOSUE BRICENO took the Pro Metric examination, sponsored by Lee County. BUSINESS&LAW: 86.0% DATE: 02/02/2003 Glass&Glazing Contractor-GL: 76.0% DATE: 01/05/2013 The applicant needed to prove three years experience in the trade at the Licensing Board appearance, JOSUE BRICENO has had a Glass and Glazing Contractor License in Lee County since 06/28/2013. If you have any questions or if I can be of further assistance, please contact Contractors Licensing at(239) 533-8895, Sincerely, /( Fes.• , t David Pas ha Contractor ►icensi g e � n P.O.Box 398,Fort Myers,Florida 33902-0398 (239)533.2111 `"r Aiclnrcp.rpt Internet address httpJAwm.lee-county.com 2 Q 9 AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER From: FAXmaker To: 92522469 Page: 2/2 Date:212/2015 3:07:50 PM Lee County Sou( west 'Florida BOARD OF COUNTY COMMISSIONERS 1,4 John E.Manning District One 16 Coati L Pendergrass Qistnct Two - let L arty}Okar February 02,2015 4/c Qistr:rt Three Brion Hamm ur ritrict four COLLIER COUNTY CONTRACTOR LIC Qisf Frank Mann 2800 N HORSESHOE DRIVE Qistrct Frye NAPLES,FL 33942 Roger Desjarlats County Manager Richard Wrn.Mach County Attorney Donna Marie Collins Hearing Exatrane, LETTER OF RECIPROCITY This letter is to verify that JOSUE BRICENO took the Pro Metric examination, sponsored by Lee County. BUSINESS &LAW: 86.0% DATE: 02/02/2003 Glass&Glazing Contractor-GE:: 76.0% DATE: 01/05/2013 The applicant needed to prove three years experience in the trade at the Licensing Board appearance. JOSUE BRICENO has had a Glass and Glazing Contractor License in Lee County since 06/28/2013. If you have any questions or if 1 can be of further assistance, please contact Contractors Licensing at(239) 533-8895. Sincerely, David Paschall Contractor Licensing P.O.Box 398,Fort Myers,Florida 33902.0398 (239)533-2111 tticlnrep.ipt Internet address http://www.lee-county.com AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER 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. SW( Brienô 16e APPLICANT(PLEASE// 4kPRIN/Anoat've T) /� /f I tu,)lI W 4 he •la l OMPANY i . ,Ark f i!1*: , .; 7 ;r-"ICAN M` STATE OF FLORIDA - COUNTY OF Le.- The foregoing instrument as acknowledged before me this .� �� m1 or r oc dj i� (Date) By �._J�j5 U�' f Sie..Je° v who has produced 1 ),e I v'2�L.5 km 1.-.5-{ ,�G :5 X13 �' �'y/ (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL f '1-1,y / r 7� I (SIGNATUR OF NOTARY) t�+Q�1j�'fk i J.DARLENEJARRETT MY COMM SSION II FF 024256 �, ,. a EXPIRES:June 8,2017 Sa.„', envied TM Natzry PUt&Undereker 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. r, , \, , n <------------ 1 f I • . S14 RE OF A e'LICA C v 'Lvi - BUSINESS NAME -0 ) 312015 " DATE )(- BEFORE ME this day personally appeared ---30f7TA-4.,C. 1#(.. r"\0 who . affirms and says that he has less than one employee and does not require • Workmen's Compensation and understands that at any time he employs one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF ( The foregoing instrument was acknowledged before me this --) 3— • Date by --3 (N'''S\.),.•4:L - l' t C -'2...-A,0 ' who has produced Of.t. c----- 6 i".c- (name of person acknowledging) (Type of idontlflOatiOn) as identification and who did not take an oath. - - ... ( '` / . . • . ' (, , ' ), \-:\---)c.„,-;--- . • IGNA° URE OF NOTARY . NOTARY 0EA,L NOTARY PUBLIC MY COMMISSION#FF161686 • ..-1.4.0","' EXPIRES September 21,2018 r - ,(407).. Ai 53 loridallotaryServICe.coM • • f VERIFICATION OF CONSTRUCTION EXPERIENCE Lee County Contractor Licensing P.O.Box 398, Fort Myers,Florida 33902 (239)533.8895 Contractorlicensinc( leegov.com Applicant's Name:a� � 1?CQ-nO Certificate/Trade Category Requested: a la.. , Q-/x d C l 21t es2_ tax-4-- �c4-�� The Applicant is seeking a Lee County Certificate of Competency in the trade indcated abode. As part of the application PP 9 Y p Y P Pp for this certificate the Applicant must verify their experience within this trade. Your are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working for you 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 following information must be provided by the person verifying trad experience for the�a ove-named applicant: Name: 16`Ccel oo 1 k e (Name of the person signing below and verifying the Applicant's relevant experience) rf /�(� Title: License Number: ,P9 oot t' [:.4'�'3 (e.g.,Owner,Supervisor,Etc.) c / Name of Company or Business: 0 C� 1 �.'e._L 'S G ct.S S Se r V t Q._e 1 NVV Company or Business Address: 3 t I /1 � - Ale t�j 1 e s -L_ 34- 1 1 Street or P.O.Box City State Zip E-Mail Address: -e ,fY1("AO_rfl(7(5C.MMCt(5',S 41,c.o M Business or Office Phone: (((Z3?- ,,tO• '7`71 ? Applicant's Title(s) .. 1./\6 f F O re PO CU") / The Applicant was employed by me from ( Z_ / 0 11 to i 0067 The Applicant's scope of work(identify specific duties)while employed by me included: 41 rr1 m--1 1) Jts 6 Sup'----eVi 5z,t Or. 0'11 d"-estetn•1f6,1 O-r-Ncd C D eY1erefart j X45. to S List five (5)construction task/projects completed by applicant while employed by you/your company, including but not limited to task/project title, location and dated comple ec( I Drier ucCLfIQ f,, J 1Lp!/t',s} 001Yt re\crC(c 4 S t oiN - ..1..... off 1 a 1 clemC r-e- 2 C (' �.(- 441 (1<1,40 , FL F' /fa pf\AJ t:rF re o>i� a)tivt O) S. Ni)(f IAA tL V/1 le S t *- _. t rkft .rYC.0 - t)- ,..t(at N 6(1 tt�z),K1 (,'i2` • c ) .._voc. Cori .d o • ./J i /c' S h L�r c i +� ,c_ Ok ii r� Q.. t'r rye r �t—e t c ,n e.e. S G� cj • ► 0.r2btt+ t SC�\t�Stto�v 't2Z 6{ � It tR6;tyy e of conttrac ing under t 'n by you/your organization and the total number of years of experience you hay within that type of contracting: tC-e S 1 C'61. l CO 0_,M( i Try,f7ve r-c 0 > -" LQ S S a C) 11 is^L2 ) t7 , ,r /17 II L CLr-s P f JO ac'fe r'l C n .-- -. Page 8 of 9 S:'PERSIIT CODE_LICAn,uttin;Ccr s Wc4ig4 rotuu•Co■ruing Io IiMt.,tdr kna:\,+ptirAi.rn k tse(..wni)CmtiGtate aCwnpcts,ky dxr 1;20/2012 8.40:00 A\l List the amount of time the applicant has worked for you/your organization as a skilled worker: / t LieL List the amount of time the applicant has worked for you/your organization as a supervisor/administrator:_4 Additional Comments: NOTE TO LICENSED CONTRACTORS: Falsifying an information provided herein may subject your icense to revocation. '7' / l. r /' / f / # ' 4Sign/tur Person providing alern f) Under penalties of perjury, I declare that I have read the forgoing Application and that the facts stated in it are true. Applicant's Signature Date Page 9 of 9 VERIFICATION OF CONSTRUCTION EXPERIENCE Lee County Contractor Licensing P.O. Box 398, Fort Myers,Florida 33902 (239) 533-8895 Contractorlicensinq(lu leegov.com Applicant's Name:j-CS.u_e...., (?o Q-ika Certificatetfrade Category Requested: a la .55 0.-1‘c t GI E eA 2(11 0p._i'1,4cc C4-� The Applicant is seeking a Lee Count Certificate of Competency in the trade indicated dbcJe. As part of the application Pp g Y p Y P PP for this certificate the Applicant must verify their experience within this trade. Your are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working for you 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 following information must be provided by the person verifying trade experience for the above-named applicant: Name: •Rokx?,.4.- a oldie, .. iz_.. (Name of the person signing below and verifying the Applicant's relevant experience) Title: 1) I €? Cr e.,5, OW` License Number: SC., (e.g.,Owner,Supervisor,Etc.) p Name of Company or Business: l....t_t.STOA c-!A- S'-'' " - krc1t1-f 4' Company or Business Address: 372 I-t'Uti,LCCX 6Av- Ab4plexst : i-- 3=t/1,j_ Street or P.O.Box City State Zip E-Mail Address: Business or Office Phone: ( ) Applicant's Title(s) ( iicc; illl till-1- +" The Applicant was empl d by me from / to / The Applicant's scope of work(identify specific duties) Jwhile employed by me included: T rt15 t f-kli/fl l C� la 'S Qeti t._i/\9 Vbilpte3 + r'11155 List five(5)construction task/projects completed by applicant while employed by you/your company, including but not limited to task/project title,location and dated completed: *Ca L.)r ett-4e' r t r��irt, p ctrl€k1 (.1. C{' S' c�1, - fi ck_ rccC-E s i 1 u5'�Ct.iL .'h°cue( citioJS - 1nl rCOr c•CttevA Indicate the type of contracting under taken by you/your organization and the total number of years of experience you have within that type of contracting: l`T\ S 4 Lt Mum M t r\v rr n j,- -a,i. 1 i t,i +- q etfe>, 7 ) �cit Lcc t ltt't c_(04 a.( t:; Gcts? ri cji, ; cis- c;� t6vt a t)rka ''iitt Er ((Ott: fi mi IN'CfS' ( if ` (9-(2/(;`) Page 8 of 9 s:sPF CAI IT CODES_LK,Pcntittiog Ccra'a Worthy roWr-Corncning to liithbl,Tara pplit:+i.x,ref Lte Cowx)Catirieaic ofCotttlxitm.J■e, 1/20/7Ot 2 8:40:00 AM List the amount of time the applicant has worked for you/your organization as a skilled worker: 12-66,3 _ 2 dO?, List the amount of time the applicant has worked for you/your organization as a supervisor/administrator: Additional Comments: ^� ,t1 I S Ct. CV-Cy s ieiit4 l e.s= pers0 °, c-Ad �i(1 AocticC: Ct Cf0U4 6,)cc rd'c5 ; avelC'r/'. NOTE TO LICENSED CONTRACTORS: Falsifying an information provided herein may subject your license to revocation. mac (Signature of Person providing the slat n ent) Under penalties of perjury, I declare that I have read the forgoing Application and that the facts stated in it are true. Applicant's Signature � *"' � ° � = °""'- Date /' e-13 Page 9 of 9 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, 'S'll cri goice(10 , am a resident of L e e County, (fir LI A (State) and have resided here for more than five (5) years. During the last five years I have known „_) O c\i e R.,-1.(€4*4 applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. " (Signature) AcW4C43Pn (Name) cl.vcis) leeth.63‘1.- .4 e \ (Address) 70 W t . t.dA)in ficre ). ft. 339'71; ..-------- Telephone) 2 3 9 a'2 `.-(-- STATE OF FLORIDA COUNTY OF /--(2. <- 961,5-- 2A/ ;\ The foregoing instrument was acknowledged before me this •J ,--/tzi CIC if;:e-/-.e et:-Yby (Date) -S-/-1.,2-,, I 4 ie/6,4,-/0 who has produced ri- ae-i43 X iciej,‘ < '4 724„167 71.6, //- o (name of person acknowledging) (Type of identification) as identification and who did not take an oath. , -1)-Stiltx- 11,-, - ,, v.,, 2--// GNATURE OF ,OTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC s.0v7ik., J.DARLENE JARRETT E'Z' tk t% MY COMMISSION It FF 024256 EXPIRES:June 8,2017 Banded Thru hkItaryPubtic Unchhwtters • • AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, AnUTICI, U 1 ' 1t ' 'kE, rm a resident of e-e County, Flcoda (State) and have resided here for more than five (5) years. During the last five years I have known (Applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. (Signature) (Name) apn \I CL V (Address) 101 511rs cS� t�h tiextsz F't133q-Z Telephone) 239 " STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 31� �/ � � �by (Date) .rp 44 bA elli( t s- Y[=7/S@) ho has produced / &A/46s (name of person acknowledging) (Type of identification) as identification and who did not take an oath. "'" J.DARLENEJARRETf atd-A-q, i r rY.,, = MY COMMISSION#FF 024256 y+ a EXPIRES:Junes,2017 S NATURE OF OTARY ',kW" Booded Trim Way Restikrdervertem NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC COLLI R COUNTY GOVERNMENT CO I Y DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples,Florida 34104 • 239-403-2400 • FAX 239-403-2334 y. -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, Floiida Statues and Collier County Contractor Licensing Ordinance 2005 45 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. • • 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 6/98 02/03/15 09:43CT [SUBJECT] [SSN] [BIRTH DATE] BRICENO, JOSUE V. [ALSO KNOWN AS] BRICENO,JOSVE [CURRENT ADDRESS] [DATE RPTD] 701 W. 5TH ST., LEHIGH ACRES FL. 33972 8/12 [FORMER ADDRESS] 6115 LINCOLN ST., HOLLYWOOD FL. 33024 10/08 6401 MAIN ST., 4303. HIALEAH FL. 33014 MODEL P R O F I L E * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +505 : 038, 013, 010, 018 *** 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=4 HSTNEG=2-5 TRD=7 RVL=3 INST=4 MTG=0 OPN=0 INQ=18 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE INSTALLMENT: $23.7K $ $20.5K $0 $914 CLOSED W/BAL: $2487 $1414 $34 TOTALS: $23.7K $ $23.0K $1414 $948 COL L E C T ION S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS PORTFOLIO RC Y 1KSE003 I 5/14 $211 GE CAPITAL RETAIL 09B 1/15A $211 PLACED FOR COLLECTIO ENHANCRCVRCO Y 26MT002 I 8/13 $102 11 AT T 09B 11/14A $102 PLACED FOR COLLECTIO ENHANCRCVRCO Y 26MT002 I 12/13 $555 11 SPRINT 09B 10/14A $555 PLACED FOR COLLECTIO TRADES 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 APPLIED BNK B 24UB102 9/12 $1229 R09 11/14A $500 $1229 I BUSINESS CREDIT C 5/13F $1229 UNPAID BLNC CHRGD OFF SYNCB/WALMAR D 235057X 8/12 $50 R09 7/14A $150 $0 I CHARGE ACCOUNT 8/13F $0 PURCH BY OTHER LENDER FIRST DATA F 852N001 12/12 $1677 48M34 109 6/14A $185 I LEASE 6/14F $1258 UNPAID BLNC CHRGD OFF WELLSRECOVER B 908N657 3/07 $19.3K 72M 109 12/09A so C AUTOMOBILE 12/09F $0 ACCT INFO DSP BY CSMR ODPC/C8NA H 1YKS001 2/11 $639 12/11 111111111111 R01 1/15A $500 $0 03 111111111111 A CHARGE ACCOUNT 1/12C $0 ACCT INFO DSP BY CSMR 46 1/ 1/ 0 LEECO FUNDNG F 2AC9001 1/14 $16.4K 48M564 1111111111 I01 12/14A $0 I NOTE LOAN $14.4K 10 0/ 0/ 0 WESTLAKE FIN F 1T9Q001 11/13 $7270 29M350 11/14 322111111X1 I01 12/14A $0 $700 03 I AUTOMOBILE $6190 11 2/ 1/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 2/03/15 ZNP6284423(FLA) MERIT CREDIT 12/22/14 FAM5832625(FLA) CAN CAPITAL 12/02/14 BMS0851016(WIS) US BANK 7/08/14 UWA3747126(WAS) T-MOBILE 5/22/14 ZCH0008281(CHI) EQUIFAX MTG 1/06/14 FNP3343439(FLA) LEE CTY FUND 11/11/13 BPC2699824(NTL) CAP ONE 10/22/13 PNY4553865(EAS) PLATINUM RAP 10/11/13 PMI5406701(FLA) WORLD GLOBAL 10/08/13 BCI0002250(DAY) FIFTH THIRD 10/02/13 PMI5406701(FLA) WORLD GLOBAL 9/13/13 FAM5832625(FLA) CAN CAPITAL 7/29/13 FAM5832625(FLA) CAN CAPITAL 7/17/13 BPC2699824(NTL) CAP ONE 7/09/13 FNP3343439(FLA) LEE CTY FUND 7/09/13 FST0008388(FLA) NICHOLAS FIN 3/18/13 LTA0001070(FLA) PGT INDUSTRY 2/26/13 FDF1767060(SCT) MOBILOANSLLC 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.corn CREDITOR CONTACT INFORMATION PORTFOLIO RC YCIKSE003 (800) 772-1413 287 INDEPENDENCE VIRGINIA BEACH VA. 23462 ENHANCRCVRCO YC26MT002 (800) 496-8941 PO BOX 57547 JACKSONVILLE FL. 32241 APPLIED BNK BC24UB102 4700 EXCHANGE COUR BOCA RATON FL. 33431 SYNCB/WALMAR DC235057X (877) 294-7880 PO BOX 965024 EL PASO TX. 79998 FIRST DATA FZ85ZN001 (516) 843-6000 265 BROAD HOLLOW R MELVILLE NY. 11747 WELLSRECOVER BY908N657 (925) 746-3356 MAC 4031-080 PHOENIX AZ. 85038 ODPC/CBNA HY1YKS001 PO BOX 6497 SIOUX FALLS SD. 57117 LEECO FUNDNG FZ2AC9001 12647 NEW BRITTANY FORT MYERS FL. 33907 WESTLAKE FIN FS1T9Q001 (323) 692-8800 4751 WILSHIRE BVLD LOS ANGELES CA. 90010 CAN CAPITAL F 5832625 (877) 550-4731 414 W 14TH ST NEW YORK NY. 10014 US BANK B 0851016 (800) 481-9057 4325 17TH AVE SW FARGO ND. 58125 T-MOBILE U 3747126 (800) 318-9270 12920 SE 38TH STRE BELLEVUE WA. 98006 EQUIFAX MTG Z 0008281 (800) 685-5000 815 EAST GATE DR MOUNT LAUREL NJ. 08054 LEE CTY FUND F 3343439 (941) 461-0448 12647 NEW BRITTANY FT MYERS FL. 33907 CAP ONE B 2699824 (800) 955-7070 PO BOX 30281 SALT LAKE CITY UT. 84130 PLATINUM RAP P 4553865 (515) 645-5386 348 RXR PLAZA UNIONDALE NY. 11556 WORLD GLOBAL P 5406701 (866) 881-1128 888 BISCAYNE BLVD MIAMI FL. 33132 FIFTH THIRD B 0002250 (513) 579-5353 38 FOUNTAIN SQ CINCINNATI OH. 45263 NICHOLAS FIN F 0008388 (727) 431-6130 2454 MCMULLEN BOOT CLEARWATER FL. 33759 PGT INDUSTRY L 0001070 (800) 282-6019 1070 TECHNOLOGY DR NOKOMIS FL. 34275 MOBILOANSLLC F 1767060 (877) 836-1518 151 MELACON DR MARKSVILLE LA. 71351 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 V SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Premier Profile-INNOVATIVE GLASS&WINDOW,LLC Subcode:970135 Ordered:02/03/2015 09:46:04 CST .r.:.EXperiar�„ Transaction Number:C500724544 .eaea p Search Inquiry:innovative glass/226 HOMESTEAD RD S/LEHIGH ACRESIFLI33936/USIN/A1959432846 A world of insight Model Description:Intelliscore Plus V2 Business Name , ;, Business Identification Number INNOVATIVE GLASS &WINDOW, LLC - 96 2846 ou Primary Address: 226 HOMESTEAD RD S Website: innavativeglassandrailings,.com LEHIGH ACRES,FL 33936-7607 Tax ID: 46-1292065 This business is the ultimate parent. See the corporate hierarchy by clic ' ft here TOP Risk Dashboard Risk Scores and Credit Limit Recommendation Days Beyond Terms Derogatory Legal Fraud Alerts Intelliscore Plus Financial Stability Risk Company DBT Original Filings High Risk Alerts HIGH RISK HIGH RISK Score range:1 -100 percentile Credit Limit Recommendation: N/A TOP Business Facts Years on File: 3(FILE ESTABLISHED 11/2012) SIC Code: PAINT,GLASS&WALLPAPER STORES-5231 State of Incorporation: FL NAICS Code: Other Building Material Dealers-444190 Date of Incorporation: 10/29/2012 Building Material and Supplies Dealers-444100 Business Type: Profit Number of Employees: 2 Contacts: JOSUE BRICENO Sales: $686,000 TOP Commercial Fraud Shield Evaluation for:INNOVATIVE GLASS&WINDOW,LLC,226 HOMESTEAD RD S,LEHIGH ACRES,FL33936-7607 Business Alerts Verification Triggers Active Business Indicator: VIP I Experian shows this business as active PRESENCE OF TRADES IN THE CURRENT MONTH WITH DBT>THAN 92 DAYS Possible OFAC Match: • No OFAC match found Business Victim Statement: * No victim statement on file TOP Credit Risk Score and Credit Limit Recommendation Credit Risk Scare:lr`ttelliscare Plus Current Intelliscore Plus Score: I Risk Class: 5 The risk class groups scores by risk into ranges of similar performance.Range 5 is the highest risk,range 1 is the lowest risk. Premier Profile-INNOVATIVE GLASS&WINDOW,LLC 1/6 1 High :.....', Low Risk , �� .. Risk yam. t 0 10 2s 50 75 100 This score predicts the likelihood of serious credit delinquencies for this business within the next 12 months.Payment history and public record along with other variables are used to predict future risk.Higher scores indicate lower risk. Factors lowering the score industry Risk Comparison AVERAGE BALANCE OF RECENTLY DELINQUENT COMMERCIAL ACCOUNTS 0%of businesses indicate a higher likelihood of severe delinquency. > NUMBER OF COMMERCIAL ACCOUNTS WITH NET 1-30 DAYS TERM • NUMBER OF RECENTLY ACTIVE COMMERCIAL ACCOUNTS • NUMBER OF COMMERCIAL ACCOUNTS WITH HIGH UTILIZATION Quarterly Score Trends Quarterly Score Trends 100 go 80 70l The Quarterly Score Trends provide a view of the 60 7 likelihood of delinquency over the past 12 months for this CO 4 ' business.The trends will indicate if the score improved, 40 4 remained stable,fluctuated or declined over the last 12 months. 304 F 20 1 10 ,ppE� � SUS p�0.00t O.4.,) Credit Risk Score Financial Stability Risk'- Current Financial Stability Risk Score: 1 Risk Class: 5 llle l' iSR } High ..,. , , , Low The risk class groups scores by risk into ranges of similar Risk Risk performance.Range 5 is the highest risk,range 1 is the r 0 3 l0 30 65 100 lowest risk. 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 towering the score Industry Risk Comparison NUMBER OF COMMERCIAL COLLECTION ACCOUNTS 0%of businesses indicate a higher likelihood of financial ( stability risk. • PERCENT OF TOTAL COMMERCIAL BALANCE SERIOUSLY DELINQUENT > PAST COMMERCIAL DEROGATORY BALANCE NUMBER OF ACTIVE COMMERCIAL ACCOUNTS I Credit Limit Recommendation Credit Limit Recommendation This recommendation compares this business against similar businesses in the Experian business Not available-A credit limit credit database.It is based on trade information,industry,age of business and the Intelliscore recommendation is not available for a Plus.The recommendation is a guide.The final decision must be made based on your company's business with a current DBT>60. business policies. TOP Fayrrtent and Legal Filings Summary Premier Profile-INNOVATIVE GLASS&WINDOW,LLC 216 Payment Performance Trade and Collection Balance Legal Filings Current DBT: 105 Total trade and collection(5): $33,248 Bankruptcy: No Predicted DBT: N/A All trades(3): $32,900 Tax Lien filings: 0 Judgment filings: 0 I Monthly Average DBT: 105 All collections(2): $348 Sum of legal filings: $0 1 Highest DBT Previous 6 Months: 105 Continuous trade(2): $32,900 UCC filings: 3 Highest DBT Previous 5 Quarters: 105 6 month average: N/A Cautionary UCC filings: Yes Payment Trend Indication: Highest credit amount extended: $28,900 I Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms not available industry Comparison Industry DBT Range Comparison The current DBT of this business is 105.9%of businesses have a DBT range of 16+. DBT for this business: 105 °f husinesse5=. �r9.8' 11a DBT Range 0-5 6-15 16+ TOP Payment Trending DBT Trends Monthly DBT Trends Quarterly DBT Trends 105 105 105 105 105 105 105 104 105 105 100 100 81 75 75 25 ( 25 - ,' , I \‘,A-A p+V0{QS Y� 0Git N1ctj1 V G'tGu►tafit 4 Q1S 14{k ,40A ,QUA AC1 Monthly Payment Trends Payment Trends Analysis Account Status PAINT,GLASS&WALLPAPER STORES-5231 Days Beyond Terms Date Reported Industry Business Cur DBT DBT Balance Cur 1-30 31-60 61-90 91+ I CURRENT N/A N/A._ 105 $32,900 100% DEC14 75% 17 105 $32,900 100% NOV14 76% 16 105 $32,900 100% OCT14 76% 16 105 $32,900 100% SEP14 75% 17 105 $32,900 100% AUG14 77% 16 105 $32,900 100% JUL14 76% 16 105 $32,900 100% Quarterly Payment Trends 3/6 Premier Profile-INNOVATIVE GLASS&WINDOW,LLC • Payment History-Quarterly Averages Account Status Days Beyond Terms Quarter Months DBT Balance Cur 1-30 31-60 61-90 91+ 04- 14 OCT-DEC 105 $32,900 100% , 03-14 JUL-SEP 105 $32,900 100% I l Q2-14 APR-JUN 104 $32,900 1% 99% 01 -14 JAN-MAR 81 $29,800 1% 24% 1% 9% 67% 04-13 OCT-DEC 23 $23,700 89% 2% 1% 8% 1 TOP 0 Collection Experiences Date Original Outstanding Date Status Agency Agency Phone Placed Balance Balance Closed ASSOCIATED CREDIT 02/2014 Open Account $164 $164 SERVICES (800)531-6500 02/2014 Open Account $184 $184 ASSOCIATED CREDIT SERVICES (800)531-6500 TOP Trade Payment Surrirttary Recent High Trade Line Typo Lines Reported DBT Balance Current 01-30 31-60 61-90 91+ Credit Continuous 2 105 $32,900 $32,900 100% New 0 $0 Combined Trade 2 105 $32,900 $32,900 100% Additional 'I $0 Total Trade 3 $32,900 $32,900 100% ..,' TOP Trade Payment-New and Continuously Reported Trade Details Payment Experiences Account Status (Trade Lines with an(*)after the date are newly reported) Days Beyond Terms Business Date Last Payment Recent High Category Reported Sale Terms Credit Balance Cur 1-30 31-60 61-90 91+ Comments BLDG MATRL 01/2015 11/2013 VARIED $28,900 $28,900 100% PRNIG&PUBL 01/2015 VARIED $4,000 $4,000 100% TOP 0 Trade Payment-Atiditiorial Trade Details Payment Experiences Account Status (Trade Lines with an()after the date are newly reported) Days Beyond Terms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Category Re•orted Sale Terms Credit --- CRED CARD 01/2015 REVOLVE $0 TOP 0 Urtift)rirt Commercial Code(UCC)Filings 1.1CC Filing Summary Cautionary Total Released/ Amended/ Date Range Year ,.. Continuous UCCs Filed Termination Assigned JAN-PRESENT 2015 JUL-DEC 2014 JAN-JUN 2014 1 1 JUL-DEC 2013 1 JAN-JUN 2013 1 1 PRIOR TO JAN 2013 I I I Premier Profile-INNOVATIVE GLASS&WINDOW,LLC 4/6 Total 2 3 0 0 0 "Cautionary UCC Filings include one or more of the following collateral: Accounts,Accounts Receivables,Contract Rights,Hereafter Acquired Property,Inventory,Leases,Notes Receivable or Proceeds. UCC Details. UCC FILED Date:02/11/2014 UCC FILED Date:07/26/2013 Filing Number:201400729783 Filing Number:201309507927 Jurisdiction:SEC OF STATE FL Jurisdiction:SEC OF STATE FL Secured Party:CAMO FUNDERS INC.,AS AGENT NY BUFFALO Secured Party:CASH COW CAPITAL LLC NY LONG ISLAND CITY 14221 25 DEERWOOD DR! 11105 3841 DITMARS Collateral:UNDEFINED,EQUIP,INVENTORY,HEREAFTER Collateral:UNDEFINED AQUIRED PROP UCC FILED Date:02/04/2013 Filing Number:201308371525 Jurisdiction:SEC OF STATE FL I Secured Party:APZB INDUSTRIES MA ROCKLAND 02370 300 LEDGEWOOD PLACE,SUITE Collateral:UNDEFINED,HEREAFTER AQUIRED PROP Tt}P Additional Bid s)t'tess Farts Corporate Registration THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA.THE DATA IS CURRENT AS OF 02/03/2015. State of Origin: FL Date of Incorporation: 10/29/2012 Current Status: Active Business Type: Profit Charter Number: L120001370 Agent: BRICENO JOSUE V Agent Address: 226 HOMESTEAD ROAD S LEHIGH ACRES,FL TOP Corporate linkage Business Name Location HIN, The inquired upon business,INNOVATIVE GLASS&WINDOW,LLC,is the Ultimate Parent INNOVATIVE GLASS&WINDOW,LLC 226 HOMESTEAD RD S-LEHIGH ACRES,FL 969432846 Branches of the inquired upon business: INNOVATIVE GLASS&WINDOW,LLC 13460 RICKENBACKER PKWY STE 3-FORT MYERS,FL 965571711 INNOVATIVE GLASS&WINDOW,LLC 226 HOMESTEAD RD S UNIT B-LEHIGH ACRES,FL 984397371 INNOVATIVE GLASS&WINDOW,LLC 701 W 5TH ST-LEHIGH ACRES,FL 992594037 TOP 0 inquiries' Summary of inquiries Business Category FEB15 JAN15 DEC14 NOV14 OCT14 SEP14 AUG14 JULIA JUN14 CHEMICALS 1 EQUIP LEAS 1 FINCL SVCS 1 1 1 GENERAL 1 . PERSNLSVCS 1 1 TELECOM 1 Totals 3 1 2 3 TOP Experian prides itself on the depth and accuracy of the data maintained on our databases.Reporting your customer's Premier Profile-INNOVATIVE GLASS&WINDOW,LLC 5/6 payment behavior to Experian will further strengthen and enhance the power of the information available for making sound credit decisions. Give credit where credit is due. Call 1-800-520-1221, option#4 for more information. End of report 1 of 1 report The information herein is furnished in confidence for your exclusive use for legitimate business purposes and shall not be reproduced.Neither Experian Information Solutions,Inc.,nor their sources or distributors warrant such information nor shall they he liable for your use or reliance upon it Q Experian 2015.All rights reserved.Privacy policy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. Premier Profile-INNOVATIVE GLASS&WINDOW,LLC 616 r Merit Credit Fast, Accurate &Se'cure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 3 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800-371-3348 OR 239-277-3202. COMPANY NAME: INNOVATIVE GLASS AND WINDOWS LLC FEDERAL ID:46-1292065 CURRENT STATUS: ACTIVE BUSINESS PRINCIPAL(S): SHERI BRICENO TITLE: MANAGER JOSUE BRICENO TITLE: MANAGER DATE INCORPORATED: 10/29/2012 STATEMENT OF OWNERSHIP This certifies that I, 054 il ,,, am a member or (APPLICANT'S NAME) �,,r� G/ $ itiiWiw Mana in member of ! W I fr L11 g � 1� l� (LIMITED LIABILITY COMPANY NAME) I own 75 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. lia.e. iPRINT NAME) a , , i tali •LICANT'S. (MATURE) 0))46- (DATE) 2/2/2015 Detail by Entity Name FLORIDA DEPARTMENT r 1., OF STATE DIVISION OF CORPORATIONS ,,Idi Detail by Entity Name Florida Limited Liability Company INNOVATIVE GLASS & WINDOW, LLC Filing Information Document Number L12000137082 FEI/EIN Number 461292065 Date Filed 10/29/2012 State FL Status ACTIVE Effective Date 10/29/2012 Last Event LC AMENDMENT AND NAME CHANGE Event Date Filed 05/13/2014 Event Effective Date NONE Principal Address 226 Homestead Road S Unit B Lehigh Acres, FL 33936 Changed: 03/19/2014 Mailing Address 226 Homestead Road S Unit B Lehigh Acres, FL 33936 Changed: 03/19/2014 Registered Agent Name & Address BRICENO, JOSUE V 226 Homestead Road S Unit B Lehigh Acres, FL 33936 Address Changed: 03/1912014 Authorized Person(s) Detail Name & Address http://search.sunbiz.ag/1 nq tiryrorp:rationSearch/SeacchResultDetail?Inquinitype=EntityNatne8drectionTwe=1nitial&searchN arneOrder=INN OVATIVEGLAS... 1/2 2/2/2015 Detail by Entity Name Title MGRM BRICENO, SHERI L 226 Homestead Road S Unit B Lehigh Acres, FL 33936 Title MGRM BRICENO, JOSUE 226 Homestead Road S Unit B Lehigh Acres, FL 33936 Annual Reports Report Year Filed Date 2013 04/15/2013 2014 03/19/2014 Document Images 05/13/2014 — LC Amendment and Name Change I View image in PDF format 03/19/2014 --ANNUAL REPORT View image in PDF format 04/15/2013 --ANNUAL REPORT View image in PDF format 12/14/2012 -- LC Amendment View image in PDF format 10/29/2012 -- Florida Limited Liability View image in PDF format http://seareh.sunblz.org/InquiryCorperationSeacch/SearchResultDetail?inquirytwe=EnlityName&drectionTwe=lnitiat&searchNaineOrder=INNOVAT1VEGLAS... 2/2 , Electronic Articles of Organization L 00 LED 8: AM For October 29 2012 Florida Limited Liability Company Sec. Of state dbruce Article I The name of the Limited Liability Company is: INNOVATIVE GLASS AND RAILING LLC Article II The street address of the principal office of the Limited Liability Company is: 701 W. 5TI-I STREET LEI-IIHG ACRES, FL. 33972 The mailing address of the Limited Liability Company is: 701 W. 5TH STREET LEHIHG ACRES, FL. 33972 Article III The purpose for which this Limited Liability Company is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The name and Florida street address of the registered agent is: JOSUE V BRICENO 701 W. 5TH STREET LEHIGH ACRES, FL. 33972 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. 1 further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: JOSUE V. BRICENO Article V L12000137082 The name and address of managing members/managers are: FILED ber:29,2012 Title: MGRM Sec. Of Stae ROBERT G MILLER JR. dbruce 701 W. 5TH STREET LEHIGH ACRES, FL. 33972 US Title: MGRM CONSWF,LA K THOMAS 701 W. 5TH STREET LEHIGH ACRES, FL. 33972 US Title: MGRM SHERI L BRICENO 701 W. 5TH STREET LEHIGH ACRES, FL. 33972 US Title: MGRM CHRISTOPHER T ALLEN 701 W. 5TH STREET LEHIGH ACRES, FL. 33972 US Title: MGRM MUSLIM AL-ASSADI 701 W. 5TH STREET LEHIGH ACRES, FL. 33972 US Article VI The effective date for this Limited Liability Company shall be: 10/29/2012 Signature of member or an authorized representative of a member Electronic Signature: JOSUE V. BRICENO I am the member or authorized representative submitting these Articles of Organization 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 1st and May 1st in the calendar year following formation of the LLC and every year thereafter to maintain "active" status. ARTICLES OF AMENDMENT TO ARTICLES OF ORGANIZATION OF Innovative Glass & Railing, LLC • (Name of the Limited Liability Company as it now appears on our records.) .+ (A Florida Limited Liability Company) dy t'� Limited Liability Company were tiled on 10/29/12 nd cosign d The Articles of Organization for this Ltmt ty g y � � �, Florida document number LI 2000137082 p rock ..nom This amendment is submitted to amend the following: • rpm ra A. If amending name,enter the new name of the limited liability company here: ? The new name must be distinguishable and end with the words"Limited Liability Company,"the designation"LLC"or the abbreviation "L.L.C." Enter new principal offices address,if applicable: (Principal office address MUST BE A STREET ADDRESS) Enter new mailing address,if applicable: LMailin2 address MAY BE A POST OFFICE BOX) B. If amending the registered agent and/or registered office address on our records, enter the name of the new registered agent and/or the new registered office address here: Name of New Registered Agent: New Registered Office Address: 13460 Rickenbacker Pky Unit 3 Enter Florida street address Ft Myers ,Florida 33913 City Zip Code New Registered Agent's Signature,if changing Registered Agent: I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relative to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent as provided for in Chapter 608, F.S. Or, if this document is beingfiled to merely reflect a change in the registered office address, I hereby confirm that the limited liability company has been notified in writing of this change. 11 Changing Registered Agent,Signature of New Registered Agent Page I of 3 • If amending the Managers or Managing Members on our records,enter the title,name, and address of each Manager or Managing Member being added or removed from our records: MGR=Manager MGRM=Managing Member Title Name Address Tyne of Action MGRM Josue Briceno 13460 Rickenbacker Pky Unit 3 n Add Ft Myers, FL 33913 I 'Remove Add El Remove LI Add Remove aAdd 1 Remove Fl Add Remove • Add ElRemove Page 2 of 3 • • D. If amending any other information,enter change(s)here: (Attach additional sheets, if necessary.) The address for all 6 Members needs to be: 13460 Rickenbacker Pky Unit 3 Ft Myers, Florida 33913 Dated December 12, 2012 / 16. aity,Signature of a member or authorized representative of a member Sheri Briceno Typed or printed name of signet Page 3 of 3 Filing Fee: $25.00 2013 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED DOCUMENT#L12000137082 Apr 15, 2013 Entity Name: INNOVATIVE GLASS AND RAILING LLC Secretary of State CC6269914929 Current Principal Place of Business: 13460 RICKENBACKER PARKWAY,UNIT 3 FORT MYERS, FL 33913 Current Mailing Address: 13460 RICKENBACKER PARKWAY, UNIT 3 FORT MYERS, FL 33913 FEI Number: 46-1292206 Certificate of Status Desired: No Name and Address of Current Registered Agent: BRICENO,JOSUE V 13460 RICKENBACKER PARKWAY,UNIT 3 FORT MYERS,FL 33913 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGRM Title MGRM Name MILLER,ROBERT GJR. Name THOMAS,CONSWELA K Address 13460 RICKENBACKER PARKWAY Address 13460 RICKENBACKER PARKWAY UNIT 3 UNIT 3 City-State-Zip: FT MYERS FL 33913 City-State-Zip: FT MYERS FL 33913 Title MGRM Title MGRM Name BRICENO,SHERI L Name BRICENO,JOSUE Address 13460 RICKENBACKER PARKWAY Address 13460 RICKENBACKER PARKWAY, UNIT 3 UNIT 3 City-State-Zip: FT MYERS FL 33913 City-State-Zip: FORT MYERS FL 33913 I hereby codify that the information indicated on this report or supplemental report is true and accurate and that my elecuonie signature shall have the same legal effect as if made under oath;that t am a managing member or manager of the limited Cabitity company or the receiver or trustee empowered to execute this report as required by Chapter 648,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:SHERI BRICENO MANAGER 04/15/2013 Electronic Signature of Signing Authorized Person(s)Detail Date 2014 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED DOCUMENT#L12000137082 Mar 19, 2014 Entity Narne: INNOVATIVE GLASS AND RAILING LLC Secretary of State CC8896972777 Current Principal Place of Business: 226 HOMESTEAD ROAD S UNIT B LEHIGH ACRES, FL 33936 Current Mailing Address: 226 HOMESTEAD ROAD S UNIT B LEHIGH ACRES, FL 33936 US FEI Number: 46-1292065 Certificate of Status Desired: No Name and Address of Current Registered Agent: BRICENO,JOSUE V 226 HOMESTEAD ROAD S UNIT B LEHIGH ACRES,FL 33936 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGRM Title MGRM Name BRICENO,SHERI L Name BRICENO,JOSUE Address 226 HOMESTEAD ROAD S Address 226 HOMESTEAD ROAD S UNIT B UNIT B City-State-Zip: LEHIGH ACRES FL 33936 City-State-Zip: LEHIGH ACRES FL 33936 I hereby certify that the Information indicated on this report or supplemental report is true and accurate and that my electronic signature shat have the same legal effect as if made under oath;that!am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and that my name appears above,or on an attachment n,th all other like empowered. SIGNATURE:SHERI BRICENO MGRM 03/19/2014 Electronic Signature of Signing Authorized Person(s)Detail Date ARTICLES OF AMENDMENT F I L..F-7 0 TO ARTICLES OF ORGANIZATION 2014 FIiVi 13 P14 3: 56 OF Innovative Glass & Railing, LLC (Name of the limited liability Company a.it now appears on our records.) (A Florida Limited Liability Company) The Articles of Organization for this Limited Liability Company were filed on 10/29/12 and assigned Florida document number L12000137082 This amendment is submitted to amend the following: A. If amending name,enter the new name of the limited liability company here: Innovative Glass & Window, LLC The new name must be distinguishable and end with the words"Limited Liability Company,"the designation"LLC"or the abbreviation`'L,L.C. Enter new principal offices address,if applicable: (Principal office address MUST BE A STREET ADDRESS) Enter new mailing address,if applicable: fMailinj address MAY BE A POST OFFICE BOX) B. If amending the registered agent and/or registered office address on our records, enter the name of the new registered agent and/or the new registered office address here: Name of New Registered Agent: New Registered Office Address: Eater Florida street address ,Florida City Zip Code New Registered Agent's Signature,if changing Registered Agent: I hereby accept the appointment as registered agent and agree to act in this capacity. t further agree to comply with the provisions ofa!i statutes relative to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent as provided fir in Chapter 605, F.S. Or, if this document is being filed to merely reflect a change in the registered office address, /hereby confirm that the limited liability company has been notified in writing of this change. if Changing Registered Agent,Signature of New Registered Agent Page 1 of 3 , n.,If amending any other information,enter change(s)here: (Attach additional sheets, if necessary.) • E. Effective date,if other than the date of filing: (optional) (The effective date must be specific,cannot be prior to date of receipt or filed date and cannot be more than 90 days alter the date this document is filet by the Florida Dcparm cnt of State) Dated May 7 2014 , Signature of a member or authorized representative of a member Sheri L Briceno Typed or printed name of sigtec Page 3 of 3 .� Filing Fee: $25.00 = —. 1~ r, 0.) -rT � i,: DEPARIT1ENT OF THE TREASURY i INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 10-30-2012 Employer Identification Number: 46-1292065 Form: SS-4 Number of this notice: CP 575 A INNOVATIVE GLASS AND RAILING JOSUE V BRICHNO GEN PTR 701 %l 5TH ST For assistance you may call us at: LEHIGH ACRES, FL 33972 1-800-829-4933 • IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 46-1292065. This EIN will identify you, your business accounts, tax returns,permanent records. documents, even if you have no employees. Please keep this notice in your pe records. When filing tax documents, payments, and related correspondence, it is very important that you use your BIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one 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 04/30/2013 Form 940 01/31/2014 Form 1065 04/15/2013 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 ofyour tta in ax assification, You may request a private letter ruling from the IRS under the gu i 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure fioi the e ye 8832,at,issue . Note: Certain tax classification elections can be requested by Classification Election. See Form 8832 and its instructions for additional information. A limited liability company ( ) may file Form 8832, Entity Classification Election, and elect to be classified as an assocpationttaa ablecas certain corporation. ion it If the LLC is eligible to be treated as a corporation file Form 2553, tests and by a will be electing S corporation status, it must timely Small Business Corporation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8032. /� p p� SUOCO177 E$c ,,, Lee County Tax Collector 2480 Thompson Street Tax Co ' tor Fort Myers, Florida 33901 s�f8 at Fto`,e' www.leetc.com Tel: 239.533.6000 Local Business Tax Account: 1403124 Dear Business Owner: Your 2014-2015 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. It mete is a cttatige in the UusItiess ion le, uwt lei bItill, iIiystc;at luuatiutt ul if t iu Uuair1Caa ib Uairsy closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records , c°u4y LEE COUNTY LOCAL BUSINESS TAX RECEIPT 2014 - 2015 Tax Co ( tvi• ACCOUNT NUMBER: 1403124 ACCOUNT EXPIRES SEPTEMBER 30, 2015 4,4 .4 of Ft°,a May engage in the business of: GLASS&GLAZING CONTRACTOR Location 226 HOMESTEAD RD S LEHIGH ACRES FL 33936 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY INNOVATIVE GLASS AND WINDOWS LLC THIS IS NOT A BILL-DO NOT PAY BRICENO JOSUE 226 HOMESTEAD RD S LEHIGH ACRES FL 33936 PAID 363895-24-1 09/24/2014 08:41 WEB $50.00 SU000180 ve°C°"„y Lee County Tax Collector Tax Co tor 2480 Thompson Street Fort Myers, Florida 33901 rife or ocii” www.leetc.com Tel: 239.533.6000 Local Business Tax Account: 1301082 Dear Business Owner: Your 2014-2015 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records voecoyoy LEE COUNTY LOCAL BUSINESS TAX RECEIPT yam{ 2014. - 2015 Tax Co }tor ACCOUNT NUMBER: 1301082 ACCOUNT EXPIRES SEPTEMBER 30, 2015 am m%1e of °t May engage in the business of: MANUFACTURING MISC Location 226 HOMESTEAD RD S LEHIGH ACRES FL 33936 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY INNOVATIVE GLASS AND WINDOWS LLC THIS IS NOT A BILL-DO NOT PAY INNOVATIVE GLASS AND WINDOWS LLC 226 HOMESTEAD RD S LEHIGH ACRES FL 33936 PAID 363895-24-3 09/24/2014 08:41 WEB $50.00 • vn r - R. +. }",' '� �" e .:�Z�y m' ''�., "*l� { f -:- .°1 + t -.. 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'tcc.� „F{!,.4,,,,,, , t 1.�. _ t .F E` 4 *t : , .%*tl 17,\F • ‘„ ; k r t'rr''�� j _ a�1`p t. t. `S5�F� r ,,!.' t FF'l t:tr* ' ��..,,��- - .%•,\' , Fh�‘ "{* , ,t i`s 1 F�* 'ti{ . . i 1 11,i. f '7,7, `� ,0 ,1"5,./ , '8 �' _i- t ,. :y. ....% +•r:• +e.`y'. -` i '1,.V 't* - ;:>,.t;' * ; [ 't ILQf 4 � 3 e w } nv�e COLLIER COUNTY GROWTH MANAGEMENT.DIVISION TATI ant to section 489.127. ).Florida Statutes,the undersigned hereby certifies that t nal investigation,he/she has reasonable and probable grounds to believe that the person w appears below as issued to,did violate subsection 489.127.(1),Florida Statutes,and the Cc dy Contractor's Licensing Ordinance No.21706.46(as may be amended)by conunitling lion stated below. l'''0 t. Yearn AM M nit -, } --t r edit) t o F z )t 4 t I y t (rest 7 : :A. . .1 ;t0 ,7' 1. Zip 31 t`t Stata t i r pate If Buhr iiii® Height , f b k i Make/Type p a ca, ! s,:•,,.. W1 Color ' Tag No. ucle A1akell'ype(if applicable) ration of Violation f.t°) OPTIONS gave been informed of the violation for which I have been charged and elect the flowing option(Check one) : ;ef - ❑ I choose to pay the penalty of$ t t certified mail or l ❑ I choose not to pay the penalt ,and will request in writing by delivery an Administrative g before the Contractor's Licensing Board. escription of Violation `,t '"'f / 4'47,!bate Violation Observed {_.r.'` •, i ❑ Falsely hold self okhusine4sprganization out as a licensee,certificate holde. registrant; ❑ Falsely impersonate a certificate holder or registrant; ❑ Present as his/her own the certificate or registration of another; ) ❑ Knowingly give false or forged evidence to the Board or a member thereof; ) ❑.Use or attempt to use a certificate or registration which has been suspended (7 revoked; ) 0 Engage in the business or act in the capacity off a a business or adve act in die l or business organization as available to engage capacity of a contractor without being duly registered or certified; g) 0 Operate a business organization engaged in contracting after(60)days; s) ❑ Commence or perform work for which a building permit is required pursue) an adopted state minimum building code or without such permit being in of ., 11 Rrnin,tt,,nr r1Pl:twratolu`licraaarrt nr viniatP any Cnilier County ordinance -�' CERTIFICATE OF LIABILITY INSURANCE -TICS PtCATE is ES-WED AS AAtAT OF INFORMATION DAILY MU CCH IS t RIMITS UPON THE SCAT= HOLDDL THIS _ cERTIrICATE DOES NOT AFFIRMATIVELY OR N ;ATIVRTX Aim Exrem OR at-r -me COVERAGE AID BY TIE POLICIES - BELOW THIS CERTIFICATE OF INSURANCE 1)0-4- NOT [7D?>;YIr UT A CONTRACT IIEIVIMI T1z ISSUING Q LS). A TR O REPRESENTATIVE OR PRODUCER, Mn TLS¢CatTIACAT HOWER. - - - . -IMPORTANT: If Me cei ificam Wader fe an�.f the pacifies) most be smdame7L II SUBROGATION IS wive). ss 4ae*to • the Leans end cnordinne of dee pond. Certain pelides me an Air on Ms canZbaste dotes not r rarer stones mum cendfcate•trotter In Oyu it such enttomemeata). . Work Cow Systems - - Lir.24m.,-4.• 863-43:-2.710 " - 863-438-2711 711 Z- M'a.in Street j,sTZ #1 - - . . Haines .Cii-y,ZZ 33936 - T'-re-.94.- - cusTraet a - - - . - .. ,-r-- AEG cO UIE rwCa Innovative G1gs and �,LLLC-- ° A= 226 Homest-ear Unit: B Rd S U a c. ut o_ Lehigh Acres, FL 33936 - Di y: Star insurance Company 239-303-931 _ __ nor: COVERAGES - Cell FICATEENU ER - - -REVISION WARM -T IS 13 f0 calm' THAT RE PCBJC CF 124311RANM IJSTE6 ascot/ HAVE Ball ISSuED TO TI.mmuffED imaaaff wawa Rat me aaJCY "^" - . INDICATED_ NOTWITHSTANDING G ANIY PaCIUDIEllafT. .TAI OR OONTATION CF ANY CONTRACT OR OMER DOCUMENT WITH RESPECT TO YACC I RATS • CEITIfICATE MAY.RE CR M*Y a zttA^L -He Arr ) BY THE'POLICIES D TS ein m— ID ALT.vs .-. ..v.s. ,• c'XCWSION S AND manors OF SOS P(AIC!ESS. LB3ITS a"3taV'i'.i MAY NAVE 8311 szotkain BY MD CIAllta . • *MI itz 6'' IR AWL. '� - _. -.. r M=ZW ' .- LTa .xs r -tc!!C.'YNnAMat t+ h , - s _ 63‘a.A3-WaS TTY a:AC-I a . a?3Atic tur=i+TmI - :r - e cam.r�ti ears irk soot 1. s =_ all _ - -- HECISVPInin • 3 . co*a=in, AemiseAri T . Cr_NL.Ate—DINT A.'c - _ - T'_GC>3�O?.t a_I POLICY t 1 i6 t - I bm I _ s z ■ .V.Le3Yt Ai '. - _ p — a . 3 il ? f Jx,-,m - _ - .. - 6 a _ � - 3 - w.a ai UA3 2 - - 1 - �E - _ 5 D Ucual-s 3 I s�j ri43T - - - - 1 ; mss. z 1,000 T 000 �kP.OYsC`'+•LtR�?!IY YTV _ = g CIA 4 • S2lT7 - _ l {I:t � �� : 3 jdOd;000 Tt4C�f'lu_'7__$1. 1,400,4)00 - peanerany la MI - - - - .o -�DC�cviar thim.demibaunder*gammon OP oIE1A ^�Yi sue' - - Ct-� notl.t>*a slaTett .:�sv? i? - .6s. � .a k - • - - r - • 30 days written notice ixl.. averilr of ccelZati on_ - CANcE]1 Ai1{3R CERT•IFlCATE<i0U - • --,STCaR3� D----1-.'1='''%53 .i C > 3 75r:CA3 e�a Daes .. x = -1:41 ). . Collier- County licensing Department ,;;,i T;ir POLE • 2$00•North Horseshoe Drive .- ,...� - - Naples, FL 34104 ._ , _ l 33?ACS9-AC0RD c`�R 0 A31° r Ittis r + -' - ai3OR13Z (2 t3&�33t T D A.; Ft3 t► ant 3D Sac)103 D e - - tf ti Ctl3 't..„7 1 t <rJ _--��.v 1 I X?ial. i�l_a z 'ar i�.� MAi_"`"-�„ ��or�€1`� ESa'�-`sL ui°.ii ��'�::. c� S_t.. } :. �� F ;i,� u_ .Oi.r3 t:si �-As ir='TEt'�T � ALTER THE COV&._ 11 POUCIES 1 C-.'°_F'-_=�sFfCAtis DOES NOT[;F?�'.t�ets?34.f�.;1�i.:�}2'�#t.�_ OWING SUS" :c.-��'�{5j,3ti��.ti3: I1 BELOW. IS GE cs.FM;:ATE OF'i JF DOES NOT CONSTITUTE A r.-NTRACT£l d THE REPRESENTATIUE O,OI ODL C :-'4f-Z. Cr rea.GA*E siLLD'" s r � �t�{.��E� e is-`:o ll tt�S°TA+1�: If S iIE ai Trc,•' s.n M eO;.tAL N s'u'm ',° tFSX tts terms and coma`Iw s cf R:a1>rj,: ,?piSlin .. ,= c'sn an Ea:ct isms,=.;. A 11a-t r i.•— coffer slehts to the,- _ nzzitr F^�a s=tz � : s _ — PRODUCER ES RELLA INS#166 DSA SKY INSURANCE GROUP COR ,i•sLti- I i 1: f r,T_tzQ I 2329 NORTH STATE RD 7 `„ `t HOLLYWOOD FL 33021 mW :-z r3 iot a I mot € (954)241-0642 (954)969-2565 Its -I= }I"-- '-_A T�TA T:OW - I - &LSt }I I INNOVATIVE GLASS AND WINDOW LLC - _ ' I 226 HOMESTEAD RID S UNIT B t ,q «_ I LEHIGH ACRES,FL 33936 i .d c.J.Ta-s _ COVE-RAGES ;GI~.>2ACA E NLII"'SR; 3 "'V1SaMN TI1b.I5E : 1 THIS IS TO C :tit-Y THAT THE FUMES OF 11+1SURAN LIS} ssww HAVE 8 '?SSL' me :F Nt ABOVE FOP.THE_D�JCV O S INDICA NOt a HSTA�i'EIN P"' ." ,'TERM OR Imo^RION OF ATV CON!,A 'OR G I E'i EOC PS SUBJECT E( T WHICH 'TERMS.T NS. - C i1FICKIE€6AY RE ISSUED OI LE:ex I iiiIN,THE Ei a tLIRAHC`cT AscORD : FrfE FOLICi DESCR16 }:� `I I EXCLUSIONS AND CCN D11IONS OF SUCH FOUCIES.�LRA '?OWNM'4YHAVE6 REUCMEYFAID WINE.tie-Tim.' i'FFEtYr T}.fittP.lt? - ._. I -'-oCC:M - S$1,000,000 =lea:sue s� Ra TO- j .IC?000 1 'sue a co= c-$,EAD. ct?a�to G , 137E2 4 141271X1` r: -;,,,,...=a) 5 95,000 0 j G Lr t`mug t GL-go.G:,t� R"c -'JIB ,Ot0{3OOC } I ot !��fiI X I1 s }}. • I c J= i`S /UUCP 'FF 3,-f/3 PfOPt�, 15 $2,000 0001 _...n;G---att. "----ATE _ S t tb.rioaomoil.ABOTS, • I I ' i r bYAUTO I 1. ?As°.ZYcitik2'r aata gs 3 I SC.'�UI.M-• t I 1 t�SiOS —...3 •UTt3 rsctt. :Lt�??tr i v -' Auras I I ,-:- I + i F1;�iCCil ^ S iir..m _L..t t..:a G-il. t - " ctSi k3 CtrZ_'a^-sc ; 'c 1. _ E=i- I S _ ANY ir TRECO MA t 1—dui5 —I tt: I - i f = -�`_�' $ G�zn tawill I E, Esc _t; ; Fti ir:i s Yom.d:S.�"ONI OF 0, I - s t� '�t�tQi�t � L/St�Ii '.i«.".? i .. H I t i • 1 I ca FPi7aNOFO?-.A IONSfR1Mkr. �1` ' iLi::*3Y3iya54- -"^ i ...1 I MANUFACTURE OF GLASS & INSTALLATION OF WINDOWS,GLASS &DOORS 1 _. sr1'YeOULD ANY F ir.Es r DEEM 1:: I:DLICI:S EE 4 C T�".B IN } r s.S;s"tI FAT-------t� leg 4x5 [G t�3... 3- 13., _ F al-C REAM .:.i'g_zTr.,r.�'c3t-SLL FRVAr; = - 4 Collier county licensing department !d I -2800 North Horseshoe Drive trrrtc ��_ - Naples, FL 34104 _ `'� w, 1 ` -tiG C�3i9�E3-2(plr[l0-AC.4- CORPORATION. ATT tET ►'a reserved. GreenbergJoann From: Tania de Ia Cruz [tania.delacruz@estrellainsurance.com] Sent: Wednesday, February 04, 2015 2:31 PM To: ContractorsLicensing Subject: RE: INNOVATIVE GLASS & RAILING, LLC Attachments: doc04371120150204142133.pdf Please find attached a COI for Innovative Glass& Window, LLC. Feel free to contact me if you have any further questions. Thanks, Tania DeLaCruz Licensed Agent!Manager Estrella Insurance 2329 N State Rd 7 Hollywood, FL 33021 Sedanos Shopping Plaza Office: 954-241-0542 Fax: 954-989-2565 Mobile: 954-937-5945 Email:tania.delacruz a,estreilainsurance.com Referrals Much Appreciated and Welcomed! n.„ ESTRELLA INSURANCE From: Tania de Ia Cruz Sent: Tuesday, February 03, 2015 4:09 PM To: 'CONTRACTORSLICENSING @COLLIERGOV.NLI' Subject: INNOVATIVE GLASS & RAILING, LLC Importance: High Please find attached a copy of the application of the CGL policy effective on 11/27/13 and a cancellation doc for the same policy effective on 07/23/2014. Please forward the COI that you received from Innovative Glass& Railing, LLc Please feel free to contact me if you have any further questions. Thanks, Tanta DeLaCruz Licensed Agent/Manager Estrella Insurance 2329 N State Rd 7 iveNisivirs Hollywood, FL 33021 Sedanos Shopping Plaza rEa Office: 954-241-0542 2015 Fax: 954-989-2565 ` Mobile: 954-937-5945 "•••• Email: tania.delacruzestrellainsurance.com 1 Referrals Much Appreciated and Welcomed! ESTRICLA' INSURANCE 2 CC)I2 CERTIFICATE OF LIABILITY INSURANCE 2/4t A C'C7RC7 i2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsament(s). coat-TACT NAME: ESTRELLA INS#166 DBA SKY INSURANCE GROUP COR ?1i,rO„11 I,Ezn: AX,No}: 2329 NORTH STATE RD 7 E-MAIL ADDRESS: HOLLYWOOD FL 33021 INSURER(S)AFFORDING COVERAGE NAIC It (954)241-0542 (954)989-2565 INSURERA:FEDERATED NATIONAL 10790 INSURED INSURER B: INNOVATIVE GLASS&WINDOW, LLC INSURER C: INSURER 0: 226 HOMESTEAD ROAD S#B INSURERS: LEHIGH ACRES, FL 33936 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 SOan- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 111SR YND POLICY NUMBER LMMIDDIYYWI JMMNDDM'YY) LIMITS C v/ GENERAL LIABILITY EACH OCCURRENCE S$1,000,000 ✓ COMMERCIAL GENERAL LIABILITY PREM S E a catmenco) s$100,000 CLAIMS.MADE 171 OCCUR GL-0000026354-00 0210512015 02/052016 PAM EXP(Any ono person) $$5,000 PERSONAL&AOVINJURY S$1,000,000 • GENERAL AGGREGATE S$2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP(OP AGG S$2 000,000 POLICY P {�� JFCROi i t Loc •S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEd ectIdenl) ANY AUTO BODILY INJURY(Per person) S All OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aecldenl) $ PROPERTY DAMAGE HIRED AUTOS AUTOS ED (Per accident) _ S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAO CLAIMS-MADE AGGREGATE S DEO J RETENTIONS yy ) WORKERS COMPENSATION 1 TORY TA TS 1 T AND EMPLOYERS'LIABILITY Y I ANY PROPRIETOR/PARTNER/EXECUTIVE 1{r A E.L.EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED (Mandatory In NH} El_DISEASE-EA EMPLOYEE $ Ifyes.descnbe under DESCRIPTION OFOPERATiONSbclaw El.DISEASE POLICY LIMIT S ,40> DESCRIPTION OF OPERATIONS f LOCATIONS(VEHICLES(Attach ACORD 101,AddltIonal Remarks Schedule,If more apace Is required) INSTALLATION OF GLASS WINDOW& DOORS CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY CONTRACTORS LICENSING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 N HORSESHOES DRIVE ACCORDANCE WITH THE POLICY PROVISIONS. NAPLES, FL 34104 AUTHORIZEDREPRESENTATNE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD namo and logo are registered marks of ACORD Findings of Fact, Conclusions of Law and Decision of the Board Collier County Contractors' Licensing Board For Applications Submitted to the Board for Review Type of Application: Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity X Other (specify) Application for Board Review THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on August 20, 2014, for consideration of the application submitted to the Board for review. The type of application is set out above. The Board having heard testimony under oath, received evidence, and heard arguments relative to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law and Order of the Board as follows: FINDINGS OF FACT 1. That Luis F. Escobar d/b/a Florida lB&S, LLC (the "Applicant") has submitted an application to the Collier County Contractor Licensing Supervisor or his designee for a Certificate of Competency as a Drywall Contractor and based on the application supplied by the Applicant the Licensing Supervisor determined a review by the Board is necessary. 2. That pursuant to Section 22-184(b) of the Code of Laws and Ordinances of Collier County, Florida applications which do not appear on their face to be sufficient require referral to the Board for a decision regarding approval or denial of said application. 1 337709.1 8/25(2014 3. That the Board has jurisdiction over this matter and that Luis F. Escobar was present at the public hearing on August 20, 2014, and was not represented by counsel. 4. All notices required by of the Code of Laws and Ordinances of Collier County, Florida, as amended, have been properly issued. 5. The facts in this case are found to be: a. Applicant's credit history is such that probation and follow up with the Board is necessary. CONCLUSIONS OF LAW 1. Based upon the foregoing facts, the Board concluded that the applicant has not met the standard set out in of the Code of Laws and Ordinances of Collier County, Florida, as amended, for approval of the application without probationary terms. ORDER OF THE BOARD, 1. Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and of the Code of Laws and Ordinances of Collier County, Florida, as amended, the Applicant's application was granted with the following condition(s): a. The Applicant shall be placed on probation for a period of six (6) months and shall appear before the Board in six (6) months for a review of his credit before the Board. ORDERED by the Contractors Licensing Board effective the 20th day of August, 2014. 2 337709.1 8/25/2014 CONTRACTOR'S LICENSING BOARD 'OLLIER COUNTY, FLORIDA (C)44N1 By: Patrick White, Chairman I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorio, Licensing Compliance Supervi or, 2800 North Horseshoe Drive, Naples, FL 34103 on this th day of , 2014. • Secre ary/Contractor's Licensing Board 3 337709.1 8/25/2014 Individual Credit Report Ordered By: Jame • ESCOBAR, LUIS FERNANDO Customer : 9999 Nddress : 1015 SILVERSTRAND DRIVE Received : 01/21/15 NAPLES, FL 34110 Completed : 01/21/15 Bill Amt : $60 . 00 Social #: Applicant: -7988 CREDIT RECORD Credit histor has been checked for a .eriod of seven ears or from o•en date. Date High Unpaid Past Pay Historic Stat Current Mos Date Due Terms 30 60 90 Status Rev ECOA Creditor Credit Balance Account Number Reported Opened COLLECTION A20204898 - -- -- O9-* 02 A 06/14 04112 255 255 255 COLL - ORIGINAL CREDITOR: CITY OF RICHMOND UTILITY COLLECTION ALLY FINCL _ __ __ I}* 08 S 01/15 04/08 21709 5276 5276 302 - DLA=01/13 COLLECTION AMEX _ __ _- 09-* 09 A 05/14 11/06 6664 6664 6664 0 - DLA=05/14 AS AGREED FORECLOSURE BK OF AMER 0 0 0 0403 10 M5-* 48 A 03/12 05/06 313200 DLA=03/12 AS AGREED BMW FIN SVC 10/08 02/08 16886 CLOSED 0 0 0000 00 I1 07 A DLA=10/08 COLLECTION CACH LLC _ __ __ 09-* 03 S 12/14 06/12 51056 5105651066 COLL - ORIGINAL CREDITOR: WELLS FARGO BANK N A COLLECTION CAP ONE _ __ __ R9-* 11 A 01/15 02/05 2925 2982 2982 89 - DLA=08/11 AS AGREED CAP ONE 10/11 02/03 2675 PAID 0 REV 00 � ,7'nr T DLA=10/11 4 JAN 2 3 2015 Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H,West Palm Beach, FL 33 61F5556 :,__(5.6�.). %. IVL1LJl 1 v JIL LJ J % lam game • ESCOBAR, LUIS FERNANDO Customer: 9999 Page: 2 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date. ) Creditor Date Date High Unpaid Past Pay Historic Stat Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA CAP ONE AS AGREED 01/10 05/04 2690 PAID 0 REV 00 00 00 R1 48 A DLA=01/10 CBE GROUP COLLECTION 11/14 05/13 769 230 230 COLL -- -- -- 09-* 01 A ORIGINAL CREDITOR: DOMINION ELECTRIC WAREHOUSE CHASE COLLECTION 10/13 09/03 8127 8127 8127 243 -- -- -- R9-* 12 A DLA=08/11 CITIFINANCIA AS AGREED 07/05 07/04 4165 CLOSED 0 0 0000 00 I1 12 A DLA=07/05 DEBT REC SOL COLLECTION 04/14 01/14 4444 4444 4444 COLL -- -- -- 09-* 00 A ORIGINAL CREDITOR: VERIZON VIRGINIA INC FCO NO STATUS 10/10 06/10 1915 1715 0 COLL -- -- -- 09-* 00 A ACCOUNT INFORMATION DISPUTED BY CONSUMER-ORIGINAL CREDITOR: THE MADISON AT SPRING OAK GREEN TREE FORECLOSURE 08/11 09/07 399750 0 0 0 0200 00 M2-* 07 A DLA=04/11 LITTON LOAN PD WAS 120 01/11 09/07 399750 0 0 0 02 05 01 M5-* 38 A DLA=11/10 NATL FITNESS PD COLLECT 09/14 09/11 164 0 0 0 -- -- -- 09-* 03 A ORIGINAL CREDITOR: AMERICAN FAM FITNSS WEST END SEARS/CBNA AS AGREED 12/14 06/07 4571 CLOSED 0 REV 0000 00 R1 48 A DLA=10/08 SEARS/CBNA AS AGREED 12/14 03/07 9032 CLOSED 0 REV 0000 00 R1 48 A DLA=02/08 Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 1...-1‘.EJ LI A I Ii.....-IL x.1...4 — sme. . . . : ESCOBAR, LUIS FERNANDO Page: 3 Customer: 9999 CREDIT RECORD has been checked for a .eriod of seven ears or from o.en date. histor ha Current Mos Credit Past Pay Historic Stat Roe ECOA High Unpaid 30 60 90 Status Date Date Balance Due Terms Creditor Opened Credit Reported P Account Number PD WAS 90 >T FARM BK 49192 CLOSED 0 0 0502 01 I1--* 32 C 06/11 10/08 DLA=06/11 PD WAS 30 ST FARM 06/11 10/08 29833 CLOSED 0 0 0600 00 I1--* 31 C DLA=06/11 WAS 120 SUNTRUST MTG 79950 0 0 0 0503 02 PD D-* 46 A 09/11 09/07 DLA=04/11 AS AGREED DLA=04/08 TILESTORE AS AGREED 09/09 06/07 3000 PAID 0 REV 0000 00 R1 27 A 25 Total trade lines on this resort: PUBLIC RECORDS: VE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WIT PUBLIC RECORDS HAH THE FOLLOWING RESULTS AS OF 01/21/15: SEE BELOW. TRANSUNION PUBLIC RECORD --- DOCKET# DATE LIAB ECOA PLAINTIFF/ATTORNEY Z SOURCE COURT LOC V1102752700 TYPE P110275 TRACT VET HOSP CIVIL 04887406 JUDGMENT $209 HENRICO COUNTY CT (VA) CIVIL JUDGMENT Z 04887406 V1200775300 CIVIL IL JUDGMENT 05/18/12 $4,212 I HENRICO COUNTY CT (VA) FORD MOTOR CREDIT JUD SOURCE(S) : EQUIFAX TRANSUNION INQUIRIES: (TU) #00630273 01/21/15 by CREDIT CHECK COMMENTS: BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS. FRAUD RECORDS HAVE Ordered by: APPLICANT - SEE NAME ABOVE 616-5556 Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 LIVLL!1. .i v� �.j.... -- - ame. . . . . ESCOBAR, LUIS FERNANDO Page: 4 Customer: 9999 ;OMMENTS: AFESCAN/EQUIFAX, HAWK ALERT/TRANSUNION CHECKED FOR FRAUD. tEPORT WORKED BY RENEE 1,REDIT SCORE: (scores range from 300 to 850) APPLICANT FICO SCORE: 571 *** END OF REPORT *** s It is based upon information obtained in good faith by this agency from sources deemed reliable. This information is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. uant This personal report is furnished simply as an aid in determining the credit desirability of the app The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. applicant(s). Ordered by: APPLICANT — SEE NAME ABOVE 616-5556 Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H,West Palm Beach, FL 33409 S T, `Lt `s �{ ' o The information contained in this document is confidential and is to be read by authorized parties only.Please refer to the confidentiality agreement for further details. CONFIDENTIALITY AGREEMENT The undersigned acknowledges that the information provided in this business plan is confidential; therefore,the reader agrees not to disclose,copy,reproduce,or distribute it without the express prior written permission of Florida 113&S,LLC.Upon request,this document is to be immediately returned. This is a business plan.It does not imply an offering of securities. og"- I. EXECUTIVE SUMMARY Florida IB&S,LLC, (hereinafter "Business") is formed as a Florida Limited Liability Company, located at 3395 Sandpiper Way, Naples, Florida 34109, poised for rapid growth in the Construction Industry. The Business seeks funding to take advantage of a window of opportunity for introducing a new Drywall Contractor service, which has the potential to dominate the market. Mission Statement. Florida IB&S, LLC is committed to building relationships for the future through honor, integrity and trust that achieve our clients goals while having a positive influence on our employees, subcontractors, community and industry. Business Description. The Business is to be organized as a Limited Liability Company formed and authorized under the laws of the state of Florida, and will be led by Luis F. Escobar, who will serve as the Business' Partner. Luis is a skilled leader with an intense passion and focus on exceeding client expectations. With more than 13 years of experience in the construction industry, Luis combines his deep knowledge, extensive experience, and client first approach to manage the success and price value of Florida IB&S projects. In addition to providing �. • •. • • '. • •. projects including job progress, schedule adherence, quality control, and financial reviews. • IL BUSINESS SUMMARY The business is a start up business, providing clients with Drywall Contractor. Florida IB&S will produce excellent services with the highest levels of quality. We will use all available resources including our relationships, talents, technology,gy, and leadership to excel in our processes and final products. Not only should our final products be of the highest quality but the process that gets us there should also,be one that people can enjoy. True quality and excellence is achieved when our clients can say that it was a great experience and they would hire us again. Industry Overview. Excellence and Quality Florida IB&S will produce excellent services with the highest levels of quality. We will use all available resources including our relationships, talents, technology, and leadership to excel in our processes and final products. Not only should our final products be of the highest quality but the process that gets us there should also be one that people can enjoy. True quality and excellence is achieved when our clients can say that it was a great experience and they would hire us again. Leadership Everything rises and falls on Leadership and everyone at Florida IB&S is a leader. Leadership is influence not position. We will develop effective leaders that are influential to the success of the corporation while adhering to our core values and principles. Healthy Environment and Culture Our employees are our most significant asset. The environment and culture of our workplace will motivate, encouragg and praninte our people and their talents. We want our people to feel this is the greatest work experience they can have. We recognize that career and family life should be in balance. In this spirit and in accordance to our values and principles our culture will develop and encourage healthy families. Integrity Everyone at Florida IB&S, should be honest, fair and reliable, having the courage to do what is right in all situations. It is our responsibility to achieve our clients, goals with the highest levels of integrity. The Business intends to provide exceptional, personalized service, which will be the pleasure to Build Our Company Motto is "The pleasure to Build." It is an Honor to be involved in a worthy profession for which we have a love and passion. We consider it an Honor that our clients entrust us to accomplish a great task on their behalf. We are therefore, committed to achieving their goals while making their experience enjoyable and successful. Florida IB&S,LLC, works diligently every moment to expand our reputation as a leader in the construction industry. Our firm fully understands that quality and service must be a top priority and we strongly promote that fact in all aspects of our company. We have an uncompromising commitment to total quality management from pre-construction through warranty administration. Our list of references represents a sample of satisfied customers What they have in common is that, like you, they need more than a builder. They need someone with integrity they can trust who believes in taking the process to a higher standard, and takes seriously the pleasure to build. I gl-,art-R-i----im— ____7677rTi„:7____,_., 5 ml ,,s,„, ,:,,, , lai 10I00,..41 lol ' I criPs..1 ir,sirlF411sstril i I2i i1[13( ! "9 iii . 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' ''''iWakii&igaiM . 4 /-1...-o 1.-vitnIty, F-1-1 1---- 1 1 II 11.5t18;C41/ ;ft/ ,cr! I 5 N031Crq ;PH 1 I ff4 qP1Igirril 1(101 Lei,to;of:0' cui, mit-4i I I n'•;; 0 0 0 0 0 0 0 8 0 0 : 1 I I 1. 1: 0 0 0 0 0 , I ; 0. .1. ■• 0 0 r I i 1 i I 1 ' - 1 i 1 Ln .1- rn NI r-1 1 ; ) ; , k i 1 k -.1. 1 ;—; .: sr TO iiilii'---11, “zz,11-4,0 II' 1 11=3141gFi 18! i I 1 irli 11'11q;c10W.1 It'lf NIP cr:, ,N. 1,1116k6! Hi .1.' CF4t01121,M 41;1 1mi iint"I ' ir.1;;NI I ;01' I'll IIIIIIIII ' i ; 1 • : ; , , I . t i ; i ; ! IIIIIIiiiii . ' I I 1 ; ' •• i 1 111 : 111 ) 11 . , I jig 1 I I 1 f rEi.i { VI . 1 0.1,, .. .6-:_I 1 )ifs'i J jx: 1i tniM, attei x1Z;i ..4-1 a gi• E• f I m w/w °I IflIWI 12; t i I.n 11°111M!'"I 1 I t w 5 g., t Jalith51,,,a.A1-1 1,T,1218tok 14 al CI 0 • •°' () 4.! v.i7dEillhi kti;SPX3i.W1515-3-1 0 010, 0 i 2 E di an 0143' 1 Ira t '';:314D; ;al 0;,r2' ....._,.._.„ . 500.000 -,!-• •--- 6 Total sales per productline _ . 3 years 450.000 4------ . - . '.4..,..i.,,,..i•,,,,,.„,..; 400.000 ;----- - -- i•P,=':tti;7:1:V I pf;#34-,45*,W ,Ip,.•.u.:,,,,,,'4,1,',', 350.000 --i- - -- ' - - -- 300.000 ; - - li.,..,..„,.....,....,..4-.A. -:;.f...--4.,,,-...,--•:,''' ---Ir=ift:,,n7-7.6.""ec "..%,;..Yr,-.0'.4.6 . ..77,,Z.::4':-a;;`•Fr.1:' twrivaraxeciazsom 250.000 -3,- _Einityzenamm j '-'gkiIIAIrtiv 000 -- __.....R.,5(iiwvv.-.. ,4 .,:i-.1.:30'.'4tt,:i4 ..,,,,... . a Projectline 1 an • '4.'4;':;<;;?:',i',Y...4 .;.944,2,g4. ,, 150.000 ' ;il.-1-.AW.A,!' ,..;,..;..,..;.i. ...,-,..,zv, :-.,-, -- .„.,i'slr,.-cs,??:,;•!-.,',i3"',, 100.000 ',/ _R.,...t.:,iki.v. ..,,,,,,t,..,:,,,-..:.,,-'0- ....-,.;-o.‹,../..,',".., .N. _ - -----;45;fZinnig------ i .1414V",44,t, 4-41.-V-n47-4 50.000 i.--- ---- *.. .,..v,.1.V., ___ ._._ .. .,--41;k4.,4 ,` --- ".F,-;..z.,.-1::,,,g;), '...V4-- -- ,,,q,),-,,,t,>- t4Alif:::):0414 AZWAIP12#1'iN. 0 I .,M.1■74.4;t4 4'4.- i — ,______i________ _Nd';.M72,,,h1, 2014 2015 2016 Total sales summary 3 years - - - I 400.000 ' - ,, . 1 --i.--kir-— 1 a-r•-f2t/ 4°SVi 4 ,::-.0, ..a■gq...0:0E:m ,..,e 300.000 . - Total net sales ..;',;,.-).,,.„ „ *A...,...:1--'„ .:.•:-... - if?, Q-1-3: „: •, •:• .• ' ' -. . . - Total cost of goods ' Total gross profit 100.000 0 2014 2015 2016 Total sales 3 years 500.000 , 450.000 ,' - .- - - - ------'"-------,70,:ami,1----.---. reglie.9-9..,4Sa 3 400.000 4 '‘,..------ •-.%--wig..Rwo _. _ 300.000 i - *rep*•,,;" p7,-.•,-.1,to;WA: 250.000 -: -.. . AN g 14i- tili . k.4:„,,-.•- . 4.,„...,..-4,,,,,,K.- ii4;..,,..-?• '',...q.?,34 • f‘k.'34-, -.4' . ''''s1‘. ,.:-.uiz.% ■'i',40,4PA.A.,,,':: 200.000 ' f."1314150 150.000 -' - - '7"--",-• -v‘,-‘-,,,,, • 100.000 ,-.7„,....- . . p.r IVr..,:-fr'. 1,3?,114tt•!•Y; - 01 r.,; AO.e.V.A......'■ 5 0.0 CO .. ,S.F''',katicfsirr''X■ • 4,Pe; ' e.1"I a,•,,,- o 2014 2015 2016 List of Companies p es and Projects we are working now EnviroStruct, Inc Contact: Ron Cernohous_ Project manager Phone:239-494-5700 Project:HERTZ Bonita Spring ALPHA OMEGA Construction of Naples, Inc Contact:Michael J. Wagner Jr V. President Phone:239-825-6820 Project: La Playa Ballroom Renovation AA Stucco Sc Drywa j, Inc Contact:Jack Armentrout V.P. Field Operations Phone:239-598-1100 Project: Botanical Garden Advance Interior & Stucr_n, Inc Contact: Richard Leggett Supervisor Phone:239-438-5189 Project: California Pizza Kitchen /7v List of Companies and Projects we are working now Wall Systems, Inc Contact Scott R. Morris Project Manager Phone:239-643-1921 Project:Marine of Naples Uptight Drywall Contact: Keb KyIer Project Manager Phone:239-591-3090 Project; Contessa Apartments / Golf side. Spectrum. Contracting inc. Contact: Vito De Pinto Divisions Manager Phone:239-287-9239 11\F•• r /1 r r1,1 r/r,a r 7(MS r,n.I 5 r - it UCTION Mei VA(l,. . 1 f Re:Florida NS llc. 3395 Sandpiper Way Naples, Fl. 34109 To whom it may concern, Our first project with Florida IB&S has so far been a mutual success. They have proven to be well organized and time efficient. They have been able to adjust to all changes directed to them as well as providing competitive pricing. They nave kept their materials neatly organized and their debris promptly disposed of correctly. The foreman has been very conscientious and continually checks to make sure we are satisfied. Sincerely. Ron Cernohous Estimator/Project Manager LcSTUCCO& DRYWALL, INC. DRYWALL.•METAL STUD FRAMING•STUCCO 1, c. August 15, 2014 To whom it may concern, Florida IB&S, LLC is a drywall subcontractor of AA Stucco & Drywall, Inc. They have completed two jobs for AA Stucco & Drywall, Inc., both jobs were completed on time and with great workman ship. Inquiries concerning his employment should be directed to the accounting office, phone number: (239) 598-1100. Sincerely yours, Earl LaFollette Controller 3 WELLS: F. GO Date: Aug 18th, 2014 To: Whom it may concern Regarding Customer: FLORIDA IB&S, LLC 3395 SANDPIPER WAY Naples, FL 34109 To Whom It May Concern: This letter is verification that the customer named above has an account with Wells Fargo. This account number ending in -4247, was opened 01/22/2014 and has a current balance of $xxxx.xx. If you need deposit information, refer to the customer named above. The account holder can provide deposit information from their monthly statements. If you have any questions please call us at 1-800-TO-WELLS(1-800-869-3557). Phone Bankers are available to assist you 24 hours a day, 7 days a week. Sincerely, Eric Johnson Business Banker (239)435-3313 2010 Wells Fargo Bank,N.A.AU rights reserved.Member FDIC. DSG4236(7-10 129971) List of Suppliers. Marjam Supply Company Contact:Marco Wong II Phone:239-938-0162 Kobrin Builders Supply Contac:Jeff Schoonover Phone:239-431-2572 Sunbelt Rentals Contact:Matt Roscio Phone:239-774-7117 Note: All materials purchased for each project have been paid in full. We have no line of credit with our providers. ctSUNBELT it RENTALS k_.) Page: 1 PC#:226 SUNBELT.RENTALS, INC-_._ .. .._ 2600 DAVIS BLVD Salesman; 22600 NAPLES/DAMS HIJ NAPLES, FL 34104-4333 Typed ByROSClO _- _-- 239-774-7117 Job Site: /r� /f�� -_�i�� 4.-----R_ � . FERRAGUT, ANAMILE w"�'' "` !(' GL 9787 GOUFSHORE BLVD N ��'+ V,��I� LA PLAYA HOTEL III 11111111111111111111111 NAPLES, FL 34.104 MN C#: 239-860-1180 J#: 239-860-?150 Contract #.. 47211208 Contract dt. 8/02/14 f Customer: FL F623000849580 Date out.... 8/04/14 9:00 AM J FERRAGUT, ANAMILE Est return.. 8/18/14 9:00 AM 3395 SANDPIPER WAY Job Loc..... FERRAGUT, ANAMILE;9181 GOUFSHOR FLORIDA I8&S Job No...... LA PLAYA NAPLES, FL 34109 P.O. #...... LA PLAYA Ordered By.. FERRAGUT, ANAMILE NET DUE UPON RECEIPT Created at PC# 226 for PC# 226 QTY EQUIPMENT ## Min Day Week 4 Week A 4.00 5' SCAFFOLD END FRAME 4.00 7' SCAFFOLD 8" SCAFFOLD .BRACE 5.00 5.00 5.00 27.00 40.00 Luis CASTER 2.00 2.00 941—$g5-1013 4.00 2.00 7.00 16.00 4.00 4.00 14.00 32.00 'ILES T TWp.te: v Urii i__ is i- CE 1 TRANSPORTATION SURCHJ.1.G�. L� 16. 150 i ENVIRONMENTAL ENVIRONMENTAL 1C' 7. RENTAL PROTECTION PLAN N13 EA DELIVERY CHARGE 13.20 PICKUP CHARGE 85.00 NT HISTORY ?ATE XTr PE 85.00 T14 AMEX PAYMENT *p 7 2 TRANS AMOUNT' APPLIED 293293 67 CONTINUED A%A% *f%.....k%A f!%f %f r Yif M%%*iw **a*A A%*%t%*%%A*A******A%%f f f*A A%f%A*A*A*%f f **%f f%A A*f****A%A A***4*f.•A f R A A, Rate your rental experience www.sunbeftreftals.com/suirv�� 3E1:QUIPMENT t)QES aubr wrsk i - c:f irtc.r -ttEUTIFY TFfE oF,ii6 AT oivt:i s MUL.rtpl:E'rSHIFTS O.R.: i charges are an estimate based on the `;ovERTiMe CRATES ,CUSTOMER IS'RESPONSIBLE AGES AND EEP©R Y assumes$u risks e e estimated rental period provided by Customer. MAYtAP,PLY RI F.i!wLtf�EGi-DAiNAGES ANA:REPAtR5 f,a re ssotaeted with the Equiprrtont dur apan>ible for and shalt only perm8 Propod trained,emuthorl ed ind'duals,w`ho are not Impairs uiprnent does not o yy 8 r ry nrtd domepa to porsans prpparty arxl the - pauip ent any,!hall not mutable for k immediat Intended use,does not have d tundor the inftuancp of drugs ej`r E ito use the E r shall not use the Equipment and span contact le for C stomer's,I t I the Equipment or using damaged or malfunctionin operating de and safety instructions or Customer has any Equipment. r has received.read,understands and g Equipment may result in sot iris Ledily injury or death, y questions regarding use o!the Equipment. :n as re alts Fort in hargon 74,which reo also be esttmnat www saunbo enrols cuthe niel s andct.`t tie of this Su/Chugs a :rwirOentels.comrt in S ergo iemts and conditions of this a Su/C Contract,including pl at en is and Indemnification prevision in Suction 7. r[Host contact Sunbelt to request pickup of Equipment.retain the Pick Up plumber given by � �exptanaaon b availnblo at wilt loons to the requirements of the PEW`regulation and equipment Pollution Control District �te Resources B Board(CARS}be responsible.Equipment Aealstret;n..p.,.,..e....ef��. spae qu for Equipment ie actually reVlavad by Sunbcli. lis ocnon certificate,Including ooarne.. r:.:___ SU ELT / v Page: 2 JlEN TA.LS JI PC#:226 SUNBELT RENTALS, INC. 2600 DAVIS BLVD Salesman -226©0"NAPLES/DAVIS HOU - NAPLES, FL 34104-4333 Typed By: MROSCiO 239-774-7117 Job Site: FERRAGUT, ANAMILE RESERVATION GOUFSHORE BLVD N II III � 1111111111111111� 1 LA PLAYA HOTEL NAPLES, FL 34104 C#: 239-860-1150 J#: 239-860-1150 Contract #,. 47211208 t Contract dt. 8/02/14 Date out.... 8/04/14 9:00 AM I Customer: FL F623000849580 Est return., 8/18/14 9:00 AM FERRAGUT, ANAMILE Job Loc FERRAGUT, ANAMILE;9181 GOUFSHOR 3395 DER WAY Jab No LA PLAYA FLORIDA !8&S P.O. # LA PLAYA NAPLESS,, FL FL 34109 Ordered By.. FERRAGUT, ANAMILE NET DUE UPON RECEIPT Created at PC# 226 for PC# 226 QTY EQUIPMENT # Min Day Week 4 Week Amount Sub-total: 287.35 Tax: 6.25 Total: 293.60 No refund given. Remaining deposit is 293.60 Deposit: 293.60 i i***i*F i***i*!i i********i i.4..44....*******i********i***i i i i*i i********4 ! 1 t i Y i i i i i i i i**M********i*i i i i*i**Ai* Rate your rental experience www.sunbeltrentals.com/survey 1F TNr*&CfUIPMEA[T p01:S fVOT WORT( •: PROP.EtiLY tzpTtPY Tfi�';�pi:f;1C @:+0.T ONCE;:. :• MUl.iIPLi+.SfiIFTb.OR,'., ;.�CUSTQMER;iS RESPpNSlBL£'FQR the total charges are an estimate based on the estimated rental � mVERTfME RATES•NiAY,APPLY '. REFUELING,DAMAGES ATilD:Rf:PAIRS .ustamar assumes at risks assodeted with the 1 period provided by Customer. 'ustomer IS eurnons(bfa far end abed on) Equ pment during the Rental Period,including Injury and dam a to Y ponnir property trained eulhotlzod individuals,who era not im air ar tae in roparty and N,c alcoman[. I the Equipment does not operate Properly,is not suitable for customer's Intended use,does not have operating and safety instructions or Customer has any od(under they instruc of drugs or omr ha to use the Equipment, :usromer shat not use the Equipment end Isbell contact Sunbelt immediately, llisuse Of the Equipment or using damaged or malfunctions E Y quosdans regarding use of the Equipment, :ustomer has received,read,understands and agrees to the estimated�may result in sedans bodily injury or death. charges herein and all the terms and conditions of this Contreet,ge t fee explanation the anon s and Indemnification provision in Section 7. n the Environmental Fee in Section 14,which can oho,he found at www,sunbehrentals,camfrentaicantrset,'Belhony(Pickup Surcharge fee explanation is avaRabfa at rw w.st rnb a itro nml s.co mlaukkgratg e ustomer must contact Sunbelt to request pickup of Equipment,retain the Pick Up Number given by Sunbelt end wit be responsible for Equipment until actually retrieved by Sunbelt. Sr operations in California:Customer Is renting equipment registered under the California Air Rosourcaa Board(CARE/Portable Equipment Registration Program iPERPI, The subject to the requirements of the PERP rage/alien and local Air Pollution Control District mtes. Under the PERP Regulation,the Customer is required to keep registration certificate.including operating conditions and notification re operator of the Equipment quired by PERP and returning the log with the Equipment requirements,with the q oep a copy of the rental agreement end . q pment(see wwwnfi re. ,r ._r,_r__._.. E4kkq,mont at ail times. Customer m„er,a. �,_._ I -4/ y J Z . arii1L `� � .ijr y fir A:,w: > vL.. ti , ,-'r rl / VKVOi LEDV E 1E1', ?S .. 4: � r A s-, y7 , . Wi�t R: Y ailV >supply COMPANY DO NOT PICK of Florida LLC 1 . I�,fr wvw marjam.com UPC VENDOR ACK DATE ORDER NO. 000000 07/28/14 22034297-0 P.O.ND. I PAGE I CUST4 1041065 LUIS 1 SHIPTO: Residential DW Install 2910 CARGO STREET FT MYERS, FL 33916 CORRESPONDENCE TO: MARATAM -- FT_MYERS 16911 GATOR RD FORT MYERS, FL 33912 801_70: CASH MARJAM FT MYERS 16911 GATOR ROAD FT MYERS, FL 33912 INSTRUCTIONS TERMS,. ' iCOD SHIP POINT SHIP VIA - SHIPPED MARJAhi - FT.MYERS PICK UP 07/28/14 UNE :. PRODUCT - 1 •QUANTITY QUANTITY • QTY. MY; •UNIT PRICING AMOUNT NO. AND DESCRIPTION .... ORDERED.. '• • .' 8.0. SHIPPED U!M • PRICE • . UM ._(NET) 1 USGJC 1 1 PCE 13.15 PCE 13.15 USG COMPOUND GREEN LID ALL PURPOSE JOINT 2 D45EZU 2 2 BAG 8.25 BAG 16.50 USG EZ SAND 45 COMPOUND 3 PT 1 1 PCE 2.13 PCE 2.13 PAPER DRYWALL TAPE 250FT 20/ROLL CTN Q. 1T2 1 IMPERIAL TAPE 2" ZOO' roll PCE 4,QG. PC? [ Oc I - - mot.. cr ,_.._ -c 5cta4 Invoice Tota=. =c c- 1 I )2f.K., i.;;;;;:t•-• ::', lip, P31'. 4'..ff' :50, Ilia .1.:;',-,n 1::;%•ki ;r:C•- 4: ,s;;.' .,*:.;;; :,,,,p,, ,,i,.1.,,,,,,,:v 'All,:igi: A,:*.ii• F.1-.4- 4',' =?,'''':'-g: -1:7 .' jaP-:-.,2Yt. ;V:''P'it•!-..,1 ACKNOWLEDGEM1 6 Si' .M.:;',?.gaiWPWWVIUPPLYCMWPANY DO NOT PICK c,f Florida LLC www.marjam.corn - UPC VENDOR ACK DATE I ORDER NI - / 7 000000 07/28/14 22034262 I 16-1 f t- P.O.NO. PAG . ,...-1- oust* 1041065 FLORIDA IB&SLLC 1 SHIP TO Residential DW Install 3181 N. BAY VILLAGE CT LUIS JR 941-855-1013 cORREsPoNDENcE To: mARJAr4 - FT.N7ERS BONITA S PRINGS, r.r... 341 35 16911 GATOR RD FORT MYERS, FL 33912 BUM CASE NARJAM FT MYERS 16911 GATOR ROAD FT MYERS, FL 33912 DROP IN GARAGE iNsTRuctrONs ' . ' TERMS . COD _ • . . • SHIP POINT SHIP VIA SHIPPED MARJAM - FT.M/ERS DELIVERY 07/28/3 Ltipo I. .. PRODUCT 1 QIJANTITY 'I OUNITTIY . 1 Oy. ' dry. war pRicyls. AMOUNT 1 3507,20. . ANDDEscRipTioN _ ORDERED so. . SHIPPED %UM - PRICE . 10 3-5/8 x 10' TRACK 20EQ 10 PCE BDL 2 35081020 3-5/8 x 10' STUD 20EQ 10 PCE BDL 3 2410:6 PCS ONLY 4 r_,I2G:Ka4,710' PREMIUM SPF 34 0.10 10 BDL 28.60 BDL 34 PCE 0.10 PPS 0.00 0.3810 Cf.,F7 381.00 0.3880CLFT 0.4820CLFT ESE 1109.68 163.88 G.00 ::::::-:.CF F01..TE": 2 1..-_.:-. -, ''.1-- ...z... r.:,-"-%- 5-,1":_rr,,,-: `7:-.--.,- -:. 7r Tctai FUEL 8 0-RC:ET:C.: Tar,CGS 9C.Cg Invoice Total 1773.85 H0,4, .47,4' ItW Zak Ari fa.. 41.;4,; Ilm ACKNOWLEDGEME iv *IV ;it. ., ... - ..--04 kV-MCIKagt,W RIPPIYCOMPANY DO NOT PICK of Florida LLC www-marjant.com IUPC VENDOR ACK DATE ORDER NO 000000 07/28/14 22034297- P.O.NO. PAGE 0 CUSTA 1041065 [MS 1 SHIPTO: Residential DW Install 2910 CARGO STREET FT MYERS, FL 33916 CORRESPONDENCETO: MARJAM - FT.MYERS 16911 GATOR RD FORT MYERS, FL 33912 tot.I.Ta CASH MitIRJA14 FT MYERS 16911 GATOR ROAD FT MYERS, FL 33912 INSTRUCTIONS TERMS • * • 1 COD SHIP ecii,rr VIA MARJAM FT.MYERS . U SHIP SHIPPED - PICK P _. 07/28/14 LINE ' PRODUCT - -QUANTITY . QUANTITY OTY. QTY. [ . UNIT PRICING AMOUNT NO. AND DESCR/PTION • ORDERED . B.O. SHIPPED WM PRICE . I UIM 1 USGJC 1 1 PCE 13.15 PCE 13.15 USG COMPOUND GREEN LID ALL PURPOSE JOINT 2 D45EZU 2 2 BAG 8.25 BAG 16.50 USG EZ SAND 45 COMPOUND 3 PT 1 1 PCE 2.13 PCE 2.13 PAPER DRYWALL TAPE 250FT 20/ROLL CTN 4 1T2 1 1 PCE 41,95 ' C .11,SPEFIZI TAPF 2" 200' .,-c71 cty S":- - - --: -- Y.2 cice . _. . . .. A . . . / c. 1 .--;-,, ,..v -"7. .. , , • t . , \,s. .- i /2'.CI) ../1..,. ORLER NC) .. .._ . 9v,--- I ! 4 INVOICE t.)!SCPEPANCIEfi- Ali an,orce:ou:crepao,:., gic lifInIq e IL SULIEt:7 re I rlf rE::Imr:pr41)cevon ior.: Dricx,allusirricrus.procenulp IC,4;Z.-Z‘n rrhor add,-...,r,trwt::f:f; riCREOP tA/1-40-1 'NCI ME I.VA;.4P.ANn. D.S.clAtt.a.9. L diwmied within tti(Says of invoict, SEMED1C-..ANI?NOTICE OF fiF.01-nrill MEN:Pi.104,shonS 13 S I 1.. 1 IP It i DATE • ACCOUNT NO. CUSTOMER P.O.NO. SHIP'VIA . TERMS SALESMAN ------------ U0 _ .__________- ..wi.i;,..p•-•.0„,..if.t.z.;q7c.zi,:i 4,-..,-..-5.,...71.44,1 ...,..,..-••,,,,,i.•,,.6.--„,,y,70.,0.-4,,,„;;;.,A,..... r OTT. Sirl BIN ITEM II . DESCRIPTION •..,,,,,,- -,......9,,..•:.•7...,.,-......,,,,..• ORD. • _ • - ' • ------ iZgl,tygg(40:33F:iibti5i 1 ill . ..,'• -C C,,..I.I. .: ",....4..„„...,;:,,..,.,•••,14....val,,,irti. ,..;_i.j,0./1.,..:11;:-1,.,'•••:.7:1;::•-(...:,..:;:t 0'..:;..4:1;j:,...1.41;;;., 44!...7 it. .... f■ C:...nt.,. - y ••• - ,....,...." 4 ...' ...It .1. -Ve..,ItfO4Vr.4/tITAVi'l...44/.72.V AO." -44 4,trlyWr44-.4, -gil....4',•74:?;4A,1-...*:4-tils,1".: .ykr,ocis 44,..v.*:1--=roilFr4f.ti.I,r.If"..rr6 #1.-1,4144014'...-41.21;:p.,,, -,,i-.., I I i tz-- •.--e. - -,'.-'., -",". ..,,,44.-ozw ---y,,,....... , • :-,..r .,...„4:. i I ! 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TROC f...c:CROSS SfDEWAL KfCtiFir:AT CLISrOIVER'S OWN n1.-4k :400E18 rOf 'CV -• '1, ,, 1.;. szn-• ,kur, ,1L; ?II •I:1.,•,r•.■ .ii,,,;•,-., .. ,,,, ,,, -•• 1011 IN utr-.1.,........_ 2 ! .iA -4^0. .%,,11: te .14t4`if 4Vg-7-21 A-et=i, :fcg-.F,';z' ,e4,t it.t,,,,liz, N,tit,;.z; ACKNOWLEDGEME .,,,,, v.,,,,-A A .„1;. .:0: 07,,,, 4-4;;, ...q 7: ._• ...„ , • - • - -- -- tit e' IA tV,P4,001$41W Sony compAgy DO NOT PICK of Florida LLC vvvirmararjarn_corn UPC VENDOR ACK DATE ORDER NO. 000000 07/28/14 _ 22034263- P.O.NO, PAGE Cusr.#. 1041065 FLORIDA IB&SLLC 1 SHIPTO Residential DW Install 3182 N. BAY VILLAGE CT LUIS JR 941-855-1013 CORRESPONDENCE TO: MARJAH - FT_MYERS BONITA SPRINGS, FL 34135 16911 GATOR RD FORT MYERS, FL 33912 wuro CASH MARIAN AD FT MYERS, FL 33912 IIISTR°611°NS . SHIP POINT SHIP vi MARIAN 'SHIPPED OD DELIVERY TERMS DROP IN GARAGE 07/28/1 UNE PRODUCT QUANTITY QUA NIT1Y QM QTY. UNIT PRICING AMOUNT NO. AND'DESCRIPTION ORDERED 8.0. SHIPPED (JIM -- PRICE UfM (NET) 1 358T20 10 10 BDL 0.3810CLFT 381.00 3-5/8 x 10' TRACK 20EQ 10 PCE BDL 2 358S1020 28.60 28.60 BDL 0.388oaxT 1109.68 3-5/8 x 10' STUD 20EQ 10 PCE BDL 286 PCS ONLY 3 2410SP 34 34 PCB 0.4820/XT 163.88 2x4x10' PREMIUM SPF 4 17C-CY , 0.20 0.10 ERS 0.00 ERS • PI-cr--- : CF a:1:,.-7 1...E!::T1_I • _ . .... c_ra: UE.„ :-.:::-.C1-1T.S 2( CO .• Taxes SS.25.= Invoice Total 1773.85 ., . • , .. . . , . • •" ' . - . ilei3'121fArN-ii1-1—M- 2/27 INVOICE WAVERS SUPPLY An F8M Company FIRST in Service•BEST In Value 6190 Shirley St PH (239)431-2472 INVOICE NUMBER INVOICE DATE c;;' Naples FL 34109 FX:(239)513-1390 57103285-00 CUSTOMER RO#:` ;.ORDERED:BY LA PLAYA VANDERBILT LUIS TERMS :. . ,`::DUE DATE;:: ``.:CUSTOMER4 -- Net 30 Da s ,11111111111 257 '.PLEASE:REMITALEJPAYMENT5:TO:• KOBRIN BUILDERS SUPPLY 1924 WEST PRINCETON ST ORLANDO FL 32804-9706 BILL TO: CASH CUST - NPL - SPECIAL TERM SFtIPTO: CASH CUST - NAPLES Level 3 Pricing Napies, FL :; ORDER DATE- .' :';'ORDER`:TAKEF1'BY;'... r;.SHIP VIA ."`:;SHIP:DATE JOB:NUMBER:):NAM :!:! 08/12/14 Lo•ez Tiffan Cust Pick-u. 08/12/14 IIIIIIIIIIIIIIIIIIIIIIIIIII ,QUANTITY: QUANTITY `.SELL ITEMNUMBER 'PRICE UNIT UNIT PRICE ORDERED;: :SHIPPED .UNIT :.ITEM DESCRIPTION 'NET . `?:QUANTITY '-:'.:AftiCc. .'.,°UOM ,Afs10UA'T.DUE., 6 6 BAG QS45L 6.000 9.00 BAG 54.00 4 4 BAG QSICK SET LITE 45 MIN 18 LB BAG 313245 (104) 2 2 PL QUICK SET LITE 20 MIN 18 LB BAG 313220 (104) 4.000 9.00 BAG 36.00 1 5 GAL NGC PROFORM A-P 61.7LB PAIL 31.0070 2.000 13.70 PL 27.40 KOBRIN BUILDERS SUPPLY 6190 SHIPLEY c PFF i CREDIT CARD a4 RD SALE .! t4RD n" INVOICE XXXXXXXXXXXXI858 SEQ n: 0005 Batch ti: 0005 Approval Code: 000038 Entry Method: 286113 Mode Manual fr in Code: $0.00 ALE AMOUNT NrZ CUSTOMER COPY Eber with your payment. Sub-Total Y- 117.40 FL Sales Tax 7.04 ance charge of 1-1/2%per month (1S% per year) will be charged on all past due accounts. Invoice Total $124.44 claims and returned goods MUST be accompanied by appropriate nanerwnrie afi ' BRIN 2j3 INVOICE $UiirofS sur+i+►x An FBM Company FIRST in Service•BEST in Value 6190 Shirley St PH:(239)431-2472 INVOICE'NUMBER: INVOICE DATE •' Naples FL 34109 FX:(239)513-1390 57103119-00 CUSTOMER POD ORDERED.BY LA PLAYA •':TERMS 'DUE DATE:' 'CUSTOMER# 'i; Net 30 Da s �W 1 PLEASE REMIT ALLPAYMENTS TO: KOBRIN BUTLDERS SUPPLY 1924 WEST PRINCETON ST ORLANDO FL 32804-4706 BILL TO: SHIP TO: CASH CUST - NPL - SPECIAL TERM LA PLAYA 9891 UULFSHORC DRIVE LUIS #804-624-7159 Naples, FL 4A* DUPL I CAIE *** :',ORDER DATE':: = ' ,ORDER TAKEN BY.;. :SHIP VIA r SHIP DATE :45.NUMBER/NAME 087 4 Default Salesre' Our Truck QUANTA.. ...QUANTITY :SELL •ITEM NUMBER . PRICE UNIT UNIT :;PRICE NET .ORDERED: SHIPPED. . NlT, ..,' fTEMDESCRIPTION , . -QUANTITY ' •-PRICE• :-UOM `iAMOUNT:DUE 24 24 SHT DF510 0.960 270.00 MSF 259.20 DW 10 5/8 FC 24 24 SHT DRL110L 0.960 250.00 MSF 240.00 LAFARGE 10 1/2 LIFTLITE DW KOBRJLi BUILDERS SUPPLY (k:6 C; 190 SHIRLEY SIRE*' r^ �. /ta, Vii.':- ' , cREDI i CARD AMEX SALE XXXXXXXXXXX22G0 0001 0001 000037 `ode: 273008 od: Swiped )U 1 $5010 • CUSTOMER COPY ase reference the invoice number with your payment. Sub-Total 499.20 al Drywall MSF on this order; 1.920 Trans e FL Sales s Tax 2 2 15 9.9.95 95 lance charge of 1-112%per month (19% per year) will be charged on all past due accounts. Invoice Total $544.15 claims and returned goods MUST be accompanied by appropriate paperwork. access is the contractor's responsibility_ inrluriinn BRIM ziut INVOICE BUILDERS SUPPLY /// An Company 4 FIRST N Service*BEST in Value 6190 Shirley St PH:(239)431-2472 INVOICE NUMBER INVOICE ATE... Naples FL 34109 FX:(239)513-1390 j 1 ! 57103101-00 1 .. CUSTOMER po#':: ORDERED BY G HERTZ p,,,7P>lit't _ - LUIS TERMS.. ':'• DUE DATE CUSTOMER;k.':` Net 30 Da s 257 �, PLEASE REMIT ALLPAYMENTS:TO: KOBRIN BUILDERS SUPPLY 1924 WEST PRINCETON ST ORLANDO FL 32804-4706 BILL TO: SHIP TO: CASH CUST - NPL - SPECIAL TERM HERTZ 3181 N. BAY VILLAGE LUIS #804-624.7159 BONITA SPRINGS. FL ** DUPLICATE *** s. ORDER DATE ORDER TAKEN BY , SHIPVIA SHIP:DATE. JOE,NUMBER 1:iNAME. : 08' 4 Default Salesre. Our Truck IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII QUANTITY QUANTITY ''SELL ITEM NUMBER . PRICE UNIT ,PRICE• •NET. ,SHIPPED:. UNIT . . •17EM.DESCRIPTION . • QUANTITY ''°RifE. :..0 OM• :. :Al:40UNTOUc 1 1 . .1 1.000 1ST FLOOR ** SPREAD BOARD THROUGHOUT ** ** SEE LUIS FOR STOCKING ** 101 101 SHT DFL512 4.848 270.00 MSF 1308.96 LAFARGE 12 5/8 FC DW 12 12 SHT DRL112L 0.576 250.00 MSF 144.00 LAFARGE 12 1/2 LIFTLIGIITDW ase reference the invoice.number with your payment. Sub-Total 1.452.96 al Drywall MSF on this order: 5.424 Trans Chg 15 15.00 lance charge of 1-f 2%per month Iii°/u FL Sales Tax 87.18 s / p { per year) will be charged on all past due accounts. Invoice Total $1,555.14 claims and returned goods MUST be accompanied by appropriate paperwork. aCCeSS is the conIrarI-nr'e re.en...dI-.I,-.. :..,.1..- -_ • __ B�t®,� C///j INVOICE BUILDERS SUPPLY J"' An FBM Company FIRST in Service+BEST-in Value 111 6190 Shirley St PH:(239)431-2472 �7 I !'+ ( CS - 'INVOlCE`.NUMBER INVOICE DATE::: ^laples FL 34109 FX:(239)513-1390 j(` (/'! � 57202885 00 f v 1 CUSTO MER: M 'HRIId /`,P INVOICE BUILDERS SUPPLY Rn niM Company FIRST in Service•BEST in Value 6190 Shirley SI PH:(239)431-2472 "INVOICE NUMBER INVOICE DATE Naples FL 34109 FX:(239)513-1390 57102924-00 • CUSTOMER PO#`:'.. ORDERED BY ;: LA PLAYA 111111011111 TERMS • DUE DATE CUSTOMER:#:•.3 Net 30 Da s PLEASE:REMITALLPAYMENTE TO`::. . KOBRI'b7 BUILDERS SUPPLY 1924 WEST PRINCETON ST ORLANDO FL 32804-4706 BILL TO: SHIP TO: KM, CASH CUST - NPL - SPECIAL TERM CPU BY LUIS ,4,A. / Naples, FL ,ORDER:DATE. 'ORDER'TAKEN B Y:. .' • 'SHIP VIA :: ''-SHlPDATE. . fOE.NUMSER'i?.NAfvlE. . .; /04/14 Default Salesre, Cust Pick u. 08/04/14 $ANTITY 'QUANTITY SELL ;iTEM;NUMBER :PRICE.'UNIT UNIT PRICE NET !RDERED `?:SHIPPED ;UNIT.:" ;IT.EI�;DESCRIPTION ' ::QUANTITY ' .. � , . .. - ::PRICE :: .UOIwi4 AMOUNTDUE =` 1 1 TB FCLK-10 1.000 11.50 TB 11.50 FIRE CAULKING TUBE 10 OZ +f) 1A n. .m iL NGC PROFORM A-P 61.7L8 PAIL JT0070 10.000 13.70 PL 137.00 iL 10.000 9.00 BAG 90.00 KOBRIN BUIILOERS SUPPLY :K SET LITE 45 MIN 18 LB BAG JT3245 (104) 6190 SHIRLEY STREET 4 X 8' WOOD STUD 3.000 3.75 EA 11.25 NAPLES,FL 34109 50N 5.000 2.00 RL 10.00 !yA 11. 12115:00 DW TAPE NATIONAL, (20/CTN) JT2342 000000003771965 11D'D5790690 UE9li cNi.rT h_ .f.:. C,d)H\ 0007• d; 000033 rat Code: 7182 +4etliod: (iffli.ic MOUNT $275,34 CUSTOMER COPY reference the invoice number with your payment. Sub-Total 259.75 FL Sales Tax 15.59 nce charge of 1-1/2%per month (18%per year) will be charged on all past due accounts. Downpayment 2$0.00 T 'aims and returned goods MUST be accompanied by appropriate paperwork. nvoice Total $0.00 :cess is the contractor's responsibility, including ingress and egress. INVOICE SUILDEffS SUPPLY An FIMS Company FIRST In Service•BEST in Value 61,'9 Shirley Si PH:(239)431-2472 INVOICE NUMBER .INVOICE DATE Nap a FL 34109 FX:(239)513-1390 57102923-00 CUSTOMER RO# ORDERED BY LA PLAYA LUIS TERMS DUEDATE 'CUSTOMER# ; Net 30 Da s IIIIIIIIIIIIII 257 :PLEASE REMIT ALL.PAYMENTS TO; . . icon l BUILDtRS SUPPLY 1924 NEST PRINCETON ST ORLANDO El 32804-4706 BILL TO: SHIP TO: — CASH CUST - NPL - SPECIAL TERM LA PLAYA Naples, FL ORDER DATE 'ORDER TAKEN By SHIP VIA %SHIP.DATE' ' ..:10S'NUMBER/NAME ' O 04/14 Lane Dan Cust Pick-up 08/04/14 NTITY-QUANTITY 'SELL ITEM NUMBER • : ' ' • ' " ' ' "' PRICE"UNIT ! UNIT , PRICE '• NET•:ORDERED . SHIPPED'•.•...UNIT•' „ITEM;DESCRIPTION . . tOUANTITY• ' %.PRICE .:ISOM ;AMOUNT DUE 10 10 PC ST15825DWS8' 0.080 225.00 MLF 18.00 25E0 1 5/8" DW STUD 8FT 3 3 SHT DFL58 0.096 270.00 MSF 25.92 LAFARGE 8 5/8 FC DW KONUNBURDERSSUPPLY 6190 SHIRLEY STREET NMIES,Ft31109 12,.2G1-f CREL,L,. AMEX SALE D XXXXXXXXXXX2260 ACE 0006 0006 #: 000033 #: oval Code: 876004 Method: Swiped Online i I CUSTOMER COPY Ise reference the invoice number with your payment. Sub-Total 43.92 FL Sales Tax 2.64 1 Drywall MSF on this order: 0.096 Dompayment 46.56 once charge of 1-1/2%per month (18%per year) will be charged on all past due accounts. Invoice Total $0.00 ;iaims and returned goods MUST be accompanied by appropriate paperwork. ccess IS tip • .. ( A Agfiem INVOICE Bemoan supprx F14 Company FIRST in Service•BEST In Value 6190 Shirley St PH:(239)431-2472 INVOICE NUMBER ' INVOICE DATE. Naples FL 34109 FX:(239)513-1390 57102945-00 ;CUSTOMER POI/ ORDERED BY LA PLAYA 1E111111ln TERMS DUE DATE •:CU3T.OMER s .. Net 30 Da s PLEASE REMITALL PAYMENTS TO: ., . KOBR.IN BUILDERS SUPPLY 1924 WEST PRINCETON ST ORLANDO FL 32804-4706 BILL TO: SHIP TO: / 7-11 c4 CASH CUST - NPL - SPECIAL TERM CPU BY LUIS I • te Naples. FL ,ORDER DATE . • . ORDEIVTAKEN BY'. ' SHIP VIA . SHIP DATE. - Jos NUMBER NAME . . . 04/14 Lange, Dan Cust Pick-up 08/04/14 111111111111111111111111111111111111111111 -QUANTITY SELL :.--.ITEM NUMBER . ' ' . ... • RICE UNIT 'UNIT '.PR/CE NET . ORDERED :SHIPP,ED • 1,17ENI:DESCRIRT,ION , • . .:;.QUANTITY " PRICE. UOM AMOUNT DUE 5 5 SHT DRL18L 0.160 250.00 NSF 40.00 LAFARGE 8 1/2 L I FTL I GHTIJW KOBruiv BUILDERS SUPPLY 6I90 SHIRLEY STREET NAPLES,FL 34109 08'04.2014 1+11C• LALL VXXVXXXXX22611 0013 #: 0009 tth 000033 oroval Code; 165004 ry Method: Swiped le: Ontile .E AMOUNT CUSTOMER COPY Ise reference the invoice number with your payment. Sub-Total 40.00 ii FL Sales Tax 2.40 Drywall NSF on this order: 0.160 Downpayment 42.40 ance charge of 1-1/2% per month (18%per year) will be charged on all past due accounts. Invoice Total $0.00 claims and returned goods MUST be accompanied by appropriate paperwork. access Is the contractor's rpsnnn‹lhait, AliArEOBRINAIININ INVOICE BUILDERS SUPPLY JI.n 173d1CompanY FIRST In Sen4ce•BEST in Value 6190 Shirley St PH:(239)431-2472 INVOICE NUMBER' INVOICE DATE Afar,'-- FL 34109 FX:(239)513-1390 57102976-00 MM. CUSTOMER PO# . ORDERED BY LA PLAYA MM. TERMS .DUE DATE .CUSTOMER# Net 30 Da s 111111111111111=111.111 PLEASE REMITALL PAYMENTS TO: KOBRIN BUILDERS SUPPLY 1924 WEST PRINCETON ST ORLANDO FL 32804-4706 BILL TO: SHIP TO: CASH CUST - NPL - SPECIAL TERM CPU BY LUIS Naples, FL ORDER DATE , ORDER TAKENSY" . . .:SHIP VIA "SHIP DATE ..JOB NUMBER/NA LIE • 08/; oi Lange, Dan Cust Pick-up 08/05/14 QUANTITY--'QUANTITY :SELL ITEM NUMBER • ' ' • ' ' " "'. PRICE UNIT ' UNIT . PRICE .' NET 'ORDERED :SHIFTED .uNIT .-ITEM DESCRIPTION ' . • , . : QUANTITY. :P.RICE. UOM ..ANIOUNT DUE 3 3 SHY DRL18L 0.096 250.00 MSF 24.00 LAFARGE 8 1/2 LIFTLIGHTOW KOBRIN BUILDERS SUPPLY 6190 gal FY STREET e"' NAPLES,FL 3-1109 DiI E Of):IV SALE t7 XXXXXXXXXXX2260 / 49° 010E 0002 / 0002 If 4. 000034 ,7 40\ oval Code' 556005 Method: Swiped Online EAMOUNT CUSTOMER COPY V's lse reference the invoice number with your payment. Sub-Total 24.00 FL Sales Tax 1.44 al Drywall MSF on this order: 0.096 Invoice Total $25.44 lance charge of 1-112%per month (18% per year) will be charged on all past due accounts. claims and returned goods MUST be accompanied by appropriate paperwork, access is the contractor's responsibility, including ingress and eoress. • Iliffirikalififfirl I'i 17111111111111111, BUILDERS SUPPLY PACKING SLIP 5t, Ar.rnta Company FIRST In Service•BEST in Value 6190 Shirley St PH:(239)431-2472 ::::::::::::ORDER t...--......-,.....,..,........CUSTOMER:Pa#::..-- ...: :: .PAt3E. Naples FL 34109 FX:(239)513-1390 57103410-00 LA PLAYA - BAYVIEW 1 ::::::::)ittfiti4'oAtt.::,.:::::::::. :: ,..,-.:jti13 if lyit-:. .,::.• ..•....: 08/14/14 PICKED DATE,.....:7::::::-..:2.SHIP VIA': .."."•:Osb4R TAKEN BY SHIP TO: LA PLAYA - BAYVIEW GUST#: OB/14/14 Cust Pick-up Lange, Dan 257 .v.P1302.MIP"04.1g.:,:-..•":::PtiPB4D sy.: .: - ..sALS.REp ..:. CPU BY LUIS 08/14/14 .LUIS Default Sales Naples, FL BILL TO: CASH CUST - NPL - SPECIAL TERM 11111'1111111111111111111111P1/111111111/1 ' 'QUANTITY •-.1- -:::.:.::::::•.:,;:•:„:::••:-::,.::•:::,„,,:v.„,,,,::•:'tn,,:::::::::::::::::::::::: '.:::•:::::::: .:.: :::::::::: ::::::::::::::::::::::::?::::::::-,:Y=•:':',;;Iiiii;,.;,%„,::::.:::.:::::::::::::::::::::::::::::.:::::::::::.:::::.::::::::::::::::::::::AYATITIY..:::l-.....p.RIC. -UN ..f!F3![0 '„.....-.:•.•ikii-d4;:::::....„ ..SI-IIPPED .:'...UNIT:•••::-::•:-•-::::::-• • •`-`•!:-....!Y:`Yr!-F!. :::::::: :::::::::-:::::::-:•:::::•-•::::::::::••.--..-:::•-•:::•-:.--::::::::::•::::::::•-•::::::".f.:t . ..:,...::::'...-I.Y',7.-,:,:-:-:.•-...:-.....-yr....;:-.•:-:•-•-•:::-••::::•-•;•::;••••••••..-.•••••••••••13.0•••"'QUANTITY,:.......,:tINIT-••:•:.......:...::. ....::::. 1.... . — . . ..--... ...;:-..- ...:::-.::::..::....X.: .':: •, :.::.. ..:..- .... .: ..:: : .. . !Yz......:;,)00.:.$1k.:.40:AtouziEck•....-.-:.*.:•..-.:-.......,..-...-....•..:.,:-.......,..:y.:...........,......,..,......,.y.. — .. . ... -. 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(645L 150:ICk:::.&Et2tttE::::4- fliNi ::iii'.BA6.::/..J4i7 .24 .4.1.644::::-..-. ...... : 0.00 .-:........-::::::::.4:00-......: BAG •....•:- :::::54':0 . ......::::::•.• -::::::.1:::::::-::::::::::::-::::::::::::::::::::::::::::::::::::::::::::::::::::::-:::::::::::::::-.:::::::::::::::::::',::::::::::::::::::•::::::•:::::•:::•::..,...,,..,....::,--..- • • -.:•.::.•::::::.:::.•:-:-•;•.--,:::•.-:::::::•:::::::::::::::::::::::•:::::.::::::::::::::::::.:::::::':::::::::::::::::::7:.::::::::•::::::::::::::-:-:•:::::::::-::::::•:::::::::: ::•-:'•:::. : • . .. . . . . • . . . . . . . • . • :: . • - • . ... .- . ..• ..• . . . -:-...--..:-•. ..... 2. , . . • ".. ,. •.• . .. . ,..... . ._ . .. . , ... .. • • • • . -" . . . ..... . . . . . .. .. . .., . . . . . . .... .... .• - .. . "... • . 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". • • •• ...... .... .. ..... .; . - . ..• . .. ....•... . : • •• . . . :: .. ..,-..-...,- ... , .... „ . ,........,..,..,.. ...........,......,...........:,....,...„............. • - •• • ... ,.*.. :. .. ... . •. •• . . .. :-......:. ... . -. .••• . • . . - . • . . • . . • •,. . . . .. . • • . . • ••• . . - -- ---:-: • : • — • - — -..- : : : : - • , . -• • . . . . . . ivered by Date Received by Date•PICKED BY.•• : :: •:::::-:.: FlECKEBIBY.::::::•:: :::::::: ::•:•:::-.LOADED:8Y ::'--••••• : • •::..IRUCK.#.':•:••::.: ..•:- '..• -..•-CUBE--., ::... :--:- ..::: • :. WEIGHT . .:: •- 0.00000 172.50000 Page , 1 A Finance charge of 1-1/2%per mouth(l8%per year)may he charged on all past due accounts. ALL claims and returned goods MUST be accompanied by appropriate paperwork. Yoh access is the contractor's responsibility,including ingress and egress. California Customers:Title passes F.O.B warehouse on pick-ups. Title passes F.O.6 curbside before stocking and spreading when delivered. =Bif 1117—s 4." BUILD/33S SUPPLY PACKING SLIP , 1 An r6M Company FIRST In Service•BEST In Value 8190 Shirley St PI-1:(239)431-2472 Naples FL 34109 FX:(239)513-9390 57103410-00 LA PLAYA BAYUIEW 1 ORDER:DATE NAME" 08/14/14 SNIP TA: LA PLAYA $AYVIEW VIA;;((;? ':ORDER TAKEN-BY CUST#: 08/14/14 Cust Pick-up Lange, Dan 257 :PROMISED:DATE.: :;ORDERED'SY:;:: ;:SALES:REP • CPU BY LUIS Naples, FL 08/14/14 LUIS Default Sales SILL TO: CASH CUST - NPL - SPECIAL TERM Illl1!iI!IffIOhII1IffhII _1111111111 1111111 1 . . . . `QUANTITY SELL PART NUMBER DESCftiP7iQN ClUAN71TY PRiAN er tUNiT :• 3 :-: CIUANTITY, i.N1T. .. A.CAAAA kAsAA AaAAcF�Yk�k;t k$�g ** - - :. •: .i. ! .. .:.?.r , • J()$::SITE::FORM;:REQUIRED • h4i{k�rkkHckS;A;�:ki** ilAklk�r/ 1.00 AL APN5 5'GAL NSC RRQFORM;A P61`7LB PAIL JT0070 `? 0.00 :`....:..1:000 PL 64.50 3•00 BAG. QS2OL QUTCI SST L TE 2Q MINI$ L8 BAG T3220 1bgj :.:::. :::'. 0.00 3 QQ BAG 3.00 -BAG.- QS45L QUICK SET LiTE 45 MIN18 L$ BAG J73245 X104} 0,00 3:00 BAG 54 00' • • • • • • • • livered by Date Received by Date PICKED BY.,.:. . C GKEQ BY.::::: :.LOAD'ED.BY:---:-,.. • .. :TRUCK# ..:.. : :.• ..:UUE1GiiT: .. .:.` • 0.00000 172.50000 Page A Flnance charge of 1-1/2%per month(18%per year)may be charged on all past due accounts. ALL claims and returned goods MUST be accompanied by appropriate paperwork. Job access is the contractor's responsibility,including ingress and egrets. California Customers;Title passes F-o.iB warehouse on pick-ups. Title passes F.0.B curbside before stocking and spreading when delivered. individual Credit Report Name. • ESCOBAR, LUIS FERNANDO Ordered By: RUSH Address : 3395 SANDPIPER WAY Customer : 9999 Received : 03/24/14 NAPLES, FL 34109 Completed : 03/24/14 Social #t: Applicar -7988 Bill Amt : $75 . 00 CREID. i T RECORD (^-edit history has been checked for a period of seven years or from open date. ) Creditor Date Date High Unpaid Past Pay HisPYic Stat Current Mos Account Number Reported Opened Credit Balance Due Terms 3,Dff 60 90 Status Rev ECOA ALLY FINCL f COLLECTION 02/13 04/08 0 4811 4811 0 -- -- -- 19-* 05 C DLA=01/13 AMEX COLLECTION 04/12 11/06 8773 6664 6664 0 -- -- - 09-* 06 A DLA=04/12 BB&T AS 10/08 07/07 56916 CLOSED 0 0 00 00 00 I1 AGR15 D S DLA=10/08 OF AMER FORECLOSURE . 03/12 05/06 313200 0 0 0 04 03 10 M5-* 48 A DLA=03/12_ 3MW FIN SVC AS AGREED 'ACH LLC COLLECTION WELLS FARGO BANK N A AP ONE COLLECTION 41.1507702780 . 03/14 02/05 2925 29-82 2982 89 - - — --- R9-* 10 A DLA=08/11 AP ONE COLLECTION kP ONE AS AGREED ; 10/11 02/03 2675 PAID 0 REV 00 00 00 R1 48 T )LA=10/11 tiered by: APPLICANT - SEE NAME ABOVE !porting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 LKLDL 1 ' LITILK i(.: CONFIDENTIAL Name • ESCOBAR, LUIS FERNANDO Customer: 9999 Page: 2 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date. ) Creditor Date Date High Unpaid Past Pay Historic Stet Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev RCDA CBE GROUP COLLECTION 06/13 05/13 769 769 769 COLL -- -- -- 09-* 00 A ORIGINAL CREDITOR: DOMINION ELECTRIC II CHASE 10/13 09/03 8127 8127 8127 243 _ R9-COLLECTION t, A=08/11. -- _` 12 A CITIFINANCIA AS 07/05 07/04 4165 CLOSED 0 0 0000 00 I1 AGR 2D A DLA=07/05 DSNB MACYS CUR 03/14 09/07 1750 0 0 REV 02 00 00 R1* WAS 30 DLA=02/14 35 A FCO NO STATUS THE MADISON AT SPRING OAK -- CONSUMER DISPUTES GREEN TREE FORECLOSURE 08/11 09/07 399750 37248411180 2795 0200 00 M2-* 07 A . A=04/11 ISBC BANK 01/10 05/04 2690 PAID 0 REV 0000 00 R1 AGR48ED A DLA=01/10 LITTON LOAN PD WAS 120 01/11 09/07 399750 0 0 0 02 05 01 M5-* 38 A DLA=11/10 ATL FITNESS 12/13 09/11 564 564 564 COLL - - COLLECTION ZIGINAL CREDITOR: AMERICAN FAM FITNSS LEST FNn - 02 A BARS/CBNA AS . 03/14 03/07 9032 CLOSED 0 REV 00 00 00 RR1 AGR48ED A )LA=02/08 ,ARS/CBNA AS AGREED 02/14 06/07 4571 CLOSED 0 REV 0000 00 R1 48 A L'A=10/08 erect by: APPLICANT - SEE NAME ABOVE orting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 LKLU.I r L L C CONFIDENTIAL. O 'Name • ESCOBAR, LUIS FERNANDO Customer: 9999 Page: 3 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date. ) Creditor Date Date High Unpaid Past Pa Account Number. Y Historic Stet Current Moe Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA ST FARM BK PD 06/11 10/08 29833 CLOSED 0 0 0600 00 11-*WAS 310 C DLA=06/11 ST FARM BK PD WAS 90 SUNTRUST MTG SUNTRUST TILESTORE AS AGREED 09/09 06/07 3000 PAID 0 REV 0000 00 Ri 27 A DLA=02/08 —_ — Total trade lines on this report : 25 )udLIC RECORDS: 'UBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH 'HE FOLLOWING RESULTS AS OF 03/24/14 : SEE BELOW. TRANSUNION PUBLIC RECORD -- - OURCE DATE LIAB ECOA DOCKET# YPE COURT LOC PLAINTIFF/ATTORNEY 04887406 12/16/11 $209 . 00 I V1102752700 IVIL JUDGMENT HENRICO COUNTY COURT POUNCEY TRACT VET NOSP 04887406 05/18/12 $4, 212 I V1200775300 EVIL JUDGMENT HENRICO COUNTY COURT FORD MOTOR CREDIT )URCE (S) : EQUIFAX TRANSUNION QUIRIES: /24/14 by CREDIT CHECK (TU) #00630273 )MMENTS: AUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS. FESCAN/EQUIFAX, HAWK ALERT/TRANSUNION CHECKED FOR FRAUD. eied by: APPLICANT - SEE NAME ABOVE orting Agency: Credit Check, Inc. -3017 Exchange Court, Suite H, West Palm Beach, FL 33409 (561) 616-5556 - Credit Record ALLY FINC--- Negotiating monthly payment for 12 months for 200.00. Beginning Sep 1st-2014. Agent: Melissa Carmen Phone: 1877-846-3731 ext1405 AMEX------ Negotiating Monthly Payments. WELLS FARGO- Negotiating Monthly Payments. CAP ONE----Disputed ( on the Capital One System we don't have any balance) CBE GROUP-- 2 Payments of$26932 1st paid on Aug 18-2014 and next payment on Aug 30-2014 CHASSE-------- Negotiating Monthly Payments. FCO-------- Disputed GREEN TREE-- Disputed ( when we sold the house....) NAIL FITNESS—Paid on Aug 19 totally Conf Number 773058 SUNTRUT BANK- Disputed ( the account is in $0.00) PUBLIC RECORDS: Poncey Tract Vet Hosp : balance $0.00 (account was closed) Ford Motor Credit: balance $0.00 Henrico General District Court (-2,0( Civil Case Details Case Information Case GV12007753-01 I iled : II ate : 07/19/2012 Case Garnishment ►�ebt Type: ype : Plaintiff Information _ Name DBA/TA _ Address— 1 Judgment Attorney –ORD MOTOR ORD MOTOR REDIT REDIT GARN/RANDOLPH&BOYD OMPANY LLC OMPANY Defendant Information I ame IDBAJTA ddress Judgment Attorney I SCOBAR, LUIS F CHMOND VA 3233 earing Information _ -- sate ime esult Hearing Type Courtroom $9/21/2012 08:30 AM .eleased Civil Hearing 5 Service/Process Reports udgz-nent Information ud!ment : If, : $0.00 Attorney Fees : Princi al Amount : $0.00 Other Amount : _ $0.00 Interest Award : 'ossession : Writ Issued Homestead Date : Exemption Waived : s Judgment Date Satisfied : Satisfaction Other Awarded : Filed : urther Case — I formation : Garuislzzzzeut Izzforzxzation Garnishee : WELLS FARGO BANK Address : RICHMOND VA 23219 Garnishee Answer umber of Checks Answer : Date : deceived : 0 Appeal Info_rmation Appeal ( Ayppealed I Date : : SUN TRUST MORTGAGE Equifax TransUnion Experian Account Type: Installment Mortgage Payment Individual Responsibility: Individual Individual Date Opened: 09/2007 09/2007 09/2007 Balance Date: 07/2014 05/2008 05/2008 Balance Amount: $0 $0 $0 Monthly Payment: $0 High/Limit: $399,750 $399,750 $399,750 Account Status: As Agreed As Agreed As Agreed Past Due Amount: $0. $0 $0 CURRENT CONSUMER ACCOUNT DISPUTES THIS ACCOUNT ACCOUNT ACCT INFO TRANSFERED TO Comments: INFORMATION DISPUTED MEETS ``OTHER OFFICE ACCOUNT FCRA ACCOUNT TRANSFERRED OR INFORMATION SOLD DISPUTED BY CONSUMER LAST PAID: 04/2008 SUN TRUST MORTGAGE PO Box 85526 RICHMOND, VA-23285 (800) 963-4792 24-Month Payment History Equifax No 24-Month Payment Data available for display. TransUnion * * * * * * NRNR NR R R NR NR NR NR R NR NR NRNR NR R R NR Ap Ma Fe Jo De No Oc Se Au Jul Ju Ma Ap Ma Fe De No Oc Se Au Ju Ma r r b n c v t p g ny r r b Jan lac v tpg Julny 08 08 08 08 07 07 07 07 07 07 07 07 07 07 07 07 06 06 06 06 06 06 06 06 Experian Open Accounts CAPITAL ONE Equifax TransUnion Experian Account Type: Revolving Account Number: Payment Individual Responsibility: Date Opened: 01/2003 Balance Date: 08/2014 Balance Amount: $465 Monthly$0 Payment: High/Limit: $510 Account Status: Collection Past Due$465 Amount: LAST REPORTED DELINQUENCIES: 07/2014=R9,06/2014=R9,05/20I 4=R9 Comments: AMOUNT IN HIGH CREDIT ORIGINAL CHARGE-OFF AMOUNT CONS DISPUTES - REINVESTIGATION IN PROCESS CAPITAL ONE PO Box 30281 Salt Lake City, UT-841300281 (800) 955-7070 24-Month Payment History Equifax • CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO C CAPITAL ONE Equifax TransUnion Experian Account Type: Revolving Account Number: 41150770XXXX Findings of Fact, Conclusions of Law and Decision of the Board Collier County Contractors' Licensing Board For Applications Submitted to the Board for Review Type of Application: Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity X Other (specify) Application for Board Review THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on May 21, 2014, for consideration of the application submitted to the Board for review. The type of application is set out above, The Board having heard testimony under oath, received evidence, and heard arguments relative to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law and Order of the Board as follows: FINDINGS OF FACT 1. That Luis F. Fscohar d/b/a Florida IB&S, LLC (the "Applicant") has submitted an application to the Collier County Contractor Licensing Supervisor or his designee for a Certificate of Competency as a Drywall Contractor and based on the application supplied by the Applicant the Licensing Supervisor determined a review by the Board is necessary. 2. That pursuant to Section 22-184(b) of the Code of Laws and Ordinances of Collier County, Florida applications which do not appear on their face to be sufficient require referral to the Board for a decision regarding approval or denial of said application. 1 330124.1 6/11/2014 3. That the Board has jurisdiction over this matter and that Luis F. Escobar was present at the public hearing on May 21, 2014, and was not represented by counsel. 4. All notices required by of the Code of Laws and Ordinances of Collier County, Florida, as amended, have been properly issued. 5. The facts in this case are found to be: a. Applicant's credit history is such that probation and follow up with the Board is necessary. b. The Applicant has not prepared an adequate plan to address resolution of the credit issues. CONCLUSIONS OF LAW 1. Based upon the foregoing facts, the Board concluded that the applicant has not met the standard set out in of the Code of Laws and Ordinances of Collier County, Florida, as amended, for approval of the application without probationary terms. ORDER OF THE BOARD 1. Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and of the Code of Laws and Ordinances of Collier County, Florida, as amended, the Applicant's application was granted with the following conditions: a. The Applicant shall be placed on probation for a period of three (3) months and shall appear before the Board in three (3) months with a written plan to address improvement of his credit including the following items: i. Listing of all jobs and value of the jobs; ii. Creditors contacted; 2 330124.1 6/11/2014 Payments made to creditors; and iv. Suppliers paid. b. If the plan is not provided as required the license shall be revoked; c. If the plan is provided the Applicant shall continue on probation for an additional six (6) months with a credit review before the Board at the end of six (6) months. ORDERED by the Contractors Licensing Board effective the 21st day of May, 2014. CONTRACTOR'S LICENSING BOARD —0 LIER COUNTY, FLORIDA By: Patrick White, Chairman I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorio, Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this /1' th day of , 2014. Secretary/Contractor's Licensing Board 3 330124.1 6/11/2014 a s.- 77 GMD Operations & Regulatory Managem,-pt Licensing Section '> ,� ; 2800 North Horseshoe Drive ORI MAL:-. rJ ! � Naples, FL 34104 .r _,... (` { � - 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/Business Nae: C- m C Fiction Name/DBA: P fi Qualifier Name: L!, - ^ J:;h` Physical Address: ✓ Cl /?�d r C 'f W t2-.-. 4 / ,t C -: _116; (Number & Street) i / (Cite) (State) (Zip Code) Mailing Address:3 5 ta 02-C_t._." (I)-1s i i I-) 9"/f: 'Q (Number & Str t) ( (Ciiy) State (Zip Code) C` ( ) ( p -- / E-Mail: 1 f Telephone: � 3C/ G:(.) .5 -ebat. it-t/ 1CI J TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 El merhRnicA $73f}00 ❑ 5vviiiiiititf4 [foul ,',.2_30.00 ❑ Roofing $230.00 ❑ Specialty $205.00 Specialty trade: i i`,,��' } '� ;1�� CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 f,i fI ru.r. i_'/\ ?4-) 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. Of 7,C9,} r o � a3� - 0o 33,5- S A±t naps _3(// pq 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. CA-Lid 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 yi*,1 / I, - 1?-‘ tcertify that the foregoing is true and c :ct to the best of my knowledge. thorized Officer of the Firm STATE OF FLORID• COUNTY OF P'r/' I l The foregoing instrument as acknowledged before me this j �j ;/ � �eC ('A -0/2/ (Date) By C4Aki of -lc-LT-5 (Name of officer, title/agent) (Name of Corporation) a 1 Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced identification and did not take an oath. (Typc of idc ificaticn) ?; ANAMILE FERR GUT , t, MY COMMISSION*FF071969 NOTARY'S SEAL. °' o,� `. EXPIRES November 20.2017 (4w)JUIJ IIb.1 h 1;7r1.7',tNelar ;ie(y{Ce.l;U;71 ■.4 L_Alaihaill ( = ' S NOTARY) Page 2 of 4 QUALIFIER INFORMATION: „--- Name: iii"--%1_,' �,-ii �. - .L ,j -Cq_e _.L r -'` • r Address: 339 j G A-4 .0 liUa i abtfp'3 ' L 3 q/C l (Number& Street) (City) 1 (State) (Zip Code) i Telephone: P 3 '`- A2 0 — I/ 6 Date of Birth: S.S. #: 000-00- ` E-Mail: (0,cC hcc 1 c ', ikd �.E. c , r lie. c_,- �_ Driver's License: t 6—5-c2 6- 7h 90-5-0 1. Type of Certificat�Competency for which application is made. 2. The mes and telephone numbers of two persons who will know your whereabouts. k - � �� w ( 039 - dpc - i. -t (,, ( Ohe A 30Y- - 980 - 67'7 . 3. Have you ever been convicted of a crime related to Contracting? ",. Y 9- _�d ' (If yes attach extra sheet with explanation) 7. Have you or any firms you have heen ac nriaated with Over filod bankruptcy? (\ (' 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. nip 9. List your business or work experience during the past ten years. '---r--12-44-7,-)--e---/\_ - c_xfe,,---C-Ate-sti2A-et--/ - 7/--/7-7-7-----,-(7_. - L e-26----K, 10. Statement of any formal training you have had in the area for which the application is made. Page 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. ------/) APPLICANT(PLEASE PRINT) ,■• (, . NAME OF PANY ,f Ifig�.6. / ' - ° SIG K E F APPI ICAN1' u, i t STATE OF FLORIDA c f `' ti } . COUNTY OF r '�-��' The foregoing instrument as acknowledged before me this c2f -5/ i fly- ' 0 /7/2a 4 C-Date Ai By f GC, -0 -a- who has produced / - 'ri-a (Name of person acknowledging) (Type of identifi ation) as identification and did not take an oath. f": ' ° ANAMILE FERRAGUT c MY COMMISSION#FF071969 Sco' ___. ', t 01 EXPIRES November 20.2017 NOTARY'S SEAL (407)3m-°153 Florldallotaryservice.com i, r/i,i _t itl ------------) C( itNATU E. OF N 11AKY _"" i Page 4 of 4 AFFIDAVIT [T 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. SIGNlam"E OF'� r , � � LIR APPLICANT (i , _. BUSINESS NAME 7 • 610 - PI - ,_ .---r,,,,/ Li , __ DATE -' 1 FORE ME this day personally appeared (..ti:d- C.::,,::- = F - who affirms and says that he s less than one employee and does not requiWorkmen's Compensation understands that at any le he employees one or more persons he must obtain said Workmen's Compensation Insurance. 4TE OF FLORIDA LINTY OF for, oing instrument was acknowledged before me this I e, r2-76?_ -�"' -i G%/ C/ .j1 `� Cf (Date) � f who has produced ;Ik-f-� /1_17_4';, -, . (name of person acknowledging) (Type of identification) lentification and who did not take an oath. �` 1/ I .s''''''`'0.' ANAMILE FERRAGUT L, u�l MY COMMISSION#FF071969 SI NA E OF I. -^�_ ' EXPIRES November 20,2017 fi ~" ' oFrt ;" ' --- � „ . ,- �;(<07.3.98-D153 FloridallotaryServfce.com 4 ill. W f/ ! t.t..fir / y:/f(f qt„.._ - -° SEAL (PRINT NAME OF NOTARY P h LIC) NOTARY PUBLIC 'VERIFICATION OF CONSTRUCTION EXPERIENCE[ . GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples,FL 34104 r.- -: ` ,pplicant's Name: �'� t,--6 , a7�'� �G _, _ _t (.7 C , 'ertificate Category Requested: '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: am e, Title and license number,of the person signing below and verifying Applicants relevantexperience: nine: lr c4( 1g f"\ 4 '1%( i f r ; Cii1 �_c i r� r '' ( ( '9 ) tle: P 'C'2SI ; 7) / License Number(if applicable): 7705 ('�25 7d AT , T____� gI r ame of Business: '._., ° - ! 4477/_)!v"i C_-t f 1SInCS3 Address: : i jt' r �'w` (}"l, o.:` t t (-St7:: c..-,, t° r.. /L v'z i 1'.- isiness Phone: n rd— Lt C.. 7-::- �/s The Applicant's years of experience from ? to // ie applicant's scope of work (specific duties)included: , ",- �` i,i\ ft.i�.(i!F `-( i"'1-41?4' iditional Comments: i 1 lsifying any information provided herein may subject your license to revocation. r� Signature L_i '-t i i , " R Print Name. _'' E Lfi i ` �r.. f !te of Florida unty of Collier e nstrumPnt was acknnwierigPri hefore me on this ,/' t /r ,of 7✓! ( ,mot j( ,F CI f+o�eeoin� i �' 4`(1-t ',.4./`) (I, ( 1 it:j` `. c(i who is-fiersoonally kn to me or oduced identification and who did not tale an oath. ` _ � .t , .� S inn atrire�f 1ta ' ` - ; .MILE F E.R RAG UT COMMlSSiOE'J#FFO71989 IRES November 20.2017 Rondallotaryservice.com ;VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 .pplicant's Name: - �� '- 'ertificate Category Requested: 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 person signing below and verifying Applicants relevantexperience: ame: It._a r-r i..� P A c� ..i 5 tle: C'r e. t A e c-, License Number(if applicable): ;Xi.UNiS , "' ame of Business: j-}-1 $ c c Er D c--^,..3 t ,,,....,(,:i ii \ t ` .., ,-ss i Isiness Address: L) c..i._a - -. -, .*4. r: 1 '..',r. `. �'" i.sine.ss Phone: �P, -^c? — 11 cin The Applicant's years of experience from C.0-') to C` VA' - le applicant's scope of work (specific duties) included: fT, :--n 1 -Pry', in i n cA 0,-r c`\ A,-,3:_z.:‘..0. \ iditional Comments: [Isifying any information provided herein may subject your license to rircation. Signature �, , Print Name: 'l P,t ._`i Ai') ()Li_5 ste of Florida ,unty of Collier s,=..- L. fwt.guin , ;11311 WI ,t,a3 a,,k,twiILAgcd hcfu,c me uiithis ' day of Y ` `,G,(4 Lc, c- 2 . i 0 n ,..)5 who is ii ersonally kiio—w-lr to me or produced identification and who did not take an oath. ; c7 _�.:' .'�.C.S/'r i" Signature of Notary --> .,°"*:fri. DENISE GROSMAN a' �� -SW*of Florida ?�.2017 4 t rir *t' My Comm.Expires Mar 24.201, EE®75620 ,. .1,6: Commission 0 EE 575820 4`'aa' National Notary Assn. °°°aaf»iN"" °VERIFICATION OF CONSTRUCTION EXPERIENCEr GMD Operations & Regulatory Management Department Licensing Section 2 .00 N.Horseshoe Drive �. Naples,FL 34104 / R pplicant's Name: r 1� `_ '--A-..-ttA---6��. (_- ^.,f -/.2)k— G'� :L---) ertificate Category. Requested, 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 Iicense number of the person signing below and verifying Applicants relevantexperience: am e: i S ,i7e CAh)e2 A(-00T- tle: e(43,64 C License Number(if applicable): ame of Business: (4j,6'1rKJ 90114 / . Isiness Address: .),/,7,,,-)' (D/ lam ` /2-1‘L j-e 2 PGOc%u-t/Cc. V/4 asiness Phone: 90 *- 2 - _.5:/-2 The Applicant's years of experience from 760 3 to Z c2ii le applicant's scope of work (specific diit.i?e) included: '16(C n -- 1ol'o it/t'er i /ell° Pui - Le,I l9 acv, 1-)01'k --/o v war 4 ,scki �1,,,-) 1 ,-r �i �,(r v L,�,r e�„-�frs '67r j04 ,. Iditional Comments: lsifying any information provided herein may subject your license to revocation. Signature Print Nam-. UPS / Z.5- of . Ite of Florida ■unty of Collier -- 1f ,firs .7, if' futL8viii&-a oll uilitiiil v1,4L.�avi tu1v Iodgvtl Lcfvee we vii this day of_ r t- s R,. / , t.5 l , it ;-c r' ' rt o t)c1 who is p; rsonally known MC or pro,uced / . -7 identification ann jwho did not take an oath. Al - .. Signature ,.rem"`°��:,_ ANAMILE FERRAGUT € MY COMMISSION #FF07i969 :T. °4 P EXPIRES November 20,2017 (407}398-0153 FIoilctallotarySencice.co AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, Q- 0-6 - - am a resident of7-4)-/a/L) ounty, Bier d (State) and have resided here for more than five (5) years. During the last five years I have known (ite/1J � applicant). I have had he opportunity to observe his or her business and ersonal dealings and find him or her to be a person of onesty, integrity and good character. (Signature) 49//-06( i4 ' , 17(Name) Agra y , � (Address) MS)S) Ai t Loa, Telephone) 3'fc")S ' 117 C7 - 0 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this S/ Q 21y (llate) - who has produced pn,C.1� e on ack fled fl ) of identification) (name of P .� g g as identification and who did not take an oath. 4_ — ST k , URE OF 1' fi_0/9-1-geU cg-fraf7--r - NOTARY'S SEAL (P INT NAME OF NOTARY) NOTARY PUBLIC _'o`" .�a •. ANAM Lc FE:iiilAGUT MY CODA iv:+SS!^ t7-F071464 o;,- . EXP: ;ES ''oveinber 20,2017 (407) Nol%3rjSr_.rvice.corn AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER , P' ell al--/Y)ohaf-e6am a resident of / /L.Al_! < County, / / 401 rtC0 (State) and have resided here for more than five (5) years. )wring the last five years I have for mo (-4 (Applicant). I have had he opportunity to observe his or her business and personal dealings and find him or her to be a person of onesty, integrity and good character. i (Signature) _ ' (Name) i' ° ,..4 0`-wY& (Address) go U / B[V ,c/ ,e12 .t_,/,,7,4i-t,c1 v4 ,.3a-q q Telephone) go(71 qgo -577D- s STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this f 5// f-7 b Oril/yro j� (Dan rt,-- - kil who has produced )-/92 (/(- 't (namo of poroon acknowledging) '(Type of iden Dication) as identification and who did not take an oath, A i SIGN i,"j/.,11-1,-0 • 1 1' ' ijojy:Leej 41 (; NOTARY'S SEAL RINT NAME OF NOTARY)! NOTARY PUBLIC 'tiGit 1T i MY COMMISSION#FF071969 '',w.z EXPIRES NOVamber 20,2017 n,},;3�:,i3 FYOridaNOfaysenicecom RESOLUTION OF AUTHORIZATON WHEREAS -/'+�1 C G� -- „°- S �C - , proposes to (Name of Business ntlty) engage in contracting as ( in (Type of legal entity: corp.,partnership, etc. Collier County, Florida, according to Collier County Ordinance 2006-46,as amended;and WHEREAS �-7: i coo S proposes to (Name of business Entity) qualify for a Certificate of Competency with ht o t:k ' (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned -L i,(,Crr'` �k-6 L),tp ` of (Officers Owners,Partners) \,0`` C, -�_J .'S ; Lt._Q._ hereby resolve and represent to the Collier County (Name of Business Entity)/ Contractors'Licensing Board that the qualifying agent, PL t',t,k-,i (�2:C �4\r , is active (Name of Iujivi uaL) in all matters connected with the contracting business of•%-G� .T (_.. � and 1, .kName ofBus}}'ness Entity) We further resolve and represent that %,i ,i-ni Lo e•-( is ,-", tl (Names of Individual) legally empowered to act for ~ I(.`Nrt ( 0, ;,- ( in all matters connected with its (Name of Business Entity) ca -actinzbusi ess, td has the authority to supervise construction undertaken by (Name of Business Entity)' rl 5 ,, DULY PASSED AND ADO/'IEll THIS 2 1 day of /i I t C rrk )-('rq ' (Officers,Partners,Owners-with 0 -_----- Designation underneath) C j Witness Witness Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this 3-1 day of Th I'�, ,C I tI by 1 (, ,'' �,€),;c,:, -'1,t��t.k'L'tiJ�-(. 1-E.,-..-10,_,C),,`' y �� C.;;�� ^ C. t ��C�,7 Notary Public Name Prints i Notar ,11 ir.. Eirti,TP -_ C:ouunlsslun Number C 7/ %u .i My Commission expires: l i , -X - 0--vi f - 4'''''''''.''',.,�:, ANAMJLE FERRAGUT MY COMMISSION#FF071969..,,,,, \ / EXPIRES November 20,2017 '-..of n, (-(17).398-0153 FloridallofaryService.com �.�._� 1.i-z.LL1 v t COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 e 239-403-240C) e FAX 239-403-• 334 ;;M z Ya`r 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 '16 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 inform tine 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. f ' a ') (V( ( s• April 1, 2014 Collier County Contractor Licensing Board RE: Review of Credit Reports To whom it may concern, I have been informed that according to county regulations, my credit does not meet the requirements needed for immediate license approval. Due to the decline in our economy in the past years, my credit score has been affected and damaged.Though payments have fallen behind, it is not my intention to file bankruptcy. My main goal is to eliminate my debt, improve my financial situation, and move forward. It is greatly appreciated that you are taking the time to review this case.The outcome of this meeting is going to determine if my company and I will succeed in this country. Thank you very much for your Time. r t,aic Escobar Manager, Florida lB&S 3395 Sandpiper Way Naples, FL 34109 (239)860-1150 Individual Credit Report [dame • ESCOBAR, LUIS FERNANDO Ordered By: RUSH Address : 3395 SANDPIPER WAY Customer : 9999 Received : 03/24/14 NAPLES, FL 34109 Completed : 03/24/14 Social # : Applicar -7988 Bill Amt : $75 . 00 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date . ) Creditor Date Date High Unpaid Past Pay Historic Stat Current has Account Number Reported Opened Credit Balance Due Terms 30 50 90 Status Rev ECOA 3LLY FINCL COLLECTION 02/13 04/08 0 4811 4811 0 - - - - -- I9-* 05 C DLA=01/13 AMEX COLLECTION 04/12 11/06 8773 6664 6664 0 - - - - - - 09-* 06 A DLA=04/12 3B&T AS AGREED 10/08 07/07 56916 CLOSED 0 0 0000 00 I1 15 S DLA=10/08 3K OF AMER FORECLOSURE 03/12 05/06 313200 0 0 U U4 U3 10 M5-* 48 A DLA-03/12 NW FIN SVC AS AGREED 2n/n8 n7,/nP 1 tiRRF CLOSED 0 n nn 00 00 Ii 07 A DLA=10/08 'ACH LLC COLLECTION 03/14 06/12 51056 510565/056 COLL - - -- -- 09-* 02 S )RIGINAL CREDITOR: WELLS FARGO BANK N A AP ONE COLLECTION 03/14 02/05 2925 2982 2982 89 - - -- - - R9-* 10 A DLA=08/11 AP ONE COLLECTION 03/14 01/03 510 465 465 13 -- - - - - R9-* 13 A llLLi-U 0/11 'AP ONE AS AGREED 10/11 02/03 2675 PAID 0 REV 0000 00 R1 42 T DLA=10/11 ■rdered by: APPLICANT - SEE NAME ABOVE .eporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 (561) 616-5556 Name ESCOBAR, LUIS FERNANDO Customer: 9999 Page: 2 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date . ) Creditor Date Date High Unpaid Past Pay Historic Stet Current Moe Account Number Reported Opened Credit Balance Dce Terms 30 60 90 Status Rev ECOA 2BE GROUP COLLECTION 06/13 05/13 769 769 769 COLL - - - - -- 09-* 00 A ORIGINAL CREDITOR: DOMINION ELECTRIC II 2HASE COLLECTION 10/13 09/03 8127 8127 8127 243 -- - - -- R9-* 12 A DLA=08/11 :ITIFINANCIA AS AGREED 07/05 07/04 4165 CLOSED 0 0 0000 00 I1 12 A DLA=07/05 )SNB MACYS CUR WAS 30 03/14 09/07 1750 0 0 REV 0200 00 R1-* 35 A DLA=02/14 CO NO STATUS 10/10 06/10 1915 1715 0 COLL - - - - -- 09-* 00 A )RIGINAL CREDITOR: THE MADISON AT SPRING OAK - CONSUMER DISPUTES 4REEN TREE FORECLOSURE 08/11 09/07 399750 37248411180 2795 0200 00 M2-* 07 A DLA=04/11 {SBC BANK AS AGREED 01/10 05/04 2690 PAID 0 REV 00 00 00 R1 48 A DLA=01/10 ,ITTON LOAN PD WAS 120 01/11 09/07 399750 0 0 0 02 05 01 M5-* 38 A DLA=11/10 TATL FITNESS COLLECTION 12/13 09/11 564 564 564 COLL -- - - - - 09-* 02 A )RIGINAL CREDITOR: AMERICAN FAM FITNSS WEST END EARS/CBNA AS AGREED 03/14 03/07 9032 CLOSED 0 REV 00 00 00 R1 48 A DLA=02/08 ;EARS/CBNA AS AGREED 02/14 06/07 4571 CLOSED 0 REV 00 00 00 R1 48 A DLA=10/08 )rdered by: APPLICANT - SEE NAME ABOVE reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 (561) 616-5556 i- <LlJ 1 1 `sl .1 AL • [dame - ESCOBAR, LUIS FERNANDO Customer: 9999 Page : 3 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date . ) Creditor Date Date High Unpaid Past Pay Historic Scat Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECOA 3T FARM BK PD WAS 30 06/11 10/08 29833 CLOSED 0 0 0600 00 I1-* 31 C DLA=06/11 3T FARM BK PD WAS 90 3UNTRUST MTG PASTDUE120 09/11 09/07 79950 72385 4077 680 05 03 02 M5-* 46 A DLA=04/11 3UNTRUST MTG AS AGREED 05/08 09/07 399750 CLOSED 0 0 0000 00 Ml 06 A DLA=04/08 CILESTORE AS AGREED 09/09 06/07 3000 PAID 0 REV 0000 00 R1 27 A DLA=02/08 Total trade lines on this report : 25 3UBLIC RECORDS: UBL1C RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH :'HE FOLLOWING RESULTS AS OF 03/24/14 : SEE BELOW. TRANCUNION PUBLIC =CORD SOURCE DATE LIAB ECOA DOCKET# 'YPE COURT LOC PLAINTIFF/ATTORNEY 1 04887406 12/16/11 $209 . 00 I V1102752700 :IVIL JUDGMENT HENRICO COUNTY COURT POUNCEY TRACT VET HOSP 04887406 05/18/12 $4 , 212 I V1200775300 ;IVIL JUDGMENT HENRICO COUNTY COURT FORD MOTOR CREDIT 3OURCE (S) : EQUIFAX TRANSUNION NQUIRIES: )3/24/14 by CREDIT CHECK (TU) #00630273 COMMENTS: BRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS . ;AFR.grAN/W1TTTrAX, HAWK AT,FFRT/TRAN,CTT1\TT(livj CHECKED FOR FPATTD. )rdered by: APPLICANT - SEE NAME ABOVE eporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 LMALLIji l UTI.L \Tame • ESCOBAR, LUIS FERNANDO Customer: 9999 Page : 4 COMMENTS: REPORT WORKED BY NICOLE . CREDIT SCORE: kPPLICANT FICO SCORE : 542 (scores range from 300 to 850) *** END OF REPORT *** This information is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. This personal report is furnished simply as an aid in determining the credit desirability of the appticant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,inc.harmless from any liability whatsoever. Ordered by: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 FA xT iti f7 r t - 1- ., Detail by Document Number Florida Limited Liability Company FLORIDA IB&S, LLC Filing Information Document Number L14000007213 FEI/EIN Number NONE Date Filed 01/02/2014 State FL Status ACTIVE Effective Date 01/01/2014 Principal Address 3395 SANDPIPER WAY NAPLES, FL 34109 Mailing Address 3395 SANDPIPER WAY NAPLES, FL 34109 Registered Agent Name & Address ESCOBAR, LUIS F 3395 SANDPIPER WAY NAPLES, FL 34109 AuthuriLed Pelsuuu(s) Detail Name & Address Title AMBR FERRAGUT, ANAMILE 3395 SANDPIPER WAY NAPLES, FL 34109 Title MGR ESCOBAR, LUIS F 3.39b bKINUI-411-'EK VVHY NAPLES, FL 34109 Annual Reports No Annual Reports Filed http:l/search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/DocumentNumber/... 3/31/2014 Document images 01i02/2014_-- Florida Limited Liability View image in PDF format privacv oi SrEtz,. http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail/DocumentNumber/... 3/3 1/20 14 State of Florida Department of State I certify from the records of this office that FLORIDA IB&S, LLC, is a limited liability company organized under the laws of the State of Florida, filed on January 2, 2014, effective January 1, 2014. The document number of this company is L14000007213. I further certify that said limited liability company has paid all fees due this office through December 31, 2014, and its status is active. Given under nay hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the,cirth day of Febrawy, 2014 -,-- 4, VAIN 0*, J221 1‘. . Secretary of State Authentication ID: CUS364591509 To authenticate this certificate,visit the following site,enter this ID,and then follow the instructions dispiayed. https://efile.sunbiz.orgicertautliver.htini IRS INTERNAL REVENUE THE ER CEY CINCINNATI OH 45999-0023 Date of this notice: 01-21-2014 Employer Identification Number: 46-4562848 Foiin: SS-4 Number of this notice: CP 575 G FLORIDA IB&S LLC IB ANAMILF FERRAGUT SOLE MBR For assistance you may call us at: 3395 SANDPIPER WAY 1-800-829-4933 NAPLES, FL 34109 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 46-4562848. This EIN will idenLify 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 cauwc a delay iti piocesaing, FesulL 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. A limited liability company (LLC) may file Form 8832, Entity Classification Election, and elect to be classified as an association taxable as a corporation. If the LLC is eligible to be treated as a corporation that meets certain tests and it will be elecLiuy S corporation status, it must timely file Form 2553, Election by a Small Business Corporation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8832. 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 pezuanent 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 havo Huoctiona about your EIN, you nnn nnl l un nt tl u. plh, nr rnmt r :.r .LiL,_ L� us at the address shown at the top of this notice. if you write, please tear ntt 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 b'LUR. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. Lt>aR DA BPART Rio OF TATB K - xr I1 ttt a �r as Detail by Entity Name Florida Limited Liability Company FLORIDA IB&S, LLC Filing Information Document Number L14000007213 FEI/EIN Number NONE Date Filed 01/02/2014 State FL Status ACTIVE Effective Date 01/01/2014 Principal Address SANDPIPER WAY NAPLES3395 , FL 34109 Mailing Address 3395 SANDPIPER WAY NAPLES, FL 34109 Registered Agent Name & Address ESCOBAR, LUIS F 3395 SANDPIPER WAY NAPLES, FL 34109 Autnorized I'erson(s) L)etail Name & Address Title AMBR FERRAGUT, ANAMILE 3395 NAPL SANDPIPER WAY ES, FL 34109 Title MGR ESCOBAR, LUIS F 3395 NAPLE SANDPIPER WAY S, FL 34109 Annual l<eports No Annual Reports Filed http://search.sunbiz.org,/Inquiry/CorporationSearcl�/SearchResultDetail/EntityNarne/flal-11... 5/23/2014 Document images 01/02/2014 -- Florida Limited Liability View image in PDF format (7c,Dvrio"lt ;n,j Pchc: s c;t. Departme.,,1 of-St:-Jte httn://se2rch.sirnhiz.org/Innuirv/CornorAtionSenrch/SearchR esultnet2i1/PntityNam e/fl a 1-1 1 ... 5/2'-1/901 4 sy,tl,JO t 0■to,/ra_,tzunx a laza e,111C7'll IL 11]-316.ii1qW V X 'a/k 14=4,4 k \,54■4 6 1\ If \7/R \43Filt 1\—,••!,/ ,4-, 1 rd-_-A7LIZ:57. 0, 2_,,x\c 4:0 1, f` 3158 ..., :, , -- '4,\Q). Pj-sC,4 • ,- `4 •:,.,:,01) 411110'''4 q, ' '„ 4 :e0\;-St DC .. ---- z1v---;-'-.-4.-"f-r.i: .".•1's----. ', .D.X,„„ ;0 C, p..x._[ 3 3 0 8 30 WO\8.` Bevartment of ,fttp ,DX $ 'k)-= R ti/8 oiev,9 S4),3 D C I certify from the records of this office that FLORIDA IB&S, LLC, is a limited 3 0 8 liability company organized under the laws of the State of Florida, filed on 3 , 0 8 January 2, 2014, effective January 1, 2014. D ---,, ?xc. 20)13 The document number of this company is L14000007213. ..e ru DY I further certify that said company has paid ail fees due this office through 'b 41)3-..., December 31, 2014, and its status is active. Vc- 3-igg -. 0 .A*0,8 D C ,.D. ;_., 01 D-q z_-. .40,9. D'.-.1 ly„ D. ::-.,.08 .c D. C 3 0 8 3 0 8 D -0 8 KGiven under my hand and the D C 13 0 8 -k)- Great Seal of the State of Florida DA.. at Tallahassee, the Capital, this the 3 U8 ---------- D C Fourteenth day of January, 2014 -, 8- D- F(0' .4r%1 V9A44' *1444 ,......_.; ...tf t........,,, ,, V4. ----7-----ayti ',.-"-<,:fr:C:' r c.' CR2E022 (1-11) - ci-OlizAcj 7..v• Icp.5v:xr,..,- b-‘vc--,svcsycsuicsuc:)o.Oc) STATEMENT OF OWNERSHIP This certifies that I, f ? � am a member or (APPLICANT'S NAME) Managing member of -T71idc(..) :5 - -i (LIMITED LIABILITY COMPANY NAME) I own - % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify that the information contained is a true and correct statement to the best of my knowledge. /I r �� eRINT NAME} ( (A?PTJCANTS SIGNA'PIIRE) ((,)3, 7(-) { (DATE) Ca Oil 0.11'1 0i 'i,4 0�j i� VI. ® i�4 /4,j�014, 0 V Sit Q �t r% 4 YO &v# 401.... 4# 4 *yo.4 )r% . h4 �, 0 -ter► 1►.-�►♦.m• [®- .*► ►♦ems.♦ % 0 - V%A 4 %At■ 4• 0 ', t{ 0 Alt) x{ 440 00:1 AAA rt AA „ tit`♦ A 4o 1 *ligt-or$, -E, 3 0 ,4 .to - 1/0 i 01 k ®r' o r O •t►o 40 o ct al � L 44 010. *I a) -\--) \ :2) - Pi °' 4_(-21 ci it 11 1) ct aa _:. ti----m--4 a c--(-;.). ti r 'r 2 V) E-5-, Q f i.." i .- -- 1 C ) H g` '- L-j CO ,0 , 10 0 411 e-'), i fir01% . ;Ili if 1 ii(k c,-,>i . 6 cg - -- -,,-1 ,,.,, .4:14 -,-,/ A If# 4:6' ;4 itiikt « , 1 r'.4-- / '•.- - - Ct ri:i ' Ctt . 4 (-1-< ) E 11 OVItv cl) -,,,- 13 '-.) '') _;'-,' ,..., g „, „, , .01[0:4-4,7-. ,, 0 .- ›, - ,"2 # tt ' [l lilt Q-- t .t o 4 0y IC J p __ P g U 4 -t > 1* a r Ye silk. 4 s 3 II/0114 / N ,--0 OAS v4 ° Cl) o o L4Oy u o b r4 OW* 0 •11A 0* c....)G1 V 2 its- . . •tiJ ' .2 .'' .LI ; j.; 11 ' �,+ ' ayg t(lo :".L. 1:n::( #. .�•• # 4 `. * 4. 4 ) 0.4e * # 44 * • 4 ► .� .•� ► 0�••• r► •. �rii:pi ..k.u :► ° % i 0A . it r s -- vi �r#A* l► a A CERTIFICATE OF LIABILITY INSURANCE 3/24/2(014 fYYYY) 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 Ott Insurance Agency, LLC CONTACT Brian Seneski NAME: 10915 Bonita Beach Rd. Ste. 1141 j PHONE No.Eot);2399480001 i (A/C,No):2399482004 Bonita Springs FL 34135 A ADDRESS:ADDR bseneski @hotmail.com _ INSURER(S)AFFORDING COVERAGE NAIC# IB&S INSURER A: Cypress Property and Casualty Insurance Co INSURED Florida & LLC INSURERB: .A --- 3395 Sandpiper Way INSURER C: _ Naples FL 34109 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. LT TYPE OF INSURANCE ADDL ISwVD POLICY NUMBER I(MM/DDY )!(MMIDD//YYYY)' LIMITS GENERAL LIABILITY i EACH OCCURRENCE ;S 1.000,000 ,DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY ! 100,000 PREMISES,Ea occurrence) �S A _j CLAIMS M^.DE ��x ,OCCUR I MED EXP i 0uy one person! d 3,000. I"'l 1,000.000 � n � n 20P0040741 ':3!24/2014 3/24/2015 j PERSONAL�ADV INJURY s 2,0 ! � i ;GENERAL AGGREGATE,, �S 00,000 GEN'L AGGREGATE LMIT APPLIES PER. PRODUCTS-COMP/OP AGG s 2,000,000 I X POLICY I I JC PRCT O- LOC I AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT !i (Ea era:neat) ANY AUTO j I�'BODILY INJURY(Per person) S ALL OWNED F-1 SCHEDULED — _— AUTOS I AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident)I I I _ S UMBRELLA LIAB OCCUR I FACH OCr11 IRRFbir.P EXCESS LIAB I l CL^.IMS MADE j AGGREGATE DED i RETENTION S S WORKERS COMPENSATION I WC STATU- ::OTH!, AND EMPLOYERS'LIABILITY YIN '�I�TORY LIMITS Ems_ ANY PRPPRIFTOR/PARTNFR(FXPITI ITniF C.L.C 011,',00IDENT O ICER/MEMBER EXCLUDED? N/A' I i --- (Mandatory In NH) E L DISEASE-EA EMPLOYEE S If es,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT I S 1 ! � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 91436 Ceiling or wall installation 92338 Drywall or wallboard installation 98305 Painting-Interior CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractors Licensing THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 N Horse shoe Dr ACCORDANCE WITH THE POLICY PROVISIONS. NddpICS,FL 34104 AUTHORIZED REPRESENTATIVE 239 252 2469 fax *.442. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i'lorkla CIient Setup Sheet For: Florida IB&S,LLC dba: Date: Mar24 2014Sales Rep: Joey Agent: 1st Choice Payroll Soluticii Customer#: **For SPLI NCSU Department use only:** W/C Approval Date: Payroll Tech: Delivery Method: System: Payroll Information: Contact Name: Anamile Contact Phone#: (239) 860-1216 Fax#: (239) 596-6875 Cell Phone#: Contact Email: anamile tb @yahoo.com Pay Period Begins: Mon, Mar 31 Ends: Sun , Apr 6 Day To Submit: Wed, Apr 9 Pay Day: Fri , Apr 11 Delivery Day: Thu , Apr 10 These services will be available after you have been approved and paid for at least three payrolls. If interested please check below: Direct Deposit: ❑ Yes it No EFT/Debit: ❑ Yes ✓No (Payroll must be processed 2 days prior to check date) (Account will be debited on the payroll check date) Company Information: Owner Information: Company Name: Florida IB&S, LLC Name: Luis Escobar Co Address: 3395 Sandpiper Way Title: MGRM SS#: 697-03-7988 City: Naples State: FL Zip:34109 Address: 3395 Sandpiper Way Phone#: (239) 860-1150 City: Naples State: FL Zip: 34109 Federal Tax#:464562848 Cell Phone#: 804-382-9828 State Tax#: Email Address: anamile_fb @yahoo.com anamile @industrialbuildingllc.com NAJ.CS Code: County: Check Issuing Bank: Eff Wells ❑ SunTrust ❑ BOA Pay Frequency: i 1 Weekly ❑ Bi-weekly ❑ Semi Monthly PTO Accrual: ❑ Yes (Rf No (mark all that apply) Pay Types: g Hourly ❑ Salary ❑ Tips ❑ Commission/Piece Work(Must Track Hrs) (mark all that apply) Payroll Type: ❑Departmental ❑Job Costing ❑Certified ❑OCIP (mark all that apply) Deductions: ❑Emp.Loans ❑ Insurance ❑401K ❑ Tax Levy ❑Child Support (mark all that apply) ❑401K Rollover? ❑Is it a Safe Harbor? ❑Other: Submittal Method: ❑ Online ❑Will Call ❑Will Fax ❑Email Report Delivery: ❑Email ❑Online ❑Fax Does the Company want information on our insurance? ❑ Yes d No WC Codes: 5474 Employee Setup Fees: $ too per employee Payroll Delivery Charges: $ per pay period Comments/Delivery Instructions: 339s- ..A_ pe,.- ULAG y Florida-Revised 10-24-13 SOUTH EAST PERSONNEL LEASING, INC. CLIENT LEASING AGREEMENT rMy i. This Agreement(herein referred to as"Client Leasing Agreement,""Leasing Agreement"or"Agreements is entered into this 24 day of 5 Mar ,20 and between South East Personnel Leasing Inc.,a Florida corporation and its subsidiaries(herein referred to �� r■• � collectively as"SPLI`),and Florida tBS,S,LLC (hereafter referred to as"Client"or"Client PIRSONNFI LcASIHG. INC. Company"),whose respective addresses are set forth on the signature page of this Agreement I. PURPOSE subject to the terms and conditions of the plans offered by SPLI.SPLI and its applicable The Parties agree that SPLI is a company engaged in the business of providing carrier reserve the right to change or substitute benefit plans or to implement cost • employee leasing services to Client pursuant to this Agreement This Agreement defines _ increases. SPLI shall endeavor to provide at least twenty(20)days prior notice of any the allocation of responsibilities between SPLI and Client This Agreement defines when such change,substitution,or cost increase. No Leased Employee shall be covered by an individual is and is not considered a Leased Employee of SPLI. In consideration of any benefit plan until the Leased Employee has prepared the appropriate submission the mutual promises and covenants contained herein,and for other good and valuable fort, submitted it to the carrier, been notified by the carrier of Leased Employee's consideration,SPLI and Client agree to enter into the Client Leasing Agreement,whose acceptance into the plan,and paid the premium for the first month; terms and conditions are set forth below. 4. Consistent with applicable law, the provision of workers' compensation insurance coverage during the Term for Leased Employees,for which upon request SPLI shall II.TERM provide Client a certificate of coverage, and management of workers' compensation This Agreement shall commence on the Effective Date and remain in full force and effect claims for Leased Employees; for a period of one(1)year thereafter("Inifal Period"),unless terminated by either Party 5. Provide unemployment compensator insurance in accordance with app€se Cl law. Where required or allowed by law or regulation,SPLI shall have the right to use Clients with thirty(30)days prior written notice or as provided in Paragraph Xf. After the Initial state identification numbers for ax unemployment re ortim s. Period,this Agreement shall automatically renew for one(1)year periods until terminated reporting Purpose In such states, by either Party with thirty(30)days prior written notice or as provided for in Paragraph XI. Client shall provide SPLI with its state identification number used for reporting state During the thirty(30)days from the date written cancellation is sent to the other Party,the unemployment insurance and shall forward all state unemployment information and (5) Parties will continue to meet the obligations set forth in this Agreement,including without notices to SPLI within five ep business days of receipt In the event applicable law limitation,the obligation of Client to pay all SPLI invoices. The period that this Agreement affords SPLI the option to report under Clients state identification number,SPLI shall shall be in full force and effect is referred to as the'Term." have,at its sole writing Leased the right to ee so; 6. Notify in writing all Leased Employees of the inception,termination,and expiration of this Agreement III. SERVICES PROVIDED BY AND OBLIGATIONS OF SPLI 7. Client and SPLi agree that should any Leased Employee raise an issue of A. Leased Employees covered by this Agreement only include those employees who discrimination.harassruerd,retaliation,or any other employment related issue,it shall be have completed SPLI's employment process and have been accepted,approved,and Client's responsibility to handle, investigate and resolve such issue(s). Should any paid by SPLI(hereafter referred to as"Leased Employees"). Any individual who does not investigation of such issue(s)occur and should the Leased Employee and Client desire complete SPLI's employment process and is not accepted and approved by SPLI as a SPLI to be involved in such investigation of the issue(s),if SPLI,in its sole discretion, Leased Employee shall not be considered an employee of SPLI for any purpose agrees to be involved in the investigation,SPLIs role shall be strictly limited. SPLI shall including,but not limited to,workers'compensation,benefits or employment related laws. not be a decision-maker/joint employer and SPLI's role shall be limited to conducting Client is solely responsible for all matters,including without limitation,worker injuries and such investigation deemed appropriate by SPLI and attempting to facilitate a resolution of wages that occur while an employee is not acting in the capacity of a I eased Fmpleyee. the Issue(s)whicn is mutually agreeable to the Leased Employee and to Client The In addition,Client acknowledges and agrees that,to the fullest extent allowed by law,it responsibility to defend,resolve and/or end any such inappropriate conduct which may has been allocated all responsibility to properly obtain and to maintain 1-9 forms in be occurring rests solely with Client conformity with the Immigration Reform and Control Act of 19E6 for all current and future Leased Employees. Client represents and warrants that all of its current Leased C. SPLI reserves such right of direction and control over Leased Employees and retains Employees have properly completed 1-9 forms. cuoh right to hire,fire,reassign,diseipllrie el nJuJilipeneate Leased Employees only as is R The services to be provided by SPLI for Leased Employees include, but are not required by applicable law. limited to,the following: D. The Parties acknowledge that they are entering into a contractual relationship 1. Payment of wages to Leased Employees to the extent required by applicable law and concerning Leased Employees.Client further acknowledges that the Parties'relationship may be influenced by Internal Revenue Code §414(n) and that an employment preparation, administration, compilation, and filing of all payroll information and relationship is boing ootnbliahed b tweee OPLI acid Leeeed Erirpluyees. distribution of payroll cnecKS tO Leased Employees from SPLI's own accounts following invoicing and payment of Client of Service Fee. In the event Client does not pay SPLI E. No person shall become employed by SPLI, covered by SPLI's workers' the invoiced Service Fee,SPLI may,to the extent allowed by applicable law,pay Leased compensation insurance, eligible for any other benefit or term and condition of Employees at the minimum wage rate or minimum salary provided for in the Fair Labor employment,or issued a payroll check,unless and until the following have occurred: Standards Act and pursuant to state law.This provision in no way affects the obligation of Client to pay SPLI for all services rendered during the payroll period,and in no way 1. The applicant has provided all requested information in the Complete SPLI Employee affects the obligations of Client pursuant to local,state and federal law,including,but not Leasing Application and the applicant has signed and dated the Complete SPLI limited to,the requirement to timely pay the invoiced Service Fee which includes,inter Employee Leasing Application. 'The Complete SPLI Employee Leasing Application" alia,all Leased Employees'wages. Unless otherwise required by law,the term'wages" includes the SPLI Employee Leasing Application,the Applicant Acknowledgement,the does not include any obligation between Client and a Leased Employee for payment Safe Working Practices Acknowledgement the Acknowledgment of the Post- beyond or in addition to the Leased Employee's salary,draw,or regular rate of pay,such Accident/Reasonable Suspicion Program,the Form 1-9,and the Form W-4; as bonuses, commissions, severance pay, deferred compensation, profit sharing or 2. The Complete SPLI Employee Leasing Application is delivered to the SPLI payroll vacation,sick or other paid time off pay,unless SPLI has expressly agreed to assume department "Delivered" means all parts of the Complete SPLI Employee Leasing liability for such payments in this Agreement; Application are mailed,faxed or hand-delivered to the SPLI payroll department and the 2. To the extent required by applicable law, SPLI assumes responsibility for the SPLi payroll department has date and time stamped all parts of the Complete SPLI withholding and remittance of federal and state employment taxes, including but not Employee Leasing Application as received; limited to, federal income tax, state and local income lax, Federal Insurance 3, SPLI must thereafter Recent the appfrmnt ac a I eacad cmr{n ee of cPLI, rentkmionc Pet ("FIG°."), Federal ilnnmpinrm.,r,t Ta, Arc ("IUTA'), al d stale unemployment tax("SUTA")fui Leased Employees; IV, SERVICE FEES 3.Administration of applicable benefit plans including remitting Leased Employee benefit payments from SPLI's accounts(as required by law)for benefit programs set forth in the A. In consideration for services rendered, Client agrees to pay SPLI service fees attached Exhibits,if applicable,beginning on the Effective Date.A Leased Employee's (Service Fee)in the amount set forth in the Exhibit(s),which is attached and made a part availahlp rnvera0a and eligibility to participate in 0 given plan oholl be governed by dm] of this AQropmant Thi S4rvico Foo includoo but i0 not limited to funds sulfa:mi ll to pay Page 1 of 7 Revision 02/28/2014 and administer all wages,payroll taxes,workers'compensation expenses and benefit day job duties of Leased Employees and over the job site at which, or from which, costs incurred by or payable to at Leased Employees.For existing SPLI clients who are Leased Employees perform their services, Client shall be solely responsible for the signing this new Agreement the Service Fee at the commencement of this Agreement quality, adequacy, and safety of the goods or services produced or sold in Clients shall be that which currently exist with the acknowledgment that the total Service Fee is business and Client and not SPLI shall be liable for the acts,errors,or omissions of defined as set forth in this agreement. Clients Service Fee obligation shall continue Client and those of any Leased Employee. during normal periods of Leased Employee absence for vacation, sick leave, legal holidays and emergency situations. It is the intent of the Parties that the Service Fee C. At the end of each pay period,Client shall obtain,maintain,and provide to SPLI all invoiced to Client is one charge where Client accepts,and is satisfied with,the total bill records of actual time worked by each Leased Employee, the status of the Leased that is invoiced to Client,irrespective of what SPLI's actual liability for any component Employee as either exempt or nonexempt,and verify that this information is accurate and part(including, but not limited to administrative fees, payroll taxes, wages, workers' in compliance with the requirements of the Fair Labor Standards Act, other laws compensation expenses,benefits,and other associated costs)may be irrespective of administered by the U.S. Department of Labor's Wage and Hour Division, and any any refund,rebate,or credit which may be applicable.In addition,Client understands that applicable local or state law. Client shall be solely responsible for the verification of the cost of the illustrative component parts enumerated above may change from time to payroll information, including but not limited to verifying that wages, minimum wage, time by the applicable state or federal government,or benefit provider,the Service Fee overtime, prevailing wage rate, piece rate, commissions, and bonuses have been may be increased at any time by SPLI using reasonable business judgment following,or correctly calculated and exempt and non-exempt status has been correctly determined. in anticipation of,such increases. In addition, Client shall be solely responsible for any and all liability to any Leased Employee with regard to all aspects of Clients payroll,whether or not such payroll has B. Client shall pay the entire Service Fee upon delivery of the invoice to Client.Payment been paid through SPLI,including but not limited to wages,minimum wage,overtime, shall be made by either cashier's check or bank wire transfer.If payment is refused by prevailing wage rate, piece rate, commissions, and bonus obligations to Leased Client's bank for any reason,Client agrees to pay any bank or other service charges Employees. Client shall review all payrolls and payroll information provided to Client by imposed upon SPLI by any third-party. To the extent allowed by law,if Client fails to SPLI to ensure that all data and paychecks are accurate and that no incorrect or make payment as provided herein,Client assumes full liability and responsibility for any fraudulent information has been supplied to SPLI. Client acknowledges and agrees that wages,taxes, insurances and employment matters arising subsequent to the last pay any failure on its part to timely review the documentation and paychecks provided by period concerning which Client paid according to these terms. SPLI prior to the time that paychecks are disseminated to Leased Employees shall be an absolute bar to any claim for damages against SPLI.Unless otherwise provided to Client C. If payment is not made when due, Client shall pay SPLI, in addition to all other by SPLI in writing,within forty-eight(48)hours prior to the Clients payday,Client shall amounts due,a three percent(3%)charge on the delinquent amount In addition,Client provide to SPLI via facsimile transmission, email or via SPLIs Internet connection, a shall pay one and one-half percent(1%%)of the delinquent amount(or such maximum report of the total hours worked by Leased Employees. Client warrants that the lesser interest amount if set by applicable law at a lower amount)for each thirty(30)day information reported to SPLI is correct and accurate. Without regard to the fault or period that the unpaid balance remains outstanding,but in no event shall the amount negligence of any party, Client indemnifies, holds harmless, protects and defends all exceed the lawful rate of interest. SPLI Indemnified Parties(as hereafter defined)from any claims and liabilities that may arise as a result of the improper reportiiiy of au Ii iufounaliun by Client to SPLI.Client D. SPLI retains the right to modify the payment terms as SPLI deems reasonable, shall be solely responsible for incorrect,improper or fraudulent records of hours worked, including the right to require, among other things, payment prior to the provision of for improper classification of Leased Employees,for all child labor violations,and for any services based on the invoice for the previous pay period.AU payments will be applied to fraudulent,improper,or illegal activity engaged in by any Leased Employee,Client shall the most recent invoice issued to Client SPLI retains the right to apply any overpayment be responsible for any checks that have been requested by Client and which have been to the subsequent invoice issued to Client. issued by SPLI to any Leased Employee,including any checks that have been cashed by a holder in due course,whether or not a stop payment request has been filed. E. Client agrees to pay for any compensation corned but not paid to or for Leased Employees prior to, during, upon termination or expiration, and subsequent to their D. Client agrees it will be solely responsible for damages of any nature arising out of employment with SPLI,including,but not limited to,premiums or contributions payable Client's failure to report to SPLI the payment to an employee of any remuneration for for Leased Employee benefit plans through the end of the month in which the Leased services rendered for Client In addition,SPLI shall not be considered to be an employer Employee was terminated,unused paid time off,vacation and sick leave,and expense of any individual for whom required payroll information is not supplied during any payroll reimbursement. period(except as may be required by taw). Cliont aooumce full rcaponsibility for workers' compensation claims,benefit claims(including but not limited to health insurance claims V. OBLIGATIONS AND DUTIES OF CLIENT and pension claims),tax obligations,employment discrimination claims,general liability A. To the extent allowed by applicable law,Client shall retain sufficient direction and claims,third-party claims,and any and all other obligations or claims pertaining in any • control over the workplace and over Leased Employees as is necessary to supervise all way to any individual for whom payroll information is not supplied during any payroll day-to-day work activities of Leased Employees. In addition, Client shall retain such period(except as may be required by law),or who is paid in whole or in part by Client,as sufficient direction and control over Loaned Employooa and over the‘a rkptae as io a non Leased kmployao, uuboentraotor, volunteer, independent e ItLa Eu, vi it, diy necessary to conduct Clients business and without which Client would be unable to other capacity.SPLI shall have no obligation to provide workers'compensation insurance conduct its business,discharge any fiduciary responsibility that it may have,or comply for subcontractors and for employees of subcontractors engaged or hired by Client. with any applicable licensure,regulatory,or statutory requirement of Client or any Leased Client shall not, directly or indirectly, engage or hire any independent contractor or Employee. Such authority maintained by Client shall include the right to accept or cancel subcontractor that does not have workers' compensation insurance coverage with the assignment of any Leased Employee. Client will be responsible for verifying skills respect to itself and its employees. Client shall obtain a certificate evidencing workers' and qualifications for employment If a license or registration is necessary for the compensation insurance coverage with respect to any independent contractor, performance of Client's work,Client shall verify the existence,maintenance and validity subcontractor,and the employees of any such independent contractor or subcontractor of such license or registration for itself and all Leased Employees. engaged or hired by Client it is the intent of the parties that in no event will any independent contractor,subcontractor,volunteer,non-Leased Employee,or any of the B.To the extent allowed by applicable law, Client shall be responsible for directing, aforementioned individuals be covered by SPLI's workers'compensation policy or be supervising,training,and controlling the work of Leased Employees with respect to the considered a Leased Employee of SPLI. Client shall at all times maintain a workers' business activities of Client. Client shall make any and all strategic,operational,and all compensation policy encompassing all of its employees who are not Leased Employees other business-related decisions regarding Clients business. Such decisions and related pursuant to this Agreement outcomes shall exclusively be the responsibility of Client and SPLi shall bear no responsibility or liability for any actions or inactions by Client or by any Leased Employee. E. At its own expense,Client shall provide a suitable place of employment for all Leased Additionally,Client shall have sole and exclusive control over the day-to-day job duties of Employees, which shall comply with all applicable local, state and federal laws, all Leased Employees and SPLI shall have rip responsibilities with regard to t e,,a.SPti ordinances,and regulations related to Occupational health and safety the environment Employees' performance of such day-to-day ph rtntiec Furthermore, SPLI shall not equipment,machinery,and all other matters affecting Leased Employoo safety. Client have control over the job site at which,or from which,Leased Employees perform their agrees to provide all facilities,supplies,equipment,training and all other necessary items services. Control over the day-to-day job duties of Leased Employees and over the job that may be required by Leased Employees to perform the Leased Employee services. site at which, or from which, Leased Employees perform their services is solely and Client represents that its working environment, equipment, machinery, supplies and exclusively assigned to Client Client expressly absolves SPLI of control over the day-to- training for existing employees currently meet all local.state.and federal occrtpafinnel safety and health standards and that they will be maintained in compliance with such Page 2 of 7 Revision 02/28/2014 standards during the duration of this Agreement. Client is responsible for compliance with safe work practices and the use of protective equipment imposed by controlling L. Any tax imposed by any focal or state taxing authority based upon Clients relationship federal, state and local government as well as any required by SPLI's workers' with SPLI, such as a sales or use tax, or gross receipts tax, shall be the sole compensation carrier. Client shall comply with any and all safety requirements and responsibility of Client recommendations made by SPLI's workers'compensation carrier. M. Client shall appoint an authorized representative(s) who wll be responsible for F. Client shall provide,at its own expense,reasonable access and accommodations as reporting any and all information to SPLI or receiving Leased Employee information from required by the Americans with Disabilities Act,as amended(°ADA"),and any regulations SPLI. Client agrees that the authorized representative has full and complete authority to related thereto.In addition,Client shall comply with the guidelines and provisions of the report information to SPLI and that SPLI may rely on this information.Without regard to ADA in its determinations of individuals it desires to hire,promote,place at certain Client the fault or negligence of any party, Client indemnifies,holds harmless, protects and work location(s),or fire. defends all SPLI Indemnified Parties as hereafter defined from any claims and liabilities and with regard to any action taken by SPLI as a result of the information provided by or a Upon any request by SPLI or its assigns, Client shall allow an on-site physical to the authorized representative. examination of such books,records,documents and other information sources deemed appropriate by SPLI and/or its assigns to aid SPLI and its assigns in the determination of N. Client agrees to report any complaint,claim,accident,or other employment related proper workers' compensation classifications of Leased Employees, to aid in the issue raised by a Leased Employee to SPLI as soon as it becomes known to Client in determination of payroll amounts paid to such Leased Employees, to aid in the order for SPLI to evaluate whether it is encompassed by any SPLI maintained insurance. determination and evaluation of workers'compensation issues,and to verify compliance Client further agrees to abide by all local, state, and federal employment laws and with safety requirements during the Term of this Agreement. Client shall remain regulations. obligated to SPLI for any misclassification,delinquency and/or unpaid premium amount found in the examination. SPLI or its assigns shall have the right to audit the Clients 0. Client shall provide SPLI written statements of its polities regarding employee records and worksite for up to one year after the end of any policy period,even if this benefits.Such policies will comply with all federal,state and local governmental laws and Agreement has been terminated or has expired. Should Client fail to give access to SPLI regulations. Client will pay for any unpaid benefits due to Leased Employees upon or its assigns,the Client shall pay to SPLI liquidated damages in the amount of three commencement,termination,or expiration of this Agreement,including but not limited to times the most recent annual workers'compensation premium. unused vacation,severance pay,or continuing health and life insurance premiums until the end of the month during which this Agreement is terminated or expires or until the H. For employees hired prior to the Effective Date of this Agreement,Client warrants that end of the month in which the Leased Employee separates employment. SPLI assumes all Leased Employees are United States citizens or have provided proof of employment no liability or responsibility in its receipt of such statements of policies from Client. eligibility documents accepted by the USCIS or its predecessors at the time of said Leased Employee's hire. Any Leased Employee whose proof of employment eligibility P. All accidents or injuries involving Leased Employees shall be reported to SPLI documents(such as temporary work visas issued by USCIS,Bureau of Citizenship and immediately.Client agrees to cooperate with SPLI's workers'compensation carrier in the Immigration Service or Immigration and Naturalization Service)expire while said Leased inspection of work locations and too invoctigation of workplace accident and injuries. Employee is covered by this Agreement,must have their 1-9 form re-verified by Client Nothing in this Agreement shall relieve Client of any obligations imposed under safety- according to USCIS requirements.It is Clients sole responsibility to complete such re- related law. verification.Furthermore,Client warrants that all Leased Employees'names and social security numbers match and that all Leased Employees hired after the Effective Date of Q. Client maintains the right to request and purchase from SPLI,workers'compensation this Agreement are United States citizens or they have one of the documents currently loss experience data upon termination or expiration of this Agreement(if Client has no accepted by the USCIS as proof of employment eligibility, as shown on USCIS' invoice balance due SPLI,to the extent allowed by applicable law). Notwithstanding instructions for Form 19.Client agrooc to retain tho original of the Loosed Employoo I 0 anything to the contrary contained herein,such data shall be made available to Client in Forms and to deliver a copy to SPLI upon completion by the Leased Employee. Client accordance with applicable law. acknowledges and agrees that during the term of this Agreement, Client will be the sponsoring employer for purposes of petitioning or applying for immigration visas for the R. Client shall maintain workers'compensation insurance coverage for all employees of employment of an alien selected for hire as an employee and that Client shall have sole Client working for Client that are not covered by this Agreement. Furthermore,in states and exclusive for compliance with toe.requirements of law regarding the requiring came, Client agrees in maintain ceperste workers' r'empensation insurance employment of individuals working pursuant to a visa. Client understands and agrees covering Leased Employees. that It is Clients responsibility to obtain and maintain any necessary visas and to pay all associated costs. S. If any Leased Employee is required in the performance of their duties,to deal with confidential or proprietary information of Client, Client agrees to institute any control I. Any obligation placed upon an employer by applicable law to verify the eligibility of an procedures or confidentiality agreements deemed necessary by Client to ensure against individual for e..mpiovment through the Racir Fmpinyment Verifiratinn Pilot Prniaram ac rfic•lnci,rp of camp \Atthrert rnoarri to it' f.iwit or negligence of any party, Client jointly administered by the United States Department of Homeland Security and the indemnifies,holds harmless,protects and defends all SPLI Indemnified Parties from any Social Security Administration ("E-Verify") or any successor program, to the extent and all claims and liabilities which results from a disclosure of same whether during or allowed by law,is retained solely and exclusively by Client after the Term. J. If any Leased Employee is required to be licensed,registered or certified under any T. Client agrees that for any benefit plan maintained by Client prior to,during,or after the federal,state,or municipal law or regulation,or to act under the supervision of such a Term. Client is solely responsible for determining eligibility, participation, contribution licensed, registered or certified person or entity in performing the Leased Employee matters,administration of Section 125 Plan if applicable,and the proper administration of services,then any such Leased Employee shall be deemed to be an employee of Client COBRA,and that SPLI has no responsibility for such benefits.Without regard to the fault for such purposes but shall remain a Leased Employee of SPLI for unemployment or negligence of any party,Client indemnifies,holds harmless,protects and defends all purposes as allowed by taw (SPLI may report Leased Employees under Clients SPLI Indemnified Parties for any and all claims and liabilities or consequences arising out unemployment rate where allowed or mandated by law)and for workers'compensation of the maintenance of such benefits. purposes(where SPLI is supplying workers'compensation coverage). Client shall also be solely responsible for verifying such licensure, registration, or certification and/or VI. WORKERS'COMPENSATION AND SAFETY PRACTICES providing such required supervision. A.Client's workplace must continue to comply with all regulatory aspects of doing business which applied to Client prior to the Effective Date of this Agreement. K. SPLI does not assume any responsibility for and makes no assurances,warranties, or guarantees as to the ability or competence of any Leased Employee. This Agreement R. In relatign to the provision of workers'romp ncafinn honptfc by.Pei r rter,r chair in no way alters any responsiollIues at Client to perform any and vi work history. reference checks and background checks on Leased Employees. Additionally,Client 1. Cooperate with SPLI in the maintenance of a drug-free workplace by requiring assumes full and complete responsibility for the consequences of performing or failing to mandatory,immediate post-accident drug testing; perform,initially and on an on-going basis, such work history, reference checks and background checks on Leased Employees,including,but not limited to,driving record auk!accldeul recuid baukgiuund checks on Leased Employees. Page 3 of 7 Revision 02128/2014 2, Cooperate with SPLI in conducting preemployment background investigations,as providing for not less than 30 days'prior written notice to SPLI of cancellation of or any permitted by law,for such job positions as may be determined by SPLI and its workers' changes to such coverage and identify SPLI as an additional insured. compensation carder to represent significant risk; 3. Cooperate in the investigation of any workplace complaint or injury with SPLI,or its C. If any Leased Employee performs any duties which requires the maintenance of a workers'compensation canter,and provide SPLI,or its workers'compensation carver, professional license and corresponding professional liability insurance,Client agrees to the right to inspect and access,upon request,Client's premises,records,and employees keep in full force and effect during the Term professional liability insurance which shall in order to investigate the alleged violation of any handbook policy,safety concern,injury cover any act,errors or omissions,including but not limited to the negligent acts of the or other workplace incident; professional Leased Employee with a minimum limit of One Million Dollars($1,000,000). 4. Timely comply, at its sole expense,with any specific directives from SPLI, or its Not later than five business days after its execution and delivery of this Agreement,Client workers'compensation carder,regarding the safety of Leased Employees; shall cause its insurance carder to issue a certificate of insurance to SPLI verifying such 5. Notify SPLI before assigning any Leased Employee to work outside the state(s) coverage and providing for not less than 30 days' prior written notice to SPLI of identified in Addendums to this Agreement; cancellation of or any changes to such coverage and identify SPLI as an additional 6. If any Leased Employee is injured,immediately report the accident or injury to SPLI; insured. 7. Comply with SPLI's, or its workers' compensation carrier's, modified-duty requirements,including reinstatement of Leased Employees in a modified-duty capacity. D.With respect to any group health plan maintained by SPLI which provides coverage to If Client fails to accommodate any Leased Employee released for modified duty eligible Leased Employees, SPLI assumes responsibility for proper COBRA assignment,Client shall pay to SPLI at workers'compensation wages disbursed to such administration,subject to timely notification by Client of the occurrence of any"qualifying Leased Employee as should have been paid in the form of earned wages for performing event" For these purposes any group health plan shall be maintained by SPLI only if the modified-duty services. This provision shall survive the termination or expiration of this contact is between SPLI and the insurer. Client agrees to provide continuation of health Agreement. insurance coverage required by COBRA to any and all eligible participants in Client's current plan or upon termination or expiration of this Agreement,and indemnifies,holds C. SPLI retains the right to change the classification codes,where necessary,to comply harmless, protects and defends all SPLi Indemnified Parties from any daims and with the guidelines set forth by the National Council on Compensation Insurance or liabilities therefor. applicable state regulatory agency. Client agrees to provide prior written notice to SPLI before the addition of any workers'compensation classification. if Client understates or E. All insurance policies maintained by Client shall provide coverage which will be conceals payroll,or misrepresents or conceals information pertinent to the computation primary in the event of any claim. All insurance policies shall waive Clients subrogation and application of an experience rating modification factor, the Client shall pay, as rights in favor of SPLI. Clients obligation under this Section VII shall survive termination liquidated damages, 10 times the amount of the difference in premium paid and the or expiration of this Agreement amount the Client should have paid plus reasonable attomey's fees. This entire provision may be enforced in the courts of the State of Florida. F. Neither the Client nor employees of the Client are covered by any part of SPLI's Workers Compensation and Employers Liability Insurance Policy. Neither SPLI nor any D. Cliont undorctandc that SPLI exproecly prohibits any of its Leased Employees from of its insurance carriers have any duty to defend the Client or the omployeoc of tho Client working outside the state(s) identified in Addendums to this Agreement If a Leased in any action whatsoever without exception. Employee is directed to work outside the state(s) identified in Addendums to this Agreement,that Leased Employee will be considered immediately terminated from SPLI. VIII. CLIENT REPRESENTATIONS Termination will be effective upon commencement of the trip outside of the state(s) A. Client is a sole proprietorship or a corporation, partnership, limited partnership or identified in Addendums to this Agreement. If the employee is injured while outside of limited liability company in good standing,and the undersigned officer or representative the state(s)identified in Addendums to this Agreement or on a trip outside the state(s) is duly authorized to enter into this Agreement identified in Addendums to this Agreement he or she will be considered the employee of the Client and it will be the responsibility of the Client to provide workers'compensation B. Client has fully disclosed to SPLI, all investigations, lawsuits, claims, labor coverage and benefits to the injured worker. proceedings,employment related claims or other adversary proceedings involving Client E. Client understands that SPLI will never be considered the employer of an individual, C. Client warrants that in regard to any individual employed by Client prior to the fnr any purpnae, inrhiriing wrirkPrc' enmp?ncafinn rrwwragP, when Client hays alit Cffective Date,all wages and benefits for such individual are current and have been paid, individual any compensation whatsoever that is not paid through SPLI,including but not and there is no liability for same,including any benefit for retirees. limited to tips, cash, barter, trade, side job(s) or bonuses. The Client or another entity/individual,other than SPLI,will be exclusively liable and responsible for all workers' D. Client warrants that there are no claims or threatened claims or charges pending by compensation claims for any individual that is not considered an employee of SPLI. any employee claiming that Client engaged in any work practices which were in violation of any employment related law including,but not limited to,The VII of the Civil Rights Act F if the Client pays any employee of the Client nr any employee rlf SPl I any money fnr tf 1004 es amended,the ADA,the f amid,t;',J McJii,al Le.ave Awl("`Flv1LA`),the NeOunal services rendered during any period that this contract is in effect,the Client must have its Labor Relations Act("NLRA")and any federal or state discrimination laws. own workers'compensation coverage to cover any such employees as those employees will be considered the employees of the Client and not Leased Employees of SPLI. E. Client has disclosed all employment related agreements pertaining to Leased Employees in effect as of the Effective Date including, but not limited to, collective VII. INSURANCES bargaining agreements and any employment agreements. A. if any Leased Employee is required to drive a vehicle of any kind for Client,Client will provide liability insurance which will insure against public liability for bodily injury,death F. Client warrants that workers'compensation classification codes provided to SPLI are and property damage with a minimum combined single limit of One Millen Dollars correct and that Client will utilize Leased Employees only in a manner consistent with ($1,000,000)and uninsured motorist insurance with a minimum combined single limit of those codes.Client will notify SPLI in writing if Leased Employees'job duties change. One Million Dollars($1,000,000).Not later than five business days after its execution and Failure to notify SPLI of Leased Employees' job duties may result in a workers' delivery of this Agreement,Client shall cause its insurance carder to issue a certificate of compensation rate adjustment and/or termination of this Agreement. Client will be insurance to SPLI verifying such coverage and providing for not less than 30 days'prior responsible for paying any adjustments. written notice to SPLI of cancellation of or any changes to such coverage and identify SPLI as an additional insured. G. Client warrants that it is not a federal, state or local government contractor or subcontractor and that none of the Leased Employees perform work on government B. Client agrees to keep in full force and effect at all times during the Term of this contracts,except as previously disclosed in writing to SPLI. Client agrees to provide 9greement a rnmprehenaive general liehilityi rood hence pnliry in the minimum limit of One written nntire trr SPI I print In enterin0 into any govemment rnntranf Million Dollars($1,000,000)insuring Client against bodily injury and property damage caused by Client's premises-operations or completed operations. Not later than five H. Without regard to the fault or negligence of any party, Client expressly agrees to business days after the execution and delivery of this Agreement Client shall cause its indemnify,hold harmless,protect and defend all SPLI Indemnified Parties from any and insurance carder to issue a certificate of insurance to SPLI verifying such coverage and all claims and liabilities which may arise as a result of acts which occurred prior to the inception of this Agreement Page 4 of 7 Revision 02/2812014 B. All indemnifications are and shall be deemed to be contractual in nature and shall I. Client represents that it has met any and all prior premium and fee obligations with survive the termination or expiration of this Agreement regard to workers'compensation premiums and employee leasing/professional employer organization payments,to all prior employee leasing/professional employer organizations XI,TERMiNATION and workers'compensation carriers,with which Client has previously had a contractual A. If for any reason payment is not made when due,Client agrees that SPLI will have relationship. the right to immediately and retroactively terminate this, its performance hereunder, withhold its employees'services,and/or bring suit seeking damages against The Client. IX. EMPLOYMENT PRACTICES Upon termination or expiration of this Agreement for any reason,or should Client fail to A. Client agrees it is responsible for compliance with all applicable federal,state and pay SPLI for its services when due,all Leased Employees shall be deemed to have been local employment-related laws induding,but not limited to,all laws administered by the immediately laid off by SPLI and immediate notification of this shall be provided by Client U.S.Equal Employment Opportunity Commission,Title VII of the Civil Rights Act of 1964, to Leased Employees who have been leased/assigned pursuant to this Agreement as amended,the Americans with Disabilities Act,as amended("ADA'),the Family and Client will immediately assume all federal,state and local obligations of an employer to Medical Leave Act (FMLA), the Equal Pay Act ("EPA"), the Uniformed Services the employees,which are not in conflict with state or federal law,and will immediately Employment and Reemployment Rights Act(USERRA"},the National Labor Relations assume full responsibility for providing workers' compensation coverage. SPLI will Act, as amended(`NLRA"), the Fair Labor Standards Act("FLSA'),the Occupational immediately be released from such obligations as permitted by law. if for any reason Safety and Health Act ("OSHA"), all environmental protection laws, the Worker (whether or not required by applicable law) SPLI makes any payment to any of the Adjustment and Retraining Notification Act(WARN"),Health Care Reform(as hereafter employees after this Agreement has been terminated or after it has expired,SPLI will be defined)and all local,federal,and state discrimination laws,including,but not limited to, entifted to full reimbursement from Client for such expenditures. those related to child labor laws,discrimination based on race,sex,disability,color,age, genetic information,national origin, religion, and union status, as well as those laws B. SPLI may also immediately and retroactively terminate this Agreement if,at any time, governing harassment of any nature, sexual harassment, and/or discrimination. In SPLI in its sole discretion determines that a material adverse change has occurred in the addition,Client agrees to comply with applicable law in returning Leased Employees to financial condition of Client,or that Client is unable to pay its debts as they become due work upon completion of any approved leave, including FMLA leave, and make in the ordinary course of business. SPLI may also immediately and retroactively reasonable accommodations under applicable disability laws. terminate this agreement in the event of any federal,state,or local legislation,regulatory action, or judicial derision which, in the sole discretion of SPLI, adversely affects its B. With respect to the premises accommodation provisions of the ADA,Client agrees interest under this Agreement In addition,this Agreement may be immediately and that such responsibilities are solely the responsibility of Client and Client agrees,without retroactively terminated by SPLI where SPLI in its sole discretion determines the workers' regard to the fault or negligence of any party,to indemnify,hold harmless,protect and compensation risk is unacceptable.Any termination or expiration shall not relieve Client defend all SPLI indemnified Parties from any and all claims and liabilities as a result of of any obligations set forth herein,including but not limited to its payment obligations to Clients failure to abide by same. SPLI. C. SPLi and Client are each individually responsible tor determining whether such Party C. Client's failure to report payroll to SPLI for one or more payroll periods shall result in is a'covered entity"pursuant to HIPAA. if SPU or Client determines that it is a'covered retroactive termination of this Agreement and cancellation of workers' compensation entity'under HIPAA,such Party is responsible for complying with the HIPAA privacy coverage dating back to the last day that payroll was reported except as otherwise rules in respect of Leased Employee's protected health information. If SPLI is provided by law. Client must notify employees of the retroactive termination of this determined to be a`covered entity"pursuant to HIPAA or is required to sign or obtain a contract immediately. business associate agreement with Client,Client agrees to cooperate in complying with same. XiI. HFAI TH CARP RFFARM A. Any and all penalties and liabilities assessed or incurred by any SPLi Indemnified X. INDEMNIFICATIONS Party as a result of a violation of the provisions of the Patient Protection and Affordable A. Without regard to the fault or negligence of any party,Client hereby unconditionally Care Act of 2010,the Health Care and Education Reconciliation Act of 2010,as well as indemnifies,holds harmless,protects and defends and unconditionally releases,acquits, any guidance and regulation issued thereunder(such laws,guidance and regulations are remises, waives and forever discharges, and to the fullest extent allowed by law collectively referred to as'Health Care Reform')with respect to the 1 eased Fmpiny'ea covenants not to sue SPLI,and all subsidiary,affiliate,related,and parent companies, are the sole responsibility of Client except as is set forth in Section XII. B. their current and former respective shareholders,attorneys, officers,directors, agents Notwithstanding and iii addition to any other indemnification provision contained in this and representatives(all indemnified parties referred to as'SPLI indemnified Parties") Agreement, without regard to the fault or negligence of any party, Client hereby from and against any and all claims,demands,damages(including Liquidated,punitive unconditionally indemnifies,holds harmless,protects and defends all SPLI Indemnified and compensatory),injuries,deaths,actions and causes of actions,costs and expenses Parties and unconditionally releases,acquits,remises,waives and forever discharges (including attorney's fees and expenses at all levels of proceedings),lessee and liebjlities (and to the fullest extent allowed by law covenants not to w ie) all SPI I tnrsemnieee of whatever nature(including liability to third parties),and all other consequences of any Parties from and against any and all penalties and liabilities assessed against any SPLI sort,whether known or unknown,without limit and without regard to the cause or causes Indemnified Party,incurred by any SPLI Indemnified Party,or due as a result of an actual thereof or the negligence(whether active or passive)of SPLI or any SPLI indemnified or alleged Health Care Reform violation,including,but not limited to,any penalty and/or Party that may be asserted or brought against any SPLI Indemnified Party which is in any liability resulting from a violation of the nondiscrimination requirements and/or the way related to this Agreement,the products or services provided by Client or by SPLI, employer mandate requirements regarding the provision of affordable minimum essential the actions of any Leased Employee,the actions of any employee of Client or of any coverage related to Client's Leased and non-Leased Employees and their dependents. other individual,any act by or against any individual who is acting outside the capacity of Furthermore,in the event that penalties are assessed or liabilities are incurred by any an employee or Leased Employee at the time the matter arises, including without SPLI Indemnified Party in any situation where:(i)any SPU Indemnified Party acts(or limitation, any violation of any local, state and/or federal law, regulation, ordinance, does not act)with respect to Leased Employees in the absence of any written directions directive or rule whatsoever,and all employment-related matters which shall include but from Client;(ii)as a result of incorrect information provided to SPLI by Client;or(iii)the not be limited to all matters arising under local,state and/or federal right-to-know laws, failure of Client to provide required information, which in turn was included or not environmental laws, immigration laws (including 1-9 obligations), all laws within the included on reports or returns provided and/or generated by SPU, including, but not jurisdiction of the NLRB,OSHA,U.S.Department of Labor,and EEOC,including Title VII limited to Form W-2,Client agrees to indemnify,hold harmless,protect and defend all of the Civil Rights Act of 1964,as amended,the ADA(including without limitation those SPLI Indemnified Parties. The provisions of this Paragraph shall not apply in the event aspects relating to employment public access and public accommodation),the WARN that any penalty imposed by Health Care Reform is assessed against any SPLI Act,ERISA,all laws governing wages and hours(including without limitation:prevailing Indemnified Party as a direct result of SPLI's actions(or inactions)that are contrary to the wage rate; exempt and non-exempt status;child labor;family and medical leave;and lawful and timely written directions received by SPU from Client regarding Health Care minimum wage end Gee „ouit_,a),all lows I rsiut.uiem ui uny Rufuuu. nature, sexual narassment, retaliation, religion, national origin, color, age, genetic information,veteran status,disability,union status,marital status,and all other types of B. In the event Client offers its own health benefits to Leased Employees,Client shall, discrimination prohibited by applicable law,all laws governing disclosed and undisclosed with or without the assistance of SPLI,be the sole plan sponsor and administrator of benefit plans,and all other labor laws. such plan(s). In any case, Client understnds and agrees that Client is solely leseeeslLle he establishing and monrconng: (1) true plan under Client's own tax Page 5 of 7 Revision 02/2812014 identification number; (ii) employee notices, Form 5500, plan updates, plan testing, proceedings. The Parties agree that this provision shall survive the termination or HIPAA compliance, COBRA compliance, compliance with Health Care Reform and expiration of this Agreement ERISA responsibilities;and(iii)the correct identification and representation of the plan in any correspondence, communication, or statement issued by Client or by any J. With respect to any dispute concerning the meaning of this Agreement, this representative of Client Client may,in SPLI's sole discretion,be allowed by SPU to Agreement shall be interpreted as a whole with reference to its relevant provisions and in adopt SPLI's multiple employer Section 125 plan in order to allow the Leased Employees' accordance with its fair meaning, and no part of this Agreement shall be construed Contributions,if any,to be deducted on a pre-tax basis,as allowed by applicable law. If against SPU on the basis that SPLI drafted it This Agreement shall be viewed as if Client requests assistance from SPLI with the administration of such plan(s),then SPLI, prepared jointly by SPU and Client with written direction from Client, shall assist with plan administration, including bill reconciliation and claims processing. Client shall execute those additional agreements K. Client acknowledges and agrees that SPLI is not an insurance company or insurance necessary or required by SPLI to provide such assistance. In addition to the foregoing, carrier,and is not offering to sell insurance.As a result,no insurable risk is transferred to Client is solely responsible for any premium payments due under its own health benefits SPU as a result of the Parties entering into this Agreement plan and any COBRA continuation coverage plan. L. Any and all inventions,discoveries,improvements,copyrightable works and creations XIII. GENERAL PROVISIONS (hereafter referred to as'Intellectual Property)which Client has previously, solely or A. This Agreement shall be governed by the laws of Florida and both Parties agree that jointly,conceived or made or may conceive or make during the period of this Agreement, • the exclusive venue for any disputes arising from or in any way related to this Agreement whether or not accomplished through the use of Leased Employees,shall be the sole shall be in the federal or state courts located in Hillsborough County,Florida and boar and exclusive property of Client Client shall have sole and exclusive responsibility for protecting its rights to such Intellectual Property and to all of its other assets and SPLI Parties consent to personal jurisdiction over by such courts. shall have no responsibility with regard to same. B. Client cannot assign this Agreement without the written consent of SPLI. Its M. Client acknowledges and agrees that it has not been induced to enter into this expressly understood and agreed between the Parties that this Agreement may be Agreement by any representation or warranty not set forth in this Agreement including assigned by SPU at its sole discretion. but not limited to any statement made by any marketing y y g agent of SPLI. Client C. Should any term,condition or provision of this Agreement be held to be invalid or acknowledges and agrees that SPLI has made no representation concerning whether unenforceable by a court of competent jurisdiction, the remaining terms, conditions, SPLI's services will improve the performance of Clients business. Client acknowledges and/or provisions of this Agreement shall remain in force and shall stand as if the and agrees that any decisions made relative to cancellation or termination of any unenforceable part did not exist insurance policies in effect prior to the Effective Date of this Agreement are the sole responsibility of Client D. Whenever notices are required to be sent to either party,the notices shall be sent to N. Client acknowledges and agrees that SPLI shall not be liable for any Client loss of the following addresses: business,goodwill,profits,or other damages, South East Personnel Leasing,Inc. O. Client specifically authorizes SPLI to conduct a credit and background reference 2739 U.S.Hwy.19 North check on Client and such officers of Client as SPLI deems appropriate in compliance with Holiday,FL 34691 the requirements of law. Attn:Legal Department Client: Florida lB&S,LLC P. This Agreement constitutes the entire agreement between the parties with regard to this subject matter and no other agreement statement,promise or practice between the E. The failure of any Party to enforce at any time the provisions of this Agreement shall parties relating to the subject matter shall be binding on the parties. This Agreement may be not be construed as a waiver of any provision or of the right of such party thereafter to changed only by a written amendment signed by both parties,with the exception of enforce each and every provision of this Agreement any change to this Agreement sent by SPLI to Client in writing,in a manner in which proof of delivery can be established and which shall be deemed to have amended this F. The headings of mill Agreement are inserted solely for the convenience of reference. Agreement arid have bee+auxpted by Client K not objected to in writing by Client. They shall in no way define,limit,extend or aid in the construction,extent or intent of this Notice of such objection must he received f Iry SPLI within fourteen(14)days of Clients Agreement receipt of SPLI's notification of change(proof of SPLI's receipt of objection must be supplied by Client upon request of SPLI). G. The Parties acknowledge and agree that this Agreement creates no rights for or in Q. The failure by either party at any time to require strict performance by the other party favor of any person or third party not a party to this Agreement and that no such person or to claim a brooch of any i.ruA i;„+ rib Aeree++ie+d will uui be umsuueo as a waiver ti ey plct,e airy+cflaui,e Ge+euu. of any subsequent breach nor affect the effectiveness of this Agreement,or any part H. Client acknowledges and agrees that it is solely responsible for obtaining thereof,or prejudice either party as regards to any subsequent action. independent legal advice regarding this Agreement,the relationship created hereby,as It Any false statement or omission with regard to any information supplied by Client to well as the related tax and employment law and other ramifications transact ng SPLI in anticipation of Clients contracting with SPLI or at any other time shall be deemed business with an employee leasing company. Client acknowledges and agrees that SPLI a material breach of this Agreement and SPLI, at its option, may terminate this is not engaged in the practice of law or the provision of legal,financial,tax,or investment advice or services,and that Client alone is completely and independently responsible for Agreement and seek appropriate relief its own legal rights and obligations,regardless of any human resource advice which may be supplied to Client Client at all times retains the right to seek appropriate advice from S. Client represents that there is no existing employee who is subject to collective professionals of its own choosing,including,but not limited to attorneys and accountants bargaining or who is subject to any collective bargaining agreement at any Client and Client is advised and encouraged to supplement any consulting service provided by worksite. This Agreement shall have no effect on any collective bargaining agreement SPLI with advice of its own attorney. between Client and any union which arises during the term of this Agreement Any responsibility and/or liability with regard to any union contract, union representation I. If an employee or a government agency or entity files any type of claim,lawsuit or petition, union drive, unfair labor practice charge,and with regard to any employment charge against SPLI,Client or both,alleging a violation(s)of any law or failure to do contract between Client and any Leased Employee shall be the exclusive responsibility something which was otherwise required by law,Client and SPLI shall each cooperate and/or liability of Client SPLI shall not be a party to any such contract SPLI will have no h the^than defence of such claim, lawnuit nr nhnrgo_ Of Ll ar'n1 Oli +d gill n+nFe respnnsihility nr liability in rr rr 'an with nr ericing out of any ninth nmpleyneee available to each die; upon request any and all documents that either Party has in its contact,except to prepare checks and lu pay wry such Leased Employee who is a party possession which relate to any such claim,lawsuit or charge. However,neither Party to such a contract, in conformity with information provided by Client and in conformity shall have the duty to cooperate with the other if the dispute is between the Parties with this Agreement With respect to any employment contract between Client and any themselves,nor shall this provision preclude the raising of cross claims,counter claims, Leased Employee,and with regard to any union contract,Client shall be acting solely on or third party claims hetwpen r:lipnt and CPI i if the circumstances junch, ouch own volition and rPSpnnsihitity with toner t to alt a�rg is of any such contract, including but not limited to its negotiation, compliance, implementation, renewal, Page 6 of 7 Revision 02/28/2014 enforcement,and termination. The Parties agree that SPLI is not and will not become a paying entity or contributing employer within the meaning of the Multi-Employer Pension Plan Amendment Act and does not and will not have any withdrawal liability under this Act or any comparable law. Under the penalties of perjury,I declare I have read the foregoing document and the facts stated therein are true. I have the authority as a director,officer,and/or owner to bind the applicable party to this agreement AGREED TO: AGREED r,&S,LLC SPLI CLIENT NAM AME! �� 4,7 l Signature Date 3-DV-I ``f Signature Date Typed/Printed Name Luis Escobar Typed/Printed Name Title of SPLI representative MGRM 2739 U.S.Highway 19 North,Holiday,FL 34691 Title 3395 Sandpiper Way Address 988 E216-526-71-025-0 Social Security Number Driver's License Number GUARANTY: Guarantor,whose signature appears below,acknowledges that Guarantor is a direct beneficiary of the above-signed Client Leasing Agreement between SPLI and Client and understands that SPLI is unwilling to enter into or continue the Leasing Agreement without this guaranty being signed. The Guarantor is desirous of ensuring the fulfillment of all obligations of Client. Accordingly: A. Guarantor agrees that in the event Client has riot fully complied with all of its obligations under the Leasing Agreement,including indemnification,Guarantor will,upon demand by SPLI,pay to SPLI all payments not made by Client and will perform all unfulfilled obligations of Client. B. This Guaranty is an absolute and unconditional guarantee of payment and performance. It shall be enforceable against Guarantor without the necessity of:(a)any suit or proceeding on SPLI's part against Client,its successors or assigns;(b)any notice of amendment,modification,supplementation,performance or nonperformance of or under the Leasing Agreement; or(c)any other notice or demand to which Guarantor might be entitled,all of which Guarantor hereby expressly waives. Guarantor expressly agrees that the validity of this Guaranty and Guarantor's obligations hereunder shall not be affected or diminished by any inaction of SPLI,under the Leasing Agreement,or by(i)the release or discharge of Client in any creditors' proceedings,receivership or bankrupt • ')the limitation or modification of the liability of Client,or any remedy for the enforcement of Client's liability under the Leasing Agreement roauiting from the op o of an +ovisioo of Tito 11, U.S.C., or any other statute or any court decision;(m)any modification of the Leasing Agreement or(iv)the rejection or disaffirmance ofth: x ' •Agr:-••:- . -•y proceedings. � s Guarantor. I/ ! Lv c Escok6a t rAd; 1 3.De/.-I tf' •ig _,re Typed/Printed Noma Title Uate Page 7 of 7 Revision 02128/2014 SOUTH EAST PERSONNEL LEASING, INC. ` CLIENT LEASING AGREEMENT n�£'i STATE ADDENDUM SOUTHEAST FLORIDA PERSONNEL LEASING. INC. L This State Addendum to the South East Personnel Leasing, Inc. ("SPLI") Client coverage and the management of workers' compensation claims, claims filings, and Leasing Agreement is applicable to Florida Leased Employees (-Addendum') and related procedures. modifies the Client Leasing Agreement entered into between Florida[B&B,LLC III. SPLI shall provide written notice of the relationship between SPLI and Client to (°Client] and SPLI dated Mar 24,14 rAgreemenr). In the event of any conflict Leased Employees. between the Agreement and this Addendum, this Addendum shall control for Florida Leased Employees and all other terms of the Agreement still apply.If,at any time,state IV. Pursuant to Fla.Admin.Code R.61G7-12.001,Client shall permit SPLI or its assigns law changes establishing requirements different from the terms contained in this to conduct an annual onsite physical examination of the Client to confirm proper workers' Addendum,Client and SPLI agree to apply the terms in affect according to state law. compensation classification of Leased Employees and to aid in the determination of R. in accordance with§468.525,Fla.Stat.,SPLI: payroll amounts paid to Leased Employees. A. Reserves a right of direction and control over Leased Employees. However,the Client retains such sufficient direction and control as is necessary to conduct the Client's V. Client shall be responsible for the day-to-day supervision and control of Leased business, discharge any fiduciary responsibilities, and/or comply with any applicable Employees with respect to products or services offered by Client and SPLI shall have no licensure,regulatory,or statutory requirements; responsibility with regard to Leased Employee's performance of day-to-day job duties. Client expressly absolves SPLI of control over the day-to-day job duties of Leased B. Assumes responsibility Employees and over the job site at which,or from which, Leased Employees perform ty for the payment of Leased Employee wages without regard to payment by Client. "Wages" does not include any obligation between Client and a their services.This Agreement in no way alters any responsibilities of Client which arise Leased Employee for payments beyond or in addition to the Leased Employee's salary, from§768.096,Fla.Stat.,and Client assumes all responsibilities pursuant to§768.096, draw,or regular rate of pay,such as bonuses,commissions,severance pay,deferred Fla,Slat,including,without limitation,responsibility to perform any and all work history, compensation,profit sharing or vacation,sick or other paid time off pay,unless SPLI has reference checks and background checks in respect of the Leased Employees. Upon expressly agreed to assume liability for such payments in the Agreement. becoming known by Client Client shall immediately provide SPLI with written notice of the assertion of any and all claims, complaints, charges, allegations or incidents of tortious misconduct or workplace safety violations. C. Assumes full responsibility for the payment of payroll taxes and collection of taxes from payroll on I eased Employees: VI. Client understands that,pursuant to Florida law,it may not enter into an employee leasing relationship with SPLI if Client owes a current or prior employee leasing company D. Retains the authority to hire,terminate,discipline and reassign Leased Employees. any money pursuant to any service agreement which existed between that current or Client retains the right to accept or cancel the assignment of any Leased Employees; prior employee leasing company and Client or if Client owes a current or prior insurer any premium for workers' compensation insurance. Client hereby represents and E. Retains a right of direction and control over the management of safety, risk and warrants to SPLI that it has met and paid any and all prior premium obligations in relation hazard control at the work site including responsibility for performing safety inspections of to workers'compensation premiums or other insurance carriers and all fee payments to Client equipment and premises,responsibility for the promulgation and administration of any employee leasing company. employment and safety policies,and responsibility for providing workers'compensation Under penalties of perjury,I declare that I have read the foregoing Addendum and that the facts stated in Section 6 therein are true. AGREED TO: tta&S,L)K CLIEN I Signatu• Date Lois L_ vebar Typed/Printed Name I GNM Title AGREED TO: SPLI Signature Date Typed/Printed Name Title of SPLI representative Page 1 of 1 Revision 0211112014 If this application contains incomplete or inaccurate information, it may cause a delay in the issuance of your exemption. An officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under this chapter. Section 1: APPLICANT INFORMATION First&Last Name: LUIS F ESCOBAR Sr State Driver's License Number: State ID Number: State: FL E216526710250 Date of Birth: 1/25/1971 Social Security Number(last four digits): 7988 Email Address: anamile @industrialbuildingllc.com Section 2: CONSTRUCTION INDUSTRY APPLICANT($50 FEE REQUIRED) Officer of a Corporation (Construction) Corporate Title: OTHER Section 3: This section should be completed with information specific to your corporation or to the limited liability company in which you are a member. The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations. Name of Corporation or LLC: Florida IB&S,LLC FEIN• 46-456.2848 IF YOU NEED TO APPLY FOR A FEIN,CLICK HERE Business Name (DBA): Florida IB&S,LLC Phone: (239)860-1150 Applicant's Address of Record: 3395 SANDPIPER WAY City naples State: FL Zip 34109 County: Collier Click on the&rruw(S) 1)6Al LO leAl LoA(J) to view a lial of available Scope ulasslllcatlortsitrades for the form type cnosen In Section 2. Click on the appropriate scope to select. If you are unsure as to which classification/trade to choose, please contact your workers'compensation insurance carrier. If you do not have a workers'compensation insurance policy, contact the National Council on Compensation Insurance (NCCI) at 1-800-622-4123 option 5 to obtain a classification code. Scope 1: 05445 Scope 2: Scope 3: Scope 4: Wallboard,Sheetrock,Dr ywall,Plasterboard, 'Section 4: The corporation of which you are an officer or limited liability company of which you are a member must be registered and in ACTIVE status with the Florida Division of Corporations. Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with the Florida Division of Corporations. List the document number on file with the Florida Division of Corporations. L14000007213 Section 5: Pursuant to Chapter 489, F.S. (contractor licensing law), list certified or registered licenses related to the scope of business or trade listed in Section 3 held by the applicant, or the certified or registered license numbers held by the qualifier for the corporallurr or limited liability company listed on this application. I he business name listed on the license MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations and on this Notice of Election to be Exempt. No DBPR License Listed This section is not applicable to my business Section 6: If you have submitted an electronic payment for this application, the transaction confirmation number is listed in the following space: Confirmation Number: 197077833 Application Number: E00219262 Section 7: N/A Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which this application applies? Name: FEIN Name: FEIN Name: FEIN Section 8: CONSTRUCTION INDUSTRY AND NON-CONSTRUCTION INDUSTRY LLC MEMBERS ONLY To be eligible for a construction industry exemption or a non-construction limited liability company exemption, an applicant must have the required ownership of the corporation or limited liability company. I am a shareholder owning at least ten percent(10%) of stock of the corporation listed on this application. Section 9: I certify that any employees of the corporation or members of the limited liability company listed in Section 3 are covered by workers'compensation insurance. Please identify the workers' compensation insurance carrier that covers any non-exempt employees. Carrier Name: My business does not have any non-exempt employees Section 10: FRAUD NOTICE A. Any person who, knowingly and with intent to injure, defraud, or deceive the department or any employer or employee, insurance company or any other person, files a Notice of Election to be Exempt containing any false or misleading information is guilty of a felony of the third degree. B. Attestation of applicant—By providing my name below, I attest that I have read, understand and acknowledge the foregoing notice. C. Acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any affiliated corporations as provided in Section 440.02, Florida Statiitas First Name: LUIS Last Name: ESCOBAR Nult. Iiab 30 dap to review yuur application to determine it It meets the eligibility requirements for the issuance of an exemption. The Division will either issue a Certificate of Election to be Exempt or notify you that your application is incomplete. The Division reviews and processes exemption applications in the order they are received. Exemption information is reflected on the Proof of Coverage database the day following the issuance of the exemption. Visit the Division's website at http://www.myfioridacfo.com/wc to print your certificate. N . M ri O s- r-- O <Y r F- r) V V N N O cC ti• (/)g ' W N z J CO N< . 0 Q Zrd J V ' W W r....--..N 0 2Z6 = Qw a.0 m O < Q ;o ice or I- g W ce z O - W a o W C� ZLLI a W Z J W W' rn ' 0 ,O z O W O. �" a) E 0 0 o 5 d c1- O m� Z .5 _J co w u.0 - mI0 � CL O� >< < < Z to W COE ,t Li cgo op Ia- C0 � -J adN g0 c o (3a) a a= a I-- = w W co 4z Z Nr I-W 1-- a� x >8w •r3 CO g� o1 a cn w rW- u) '--.1 ° w =< w ❑ •'}yS..,4 v, .�..�,.wad, "�•( c f Z CO W N "4 tir ° 3 7 viii} W ', tip �„.. ¢ .+ w 0 •' } Z O D 0 J �.'� s■ 0 6 N I_ ir i.� •- N N O V CO w � i _I J ':T ./ g3 al �. - d' `14.}, .r�. L...1.. a) m <o cn ," 0 N , ; d y c c E 0 i,i' ° E 0 ° m N w 3 f On c W .w 0 E' x ° } 4' 0 OJ cc C m ° 0 a N a F co 0 < OZ r Z O O > C > o 0 o x ° a) W a _� . J N w N Cl Ct. e-- w a 0 c. O Qo 0 oo � nt r) 0 0 N W � aEi (") = d U LL Q Q C Q) X Z u) J 0 0 °) Q' ° O E w F" O W (n (q U COQ)-.03 0 0 D o z g 0 t N m 0 I- 1 ..,t ,„ ; Got Lier County Growth Management Division Planning & Regulation February 24, 2014 Escobar, Luis fernando 3395 Sandpiper Way Naples, FL 34109 Re: Citation No. 8587 This notice is to inform you that you have been found in violation, and are required to pay fine within 10 days of receipt of this letter. Our records indicate that we have not received payment for the citation you were issued on 02/07/14, in the amount of$1,000.00. in the event a first uncontested violation is the result of the violator engaging in the business or acting in the capacity of a contractor of advertising himself or herself or a business organization as available to engage in the business or act in the capacity of t-rastQ,r without being duly registered or certified, the penalty shall be abated from $1,000.00 $300.00 if tthe violator submits a completed application in accordance with Section 2.1 and 2.2 of th's9-r-di and within forty-five(45) days of the date of issuance of the Citation for the violation Failing to pay the fine with which you were cited may result in one or all of the following: Collection of amounts due under this citation are governed by Florida Statutes Section 489,127 and Collier County Ordinance 90-105, as amended Failure to pay this citation grants the power to Collier County to take certain collection actions. These actions include, but are not limited to: • Reporting of the delinquency to credit reporting agencies. • Referral of the matter to a collection agency. • Additional fines imposed by the Contractor's Licensing Roard. • Filing a lien on all of your personal and real property with the Clerk of Courts, which lien shall remain in place until paid and satisfied. • Foreclosure of the lien_tatake_possession.and._sale of the property subject to lien in order to ___-satisfyfh outstanding obligation. You can prevent these actions by mailing or delivering your check, cash, or money within ten (10) days of the date of this letter to: ----Ca ier County Contractor Licensing 2800 North Horseshoe Drive Naples, Florida 34104 MAKE ALL CHECKS PAYABLE TO BOCC CHECKS MADE PAYABLE TO OTHE AGENCIES CANNOT BE ACCEPTED If you have already mailed your payment, you can isregard this reminder, though we strongly r¢r-r+mmmanrf y'u call to confirm thnt your payment e47 't ivcd. if you l ruve ally questions_regaraing your citation, please contact us at(239),52- 3l `.' F T nk you, z Michae sorio Licensing Supervisor ; GROWTH MANAGEMENT DIVISION CITATION Pursuant to section 489.127.(3)(a).Florida Statutes,the undersigned hereby certifies that upon personal investigation,he/she has reasonable and probable grounds to believe that the person whose name appears below as issued to,did violate subsection 489.127.(1),Florida Statutes,and the Collier County Contractor's Licensing Ordinance No.2006-46(as may be amended)by committing the violation stated below. / Month r:nV', Dan Year; Time-' AM/PM Issued To ",L"> ;r. , „ / E, , . 1 Address `, City /iu�`i1'f 3 State 1- I Zip - Telgpphoqse N i. I.D. Date of Birth Race Sex Height I •�� -1't'; py ti,. ; r.(i r. -c Vehicle Make/Type(if applifable) ; Year Color Tag No. Location of Violation I)i -, OPTIONS I have been informed of We violation for which I have been charged and elect the following option(Check one) 1) ❑ I choose to pay the penalty of S , . 2) ❑ I choose not to pay the penalty,and will request in writing by certifif.d mail or hand - delivery an Administrative Hearing before the Contractor's Licensing Board. Description of Violation �d2.'-'7 I Date Violation Observed t i • a) ❑ Falsely hold self or busine`ss'organization out as a licensee,certificate holder or registrant; b) ❑ Falsely impersonate a certificate holder or registrant; c) ❑ Present as his/her own the certificate or registration of another; d) ❑ Knowingly give false or forged evidence to the Board or a member thereof; e) ❑ Use or attempt to use a certificate or registration which has been suspended or �,{'revoked; f)aa-t Engage in the business or act in the capacity of a contractor or advertise self or business organization as available to engage in the business or act in the capacity of a contractor without being duly registered or certified; g,) ❑ Operate a business organization engaged in contracting after(60)days; h) ❑ Commence or perform'work for which a building permit is required pursuant to an adopted state minimum building code or without such permit being in effect; i) ❑ Willfully or deliberately disregard or violate any Collier County ordinance relating to uncertified or unregistered contractors. A person or business organization operating on an inactive or suspended certificate. tit tcgisautiun,or operating beyond the scope of work or geographical scope of the regisuatio, ,,is not duly certifiedor registered. SIGNATURE(RECIPIENT) SIGNATURE(INVESTIGATOR) • PRINT(RECIPIENTS NAME) PRINT(INVESTIGATOR'S NAME) Pursuant to 489.127, Florida Statutes, willful refusal to sign and accept this citation constitutes a misdemeanor of the second degree, punishable as provided in section 775.082 or 775.083 Florida Statutes. (SEE REVERSE FOR INSTRUCTIONS) Case Information =•: 1 Neo; Case (current project) l l New Case (no project) 'TT Cas,-, Number 10EUL20140002629 Status Closed r--1 Case Type Unlicensed IN- L...._i Date &Time Entered 102/07/2014 08:27 AM . . - r—. Priority :Normal J..i i , Entered Sy Ian Jackson r;,1 ; Inspector Ian Jackson i-.i Department Contractors Licensing i 1---T Jurisdiction Contractor's Licensing l'•'l Property Valuation 1$0.00 —...2 r--1 Oriain Field Observation i 1 L__r . „ . .. Detailed Citation 8587 to Luis Fernando Escobar, unlicensed drywall advertisement ., Description ... . . Location advertisement Comments Show More Fields l I Hide or Clear Fields Alleged violation Date/Time 102/06/2014 12:00 AM — Complaint Date/Time 102/07/2014 08:27.AM -- r-----, Case Disposition Unpaid i r-T■ SpecialistInvestigation Not Required . , I--; Property Zone 1 Site Development I'' Contractor licensing Attributes A State Certified?_ State Registered' 7-1. Issuance Number [— Status Tracking 1 tati_is type i i Cate ErtereC I Ertered By Notes New . 01'07/2014 :Ian Jackson Preliminary.Review. t..„. i 01,'07/2014 Ian Jackson [Citation : hp,/07/7014 :Ian Jackson ClJ 0131;2014 Judiiii ..Sicrill,tig . ____i Show More Fields i i Hide or Clear Fields ( goirrt.-puty. Growth Marnzgernent Diviskul PhilininF, & Regulation Operations Department Licensing Section April 1, 2014 Luis Escobar Florida 1B & S 3395 Sandpiper Way Naples, FL 34109 RE: Review of Credit Report Dear Mr. Escobar, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, May 21, 2014. The meeting is held at 9:00am at the W. Harmon Turner Building (Bldg. F, Admin. Bldg.), 3299 Tamiami Trl. E., Naples, FL in the Commissioner's Meeting Room on the 3rd floor. If you have any questions or concerns, please call (239) 252-2431. cm Sincerely, ; r . t SO-ran ttia Roe mer Service Specialist Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 — --- Growth lvirsnagiensent DvorPN'nu &Reguiathan'2800 Not Horseshoe DrivewNaales.Florida 34.1.04'239-252-2400'www r,oiliergov net