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CLB Agenda 04/15/2015
CO 6Y County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA APRIL 15, 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: March 18, 2015 DATE: February 18, 2015 V. DISCUSSION VI. NEW BUSINESS: (A) Orders of the Board. (B) Matthew R. Rambo, Neapolitan Tree Service, Inc– Review of Credit (C) Manuel Orosa, Orosa Custom Renovations, Inc. – Review of Credit (D) Antonio A. Huerta, Arctic Condition Air, Inc. – Review of Experience (E) Matthew R. Nero, Naples Platinum Pool and Spa– Review of Experience (F) Robert Saviste, Saviste Inc. D/B/A All in One Painters and Cleaners—Waiver of Exam(s) VII. OLD BUSINESS: (A) Mikel G. Diehl, Florida Hardscapes & Paver Maintenance, Inc– 12 Month Review of Credit (B) Yanira I. Tejada, Paradise Landscaping Of Florida Inc–6 Month Review of Credit VIII. PUBLIC HEARINGS: (A) Case: 2015 -02 – Enrique Vasquez D/B/A: SW Florida Painting Corp. IX. REPORTS X. NEXT MEETING DATE WEDNESDAY, MAY 20, 2015 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 TAMIAMI TRAIL E. NAPLES, FL 34112 March 18,2015 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING March 18, 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 Vice Chair: Thomas Lykos Members: Michael Boyd Ronald Donino Terry Jerulle Richard Joslin Kyle Lantz Gary McNally Excused: Robert Meister ALSO PRESENT: Michael Ossorio — Supervisor, Contractors' Licensing Office Kevin Noe11, Esq. —Assistant County Attorney James F. Morey, Esq. — Attorney for the Contractors' Licensing Board Rob Ganguli — Collier County Licensing Compliance Officer 1 March 18, 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 said proceedings is made, which record includes the testimony and evidence upon which any Appeal is to be based. ROLL CALL: Chairman Patrick White called the meeting to order at 9:02 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 (8)voting members were present. Chairman White noted Robert Meister had been excused. II. AGENDA—ADDITIONS, DELETIONS, OR CHANGES: Changes: • Item #VIII, "Public Hearings,"will be heard following Item #V, "Discussion." III. APPROVAL OF AGENDA: Vice Chairman Thomas Lykos moved to approve the Agenda as amended. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. V. DISCUSSION: (None) VIII. PUBLIC HEARINGS: (Note: With reference to the cases heard under Section VIII, the individuals who testified were first sworn in by the Attorney for the Board.) A. Case #2015-01: Board of County Commissioners vs. Tracy Lee Cummings, d/b/a "Catch `Em All Contracting,Inc." Chairman White outlined the order of the proceedings: • The Public Hearing will be opened, witnesses will be sworn in, and evidence from the parties will be presented; • The County will present its "Opening Statement," followed by the Respondent's "Opening Statement;" • The County will present its "Case in Chief;" • The Respondent will present his/her Defense; • The County may offer any rebuttal; • The process is then concluded. • After closing the Public Hearing portion of the proceedings, the Board will receive instruction from its Attorney, similar to a"Charge to a Jury" in a civil trial, which sets out the parameters upon which the Board will base its decision. 2 March 18, 2015 • During deliberations, the Board members may ask for additional information and clarification from the parties. • The Board will decide two different issues: o Whether the Respondent is guilty of the offense(s) as charged in the Administrative Complaint. A vote will be taken on the matter. o If the Respondent is found guilty, the Board must decide the Sanctions to be imposed. • The Board's Attorney will advise the Board concerning the Sanctions that may be imposed and the factors to be considered. • The Board will discuss the Sanctions and vote. • The Chair will orally report the decision of the Board. Chairman White moved to open the Public Hearing. Vice Chairman Lykos offered a Second in support of the motion. Motion carried, 8—0. Rob Ganguli, Licensing Compliance Officer, requested to enter the County's case packet in Case #2015-01: Board of Collier County Commissioners vs. Tracy Lee Cummings, d/b/a "Catch `Em All Contracting, Inc." into evidence. Chairman White, noting there were no objections from the Board, approved entering the information packet into evidence as County's Exhibit "A." Rob Ganguli presented the County's combined"Opening Statement "and "Case in Chief" • Tracy Lee Cummings is the holder of State-issued License CGC 1522156 and Collier County License#201400001622 • Ms. Cummings is the also Qualifier of"Catch `Em All Contracting, Inc." • She is appearing before the Contractors' Licensing Board for having committed a willful Building Code violation. • The County is prepared to show evidence that "Catch `Em All Contracting, Inc." accepted and performed subcontracted work on the construction of new residential swimming pools located in the Olde Cypress community. • During the course of performing the subcontracted work, a willful Building Code violation was committed by employees of"Catch `Em All Contracting, Inc." and was discovered through the inspection process conducted by the Collier County Building Department. Chairman White asked the Respondent if she wished to present an "Opening Statement" but she declined. She did not have any questions or comments. Chairman White asked the Respondent to present her defense. Tracy Cummings stated: • It was an error and her employees made a bad judgment call or just didn't do their jobs properly. • She was made aware of the situation and accepted complete responsibility. 3 March 18,2015 • "It will not happen again—we have taken appropriate measures to see that this work—the equal potential bond grid—is installed properly at this point and from here out." • She indicated the employee who did not install the equal potential bond grid properly was no longer working for her company and the remaining members of the crew were "put on notice" that this type of work was not acceptable or reflective of what she wants her company to do. Greg Surniak, Collier County Electrical Inspector, was called to testify on behalf of the County. Richard Joslin questioned Inspector Surniak. Q. Mr. Surniak, you are a Certified Inspector for Collier County as far as reporting or doing inspecting for what phases? A. For the electrical phase. Q. How many electrical inspections are required for swimming pools in Collier County? A. There are approximately—I believe there are six. Q. Six. Out of those six, how many bonding wires are in each pool? How many blank wires would there be in each pool? A. Each shell requires a minimum of four bond wires today ... to the shell itself which connects to a bonding ring which goes around the pool. Q. Could there be more? A. Yes, absolutely. Q. Could it be that one of these wires was just a blank, dummy wire that someone stuck in the ground or maybe a piece that someone cut off? Because I build swimming pools also, and I know for a fact that when a pool is back-filled—lots of times—the wires will be buried or cut off, but generally there are more boundary wires that can be bonded to complete the consequential bonding that goes around a pool. A. I checked the ones that are bonded at the shell inspection. Q. As an Inspector, how do you check those? What is your procedure for checking them? A. For checking them—my procedure is ... on the equal potential or the shell? Q. On both ... either one. A. For the shell inspection, we make sure that the right connections are used on the steel, that they are sticking out ... and there are at least four of them—sometimes there are six, sometimes there are seven. Okay? But there are at least four—that's the minimum requirement. That inspection was done. It could have been a month prior. Q. Do you know for a fact that the inspection was done in the past? A. Yes. Q. It was done and completed? A. Yes. Q. So the bond wires were there? A. Yes. In fact, in the computer—I can't tell you who did that inspection ... it might have been me. We do many of them. But the computer indicates that the inspection was done because we review it before we go in. And I couldn't have done the four— the equal potential—without having that shell done—because the computer would show it as unresolved. 4 March 18,2015 Q. When you check the bonding for the steel shell, when it's raw ... when there's just steel showing ... where there's no concrete ... all those wires are connected? A. Yes. Q. And they are all out at some point ... above the pool—in the pool? A. Yes. Q, The wires are exposed. If you wanted to know if all the wires were actually tied together, grounded to the steel, how would you do that? How do you do that? Other than pulling on the wire? A. Once they back-fill and they put the ring around and connect those four conductors to that ring—those conductors are exposed. I personally go around and I tug on each one. Q. Does a paver deck need a footer inspection? Terry Jerulle expressed his concern about the content of the questions—he noted it was a Public Hearing—he did not understand the questions or why the County was being questioned on its procedures. Richard Joslin explained his concern was the "willful" charge. He stated, "In my opinion, after reading the case and some of the items in the case, I don't believe this is a `willful' violation. I think it was a missed violation, yes. But as far as being a `willful' Code violation, I don't think that applies." Terry Jerulle stated he would like to hear both sides and then ask questions. It was noted the Respondent admitted to the violation—there were no questions to ask of her. Richard Jerulle continued the Respondent understood that she was in the wrong. The point of his questioning was to determine whether or not the violation was `willful.' Chairman White stated while he appreciated having additional information presented about the bonding process for a pool, it would likely be—regardless of our questions— that the opinion of the Building Official who is not present will probably not be reversed. He continued the Board will be required to weigh the evidence to determine whether or not there has been a `willful' violation. He noted it is up to the Respondent to change her position. Tracy Lee stated she had not taken into consideration that she could explain. She stated she knew that three of the four wires had been bonded. When the backfill process took place—she stated it was clear—she saw that it was not connected properly. She stated, "My bottom line is—yes, it is an error and it was made by my company." Chairman White stated the first time the pool was inspected and the error was found, it may have been accidental. He noted in the reports that the second time the pool was inspected; the wire was attached to a plastic pipe and could not have been properly installed. His conclusion: it was `willful.' Ms. Lee agreed and continued, stating that she took responsibility because "it is not how I want to put my work out there—it's not who I am. It is not what my company is about." 5 March 18,2015 Richard Joslin referenced the County's photograph: E-20, E-21, E-22 and E-23. He asked where the pipe was located, i.e., was it around the corners of the pool where the Inspector said that he found the ground wires. Inspector Surniak replied the four conductors were arbitrarily placed at equal distances from each other since some pools are not square and do not have corners. He noted the inspections of the two pools took place the day before the photos were taken and they were just"stuck in the ground" on the house side of the pool. Rob Ganguli stated he returned to the jobsite after the inspection was completed and took the photographs. Inspector Surniak established that after he failed the work after the first inspection, the errors were repaired and it was passed after a second inspection. The County's case was concluded. Terry Lee stated her company has taken measures to ensure that there are at least four wires connected at all times, even after the pool has been backfilled. She confirmed her company has taken drastic measures to ensure that this error will not happen again. She stated she contacted Gary Martin with Serenity Pools and have come to an agreement concerning the equal potential bond grids that are used, i.e., all of the wires will have a coating of orange reflective paint. She stated her employees have been instructed that after the backfill, if they can't dig and find the wires, they are to stop working. The goal is to ensure that everyone on the crew knows where the ground wires are located. Ms. Lee stated there has been vandalism at some jobsites, i.e., the copper portion of the wires has been stolen. She confirmed her company's crew and supervisors have been instructed that if they find wires that are missing the copper component, they are to stop work immediately Gary Martin, Serenity Pools and Spas, stated he was the Contractor and had hired Ms. Lee's company to perform the work as a subcontractor. He confirmed the additional steps that both companies have set in place to ensure the bonding wires will be identified on every pool that they install. He further stated everything was done for compliance on the case and it was a first violation for Ms. Lee. Terry Jerulle stated he may have worked with Serenity Pool several years ago and did not feel that his judgment would be influenced. Chairman White stated he appreciated Mr. Jerulle's disclosure but did not feel there was a potential for conflict since Serenity Pools was not the Respondent. Rob Ganguli stated the Contactors Licensing Office had received a notarized Affidavit from Mr. Martin attesting to his inspection of all the jobsites where "Catch `em all" Contracting had been subcontracted and he validated the work that was done. Vice Chairman Lykos moved to approve closing the Public Hearing. Terry Jerulle offered a Second in support of the motion. Carried unanimously, 8— 0. 6 March 18, 2015 Chairman White noted the Respondent was charged with: "Willfully violating the applicable Building Codes of law of the State, City, or Collier County,"pursuant to Ordinance #90-105, as amended, Section 22-202.1(2). Vice Chairman Lykos moved to find the Respondent guilty of the violation as charged. Ronald Donino offered a Second in Support of the motion. Motion carried, "7— Yes"/1 —No." Richard Joslin was opposed. Attorney James Morey, Attorney for the Board, was requested to advise the Board concerning possible Sanctions. He stated: • The Respondent is a State-certified Contractor, License #CGC 1522156, and holder of a Collier County Certificate of Competency, #201400001622. • If, after a Hearing, the Board determines there has been misconduct by a State- certified Contractor, the Board may deny the issuance of Collier County Building Permits or require the issuance of permits with specific conditions. • Notification of, and information concerning any permit denials shall be submitted to the Florida Department of Business and Professional Regulation within fifteen days after the Licensing Board's decision to deny issuance of the permit. Mr. Morey continued that when imposing any specific Sanctions on a State-certified Contractor, the Licensing Board shall consider the following: • The gravity of the violation; • The impact of the violation on the Public Health/Welfare/Safety; • Any action taken by the violator to correct the action; • Any previous violations committed by the violator; • Any evidence presented by the parties during the Hearing that is relevant to the Sanctions which is appropriate to the case, given the nature of the violation and the violator. Michael Ossorio recommended suspending the permit pulling privileges for a period of two months; request that the company pay the investigative costs of$540 (voluntary); and provide a"no penalty recommendation" letter to the State. After a discussion of potential Sanctions, it was suggested to re-open the Public Hearing in order to further question the Respondent. Terry Jerulle moved to approve re-opening the Public Hearing. Ronald Donino offered a Second in support of the motion. Carried unanimously, 8— 0. Terry Jerulle asked the Respondent if she had instructed the employee to cover up his error or was it the employee's decision alone. A. I would never instruct my employee to take the lazy way out. Because he was lazy and not attentive to his job. He no longer has that job. Q. Did you terminate this person? 7 • March 18, 2015 A. Absolutely. I will not have an employee who is too lazy to do a proper job— I don't need him on my jobsite. I don't want my name put out there like that—I've worked very hard to get my State license and I don't need employees like that. He was let go. Everyone who is employed by me is on notice—there is no room in my business for the mis-handling of any type of work, period. Michael Boyd asked if the company had failed inspections at the two different pools and the response was, "Yes—with the same employee." Kyle Lantz: Q. Does your company primarily do pool shells? A. Pretty much. I obtained my State license because, in the future, we may do more. But at this point, no ... we strictly do shells and footers. Q. How many employees do you have? A. Three, now. Q. So your company is small? A. Oh, absolutely. And I want to keep it small. I like knowing that our work is consistent and as close to perfect as it can be. I'll take quality over quantity any day. Terry Jerulle moved to approve closing the Public Hearing. Vice Chairman Lykos offered a Second in support of the motion. Carried unanimously, 8— 0. Kyle Lantz commented concerning the Sanctions: • Serenity Pools has stood by Ms. Lee and her company. They acknowledged hiring her—acknowledged the problem and also that they were working together on resolving it. • Because of this, I am pretty confident this problem will not occur again. Chairman White stated he was comfortable accepting the County's recommendation concerning Sanctions. Vice Chairman Lykos asked Michael Boyd for his opinion concerning the County's recommendation, since he discovered the same Violation existed at two different jobsites where the Respondent had been hired to work. Michael Boyd replied: • They repaired at least one pool—I think they attempted to repair both of them. • Obviously, there was a lazy employee who didn't care about his work—all of us have run into that over the years. • I have a tough time thinking she really did this "willfully" on her own. • Yes, she's responsible because she is the Licensee but the "willful"—I have a tough time accepting that. Chairman White explained that, as a legal matter,the "Agency"relationship flows from the employee. He stated it as clear that the former employee intended to deceive which led to the Building Official's conclusion. He continued that anyone who accepted responsibility in the first place, and then demonstrated how, in a detailed process, they eliminated the "problem employee" and 8 • March 18, 2015 created a system that supports the Code's goal, i.e., that all of the equal potential bonds are made. His conclusion: The "impact" on the Health/Safety/Welfare of the County's resident was almost a net-zero because no one testified that, if the problem had not been caught, a person would have been shocked or electrocuted upon entering the pool. Chairman White moved to approve accepting the County's recommendation for Sanctions as follows: • To suspend the permit pulling privileges for a period of two months; • To request the company voluntarily pay the investigative costs of$540.00 incurred by the County; • To send a letter to the State that recommends "no penalty." Gary McNally offered a Second in support of the motion. Motion carried, "7— Yes"/"1 —No." Vice Chairman Lykos was opposed. VI. NEW BUSINESS: A. Orders of the Board Vice Chairman Thomas Lykos moved to approve authorizing the Chairman to sign the Orders of the Board. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8— 0. III. APPROVAL OF AMENDED AGENDA: (2" Amendment) Michael Ossorio requested the following change: • To move Item VIII- B to Item VII-A: The case of Veronica A. Compean (d/b/a: "Compean Maintenance, Inc.") will be heard under Item VII, "Old Business." Vice Chairman Thomas Lykos moved to approve amending the Amended Agenda as stated above. Ronald Donino offered a Second in support of the motion. Carried unanimously, 8— 0. VI. NEW BUSINESS: (Note: With reference to the cases heard under Section VI, the individuals who testified were first sworn in by the Attorney for the Board.) B. Steven M. Hall—Waiver of Examination(s) (d/b/a: "Stahlman-England Irrigation, Inc.") Steven M. Hall stated: • He was appearing before the Board to request a re-instatement of his Collier County Contractor's License for Landscaping—Restricted. 9 • March 18,2015 Chairman White explained since Mr. Hall previous Contractor's license had lapsed, one of the County's requirements for reinstatement was to take the required exams. Mr. Hall replied he did not think he needed to take the exam again was because he had passed it and has remained working in his field for the past 15 years. He is also licensed in Lee County and worked in Lee County during the period when his Collier License had expired. When asked about Continuing Education, he responded that CE credits were not required for a Landscaping/Restricted license. He stated he also holds a license for fertilization which requires that he obtain CE credits. He obtained the Fertilization license within the past two years. Chairman White referenced Page 2 of his Application and asked Mr. Hall to identify the Officers of Stahlman-England Irrigation, Inc. A. James England—President, Mark Stahlman—VP and Founder, Steve Hall—VP. Chairman White referenced Page 3 of his Application and asked Mr. Hall to list any formal training which he omitted to include. A. In addition to the Fertilization license, he also obtained the Florida Water-Star AP accredited Professional. He has obtained a Certified Irrigation Contractor designation through the Irrigation Association as well as a Certified Landscape Auditor. They are all four-hour closed book exams. The passing grade is 75. They are kept up to date. He further stated he has a Miami-Dade license that requires CEUs every two years. He maintains his Continuing Education within the industry. Michael Ossorio: • Mr. Hall was licensed in 2012 but it did lapse. • He has been working with Mark Stahlman since then. Steven Hall stated Mark Stahlman is a licensed Landscape Contractor. He stated he wanted his license as a back-up and to obtain the requirement he needed to move forward. Vice Chairman Lykos moved to approve granting the Applicant's Request for a Waiver and reinstate his license without requiring testing. Richard Joslin offered a Second in support of the motion. Motion carried, 8—0. C. Michael L. Catanzaro —Review of Experience ("SWFL Pool & Spa, LLC" — d/b/a "ASP—America's Swimming Pool Co.") Michael Ossorio stated to be a Licensed Pool Cleaning Contractor, an applicant should have twelve months of experience. He has some education and training but not all education and training can be forwarded or considered as on-the-job training . 10 • March 18, 2015 Michael Catanzaro: • He is requesting a Waiver of the One-Year Requirement concerning cleaning swimming pools experience in order to obtain a license • He purchased the pool cleaning franchise in November, 2014 • For the past 25 years, his experience has been in the hospitality industry—he was the General Manager of country clubs in Fairfield County, CT, and was a caterer earlier in his career. • He managed not only the clubhouse but also the facilities and has extensive experience managing people. • He has learned a"good amount" about pools, i.e., testing and balancing. • He has received 13 days of training from ASP which he completed in February. • He recently obtained his CPO (Certified Pool Operator) license. • His immediate goal is to begin cleaning pools and to obtain a CPC license in the future. Richard Joslin asked the Applicant if he had ever run a business before by himself. A. Yes, sir. I owned a catering business before I began managing country clubs. Q. How long have you been actually involved in swimming pools? A. I'm just getting into it. The closest I have been to "hands-on" experience has been in country clubs in the past. They all have pools—getting the open and running and staffed ... making sure the lifeguards are taking readings when they should for the health inspections. Q. Did you do that yourself or did your employees do it? A. Occasionally, I would. If there was an issue, I'd be called out. I obtained my CPO about 10 to 15 years ago to have a better understanding of pool water balancing and to be able to help his staff to figure out when the levels were off. Q. Do you have a CPO now? A. I do. Vice Chairman Lykos asked Mr. Joslin for his opinion concerning whether or not the applicant's classes and previous experience would be enough since he had never worked for a pool cleaning company previously. Richard Joslin: "Considering that he has taken the CPO course and he has been in golf communities where there are commercial pools ..." Q. Are you going to try to maintain in your business commercial or just residential pools? A. I would like to try although I understand HOA's want companies with more experience. Q. Have you been involved with any type of commercial pools before other than those in clubhouses that you managed? A. No, sir. Richard Joslin stated he would not vote in favor of granting a license to the applicant before he took the required test. Chairman White asked if there was an exam that could substitute for the required 12 months of experience. 11 March 18,2015 Attorney James Morey explained the application had been summited not for a Waiver of Examination but for an explanation of experience from the Applicant. He outlined the "Proof of Experience" required under Section 22-183(B) of the Collier County Code: • Affidavits from former employers with specifics as to the number of years of experience, work performed and any other relevant information; • Copies of other certificates of competency, if any, held by the applicant in other counties or cities; • Affidavits from any Building Director in locations where the applicant has worked; • Affidavits from any union organization of which the applicant has been a member relating to the trade for which the Applicant has made application; • Affidavits from any other source within the trade applied for. • The Applicant's personal testimony as to his/her experience. Under Section 22-183(C): "Education at an accredited school may be presented to satisfy a portion of the experience requirements of this Section. Specifically, each full year of school-level work in the trade for which application is made shall be credited to the Applicant as 0.75 years' experience, but such credit shall be for no more than one-half of the total experience required by this Section." Richard Joslin expressed concern that even though the Applicant recently took the CPO test, he did not have enough experience to know how to set-up and manage a pool cleaning business. Chairman White: "What would be the appropriate ways for the Applicant to obtain the experience that the Board may feel he needs. What other avenues are available to him?" Richard Joslin replied the Applicant should work for a licensed pool contractor as an employee. Michael Ossorio stated the Board had the option to restrict the license to residential pools only. The Board could also place the Applicant on probation while granting a provisional license. Richard Joslin stated he would support placing the Applicant on probation for one year while restricting him to cleaning only residential pools to gain experience. Then he could be granted a permanent license. Kyle Lantz asked the Applicant if he had cleaned his own pool and the response was, "No." When asked how many months of experience the Applicant felt he had, based upon his prior experience in country club management or anything else, Mr. Catanzaro replied that his experience with the country clubs and training with the franchisor was probably more than someone who was just hired "off the street"to clean pools. He stated the training he received from ASP and the CPO was "pretty valuable." 12 March 18,2015 Richard Joslin stated he reviewed the Affidavits that were part of the application. He observed that each one listed the Applicant as a handyman for various projects and in various capacities but there was nothing that directly related to pools or pool cleaning. Mr. Catanzaro clarified that his experience in the country clubs was as a General Manager which he stated was "a little more than just a handyman." Vice Chairman Lykos stated the limitation being considered was to restrict the Applicant to cleaning residential pools only but he lacked experience in residential pools and had only limited experience in commercial pools. Mr. Catanzaro explained that one of the reasons why he went to a franchise company was for the support. He stated he could call anytime he had a question concerning water balance or any other issue and they would respond. Kyle Lantz stated there is a big difference between"support" and "supervision." He further stated he understood that cleaning pools was not "rocket science," but the Applicant should have personally done even a little bit before he could charge someone for his services. When the Applicant asked "for how long,"the response was "12 months." Mr. Lantz explained that the requirement did not mean the Applicant could clean his own pool, rather, it meant working a 40-hour week for one year, i.e., a full-time job. Vice Chairman Lykos strongly suggested the Applicant should invest some time and work for someone else or hire someone who has the required license to run his business—the Applicant could learn from the qualified licensee because the Applicant lacks residential pool experience. Mr. Catanzaro stated the reason why he got into the franchise was not to spend a year working for someone else cleaning pools. He further stated his investment in the franchise precluded him for going to work for someone at $13.00 an hour. Chairman White reiterated that the Applicant could bring someone into his business who has the required licensure to run his business. The Chairman reminded the Applicant it was not the Board's responsibility to explain to an applicant what the requirements are for a specific license. Richard Joslin stated the Applicant might find a Contractor who would allow him to work under his umbrella. He noted there are "smaller" tests that would permit the Applicant to work for a licensed pool contractor. The only other option would be to take the "big"test through the testing agencies in Tallahassee. If he passed, he could work as a subcontractor for a licensed pool contractor. Attorney Morey suggested Mr. Catanzaro contact the franchisor to see if there is a local franchisee willing to partner with him or work with him. Vice Chairman Lykos stated the Ordinance allows the Board to give the Applicant six months of credit toward his experience. He suggested the Applicant should find a 13 March 18,2015 way to prove six months of on-the-job experience in order for the Board to approve his application. Richard Joslin suggested since the Applicant did have a CPO license, he could apply to any hotel or condo complex to work directly for the entity. He would be an employee of the hotel or condo complex. Kyle Lantz moved to deny the Applicant's request for a license. Vice Chairman Lykos offered a Second in support of the motion. Carried unanimously, 8— 0. RECESS: 10:23 AM RECONVENED: 10:29 AM IV. APPROVAL OF MINUTES—FEBRUARY 18,2015: • A discrepancy was noted on Page 12, i.e., information was missing. • Approval of the Minutes was tabled until the April meeting to allow the Hearing Reporter an opportunity to research the issue. Gary McNally moved to approve tabling the vote on the February minutes until the next meeting. Vice Chairman Lykos offered a Second in support of the motion. Carried unanimously, 8— 0. VI. NEW BUSINESS: (Note: With reference to the cases heard under Section VI, the individuals who testified were first sworn in by the Attorney for the Board.) D. Janet Ramirez—Waiver of Credit (d/b/a: "Castaway Flooring Service, Inc.") Janet Ramirez: • She contacted the creditors listed on her application and made payment arrangements with each; • She is currently working out of Lee County and her fuel costs have become quite expensive; • She has applied for a license in Collier County to generate more income which will also allow her to pay off her old debts more quickly. Michael Ossorio: • Ms. Ramirez is currently licensed in Lee County in floor covering and has been doing business for many years in Lee County; • She has been to the Contractors' Licensing Office to review her credit and she has a Business Plan to present to the Board; • She is attempting to correct her credit issues; 14 • March 18,2015 • The corporate credit report has nothing to report; • He has no concerns about her company • He recommends issuing a probationary license for 30 or 60 days to monitor the payments she intends to make. Chairman White asked Ms. Ramirez to provide more details about her business plan. (Note: Hard copies of the Ramirez business plan were distributed to the Board.) Janet Ramirez: • She contacted her creditors—found that new issues had arisen because she had three addresses (family home—PO Box—her apartment); • She verified balances with the new creditors—some were from 2008; • She made payment arrangements with Bank of America and Sprint; she submitted partial payments to each creditor on March 9th; (Note: There was a pause in the proceeding to allow the Members to review the Business Plan.) Ms. Ramirez summarized her goals: • To obtain her license in Collier County; • To work locally and reduce her expenses; • To establish her business in Naples; • To pay off her debts by the end of the calendar year. Kyle Lantz noticed a typo in the verification of experience provided by Ronald Ohner; the Applicant could not have begun working for his company in 1985 because she was born in 1986. Kyle Lantz: Q. You have a business now in Lee County? A. Yes. Q. How long have you been doing it? A. Since 2012; I have been a subcontractor for Wayne Wiles Floor Covering. Q. And that is Castaway Flooring Service, Inc.? A. Yes. Q. Your application states your opening date of business as 02/04/2015? A. In Collier County—I haven't done any business in Collier yet. Q. So your business has been open and operating for almost three years? A. It will be three years in June. I have been limited to only carpet, linoleum and vinyl. Mr. Lantz asked why the Board was reviewing the Applicant's personal credit since she has been in business for more than two years. 15 March 18, 2015 Michael Ossorio responded there wasn't anything on her business credit which is why the personal credit was under review. He stated he called Mr. Wyles to verify the dates the Applicant worked for his company. Vice Chairman Lykos stated he was leaning toward approving the application provided there was a probationary license with a review at either six or twelve months. Chairman White stated he would support such a motion. Vice Chairman Lykos moved to approve granting a probationary license to the Applicant;she is to appear before the Board at the end of six months and present an updated credit report for review by the Board. Richard Joslin offered a Second in support of the motion. Vice Chairman Lykos explained the Board will want to see how well she performed based on the business plan that she provided. Chairman White stated she could also bring receipts and other documentation to the review. Michael Ossorio stated he supported the motion. He explained t if, within the six month probationary period, the Applicant's credit score was 660 or better, she could be removed from probation administratively and the Applicant would not need to appear before the Board. Chairman White stated he supported the policy. Gary McNally noted that bankruptcies and other items can"hang" on a credit report and take up to two years to be removed. He stated even if the Applicant paid her creditors in full, it might take longer than six months to clear the credit bureau. Chairman White stated if the Applicant produced a credit report of 660 or better, the Contractor Licensing Supervisor would have discretion to automatically issue her a permanent license. Vice Chairman Lykos amended his motion to allow the Contracting Licensing Supervisor to issue a permanent license to the Applicant if she produced a credit score of 660 or better at the end of six months. Richard Joslin offered a Second in support of the Amended Motion. Carried unanimously, 8— 0. E. Jim E. Skelton—Waiver of Examination (d/b/a: "Skelton's Construction,Inc.") Jim Skelton: • Has been licensed in Collier County since 1993 doing framing. • Developed Stage 3 cancer and did not renew his license. • Has been in remission since 2014. • Wants to reinstate his license without taking the exam. 16 March 18,2015 Michael Ossorio noted Mr. Skelton took the Carpentry exam in 1991 but never took the Business and Law exam because it was not required in 1991. The Applicant is requesting the Board to waive both the Carpentry exam AND the Business and Law exam. Chairman White asked if the County had a recommendation. Mr. Ossorio stated the Applicant must take the Business and Law exam to comply with the new Ordinance. Mr. Skelton stated he has been in business for 20+ years and should be exempted from being required to take the Business and Law exam—he would not have allowed his license to lapse if he hadn't become ill. Chairman White stated he did not see any negative items on the Applicant's business credit report which suggests that Mr. Skelton's business is being conducted appropriately. He noted some negatives on the personal credit report. Jim Skelton explained his business had been affected by the downturn in the economy, but he managed to pay his suppliers and other creditors. However his personal credit suffered. Most of the negatives on his personal credit report were due to medical bills. Terry Jerulle asked what type of carpentry he did. A. Framing, custom homes in Mediterra—mostly custom homes. Q. So it's rough carpentry? A. Yes. Q. What size crews do you think you will have? A. Usually it takes 5 or 6 of us to do the houses that I normally do. I don't want to get big ... I've been there before and it wasn't worth it for me. Small—just enough to do one house at a time. Richard Joslin stated since the Applicant has been in business in Collier County since 1993, he must know how to run a business or he wouldn't still be in business. His opinion: it was not necessary for Mr. Skelton to take the Business and Law exam because he has the technical training and the experience. Kyle Lantz concurred with Mr. Joslin's opinion. Terry Jerulle: Q. Have you ever been in front of the Board before? A. No, sir. Q. Any fines or trouble with the County? A. No, sir. Terry Jerulle stated, in this case, he would make an exemption and not require the exam. Vice Chairman Lykos was concerned with the Applicant's liability coverage which he considered to be insufficient especially since the Applicant worked on custom homes. 17 March 18,2015 Mr. Skelton stated as soon as he begins to work again, he will increase the liability coverage. He just wanted to show there was a binder so he could submit his application. In order to work on custom homes, his insurance aggregate will be increased to at least $1M. Vice Chairman Lykos strongly recommended that Mr. Skelton meet his insurance agent to review his policy limits and obtain information concerning the gaps in coverage. He noted some insurance companies require Contractors to maintain a higher threshold. Jim Skelton agreed. He stated he has worked with the same insurance company since he began his business and his insurance agent was very good about letting him why type of insurance coverage is needed for each builder. He confirmed his insurance will be upgraded as soon as he begins to work again. Michael Boyd stated every two years he is required to take CE courses and he feels that he always learns something new. He strong recommended that Mr. Skelton take the Business and Law exam. Jim Skelton stated he runs his employees through a leasing company which provides Workers' Compensation insurance coverage. Terry Jerulle asked Mr. Skelton why he did not want to take the test. A. I feel that my experience running a business should supersede the test. I have been licensed in Collier County since 1993. Q. So it's not a money issue? A. No. Q. Is it a time sensitive issue? A. Actually it is because if I have to take the time to study for the test, it will take more time for me to get my license. Q. So if we gave you a license and you agreed to take the test within a certain time frame? A. Whatever you decide, that will be fine. I don't mind taking the test if I have to but I'd like to have my license. Kyle Lantz moved to approve granting a probationary license to the Applicant. The testing requirement for the Carpentry test is waived but the Applicant is required to take the Business and Law exam within the next six months. The probation will terminate when the exam is passed. If he does not pass the test within six months, his license is revoked. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8— 0. Chairman White asked Staff to inform the Board of the Mr. Skelton's test results. VII. OLD BUSINESS: (Note: With reference to the case heard under Section VII, "Old Business,"the individual who testified was first sworn in by the Attorney for the Board.) 18 March 18,2015 A. Veronica A. Compean —Review of Order of the Board —One Year Probation (d/b/a: "Compean Maintenance, Inc.") Michael Ossorio: • The company is run by a husband and wife team, Veronica and Alfonso Compean. • There have been no complaints made against the business or the license holder, Veronica Compean. • He has no issue with the Board terminating probation and granting a permanent Landscaping license. Veronica Compean and Alfonso Compean appeared before the Board. Richard Joslin moved to approve terminating the probation and to issue a permanent Landscaping Contractor's license to Veronica Compean. Terry Jerulle offered a Second in support of the motion. Carried unanimously, 8— 0. IX. REPORTS: • Michael Ossorio stated there was a joint venture between Workers' Compensation and the Fraud Unit. Spot checks were conducted in the City of Naples and four or five arrests were made. • Vice Chairman Lykos announced that he will be unable to attend the April meeting. X. NEXT MEETING DATE: Wednesday, April 15, 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 11:40 AM. COLLIER COUNTY CONTRACTORS' LICENSING BOARD PATRICK WHITE, Chairman The Minutes were approved by the Committee Chair/Vice Chair on , 2015, "as submitted" F 1 OR "as amended" 1 1. 19 February 18,2015 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING February 18, 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 Vice Chair: Thomas Lykos Members: Michael Boyd Ronald Donino Terry Jerulle Richard Joslin Kyle Lantz Gary McNally Robert Meister ALSO PRESENT: Michael Ossorio — Supervisor, Contractors' Licensing Office Kevin Noell, Esq. —Assistant County Attorney James F. Morey, Esq. —Attorney for the Contractors' Licensing Board Joe Nurse — Collier County Licensing Compliance Officer 1 February 18, 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 said proceedings is made, which record includes the testimony and evidence upon which any 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; seven (7) voting members were present. II. AGENDA—ADDITIONS, DELETIONS, OR CHANGES: (None) III. APPROVAL OF AGENDA: Vice Chairman Lykos moved to approve the Agenda as submitted. Kyle Lantz offered a Second in support of the motion. Carried unanimously, 7— 0. IV. APPROVAL OF MINUTES—JANUARY 21,2015: Gary McNally moved to approve the Minutes of the January 21, 2015 meeting as submitted. Richard Joslin offered a Second in support of the Motion. (Terry Jerulle arrived @ 9:02 AM; eight voting members were present.) Chairman White asked Mr. Jerulle if he had any questions concerning the Minutes and his response was, "No." Carried unanimously, 8— 0. V. DISCUSSION: • Michael Ossorio has been in contact with the City of Naples and the Board of County Commissioners. Robert Meister has been re-appointed as the City's representative to the Contractors' Licensing Board and has been approved by the Board of County Commissioners. • Michael Ossorio and the Board's Attorney, James Morey, have been working together concerning the Application, i.e., the format of the Affidavit has been revised and a copy will be provided to the Board for their review. VI. NEW BUSINESS: A. Orders of the Board Vice Chairman Thomas Lykos 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. 2 February 18, 2015 (Note: With reference to the cases heard under Section VI, "New Business,"the individuals who testified were first sworn in by the Attorney for the Board.) B. Paul E. Heaton—Waiver of Exam(s) (d/b/a "Kyle's Finish Carpentry, Inc.") Paul Heaton stated he was appearing before the Board to reinstate his finish carpentry installer's license. He noted he had taken the exam in Lee County in 2005. Michael Ossorio: • In Lee County, Mr. Heaton has a Certificate of Competency for"Finish Carpentry Contractor." • In Collier County, he had a"Cabinet Installing License" which includes his finish carpentry and requires taking the Business Procedures test. It is not a Carpentry License. It is a Cabinetry and Millwork License. • Mr. Heaton has petitioned the Board to waive the requirement to retake the test. • Mr. Heaton was asked to explain his work experience for the past five years. Paul Heaton: • Has been in the same trade for the past 30 years. • His line of work consists of finish carpentry; cabinet building; installation. • He stated he has the qualifications to do what he has asked to do. Chairman White asked Mr. Heaton if he had been able to keep up with the current practices in his trade since his license lapsed and the response was, "That's all I've done." (Robert Meister arrived; nine voting members were present.) Paul Heaton: • From Ohio and began working in his trade in the early `80s. • Moved to Naples in April, 2005 and obtained his license. • Returned to Ohio in 2006 due to the economic downturn and allowed his Collier County license to lapse in 2007. • Has worked continuously in his trade in Ohio and since his return to Naples in 2014. • There are no license requirements in Ohio. His company was incorporated in March, 1998 and he is still in the same business. A copy of the "Certificate of Good Standing" signed by the Ohio Secretary of State, dated September 15, 2014, is attached to the Application. • Has been working in Naples for the past ten months until he was injured in September, 2014. He had been employed by CTC Frame and Finish. • Will be his company's sole employee 3 February 18,2015 Chairman White questioned the Applicant concerning one of his references, Christopher M. Parker. Mr. Heaton replied he has known Mr. Parker for the past 19 years and has worked for him in both Ohio and Florida. He stated Mr. Parker is a licensed contractor and owner of The Parkerbilt Co, LLC, and also owns Absolute Roofing in Naples. Kyle Lantz moved to approve the Application and grant the Applicant's request for a waiver of examination. Gary McNally offered a Second in Support of the motion. Carried unanimously, 9—0. Michael Ossorio explained to the Applicant that, since the Board approved his application, his license would be reinstated upon payment of the required fees. C. Teodor Danilov—Review of Credit (d/b/a "Custom Flooring Design, Inc.") Mr. Danilov stated he had applied for Contractor's licenses for tile and marble, and floor covering but his credit score was low(509). • He worked with Lexington Law to improve his credit • January 30, 2015: his credit score had increased to 543. He anticipates another increase within the next two to four months. • There are no bankruptcies on his credit report; nothing is in collection; he does have some late payments showing on the credit report • He explained a problem with a laptop purchase (in 2006) from Best Buy and the issue is being resolved. Kyle Lantz noted the Applicant's problem with his credit is not that he had "bad" credit—he had not borrowed very much and preferred to pay in cash via his debit card. He also noted Mr. Danilov usually worked for Contractors who supplied the materials that he installed. He stated he would approve a motion without placing Mr. Danilov on probation. Terry Jerulle disagreed, noting the Applicant stated his intention was to improve his credit score. Mr. Jerulle would like to see evidence of settlement of the Best Buy account in the future. Richard Joslin moved to approve Teodor Danilov's Application for a License, subject to a six-month probationary period. At the end of the probationary period, Mr. Danilov will appear before the Contractors'Licensing Board to represent a new, improved credit report. If there has not been a significant improvement in the credit report, the Board may reverse its position regarding licensure. Gary McNally offered a Second in support of the motion. Motion carried, 9— 0. 4 February 18, 2015 D. Abel Arredondo —Waiver of Exam(s) (d/b/a: "Superior Woodworking, Inc.') Abel Arredondo stated he was appearing before the Board to request that his license as a Cabinet Installer/Millwork Contractor be reinstated and to request that he is allowed to waive taking the examination. • He had been licensed for several years but, due to the economic down-turn in 2007, he took a salaried position as a project manager for Palm Bay Kitchens and later their sole service person until the company closed in January 2012. • He was not aware he could have applied to have his license declared "inactive." • He previously attempted to reinstate his license but was informed he would need to sit for the Business Procedures exam. • From July 2012 through January 2015, he worked for Grand Woodworking as their sole installer/service man. • Grand Woodworking is currently being dismantled. • Several companies including Artisan & Guild, Alli-Kriste, and Rufino have contacted him to work as their cabinet installer. • He stated he did not feel it was necessary for him to retake the test since he has been continually working in his field since 2007. Chairman White noted that one of the owners of Grand Woodworking was a client of his law firm. Gary McNally asked Mr. Arrendondo what he was doing to improve his credit rating. Abel Arrendondo explained that his personal credit suffered most during the economic down-turn. He is twice-divorced and has spent "thousands of dollars" on attorneys' fees in order to fight for visitation/custody of his children. His priorities were to fight for his children and pay his rent. He acknowledged being behind on bills but he stated he has, the past two months, been in contact with two collection agencies who have agreed to "work with him." He produced a letter from one agency verifying he has paid the debt ("Proof of Pay-Off' Letter). He further stated that construction has begun to improve in Collier County and he felt certain that he will be able to make a"decent amount of money" to pay off his remaining debts within the next 6 to 12 months if the Board will reinstate his license. Mr. Arrendondo noted his goal is to avoid declaring bankruptcy, although he stated many people in his financial situation would have gone through a bankruptcy—he does not want that on his credit record. It was noted Mr. Arrendondo also submitted his old business credit report which was debt-free. Abel Arrendondo stated his business will consist of the installation of factory-made cabinets. He will not buy the materials because they will be provided by the Contractor. He indicated he will probably not hire any employees. He assured the Board that in the event he does hire employees, they will be covered by Workers' Compensation Insurance. To not have it is, in his opinion, "crazy." 5 February 18,2015 Gary McNally moved to approve granting Abel Arrendondo request for a Waiver of the Testing Requirement. Mr. Arrendondo will be granted a probationary license and will appear before the Board in six months for a review of his credit. Kyle Lantz offered a Second in support of the motion. Carried unanimously, 9— 0. E. Josue ("Joshua") Briceno —Review of Application (d/b/a: "Innovative Glass & Window, LLC".) Michael Ossorio provided background information: • On February 2, 2015, Mr. Briceno was issued Citation#09078 and was fined $1,000 for working without a license in the City of Naples. • He applied for a license within 45 days, per the Ordinance, on February 4, 2015. • He noted Mr. Briceno has taken all of the necessary exams and is licensed in Lee County. o Business & Law— 02/02/2003 —86.0% o Glass & Glazing Contractor—01/05/2013 — 76.0% • Staff reviewed his application and noted the Workers Comp System Certificate of Liability Insurance had an expiration date of 12/11/2015 and the Certificate for the General Liability insurance had an expiration date of 11/17/2015. • Staff then contacted the insurance carrier stated that the dates were not correct and the certificate had been either forged or altered. • It was determined that the Applicant had not had insurance coverage for at least several months. • The Applicant intends to abate the Citation and has appeared before the Board to explain the email sent by his wife who is the office manager. • The Applicant obtained General Liability insurance on February 5, 2015 and provided a copy of it with his application. Josue Briceno confirmed he had copies of the binders for both policies and he provided the copies to the Board's attorney, James Morey, to review. Vice Chairman Lykos asked Mr. Ossorio if the first set of insurance certification attached to the application were "forged" and the response was "Correct." Michael Ossorio noted the State of Florida's Department of Financial Services is conducting a preliminary investigation of the issue. Josue Briceno: "I am not here to make any excuses. I think what happened was wrong. I am not here to try to give you an excuse—it was wrong. We should have given the Board the right documents. On behalf of my wife and my company, I apologize." He explained he handles the instillation and field work and his wife handles the office. He stated he was on a job when the Citation was issued and he immediately went to the City of Naples to handle it. He reiterated that he had no excuse. 6 February 18,2015 Michael Ossorio: "Maybe the use of the word `forge' is too strong, but the documents appeared to have been altered." Chairman White stated while the Applicant did not represent himself as someone else, it [altering the documents] was a bad business practice. He suggested the investigation should be "left to others and any consequences from that." He stated the question was the degree to which the Applicant's actions may impact the Board's review of his application. Chairman White asked Attorney Morey to provide a brief summary of the documents provided to him by Josue Briceno that he had reviewed. Attorney James Morey stated there were two declaration pages—one was for the General Liability policy and the other was for the Workers' Comp policy. (The signed documents were reviewed by the Board members.) Gary McNally noted the Applicant's credit score was 505 and asked him what he was doing to correct/improve the score. A. We incorporated the company two years ago. When we first started, I had six partners including my wife and myself. Since I was the license holder, I signed for the many loans. After the first year, we found out that some of our partners had been stealing money—it was a big mess and we parted ways. The company had been called Innovative Glass and Railing. We changed the name to Innovative Glass and Window, LLC with only my wife and me as partners. Since I personally guaranteed all the loans, it affected my credit. I am working on my credit scores with a company that is helping to remove old items from my credit history. I am pretty sure that within six months, the scores should be back up again. Lyle Lantz directed a question to Michael Ossorio: Q. Since he has been in business for more than two years, it is my understanding that we only look at the business credit report—not the personal. Am I correct? A. That is true. However in some cases, we look at the totality of both credit reports. In this particular application, it appears that he would have been before the Board for the issue of co-mingling funds and personally guaranteeing his business. It was noted the Applicant has been licensed in Lee County for the past two years. Mr. Brieno stated when he applied for the Lee County license, his credit scores were higher. Michael Ossorio explained the Board was conducting a full review of the application and not just on the merits of the signed affidavits. He stated the credit scores had to be addressed. Chairman White stated many of the items on the credit report appeared to have been charged off or were relatively small amounts. 7 February 18,2015 Terry Jerulle questioned the Applicant: Q. Can you please explain your business? What you do and who your work for? A. I've been doing installations since I was fifteen years old. I started by cutting glass and cut glass for at least eight years. I worked for a glass service company. I did glass replacements and window repairs, sliding glass door repairs. I started doing shower enclosures, mirror walls, and glass walls. I became very good at my trade. When I had partners, the company had the glass portion and the railing portion. They were glass rails. But now we are a glass service company. If you have a break in at your house, we will come out and cut the glass on site to repair it for you. I do have two employees who are included in the Workers' Comp policy. Q. Do you replace windows in sliding glass doors? A. We sell them but we usually don't install them at all. It's very rare. I do mostly sales because I'm a PGT Dealer. Q. Do you sell the PGT windows? A. Yes. Q. To whom? A. To homeowners, to contractors ... Q. And who installs them? A. Usually they have someone who will install it. Sometimes we do some installations, but very rare. Q. On those installations, you didn't pull any permits ... correct? A. No we have ... but it's usually with ... when I've done installations, it's with the Contractor—either we're doing a glass wall and they ask if we can install a window for them. They just pay us for the labor. Q. As a PGT dealer, do you have credit with PGT? A. Yes, I do. I have been a dealer for two years with them. You see, when we started the business, my credit was good. It's just all this baggage that was left over from all my ex-partners. I was part of that, too. I'm not running away from it. I'm trying my best to pay everybody off. I know it's going to take time, but I am paying them off little by little. Chairman White questioned the Applicant's name as it appeared on the Citation as well as on his driver's license and requested an explanation. A. I am from Central America. In Nicaragua, some families give second names. "Joshua" is my first name. "Vinerte" is my middle name. "Briceno" is my Dad's last name and"Urbina" is my Mom's last name. When we came to the United States ... when you enroll in school ... they only have your first name and then my Dad's last name. But my passport, my license, my immigration papers .. all have Josue Vinerte Briceno Urbina. Chairman White stated he was comfortable that the documents identified the same person using the convention applicable in the United States. He acknowledged the corporate entity would be named something else. It was noted the Articles of Organization for a Florida Limited Liability Company referred to the Applicant as "Josue V. Briceno." 8 February 18, 2015 Vice Chairman Lykos questioned the Applicant: Q. Josh, is your license in Lee County is current right now? You are active in Lee County? A. Yes, sir. Q. So what you're trying to do is to get your license in Collier County to operate in both counties? A. To be honest, that was not my intent. My shop is in Lee County in Lehigh Acres —that's where I do most of my business. It just happened that with the Contractor the job was in Naples and I wasn't aware that I had to get a Collier County license. If I am accepted for my license in Collier, I wouldn't mind coming to Collier but most of my business will be in Lee County. Q. Part of why you are here is because you received a Citation and was fined $1,000. If you can get a license here, it will reduce the amount of the fine—correct? A. Part of it—yes. But for me to get a Collier license will be an upgrade for my company and for access ... I can add more advertisement ... it could be good for the business as well. Q. I understand you have been proactive in submitting your application and getting your insurance squared away, but I have issues with what led you to be here in the first place which I think need to be resolved before I am comfortable allowing you to have a license here: you operated without insurance and then you provided— what's the word we're using—"altered" documents when you were confronted about working without a license in Collier County. I don't think your credit is the issue. The issue for me is that you operated without insurance and the resolution of that is still pending. Then you submitted altered documents. I am not comfortable at all having a conversation about your having a license here until all the other issues have been resolved. You pay the fine for the Citation and then you have resolution with the State on operating without Workers' Comp. I am only one of nine but I couldn't care less about the credit right now. You have some other issues that are geiniane to operating as a licensed Contractor in Collier County and those are a lot more critical than what your credit score is. A. I understand. Chairman White: "As I said before, the thing that was pertinent was how the altered documents were explained and what their impact was on the operation of the business, in particular in Collier that led to the Citation and it being resolved." He continued: "Knowing that there is an ongoing State investigation to me ..... What are the potential outcomes—if you are aware of what they might be, Mr. Ossorio, as a result of that investigation? Would it be possible that they might look to revoke his license in Lee --- I'm just trying to get to the licensure piece of it. I am certain there could be fines and probation imposed, but I'm trying to get the license component and whether there is any jurisdictional authority that the State may have. The reason for that is we wouldn't want to give him a license and then have the State say he can't have a license." 9 February 18, 2015 Michael Ossorio: The State will not tell you that you cannot have a license but they will tell you that you cannot have a corporation any longer. We have an obligation to abate the Citation. I am not saying that the Application was in good faith but he did submit it, pursuant to the Ordinance. I believe we have a duty to go ahead and abate the Citation. But my recommendation is to not hear this case other than to deny the application for six months until he gets his Order from the State of Florida because this could impact Lee County as well." Chairman White: "Rather than waiting six months, if we deny his application, can we re-time it so that he does not submit another application before the determination is made? I don't want to set an artificial time longer than it may take the State." Michael Ossorio: "If the Board denies his application, we would abate the Citation in the first place. If the State imposes a punitive measure—or doesn't impose—and his credit score is about 580 or 590, you might not see the application or I might approve the application because he has a Letter of Reciprocity from Lee County. And he is in good standing with Lee County—his corporation papers are in order and there is no issue with the credit score for his corporation. Theoretically, you might not see the [resubmitted] application." Chairman White asked if there were any other questions for the Applicant. Richard Joslin moved to approve denying the application. Ronald Donino offered a Second in support of the motion. Carried unanimously, 9— 0. Chairman White noted the Citation would be abated and the amount of the fine would be reduced. VII. OLD BUSINESS: (Note: With reference to the case heard under Section VII, "Old Business,"the individual who testified was first sworn in by the Attorney for the Board.) A. Luis Escobar—Review of Probation Chairman White stated Mr. Escobar was appearing before the Board for a review of his probationary license and asked him if there was anything that he would like to tell the Board. Luis Escobar: • Regarding his credit report, he stated the large amounts from the previous credit report ($72,385 — SunTrust Mortgage) "were gone, really." • He explained each open item on the credit report (dated January 21, 2015) as follows: o AllianceOne— ($255) —has been paid in full. Confirmation#1170146 o Ally Financial — ($5,276) —has not contacted them yet o Amex—($6,664)—has not contacted them yet o Cach LLC — ($51,056)— an attorney was hired to negotiate a settlement 10 February 18,2015 o Capital One—($2,982)—have made two payments—the balance will be paid off in four months o CBE Group —($230) —has been paid in full o Chase—($8,127) —has not been contacted yet o CitiFinancial—closed o Debt Rec Solutions—($4,444)—has not been contacted yet o FCO — ($1,715) —have paid 50% of the balance and the remainder will be paid next month o Public Records: • Civil Judgment: Vet Hospital ($209)—has been paid in full • Civil Judgment: Ford Motor Credit ($4,212)—amount has been reduced to $2,400; paying $200 @ month until December 2015 Mr. Escobar explained that, initially, he could not speak with all of his creditors because he knew he couldn't pay them all at once. He could only pay a few at a time, and negotiated settlements with the ones he could pay off first. He will contact the others within the next two months. Kyle Lantz explained his interpretation of Mr. Escobar's payment philosophy: He is starting with the smallest payments and working his way up to handling the largest amounts, i.e., whittling the list down to a more manageable size by paying off the ones that he could first. Luis Escobar agreed and noted he still needed a cash flow to keep his business going and to keep paying off his creditors. He was paying off the creditors he could as soon as he could. The ones that have not been previously contacted will be during the next two months. Kyle Lantz questioned Luis Escobar: Q. It seems like you are making "baby steps" on your personal credit report—you are paying things off? A. (Agreed—nodding his head) Q. How is your business going? Is it doing well and are you paying all your bills? Do you have any back payments due to any of your suppliers? A. No. The business credit report dated January 27, 2015 doesn't show any open accounts. Mr. Escobar noted his major supplier is Korbin Builders Supply and he has a$5,000 line of credit with Korbin. He also buys supplies from both Home Depot and Lowe's but pays in cash. He stated—gesturing with his credit report—"Let me tell you one thing very quickly —this is my issue. I don't have any more issues. I am paying everything—you see, I am taking care of the big ones—even the ones that are not supposed to be in here. I am taking care of the small ones." He further stated: "I am doing the right things—I am paying the people. My customers—I am trying to make happy. My employees—I am trying to make happy, too, at the same time." 11 February 18,2015 He continued: "I am fine. We are doing pretty well. We are handling all of our money pretty good—keeping the money we need to pay the jobs—to pay the people on time ... we are doing the right things." Vice Chairman Lykos: Q. Do you remember the business plan you gave us and the sales charts you gave us? Do you refer back to those? A. Yes. It was five percent per month—we are exceeding that a lot. Q. For example you had projected approximately $25,000 in sales for the last three months of 2014. What kind of sales volume did you do for those three months? A. We made about $75,000 for the last two months. We are providing services to AA Stucco & Drywall and that will be another $20,000. By the end of December, about $150,000 for November and December. Chairman White observed: • Mr. Escobar has paid approximately $6,000 since his last appearance before the Board. • He still owes approximately $26,000 to various creditors that he has not contacted. • He still owes approximately $51,000 on the mortgage with Wells Fargo Bank. Chairman White asked Mr. Escobar how much he would need each month in order to pay off his other debts. He commended Mr. Escobar for providing a business plan, as the Board asked, and for the update he provided. He noted Mr. Escobar has managed to pay approximately $6,000 in back debt while incurring the cost of hiring an attorney (approximately $6,000). He was impressed that the company's sales had exceeded its goals, but he expressed concern at the amount of time it would take Mr. Escobar to completely pay off his debts. With reference to the Green Tree foreclosure, Mr. Escobar hired an attorney to have the item removed from his credit report. He stated the balance should be "zero" because he had paid it. He paid $6,000 to his attorney to fight the additional charges Green Tree is trying to charge him. With regard to the Wells Fargo mortgage, Mr. Escobar stated he is working with the bank to make payments for the next 24 months. Chairman White asked Mr. Escobar if he knew how much money he would need on a monthly basis in order to pay off his bills. He acknowledged that Mr. Escobar had made a "modest amount of progress" in the nine months that his case has been before the Board and has been managing his business appropriately because his sales and profits have exceeded the goals in his business plan. His concern was for the amount of time it would take—a"substantial amount of time"—before Mr. Escobar would be able to pay off his bills and "wrap this up." Luis Escobar agreed and noted that during his first appearance before the Board, he stated he planned to pay off everything within three years. He stated he did not want 12 February 18, 2015 to lie to the Board by claiming he could pay his debts sooner ... he reiterated "in the worst case" it would still take an additional 24 months to pay everything. He stated he is picking up a little more business each month—he "knows" his business will be even more profitable. He continued he knew the Board wanted him to show results. Terry Jerulle expressed concern that there was $24,000 of debt and Mr. Escobar had not contacted the creditors concerning those debts to try to resolve the issue. Chairman White explained that if a debtor make contact with a creditor but was unable to immediately begin making payments, the effort would not reflect positively. In many cases, it was considered as a"refusal" to pay. Richard Joslin pointed out the Board's only concern should be the license that was granted to Mr. Escobar—not how he would pay off his debts or when. He noted the Board had previously terminated probation for some Contractors because they had showed a reasonable attempt at reducing their debt load. Mr. Escobar's recent credit history showed that he has been able to pay "something"to his creditors. His recommendation was for the Board to allow Mr. Escobar the opportunity to work and to continue to monitor him. Richard Joslin moved to approve continuing Mr. Escobar's probation and allowing him to work for a period of six months, at the end of which time, he is to return to the Board to present an updated credit report. At that time, he will also present a list of creditors that he had contacted and those whom he has paid. Mr. Joslin suggested to Mr. Escobar that he concentrate on paying the smaller debts of$200 to $300 first before tackling the larger debts. Luis Escobar reiterated he needed to keep money to continue to pay his suppliers and employees and to re-invest in the business going. He noted General Contracts usually wait the full 45 days before paying him and he needs to have enough money on hand to bridge the gap. He explained that his wife is also helping him—"we are in, I think, the right way"—but his goal is to get his life back again and buy a house. Gary McNally offered a Second in support of the motion. Comment by Vice Chairman Lykos: • If the Board's intention is to monitor a Contractor until all his bills are paid, that's one thing. If the Board's intention is to make sure that a Contractor is "going down the right path," then that's a different goal. We need to decide which one of those two we are going to take responsibility for and then act accordingly." • "I don't know how much we should expect to have done in three months or six months." • "We are looking for intent and we are looking for progress." Chairman White agreed and suggested a time frame of nine to twelve months. He stated he would not vote in favor of the motion. 13 • February 18, 2015 Richard Joslin objected, stating he thought the Board should not wait for twelve months to review Mr. Escobar's anticipated progress. Chairman White countered that substantial progress should be demonstrated by the end of nine months. He stated if the Board saw what it was hoping to see at that point, the case could be closed. Vice Chairman Lykos concurred stating that six months might not be enough time to see a trend—that Mr. Escobar was making the progress the Board wanted. Kyle Lantz stated he didn't care if Mr. Escobar paid off any of the bills. He explained his understanding of the Board's responsibility was to ensure that Luis Escobar did not harm the residents of Collier County. He further stated it appeared that Mr. Escobar's business was in order; he was paying his suppliers and employees. He concluded by stating he did not feel the need for Mr. Escobar to return to the Board every six months to prove that he was on the right path. Chairman White reiterated his opinion, i.e., nine months was the optimum time frame and the Board should be able to teiniinate the probation at that time. Michael Boyd stated he didn't know why the Board was requiring Mr. Escobar to return at all noting, that he had raised his credit score by 30 points in three months. He further noted the Board had granted licenses to two individuals whose credit scores were lower than Mr. Escobar's current score. Richard Joslin stated he wanted Mr. Escobar to return in six months because, if he made the same amount of progress at that point as he has, then he would vote to terminate the probation. He further stated he would not change his motion. Chairman White called for a vote on the motion. The motion failed by a vote of"3— Yes/6—No." Chairman White moved to approve extending the probationary license of Luis Escobar for an additional nine months, at which time, he is to return before the Board to present an update credit report. Vice Chairman Lykos offered a Second in support of the motion. Vice Chairman Lykos noted that as long as the Board was shown continued progress by Mr. Escobar at the end of the six months, he would vote to terminate the probation. Chairman White called for a vote on the motion. Motion carried, "8— Yes/1 —No."Richard Joslin was opposed. VIII. PUBLIC HEARINGS: (None) IX. REPORTS: • Michael Ossorio noted there was an interest in developing a regional website for Contractors Licensing Boards of Cape Coral, Lee County, Charlotte County, Port Charlotte and Sarasota. The goal is to better communicate with other jurisdictions 14 February 18,2015 concerning unlicensed activity. The website is currently under development. He will keep the Board informed of any progress. • Michael Ossorio introduced Joe Nurse, the new Licensing Compliance Officer, to the members of the Board. Mr. Nurse is a Naples resident who returned to Collier County after serving in the U.S. Navy as a Senior Chief for 26 years. X. NEXT MEETING DATE: Wednesday, March 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 11:00 AM. COLLIER COUNTY CONTRACTORS' LICENSING BOARD PATRICK WHITE, Chairman The Minutes were approved by the Committee Chair/Vice Chair on , 2015, "as submitted" [ 1 OR "as amended" [ 1. 15 Z/S) /21e- ci gIng Cdoite-r CA:runty k GMu-Operations & Regulatory Management ,v-1--- ar- �.. Licens' i'n 00 J . Drive i • f 28 _ aU ? Fl. 34104 2015 ` 4'7 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 Name: NP.apol/#a n Irfe- Servg e.. Fiction Name/DBA: Qualifier Name: Mo fMe4/ft•Rambo Physical Address: 13 q5 dutries+on SI, De ti l f.2.2 A/Jples, FL 34/10 (Number& Street) (City) (State) (Zip Code) Mailing Address: IV; Ctiari S+ n 51. be. y hf 42.2, Naples/ 34///Q (Number& Street) (City) (State) (Zip Code) Telephone: (ui) 614 N j 0 Ai E-Mail: fhei vec l er0 5 48111/.IO Le m 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 ❑, wimming Pool $230.00 ❑ Roofing $230.00 G.1 Specialty $205.00 Specialty trade: 'ree- Con-trAU{'ar 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. MAfth& RAMb# �3�15 Ckt,lest•n N^ vn lld- 2e. MkpleS, F(. lib to (23?)el v-/D2i 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. 14anv 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. et%&he_ AFFIDAVIT I, /"'do-i"61e0 1 '* ")b certify that the foregoing is true and correct tot ! my knowledge. 727717/ , Authorized Officer of the Firm STATE OF FLORIDA COUNTY OF L -(i:'1 The foregoing instrument as acknowledged before me this 211 2 // 5 (Date) By 477W`..s �„7✓ " O of t)e f'ro. 1461,-, r'rt'-C rl )f:L L. L, (Name of officer, title/agent) (Name of Corporation) a 1=1 P...! p A Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced j• .-< s tit/ IC k^", identification and did not take an oath. (Type of identification) NOTARY'S SEAL """• 'J.GARY SHIRK " "/ 1 Ai '�;a�"Oa'• ` : Notary Public-State of Florida ( IGNATU eO O; ARY) 1 •_ My Comm.Expires Oct 27.2015 ' . tit . ;' Commission#EE 142041 'f ` 1 . Bonded Through National Notary Assn. Page 2 of 4 fimirgrlowqrms QUALIFIER INFORMATION: Name: MA 1+ RfMhb Address: 131f5 d,teifo-> 1. Dr. (MI4tea NAGS FL (Number& Street) (City) (State) (Zip Code) Telephone: (2.3 ) 96/"/OA( Date of Birth: 'ifii( 11a/ S.S.#: 000-00- tool E-Mail: - Y}V i )er OS 00 QMq it LOM Driver's License: R-6(t) -654, - ' ( - `t (u 0 Q 1. Type of Certificate of Competency for which application is made. ! rte.., G o ri 4 ra r- 2. The names telephone numbers of two persons who will know your/whereabouts. NItLC RAM', D a39 ' 76 a - 711/ s/ 1 A+ RambP — 0Q 7711- 3. Have you ever been convicted of a crime related to Contracting? /Vd (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? N0 8. List all debts you or any company(s)eassociated with you refused or failed to pay and reasons why. C.6 A.t*4 L 7 mot 9. List your business 0or work experience during the past ten years. 'c or / N•n0ra I1* OttSC}*r� 4r•M -f�+r. �pVt� in 'IDOL h1ork(J for M tietht'r.t lAr SLkpt-- csmpogs �*; .e' .f. .2on. (04e.4LI4. Cs+y of tJApks, fa-&•t d- Ut.G�vs er.n .2oa9- 2°ig 10. Statement of any formal training you have had in the area for which the application is made. y� AU "JS on eXeeet4nc.G. kidrk'ept tov CA+1+e-' 1 ( 'irk-Ape /b(ain4C'/7 n(G Comp, 4.60.4 hAs (�>!Cr1 Ore,e-A-t^�i, to G•tttC✓ Cv,,n �� S4'- L LIT Phe ed f- t.4vv d G l Nup�c t fog 5� y�Ar-c, Z Was SE�1 t►r- 100,01S cape_ -{-cc,�+. (,✓i4it +41c... r s 4 ,4 4 r-t e. 3 e is t PIP+ +AC- el4y. 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 February 2, 2015 Official Score Report: Candidate Information: Name—Matthew Rambo Candidate# 56814110R Testing Site: Ft. Myers, FL Final Score Result: Business Procedures Score: 84% These results represent the grade that has been achieved on the Business Procedures examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on January 31, 2015. 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 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report February 6, 2015 Official Score Report: Candidate Information: Name—Matthew Rambo Candidate# 56814110R Testing Site: Ft. Myers, FL Final Score Result: Tree Contractor Score: 82% These results represent the grade that has been achieved on the Tree Contractor examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on February 6, 2015. 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. APPLICANT(PLEASE PRINT) NhApeIl+0n Ietc Sert/lte. LL.L NAME OF COMPANY SIGNATURE OF APPLICA T STATE OF FLORIDA COUNTY OF The foregoing instrument as acknowledged betore me this 2 C/5 � .�; (Date) / By fr` / I `/s' RA 4 C) who has produced pLrSorc./Lr (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL ,s;.V ;e. J.GARY SHIRK IGNATURE •• Nil,A`Y) `s. Notary Public-State of Florida •% •' :•s My Comm.Expires Oct 27,2015 •r` ,. .� Commission#EE 142041 Bonded Through National Notary Assn. Page 4 of 4 AFFIDAVIT IT IS understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. / 7; SIGNATURE OF APPLICANT NEA.Pe//big% T.;-/d &Cry it-C. L.L. C� BUSINESS NAME 2/9-4 /is DATE BEFORE ME this day personally appeared MAT#CN R4Mbp 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 G ALL(cSL The foregoing instrument was acknowledged bofore me this 2126 5 by J-A!/ �'✓ M/1"-"n-'6C) (Date) who has produced Pie(Teo 4/40 (name of person acknowledging) (Type of identification) is identifir•ntinn and who did not take an oath. SIG k'ATURE OF No, • J.GARY SHIRK j Ry'+U , ; Notary Public State Oct Florida,2 S�/�e �'�1��,�,'¢pR�r�� s pct 27.2015 ia� Commission#EE 142041 (PRINT NAME OF NOTARY PUBLIC) Bonded throu4b National Notary Assn. NOTARY PUBLIC '''''I 4 .* • A • • • N • � DO , . GMD Operations &Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive /�� r,' Naples,FL 34104 Applicant's Name: i R- ( aa'th p Certificate Category Requested: re{, Coi14tath r 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 sign' g below and verifying Applicants relevant experience: Name: Th v7.S &S A Title: a §f iC ' .t 9 5 SveVE' tense Number(if applicable): 44 4 Name of Business: C-1 6 40/es- Business Address: a 70 R rvia rs J e circle iglus 1` 3y7 od- Business Phone: d37- eo 13 - 7'3?The Applicant's years of experience from 34)61/471 to ( /d 0/ / The applicant's scope of work work(specific duties)included: Tee AP('mell a� ' teA4e ic, t/ ("se vltit,tt .%P ir,�.( s ft— , Hat..�'�' tl lc �� a ticJ s%,rv4 v Additional Comments: 4a Alla Falsifying any information provided herein may subject your license to revoe, '"n. / Signature State of Florida Print Name: j�,pt t�/t D AAs'M e- - County of Collier The foregoing instrument was acknolvledged before me on this 2 b7 day of F& 8 FEregliAlAr i 2c24 S by 7124 ice/$ Artkotionwr who is personally known to me or produced as identification and who did not take an oath. _ ' i. — — — — — — — — — — — Si: re o `otary i s3r4;e,,� J.GARY SHIRK ' r `'r Notary Public-State of Florida ' s My Comm.Expires Oct 27,2015 il V • ��� Commission EE 142041 di, Bonded Through National Notary Assn. VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations &Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: r A41—hesU R4, b C Certificate Category Requested: I r e C,pf-tra* De The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement.You should verify time of active experience working as an apprentice or a skilled worker(e.g.as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name.Title and license number of the person signing below and Verifying Applicants relevant experience: Name: i4e-64her° 'Melds Title: Co»^I-s-s G+ MA niler (Arho rt 54) License Number(if applicable): A//4 Name of Business: C.1 j of fat pie 5 Business Address: `2'7 b R I,/f c 1 de.. CI rd IVA p es1 R. 34(02- Business Phone: .251- d213 — '? 1. -7 The Applicant's years of experience from 5f:Zoa1 to 4 Jaa i 4 The applicant's scope of work(specific duties)included: Ir<e_ 47'0-vAIfq don Di r'e,-i ((AI , 1 lon4.11)61,s tc -gees a not Sllrobs . QrnAmert-fra -Frt mkt t net- Additional Comments: Falsifying any information provided herein may subject your license to revocation. ce" Signature Pint Name: fi e q1 1 e r S k ; e t State of Florida County of Collier t The foregoing instrument was acknowledged before me on this �O" d of rt�is 1 t 1 2 0 l 5 by, who is personally known to me or produced as identification and who did not take an oath. I Signaaof Notary ,..�l°".o J.GARY SHIRK .�,.aY NmB% r° `o Notary Public-State of Florida • My Comm.Expires Oct 27.2015 ' 1 P; Commission#EE 142041 •.F (F. + �,„` Bonded Through National Notary Assn. 8 VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations &Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive 4411e- 5 Naples,FL 34104 /�/� Applicant's Name: / la 0 R '4 ha r a r Certificate Category Requested: I rte.—rte.— ��(a r 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: Joseph 6.9SG6iej,//,A. Title: a rL a/Ar/uvn t lj v (I (icense l c+� . fs per-,n'f Cn enT License Number(if applicable): /14 Name of Business: C I 4 of iJ&ek s Business Address: of--)0 RI V'r c/4e C.t t-ck. f Ar Fes F.-L 3C{j D 2. Business Phone:.23A-0213 7 CS 7 The Applicant's years of experience from Slap ell pto 6r�r2 D II, The applicant's scope of work(specific duties)included: c.. 7r'/MM t`1►J1 a''Pe trf fl o Wov(, - Orn,trl e^-tA/ -1,-1 m of l�j• ('(a n+1"Ids 0- -Fee-es a n sC 'L'b S Additional Comments: rrP, i Falsifying any information provided herein may subject your licens, to revo:lion. . % y� "'1 Si'fir: re ?�- State of Florida Name: V 1 2// County of Collier �f,, The foregoing instrument was acknowledged before me on this ZC day of re ilit%Iiiter 4.j 2.e)1s by who is personally kno� roduced as identification and who did not take an oath. LI '.1 ` J.GARY SHIRK t S' ture of Notary j `..urn,... l,Jty�YiB.yi 1 io -.1`o: Notary Public-State of Florida i ' h 41 My Comm.Expires Oct 27,2015 1 ,��le "�sc Commission EE 142041 6 ( '��.�rJ:CS Bonded Through National Notary Assn. P AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER k1 �1 ( C�✓ am a resident of Co County, t'° (State) and have resided here for more than five o a� (")years. Kan During the last five years I have known a 14j0 (Applicant). I have had the opportunity to observe his or her business and personal dealings and find him or h:. to be a person of honesty, integrity and good character. (Signature) (Name) I 00 //Q! (Address) 290 £'*'s 4 L r/cit Aeej ?z 3 giaL Telephone) 23 9-2/3 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 2 2 - b tt�� by ow >8 6WLIA- (,fat-) 4 who has produced � P.SOol'a./ ".,u-A4-- (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIG TURE OF NOi/ 4 f .5-,4 410/€' NOTARY'S SEAL (PRINT NAME OF NOTARY) — — — - - - - - '_ — — ' NOTARY PUBLIC +++�+��• J.GARY SHIRK .`iiav Nom. .ate. «+ Notary Public-State of Florida -•« �+ .•;My Comm.Expires Oct 27,2015 X11--«J Commission#EE 142041 td`•- Bonded Through National Notary Assn. P 10 • AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER am a resident of 651 1( !/ County, Rorf'dit (State) and have resided here for more than five (5)years. During the last five years I have known Ma RQM.Cpp applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a pe.son of honesty, integrity and good character. (Signature) 'r�L (Name) /V V(S a145`ti'd (Address) .3 S// 3.94' 4/E-- ItiV6s /4eL Telephone) 3 31 - 3oY°49r/" STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 2 26 ! by ( ate) 771406//5 AlS24 f b 7 who has produced esescr. / kN 1s-1 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. if �, f --Awcomone, A STC17ATURE OF NOT4 "" '''u . J. Y HIRK (PRINT NAME OF NOTARY) p.�.`n: Notary Public-State of Florida NOTARY PUBLIC -.:T,+ �_ .•;My Comm.Expires Oct 27,2015 . � ';• Commission#EE 142041 �i,�OF F���� "�4... Bonded Through National Notary Assn. 9 RESOLUTION OF AUTRORTZATON - WHEREAS Cw 1 Itn t yL,_ t,C LLL (Name of Business Entity) proposes to engage in Contracting zs (Type of IegaI entity. .Collier County,Florida, corp.,rP partnership,etc. da according to Collier County Ordinance 2006-46,as amended;and WHEREAS AICA ft4 , r/�,e Servi4e I-4.t.. (Name ofBusess Entity) proposes to m qualify-fora Certificate of C o m p e t e n c y with MA/NW i✓ RAM6O (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned N,, of (Officers,Owners,Partners)N�relt+4 6% Trotyu. L'4'L.' • hereby resolve and represent to the Collier County (Name of Business Entity) • Contractors'Licensing Board that the qualifying a en g t,� R.t.Mb,, ,is active - in all matters connected with the cotrtruc ring business of Nt (Name ofIndividual) • �tLits-• Tits Stet,. 1.4.1--,and (Name ofBpusmess Entity) We further resolve and represent that MarYh!�,/ r�wMb 0 il - legally empowered to act for �i't G (Names of Individual) I1le.4 ewIf•� Servrty (Name ofBusmess Entity) in connected with its ^, c /Ay ontracting business,and has the authority to supervise construction undertaken by 4( Ne we nl t Fe•. 'rr,t� tom yl cat Batt . (Name ofBusrness Entity) vii DULY PASSED AND ADOPTED THIS G K day of 1_G6 , a•,S 4 I (Officers,Partners, . —with ,) Witness .. ! /- . / . 1 Witness - - Corporate Seal(IfApplicabIc) • • `may Or Notary Public Certificate Sworn to and subscribed before me this�4' ilay of t>/�' 1 ci JS by ys.�r� t.� ■ Notary Public Name Printed IT 6-4 AT' -5171/," • • - 40(MillIMP:" . Commission Number N Public= ;.,, - j My Commission expifes: i ,r �?oa "k� J.GARY SHIRK • -s Notary Public- ' State of Florida ? ■ :' �,` o, My Comm.Expires Oct 27,2015 ',,›F nr..,. Commission#EE 142041 • """". Bonded Through up National Notary Assn. COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel • SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN)for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. • Our office will only use your SSN noted above for those reasons pursuant to Chapter 119,Florida Statues ind as may otherwise be authorized by law. Ne are fully committed to safe-guarding and protecting your SSN and once collected,will be maintained as. :onfidential and exempt under Chapter 119,Florida Statues. • • • STATEMENT OF OWNERSHIP This certifies that I, qtked &MbD (APPLICANT'S NAME) am a member Or Managing member of 1 , ' .i .- 71Pt, S prv,ce- (LIMITED •:IUTY COMPANY NAME) I own I DU % of the units issued by the Limited Company listed above. y ted Liability Affidavit ofApplicant:.I certify that the information contain and correct statement to the best of my knowledge.contained is a true /44,4f tie`✓ Rambo (PRINT NAME) (APPLICANT'S • .212•6 ()S. • (fATTi) • • +I • j • rr r } j ! From June, 1994(Sears revolving credit card),June 2004(SunTrust Bank auto loan),January, 2005(Navy Federal Credit Union consolidation loan),March,2005(NY Community Bank real estate loan),September,2005(Chase credit card)and May,2007(Discover Bank credit card) all credit was paid as agreed. January 15,2002 I was married and my wife did not have good credit. She began using my credit to obtain other cards without my knowledge. She also had control of the checkbook and record keeping. I had no knowledge of what bills were paid and to whom. We did get approved for a real estate loan in August of 2005 and had two children while in the home. Then the recession dramatically reduced the value of our property which was eventually foreclosed on. The furniture loan (Citi Financial) unbeknownst to me was not being paid. Below is a listing of debts that,other than the CitiFinancial furniture loan,was not approved by me. Citi Financial: Opened 3/7(furniture) Capital One: Opened 10/10 World Financial: Opened 3/12 Midland Fund: Opened 10/13 Verizon: Opened 11/13 Progressive Insurance: Opened 2/14 ARS (medical): Opened 9/14 We separated in December,2013 and still accounts were opened and charged off in my name without my knowledge or approval. Our divorce became final in July,2014. Feb 11 15 11:25a 2392770167 p.1 Merit Credit Fast, Accurate & Secure. Phone: 1-239-277-3202 or 1-800-371-3348 Fax Cover Sheet: Requested Credit Report Attached! Please call if you have any questions. CONFIDENTIALITY NOTICE:This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act If you are not the intended recipient, please contact the sender and destroy all copies of the communication. Feb 11 1511:25a 2392770167 p.2 Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TFANS:JNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB) [INFILE] [DATE] :TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 1/01 02/11/15 10:2=CT [SUBJECT] fESN] [BIRTH DATE] RAMBO, MATTHEW R. -1009 11/81 [CURRENT ADDRESS] DATE RPTD] 774 N. 107TH AV., NAPLES FL. 34108 1/10 [FORMER ADDRESS; 175 LEAWOOD CI., NAPLES FL. 34104 4/05 FRANKLIN RD., CEIBA PR. 00735 [CURRENT EMPLOYER ANC ADDRESS] [RPTD] UNITED STATES NAVY 0/"..-- 3/04 M O D E L P R O F I I%'E ***FICO CLASSIC 04 SCO :f t-038,+575 : t-038, 013, 010, 020 *** C R E D I T * T O T A L F I L E H I S T O R Y PR=O COL=7 NEG=9 HSTNEG=2-25 TRD=14 RVL=6 INST=2 MTG=3 OPN=3 _NQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: S4624 $5900 S4248 $0 $85 28% MORTGAGE: $163K $ $ $ CLOSED W/BAL: $279 $279 $ TOTALS: $168K S5900 $4527 $279 $85 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED SPLACED CREDITOR MOP ACCOUNT4 VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 10/13 $950 WORLD FINANCIAL NE 098 8560985507 I/15A $950 PLACED FDR COLLECTIO PORTFOLIO RC Y 1KSE003 I 3/14 $545 CAPITAL ONE BANK U 098 5178057750905189 1/15A $545 PLACED FOR COLLECTIO PORTFOLIO RC Y 1KSE003 I 3/=2 $275 WORLD FINANCIAL NE 09B 826101599 1/15A $275 PLACED FOR COLLECT:O PORTFOLIO RC Y 1KSE003 I 5/10 $3458 CITIFINANCIAL INC 09B 2009140119680 1/15A $3458 PLACED FOR COLLECTIO ASSET ACCEPT Y 1E03001 I 5/12 $3086 01 NAVY FEDERAL CR 09B 122330093 1/15A $3425 PLACED FOR COLLECTIO ARS Y 2BQ4002 I 9/14 $601 MEDICAL 39B 000000000000000000 12/14A $601 PLACED FOR COLLECTIO CREDIT COLL Y 1GZDO05 I 2/14 $276 06 PROGRESSIVE INS 09B 512/5211 7/14A $276 PLACED FOR COLLECTIO T R A D E S a0 i 1.40d 2392770167 p.3 SUBNAME SUBCODE OPENED HIGIICRED TERMS _ ACCOUNT# VERFIED CREDLIM PASTDCE AMTDMOP PAYPAT 13-24 MOP ECOA COLLAT3L/rOANTYPE CLSD/PD BALANCE REMARKS CAP ONE B 1DTV001 10/10 $507 MO 30/60/90 517805775090 4/14A $300 $0 R09 SLDTO PORTFOLIO R 9/11F $0 PURCH BY OTHER LENDER NAVY FCU Q 692N001 4/02 $3300 406095600344 5/12A $3200 $0 R09 I CREDIT CARD 6/08F $0 FJRCH BY OTHER LENDER CITIFINANCIA F 7212001 3/07 $3457 607209141711 5/10A $2900 $0 R09 I CHARGE ACCOUNT 8/09F $0 PORCH 3Y OTHER LENDER VERIZON U 1R2W002 11/13 $279 5203925980 1/15A 09B I TELECOMMUNICATION 4/14F P279 $279 PLACED FOR COLLECTION US DEPT VETS V 9181031 6/12 $353 9959:641009 4/13A $,1 09P I GOVERNMENT OVERPA 10/12F $0 PAID COLLECTION US DEPT VETS V 9181001 6/12 $5184 99591641009 4/13A 09P I GOVERNMENT OVERPA 11/12F $0 PAID COLLECTION RCS MTG F 2BJK301 8/05 $208K 396M1171 11/10 55555 1000687784 4/11A $0 M05 C CONVENTIONAL REAL 4/11C SO rORECL03URE,CLT 05 GLTRL SLD 8 0/ 0/ 5 NY COMM BANK B 543T014 8/05 $208K 360M_11.71 4/09 55555555555X M05 4605985 8/10A $0 C CONVENTIONAL REAL BllOC $5031 OS XX554333211' $0 TRNSFRD: OTHER LENDER 27 3/ 3/14 SEARS/CBNA B 6256459 6/94 $14.2K 111111111111 RO1 5:2107181349 1/15A c15.0K $0 111111111111 A CREDIT CARD 5/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ C DISCOVERBANK B 9616003 5/37 $4624 MIN85 11i111_1111Z RO1 601100428270 A CREDIT CARD 1/15A $5900 $0 111111111111 $4243 29 0/ 0/ 0 NAVY FCU Q 692N002 1/05 $5928 60M134 43000429499601 8/G5A X11111 I0 $0 M CONSOLIDATION 8/C5C $0 ACCT CLSD BY CCNSUN_ER 6 0/ 0/ 0 SUNTSUST BK B 423A022 6/04 $37.9K 72M705 21500002155025915 8/058 111111111111 I01 $0 C AUTOMOBILE. 8/050 $0 CLOSED 11 LOSED 14 0/ Cl 0 NY COMM BANK B 543T014 3/05 $163K 36CM1358 3330771 6/05A 111 MO1 C CONVENTIONAL REAL 3 0/ 0/ 0 CHASE - CC H 247V018 9/05 $0 11 1111111111 RUR 182000000450 1/07A $1500 $0 1111 �dU i i a i i.caa 2392770167 p.4 C CREDIT CARD 9/050 $0 ACCT CLSD BY CONSUMER 16 0/ C/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME 2/1'_/15 ZNP6284423(FLA) MERIT CREDIT TYPE AMOUNT C R E D I T R E P O R T S E R V I C E D BY : 7RANSUNION 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 800-388-4213 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION MIDLAND FUND YC36ET009 8875 AERO DR SAN DIEGO ('844) 235-1959 PORTFOLIO RC CA. 92123 287 INDEPENDENCE VIRGINIA BEACHSVAQ323462 (800) 772-1413 ASSET ACCEPT YC1FJ3001 P03 1630 WARREN (800) 614-4730 ARS MI. 48090 1801 NW 66TH AVE FORT LAUDERD_ALQFL0233313 (954) 321-5957 CREDIT COLL YC1GZD005 (603) 570-4784 PO BOX 9134 NEEDHAN] MA. 02494 CAP ONE BC1D^V001 POB 30281 SALT LAKE CITY UT. 84130 (900) 955-70 70 NAVY .CCU QU692N001 820 FOLLIN LANE VIENNA (800) 336-3333 rrTIFINAPdCIA VA. 22180 605 MUNN ROAD FZ7212001 (800) 922-6235 FORT MIILL SC. 29715 VERIZON CRIR2W002 NATIONAL RECOVERY MINNEAPOLIS MN. 55426 (800) 802-1922 US DEPT VETS VZ9181001 POB 11930 ST PAUL RCS MTG N.V. 55111 350 S. GRAND AVENU LOS ANGELESM2BJCA. 90071 NY COMM BANK BB543T014 1801 E 9TH ST CLEVELAND {21 n') 696-2222 SEARS/CBNA 44114 PO BOX 5282 BC625645 459 SIOUX FALLS SD. 57117 DISCOVE_RBAN< B09616003 PCB 15316 WILMINGTON (800) 347-2683 NAVY FCC) DE- 19850 1 SECURITY PLACE MERRTFIELD QU692N002 (800) 914-9494 BY423A022 (877) 596-5407 K B T SU?ITRCS VA. 22116 PO BOX 85526 RICHMOND VA. 23285 CHASE - CC RE247VC18 P.O. BOX 15298 WILMINGTON DE. 19650 (800) 432-3117 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. °" I I "' I ° • ''G �' 2392770167 p.5 PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS :r yO3 HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800_371_3348 OR (233) 277-3202. lietail by entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS 6 Detail by Entity Name Florida Limited Liability Company NEAPOLITAN TREE SERVICE, LLC Filing Information Document Number L15000025197 FEI/EIN Number NONE Date Filed 02/10/2015 Effective Date 02/10/2015 State FL Status ACTIVE Principal Address 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL 34110 Mailing Address 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL 34110 Registered Agent Name &Address RAMBO, MATTHEW 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL 34110 Authorized Person(s) Detail Name & Address Title MGRM RAMBO, MATTHEW 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL 34110 Annual Reports No Annual Reports Filed Document Images 02/10/2015 -- Florida Limited Liability View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/13/2015 u an oy minty Name Page 2 of 2 apslau C and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/13/2015 Electronic Articles of Organization L15000S 00 AM For February 10, 2015 Florida Limited Liability Company Sec. Of State syoung Article I The name of the Limited Liability Company is: NEAPOLITAN TREE SERVICE, LLC Article II The street address of the principal office of the Limited Liability Company is: 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL. US 34110 The mailing address of the Limited Liability Company is: 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL. US 34110 Article III Other provisions, if any: TREE TRIMMING, TREE REMOVAL, STUMP GRINDING Article IV The name and Florida street address of the registered agent is: MATTHEW RAMBO 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL. 34110 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. I 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: MATTHEW RAMBO Article V L15000025197 The name and address of person(s) authorized to manage LLC: FILED 8:00 , 2 P O February 10, 2015 Title: MGRM Sec. Of State MATTHEW RAMBO syoung 1345 CHARLESTON SQUARE DRIVE UNIT 202 NAPLES, FL. 34110 US Article VI The effective date for this Limited Liability Company shall be: 02/10/2015 Signature of member or an authorized representative Electronic Signature: MATTHEW RAMBO 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. " IRS IERTLNR TREASURY INTRNAEVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 02-11-2015 Employer Identification Number: 47-3089452 Form: SS-4 Number of this notice: CP 575 G NEAPOLITAN TREE SERVICE LLC MATTHEW RAMBO SOLE MBR 1345 CHARLESTON SQUARE DR APT 202 For assistance you may call us at: NAPLES, FL 34110 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 47-3089452. 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. 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 electing 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 permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is NEAP. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. I From: Matthew Rambo ampmlandscape @gmaiLcom cc Subject: Date: March 5,2015 at 6:59 PM To: Matt Rambo thehumblerO5 @gmail.com ---� :. ;late�uuTn•.-..,,. A R1) CERTIFICATE OF LIABILITY INSURANCE 3/5/2015 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 tha poheyI ss)must ha andofc d. It SUBROGATION 15 WAIVED,subtact 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 en Neu of Such endorsement(s). 7 cOhtaCt PRARIX:ER t,ay,F Jessica Horneault PrimeGroup Insurance Services, Inc. DNAMF 1813 1288-9270 rxt 1013.11S-43U p IA,L N+t.lt sA.S MI 5402 W. Laurel St. .NAIL AyosE 5 7 norneaultP Pr ame rou ins teen Suite 220 In lntnislhirtt!ERNGCaYLRA6L NAIL. • Tampa FL 33607-1726 risurcitANorthfield Insurance CoapanY 04869 1NA IIP.:J "Millen a _--.-__..—.-'-- Neapolitan Tree Service, LLC .wsurar7C; 1345 Charleston Square Drive, Unit 202 .Iasunsso: - PlaUlitn t.- Naples FL 34110 PISUALPI1: COVERAGES CERTIFICATE NUMBER:CL153513993 REVISION NUMBER: HIS, 1 I.TIry THAT THE PI I'IF .r •.J.' Ir'.:.re.r-f!SFr;-F an 1,1 r-Avr FFr J “...T T1 -IF 'i ;Ine. r W•FC A1CtvE FOR-tiE 7-01.I17Y PERIOD r S:\tEL J,: i1TM lf.N IHG tip'NE0JI1404E11' TEN E; :ON:At ita OF ANY CO`lt I4 -I OR Of-i.R DO I t'E#".WITH RESPECT TO YIk CH THl°_ _IH.TIE:AIL t. HE ItIJED OR MAY FER-AN.THE Ih31_ A.J:E 1,F-ORDED al' IME P`JLI_:_S :E--_RISER HERE,.1 I5 SLSJEGT 10 ALL THE TERMS, r..l�t.l ••.1NF•rrlC .r.",'T t'NF:IiF SHC.,1"OLti;'ES Ut17E. -iiih r,ray 1-.4'vE BEEN pr(' - 1 FY.7-Alf... -„ .iti — — — .._ —iHrY tit /•rucY MCP ICIA IYl't f N:URANCt Bare ryp POLICY NIINVLA INPJ4c"r VYI IWK'Mt.YYVYI- LINT. r.FMERa. UaRti^r f 1 l 1,000,000' X i*►,?-1R 'EF.•-i?rk-,t:FV i j o c 100,0001 1 1 4i TaT5 ?.'417o:r. - c 5,000 A 'It:u.-Imp: :=I;'_rt�a I 115715051 - - .:+.I j II„IS, c 1,000,000 I- --- I I rtes.F..aYAEi.«.-E 2,000,000 L, xF.-E L1-r AFFL F .^_->: i I 2.000.000 a t'- � r 1 1 f 1 • 5,0001 111TANEALF:I.f0.t 1111 j i �F N7lL Sf't Teti, aF I i ._. F "1 '.+iCU OCHtL/JLtU t a .1i_ .t,i I”. i.7T•«.I S ..... . ._a-.:4111_: - I ...i i,.Arts. --_1 t :MARCO IA:IAA I N xe.. Rpr4,:5 IS '-"--j 1 3: LTf - VerF4>;t.*AA ',A it,W147€ 1 4:74 F °..:FE T I .: t4 U'I S W:,WLR'COYPthPATICN { j 01 IA/1 (V?M- ! rl4J Y•I".oYtnS LUIa1DIY t ULIY_l .� tlii Y:a, a r„t L( IK A! E Enr>;4s£rkrlT 5 IY.na IA,r.rail EL r_EAze EA ENPI.C.,•ESi 5 I.. e Lk II I d'_t,LI IL-V.I art t +o 1 i : E 1_G=Ea E °•,,,,L5,Ci i S• I •.rfSfnFTIP 41F.1PFF A'iiSNS:I.1".IC ATnk:'IF1ac_.FS,&nun AC 1Ft1 I-II AA3I1:n,1 R,ni,M,,,rnn,lt.1 maw.54a'•.a„1.....n. lI I 1 CERTIFICATE HOLDER CANCELLATION (239)252-2469 ftHUtsi O ANY Of THE ea wit D£BCRIREO POI felts BY CANCF1tED Bf rat* IrAf FSPIHATtON DATE THE IF(1F NONCE West HE DEIIVFRFD IN ACCORDANCE WITH THE POLICY PROVISIONS. GHD Operation a Regulatory Mangelaent Licensing Section 2800 North Horseshoe Drive urr.ra7Fn REPFftiNTa Irr Naples, FL 34104 E Ell sasser fA077187/ -- - '.---.--# - V ,,•..►....,_ Report Viewer 2/18/15,9:24 PM • 1 /1 (100% • ��tirir.e ,...0...e. JEFF ATWATER -_ CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** NON-CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 2/18/2015 EXPIRATION DATE: 2/17/2017 PERSON: RAMBO MATTHEW R FEIN: 473089452 BUSINESS NAME AND ADDRESS: NEAPOLITAN TREE SERVICE LLC 1345 CHARLESTON SQUARE NAPLES FL 34110 SCOPES OF BUSINESS OR TRADE: TREE PRUNING, SPRAYING, REPAIR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption torn 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 at-trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation it at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 https://apps8.fldfs.com/crrepor[viewer/reportViewer.aspx?data=kdv...ZxVwgiMsBKTGmMr2wzOK%2fmfGPpbrLIyENG%2fimvdxGT9oIMj4%2fivcA%3d%3d Page 1 of 2 1. COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION " . �E if __fii arc Ales,FL 34104 •` ' ,-1.;..-'," ,i: is Make Check Payable to:Collier County Tax Collector .ti / Phone:239-252-2477 Fax:239-643-4788 Website:www,colfiertaz.com , "o" '<V/•' ooxE� 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. (850-245-6052 or 6058) www.sunbiz.org enclosed) Copy of State license from Department of Business and Copy of Marco Zoning Certificate.(239-389-5040) Professional(850-487-1395)or Department of Health. /Completed Completed Zoning application with appropriate fee made payable to:Board of County Commissioners.(239-252-5603) Copy of City Business Tax Receipt.(239-213-1800) V Completed Business Tax Receipt application with appropri a fee made payable to:Collier County Tax Collector.(239-252-247 ) .. —�/ Copy of Motor Vehicle Repair Registration Certificate — from Department ofAgriculture.(800-435-7352) Other: �./ -;-0r L(Ge�l{.1112 f Siy/1 —G' r� Copy of Health inspection from Department of Hotels and Restaurants(850-487-1395)or Department ofAgriculture. Please contact the Property Appraiser's office at 239-252-8145 (800-435-7352) regarding g tangible tax. Sri VW L ice uJ wla d't eJ5 CHECK ONE: Date: ,7_,-.7 ✓✓ Original Application _ Transfer of License# Classification � �� fRenewalofLlceflSe# Code Number - -`/� License Amount 1) CORPORATE NAME- A i __. . I ; ?'r L seev ut- L c.(- la) DBA NAME- 1b) BUSINESS OWNER OR QUALIFIER'S NAME- 4ftheA/ m.'t1 ' 2) PHYSICAL ADDRESS- , q (,e,A,•les¢en S /a# pr, (No P.O.Box allowed) I L 2a) IS RESIDENCE USED AS AN OFFICE- v^tf •� 3) BUSINESS MAILING ADDRESS �Yes No DRESS-/3Yf Chgotsfo., ft?.Dr, fvn,1 a i a AA /e Street �° 3y/�Q' 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- Ctty Zip �3�/S Ghae-/es-1•,., Si Or „r..,} 2 s /1�'p/t„t� 5) TELEPHONE-Business: .2 s 1,I p g l ‘f- s yi t♦ Home: �3f -ft 4, / • /off / 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation ✓LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- 8) OFFICE WITHIN CITY LIMITS OF NAPLES- Yes ✓No If Yes,City License No._ 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. - 4/ 3 Osiq/7 s .see back of application for expla ation 9a) TYPE OF BUSINESS CONDUCTED: l rt-y ayo,k. 10) NUMBER OF EMPLOYEES-Including number of owners: 1 FILL IN THE APPROPRIATE AREAS- a)Rental units(motel/hotel/apts.)Number of units: 0 b)Seating Capacity(rest./cafes,etc)Number of seats: U c)Number of coin-operated machines owned by business or individual: 0 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�T ARE TRUE T THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: /�/^�" v/ // DATE: /7//� (Owner and/or representative of business)TITLE: TE. �! ****THIS LICENSE IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE SECTION A,B AND C FOR OFFICE USE ONLY THIS SECTION TO BE COMPLETED BY CONTRACTOR/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. 4` ❑Business DOES COMPLY with the Collier County Zoning Ordinance.--, Property Zoned: Signed: Ti ALLA Irk 1 J Date: •r Comments: Must Seetion 5.02.00 of the me THIS SECTION TO BE COMPLETED BY THE HEALTH DEPARTMENT SECTION C ❑Business DOES COMPLY with the local and/or State requirements. Signed: Title: Date: Collier County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GROWTH MANAGEMENT DIVISION/ NAPLES, FLORIDA 34104 PLANNING AND REGULATION 239) 252-2400 FAX (239)252-6358 www.colliergov.net LAND USE AND ZONING CERTIFICATE HOME BUSINESS 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. W/Orf f ‘Iddrts5. APPLICATION DATE i/I (/1 s ZONING CERTIFICATE# APPLICANT'S PHONE 23 41" G) /Da/ Business Tax Lic k APPLICANT'S NAME /dtAlfhtk) RAM be' APPLICANT'S HOME ADDRESS 1 3 II chm' les ton SI uA r-e.. Dr. v.)i4 Vda l')4pks, F'- 3+l•I P TYPE OF BUSINESS TO BE CONDUCTED GWoek. BUSINESS NAME(IF ANY) tQAt pO(I#4n Ire e Semite. LA's I, the undersigned, hereby affirm that I am the legal owner of the property at the above address or that I have the legal right to conduct the business described above at this address by virtue of my leasehold interest in this property, and that I have read, understood, and agree to abide by the provisions of LDC Section 5.02.00 "Home Occupations"(see back of application). <2-7;2,4'0 .a(/APPLICANT SIGNATURE DATE I� CODE NO: 11 ROMZ FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" TO BE COMPLETED BY COUNTY STAFF 4 03-N+""1 oir,;(r-1 ""7 IQ\IC_ ZONING: PROPER ID# REVIEWED BY t ' - APPROVED HOLD DENIED COMMENTS/RESTRICTIONS:_Must pomply with Section 5.02.00 of the LDC(see back of application). Tax Collector Staff:Clerks Initials _ Horseshoe Greentree Please forward a copy of issued certificate and receipt to the Collier County Zoning Services. 5-24-2011 ,a T i 1 a o „n° Q 5 co .g.. ` , , 2 ' z°„... 1.:(-)I.0 ''..,;,'",-r:;11'4 c a 'J Ln Wij co Q 1 Q *. N E 1 a 0 APPLICATION FOR LICENSING COVER LETTER SUBMITTED TO COLLIER COUNTY LICENSING BOARD 2800 NORTH HORSESHOE DRIVE NAPLES, FL 34104 I hereby apply to be considered for Contractor Licensing in the trade of Cabinets Installation by the Collier County Board. I understand that I was required to resubmit a new credit application because my credit was not in good standard. I fell behind on some of my credit obligations a few years ago because the construction industry dropped. I understand that it is my responsibility to keep my credit in good standard in order to succeed in this business. I'm currently working with a credit counselor and developed a plan to pay off creditors and maintain a good credit record. Singnature: . Date: 0 r4, /5 n • Co ty GMD Operations & Regulatory Management Licensing Sec _ 2800 North H• :\ ��rive O-.)0 ill- - 155 NaAlIckV4i 1 . 10.4 11-16 -Js 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: Cr p se,. 6,1sivy, 1`6 s/ 4C Fiction Name/DBA: Qualifier Name: /at U G._ Physical Address: /73 l ?'c;_c`. eas .2��/d (Number & Street) (City) State ( ) (Zip P Code) Mailing Address: S C2 . 4 S ate 113,.. (Number & Street) (City) (State)`(Zip Code) Telephone: ��- 3(2'6- i7 2( E-Mail: 4(�-rS�,rlyeJ p .,(a a TYPE OF LICENSE: Li General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 Diwimming Pool $230.00 ❑ Roofing 230.0 / r L[ Specialty $205.00 Specialty trade: Lf J1, s /61 Sr`'` (X CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 `' QUALIFIER INFORMATION: Name: jAav i Address: qvv5 L 3 Lilt 2. (Number& Street) (Ci ) (State) (Zip Code) Telephone: (2.-3 )3 I '3 3 1 Date of Birth: O-/j � o S.S. #: 000-00- S E-Mail: oiit�O1(L7ej-voce! ( ecru'+/ Driver's License: ® 6 2_0-540--' 5- 2 i'O- 0 1. Type of Certificate of Competency for which application is made. C 2. The names and telephone numbers of two persons who will know your whereabouts. e , fe,/ � c -S �- �Z 3�'t 73 y, 09 0-7 jo.-r Ld go A6 Q i— (z3el) 38 y— O-33 3. Have you ever been convicted of a crime related to Contracting? /• 0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? /Li 0 0. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. /v O 9. List your business or work experience during the past ten years. C? w.ei7 Dooms 10. Statement of any formal training you have had in the area for which the application is made. /vQA e_ Page 3 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. AcaiAu e L O\rosn_-- or s i �� (23 .56 3 I 4)00 53-m-ryr&J A- q 1.,. _ i 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. ,,-��v✓ t-IO e. 8 w ld e,/ , 13 e f G'vo rr ��nc�r� 6u L d s v. 're "1 ■ cav Er TTtr ✓∎S 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. +� rJ/4 AFFIDAVIT I, 140-vkv 0v-0 S'- certify that the foregoing is true - f• co 1. the best of my knowledge. ut •rized Officer of the Firm STATE OF FLOE'^^ COUNTY OF CO I I _ The foregoing instrument as acknowledged before me this 3 r n (D/20 e) /� By ve L Q'ccscx Pies,cle-r�� of 010S 0._. C S 1q-k, OC pv∎OVQ:11 (Name of officer, title/agent) (Name of Corporation) a (2 LW' Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced ft OLOe O-S,/a-, S-ZO -0 identification and did not take an oath. (Type of identification) NOTARY'S SEAL ?° n,otY Rce Notary Public State of Florida o Jose M Rodriguez cz My Commission EE080266 WV 1,4I 1�° o°° Expires 06!15!2015 (S - = OT-A"Y) � 7 Page 2 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. Mo v.v eJ-- Q s— APPLICANT(PLEASE PRINT) ao3Sa- ccu vow'\ 0ll A yoiNS -3.74,‘C_ NAME OF eMPAANA II ......1 SIGNAT RE O' AP"LICANT STATE OF FLORIDA COUNTY OF 4s-,(I t./ The foregoing instrument as acknowledged before me this tO SI/? / 5" (D e) By 4:›-v` i e...C cvV ..s co..._. who has produced (fit Qt- O62'.. 5 1 0.—9-5--l 2 o (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL Notary Ad/./�=.. "� ��y`<<r<;,, Public State of Florida '' ta, Jose M Rodriguez „���� Nt• i My Commission EE080266 (SI i NA �'T �i►�[��r`" ) �{ ltrOr y�o w Expires 06/16/2015 • Page 4 of 4 • AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, V i C T S_ 5O ,0 be-s , am a resident of CO VI I County, l„-" Co I i C-4=z-- (State) and have resided here for more than five (5) years. During the last five years I have known Ro_� 'e=(...„ 0/0 Sea--- (Applicant). I have had the opportunity to observe his or her business and personal dealings and find hi 1 or her to be a person of honesty, integrity and good character. ofge, (Signature) t ll' (Name) j,2/C-&AJT5 SZk 1 £Q1 (Address) gL(00 icrlA Akte. c0,-) f'Jc ffc R-- 3 y/f Telephone) ( Voi -1/1.-- / S=3 1 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 0 s/I°l Ze,/c by (D te) V1C /T�. Sv i r, bes who has produced k OL 544Z- 5'60-- C'! -a 2-g"--fo (name of person acknowledging) (Type of identification) as identification and who did not take an oath. ao4°LY°`8�n Notary Public State of Florida ' digJose M Rodriguez / y�� My Commission EE080266 4eoo�o� Expires os»s�2ais SIG IAT(JIVE / f OPARY Ave r& . /tin - Z NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, C c br f e L aos c-dc, , am a resident of Co( h County, C L-0i‘ _ (State) and have resided here for more than five (5) years. During the last five years I have known fr&0-v\._0 e-L ar O S c - 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) 11911100'''w (Name) ` A ■0 ';SO (Address) Z& Z-0 LA i4 Piv-,es- (v --4(O /`J ✓c5 (c- y//Z Telephone) jz )36Z — 1333 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this OS//9 2o/ `'' by te) acdtcL. 20 5c-do who has produced ct-Ot—if z3I-2e-o _9 j--53 0 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. ce ll% Notary Public State of Florida /A al►- ? Jose PEA Rodriguez � */ ` My commission EEO80266j(`;N/AT ' + '�'Y 'F'.OF F,o" Expires 06115/2015 NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC 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. aid SIGMA •E'I F APPLICANT �(( 0Os — CAI S770 (eikfrovc Qv‘s BUSINESS NAME 0 C/05/20 `74 DATE BEFORE ME this day personally appeared vet__ 0(c5,=1• 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 a I / 112,01 7 (Da e) by f1/4-k.4+/t Of 05 who has produced FC_0C. 0620— 5•Y�v gs---Z9 2 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. ti*aY ou8 Njotary Public State of Florida Jose M Reariguez 14Afti / . My Commission EE080266 SIGNAT •E • ' ► • ' • Of cG°& Exp'sres 06t15l201c •' +",~1 nor it-k . a. NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLI NOTARY PUBLIC 4 Q ik 4#014* lk >%%f$AW /1 ,0/ ,4,01 h 01 4 0 ' ''Ar- * NqVX:(40:. ' To 44.4. jakvo 4A-.*. AVP tkv.00 4'..:ttrii-13:1' 4 .',1:t A-4 *-#' tk :4 * iaf' -Ilk 1 .. "i:r A 4: 4! 0 b40,,,g1 014 41t+1, ' 'c",-;' P:: ,9- ,-, , -,-. .. ,. ,,, , ,., c, +- 40.4 vs% 4 N ° C 0 or,a �lii►• Cl) 0 ' w o ti/1A. 2 C c CD ( p 4%». ♦` P. o CD CD CD ° C) 4-4104 Oil V Air - o (,:, S *TA 0 ‘0104 %, ■ 2 0') i-).-' R. y i) p. 'xi' �l� CD _ �,� 4 4. )4 g' HI 0- r a p(9" 0 'a; 77 w,``,,o A = w p,-)3. ( s kc '4 a 0 't, 2 ci) sva . .' . . . o u liiii .®<., �� 0 0 �-t 1' or ; ti■VP( �. O o o c.,.., i 0 ,_,. r--1 ait., 4. § 4 .la 0 V 0 o d j X11.Pkt0I4r. 110 4,f4 ',--' ?--t 0 ',.: .0. `t� Ar.: : LO tk r " t fi P,-1:1... 4 , f4 � '' t -14,16: A4 a► �, , . 4. [ :-400 _, . RESOLUTION OF AUTHORIZATON WHEREAS &co So.—Cw` T a eSN6 t.' Q 1,N.TiAcproposes to (Name of Business Entity) engage in contracting as �q- oyr - fc%'v-._ in (Type of leghl entity:corp.,partnership,etc. Collier County, Florida, according to Collier County Ordinance 2006-46,as amended;and WHEREAS 0(0.—(e-- CO a Jea.0e./M its A r p ses to (Name of Business Entity) qualify for a Certificate of Competency with kQ ie'L. Orif'0--( -- . (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned +'''re-.5 i clei7 of (Officers,Owners,Partners) 010-SaiXV sQ:+ v.3%,/c1-ivo, 03Tcjereby resolve and represent to the Collier County (Name of Business Entity) Contractors'Licensing Board that the qualifying agent, ►VlaAN.ue.l ( OS®— ,is active (Name of Individual) in all matters connected with the contracting business of Q-ia C:�,�w� v∎aJ,c.�-�a v\s,and I (Name of Business Entity) We further resolve and represent that e_C_OVA is (Names of Individual) legally empowered to act for 04c.S4.--Ct.r l ieNi ev ovc iI, "-S Tin matters connected with its 1,( .01 (Name of Business Entity) contracting business,and s the authority to supervise construction undertaken by iCk C'u ',k,`` k�,Q�cr�i o��sv��-- (Name of Business Entity) DULY PASSED AND ADOPTED THIS /' day of Mal , 21,/ (Officers,Partners,Owners—with Des'Ai a •�, demeath) . 5 >. ,r Witness Witness Witness Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me this/q day of ,Z/�/`/'by • A ' 011° - ..1—c)5-e_ NV, t2c)c 1c�_ / ra a1 ;� , . � Notary Public Name Printed Notary i u•l. Air Commission Number CC 08-oz4 4, My Commission expires 0 61/al Zor S' t„'p.Y Pu@°o Notary Public State of Florida Jose M Rodriguez Na o` My Commission EE080266 140,,,,4' Expires 06/15/2015 VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: !? /0 0�_6 g o s o Certificate Category Re q uested: 6 (S I VI£3 pg 0 Cc ' U ►..E f, 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: L- i & (`:© l'° a Title: K e s 1 d v ' License Number(if applicable): Name of Business: —r ..' .1( A ) )ve 60 l ` A E\ 3 .5 vC fi h 1 A � vc S P _ :W// Business Address: ��?.� ( � � /v P //� Business Phone("2 3 3) 26 8'yZ� e Applicant's years of experience from 2 Of?s to zoo The applicant's scope of work(specific duties) included: , Tt2 i with c. �k p v. eava c vl 's , /Ttc.i l4 tpAS Additional Comments: / L--0 0„- sel t_J 0 <CC E- J Falsifying any information provided herein may subject your license to revocation V Signature Print Name: Cu i S 6'Q vvk e:7._ state of Florida ":ounty of Collier The foregoing instrument was acknowledged before me on this day of kit t a �, /`, ,y (,v l S Cr)c vv`e.Z— who is personally known to me or produced GS7c c27— G'').---3 3 G -'y rs identification and who did not take an oath. o ar due, Notary Public State of Florida f f!14,�aA : 6 Jose M Rodriguez Signature of ot.r ,a_,--. if My Commission EE080266 '4,0 i.° Expires 06/1 5/2015 ['VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples,FL 34104 Applicant's Name: / '14,w 0 f2x)sA Certificate Category Requested: ] U' c T 11-o �J(s 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: L7 D -6/7 C..Title: ?1Lt d 4 License Number(if applicable): (..-CC' f 2®OO/ 12 2. 1 IO3&1 d \Jame of Business: 41:44 Ei Aire r Cl C ' '°" "A(Ads A S- `�i` ? � Lite; a ur�tr L 3`-tl� 3usiness Address: _ �� ��-��� U tt�R. �( / �/ 1 3usiness Phone(2$ 2 -elrei The Applicant's years of experience from Z3 0 to Qe"6T / Ile applicant's scope of work (specific duties) included: R.,AV`J'E,1-- .1 'A.b a'ICAX r..e &i 1 t!4S AWE• C A t...1%Vv Cply 1,....,1 * cz*3e s A,t✓A VA, mac. e.J /15 e1- a o15 x.61 war' �� \�.1A 11/4/j , , kit" gt' A 1--1 %S -✓N"-A•R.) L� :Gt-). additional Comments: �-� r alsifying any information provided herein may subject your license to revo .do,. Signatu e •• / Print Name: -DAM/01 ;tate of Florida ;ounty of Collier /".40---,1 p ,he foregoing instrum t was acknowledged before me on this-(4, day of / 2017 ,y a (y v,, (JP(r(p who is personally known to me or produced/ �. s identification and who did take an oath. % 4s3 F Notary Public state of Florida Ali , 4 A , , : ErSignature of N.080266 41 es 06/15/2015• or COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SER VICES DIVISION 2800 N.Horseshoe Dr. • Naples..Florida 34104 • 239-403-2400 e FAX 239-403-2334 MEMORANDUM • • • DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. • SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. • We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statues. • • • • • . , GITS, LLC Examination Operations Division . Providing the services and products to assist Government Agencies to make informed educated decisions. • • • . . .. . . • • - Official Examination Score Report • • . , . • . . • • . • lilt'. [4''":. IN' 1 . . ........7,......":-.,,P:-...77(7••:".7-.?."".",3•':`.7. 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'.4..'../ . ...c.•................'511.:..ii...X..L,.6,.t,•..f,';'''',...:t.ilit: ', .. :I .•...:1;.4 '.1,'".". • :' ‘ Fr• , r / ••, . .t.t.',••'' • -.,„,,::•:::- . L.17.'" '... ',--,.., ,.,...4k,„.,..,.,....., . , , ,... . „ .:, ,, ••• I •.:• •, . .IldNfirif :...:•.':• *''....• "........'.':. , ...c.r....4.4.rt.. ...'r:.'"•—•'4,vt 49,iyirt.:t ....: ..-.• . . . • 1 0* I 2,0 .30' 40: •1. t•;'.. Vs'' 1 1.'.a.1 I tCI , . • • . • . . . * . • . • • . . • . . • • . . • • •. . . . . PO Box 831127 Ocala,Florida 34483-1127—Voice(352)369-GITS -Fax(352)387-2443 800 997 2129 • • FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS r f Detail by Entity Name Florida Profit Corporation OROSA CUSTOM RENOVATIONS, INC. Filing Information Document Number P12000076371 FEI/EIN Number 46-0959040 Date Filed 09/07/2012 Effective Date 09/07/2012 State FL Status ACTIVE Last Event AMENDMENT AND NAME CHANGE Event Date Filed 07/30/2013 Event Effective Date NONE Principal Address 1732 TRADE CENTER WAY NAPLES, FL 34109 Changed: 03/10/2015 Mailing Address 1732 TRADE CENTER WAY NAPLES, FL 34109 Changed: 03/10/2015 Registered Agent Name & Address OROSA, MANUEL 1732 TRADE CENTER WAY NAPLES, FL 34109 Address Changed: 03/10/2015 Officer/Director Detail Name & Address Title P OROSA, MANUEL 1732 TRADE CENTER WAY NAPLES, FL 34109 Annual Reports Report Year Filed Date 2013 04/18/2013 2014 04/24/2014 2015 03/10/2015 Document Images 03/10/2015 -- ANNUAL REPORT View image in PDF format 04/24/2014 -- ANNUAL REPORT View image in PDF format 9 ' 07/30/2013 -- Amendment and Name Change View image in PDF format 04/18/2013 -- ANNUAL REPORT View image in PDF format 09/07/2012 -- Domestic Profit View image in PDF format May 19 14 02:56p 239-277-0167 2392770167 p.2 I A - _ J . Merit Credit INC Fast,Accurate&Secure. 12734 Kenwood Lane#85 Fort Myers, FL 33907 (Mailing address only) DATE RECEIVED REPORT TYPE F o CONTRACTORS/BUSINESS LICENSING 05/19/2014 BUSINESS R REPOSITORIES: PREPARED BY: EXPERIAN ATP ....] . APPLICANT ADDRESS NAME: OROSA CUSTOM RENOVATIONS,INC 3906 ARNOLD AVE * STE C SSN/FEIN: 46-0959040 NAPLES,FL 34104 PUBLIC RECORD CERTIFICATION THE REPORTING BUREAU CERTIFIES THAT: PUBLIC RECORDS HAVE BEEN CHECKED ON ALL COUNTY, STATE AND FEDERAL LEVEL, INCLUDING PINELLAS COUNTY FO.R JUDGEMENTS, FORECLOSURES, GARNISHMENTS, BANKRUPTCIES, TAX LIENS, AND OTHER LEGAL ACTIONS INVOLVING THE SUBJECT(S) WERE OBTAINED DIRECTLY THROUGH THE REPOSITORIES USED, OR BY DIRECT SEARCHES,OR A PUBLIC RECORDS SEARCH FIRM OTHER THAN THE REPOSITORY,OR BY ALL METHODS WITH THE FOLLOWING RESULTS: PUBLIC RECORDS LEARNED: --0 -- l' BUSINESS HISTORY PRINCIPAL: MANUEL OROSA TITLE: PRESIDENT 11 DATE FILED: 09/07/2012 STATUS:ACTIVE NO INFORMATION WAS FOUND AFTER CHECKING THE FOLLOWING DATABASES: TRADE PAYMENT DATA UCC FINANCIAL STATEMENTS PUBLIC RECORDS COMPANY BACKGROUND BANKING INFORMATION CORPORATE RECORDS SOURCE OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS FLORIDA DEPARTMENT OF STATE/DIVISION OF CORPORATIONS • MERIT CREDIT: Telephone 239-277-3202 or 1-800-371-3348 Toll Free FAX 1-239-277-0167 This information is furnished in response to an inquiry for the purpose of licensing or evaluating credit risks. The information furnished must be held in strict confidence and complies with the provisions of Public Law 91-508,the Fair Credit Reporting Act, May 19 14 11:OOa 239-277-0167 2392770167 p.2 • Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] (I) Z NP6284423 MERIT CREDIT 16 NP 2/05 05/19/14 10:O3CT [SUBJECT] OROSA, MANUEL OROSA 7R ►SRNI [BIRTH DATE] [ALSO KNOWN AS) 6516 8/85 PEREZ,MANUEL,OROSA [CURRENT ADDRESS] 4005 CINDY AV. , NAPLES FL. 34112 [DATE RPTD] [FORMER ADDRESS] 1/13 3906 SW. 14TH ST. , LEHIGH ACRES FL. 33976 2255 MALIBU LAKE CI. , #335. NAPLES FL. 34119 2/11 [CURRENT EMPLOYER AND ADDRESS] [POSITION] A F C ELECTRIC [VERF] [RPTDI [HIRE] ELECTRICIAN 4/12 4/12 4/11 S P E C I A L M E S S A G E S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES) *** M O D E L P R O F I L E * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +524 : 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=O COL=7 NEG=3 HSTNEG=2-11 TRD=13 RVL=10 INST=3 MTG=0 OPN=0 INQ=7 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $4281 $4350 $1014 $0 $40 77$ INSTALLMENT: $32.5K $ $27. 7K $0 $763 CLOSED W/BAL: $1271 $1271 $ TOTALS: $36.8K $4350 $29.9K $1271 $803 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS PIN CRED SER Y 1KM3001 I 12/09 $1150 12 BANK OF AMERICA 09B HC03350 5/14A $3465 PLACED FOR COLLECTIO RJM ACQ LLC Y 1M7S003 I 5/12 $275 08 BANK OF AMERICA 09B 229R016345763 4/14A $275 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 10/08 $1435 CITIBANK USA N A 09B 8529316731 4/14A $2302 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I CHASE 10 c / E BANK USA N A 09B 8537217245 4/14A $1610 PLACED FOR COLLECTIO EOS CCA Y 49XV008 I 11/09 10 AT T MOBILITY 09B 2769979 1/14A 1794 PLACED FOR COLLECTIO • May 19 1411:00a 239-277-0167 2392770167 p.4 • I CREDIT CARD 5/06C SO ACCT CLSD BY CONSUMER 9 0/ 0/ 0 CB/A&F C 1BDT001 11/05 $210 80418 5/06A 11111 Rpl I CHARGE ACCOUNT 4/06P $300 Sp , 06P $0 ACCT CLSD BY CONSUMER 5 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME 5/19/14 ZNP6284423 (FLA) MERIT CREDIT TYPE AMOUNT 5/02/14 BNC6199555(FLA) BK OF AMER 3/24/14 ZPA2492327 (KIN) REFERENCE SV 12/21/13 FPC1246538 (NTL) COAF 1/29/13 FPC1246538(NTL) COAF 1/27/13 FPC1246538(NTL) COAF 6/14/12 BC_I5512716(DAY) FIFTH THIRD C R E D I T R E P O R T S E R V I C E D BY : TRAMSUNION 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 800-888-4213 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION PIN CRED SER YC1KM3001 POB 5617 HOPKINS (952) 939 8100 RJM ACQ LLC MN. 55343 YC1M7S003 (800) 268-0623 575 UNDERHILL BLVD SYOSSET NY. 11791 MIDLAND FUND YC36ET009 (800) 825-8131 8875 AERO DR SAN DIEGO CA. 92123 EOS CCA YC49XV008 (888) 317-3598 700 LONGWATER DRIV NORWELL MA. 02061 NCO FIN YC73CJ021 (877) 273-3495 POB 4935 TRENTON NJ. 08650 AFNI YC96ER007 (800) 371-3645 PO BOX 3097 BLOOMINGTON IL. 61702 CHASE BC26QK004 (800) 955-9900 P.O. BOX 15298 WILMINGTON DE. 19850 BK OF AMER BC6331059 (800) 421-2110 PO BOX 982238 EL PASO TX. 79998 DSNB MACYS DC2A5T001 (800) 243-6552 PO BOX 8218 MASON OH. 45040 CAF FZ45WK001 (804) 342-6400 • 2040 THALBRO ST RICHMOND VA. 23230 CAP ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 CAPITAL 1 FA FA1W2K001 (800) 946-0332 CREDIT BUREAU DISP PLANO TX. 75025 CAP ONE BC1DTV200 (800) 477-6000 PO BOX 30253 SALT LAKE CITY UT. 84130 CB/EXPRESS CW8349001 PO BOX 182789 COLUMBUS OH. 43218 MID ATL FIN FZ1DMA001 15201 ROOSEVELT CLEARWATER FL. 34620 FST PREMIER BZ41PF023 3820 N LOUISE AVE SIOUX FALLS SD. 57107 CB/A&F CZ1BDT001 May 19 1411:00a 239-277-0167 2392770167 p.3 NCO FIN. Y 73CJ021 I 5/12 25116283 ftigp 11 DIRECTV 09B 2/13A PLACED FOR COLLECTIO AFNI Y 96ER007 I 8/08 2/09F 1023032226 10 SPRINT O9P 11/09A $0 ACCT INFO DSP BY CSM T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS ACCOUNTS MAXDELQ PAYPAT 1-12 MOP VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS CHASE B 25QK004 6/05 $1228 MO 30/60/90 514923312000 11/10A $400 $0 R09 I CREDIT CARD 1/08F $0 DISP INV CMP-BY C-RNTR BK OF AMER B 6331059 4/05 $1130 4470 1/08A R09 I CREDIT CARD $600 $0 12/07F $0 PURCH BY OTHER LENDER DSNB MACYS D 2A5T001 4/05 479193214 12/07A R09 I CHARGE ACCOUNT 12/07P CLOSD / $1271 CLOSD BY CRDT GRANTOR CAF F 45WK001 1/13 $32.5K 60M763 1/14 123222212111 I01 14871151 4/14A $0 C AUTOMOBILE 03 111 527.7K 15 6/ 1/ 0 CAP ONE B 1DTV001 9/11 $389 MINIS 6/13 211211111321 RO1 517805826058 4/14A $300 $0 $82 03 111111111111 I CREDIT CARD $299 30 3/ 1/ 0 CAPITAL 1 FA F 1W2K001 4/12 $18.8K 72M415 111111111 I01 62062102940241001 1/13A $0 C AUTOMOBILE 1/13C $0 CLOSED 9 0/ 0/ 0 CAP ONE B 1DTV200 2/09 $1020 MIN25 111111111111 RO1 526835002133 12/12A $950 $0 111111111111 A CREDIT CARD $715 45 0/ 0/ 0 CAP ONE B 1DTV001 2/07 $1850 111111111111 RO1 517805730894 8/09A $1750 111111111111 T CREDIT CARD 29 0/ 0/ 0 CAP ONE B 1DTV001 6/07 $812 111111111111 RO1 400344701637 7/09A $750 111111111111 T CREDIT CARD 25 0/ 0/ 0 CB/EXPRESS C 8349001 9/05 $0 111111111111 RO1 35743 9/08A $300 $0 111111111111 I CHARGE ACCOUNT 4/06P $0 ACCT CLSD BY CONSUMER 35 0/ 0/ 0 MID ATL FIN F 1DMA001 9/04 $7733 26M303 111111111111 I01 6698401 12/06A $0 11111111111 I AUTOMOBILE 12/06C $0 CLOSED 23 0/ 0/ 0 FST PREMIER B 41PF023 1/06 $268 111111111 R01 517760731326 10/06A $300 $0 • May 19 14 11:00a 239-277-0167 2392770167 p.5 • PO BOX 182789 COLUMBUS OH. 43218 BK OF AMER PO BOX 982238 B 6199555 (800) 421-2110 REFERENCE SV EL PASO TX. 75998 101 PLAZA, EAST SLV EVANSVILLEZ 2492327 (812) 474-9000 COAF IN. 47715 3905 N. DALLAS PAR PLANO F 1246538 (888) 396-2623 FIFTH THIRD TX• 75093 38 FOUNTAIN SQUARE CINCINNATIB 5512716 (513) 579-5353 OH. 45263 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Mar 13 1503:37p 2392770167 p.1 1 fi Merit Credit : Fast, Accurate & Secure. Phone: 1-239-277-3202 or 1-800-371-3348 Fax Cover Sheet: Requested Credit Report Attached! Please call if you have any questions. CONFIDENTIALITY NOTICE:This communication with its contents may contain confidential and/or legally privileged information. It is solely for the use of the intended recipient(s). Unauthorized interception, review, use or disclosure is prohibited and may violate applicable laws including the Electronic Communications Privacy Act.if you are not the intended recipient, please contact the sender and destroy all copies of the communication. Mar 131503:37p 2392770167 p.2 • Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FCR] [SUB NAME] [MKT SUB] (INF:LE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 2/05 03/13/15 15:45CT [SUBJECT] rcCn11 [BIRTH DATE] ORCSA, MANUEL OROSA JR. -6516 8/85 [ALSO KNOWN AS] PEREZ,MANUEL,OROSA [CURRENT ADDRESS] [DATE RPTD] 4005 CINDY AV., NAPLES FL. 34112 1/13 [FORMER ADDRESS] 3906 SW. 14TH ST., LEHIGH ACRES FL. 33976 2/11 2255 MALIBU LAKE CI., #335. NAPLES FL. 34119 [POSITION: [CURRENT EMPLOYER AND ADDRESS: [VERF] [RPTD] [HIRE] A F C ELECTRIC ELECTRICIAN 4/12 4/12 4/11 M O D E L PROFILE * * * ALERT * * * ***FICO CLASSIC 04 ALERT: SCORE +598 : 038, 013, 010, 008 *** 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=O HSTNEG=2-20 TRD=13 RVL=7 INST=3 MTG=0 OPN=0 INQ=8 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $4281 $4350 $189 $0 815 96% INSTALLMENT: $32.5K $ $24.OK $0 8763 TOTALS: $36.8K $4350 $24.2K $0 5778 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 11/10 $1229 CHASE BANK USA N A O9B 8537217245 3/15A $1646 PLACED FOR COLLECTIO RJM ACQ LLC Y 12475003 I 5/12 $275 08 BANK OF AMERICA O9B 229R016345763 1/15A $275 PLACED FOR COLLECTIO TSI/09 Y 2C1R017 I 5/12 3/15F $357 1. DIRECTV O9P 25116263 3/15A $0 PAID COLLECTION TRADES SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASFDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CAPITAL ONE B 1DTV001 9/11 $389 MIN15 6/13 211211211121 RO1 51 7805826058 2/15A $300 $0 $82 03 121111132111 I CREDIT CARD $189 40 6/ 1/ 0 CAF F 45WKO01 1/13 $32.5K 6OM763 1/14 123213321123 I01 Mar 13 15 03:37p 2392770167 p.3 14871151 1/15A $0 03 222212111111 C AUTOMOBILE $24.OK 24 9/ 4/ 0 CAP ONE AUTO F 1W2K0C1 4/12 $18.8K 72M415 11_111111 I01 62062102940241001 1/13A $C C AUTOMOBILE 1/13C $0 CLOSED 9 0/ 0/ 0 CAPITAL ONE B IDTV200 2/09 $1020 111111111111 ROl 526835002133 12/12A $950 111111111111 A CREDIT CARD 45 0/ 0/ 0 CAPITAL ONE B 1DTVOD1 2/07 $1850 111111111111 RO1 517805730894 8/09A $1750 111111111111' T CREDIT CARD 29 0/ 0/ 0 CAPITAL ONE B 1DTVO01 6/07 $812 111111111111 ROl 400344701637 7/09A $750 111111111111 T CREDIT CARD 25 0/ 0/ 0 CB/EXPRESS C 8349001 9/05 $0 111111111111 ROI 35743 9/08A $300 $0 111_11111111 I CHARGE ACCOUNT 4/06P $0 ACCT CLSD BY CONSUMER 35 0/ 0/ 0 MID ATL FIN F 1DMA001 9/04 $7733 26M303 111:11111111 I01 6698401 12/06A $0 11111111111 I AUTOMOBILE 12/06C $0 CLOSED 23 0/ 0/ 0 FST PREM:ER B 41PF023 1/06 $268 111111111 RO1 517760731326 10/06A $300 $0 I CREDIT CARD 5/06C $0 ACCT CLSD BY CONSUMER 9 0/ 0/ 0 CB/A&F C 1BDTOOI 11/05 $210 11111 RO1 80418 5/06A 5300 $0 I CHARGE ACCOUNT 4/06P SO ACCT CLSD BY CONSUMER 5 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 3/13/15 ZNP6284423(FLA) MERIT CREDIT 2/251:5 ZMI065186C (FLA) PREMIUM CB 2/13/15 BNC6199555 (FLA) BK OF AMER 1/19/15 ZSN5952757 (SCT) SARMA 5/19/14 ZNP6284423(FLA) MERIT CREDIT 5/02/14 BNC6199555(FLA) BK OF AMER 3/24/14 ZPA2492327 (KIN; REFERENCE SV 12/21/13 FPC1245536 (NTL) COAF 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 disc..osures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION MIDLAND FUND YC36ETOO9 (844) 236-1959 8875 AERO DR SAN DIEGO CA. 92123 RJM ACQ LLC YC1M7S003 (800) 268-0623 575 UNDERHILL BLVD SYOSSET NY. 11791 Mar 13 15 03:37p 2392770167 p.4 TSI/09 YC2C1R017 (877) 273-3495 PO BCX 17205 WI LMINGTON DE. 19850 CAPITAL ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 CAF F245WK001 (804) 342-6400 2040 THALBRO ST RICHMOND VA. 23230 CAP ONE AUTO FA1W2K001 (8C0) 946-0332 CREDIT BUREAU DISP PLANO TX. 75025 CAPITAL ONE BC1DTV200 (800) 477-6000 PO BOX 30253 SALT LAKE CITY UT. 84130 CB/EXPRESS CW8349001 PO BOX 182789 COLUMBUS OH. 43218 MID ATL FIN FZ1DMA001 15201 ROOSEVELT CLEARWATER FL. 34620 FST PREMIER BZ41PF023 3820 N LOUISE AVE SIOUX FALLS SD. 57107 CB/A&F CZ1BDT001 PO BOX 182789 COLUMBUS OH. 43218 PREMIUM CB Z 0651860 (800) 322-8825 24:2 NW 87 PLACE DORAL FL. 33172 BK OF AMER B 6199555 (800) 421-2110 PO BOX 982238 EL PASO TX. 79998 SARMA Z 5952757 (800) 955-5238 1801 BROADWAY SAN ANTONIO TX. 78215 REFERENCE SV Z 2492327 (812) 474-9000 101 PLAZA EAST BLV EVANSVILLE IN. 47715 COAF F 1246538 (888) 396-2E23 3905 N. DALLAS PAR PLANO TX. 75093 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED 3Y THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0_ SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Mar 13 1503:37p . 2392770167 P.5 • • • Premier Profile-OROSA CUSTOM RENOVATIONS,INC MIS• Subcode:970135 Ordered:03/13/2015 15:46:39 CST :Lii:Experian- Transaction Number C500771892 IP • lt Search Inquiry:OROSA CUSTOM RENOVATIONS.1NC/3906 ARNOLD A world of insight AVE/NAP LES/F U34104-3374/US/964128899 Model Description:Inlelliscore Plus V2 Business Name ‹... Business Identification Number .2. s OROSA CUSTOM RENOVATIONS, INC. t,;-----;:," 964128899 Leos Primary Address: 3906 ARNOLD AVE NAPLES,FL 34104-3374 ilkThis business is the ultimate parent. Seethe corporate hierarchy by clIcking_here lop a Risk Dashboard . : Risk Sepivitiii4OredttAtitgec*itnOtitiatiolk:-..':'' .• payi-tsonoTet* 1- '- 00991.0.4*.:141964.''.:*:":.::'..4'.:f_ratICI?.4640 Intelliscore Plus Financial Stability Risk Company DB7 Original Filings High Risk Alerts • :;'„A.: '• HIGH RISK a a T. , HIGH RISK i Unavailable . ,. . -•_. , MI Score range:1 -100 percentile Credit Limit Recommendation:$1,000 rep a Years on File; 3(FILE ESTABLISHED 09/2012) State of Incorporation: FL Date of Incorporation: 09107/2012 Business Type: Profit Contacts: OROSA MANUEL-PRESIDENT TOP Commercial Fraud Shield Evaluation for:OROSA CUSTOM RENOVATIONS INC, 3906 ARNOLD AVE, NAPLES. F L34104-3374 .j.4400414;44-:.::: :.: .:,,.•,;',-*:':.. :f.:.''.:',:::::,•';'',:'.: ...: -i.!. -7:..!'1'. -;.. . 1::.v.. :,:.:;, :::,.:, :. ":+4rifliiiiitililig ,,'.-....,'*::.. The primary Business Name,Address,and Active Business indicator: I/1 Experian shows this business as active Phone Number on Experian File were reviewed for High Risk indicators,no High Risk indicators were found. Possible OFAC Match: 142-1 No OFAC match found Business Victim Statement: ricill No victim statement on file .. , TOP 0 Credit Risk Score and Credit Limit Recommendation .:.,!.404**04,*:;0,0,44 ,01„.-,-,.. ;:.:4: ':-•-:.-.;.-..,:-.:.:',,:,;:f;;..::_::::, .. ::.:.,. -.t..; :.:,..-,, ::--,,,,: ,.::, . .::...:.,....,:,.:: : : .:; :: ., .: ..::: .. .-„ : . Current InteIliscore Plus Score:6 Risk Class: 5 . L.,,..titeit —sfe, The risk class groups scores by risk into ranges of similar performance.Range 5 is the highest risk,range 1 is the Premier Profile-OROSA CUSTOM RENOVATIONS,INC 1/4 Mar 13 1503:37p 2392770167 p.6 • lowest risk. High ,A„g.,,:4,,,gigiftiolligt , . Low 6 1.0 2 50 /5 100 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 NUMBER OF RECENTLY ACTIVE COMMERCIAL ACCOUNTS 5%of businesses indicate a higher likelihood of sevem delinquency. )NUMBER OF COMMERCIAL ACCOUNTS WITH NET 1-30 DAYS TERM NUMBER OF COMMERCIAL COLLECTION ACCOUNTS AGE OF MOST RECENTLY OPENED COMMERCIAL COLLECTION ACCOUNT Quarterly Score Trends • • 90 80- 70 80 4. The Quarterly Score Trends provide a view of the • • likelihood of delinquency over the past 12 months for this business.The trends will indicate if the score improved, ao remained stable,fluctuated or declined over the last 12 • - • 30- months. 20 4 • - " • • 1111111101 . . . . • .• *No score average available for this quarter drerlitAlsk Scoca:Financial-Stability Rh*, : ... •,:. Current Financial Stability Risk Score:3 Risk Class: 5 01201231110 • • • 3 . High 0111111.0.2000 • Risk The risk class groups scores by risk into ranges of similar Risk performance.Range 5 is the highest risk range 1 is the 3 lowest risk. 6 3 10 .0 160 This score predicts the likelihood of financial stability risk within the next 12 months. The score uses tradeline and collections information,public filings as well as other variables to predict future risk.Higher scores indicate lower risk. Factors lowering the score Industry Risk Comparison ) NUMBER OF ACTIVE COMMERCIAL ACCOUNTS 2%of businesses indicate a higher likelihood of financial stability risk. NUMBER OF COMMERCIAL COLLECTION ACCOUNTS ) NUMBER OF COMMERCIAL ACCOUNTS ) RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR Credit Limit Recommendation This recommendation compares this business against similar businesses in the Experian business credit database.It is based on trade information,industry,age of business and the Intelliscore $1.000 Plus.The recommendation is a guide.The final decision must be made based on your company's business policies. top et Premier Profile-OROSA CUSTOM RENOVATIONS.INC 214 Mar 13 1503:38p 2392770167 p.7 ;P:41.i.41)01.005.1746.00:-"':':'. 1.1*011: 001,*ritaglantfl ' .;:. Current DBT: Not Available Total trade and collection(1): $3,136 Bankruptcy: No Predicted DST: N/A All trades(0): $0 Tax Lien filings: 0 Judgment filings: 0 Monthly Average DBT: 0 All collections(1); $3.136 Sum of legal filings: 60 Highest DBT Previous 6 Months: 0 Continuous trade(0): 50 UCC filings: 0 Highest 138T Previous 5 Quarters: 0 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended; N/A Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms not available lndustiyComparlson Industry DBT Range Comparison The current DBT of this business is Not Available. DBT for this business: Nat Available tef businesses DBT Range -5 6-15 16+ TOP Collection Experiences Date Placed Status Original Balance Outstanding Balance Date Closed Agency Agency Phone 05/2013 Open Account 63,136 63,136 NATIONAL CHECK TRUST (951)431-5256 TOP Additional Business Facts " 7. •`; * ‘.- ' : , : THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA.THE DATA IS CURRENT AS OF 03/13/2015. State of Origin: FL Date of Incorporation: 09/07/2012 Current Status: Active Business Type: Profit Charter Number: P120000763 Agent: OROSA MANUEL Agent Address: 3946 ARNOLD AVE NAPLES,FL TOP e Corporate Linkage The inquired upon business,OROSA CUSTOM RENOVATIONS,INC,is the Ultimate Parent OROSA CUSTOM RENOVATIONS,INC 3906 ARNOLD AVE-NAPLES,FL 964128899 Branches of the inquired upon business: OROSA CUSTOM RENOVATIONS,INC 1728 55TH TER SW APT B-NAPLES,FL 992524820 TOP 0 Inquiries Business Category MARIS FEB15 JAN15 DEC14 NOV14 OCT14 SEP14 AUG14 JULIA ACCT SVCS Totals 1 3/4 Premier Profile-OROSA CUSTOM RENOVATIONS.INC Mar 13 15 03:38p 2392770167 p.8 TOP 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 shaft 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 C'Expertan 2015.All rights reserved. Privacy policy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. Premier Profile-OROSA CJSTOM RENOVATIONS.INC 414 Mar 13 15 03:38p 2392770167 p.9 • mum 'IT Merit CredCredit Fast,Accurate& Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- E00-371-3348 OR 239-277-3202. COMPANY NAME:OROSA CUSTOM RENOVATIONS, INC FEDERAL ID:46-0959040 CURRENT STATUS: ACTIVE PRINCIPAL(S):MANUEL OROSA TITLE: PRESIDENT DATE INCORPORATED:09/07/2012 A 15 DDS CERTIFICATE OF LIABILITY INSURANCE DATE(MMID YY) 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 HAMS CT Patti Muzzonigro G&P Insurance,Inc. IPV"cONE ExtL (239)353-3500 lam.No): (888)353-9910 4930 Golden Gate Pkwy ADDRESS: pattimuzzonigro @allstate.com Naples,FL 34116 INSURER(S)AFFORDING COVERAGE NAIL# Phone (239)353-3500 Fax (888)353-9910 INSURER A: Cypress Property and Casualty InsuranceCompany INSURED INSURER B: Orosa Custom Renovations,Inc INSURER C: 1732 Trade Center Way INSURER D: INSURER E: Naples,Fl 34109 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUER POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR MD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 © COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ ❑ ❑ CLAIMS-MADE ❑ OCCUR 20P0056502-0 MED EXP(Any one person $ 5,000.00 A ❑ N 05/19/2014 05/19/2015 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000•O © POLICY ❑ 28-i- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ fil❑ AUTOS ❑ AUTOS NON-OWNED (Per PROPERTY DAMAGE $ HIRED AUTOS ❑ AUTOS ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE _S ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ❑ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractor and Licensing Board THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N Horse Shoe DR Naples,FL 34104 AUTHORIZED REPRESENTATIVE FAX(239)-252 2469 kik.p))146/44 I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)OF The ACORD name and logo are registered marks of ACORD iii‘tip--- --..'94: I:{4:°'.. ........._.. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 5/7/2014 EXPIRATION DATE: 5/6/2016 PERSON: OROSA MANUEL FEIN: 460959040 BUSINESS NAME AND ADDRESS: OROSA CUSTOM RENOVATIO 1700 55TH TER SW APT B NAPLES FL 34116 SCOPES OF BUSINESS OR TRADE: CARPENTRY INSTALLATION OF CA Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 COLLIER COUNTY BUSINESS TAX RECEIPT oF�KE-S � lid APPLICATION h t� _�� ggF a[ 5 W.. , N_ O Mr 2800 N.Horseshoe Drive,Naples,FL 34104 t��.I I[ a Make Check Payable to: Collier County Tax Collector e' ' '' = Y tY ti =` Phone: 239-252-2477 Fax: 239-643-4788 Website:www.colliertax.com roo e 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- (kd' Cam`_SNTovvN (6),4A0 ' —P cw\S la) DBA NAME - lb) BUSINESS OWNER OR QUALIFIER'S NAME - Q-v'LcI-e- Gfo.S n 2) PHYSICAL ADDRESS- .4 7C3 0 S5 T— Tiqv-30J ,, 6 ,prrr'�s 1-'3 yi f (No P.O.Box allowed) / / VU 2a) IS RESIDENCE USED AS AN OFFICE - 1 Yes No 3) BUSINESS MAILING ADDRESS - gam_ Street City „ a Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- Lt()Q.S` ( 'j V161 1Q I is 'm it, F�1 4/1q 5) TELEPHONE-Business:(Z , 36 Z-- 593 I Home: / 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnerships Corpo ation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 06I/0'7 2®`e__ 8) OFFICE WITHIN CITY LIMITS OF NAPLES- Yes_No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. - - —1 to - 0 9 .5-9 OLIO *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: C.44,1 ✓'a-7r 5 Q—(/c-77( "r 10) NUMBER OF EMPLOYEES-Including number of owners: d- 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 THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: >' DATE: D'S /'9/20/ `-/ (Owner and/or representative of business)TITL : ****THIS LICENSE IS NON F NDABLE FOR BUSINESS STATED ABOVE**** • • CDeta,lan-3f a morn.,--=es c=:r___.__ anY Snh ery tesr c-' a.' • • • r' () ROSA CUSTOM RENOVATIONS , INC BUSINESS PLAN Manuel Orosa • 2014-2015 I. EXECUTIVE SUMMARY Orosa Custom Renovation, Inc. (hereinafter "business") is formed as a Florida corporation located at 1732 Trade Center Way Naples FL 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 cabinet installation service, which has the potential to dominate the market. Mission Statement Orosa Custom Renovation, Inc. is committed to building relationships for the future through honor, integrity and trust that achieve our client's goals while having a positive influence on community and industry. Business Description The business is organized as a corporation. Formed and authorized under the laws of the State of Florida, and will be led by Manuel Orosa. Mr. Orosa is a skilled leader with an intense passion and focus on exceeding client expectations. With more than 8 years of experience and client first approach to manage the success and price value of Orosa Custom Renovation, Inc. In addition he conducts quality reviews of critical aspects of projects including job progress, schedule adherence, quality control, and financial reviews. 11. BUSINESS SUMMARY The business is a startup business, providing clients with Stone Manufacturing. Orosa Custom Renovations, Inc. will produce excellent services with the highest levels of quality. We will use all available resources including our relationship, 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 archived when our clients can say that it was a great experience and they would hire us again. Excellent and Quality Everything rises and falls on leadership and everyone at Orosa Custom Renovations, Inc. is a leader. We will develop effective leaders that are influential to the success of the corporation while adhering to our core values and principles. A healthy and safe environment to our employees is a top priority to the company. The environment and culture of our workplace will motivate, encourage and promote our people and their talents. We want our people to feel the best work experience they can possibly have. We recognize that career and family life should be balance and in accordance with our values and principles. Integrity, everyone at Orosa Custom Renovations, Inc. should be honest, fair and reliable, having the courage to do what is right in all situations. It is our responsibility to achieve our client's goals with the highest levels of integrity. 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 achieving their goals while making their experience enjoyable and successful. Orosa Custom Renovations, Inc. works diligently every step of the way 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 for total quality management from pre-construction through warranty administration. Our references represent a sample of satisfied customers, what they have in common is that they need someone with integrity they can trust who believes in taking the process to higher standard. Terra Home Builders Inc. General Contractor 4420 18TH ST NE Naples, FL 34120 239-253-4243 Re: Orosa Custom Renovations, Inc. 1732 Trade Center Way Naples, FL 34109 To Whom It May Concern: Our first project with Orosa Custom Renovations, Inc. 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. Mr. Orosa has been very professional and continuously follows up to make sure we are satisfied. Sincerely, Luis Gomez President Manuel Orosa 1732 Trade Center Way Naples FL, 34109 Phone 239-362-5931 E-Mail orosacustom @gmail.com Business Plan to perform work efficiently, professionally and pay off creditors. CREDITORS Monthly Payments CARMAX AUTO (14871151) $24.0K $ 763.00 MIDLAND FUND (8537217245) $1,646.00 $200.00 RJM ACQ LLC (229R16345763) $275.00 $275.00 T51 (25116283) $357.00 Paid in full CAPITAL ONE (517805826058) $189.00 $189.00 o o o 0 < m m - 0 0 m -° v c m y v m m o /n ,rt o o F v, m _ � � '" r' � � � v v 0 ✓ tv 00 ' --I ('— X Op ID X N -1 7 X• O N 0I X O O IZ [D LI 0 r"X Q °' X O_ 0 r_ n o) fD N o Y D) CA 00) m D X N 1" m T1 0) a 0 "to v, W Ui 0 rn 0 Lo 0 N w Oo•00 00 0 00 00 0o 0 T Z lD Y Y Y Y Cr 0 U1 0 U, UI 0 0 0 0 O W O O O O O O N• O O 0 N N Y N 03 U, 03 U7 O 00 UI ' 0 OUi 0 A W O 0 43.O O O O • O O D Y Y Y Y a O A ut Y A In O O O O N O O O O O O c O O 3 r N N N Y Iv C Ui a, " w a, 0 < X 00 00 0 0 w 0 0 2 00 00 00 00 0• 0 00 m c` 73 N N I-. 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O fn CD CD Z O O O ■ O N N (D O n O 3 To Whom It \lav Concern: I would like to address the issues that arose during the processing of nt■ license application for Air Conditioning — Class A. First and foremost. please know that it is my hope and goal to become a registered Air Conditioning Conti~actor with Collier County. This field and industr is my passion and it has always been my goal to hold my own license and to stan m■ own business. Please refer to the letter from the licensing agent.. in ..-hich they take full responsibility for making an error on tri> verification letter for MG Cooling and Heating. Inc, Please note that i understand both I and Marco should have proof read this letter to catch such an error. hut we had trusted their firm to take on the role of ensuring an error such as this would not occur. Howe\er. they have taken full responsibility for the error and have expressed their deepest apologies. The second issue that I would like to address is regarding the time-frame that was submitted for mv employment with Mercur■ Rising HVAC. Inc.. under the licensed supervision of Rafael A. Perez (State Certified License = CAC 181 3688 i. Please note that while gathering information for m. application. I admit that I should have made a stronger effort in looking for the exact hire date for my employment history. As I knew that Collier County was looking for the past ten ■ears of experience. I made an estimate of employment starting in 2002. Rafael was unable to easily locate his employment records from such a long time ago and from his recollection it was around that time as well. That was w-hv there was not month listed along with the date. While I realize that I made a mistake in not performing a more thorough research effort for m\ time of employment at Mercury Rising HVAC. Inc.. I have more than enough of the required experience according to the Collier County statute. which states. "Class-A Air Conditioning Contractor requires thirty-six months experience as a licensed Journeyman or equivalent.... In addition to these years of work experience. I have several certifications in the tield of air conditioning and refrigeration. Please see certificates attached for Air Conditioning Repair Assistant. Universal Technician. EPA Certification. Refrigerant Transition Program. and 111'C- -110A Handling. Use and Reco.er. Certification. Before all of these. I was study ing Flectro Mechanic Refrigeration Units in Cuba. !-hank you for your time and consideration in reading this letter and please know that it is in greatest hope to become a licensed Air Conditioning contractor in Collier Count.. Best Regards. Antonio A. 1luerta 4 _ I'It 1" • • Cc��er County Nit lil IL3MD Operations & Regulatory Management Licensing Section •• 2800 North Horseshoe Drive Naples, FL 34104 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: Exact Corporate/Business Name: Arctic Condition Air, Inc. Fiction Name/DBA: Qualifier Name: Antonio A. Huerta Physical Address: 2236 48th St. SW Naples FL 34116 (Number 86 Street) (City) (State) (Zip Code) Mailing Address: 2236 48th St. SW Naples FL 34116 (Number 86 Street) (City) (State) (Zip Code) Telephone: (239) 825-4248 E-Mail: �U �,.��Z�% t' Cd�I,/ TYPE OF LICENSE: ❑ General $230.00 ❑ $230.00 Electrician ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 50 Air Cond.-Class A $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.01 ❑ Specialty $205.00 Specialty trade: Al 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. Antonio A. Huerta - President 2236 48th St. SW Naples, FL 34116; (239)825-4248 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. Action Maintenance & Cleaning Corp. 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. N/A AFFIDAVIT I, Antonio A. Huerta certify that the foregoing is true and cor -_ -. e best of my knowledge. i r,/ `Authorized Officer of the Firm STATE OF FLORIDA COUNTY OF . "':\ (- The foregoing instrument as acknowledged before me this .3k I e (3 (Date) By Antonio A. Huerta of Arctic Condition Air, Inc. (Name of officer, title/agent) (Name of Corporation) a Florida Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced f i 4, 1. ;C identification and did not take an oath. (Type of identification) NOTARY'S SEAL lab 46%.1':=Y-p/. ,, SENVOINI�EN (SIGNATURE OF NOTARY) ao * � * MY COMMISSION#EE 858916 EXPIRES:December 8,2016 j4 OF,,sfP Bonded ruBudgetNotarservices Page 2 of 4 QUALIFIER INFORMATION: Name: Antonio A. Huerta Address: 2236 48th St. SW Naples FL 34116 (Number& Street) (City) (State) (Zip Code) Telephone: (239) 825-4248 Date of Birth: 11/30/1956 S,S. #: 000-00- 4193 E-Mail: Driver's License: H630-001-56-430-0 1. Type of Certificate of Competency for which application is made. Air Conditioning - Class A 2. The names and telephone numbers of two persons who will know your whereabouts. Antonio Huerta, 821-0079 Yanira Huerta, 877-9382 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. Please see attached sheet for detailed work history. 10. Statement of any formal training you have had in the area for which the application is made. On the job training for many years. 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. Antonio A. Huerta APPLICANT(PLEASE PRINT) Arctic Condition Air, Inc. NAME • �I MP/ANY SI IATURE OF APPLICANT STATE OF FLORIpA COUNTY OF .( The foregoing instrument as acknowledged before me this (Da e) By Antonio A. Huerta who has produced Of f � I r � (, (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL SEAN � , MY OINf�EN (SIGNATURE OF NOTARY) * * COMMISSION t EE 856916 if EXPIRES:December 6 2016 19.toj S Bonded Nu Budget**Sarrioee 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. 0,11/1 :I •I ATURE OF APPLICANT Arctic Condition Air, Inc. BUSINESS NAME 3 1 CI DATE BEFORE ME this day personally appeared Antonio A. Huerta 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 bofore me this 3 duit by Antonio A. Huerta IDate who has produced u('I vei ` _1(' (name of person acknowledging) (Type of identification) 3s identifientinn and who did not take an oath. est. Pim D SIGNATURE OF NOTAR.? `t�, * MY COMMISSION/EE 856916 1 EXPIRES:December 6,2016 Bonded Tim Budget Nolan services e C 't ti 1/l NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC 4 RESOLUTION OF AUTI-IORIZATON WHEREAS Arctic Condition Air, Inc. proposes to (Name of Business Entity) • engage in contracting as Corporation (Type of legal entity:corp., in Collier County,Florida, •�partnership,etc. y da according to Collier County Ordinance 2006-46,as amended;and WHEREAS Arctic Condition Air, Inc. proposes to (Name of Business Entity) qualify fora Certificate of Competency with Antonio A. Huerta (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned Owners (Officers,Owners,Partners) of Arctic Condition Air, Inc. hereby resolve and rr.presesit to the Collier County (Name ofBusiness Entity) Contractors'Licensing Board that the qualifying agent, Antonio A. Huerta is active (Name of Individual) in all matters connected with the contracting business of Arctic Condition Air, Inc. ,and represent that (Name of Business Entity) We further resolve and re P Antonio A. Huerta is legally empowered to act for Arctic Condition Air, inc(Names of Individual) in all matters connected with its (Name of Business Entity) contracting business,and has the authority to supervise construction undertaken by Arctic Condition Air, Inc. (Name of Business Entity) DULY PASSED AND ADOPTED THIS l_ day 1 • (Officers,pasta rs,Owners—with 4. Witness ....�T..-Witness • - • Witness • Corporate Seal(if Applicable) eptii Or Notary Public Certificate SUM to and subscribed before me this day of_,2° l by/-74 4 (perk • Notary Public Name Printed Commission Number `otaiy 'u. 'e My Commission expires: • i �rHY PV6 SEAN I Y,jt,,_ * MY COIAI IiSSION t EE 856916 EXPIRES:December 6,2016 'rFoF,04.x' Bonded lieu Budget Notary Services CULLER COUNTY GOVEMMENT COMMUNITY NTALSERVICESDIVISION 2500 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. • Our office will only use your SSN noted above for those reasons pursuant to Chapter 119.Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt rtnrl'r Chapter 119, Florida Statwif.s. GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report March 9, 2015 Official Score Report: Candidate Information: Name—Antonio A. Huerta Candidate # 01564300H Testing Site: Naples, FL Final Score Result: Business Procedures Score: 76% These results represent the grade that has been achieved on the Business Procedures examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on February 14, 2015. 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 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report February 18, 2015 Official Score Report: Candidate Information: Name—Antonio A. Huerta Candidate # 01564300H Testing Site: Ocala, FL Final Score Result: Class "A" Air Conditioning Contractor Score: 75% These results represent the grade that has been achieved on the Class "A" Air Conditioning Contractor examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on January 10, 2015. 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 886 110th Ave. N.Suite#6, Naples, FL 34108 Phone: 239.777.1028 �Y �' ���Y 2�' Fax: 877.275.3593 tor * 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 11/96 03/02/15 09: 43CT <SUBJECT> <SSN> <BIRTH DATE> HUERTA, ANTONIO A. -4193 11/56 <ALSO KNOWN AS> HUERTAS,ANTONIO,A <CURRENT ADDRESS> <DATE RPTD> 2236 SW. 48TH ST. , NAPLES FL. 34116 8/06 <FORMER ADDRESS> 4174 GREEN BV. , #7 . NAPLES FL. 34116 5/01 2200 SW. 48TH ST. , NAPLES FL. 34116 <POSITION> <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD><HIRE> ARNIELLA CONTRACTOR PLUMMER 2/13 2/13 2/07 <FORMER EMPLOYER AND ADDRESS> ANNIELLA CONTRACT PL PLUMBER 3/12 3/12 9/09 M O D E L P R O F I L E ***FICO CLASSIC 08 SCORE +734 : SERIOUS DELINQUENCY; PROPORTION OF BALANCES ***TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER REVOLVING ***ACCOUNTS; LENGTH OF TIME ACCOUNTS HAVE BEEN ESTABLISHED; PROPORTION OF ***LOAN BALANCES TO LOAN AMOUNTS IS TOO HIGH *** 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=0 TRD=27 RVL=18 INST=5 MTG=3 OPN=1 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $23 .2K $43 . 7K $7991 $0 $155 82% INSTALLMENT: $52 . 8K $ $36. 1K $0 $837 MORTGAGE: $120K $ $99. 8K $0 $770 CLOSED W/BAL: $253 $253 $ TOTALS: $196K $43. 7K $144K $253 $1762 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 DSNB MACYS D 2A5T001 7/06 R09 6/09A $253 I CHARGE ACCOUNT 6/09F $253 CLOSD BY CRDT GRANTOR SUNCOAST CU Q 298Q001 8/07 $0 09P 1/15A $0 Page 1 of 3 C DEPOSIT ACCT OVRD 6/08F $0 PAID/WAS A CHARGE OFF SEARS/CBNA D 6256443 2/10 $434 111111111111 RO1 2/15A $1700 $0 111111111111 I CHARGE ACCOUNT 9/14C $0 INACTIVE ACCOUNT 48 0/ 0/ 0 KOHLS/CAPONE D 12EN005 8/14 $239 11111 ROl 2/15A $1000 $0 I CHARGE ACCOUNT 11/14P $0 5 0/ 0/ 0 SYNCB/IKEA H 235061H 7/10 $0 111111111111 ROl 2/15A $150 $0 111111111111 I CREDIT CARD 5/11C $0 CLOSED 48 0/ 0/ 0 CHASE B 26QK004 10/00 $3854 111111111111 RO1 2/15A $9200 $0 111111111111 I CREDIT CARD 10/14P $0 48 0/ 0/ 0 SUNCST CU Q 298Q007 12/03 $9313 MIN80 111111111111 RO1 2/15A $13. 0K $0 111111111111 I CREDIT CARD $6893 48 0/ 0/ 0 SYNCB/LOWESD B 235063Q 9/04 $391 111111111111 RO1 2/15A $224 $0 111111111111 I CREDIT CARD 10/10C $0 CLOSED 48 0/ 0/ 0 NAVIENT B 6372062 8/07 $3500 96M59 111111111111 101 2/15A $0 XXXXXX111111 C STUDENT LOAN $3650 48 0/ 0/ 0 SEARS/CBNA B 6256458 5/11 $434 111111111111 RO1 2/15A $2001 $0 111111111111 I CREDIT CARD 9/11P $0 45 0/ 0/ 0 SYNCB/LOW L 235041J 4/07 $1036 111111111111 RO1 2/15A $224 $0 111111111111 I CHARGE ACCOUNT 10/11C $0 CLOSED 48 0/ 0/ 0 SYNCB/WALMAR D 235057X 11/10 $0 111111111111 RO1 2/15A $500 $0 111111111111 I CHARGE ACCOUNT 11/12C $0 CLOSED 48 0/ 0/ 0 DISCOVERBANK B 9616003 8/99 $1246 111111111111 RO1 2/15A $900 $0 111111111111 I CREDIT CARD 9/09P $0 48 0/ 0/ 0 ALLY FINCL F 259237N 3/12 $22 . 8K 72M379 111111111111 I01 2/15A $0 111111111111 C AUTOMOBILE $13 . 7K 34 0/ 0/ 0 SUNTRUST BK B 423A022 2/13 $26. 4K 75M399 111111111111 I01 1/15A $0 1111111111 C AUTOMOBILE $18 . 7K 22 0/ 0/ 0 CITIMORTGAGE B 4625015 7/02 $120K 360M770 7/10 111111111111 M01 1/15A $0 03 111111111111 I FHA REAL ESTATE M $99. 8K LOAN MOD NON GOVT 48 0/ 0/ 0 Page 2 of 3 THD/CBNA B 26H3005 6/01 $1680 MIN25 111111111111 ROl 1/15A $2501 $0 111111111111 I CHARGE ACCOUNT $72 48 0/ 0/ 0 BK OF AMER B 6331059 12/04 $5492 MIN25 111111111111 ROl 1/15A $8500 $0 111111111111 I CREDIT CARD $502 48 0/ 0/ 0 CAP ONE NA B 1DTV003 2/10 $80 111111111111 ROl 1/15A $1500 $0 111111111111 I CREDIT CARD 3/10P $0 48 0/ 0/ 0 BK OF AMER B 6331059 8/14 $927 MIN25 11111 ROl 1/15A $5000 $0 I FLEXIBLE SPENDING $524 5 0/ 0/ 0 SUNCOAST CU Q 298Q001 8/07 $12 . 9K 60M258 111111111111 I01 3/12A $0 111111111111 I AUTOMOBILE 3/12C $0 CLOSED 48 0/ 0/ 0 CHASE B 26QK001 11/02 $1022 111111111111 ROl 2/11A $4700 $0 111111111111 I CREDIT CARD 10/10C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 CAP1/NAUTL D 1DTV046 6/08 $0 1111111XXXXX RO1 6/10A $5000 $0 XXXXXXXXXX1 I CHARGE ACCOUNT 1/10C $0 CLOSED 23 0/ 0/ 0 CITI B 8213030 10/07 111111111111 ROl 3/09A $5000 $0 1111 I CREDIT CARD 2/09C $0 CLOSD BY CRDT GRANTOR 16 0/ 0/ 0 ABN-AMRO B 624P004 7/02 $120K 360M1424 111111111111 MO1 9/07A $0 111111 I FHA REAL ESTATE M 9/07C $0 TRNSFRD: OTHER LENDER 48 0/ 0/ 0 BB&T B 295S003 6/06 $15 .2K 60M330 111111111111 I01 8/07A $0 11 I AUTOMOBILE 8/07C $0 CLOSED 14 0/ 0/ 0 SUNCOAST CU Q 298Q001 12/03 $20 . 0K M161 111111111111 MO1 7/07A $0 111111111111 I HOME EQUITY LOAN 7/07C $0 CLOSED 42 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 3/02/15 PNP7771028 (FLA) LICENSES ETC END OF REPORT Page 3 of 3 Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS 511/01,2: 7y Detail by Entity Name Florida Profit Corporation ARCTIC CONDITION AIR, INC. Filing Information Document Number P15000020560 FEI/EIN Number NONE Date Filed 03/03/2015 State FL Status ACTIVE Principal Address 2236 48TH ST. SW NAPLES, FL 34116 Mailing Address 2236 48TH ST. SW NAPLES, FL 34116 Registered Agent Name &Address HUERTA, ANTONIO A 2236 48TH ST. SW NAPLES, FL 34116 Officer/Director Detail Name & Address Title P HUERTA, ANTONIO A 2236 48TH ST. SW NAPLES, FL 34116 Annual Reports No Annual Reports Filed Document Images 03/03/2015-- Domestic Profit View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inauirvtvne=Entity... 3/13/2015 • Detail by Entity Name Page 2 of 2 Coovrioht 0 and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inauirvtvoe=Entity... 3/13/2015 Electronic Articles of Incorporation P15000020560 FILED For March O fState15 mdickey ARCTIC CONDITION AIR, 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: ARCTIC CONDITION AIR, INC. Article II The principal place of business address: 2236 48TH ST. SW NAPLES, FL. US 34116 The mailing address of the corporation is: 2236 48TH ST. SW NAPLES, FL. US 34116 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 1000 Article V The name and Florida street address of the registered agent is: ANTONIO A HUERTA 2236 48TH ST. SW NAPLES, FL. 34116 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: ANTONIO A. HUERTA P15000020560 FILED Article VI March 03 2015 Sec. Of State The name and address of the incorporator is: mdickey ANTONIO A. HUERTA 2236 48TH ST. SW NAPLES, FL 34116 Electronic Signature of Incorporator: ANTONIO A. HUERTA 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 ANTONIO A HUERTA 2236 48TH ST. SW NAPLES. FL. 34116 US AW � �© CERTIFICATE OF LIABILITY INSURANCE DATE(MYYY) 1�,r�' 03/13/20 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Domain Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 13020 Livingston Rd Ste 16 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Naples, FL 34105 INSURERS AFFORDING COVERAGE l NAIC# INSURED INSURER A: Cypress Insurance Group_ 10953 Artic Condition Air Inc INSURER B: 2236 48th St SW • INSURER C: T^ _ Naples,FL 34116 INSURER D: I I INSURER E. COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'U I POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRO TYPEOF INSURANCE f !DATE lMM/DDiYVYY1 DATEIMMIDPIYYYYI GENERAL LIABILITY ! S 1,000,000 FGL 5000252 00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY 03/12/2015 03/12/2016 PREMISES(Ea occurrence) $ 100,000 A CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 ' GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' PRODUCTS-COMP/OP AGG S 2,000,000 PRO.POLICY 1JET �: LOC i AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ ` ,HIRED AUTOS I BODILY INJURY i NON-OWNED AUTOS (Per accident) $ -- PROPERTY DAMAGE "$ 1(Per accident) GARAGE LIABILITY i 1 AUTO ONLY-EA ACCIDENT I$ I ANY AUTO ' EA ACC I $ -- OTHER THAN AUTO ONLY AGG°$ • EXCESS I UMBRELLA LIABILITY ` EACH OCCURRENCE I$ • OCCUR CLAIMS MADE AGGREGATE i S 1$ w DEDUCTIBLE . i$ RETENTION $ WORKERS COMPENSATION i ; WC STATU- OTH-� AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER j _ ANY PROPRIETOR;'PARTNERIEXECUTIVE I OFFICERIMEMBER EXCLUDED? !E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,'$ If yes.describe under ------ SPECIAL PROVISIONS below ;E.L.DISEASE-POLICY LIMIT I$ OTHER 1 I I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Collier County Contractor and Licensing Board SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 2800 N Horseshoe Dr DATE THEREOF.THE ISSUING INSURER W ENDEAVOR TO MAIL 10 DAYS WRITTEN Naples,FL 34104 NOTICE TO THE CERTIFICATE HOLDE AMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIA$ TY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REP S T TIVES. ��/ fax:239-252-2469 AUT Iz D ESENTATI JU_ r� ACORD 25(2009/01) ©198 -200 ACORD ATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF ELECTION TO BE EXEMPT If this application contains incomplete or inaccurate information, it may cause a delay in the issuance of your exemption. An officer electing an exemption under Chapter 440,Florida Statutes, is not entitled to benefits under this chapter. Section 1: APPLICANT INFORMATION Name: Antonio A. Huerta First Name M Last Name Suffix Driver's License Number: H630-001-56430-0 or Identification Number: Florida Driver's License Number or ID: Yes X or No Social Security Number(last four digits): 4193 Date of Birth: 11 / 30 / 1956 Email Address: yaniramed99 @gmail.com The Division's purpose in collecting an email address is to communicate with the applicant regarding exemption related issues. Section 2: X CONSTRUCTION INDUSTRY APPLICANT($50 FEE REQUIRED): Please check the appropriate box to identify if you are an officer of a corporation or a member of a limited liability company. X Officer of a Corporation having at least 10%ownership(Title) President O Member of a Limited Liability Company(LLC)having at least 10%ownership 0 NON-CONSTRUCTION INDUSTRY APPLICANT(NO FEE REQUIRED): O Officer of a Corporation(Title) O Member of a Limited Liability Company(LLC)having at least 10%ownership Section 3: This section should be completed with information specific to your corporation or to the limited liability company in which you are a member. The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations. Name of Corporation or LLC: Arctic Condition Air, Inc. FEIN 47 - 3320328 (To obtain a Federal Employer Identification Number contact IRS at 1-800-829-4933) Business Name(DBA): PHONE: (239)825 - 4248 Applicant's Address of Record: 2236 48th St. SW city: Naples State: FL Zip: 34116 County: Collier Place the appropriate classification code for the Scope of Business or trade for the industry type chosen in Section 2. If you are unsure which classification code applies to your business, please contact your workers'compensation insurance carrier. If you do not have a workers' compensation insurance policy, please contact the National Council on Compensation Insurance(NCCI)at 1-800-622-4123,to obtain the proper classification code(s). Classification code(s): 1. 05537 2. DFS-F2-DWC-250,NOTICE OF ELECTION TO BE EXEMPT—REVISED 03/13/13 • 3. 4. NOTICE OF ELECTION TO BE EXEMPT-Page 2 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. P15000020560 Section 5: Pursuant to Chapter 489, F.S. (contractor licensing law), list certified or registered licenses related to the scope of business or trade listed in Section 3 held by the applicant,or the certified or registered license numbers held by the qualifier for the corporation or limited liability company listed on this application.The business name listed on the license MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations and on this Notice of Election to be Exempt. DBPR License DBPR License 0 This section is not applicable to my business. Section 6: Confirmation Number(Online construction industry application submissions only) Section 7: Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which this application applies? Yes X No IF YES, PLEASE LIST THE NAME(S)AND FEIN(S)OF THE AFFILIATED CORPORATIONS)OR LLC(S): 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 non-construction limited liability company exemption, an applicant must have the required ownership of the corporation or limited liability company. X I attest that I own at least ten percent(10%)of the corporation/limited liability company listed on this application. Section 9: I certify that: 1. any employees of the construction corporation or members of the limited liability company;or 2. four or more part or full-time employees of the non construction corporation 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: Not applicable 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. I acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any affiliated corporations as provided in Section 440.02, Florida Statutes. DFS-F2-DWC-250,NOTICE OF ELECTION TO BE EXEMPT—REVISED 03/13/13 SIGNATURE *Exemption information is reflected on the Proof of Coverage database the day following the issuance of the exemption. DFS-F2-DWC-250,NOTICE OF ELECTION TO BE EXEMPT—REVISED 03/13/13 TDQ DEPARTMENT OF THE TREASURY LL. INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 03-05-2015 Employer Identification Number: 47-3320328 Form: SS-4 Number of this notice: CP 575 A ARCTIC CONDITION AIR INC 2236 48TH ST SW NAPLES, FL 34116 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 47-3320328. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 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 E/ECTI 1: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. (IRS USE ONLY) 575A 03-05-2015 ARCT B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal Identification Number (PIN) for tk1PS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT REM NDERS * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS mill not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice- on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write,. please tear off the stub at the bottom of this notice and-send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is ARCT. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. (IRS USE ONLY) 575A 03-05-2015 ARCT B 9999999999 SS-4 Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence so we may identify your account. 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Amok`.{ laro.. * , g 140stf ...40104 a>.,,- +' ire,,�q�tr,,,r "ms's Ms;.';, '1 "e•mw,.. aPi`'+'M.}- �i 1 m, -l'-"'bY• + '�+i '•N -"1G. iY..-_ J-.4:,, �=�Y,, ,,,,,,"-,'-'=,:r.-_ _-%"'•0/..--' •T.0 y..0%04.,,-s..'*- --".'" y � 1' CD I VD x c �--+ O � LflrMM N r-•J L.. 0\10/0101 O v O (0 >.- co O) = F ,- a2 >0 J O C!� N Un v 17) CD Per a' cn U) > Q a 0_a000�ao 0 Z ?Ur = 0 co o (s • o m 0 LL w = 2- �� 002 cA _Q O 0 i Mainstream Engineering Corporation Technician Certification Fp MVAC Technician Certification . , EPA Clean Air Section S09 Program Certification Date Sept 19,1996 ANTONIO A HUERTA 95F5FB5B71 EC32A20 has been certified as a Motor'Vehicle Air Conditioning Technician if as Required by 40CFR Part 82.40 Q,7mtat � '"iefrigerant Transition end Recovery Certification Program:- ' Certificate of Completion t - ?ATONIC) k HUERTA M COrithlionq Contrar siAmer, has been certified as FERRIS STATE UNIVERSAL UNIVERSITY - ' technician as required by 40 CFR Part 82,Subpart F 7; - 590514,193 �` .m °.- Mainstrea Engineering Corporation HVAC/R R-410A Certification l-IFC-410A Handling, Use and Recovery itification 4 * ANTONIO A HUERTA HVAC%R 6492B5E3146232A20 T1: R 410A �_ has been certified for HFC-410A F t� f F`�`� qM E�aG systems and equipment . 239.777.1028 Fax oilier Count: 877.275.3593 1 l \: Contractor Licensing "'8u0 \orth Horseshoe llriv e \aples. F1. 4104 I 0 11 horn It \lax Concern: Our tlrm. Licenses. tic.. was hired to process the licensing paperwork for Mr, Antonio Huerta's Collier Countx license application for .fir Conditioning - Class A. \\e were hired to assist with the process because of the fact that NIr. 1luerta's language harrier makes it difficult to communicate in C�:n dish. Part of our sery ice included helping Mr. 1luerta draft his experience erification letters. He wanted to ensure that the letters and application were filled out eorreetl� We Make It Happen! Please accept this letter as our admission to the error in writing -plumbing-- instead of ♦ Contractor "air conditioning" on \lr. Huerta's x eritication of experience form for NIG Cooling and Licensing Heating. Inc. We gathered information regarding his work history to create the letter and ultimatelx the error oft ping the xtrong vkotd is corpleteh mN fault. • New Business Please note that this kkas entirel\ a mistake on our part and to please accept our deepest Start-Ups apologies for an inconx enience that this max, hay e caused. Our greatest intention was to • Business guide \1r. Huerta through this process as easilti and quickiti as possible to help him Plans guide ichiexe his goal of becoming a registered -fir Conditioning Contractor gill Collier i oiint v. Should \ou ha\e any additional iluestion . please do not hesitate to contact me direetl\. as I 'tae been \Ir, Huerta s licensing const itant through this process. I hank ■ou for ,x our assistance. Lisa Adams 886nn0»,Ave N Suite Naples,FL 34108 15:t,t #8 239.777 8321 (phone:: 3___ 2'5.3593 taxi W ,L ice,nsesEtc cco n EMICOOLING AIR CONDITION &HEATING.INC CAC1814641 To Whom It May Concern: I am writing to highly recommend e plumbing service if Antonio Huerta. In him, we found an incredibly knowledgeable indi dual, who compl= -d numerous projects for our team. Our company deems Mr. Huerta to be leading 'onal in the HVAC trade as well as honest and fair business man. For over 2 years at MG Cooling and Heating, Inc., from 8/2008 through 9/2010, Mr. Huerta was a project manager. He was re onsible for all areas of construction including installation of large commercial coolers a d heating systems (over 25 tons/500,000 BTU); A/C, refrigeration,and heating equipment; she t metal ductwork and the fabrication of the ductwork. He has gained more than the require experience and knowledge for his own Air Conditioning license. We're very pleased to re ommend him for the Collier County Certificate of Competency. Regards, t fisi-/- , ... ., „kw/6 - ri 4---- .. Marco Gonzalez, President CAC1814641 MG Cooling and Heating, Inc. 5114 19th Court SW Naples, FL 34116 239-280-6817 State of FL4l2i County of C!eLLi&/ Su //ribed and sworn to(or affirmed)before m his !4,- day of ... ; By A4,4ii, c (-4Cw -1G.CL.. Personally known,,, OR produced identification Type identification produced MANUEL DIAZ MY COMMISSION#FF086517 / 1 sue' EXPIRES:January 26,2018 ..Y ..;-------Notary Put* r 3 ._ RSIN6 IVW To Whom It May Concern: This letter is to verify Antonio A. Huerta's experience in the Air Conditioning and Heating trades. From 2002 through August 2008 he did installations, rough-ins,ductwork,trim,etc. as an employee of Mercury Rising HVAC, Inc. The scope of the jobs which he was a foreman on included large commercial heaters and chillers,sheet metal ductwork and the fabrication of them.Antonio also repaired and serviced all aspects. Should you have any questions about his experience,please feel free to reach out to me. I can be reached at(239)348-9927. Sincerely yours, ?\ (Felk,t_ fael A. P i ez Vice President t7 Mercury Rising HVAC, Inc. /.t7 3963C Exchange Ave. 7)3/11 Naples, FL 34104 State Certified License#CAC1813688 State of 1:1 County of G'/I ej`„ Subscribed and sworn to or affirmed)before me this fit'C�• day of /l f4& ' 2v By KA F/IL Personally known l!OR produced identification_ MY COMMISSION oMartssEO D F IAZ t2 Type identification produced EXPIRES:January 26,2018 Notary Public AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, O (LCQ gtvvi P'le Z/ , am a resident of 5?/4/ /q7'4 crS&i County, Go l t'i e V (State) and have resided here for more than five (5) years. 4 tIveit-7-4 licant). I have had During the last five years I have known A 1'LTD Gu0 ' app 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) qatto q c (Name) 1,4 Alta r10-14.Z- (Address) --57/471 /q7- U J ova eS • 31-0/4, Telephone) .7-39- 2F -4F/ 7 STATE OF FL9,RIDA. COUNTY OF ))( (toe_.. The foregoing instrument was acknowledged before me this 4.lG� z '%�C by g d Date) o GO 2c who has produced 5-01-cl sif/ 4,,' 14713 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. ri, MANUEON#L DIAZ SJGNAT E OF NOTARY . MY COMMISSI FF086517 ..►. EXPIRES:January 26,2018 ilifAtoue.L DiA:), NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, 64 gn/,4 -Dei A sue.✓/e//4 , am a resident of 'S'ye'..0 P 5 i�✓ C'//'deCounty, Pl (State) and have resided here for more than five (5) years. During the last five years I have known ,4//7-0Ai. < A Hee°'rif (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) Ut=P,..f/A2AQ A r w'c-//i (Address) / ? P C- 5 V✓ iv-r P is f FL.1 3 y/lzi Telephone) 17 -i �� :i STATE OF FLORIDA COUNTY OF ao 1( € - The foregoing instrument was acknowledged before me this r261 /) f c by (Date) AACC-IIA who has produced A CS Y- 06'0 ' 3 0 (name of person acknowledging) (Type of identification) as identification and who did not take an oath. .- >'' MANUEL DIAZ EXPO ian„ary26 2018 SIGNA OF NOTARY NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC r titi.ct co,, • COLLIER COUNTY BUSINESS TAX RECEIPT } APPLICATION r 2800 N.Horseshoe Drive,Naples,FL 34104 - .�� 0 Make Check Payable to: Collier County Tax Collector • C°0li.tf-' Phone: 239-252-2477 Website: www.colliertax.com CHECKLIST X Copy of Articles of Incorporation or Fictitious letter from -Yellow Fire Compliance(list of fire district phone number the State stating that your business name is on file. enclosed) (850-245-6052 or 6058)www.sunhiz.or 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 for commercial OR to: Collier County Tax Collector for residential. 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 X Must contact Property Appraiser's Office at Restaurants(850-487-1395)or Department of Agriculture (239)252-8145 for tangible Personal Property forms. (800-435-7352) CHECK ONE: Date: X Original Application — Classification Transfer of License # — Code Number Renewal of License# — License Amount 1) CORPORATE NAME- Arctic Condition Air, Inc. la) DBA NAME- lb) BUSINESS OWNER OR QUALIFIER'S NAME - Antonio A. Huerta 2) PHYSICAL ADDRESS - 2236 48th St. SW, Naples, FL 34116 (No P.O. Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - X Yes No 3) BUSINESS MAILING ADDRESS - 2236 48th St. SW, Naples, FL 34116 Street City Zip 41 OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - 2236 48th St. SW, Naples, FL 34116 5) TELEPHONE-Business: (239) 825-4248 Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership X Corporation LLC _LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 03/03/2015 8) OFFICE WITHIN CITY LIMITS OF NAPLES - Yes X No If Yes, City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. 47 – 3320328 In accordance with Florida Statute 205.0535(5)we require you to provide us with either a Florida Employer Identification Number(FEIN)or a Social Security Number. 9a) TYPE OF BUSINESS CONDUCTED: Construction - HVAC 10)NUMBER OF EMPLOYEES -Including of number of owners: 1 11) FILL IN THE APPROPRIATE AREAS - a)Rental units(motel/hotel/apts.)Number of units: 0 b)Seating Capacity(rest./cafes,etc.)Number of seats: 0 c)Number of coin-operated machines owned by business or individual: 0 12) STATE LICENSE OR CERTIFICATION NUMBER - Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY,I DEC : ' _ HAT I HAVE READ THE FOREGOING DOCUMENT ND THAT THE FACTS STATED IN IT AR // HE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: .I: DATE: 3 G 0.7' 2/ (Owner and/or representative of bus' ess)TITLE: ?co(den} ****THIS TAX IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE**** SECTION A, B, AND C FOR OFFICE USE ONLY THIS SECTION TO BE FILLED OUT BY CONTRACTORS/BCC LICENSING BOARD SECTION A Classification of Contractor: County Certification Number: Department Supervisor: Date: THIS SECTION TO BE COMPLETED BY PLANNING SERVICES SECT N B Business is an in-home occupation and the applicant has agreed to adhere to the requirements as set forth in the �G�llier County Zoning Ordinance. ✓/ PROPERTY Bu 'ness DOES COMPLY with the Collier Co my Zonin O dinance. ZONED it Sign : Ti . Viet 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: • Co .:_-er County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GROWTH MANAGEMENT DIVISION NAPLES, FLORIDA 34104 www.colliergov.net (239) 252-2400 FAX (239) 252-6358 LAND USE AND ZONING CERTIFICATE: HOME OCCUPATION LDC section 5.02.00 & subsection 10.02.06 B.1.f Chapter 4 K. of the Administrative Code Please take the time to fill out this form as completely as possible. 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. APPLICANT CONTACT INFORMATION Name of Applicant(s): Antonio A. Huerta Telephone: (239) 825-4248 Cell: Fax: E-Mail Address: BUSINESS & USE INFORMATION Business Name(If any): Arctic Condition Air, Inc. Phone Number: (239) 825-4248 Address: 2236 48th St. SW City: Naples State: FL Zip: 34116 Description of the type of business or use: Construction - HVAC Collier County Land Development Code Section 5.02.00-Home Occupations 5.02.01-Applicability Home occupations shall be allowed in any zoning district which permits residential dwellings as a permitted use. 5.02.02-Allowable Home Occupation Uses There shall be no retail sale of materials,goods,or products from the premises. 5.02.03-Standards The home occupation shall be clearly incidental to the use of the dwelling for dwelling purposes. The existence of the home occupation shall not change the character of the dwelling. A. An allowable home occupation shall be conducted by an occupant of the dwelling. B. There shall be no on-site or off-site advertising signs. C. The use shall not generate more traffic than would be associated with the allowable residential use. To that end, traveling to and from as well as meeting or parking at the residence by either employees of the business operated there from who are not residing at the subject address or by customers or clients of the home occupations is prohibited. 1/14/2014 Page 1 of 2 Co er County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GROWTH MANAGEMENT DIVISION NAPLES, FLORIDA 34104 www.colliergov.net (239)252-2400 FAX(239) 252-6358 D. There shall be no receiving of goods or materials other than normal delivery by the U.S. Postal Service or similar carrier. E. Parking or storage of commercial vehicles or equipment shall be allowable only in compliance with the requirements for commercial vehicles in the County Code. F. The on-site use of any equipment or materials shall not create or produce excessive noise, obnoxious fumes, dust, or smoke. G. The on-site use of any equipment or tools shall not create any amount of vibration or electrical disturbance. H. No on-site use or storage of any hazardous material shall be kept in such an amount as to be potentially dangerous to persons or property outside the confines of the home occupation. I. There shall be no outside storage of goods or products, except plants. Where plants are stored, no more than fifty(50) percent of the total square footage of the lot may be used for plant storage. J. A home occupation shall be subject to all applicable County occupational licenses and other business taxes. I, the undersigned, hereby affirm that I am the legal owner of the property at the above address or that/have the legal right to conduct the business described above at this address by virtue of my leasehold interest in this property, and that I have read, understood, and agree to abide by the provisions of LDC Section 5.02.00 "Home Occupations". °._ t f' t Applicant Signature Date The following to be completed by County Staff: Zonings —"b L Property ID#(at 1 Date:(3 lg L 7Approved n Hold ❑ Denied o' ents/Restrictions: A136 '‘. -■ ..,ailb A ,",- a t A. ° ir 2I/- --_-_t.-__at -ci 4 AVM- A C-- Staff Reviewer Date 1 Tax Collector Staff: Clerks Initials: ❑ Horseshoe n Greentree Business Tax License#: 1/14/2014 Page 2 of 2 mid ,.. H6 1 ANTCI0A sf KTA 4471!STSW S.PL 3+411 Me 1136-1456 s n I 40-i Collier County Swimming Pool Cleaning License Application Matthew Nero Naples Platinum Pool a Spa Contents Application page(s) 1 - 4 Experience and integrity page(s) 5 - 9 Education page(s) 10 - 12 Verification of passing score (Business and Law Exam) page(s) 13 Individual Credit Report page(s) 14 - 17 Company Name (Fictitious Name) page(s) 18 - 19 Certificate of general liability insurance page(s) 20 Federal tax Number page(s) 21 Driver License page(s) 22 1 C/c L re-r Col.-%' ty ' YI.Cr! GMD Operations tia ki Management ilp ion _280a Horseshoe Drive ,, 2 ,, , c- . '( 2-J !Li Lt J' I I .. Naples, FL 34104 j`.�:......v. APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO INDIVIDUAL 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. QUALIFIER INFORMATION: Name: Matthew R Nero Address: 3232 Citron Drive Naples FL 34120 (Number&Street) (City) (State) (Zip Code) Telephone: 239-223-4333 Date of Birth: May 4, 1978 s.s.#: 000-00- 7379 E-Mail: naplesplatinum @gmail.com Driver's License: N600-556-78-164-0 FICTITIOUS NAME OF APPLICABLE): Naples Platinum Pool and Spa Address: 3232 Citron Drive Naples FL 34120 (Number&Street) (City) (State) (Zip Code) Telephone: 239-223-4333 E-mail, naplesplatinum @gmail.com TYPE OF LICENSE ❑ General $230.00 ❑ Electrician $230.00 U Building $230.00 U Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 ❑ Specialty $205.00 Specialty trade: 3�u,,.n.,,{,, ;;. '4 L ;��,,. 2 IF PARTNERSHIP: Name: Address: (Number&Street) (City) (State) (Zip Code) Telephone: 1. List all businesses, firms, entities or contracting businesses you have been associated (ex: held a license or was a partner) with during the past ten (10)years. Attach extra pages if needed. N/A 2. License No. of ANY CURRENT OR PREVIOUS CERTIFICATE OF COMPETENCY held by Applicant. License No. License No. License No. License No. 3. Name and telephone numbers of two persons who always know the whereabouts of the contractor. Leah S Nero 239-223-4334 Anita Nero 518-331-2555 4. Statement of business or work experience during past ten (10) years. Seminole Casino Immokalee 2008-current Sunsports Cycle &Watercraft 2003-2008 5. Statement of any formal training of the qualifying agent in area for which application is being made. Attended class for CPO at Collier County aquatics center, and passed examination. 6. List all debts you or any company(s) associated with you refused or fail to pay and reasons for its refusal to pay. None 7. Have you ever been convicted of a crime related to Contracting? ❑ Yes (If yes attach explanation). ® No 8. Have you or any firms you have been associated with ever filed bankruptcy? ❑ Yes 10 No 3 • 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 will act only for himself or that he is legally qualified to act on behalf of the business organization sought to be certified 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 qualifier 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 on any information contained herein is grounds for disqualification. Matthew R Nero APPLICANT(Please Print) Naples Platinum Pool and Spa NAME OF COMPANY SIGNATURE OF APPLICANT STATE OF FLO ID COUNTY OF CZ,C l it- The foregoing instrument was acknowledged before me this › -e. .6 ,----- __5 ,„__. .26'',...1 y�1> (Date) bye s({,WPtti X- i't 6 who has produced ,i r r').-i'�SZe. (name of person acknowledging) (Type of identification) as identification and who did not take an oath. 4%,'' - /,: %L ._ ` NATURE OF O •11•Y NOTARY'S SEAL /,,,, .%-t - - INT NAME OF NOTARY PUBLIC) JANICE C LE {N NOTARY PUBLIC .+: 4 MY CCMMISS 0A';EE 159176 I=, Q EXPIRES:February 2A 2016 " o�, Eo,r�eri'hru Notary Pub��o Unde writers 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. • /// t Pk/ SIGNATURE OF APPLICANT Naples Platinum Pool and Spa BUSINESS NAME 3-04 �5 DATE BEFORE ME this day personally appeared f%;/e ) b7/...',IC2 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 rc £ — The foregoing instrument was acknowledged before me thisc-"VG.h by /� ( C� ,,?� �,� '1(Date; Gl: ��.J ���'"o�r� who has produced 7���r ��r5/c��.S' •; -- (name of person acknowledging) (Type of identification) as identification and who did not take an oath. - JAWED MIN �.. .. �arcor�r��:�G;cr~.�4i_E1se»s A OF NOT • Y EXPaRE '��o'i;;�``� Bon�±s�7hru No a b A��24,2016 �,' c Urge w rers y ��/�t� °'�� ��/ NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC 5 EXPERIENCE I understand I have no experience working for another pool cleaning company. I do believe the following should be enough to make up for the six months of experience required: • Insurance policy in excess of the limits required • Passing all the exam requirements and obtaining CPO certification • Above average credit report • No criminal history • Honesty, Integrity and Superior work ethic • College Degree • Owning and maintaining my own pool plus advising friends and family The above statements along with my desire not to just do the job, but to do the job well, should qualify me to clean only residential pools with no repairs, no replacing parts, no electrical, no maintenance on or disassembly of equipment. I would only engage in the following; no more, no less: • Brush stairs, walls and floor of pool • Empty skimmer and skim surface of pool • Vacuum • Add water if need be, when levels are low (such as the winter months) • Test and treat water (contaminated water can be harmful to your health) • Audio and visual check of equipment and safety check of deck area If you feel that you are unable to grant me a license at this time, I would ask that you consider granting a provisional, conditional or limited license. I appreciate your consideration and would be a responsible representative of the professionals in Collier County. I would work under any additional restrictions set forth until the appropriate level of experience is obtained. 6 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, c/ e . k r < < k , am a resident of C c titer (,v v-\-4/ County, F/iU c—l d (State) and have resided here for more than five (5) years. During the last five years I have known Matthew R Nero 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) .--) rt.,.i_,.- 5 F- ,r lC�, (Address) —7 r( -'1.,< [(Z.a()i,s via . /----' 17(e 5 Telephone) _i/ '3c2o j e, (- STATE OF FLORID _ COUNTY OF C' 6ir°"-- The foregoing instrument was acknowledged before me this -:6 -.� _ �.7e2/.7 by (Date) / tes sic/i K who has produced Xf� .P��'jr?"- (name of person acknowledging) (Type of identification) as identification and who did not take an oath. f ( NATt-RE OF N ARY i" c f -s2'/l'C c.ei../.i of NOTARY'S SEAL (PRINT NAME OF NOTARY) .*.rr;.w,; dANiCEQ.LEViN NOTARY PUBLIC :i.p` += 40''CiMQ CS■ON;EE 158176 `nom' d?— EX?IRES:Fab: ary242016 ;c:F'. � Eo;,.r,;Tbru NC;ar PubLC Underwriters 7 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, ,ice -� ,�:� .t-� v am a t '� j ' JJ resident of County, `9` t; (State) and have resided here for more than five (5)years. During the last five years I have known Matthew R Nero 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'f' (Name) szie 1"t ik`Zt -tts�e r (Address) Telephone) )— 1 '-t s bOcl STATE OF FLORIDA COUNTY OF(2(6/e/e-- foregoing instrument was acknowledged before me this 4:e.,./ / veE2-75 by (Date) _ who has produced (nam- of person acknowledging) (Type of identification) as identification and who did not take an oath. ATURE OF N 'ARY NOTARY'S SEAL `q (PRINT NAME OF NOTARY) NOTARY PUBLIC < ',•• JANICE D LEVIN ...S. MY COMMISSION k EE 156176 ?, EXPIRES February 24.2016 j'''%� ;�, Borr}edThruNaty?ub!icUnderwr:ers 8 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER e ca I, L��_f f.�c-�� G , am a resident of y 11 i-L-,/ ( County, c LLB l:'(. (State) and have resided here for more than five (5)years. During the last five years I have known Matthew R Nero applicant). I have had the opportunity to observe his or her business and personal dealings and find him or jeer to be a person of honesty, integrity and good character. (Signature)" .�G�tG L Le-- C; Z .. (Name) /7't 2E'c «/ /- ,e,s (Address) /c>) / 70 L-(f/C/Ueci/"-) f 97 r ` /d C Telephone) )3 3 ICY•)3 )I STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this ( l ` ` I • by (Date) Jr f. G LI` 'h who has produced /7 ()L (name of person acknowledging) (Type of identification) as identification and who did not take an oath. i` SIGNATURE OF NOTARY mil / �`�✓ j+ Y3)cv�i NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC Gerardo Jimenez Notary Public State of Florida .i, My Commission # EE 841792 Expires: October 8. 2016 9 Timothy Borowicz 3302 E 17`h Street Lehigh Acres, FL 33972 240-440-4076 February 27. 2015 To whom it may concern, I have known Matt Nero for five plus years. I know him to be a person who has a vision of total satisfaction for everything he does. He has started and finished projects that go well beyond cleaning pools, including woodworking,plumbing and landscaping. I have seen his work first hand at his home. During the time I have known Matt we have shared home improvement ideas and shared information related to basic pool cleaning and disinfecting. I have a pool and have always cleaned and maintained the pool, so I am aware that maintaining a pool includes skimming,vacuuming,brushing and adding chemicals. I know Matt to be trustworthy. I know his work ethic,mixed with his knowledge of pool maintenance will make him a top notch pool cleaner. I will feel comfortable recommending him to anyone looking for a pool cleaning service. •7 1,. 4.-e,Lit Timothy Borowicz /.�i/mac STATE OF FLORIDA ,OUNTY OF 7 )n this day of .he foregoing or attactled Instrument was acknowledged before me by 1 , . r , who Lve ppersonalty kknow*me or who a as identification. Notary Public ,42;:Es"y�•r., SERGE S.ALBERT :__ Commission#EE 175228 -ri. Expires March 1,2016 !y e��:°�'� Sanwa TMJ Troy Fin tarce 80o 15.701! 10 40 t J $4 r i .. R V i 4 a �sam.�oria\: '4.4 tro v a 4 .. w = 3.4 0,,„ , '4..4 ,.. - S ut .� w= T. _ cz4 Ei Ntb GE a ‘& W.°- CIP `p+ a a 1.Z . � r a rs iikEitimit -- :ZS,...=" Sisk. vrt to Az to -la tIak OA S Mb. fe. 34 —, = a ---/".. ,—s -,--,--..‘,,,..;‹,- i4g jt. +4-• a ..... 3.4 11.---.1 1.4 z..) filit.‘, ‘ 14 4-4, to ti VIII tit = E i tz; . t„, ..=- .1 = = .-- 14 s a E ' - _ ,z, a Ili E tat to = ttZ = \ 'III a a a a a 2- i ____. 1 a to 11 4"''''',4-it u4�R "k 41` " F' ,a :i;--;=.: ••.,,'• Fs > .,,,s e ,,,"1,„ Q t3 , .IL U 446 @,-.� eiiitit? f 1 fi4ii#+ _{ 9 !t t'"T1.114 ii f d 4 i t t t 4� R l x S ft E q 1.1„ 7 e a F^ .yx 3 .fig+ 4 simil�/ ; ;c ' a .. © �Nr p.. Q � � • O G - d' ■ r Sim 0 L ®QO-) U. 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INew 3 44 v • E z.. 1 N w '- Q 1 ill c 0 km) . * 13 Score Report Page 1 of 1 Score Report Pro / Nero,Matthew Name Matthew R Nero Test Business and Law-(FLO8100) Sponsor Co erCo,.^ty Date 01/29/2015 ID# Test ID 633569115 Score 80 Result Pass # Unanswered Questons 0 Module Subject Area Status LOW Cut Score HIGH FLCM Contract Management FLPM Project Management FLE&B Estimating&Bidding FLFM Financiai Management FLRM Risk Management FLBO Business Organization FLLIC Licensing FLLIEN Lien laws FLTL Tax Laws FLSRR Safety Reporting Regulations FLLL Labor Laws 2/8/2015 Online Personal Credit Reports&Credit Scores-TransUnion Credit Monitoring 14 1_4J Add Equifax and Experian Reports NOW ■Account Summary J �p Credit Reporting Agency TronsUnion ECN/Ri 7lC ! :r.Experian Credit Report Period 02/09/2015 Credit Score 853 Balances $99,806 Payments $849 Credit Accounts 9 { -- Open Accounts 2 _ ; _ Closed Accounts 1 7 Delinquent 0 } _ i Inquiries(2 years) f 0 Derogatory 0 Public Records 0 v Personallnformation Reported Name i MATTHEW R NERO 02/09/2015 • } Also Known As 02/09/2015 . Date of Birth 05/04/1978 02/09/2015 Current Address 3232 CITRON DR NAPLES FL 34120 07/11/2011 Previous Address { 1208 SW 1ST AV CAPE CORAL FL 33991 j 01/31/2007 j ! 1741 RED CEDAR DR FORT MYERS FL 33907 Employer SUN SPORTS CYCLE Previous Employer Consumer Statement v Inquiries These inquiries are made by companies with whom you have applied for a loan or credit in the past two years. These inquiries can impact your credit rating.V 1 A request for your credit history is called an inquiry.Inquiries remain on your credit report for two years. There are two types of inquiries-Hard inquiries may impact your credit score.Soft inquiries do not Creditor Name I Date of Inquiry Accounts https://membershipt ui.transunion.con/tucm/creditReport TUCM.page? 1/1 2/9/2015 Online Personas Credit Reports&Credit Scores-TransUnion Credit Monitoring 15 CReal Estate Accounts - Account Name I Balance I Balance Date Monthly Payment Term ■ PNC MORTGAGE $95,239 01/12/2015 $716 360 Account Number 433800012**** Condition Open Responsibility Individual Current Balance $95,239 Original Balance $101,200 Limit $0 Monthly Payment $716 Last Payment 12/30/2014 Status OK I Term 360 months Loan Type Conventional real estate mortgage Opened 06/14/2011 } ( 01/12/2015 Reported Remarks i s Credit/ Revolving Accounts - Account Name 1 Balance I Balance Date Monthly Payment Term ► SYNCB/CARECR $0 E 01/18/2015 $0 0 ► BKOFAMER ( $0 01/17/2013 $0 0 s f ► CAP1/YMAHA f $0 1 07/28/2009 $0 0 ► CAP ONE I $0 1 03/24/2006 $0 0 Q Installment Accounts - 1 Account Name Balance i Balance Date Monthly Payment Term ► ACS/COLLEGLN $4,567 i 12/31/2014 $133 180 i Account Number 66627**** Condition Open Responsibility Individual Current Balance $4,567 { Original Balance $17,938 Limit $0 Monthly Payment $133 htfpsJ/membership.tui ransurron.corrftUcrrfcreditReport TUCM.page? y' 229/2015 Online Personal Credit Reports&Credit Scores-TransUnion Credit Monitoring Last Payment 12/17/2014 16 Status OK Term 180 months Loan Type Educational Opened 03/12/2003 Reported -- 12/31/2014 - Remarks ■ SANTANDER $0 07/31/2013 $258 72 Account Number 3000010916214—* Condition Closed Responsibility Individual 1 Current Balance $0 Original Balance $14,730 Limit $0 Monthly Payment $258 Last Payment 07/30/2013 Status OK Term 72 months Loan Type Auto Loan Opened 09/02/2007 Reported 07/31/2013 Remarks ► SOVEREIGN BK $0 05/31/2009 $258 i 72 Account Number 617406795748**** Condition Transferred Responsibility Individual Current Balance $0 Original Balance $14,731 Limit $0 Monthly Payment $258 Last Payment 04/29/2009 Status ----- OK Term 72 months Loan Type Auto Loan Opened 09/02/2007 Reported 05/31/2009 Remarks I _ Account closed due to transfer https://membership.tui.transunion.con tucmtreditReport TUCM.page? 2/9/2015 Online Personal Credit Reports&Credit Scores-TransUnion Credit Monitoring ■ AMER HONDA $0 02/09/2009 i $137 ( 60 17 Account Number 4133**** I - Condition Closed Responsibility Individual } Current Balance $0 Original Balance $6,975 Limit $0 Monthly Payment $137 Last Payment 02/09/2009 Status OK } Term 60 months Loan Type Auto Loan Opened 02/20/2004 Reported 02/09/2009 Remarks Closed ■ Public Records INs site is hosted and operated by TransUnion Interactive,Inc.. About Terms of Use Privacy a wholly owned subsidiary of TransUnion.LLC.Copyright 2015 TransUnion Interactive. All Rights Reserved. https://membership.tui.transt on.comthrm'creditReport TUCM.page? 4/4 18 APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G14000119238 Fictitious Name to be Registered: NAPLES PLATINUM POOL AND SPA Mailing Address of Business: 3232 CITRON DR. NAPLES, FL 34120 Florida County of Principal Place of Business: COLLIER FILED FEI Number: 47-2419277 Nov 28, 2014 Secretary of State Owner(s)of Fictitious Name: NERO, MATTHEW R 3232 CITRON DR NAPLES,FL 34120 US I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50. Florida Statutes; in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath and i am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s. 817.155, Florida Statutes. MATTHEW NERO 11/28/2014 Electronic Signature(s) Date Certificate of Status Requested( ) Certified Copy Requested( ) 19 FLORIDA DEPARTMENT OF STATE eidt DIVISION OF CORPORATIONS w 5iinbz Cy Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return to List Fictitious Name Search No Filing History Submit Fictitious Name Detail Fictitious Name NAPLES PLATINUM POOL AND SPA Filing Information Registration Number G14000119238 Status ACTIVE Filed Date 11/28/2014 Expiration Date 12/31/2019 Current Owners 1 County COLLIER Total Pages 1 Events Filed NONE FEIIEIN Number 47-2419277 Mailing Address 3232 CITRON DR. NAPLES, FL 34120 Owner Information NERO, MATTHEW R 3232 CITRON DR NAPLES, FL 34120 FEI/EIN Number: NONE Document Number: NONE Document Images '28/2014--Fictitious Name Filing View image in PDF format Previous on List Next on List Return to List Fictitious Name Search No Filing History Submit cn,e Co *.a:z s D,.., „er^ Sea.ct e = e; Pc ..es State - 20 ___..-"'1 NAPLEI2 OP ID:TD A�RL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY) 03/01/2015 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 PROGRESSIVE Northeast Agencies-PRG ONE FAX FAX 6467 Main St.,Ste 104 ''AuC,No.Ern:888-476-1301 i(A/c,No):877-769.7513 Williamsville,NY 14221 E-MAIL : PROGRESSIVE - INSURER(S)AFFORDING COVERAGE i NAIL* _ INSURER A:SENTINEL INSURANCE COMPANY LTD 11000 NsuRED NAPLES PLATINUM POOL AND SPA INSURER B: 3232 CITRON DR • NAPLES,FL 34120 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR. AWL'SUBR i POLICY EFF ' POLICY EXP — LTR TYPE OF INSURANCE Wsn wvD POLICY NUMBER I(MMIODllYYYL(MMIDDIYVVY1 UNITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 300,000 CLAIMS-MADE OCCUR 01SBMAZ9785 02/27/2015 02/27/2016! DAMAGE TO RENTED 300 0001 — PREMISES(Ea ocwrroncel S , MED EXP(Any one person) I S 10,000 1 PERSONAL&ADV INJURY I s 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE IS 600,000 XI POLICY_J'JE a '` LOC PRODUCTS-COMP/OP AGG 1 S 600,000 OTHER: +$ AUTOMOBILE LIABILITY •COMBINED SINGLE LIMIT ,S (Ea accident) 1 ANY AUTO BODILY INJURY(Per person) ;S ALL OWNED 'BODILY INJURY(Per accident I$AUTOS AUTOS _!SCHEDULED ( ) HIRED AUTOS !NON-OWNED PROPERTY DAMAGE ,_ !AUTOS 1 ;;(Per accident) $ — UMBRELLA!JAB r jl I ! # I S OCCUR I ;EACH OCCURRENCE $ EXCESS LIAB i i CLAIMS•MADEIr i i AGGREGATE I S DEC• i 1 RETENTIONS 1 S WORKERS COMPENSATION i I PER ' ! OTH- AND EMPLOYERS'LIABILITY ' .STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N -------- E.L.EACH ACCIDENT 'S IM OFFICEREMBER EXCLUDED? i N/A; i •(Mandatory In NH) I I 1 E.L.DISEASE•EA EMPLOYEE $ If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Licensing Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N.Horseshoe Dr. Naples,FL 34104 AUTHORIZED REPRESENTATIVE x , 1;.: 1_._ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 21 e T D C`DEPARTMENT OF THE TREASURY li�J INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 11-28-2014 Employer Identification Number: 47-2419277 Form: SS-4 Number of this notice: CP 575 G MATTHEW R NERO NAPLES PLATINUM POOL AND SPA 3232 CITRON DR For assistance you may call us at: NAPLES, FL 34120 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 47-2419277. 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. 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 electing 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 permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is NERO. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. 22 4i.. DRIVER LICENSE CLASS E N600-556-78-164-0 MATTHEW RYAN NERO 3232 CITRON DR NAPLES.FL 34120-1470 • DOB 06-04-1978 SEX M_ ' ISSUED:02-12-2014 MGT 5-Ot EXPIRES 05-04-2022 PEST-A --nt OZ/ Xt_ ,EASE: /1ff�Giflt� /W7Q� MOTORCYCLE ALSO Ooesanon of a motor reb+cke constitutes consent to an sobr'ett tes'reQU!rbc by fa. ACC In One Painters and Cleaners 4513 SW 8th Ct. Unit 105 Cape Coral Fl. 33914 239-246-4472 Allinonepainters.com/Allinonepainters @gmail.com To: Collier Licensing Board 3-25-2015 All In One Painters and Cleaners would like to reactivate the painting License in Collier County. All our work was concentrated in Lee County between 2003-2015. The recent change in the building industry is causing us to expand our territory. I would like to petition the board to reinstate my license for Collier County. Robert Saviste --/e6-1/`—`4 President , vil ())7oz C.7.014:14.ty ....,, ,,..„.........,...... GMD Operations 8E. Regulatory Management Licensing Section 2800 North Horseshoe Drive 0 c)_ 303ô Naples, FL 34104 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompan.y this application. The fee is pot 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. 90406, as amended. NAME OF COMPANY: Exact Corporate/Business Name: So -7t 34e.. 1 A c._, - Fiction Name/DlaA: _Au I r) 0,A e PO---i .1 te 15 GLVMA C 1 P ck tA e_r- Qualifier Name: Q-©b 50....cit 5 te Physical Address: 14513 G14/ cf. c_61.._ _ corck„. ( L _ 339_LY__ (Number 85 Street) (City) (State) (Zip Code) Mailing Address: ________ (Number & Street) (City) (State) (Zip Code) Telephone: 2 29 - 2.`46 "4c/7d E-Maii: a_t1 i/NorNepo.s,A-1-d_r5 0_op ww-ils (Lc)ri IyieE OF LICENSE: U Genera l ---- $230.00 L-.3 Electrician $230.00 U Building $230.00 0 Plumber $230.00 U Residential $230.00 El Air Cond. $230.00 U Mechanical $230.00 U Swimming Pool $230.00 U Roofing $230.00 4 Specialty 1 Specialty trade: 17°-.I.rvT 1 A(I) \i/- IP OXITY Mr) I \ NI MAR 2 3 2015 g C GE OF STATUS: )61:instatement j ( CO 1-- 232527 (cD+: 23287) 3/24/2015 Reinstatement Fee=$205.00 enp.Active 3 Year Fees=$555.00 *Different fees may anitly* Total=$760.00 1. The names, titles home address and phone numbers of all Officers/Managing Members of the Firm. � ��. �� `\ - J 43 �������� - , ���\�t�T I-�~�/�I c`��J �� ���.� ' ^^`~~ .~-- `~ �~� ` � ��� ���� ^8 6497 c-- Co�0�( . - �^�91~y ' 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. •�0Ne-- -- -- _ - - --_- _ ._-- - - � ' --- -_- --__- 3. List all debts you or any company(s)associated with you ref sed to pay and the reasons for the refusal to pay Attach extra pages if needed. t.J on ^� ��� AFFIDAVIT |. ‘;k3.) ���� certify that the foregoing is true arid correct to the best of my knowledge. Authorized Offic r of the Firm - STATE OF FLO COUNTY OF Lee The for i instrument k | before me this --_' 7 3/ '/ B /� // ) By / of ��' / /� f-�,//'}�ƒ/��� (Name of officer, title/agent) (Name of Corporation) a / / /7/�/ Conportion on behalf of the corporation.corporation.or Place of Corporation) He/She has produced 14 / ) / identification and did not take an oath. (Type of identification) NOTARY'S SEAL 62:- /in ) / ' (S GNATUREOFNOT '/ , sigNO Page 2of4 Nits misilitO• QUALIFIER INFORMATION: Name: 12-c7Deri- Scu}i'S+e., Address: LI 5 /3 5W (3 CJ avwt- I O Co—p 1= 1. 33,1 (Number& Street) (City) (State) (Zip Code) Telephone: 39 — Li-12 DateofBfrth: 7 —/ 1 --6 s.s. #: 000-00- -)Li 5Z E-Mail: 0.-1 1 0 n p ,Vt-C 1/. 00.1 en c-1-11 Driver's License: A 3 —7 7 7 - - 2S- 1 -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. t.) 0-1% -2(7- L/ S3 -101Z SE)-04A Ecive-115ovi 1 -3,3.1 - 32 I 616_ 3. Have you ever been convicted of a crime related to Contracting? 0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? 00 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. 9. List your business or work experience during the past ten years. I'c 1,40,--a Mt LN Ore- [20-i e5ç r- 4h 1.0c- 10. Statement of any formal training you have had in the area for which the application is made. _ - V'Cx.l I c.(7 r _A 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 thi$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. 20,6e-r+ APPLICANT(PLEASE PRINT) ` � ) Ar11 �—' OlAe- C»c��1- 1--rs mN'l t 1r5 NAME OF COMPANY - - SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF_Lee The foregoing instrument as acknowledged before me thi (Date) By ' / ��/}��� --� � \ ~�//�� �� ' `~ ` — ---'-' ~_ `- -- who has produced A21) (Name of person acknowledging) - — ' -- — (Type of identification) as identification and did not take an oath. • NOTARY'S SEA L /' ) (BGNA UREOFNOTARY) Page 4 of 4 AFFIDAVIT IT IS understood and acknowledged. by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation insurance it will result in the possible revocation of my Certificate of Competency. SIGNATURE OF APPLICANT &!1 171 one 47—„ci BUSINESS NAIVMt • DATE • BEFORE/tiM this day p ersonally appeared 20-b F'L who arms 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 orkr.en's Compensation Insurance. STATE OF FLORIDA COUNTY OF Lee The foregoing instrument was acknowledged before me this /,5//e( date by Id I__ c_Sa 1,/ who has produced L (name of person acknowledging) . (Type of identification) as identification and who did not take an oath. totimumlioi ✓.\\ • ;: "•✓,� SICK. A`I THE I NOTARY rfr 6'4'14\ eCt r Alc. NOTARY'S SEAL P.*I ""••_ 1* ; #EE 117586 ? (PRINT NA (}�+ NOTARY PUBLIC) ° ' �.-eo , , 'Q= NOTARY PUBLIC • � 0 /Wed1 G.• O A atarn SucccV_.: <c'e f 4 3 STATEMENT OF OWNERSHIP • This certifies that I, C-o&ert arn a member or (APPLICANTS NAME) • Managing member of_ 1 • (LIMITED LIABILITY COMPANY NAME) I own 1 00 % of the units issued by the-‘m Company listed above. • Affidavit of Applicant:.I certify that the information contained is a true and correct statement to the best of my knowledge. . Scxt.)t-5 tr_ (PRINT NAME) (APPLICANTS SIGNATURE) • • -2,1 -L5- • • • (1.1.A.M) • • • 1 I a 1 I • • RESOLUTION OF AUTHOR 77,E TON - • • AREAS att L o„� teo,,.t c5 proposes to (Name.ofBusiness Entity) engage in contracting as - (Type of legal entity:co in .CoIlier.Coun Florida, P•�Partnership,etc. ty, da accordiing to County Ordinance 2006-46,as amended;and WHEREAS It lh �[ pr�[nYi r� r,e�1 Yiz�nr rS (Name ofBustness Entity) proposes to qualify'for a Certificate of Competency with_g:s 4 re:;--• (Name of Individual) • NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned ' •e.r So 4A S•-G JO$icers Owners, of l�l D�.r_ P wners,Partners) �a1-.. 'S o``t.\ 1— hereby resolve and represent to the Collier County (Name of Business Entity) Contractors'Licensing Board that the qualifying agent; y+ x is active in all matters connected with the conducting business of• (Name f�d'vrdual) S _ G .,f, ,c.►,d We further resolve and represent that (Name ofBusiness Entity) Legally empowered to act fore -- Do� Pori.[rrS . (Names of In.::.� ALL, � (Name ofBusiness Entity) connected with its contracting business,and has the authority to supervise construction undertaken by (Name ofBusiness Entity) DULY PASSED AND ADOPTED THIS_____ ___day o f_ ,____o t, ).D( 1 • .(Officers,Partners,Owners—with Designation undeaneath) • -- Witness . Witness - Corporate Seal(ifAppiicablc) • n OrryPublic Cet tiiicate by Sw tq.to anti subscn�before me this /. day of t1 Ll�� 2(�/� t A ,q71-c.,:,..,i1,--,0 to41) .Commission PubIic Name Printed t„„,,►uA► is�r,� No 'i. L i� • Number ��� ��(N i{I ''% Public S',1.8; •, - My Commission expires: �`���` 'nvssioAF^. li: # E11i o6 • o °°fj1j���ii��Si tA��`r��l� COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples_Florida 34104 • 239-403-2400 • FAX 239-403-2334 11"A" MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119,Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as, confidential and exempt under Chapter 119, Florida Statues. 2014 FLORIDA PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#P99000051233 Apr 08, 2014 Entity Name: SAVISTE INC. Secretary of State Current Principal Place of Business: CC8487432890 2716 NW 4TH ST CAPE CORAL, FL 33993 Current Mailing Address: 2716 NW 4TH ST CAPE CORAL, FL 33993 FEI Number: 65-0932794 Certificate of Status Desired: No Name and Address of Current Registered Agent: SAVISTE,ROBERT 2716 NW 4TH ST CAPE CORAL,FL 33993 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : Title P Name SAVISTE,ROBERT Address 2716 NW 4TH ST City-State-Zip: CAPE CORAL FL 33993 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that lam an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:ROBERT SAVISTE PRESIDENT 04/08/2014 Electronic Signature of Signing Officer/Director Detail Date q tdli LEE COUNTY SOUTHWEST FLORIDA BOARD OF COUNTY COMMISSIONERS John E.Manning District One Cecil L.Pendergrass District Two Larry Kiker September 19, 2014 District Three Brian Hamman District Four COLLIER COUNTY CONTRACTOR LIC Frank Mann 2800 N HORSESHOE DRIVE District Five NAPLES, FL 33942 Roger Desjarlais County Manager Richard Wm.Wesch County Attorney Donna Marie Collins Hearing Examiner LETTER OF RECIPROCITY This letter is to verify that ROBERT SAVISTE took the Experior examination, sponsored by Lee County. BUSINESS & LAW: 84.0% DATE: 09/06/1997 Painting Contractor- PT: 90.0% DATE: 09/06/1997 If you have any questions or if I can be of further assistance, please contact Contractors Licensing at(239) 533-8895. Sincerely, f David Paschall Contractor Licensing SEP222014 P.O. Box 398, Fort Myers, Florida 33902-0398 (239)533-2111 flicltrrcp.rpt Internet address http://www.lee-county.com AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G12000026176 Fictitious Name to be Registered: ALL IN ONE PAINTERS AND CLEANERS Mailing Address of Business: 2716 NW 4TH ST CAPE CORAL, FL 33993 Florida County of Principal Place of Business: LEE FILED FEI Number: 65-0932794 Mar 15, 2012 Secretary of State Owner(s)of Fictitious Name: SAVISTE INC 2716 NW 4TH ST CAPE CORAL, FL 33993 Florida Document Number: P99000051233 FEI Number: 65-0932794 I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath and I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s. 817.155, Florida Statutes. ROBERT SAVISTE 03/15/2012 Electronic Signature(s) Date Certificate of Status Requested(X) Certified Copy Requested ( ) D -4 D r y i o o m o .. cD 00 m O 0 < o �°a C.I. F� D m 33 _4 CZ D 'n CO m Z r co co w C) co co v' Po co 0 ca c7 CO r' C co r— M z m C C) 03 0 m C 73 Z Co —I co -< 0 N CD 0 O jr ww C = n � - o �� 171 m C) �� Cl)D cn CD cn co O _. C) -4 w -4 � 0 0 -a > ca CO-". = z 33 0• C ° - m m-I o cp 0 33 z ° m mo o x ) v a m 70 171 co m m Z7 F -Ti N (I) o _ can o O m o am p z0 --I 0 o z z m w 0 m E N -a G) N ..< r 2) O- CA) >7 O N O A • �R L10EN E <. 123-777-68-251-0 4 � • s= 'T SCOTT SW 8Th CT UNIT 406 L,FL 83914-6441 91 i4` SOS: w Opel-anon of a moan,veiled>constitutes consent toot!U IIS Mtseteifed by i.o AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER 1> ' ! am a resident of �%C County, 66e_11)ii (State) and have resided here for more than five (5) years. � abc�� Sky 5 Duffing the last five years I have known l (Applicant), 1 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) l j/ti1�j2 (Name) C`a Y Cfrnie✓l 't (Address) 501 a stk.) [PA A p/. Cafe ��11 t��53q 14 Telephone) a39` Y g -67�� STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 1(-1/4& ( JOA.2O)' by � alr Ak (Date) who has poduced �� ��(name of p rson acknowledging) (Type of identification) as identification and who did not take an oath. i 1 A b GNATURL Ulf'NO'I'AR NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC �`"� °�a ERIN UNOBERO I E MY COMMISSION#EE 201242 o +,c EXPIRES: 23,2016 10 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, /00k 6et2-4 , am a resident of L i l �'� County, F 1 O dG_ (State) and have resided here for more than five (5)years. During the last five years I have known 12a( 4- 66a i (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) al— (Name) /000(3aa- �� �Jpp '_ (Address) /23 6. 231J 4V-e L'- ee (, It- 3309 Telephone) Z307 z/( /&2 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this ,2-,,-23-15 by l (Date) 1 A{br l tf a who has produced b'i i/•p rS i Ce h e� (name of person acknowledging) (Type of identification) as identification and who did not take an oath. / Nowry hi �1e1�el�1 A% S'G ATUFtE ur N t�'i'AK f4 Mellndik A MOFf@1I N.ARM ,.rintRom t�L (PRINT NAME OF NOTAR NOTARY PUBLIC • 10 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I 'oi IiA Kok Le , a m a resident of e_ County, Of t a (State) and have resided here for more than five (5)years. During the last five years I have known R-Ate-CA" GvU`�S � (Applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. / (Signature) LicAL ' 6 Warne) YVVAg\..1 DLO L�(Address) I S-19 (1 i\r -A`51 - 3611-q Telephone) a3 c1 c)-t al1 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 15 ruJ a by h4a 7OL )t\ 1\ who has produced �L(Date) (namY of person ack wledging) e of identification) as identification and who did not take an oath. �� ANGELA GILLETTI Florida �2, / • . Fc Notary Public,State of -' I Commission•FF 43121 My Comm. expires Aug.6, 2017 SIONATUR ' Oh'NOTARY NOTARY'S SEAL (PRINT WAME OF NOTARY) NOTARY PUBLIC 10 ALLIN-1 OP ID: CW AC-OR L CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/22/2015 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 Mike•Lane Lane Insurance Group NAME: Mike Lane (A/CN o, tl:239-947-7474 FAX Mike 21105 Design Parc Lane Ste 103 E-MAIL Estero,FL 33928 ADDRESS: Cathy Clement INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Scottsdale INSURED Saviste Inc. DBA INSURER B: All In One Painters and Cleaners INSURER C: 2716 NW 4th St INSURER D: Cape Coral, FL 33993 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/OD/YYYY) (MMIDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY AGL00568500 10/25/2014 10/25/2015 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 7 POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) _ $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS JPER ACCIDENT) $ UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? 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 (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Painting Interior building or Structures. Painting Exterior buildings or structures 3 stories or less in height CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractors THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Licensing Board ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N. Horseshoe Drive Naples,FL 34104 AUTHORIZED REPRESENTATIVE Cathy Clement ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AEf CERTIFICATE OF LIABILITY INSURANCE ZATE(M15°YYYY, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 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 CONTACTMICHAEL C GEE NAME: MICHAEL GEE INC PHONE /941) 907-0914 �FAX 941 907-0916 IA/C Nn Fxf1' l (A/C,No):( ) 7353 International Place #301 E-MAIL BTRON(3VERIZON.NET Sarasota, FL 34240 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: STAR INSURANCE COMPANY INSURED SAVISTE, INC. INSURER B: ALL IN ONE PAINTERS AND CLEANERS INSURER C: 4513 SW 8TH CT. , APT 105 INSURERD: CAPE CORAL, FL 33914 INSURER E: (239) 246-4472 INSURERF: _ 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 AUUL-SUM- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDYYY) LIMITS COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1 DAMAGE 1 O HEN I EU CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ .---,PERSONAL&ADV INJURY _ $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _ PRO- POLICY Ej JECT LOC PRODUCTS-COMP/OP AGG_ $ 0 . R: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEL) U RETENTIONS $ WORKERS COMPENSATION X I PER STATUTE OTT AND EMPLOYERS'LIABILITY TUTE Y/N ANY A OFFICER/MEMBER REXCLUDED?/PARTNER/EXECUTIVE U N/A EL EACH ACCIDENT $ 1,000,000 (Mandatory in NH) WC 0829407 00 7/28/147/28/15 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1, 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY CONTRACTORS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE LICENSING BOARD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N. HORSESHOE DRIVE NAPLES, FL 34104 AUTHORIZED REPRESENTATIVE FX# (239)252-2469 -rte,-,e1 C. t ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • • s 9 9-11 • I DO" • GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: RO -4 1(3-1-e Certificate Category Requested: Pa f'i4il 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: ULI� CCAAeI4J D/1 —� C b 3— 6 6 G LS--Title: License umber( applicable): Name of Business: A `dyrC C /rt c. Business Address: / ? / ( 5+ C∎14-i - ' ,V\ E&S j it) F FL 3-3 3 Business Phone: �3 1-3�1"I‘:t I I' The Applicant's years of experience from b to JO I The applicant's scope of work (specific duties)included: c-e) Additional Comments: Falsifying any information provided herein may subject your license to revoc. 's 43001P- Print NName: 04 n J v �r c� State of Florida County of Collier The f regoing instrument was acknowledged before me on this 2'2 day of Oval(i Po 15 by Jt-& I dv�r,�,n who i ersonally own o m r produced as identification and who did not take an oath. /01:414N, MISERLY S.POSTOR1NO ary ;t- MY COMMISSION#FF 072371 Signature of No EXPIRES:December 16,2017 t_1 Bonded Thru Notary Public Under•eitere • pc I'Ql —L tct; VERIFICATION OF CONSTRUCTION EXPERIENCE Contractor Licensing %Codes and Building Services Post Office Box 398 Fort Myers; Florida 33902 Telephone: 941-335-2205 Applicant's Name � C,s" SCcSV k 1 SQ, Certificate Category Requested q:,.\V:.nG • The Applicant is seeking a Lee 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. The following information must be provided by the person verifying trade experience: Name,Title and License number of the person verifying experience: �k�• • S, e•• Name OW4\cs' and �C�J1Q. C"e. � c� ∎■1-•o � S Title(le Owner/Supervisor etc.) License Number V Name of Business 1%4 se C.a,r\s Co,,.sVs•,c�■6,r■ Business Address `p, •r V. -Q)-a-70 'i\ Business Phone 1`1 6 "'to(t1/oI i.{1- b3- 19 S H The Applicant was employed by me from_••,414+7/45 • /7 8c to l I2r q 6,5t The Applicant's scope of work while employ by me included: VAVQ.r‘pr 'J1 '\ o.:�X c-;•r•r• eC►v.5 vor. ��•n��� "')k" .Y� a:l\ a s . ° v.'5. Ve—S: �,E,vvt( .. Ctw.'"•oe-‘‘c,\rv.N Additional Comm ts: �S 5�:�`t- �� �s (N-C-• �� s� to� 6 • J a.r\ -1 air S u t• r•.c..es 4t\f\..A- ��.�� �.;r� �I _ Cp c.d 6 Signature Printed Name: TWAT 0 sA--vas State of Fle+ide- I I;"a i S County oftee- S4—..ova... ov The foregoing Verification of Construction E)cperience was acknowledged before me this 675/day of ��74Mkirr.19 - 12-12411/0 ?!57`r— who is personally known to me or who has produced .i4 /l d IeS 4.5r as identification. w 4."107 CIVS. tom"-•"4 i" ry N Public -- - • • JEANNEIT E.CONWAY Printed Name: �/C,51/14 - C t wlgty NOTARY PUBLIC, STATE OF ILLINOIS / MY COMMISSION EXPIRES 4-24-99 Experience 7-96 14+44•24444+2.4 VERIFICATION OF CONSTRUCTION EXPERIENCE Contractor Licensing %Codes and Building Services Post Office Box 398 Fort Myers, Florida 33902 Telephone: 941-335-2205 Applicant's Name /f a e_./^71- _.p 71- L75C'.a7f`" tSi9!/7ST Certificate Category Requested V a-i n b y • C" The Applicant is seeking a Lee 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 The following information must be provided by the person verifying trade experience: Name,Title and License number of the person verifying experience:- T L ) y 11/t�y'/`,' s Name Korea ri` and h LicenseNumt i'�e^� �'� //('nc�i'S The Owner/Su ))-/ �� -P Name of Business 3;4 P) //o r'/','-5 &h,67%'ac-F,'c, It) Business Address ,3---5/67 gib - -, r16e t 72-G✓..1.9/5'l Business Phone I / 7-- W 35-73 1 The Applicant was employed by me from a.1/ •/77 3 to A-rr,4s/ The Applicants scope•of work while employed by me included: Pa,`nfi' yd ( f rt I"tn Xf.e,^ `o oo�-• 5 '±!11 4hLv4fe—rCoe 'e4 . + et '0+' t'y W4(1) try tri 4' h 1 45fe�� Additional Comments: Signature Printed Name: Zl/4/ /yJoeeeiS State of Florida County of-L-ee.. The foregoing Verificati f Contra tion Experience was acknowledged.before me this'?day of 192 by h N r t^r s who is personally known to me or who h produced • asi entification. ` • - Notary •. . ' •``✓�;' Lob[117:::16 Printed Name: Lf.S 0 r'O 2 t ) Noway ktillo, 111 Experience 7-96 Premier Profile-ALL IN ONE PAINTERS CLEANERS Subcode: 970135 Ordered:01/23/2015 10:33:49 CST •:▪ LI Experian Transaction Number:C500713023 ••••• Search Inquiry:SAVISTE INC DBA ALL IN ONE PAINTERS AND CLEANERS/4513 SW 8TH CT UNIT ▪ •A world of insight 105/CAPE CORAL/FL/33914 Model Description: Intelliscore Plus V2 Business Name Business Identification Number ALL IN ONE PAINTERS CLEANERS 738164060 Doing Business As: ALL IN ONE PAINTERS AND CLEANERS Website: allinonepainters.com Primary Address: 4513 SW 8TH CT APT 105 Phone: (239)246-4472 CAPE CORAL, FL 33914-6441 This business is the ultimate parent. igiSee the corporate hierarchy by clicking here TOP O Risk Dashboard x, 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 J4'., LOW RISK 85 LOW RISK 0 O O" ,: Score range:1 -100 percentile Credit Limit Recommendation:$5,400 TOP O Years on File: 17(FILE ESTABLISHED 02/1998) SIC Code: PAINTING&PAPER HANGING CONTRACTORS-1721 Contacts: ROBERT S SAVISTE-PRESIDENT NAICS Code: Painting and Wall Covering Contractor-238320 Number of Employees: 2 Sales: $527,000 TOP 0 Commercial Fraud Shield Evaluation for:ALL IN ONE PAINTERS CLEANERS,4513 SW 8TH CT APT 105, CAPE CORAL, FL33914-6441 Business Alerts fi '. Jh ,r Verification Triggers The primary Business Name,Address,and Active Business Indicator: /I Experian shows this business as active Phone Number on Experian File were reviewed for High Risk indicators,no High Risk indicators were found. Possible OFAC Match: I No OFAC match found Business Victim Statement: 1111-1 No victim statement on file TOP 0 Credit Risk Score and Credit Limit Recommendation 1 5A 1m i, tz Jm .i, �C l u5 r ha , l�; 9,* 'A 1 r ? ? ^ F+w� NR F xr , � Y , y ' �_„ YA ,e f, F .R [ f , M s X wr, # kL 5 ;;0 .Y c i ,„,!u+ Current Intelliscore Plus Score: 97 Risk Class: 1 LOW RISK J 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-ALL IN ONE PAINTERS CLEANERS 1/4 , x rs���`� I x s ;,f S �' ;�' 1°u :� al RBy 8 t si• �}'we M`�,q r 7K 1 • High 5., 4. 1 4.Lo Risk' Risk 0 10 25 50 75 100 6 This score predicts the likelihood of serious credit delinquencies for this business within the next 12 months.Payment history and public record along with other variables are used to predict future risk. Higher scores indicate lower risk. Factors lowering the score Industry Risk Comparison NUMBER OF RECENTLY ACTIVE COMMERCIAL ACCOUNTS 96%of businesses indicate a higher likelihood of severe delinquency. LENGTH OF TIME ON EXPERIAN'S FILE •�.0&7,9 > TyrT W s;s1_n`r (vi t n ! , .r v7}ld1>y. d2 7yyysyo5, di {q i e Ip s} .. .166 Oa I • !': r1 l ii r �. L Y 52 b..f 19 'T 1 - H1.1%a i^ l:,jr Quarterly Score Trends 100 -1 I 93 94 ao t. so 70 s . i I ' � 1s The Quarterly Score Trends provide a view of the 60 < F n3 i kc01 4Sas^Yr>'n}1 f'+ wt h2 yro Mil sM11{ r fi d likelihood of delinquency over the past 12 months for this 50 <' • es trends will the score p rTMk � business.The tdill indicate if th improved, t"44 #3 t }11 I ,�'' ,I' r '� a i� r i � ; remained stable,fluctuated or declined over the last 12 (�� J d ral "; 1 1�y 1i�) t 1 ,�y "t ,� �R'i i NS? months. 30 9' 20 10 0 t S p5& , `SO' aa�!AC' 1 �. re. ¢x Iti t i ✓. C�s'!/ Credlf)ti3..aSC r@ Tina ., !.,,. ,R 4 `�;#kS�iw�d� #¢n4ek t sC�Si Ei Id 'L-ua „YF? •N Current Financial Stability Risk Score: 85 Risk Class: 1 �, n s r 'r!6 "i'�r>✓ >, tvra >ti r'17 1 r LOW RISK HigM O4 3 �Low., The risk class groups scores by risk into ranges of similar , Risk performance.Range 5 is the highest risk,range 1 is the k 0 3 10 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 lowering the score Industry Risk Comparison NUMBER OF ACTIVE COMMERCIAL ACCOUNTS 84%of businesses indicate a higher likelihood of financial stability risk. RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR RISK ASSOCIATED WITH THE BUSINESS TYPE EMPLOYEE SIZE OF BUSINESS 16redit Limit Recommendation Credit Limit Recommendation This recommendation compares this business against similar businesses in the Experian business credit database.It is based on trade information,industry,age of business and the Intelliscore $5,400 Plus.The recommendation is a guide.The final decision must be made based on your company's business policies. TOP Payment and Legal Filings Summary Pay ent Re.rformance Trade and Collection Balance ;, F Legal Filings:; f Pa,s.ry;.M n .r i7 ,� n�t:.,w+,.��3:we?m+ Current DBT: 0 Total trade and collection(3): $0 Bankruptcy: No Premier Profile-ALL IN ONE PAINTERS CLEANERS 2/4 • 'Predicted DBT: N/A All trades(3): $0 Tax Lien filings: 0 Monthly Average DBT: 0 All collections(0): $0 Judgment filings: 0 Sum of legal filings: $0 Highest DBT Previous 6 Months: 0 Continuous trade(1): $0 UCC filings: 0 Highest DBT Previous 5 Quarters: 0 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended: N/A Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms not available e Industry m Industry DBT Range Comparison The current DBT of this business is 0.80%of businesses have a DBT range of 0-5. DBT for this business: 0 ,IV* t 4F �ti4,r ,N fig,�'6 of businesses 80% 11% 9% DBT Range 0-5 6-15 16+ TOP 0 Trade Payment Summary Trade Line Type Lines Reported DBT Recent High Balance Current 01-30 31-60 61-90 91+ Credit Continuous 1 $0 New -- 0— ------ $0 -- — — Goinbinetl Trade k R ` $p: Additional 2 $33,200 $0 - - -------- -- Toa 4 tiTrade � h f ,r 4i: - S33t2f0 TOP 0 Trade Payment- New and Continuously Reported Trade Details 4'••e " `Account Status (Trade Lines with an(*)after the date are newly reported)W a�MDays Beyond Terms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Cate•o Reported Sale Terms Credit PRNTG&PUBL 01/2015 VARIED $0 TOP 0 Trade Payment-Additional Trade Details )�4K ?°"!° ✓ -eymenf`Experiiences Account Status „. (Trade Lines with an(%,),after,-the date are newly reported) Days BeyondT , _ Te Business Date Last Payment Recent High Category Reported Sale Terms Credit Balance Cur 1-30 31-60 61-90 91+ Comments BANK CARD 10/2014 REVOLVE $14,900 $0 CRED CARD 01/2015 01/2015 REVOLVE $18,300 $0 TOP 0 Corporate Linkage a a Pd”` e11,'`,71 0 sa:^- 4,7 Ir1tcs 3.: ?+�.x,771 cX 7��r h� ,gerir -.us nes Nam .,y.t 4 s , a t ..f�� M 4k� r. 4 rt2 s1 fir` ti The inquired upon business,ALL IN ONE PAINTERS CLEANERS,is the Ultimate Parent ALL IN ONE PAINTERS CLEANERS 4513 SW 8TH CT APT 105-CAPE CORAL,FL 738164060 Branches of the inquired upon business: ALL IN ONE PAINTERS CLEANERS 2716 NW 4TH ST-CAPE CORAL,FL 844338993 TOP 3/4 Premier Profile-ALL IN ONE PAINTERS CLEANERS • 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.Privacy policy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. II Premier Profile-ALL IN ONE PAINTERS CLEANERS 414 4{4 Merit Credit INC Fast, Accurate &Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: 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: SAVISTE INC DBA ALL IN ONE PAINTERS AND CLEANERS FEDERAL ID: 65-0932794 CURRENT STATUS: ACTIVE PRINCIPAL(S): ROBERT SAVISTE TITLE: PRESIDENT DATE INCORPORATED: 06/01/1999 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 2/90 01/23/15 10:29CT [SUBJECT] [SSN] [BIRTH DATE] SAVISTE, ROBERT S. 4111.458 7/68 [ALSO KNOWN AS] SAVISTE,ROB,S [CURRENT ADDRESS] [DATE RPTD] 4513 SW. 8TH CT., #105. CAPE CORAL FL. 33914 5/14 [FORMER ADDRESS] 1759 FOUR MILE COVE PY., #412. CAPE CORAL FL. 33990 12/13 178 ACHORAGE, FORT MYERS BEACH FL. 33931 [POSITION] [CURRENT EMPLOYER AND ADDRESS] [VERF] [RPTD] ALL IN ONE PAIN OWNER 6/10 12/13 M O D E L P R O F I L E * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +758 : 039, 005, 010, 008 *** 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=0 NEG=0 HSTNEG=1-5 TRD=29 RVL=20 INST=5 MTG=4 OPN=0 INQ=4 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $123K $143K $69.OK $0 $616 51% INSTALLMENT: $19.OK $ $18.6K $0 $331 MORTGAGE: $214K $ $208K $0 $1330 TOTALS: $356K $143K $296K $0 $2277 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 12/07 $16.5K MIN25 111111111111 RO1 0786 1/15A $16.5K $0 111111111111 I FLEXIBLE SPENDING $94 48 0/ 0/ 0 BBY/CBNA H 292F021 6/07 $1887 111111111111 RO1 700119114175 1/15A $3000 $0 11 I CHARGE ACCOUNT 11/13P $0 14 0/ 0/ 0 THD/CBNA B 26H3005 6/08 $813 111111111111 RO1 603532028559 1/15A $2501 $0 111111111111 I CHARGE ACCOUNT 12/13C $0 INACTIVE ACCOUNT 48 0/ 0/ 0 SYNCB/SAMS D 2350465 5/03 $518 111111111111 RO1 771410023779 1/15A $424 $0 111111111111 I CHARGE ACCOUNT 10/08C $0 CLOSED 48 0/ 0/ 0 CAP ONE B 1DTV001 3/99 $18.2K 111111111111 R01 480213237293 1/15A $31.2K $0 111111111111 I BUSINESS CREDIT C 1/15P $0 48 0/ 0/ 0 GTEFINANCIAL Q 449N004 3/13 $214K 360M1330 111111111111 MOl 3000049290398 1/15A $0 1111111 C CONVENTIONAL REAL $208K 19 0/ 0/ 0 CHASE B 26QK001 5/14 $6370 MIN48 1111111 RO1 426684136192 1/15A $6500 $0 I CREDIT CARD $4899 7 0/ 0/ 0 SYNCB/JCP D 235058D 9/11 $0 111111111111 RO1 600889149767 1/15A $1000 $0 111111111111 I CHARGE ACCOUNT 6/14C $0 ACCT CLSD BY CONSUMER 40 0/ 0/ 0 SYNCB/WLMRTD B 235060N 11/13 $167 111111111111 RO1 523914107190 1/15A $2200 $0 11 I CREDIT CARD 6/14C $0 ACCT CLSD BY CONSUMER 14 0/ 0/ 0 SYNCB/TJXDC B 235065N 11/12 $190 111111111111 RO1 524366101246 1/15A $1024 $0 111111111111 I CREDIT CARD 6/14C $0 ACCT CLSD BY CONSUMER 26 0/ 0/ 0 SUNCST CU Q 298Q007 11/14 $0 1 RO1 460819002126 12/14A $5000 $0 I CREDIT CARD $0 1 0/ 0/ 0 REGIONS BANK B 3604047 2/06 $80.0K MIN543 111111111111 CO1 500286 12/14A $80.OK $0 111111111111 C HOME EQUITY LOAN $64.0K CLOSD BY CRDT GRANTOR 27 0/ 0/ 0 SUNCOAST CU Q 298Q001 11/14 $19.0K 60M331 1 I01 47132 12/14A $0 I AUTOMOBILE $18.6K 1 0/ 0/ 0 SYNCB/BELK D 235062A 8/11 $136 111111111111 RO1 604583155437 12/14A $1024 $0 111111111111 I CHARGE ACCOUNT 6/14C $0 ACCT CLSD BY CONSUMER 40 0/ 0/ 0 CITI B 64DB002 9/12 $2512 111111111111 RO1 542418106658 10/14A $5900 $0 111111111111 I CREDIT CARD 7/14C $0 ACCT CLSD BY CONSUMER 25 0/ 0/ 0 TARGET/TD D 6476007 12/13 $187 111111 RO1 46037 7/14A $3000 $0 I CREDIT CARD 6/14C $0 ACCT CLSD BY CONSUMER 6 0/ 0/ 0 CHASE AUTO B 402D038 7/10 $18. 6K 60M340 111111111111 I01 11020419565804 1/14A $0 111111111111 C AUTOMOBILE 1/14C $0 CLOSED 42 0/ 0/ 0 CHASE B 26QK004 11/94 $7006 111111111111 RO1 540168303287 11/13A $7200 $0 111111111111 I CREDIT CARD 2/08C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CAP1/BSTBY D 1DTV057 6/07 $1887 111111111111 ROl. . ' 700119114175 9/13A $3000 $0 111111111111 I CHARGE ACCOUNT 9/13C $0 PURCH BY OTHER LENDER 48 0/ 0/ 0 CAP1/BSTBY D 1DTV057 3/10 $413 111111111111 RO1 700106226560 9/13A $750 $0 111111111111 C CHARGE ACCOUNT 1/11C $0 ACCT CLSD BY CONSUMER 42 0/ 0/ 0 ASC F 1TG7001 6/05 $216K 312M1702 11/09 111111111111 MOl 1061218091518 3/13A $0 $8500 05 111111111111 C CONVENTIONAL REAL 3/13C $0 CLOSED 48 1/ 1/ 3 5TH 3RD BK B 9302020 12/07 $10.4K 60M207 111111111111 I01 86789 10/11A $0 111111111111 I AUTOMOBILE 10/11C $0 CLOSED 46 0/ 0/ 0 RBS CITIZENS B 7421059 9/06 $25.3K 72M436 111111111111 I01 2718346048 8/10A $0 111111111111 C AUTOMOBILE 8/1OC $0 CLOSED 47 0/ 0/ 0 REGIONS B 7610018 2/06 $80.0K 111111111111 RO1 432713200024 5/10A $80.OK $0 111111111111 C HOME EQUITY LOAN 5/10C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CHASE - CC H 247V018 10/05 $4038 111111111111 RO1 182000000511 2/09A $5000 $0 111111111111 I CREDIT CARD 12/08C $0 CLOSED 39 0/ 0/ 0 CAP ONE B 1DTV041 11/03 $4935 111111111111 RO1 546641001241 12/07A $7500 $0 111111111111 A CREDIT CARD 1/07C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 WATERFLD MTG F 852N006 6/05 $216K 360M1740 X1111111 MOl 2357196 3/06A $0 P CONVENTIONAL REAL 3/06C $0 TRNSFRD OTHER OFFICE 8 0/ 0/ 0 REGIONS BANK B 3604054 9/04 $124K 360M891 111 MO1 3103020689539 5/05A $0 P CONVENTIONAL REAL 5/05C $0 TRNSFRD: OTHER LENDER 3 0/ 0/ 0 SUNTRUST BK B 423A021 10/03 $14.3K 36M168 111111111111 I01 14700001475236327 4/05A $0 11111 I SECURED 4/05C $0 CLOSED 17 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 1/23/15 ZNP6284423 (FLA) MERIT CREDIT 8/15/14 BBH0008689 (SCT) REGIONS/AMSO 12/03/13 BBH0008689(SCT) REGIONS/AMSO 2/04/13 ZCS0001208 (CNM) FDC C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION BK OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 BBY/CBNA HE292F021 PO BOX 6497 SIOUX FALLS SD. 57117 THD/CBNA BZ26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 SYNCB/SAMS DV235046S (800) 964-1917 PO BOX 965005 ORLANDO FL. 32896 CAP ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 GTEFINANCIAL QU449N004 (813) 871-2690 711 E HENDERSON AV TAMPA FL. 33602 CHASE BC26QK001 (800) 432-3117 P.O. BOX 15298 WILMINGTON DE. 19850 SYNCB/JCP DC235058D (866) 227-5213 PO BOX 965007 ORLANDO FL. 32896 SYNCB/WLMRTD BC235060N (866) 611-1148 PO BOX 965024 ORLANDO FL. 32896 SYNCB/TJXDC BC235065N (800) 926-6299 PO BOX 965015 ORLANDO FL. 32896 SUNCST CU QC298Q007 (813) 621-7511 6801 HILLS AVE TAMPA FL. 33680 REGIONS BANK BI3604047 720 NORTH 39TH STR BIRMINGHAM AL. 35222 SUNCOAST CU QU298Q001 (813) 621-7511 PO BOX 11904 TAMPA FL. 33680 SYNCB/BELK DZ235062A (800) 669-6550 PO BOX 965028 ORLANDO FL. 32896 CITI BC64DB002 POB 6241 SIOUX FALLS SD. 57117 TARGET/TD DC6476007 PO BOX 673 MINNEAPOLIS MN. 55440 CHASE AUTO BA402D038 (800) 336-6675 P.O. BOX 901003 FORT WORTH TX. 76101 CHASE BC26QK004 (800) 432-3117 P.O. BOX 15298 WILMINGTON DE. 19850 CAP1/BSTBY DC1DTV057 (800) 695-6950 PO BOX 30253 SALT LAKE CITY UT. 84130 ASC FM1TG7001 (800) 842-7654 P.O. BOX 10328 DES MOINES IA. 50306 5TH 3RD BK BI9302020 (800) 972-3030 5050 KINGSLEY DR CINCINATTI OH. 45263 RBS CITIZENS BB7421059 (800) 610-7300 480 JEFFERSON BLVD WARWICK RI. 02886 REGIONS BC7610018 NORTH BUILDING 2ND HOOVER AL. 35244 CHASE - CC HE247V018 (800) 432-3117 P.O. BOX 15298 WILMINGTON DE. 19850 CAP ONE BC1DTV041 (800) 947-1000 PO BOX 30253 SALT LAKE CITY UT. 84130 WATERFLD MTG FZ852N006 (219) 434-8411 7500 W. JEFFERSON FORT WAYNE IN. 46801 REGIONS BANK BM3604054 (847) 619-5535 C/0 DOVENMUEHLE MO SCHAUMBURG IL. 60173 SUNTRUST BK BZ423A021 (877) 596-5407 PO BOX 85526 RICHMOND VA. 23285 REGIONS/ANSO B 0008689 (800) 734-4667 P 0 BOX 216 BIRMINGHAM AL. 35201 FDC Z 0001208 (970) 663-5700 5200 HAHNS PEAK DR LOVELAND CO. 80538 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. • j` From: FAXmaker To: 92522469 Page: 1/2 Date: 9/19/2014 9:38:15 AM FAX TRANSMISSION To: 92522469 From: Patricia Arnold Subject: LETTER OF RECIPROCITY FOR ROBERT'SAVISTE Message: SEE ATTACHED Please note:Florida has a very broad public records law.Most written communications to or from County Employees and officials regarding County business are public records available to the public and media upon request.Your email communication may be subject to public disclosure. Under Florida law,email addresses are public records.If you do not want your email address released in response to a public records request,do not send electronic mail to this entity.Instead,contact this office by phone or in writing. S .1. 1.1 , . }.. S .1. i.. '::l. R [. Lee County Website:http://www.leegov.com From: FAXmaker To: 92522469 Page: 2/2 Date: 9/19/2014 9:38:15 AM LEE COUNTY SOUTHWEST FLORIDA BOARD OF COUNTY COMMISSIONERS John E.Manning 11311IZI District One 201 Cecil L.Pendergrass SEP 1 District Two Larry Kiker September 19, 2014 District Three Brian Hammen District Four COLLIER COUNTY CONTRACTOR LIC Frank Mann 2800 N HORSESHOE DRIVE District Five NAPLES,FL 33942 Roger DesJarlais County Manager Richard Wm.Wesch County Attorney Donna Marie Collins Hearing Examiner LETTER OF RECIPROCITY This letter is to verify that ROBERT SAVISTE took the Experior examination, sponsored by Lee County. BUSINESS & LAW: 84.0% DATE: 09/06/1997 Painting Contractor-PT: 90.0% DATE: 09/06/1997 If you have any questions or if I 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 fliclmcp.rpl Internet address http://www.lee-county.com AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER CI t V$11..: OA f_0.0111, .:Ak V0111. "V Olik. .011 V OA 1, 4 A voT.; • +.l '►.ta► Z")7,yxif i • . �.0. 4.7 tl,-yj;ltt*tht4A'4• i x . ...goz � Is./0j o H A H ilk 76 .1. ,--t- r.+ VD . k .8 CA "4"Olk 40, 141 g -410.4.40 a x o Z ■ a a ,c,_)) -. )-+) R ,,_-t Cip CD n i**4 c� )-t �. 1 Ali.- ♦ o N 0 0 a CD P 4'e 0 AtIK E t _Q 6.-: `' .• ,'- I , 9 g tl) 404741 9 int,el �° a• o U' o v z -Jr- I Ii yitt g It* 0 PK c'T 1 V (-• E Ar Ti n'-'' R, vc,...1i &,k‘ittsisOl rO, til A S' / . _ cii p w k p !� mo=w 0 * tlk V 0 il,, 7-i.-2.-s. i 0 P (/‘ 5 r-a." 'VC rif OA b1/4 . sr'/.♦. .a a H N CD 5 0 �' ��a CD Ark V W ®.�� u o °o ' i e.#Atsk AV %LI ♦ 4' o ,. I�4%f o o C� tt 0 0• a. Alf x ;�. 04 V 40" ,, .. 4 J 4 P W - Q /4 411 fly .lti`♦%.4y> VOA.0 ! 41.0 04.1/10: % 04*It Co r Cou-14.ty Growth Management Division Planning & Regulation Operations Department Licensing Section March 23, 2015 Mikel G. Diehl O Florida Hardscapes & Paver Maintenance, Inc. 9/674 4530 15th Avenue SW Naples, FL 3411 gi p 6 RE: Review Of Credit Dear Mr. Diehl, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, April 15, 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, Joann Greenberg Customer Service Specialist Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 Growth Management Division*Planning&Regulation*2800 North Horseshoe Drive*Naples,Florida 34104*239-252-2400*www.colliergov.net 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 X Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity Other (specify) THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on April 16, 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 Mikel G. Diehl d/b/a Florida Hardscapes & Paver Maintenance, Inc. has submitted an application to the Collier County Contractor Licensing Supervisor or his designee for waiver of testing requirements for reinstatement of a Certificate of Competency as a Specialty Contractor— Paving Blocks. 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. 3. That the Board has jurisdiction over this matter and that Mikel G. Diehl was present at the public hearing on April 16, 2014, and was not represented by counsel. 1 4. All notices required by the Code of Laws and Ordinances of Collier County, Florida, have been properly issued. 5. The facts in this case are found to be: a. Applicant has demonstrated through testimony and evidence presented at this hearing that he has been active in the trade in another jurisdiction and has adequate knowledge of the contracting specialty to make re-testing in - the trade superfluous. b. His knowledge of the contracting business is adequate, when combined with a full application to protect the public health and safety of the citizens of Collier County under certain restrictions. CONCLUSIONS OF LAW Based upon the foregoing facts, the Board concludes that the applicant has met the standard set out in the Code of Laws and Ordinances of Collier County, Florida, and that the testing requirement may be waived under certain restrictions. ORDER OF THE BOARD Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and Collier County Ordinance No. 90-105, as amended, by a vote of 7 in favor and 0 opposed, a unanimous vote of the Board, the applicant's request to waive testing in the trade for reinstatement of his license is granted, subject to his payment of all back fees due and owing as set out in Code of Laws and Ordinances of Collier County, Florida and further subject to the following: A. The Applicant shall be subject to a one (1) year probationary period; 2 • B. Applicant shall appear before the Board and shall provide personal and business credit reports in one (1) year for further review of the Board. ORDERED by the Contractors Licensing Board effective the 16th day of April, 2014. CONTRACTOR'S LICENSING BOARD CO _ • COUNTY, FLORIDA WAAL -AZ4) 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/3 th day of , 2014. F-72— Secretary/Contractor's Licensing Board 3 CO eY COT4 Yity Growth Management Division 1\\''\'�` Planning & Regulation O \ \'4 Operations Department Licensing Section March 28, 2014 Mikel G. Diehl Florida Hardscapes & Paver Maintenance, Inc. 4530 15th Avenue SW Naples, FL 34116 RE: Waiver of Exam(s) Dear Mr. Diehl, • You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, April 16, 2014. The meeting is held at 9:00am at the W. Harmon Turner Building (Bldg. F, Admin. Bldg.), 3299 Tamiami Trl. E., Naples, FL in the Commissioner's Meeting Room on the 3rd floor. If you have any questions or concerns, please call (239) 252-2431 Sina ely; `7 ' " ■ 1" rjit ‘ kil\0 �1 u, Samantha Roe Customer Service SperiAIict Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 Growth Management Division`Planning&Regulation*2300 North Horseshoe Drive'"Napies,Florida 34104*233-252-2400*www.coliiergov,net Febr t. To Whom it may concern, I am writing this letter to request renewal of my Paving Block Contractors License. Since closing the company in 2011 due to the shift in the economy and financial difficulties which would no longer support working in the field, I changed my focus to pursuing my education,attending ITT Technical Institution. I have continued to maintain contact with a few paving block contractors and manufacturers in the area to stay current with knowledge and advances in the field.Through the support of Daniel Henthorne, I have continued to do pressure cleaning and maintenance for private homeowners and consequently, due to word of mouth advertising,found an increasing amount of requests for installation jobs. So it is with demand that I am requesting that you reinstate my license so that I might begin to work in the Paving business once again. It is my intention to provide quality work within the standards/regulations set down by Collier County to provide residents home improvements and maintenance that support the beauty of the landscape native to South Florida. Please consider my application seriously. Sincerely, '� / Mel Garrett Diehl - 4 (4;. 7,11 , / MO --...,&:, , ii. C4-3 - 1-er :..2--'4 41Its: '? \ y i,v fyit ,,... . . ,-....-..,,- er pi.CDES Operations atrons & ��i- ory ,. .a ent Licen Section r _ ..-, " i 2800 i� i - _ �, ort4', rsesh• Dr" e R4 ±t;, ,o: Na E =, FL 34 f j.4 O ► L2102, Y ,t.1 ,1 - I i'l 1 zSg 4P BY APPLICATION { rr L� ,�'. S C COLLIER COUNTY/CITY OF NA& ES/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: Ei±act Corporate/Business Name: \pr e9e..,.\-1(..i.{Asseiy.a si ver '(YV,At .%erNar-te cwt' . Fiction Name/DBA: _ Qunlifier Ntunc M .t 1'‘\6 CI CA Y r - 1' bl iCi { Physical Address: -^ y A ISM` Ave_ S. l 1:-1 . 344, , (Number& Street) ( ) (State) (Zip Code) Mni1 n g.Addreoo: U di. a, f i.. OA d -) 3q11 (o (Number es Street) (City) . (State) (Zip Code) Telephone, .r: ,-1:45. ,; E'Mail: L■, i C JSrra q.C.19"-,) TYPE OF LICENSE: CI General $230.00 Electrician $230.00 0 Building $2.30.00. ❑.Plumber $230.00 _ Q. Residential $230.00 ❑ Air Cond. $230.00, Mechanical $230.00 U Swimming Pool $230.00 U Roofing $230.00 .. . 15 Specialty Specialty trade: PC.V et et V.)C 3/6/2014 Reinstatement Fee=$205.00 CHM GE OF STATUS: New License Fee=$205.00 (,4"Reinstatement ( ' From One Business to Another 2011-2013 Back Year Fees=$555.00 i"Dtfferen- Pees may apply Total=5965.00 Pace 1 of 4 _ r= a .1.UX11J D .rr�aLSpecie \ ,\, ) --- - : Ce:�,,.1iss:o,P. EE043482 w J: SIGNATU E OF NOTARY) BONDED E%r?'-^s. 'OV.27,2014 t BOND^'"THRUAi J.2.. SONDLNG Ca,INC. 1. The names, titles, home address and phone numbers of all Officers/Managing Members of.the Firm. 4330 15-, ,a,L 5W N ,o} 3,-110 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. V4 Trle, 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. y Bch. \D6r).g — �r l C.Drf n±1 AFFIDAVIT I, 01 KQQ C•t 6..k. certify that the foregoing is true and correct to the best of my knowledge. Authorized Officer of the Firm STATE OF FLORIDA GVU1 I Yh, 0 �_..� - The foregoing instrument as acknowledged before me this 3` I` Q al g 9 1 1 (Dutt) By - 12kQ of ��Oc`',d6. ., 4 PC A nlercln T (Name of officer,title/2gcnt) (Name of C rpui tiun) a Corporation on behalf of the corporation. (State or Place of Corporation) has.produced .. identification and did not take an oath. (Type of identification) fl r-t -SL-i1-11-1—q -1-17 NOTARY'S SEAL NOTARY PUBLIC-STATE OF FLORIDA . Donna Specie e Cor..iss o- EE043482 (SIGNATU E OF NOTARY) "%.,,„4"Earn^s' OV.27,2014 BONDED TIMti ? Fi;\ULiGCO.,II1(C QUALIFIER INFORMATION: Name: ■N e/■r a C2 _ i t Q Address: 4s • YJe _.1._ 3,411(0 (Number& Street) (City) ` State) (Zip Code) Telephone: 2f1-(163° Date of Birth: I i a I 1 tq? S.S. #: 000-00- -1141 E Mail: LQ'Q �� s r • s� Driver's License: D -5L 1-24-i O.)-D 1. Type of Certificate of Competency for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. Sul e, aeko a -I - S-11- gaaS 3. Have you ever been convicted of a crime related to Contracting? 1'-1 (If yes attach extra sheet with explanation) 7. NitvO,yOU or any tirm yuu have t,'eer1 associated with ever tiled hankn ipfr:y? � t7 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. 0. List your business or work experience during the past ten years. ,A, Cl 1 ( ,_ • N 10. Statement of any formal training you have had in the area for which the application is made. ,h ; tCQ �- W cl!c 2 ' . gce u;U e S3 \r1 v, 1 U) otl.ti-v� Gvp,S bkaG � � � Licensee Information Licensee Number Q29330 Cesoncticr Type Property 4,.lert Name NIIKEL GARRETT DIEHL Type Contractor ; Status Open View Master Project View All Activities For this Licensee Add a new person or business to Address Book Examination Results Add Exam Result Link Exam/Test Type I Date d Exam/Test City Score received ExErn/Test result! INTERLOCKING PAVER 04/28/2007 .NAPLES 80.00 Pass BUSINESS 81.LAW 03/10/2007 GAINESVILLE 80.00 Pass BUSINESS 8/,LAW 01/20/2007 FT. PIERCE 68.00 Show More Fields i Hide,or Clear Field,s, Charge Exam Fee LI Exam Code I Sponsoring County 1 Sponsorship App Date 1 Sponsorship Expiration Date Testing Facility tia% At = ow At 01h, / •' . -ow ***to* - ii.V . CI ,14%.. : is,' ..1:441" At. J '.* . 4! ;:a;. V.*: .:tk . - k: 44ty 0% 0 - ► a ► . s : .,5 x *- -gie t(A k,: 4 t■ 40 . # o -) /40 s II 41"r- Oka 76 -ic7.3 74 745 OfIEN4.4$ tt 1 o °' 44410 Volk bkyo-Tio 0,, 4.1 A w O ,t. _ A _i , -0 i E Ome 0l / E O o tj , A 40 II Arm• #1,//,,, � • 0 .. V L •.E.c,, 44 ,Ni .v + =,, r b C, cri ,7 0 1� '` '--� e� c� -ci 0 c w- E ON " 4 -F",i "y 5 V7 Chi` ,the :' • I c,.). _A Af9 ..-7, ; .(1) Y 0 a, c°"-9 **4 L - y ;c-) 0 e5 \, y L 14'0'0/ .�..� : r . x a� c� E ,, L . 4 .E "e 17 O v� ct a 0 ° 4� 0 a.) ° �� � r,141 ??� g , 0 I O fl ,, +, 'V Olk Nap+ D o t 0 140 ! ,.1:z:A lik y u - ';-'' e uc n c 1-)-4 1 82 .7_,t1 P1111/4 it I ' 4.1 j H c H O ►0 g v OA VII tom x` 11- 0.4 * Pk: g . . k- : Nq- : : . X 4- A - '4" ill-f4 0117AIN*Ori * )1P**Orl' ..t- '-w4+0.r..-nior, 1.1 gt4 40. A l y- : A A ' /A .l iM 1[. AtA �:r Vr . 9.. '1s i. �*.: l 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. `0\■\&t.k APPLICANT(PLEASE PRINT) • NAME OF COMPANY • 0,17( • SIGNATURE OF APPLICANT STATE OF FL IDA COl INIY OF A The foregoing instrument as acknowledged before me this ..3( I IoZO I 14 (Date) By “\;'\ReA �.�: who has produced rVuPjs (Name of person acknowledging) (Type of identification) • as identification and did not take an oath. • NOTARY'S SEAL NOTARY PLBI.IC-STATE OF FLORIDA (SIGNATURE 0114 NOTARY) ' Donna Specie y�� 'Commission#EE043482 Expires: NOV.27,2014 BONDED TERU ATLANTIC BONDING CO.,INC. AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing • Board and myself that if I fail to acquire, or maintain at all tunes effective Workmen's Compensation Insurance it will result in the possible revocation of my . Certificate of Competency. 3e /,, ._e.f-L_____> _ SIGNATURE OF APPLICANT ?t`. G G n nc E '1-cC V Pr riN6Nr4 , C_BUSINESS NAME 3Waov-1, DATE BEFORE ME this day personally appeared; rf1:W.QQ G. 1�.4..,Q who • affirms and says that he has less than one employee and does not require • Workmen's Compensation and understands that nt any time he employs one or • More persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF .gyp The foregoing instrument was acknowledged,before me this 3 1 l oD 01 LI ( ate) �, . by 1)\‘' 4 ( E i e.Q - who has produced C A-\1)C'(`i VAS 62.v✓2g. . . (name of person acknowledging) (Type f ld5n� n1 n as identification and who did not take an oath. . - • s - .. ,ite , . OT AR Y . NOTARY-PUBLIC-STATE OF FLORIDA SIGNATURE NOTARY SEAL _ s Donna Specie . • - Ya�y`,' 'Commission#EE043482 - NOTARY PUBLIC Expires: NOV.27,2014 BONDED TERN ATLANTIC BONDD G CO.,PNC. RESOLUTION OF AUTHORIZATON \-M.t)C & L L+,gb 4 WHEREAS ICJ tP Cf 1Gki proposes to (Name of Business Entity) - engage in contracting as tA9C-?Of-C.1-1'401> in (Type of legal entity: corp.,partnership,etc. Collier County, Florida,according to Collier County Ordinance 2006-46, as amended; and WHEREAS f arle. proposes to (Name of Business Entity qualify for aCertificate-of Competency with Vr-1 (j. i-64 (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned nW ti'Q f of C6( L'. �} (Officers,Owners,Partners) v e vr)\- r Q , "Er-c. hereby-resolve and represent to the Collier County (Name of Business Entity) n Contractors'Licensing Board that the qualifying agent; ∎\& t ( U�'�.Q_ ,is active ` gape o div' in all matters connected with the contracting business of ��,E� rr _ ,and (Name of Business Entity) We further resolve and represent that q't1 \Q, G,. O (,`,Q4 is \_sC.rdS ,i_ (Names of Individual) legally empowered to act for ovpt^Y`cY1.r , T-c in all matters connected with its (Name of Business Entity) contracting business,and has the authority to supervise construction undertaken by (Name of Busines ntity) DULY PASSEL)AND ADOPTED THIS L1 y day of TY\d" , off)4 (Officers,Partners,Owners—with Designation underneath) 0.koLt Witness • Witness Witness - Corporate Seal(if Applicable) Or Notary Public Certificate • Sworn to and subscribed before me this 144. day of ¶ ,a)1 by I'll∎ t ( •oil.LX Notary Public Name Printed Notary Public Signature Commission Number E..E0t-(3y 1104 My Commission expires: 11\a,'Z k apt U NOTARY PUBLIC-STATE OF FLORIDA Donna Specie „ =Commission#EE043482 :fires: NOV.27,2014. BONDED TliaCATLANTIC BONDLNG CO.MC.. COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FA.X '39-403-1334 MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social sccurity number (SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. 13) Verification of applicant's test scnrec and lntormation. • Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and no mny othPr.ViVe he anthnri7ed by law, We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as. :onfidential and exempt under Chapter 119, Floiida Statues. • • sm CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: M & C FLORIDA PAVERS, INC. Date: 03/20/14 Cust. No.: 9999 Address: 6300 JANES LANE, #4 Price: $115 . 00 Ordered By: RUSH NAPLES, FLORIDA 34109 °? Page: 1 elephone: (234) 254-8600 (X) Corporation EIN 65-1135621 PRINCIPALS: PRESIDENT/DIRECTOR DIEHL, MICHAEL D. 4ddress: 4530 15TH AVENUE SOUTHWEST NAPLES, FLORIDA 34116 Social Security Number: -0179 Stock Ownership: 100% \ddress: -Social Security Number: Stock Ownership: \ddress: Social Security Number: Stock Ownership: \ddress: Social Security Number: ;tnck Ownership= & C FLORIDA PAVERS, INC. was INCORPORATED in the county of COLLIER, state of 'LORIDA, on 09/10, 2001 . The charter number is P01000089694 . The registered agent s DIEHL, MICHAEL D. of 6300 JANES LANE, #4, NAPLES, FLORIDA 34109 . Offices are FATTFf tram N/A at N/A per month. 'rhe company employs FIVE (5) - 4ET WORTH: ON FILE WITH STATE he company maintains banking relations with WELLS FARGO he officer handling the account is N/A - NAPLES, FLORIDA Zeported for: APPLICANT - SEE NAME ABOVE Zeported by Credit Check. Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL`'33409 . (561) 616-5556 Cl2 DIT CHECKTM CONFIDENTIAL Commercial Credit Report Company: M & C FLORIDA PAVERS, INC. Date: 03/20/14 Cust. No.: 9999 Address: 6300 JANE S LANE, #4 Price: $115 . 00 Ordered By: RUSH NAPLES, FLORIDA 34109 Page: 2 PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF COUNTY,__ STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: SEE BELOW. *** *** Credit Profile *** Creditor Opened High Balance Rating \T/A REMARKS: N/A = NOT APPLICABLE / NOT AVAILABLE ***PUBLIC RECORDS SEARCH AS OF 03/17/14 IS AS FOLLOWS : (1) STATE TAX LIEN FILED 01/23/13, $1, 037 . 59, BK4880PG2313, COLLER COUNTY CREDITOR: STATE OF FLORIDA (2) LAWSUIT FILED 07/26/07, CASE #2007CA2464, COLLIER COUNTY COURT PLAINTIFF: VIRGINIA L. SPENCER STILL PENDING (3) LAWSUIT FILED 08/20/07, CASE #2007SC2037, GLADES COUNTY COURT PLAIN'i'lt't': tL P'AV1 &3 TILL PENDING (4) LAWSUIT FILED 10/02/09, CASE #09CC007459, LEE COUNTY COURT PLAINTIFF: GEICO INDEMNITY COMPANY STILL PENDING (5) LAWSUIT FILED 04/22/10, CASE #2010CA2686, COLLIER COUNTY COURT PLAINTIFF: SCP DISTRIBUTORS LLC STILL PENDING ( 6) LAWSUIT FILED 04/27/10, CASE #COWE10006538, BROWARD COUNTY COURT PLAINTIFF: HORNEXPRESS-GULF COAST INC STILL PENDING (7 ) LAWSUIT FILED 03/26/12, CASE #12CC001727, LEE COUNTY COURT PLAINTIFF: TRICIRCLE PAVERS INC STILL PENDING (8) LAWSUIT FILED 08/14/12, CASE #2012CC9128, DUVAL COUNTY COURT ?LAINTIFF: TREMRON INC. STILL PENDING (9) JUDGMENT FILED 03/22/13, FILE #084078CA, COLLIER COUNTY COURT :REDITOR: S .T.D. ENTERPRISES OF NAPLES, INC. CREDIT CHECKTM CONFIDENTIAL Commercial Credit Report Company: M & C FLORIDA PAVERS, INC. Date: 03/20/14 Cust. No.: 9999 Address: 6300 JANES LANE, #4 Price: $115. 00 Ordered By: RUSH NAPLES, FLORIDA 34109 Page: 3 END__OF PUBLIC_RECORDS SEARCH. REPORT WORKED BY NICOLE. END +L. r l' ZS.S i Cvt i c CcimND OF REPORT. D rr qG tt, fr COY+ ( r �iSi 55 aA 6 Thie mmmarrial rannrt is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. SIN CREDIT CHECK CONFIDENTIAL Individual Credit Report Name • DIEHL, MIKEL G. Ordered By: RUSE Address : 4530 15TH AVENUE SW Customer : 9999 Received : 03/04/14 NAPLES, FL 34116 Completed : 03/04/14 Social #: Applicant: .7141 Bill Amt : $95. 00 CREDIT RECORD (Credit history has been checked for a period of seven years or from open date. ) Creditor Date Date High Unpaid Past Pay Historic Stat Current Mos Account Number Reported Opened Credit Balance Due Terms 30 60 90 Status Rev ECM BK OF AMER PD WAS 90 2133 08/10 01/07 770 PAID 0 REV 0703 03 R1-* 43 A DLA=08/10 FEDLOAN AS AGREED 502111145FD00002 12/13 11/11 6000 6672 0 0 00 00 00 I1 24 A DLA=12/13 FEDLOAN AS AGREED 502111145FD00001 12/13 11/11 3500 3500 0 0 0000 00 I1 24 A DLA=12/13 ?EDLOAN AS AGREED 502111145FD00003 12/13 OG/12 3500 3500 0 0 0000 00 I1 17 A DLA=12/13 ?EDLOAN AS AGREED 502111145FD00005 12/13 09/12 1000 1016 0 0 0000 00 I1 14 A DT,,A_ .2/13 =LOAN AS AGREED 502111145FD00004 12/13. 06/12 4101 4400 0 0 00 00 00 I1 17 A LJLA0+12/13 Total trade lines on this report: 6 )USLIC RECORDS: ,UBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE AND FEDERAL LEVELS WITH 'EE FOLLOWING RESULTS: CLEAR AS OF 03/04/14. ;OURCE(S) : EOUIFAX TRANSUNION NQU1RIES: )3/04/14 by CREDIT CHECK (TU) #00630273 .OMMENTS: )rdered by: APPLICANT - SEE NAME ABOVE 2eoorting Agency: Credit Check. Inc. -3017 Exchange Court. Suite H. West Palm Beach. FL 33409 . (5611616-5556 SM • CREDIT CHECK CONFIDENTIAL Name • DIEHL, MIKEL G. Customer: 9999 Page: 2 COMMENTS: FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ABOVE ACCESSED BUREAUS. SAFESCAiN/EOUIFAX, HAWK ALERT/TRANSUNION CHECKED FOR FRAUD. **** SEE BUSINESS REPORT ON: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. REPORT WORKED BY RENEE CREDIT SCORE: APPLICANT FICO SCORE: 674 (scores range from 300 to 850 ) *** END OF REPORT *** This information is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. This personal report is furnished simply as an aid in determining the-edit desirability of the applicant(s). It is based upon information obtained In good faith by this agency from sources deemed reliable. The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. ordered by: APPLICANT — SEE NAME ABOVE <aporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 • sm • CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. Date: 03/04/14 Cust. No.: 9 9 9 9 Address: 4530 15TH AVENUE SW Price: $125 .00 Ordered By: RUSH NAPLES, FLORIDA 34116 Page: 1 Telephone: (239) 877-6536 (X) Corporation EIN: 27-1939392 PRINCIPALS: PRESIDENT DIEHL, MIREL G. Address: 4530 15TH AVENUE SW NAPLES, FLORIDA 34116 Social Security Number: •7141 Stock Ownership: 100% Address: Social Security Number. Stock Ownership: Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: ELUR l)A. HARDSCAPES & PAVER MAINTENANCE, INC. was INiORPO ATED in the COunty u1 COLLIER, state of FLORIDA, on 02/16, 2010 . The charter number is P10000014180 . The registered agent is DIEHL, MIKEL G. of 4530 15TH AVENUE SW, NAPLES, FLORIDA 34116. Offices are OPERATED from APPLICANT' S RESIDENCE (HOME-BASED) at N/A per LULILi Lil. Vic yonipAny c iuyluy rt ONE ( 1) . NET WORTH: ON FILE WITH STATE The company maintains banking relations with WELLS FARGO The officer handling the account is N/A - NAPLES, FLORIDA Reported for: APPLICANT - DIEHL, MIKEL G. Reported by: Credit Check, Inc. - 3017 Exchange Court, Suite H,West Palm Beach, FL 33409 . (561) 616-5556 s. CREDIT CHECK CONFIDENTIAL Commercial Credit Report Company: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. Date: 03/04/14 Cust. No.: 9 9 9 9 Address: 4530 15TH AVENUE SW Price: $125 .00 Ordered By: RUSH NAPLES, FLORIDA 34116 Page: 2 PUBUC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF COUNTY, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: SEE BELOW*** *** Credit Profile *** Creditor Opened High Balance Rating GULF COAST PAVERS FAXED REMARKS: N/A = NOT APPLICABLE/NOT AVAILABLE *** PUBLIC RECORDS SEARCH AS OF 03/04/14 IS AS FOLLOWS: ( 1 ) LAWSUIT FILED 08/14/12, CASE #2012CC9128, DUVAL COUNTY/COUNTY COURT PLAINTIFF: TREMRON INC. STILL PENDING END OF PUBLIC RECORDS SEARCH. **** SEE INDIVIDUAL REPORT ON: DIEHL, MIKEL G. REPORT WORKED BY RENEE END OF REPORT. This commercial report is furnished simply as an aid in determining the credit desirability of the applicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. • The accuracy of same,however,is in no way guaranteed. By your acceptance and use of this report,you specifically agree to hold Credit Check,Inc.harmless from any liability whatsoever. Case 16-2012-CC-009128-XXXX-MA Department County Civil ( Division CC-G Case Status OPEN File Cate 8/14/2C12 Judge Name MRCHELL,SCOTT F. I 1_ Parties Name/DOB/DL/ID# � X Address PLAINTIFF TREMRONINC / FLORIDA HARDSCAPES&PAVER MAINTENANCE INC DEFENDANT M&C Florida Pavers Inc. DEFENDANT Diehl Mkel DEFENDANT G Attorneys Name Address Type W hiddon,Matthew Murray [redacted] Private Attorney Jacksonville,FL 322072269 Fees Date Description Assessed Paid Balance 08/15/2012 SUMMONS($10/ea) $10.00 $10.00 $0.00 08/15/2012 REFUNDCHECKFEE $0.00 $0.00 $0.00 08/15/2012 REFUNDCHECK $100.00 $100.00 $0.00 08/15/2012 CO/CLA1MSr$2500 3/1/2012 $300.00 $300.00 $0.00 08/15/2012 SUMNDNS($10/ea) $10.00 $10.00 $0.00 08/15/2012 St1M IONS($10/Pal $10 On $in nn $41 nn Dockets Line Count Effective Description Image littered 1 — 8/14/2012 COMPLAINT ON CONTRACT OR OTHER DEBT W15r9019 2 — 8/14/2012 COVER SHEET 8/162012 3 __ 8/14/2012 COMPLAINT 8!162012 4 — 8/15/2012 CASE FEES PAID:$330.00 ON RECEIPT NUMBER 1638366 8/15/2012 5 8/15/2012 RECEIPT NUMBER 1638366 HAD A REFUND OF$100.00 AMOUNT SENT TO ERACLIDES,JOHNS,HALL,GELMAN,JOHANNESSEN& 8/152012 GOOD 6 — 8/17/2012 SUMMONS ISSUED 8/172012 7 — 9/12/2012 NOTICE OF DESIGNATING PRIMARY EMAIL ADDRESS FOR THE SERVICE OF PLEADINGS AND PAPERS PURSUANT TO FLORIDA 9/26/2012 RULE OF JUDICIAL ADMINISTRATION 2.516 ) 8 — 1/10/2019 SUMMONS RETURNED NOT SERVED ON M&C FLORIDA PAVERS,NC.8/28/12 1232013 9 — 1/10/2019 SUMMONS RETURNED NOT SERVED ON MO(EL DIEHL 8/29/12 1232013 10 -- !10/2013 SUMMONS RETURNED NOT SERVED ON FLORIDA NARDSCAPES&PAVER MAINTENANCE,NC.8/28/12 1232013 11 -- M17/2073 MOTION TO WITHDRAW 4/182013 S -e_A 5 _{. p e . C'�{ - @ (j� CLtI. S Lti i 1 j 1 (1' ( } G X11 (0-r al c. rrt c�2�Z ) TY 4.j."1l T Z L' LA„et_W c"� Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE • DIVISION OF CORPORATIONS ,,741rip,z - BAs 1 Detail by Entity Name Florida Profit Corporation M& C FLORIDA PAVERS, INC. Filing Information Document Number P01000089694 FEl/EIN Number 651135621 Date Filed 09/10/2001 State FL Status INACTIVE Last Event ADMIN DISSOLUTION FOR ANNUAL REPORT Event Date Filed 09/23/2011 Event Effective Date NONE Principal Address 6300 JANES LANE #4 NAPLES, FL 34109 Changed: 04/01/2009 Mailing Address 6300 JANES S LAN E #4 NAPLES, FL 34109 Cliai iyet1. 04/01/2009 Registered Aaent Name & Address DIFHI MIKE 6300 JAMES LANE #4 NAPLES, FL 34109 Address Changed: 04/01/2009 Officer/Director Detail Name &Address Title PD DIEHL, MIKE 6300 JANES LANE#4 NAPLES, FL 34109 Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2008 04/02/2008 .. Home Contact Us E-Filing Services Document Searches Forms Help 2009 04/01/2009 2010 02/12/2010 Document Images 02/12/2010 --ANNUAL REPORT View image in PDF format 12/08/2009 -- Off/Dir Resignation View image in PDF format 12/08/2009 -- Off/Dir Resianation View image in PDF format 11/16/2009 -- Off/Dir Resianation View image in PDF format 04/01/2009 — ANNUAL REPORT View image in PDF format 04/02/2008 --ANNUAL REPORT View image in PDF format 04/16/2007 --ANNUAL REPORT View image in PDF format 04/11/2006 --ANNUAL REPORT View image in PDF format 07/19/2005 --ANNUAL REPORT View image in PDF format 01/29/2004 --ANNUAL REPORT View image in PDF format 04/03/2003 --ANNUAL REPORT View image in PDF format 09/24/2002 --Amendment View image in PDF format 05/12/2002 -- ANNUAL REPORT View image in PDF format 09/10/2001 — Domestic Profit View image in PDF format Sia:c of?golds:, C:aVai!niei; ur RL�tu ._ n /1 n/mil n1 A www.sunbiz.org - Department of State Page 1 of 1 FLORIDA DEPARTMENT OF STATE DIVISION OF ORPOILITIONS c 8 �^-,� �-Z• a K°";.: 1, Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return to List Fictitious Name Search Filina History 01 DC,O Submit Fictitious Name Detail Fictitious Name FLORIDA PAVERS Filing Information Registration Number 601267900221 Status EXPIRED Filed Date 09/25/2001 Expiration Date 12/31/2011 Current Owners 1 County COLLIER Total Pages 3 Events Filed 2 FEi/EIN Number NONE Mailing Address 6300 JANES LN.#4 NAPLES, FL 34109 Owner Information M & C FL ORIDA PAVERS. INC. 6300 JANES LN.#4 NAPLES, FL 34109 FEI/EIN Number: 65 1136621 Document Number: P01000089694 nnr.m,mcnt Imngr'.. 09/25/2001 --REGISTRATION View image in PDF format 04/07/2009—CHANGE NAME/ADDRESS ! View image in PDF format pFN 'A141„ I \/law imaDp in Pf1F format Previous on List Next on List Return to List Fictitious Name Search Fiiinq History Submit Horne Contact.... ! Document Searches i E-Filing Services I Forms ; Help Corvrirhi S°and Privacy Policies State of Florida, Department of State pve9antinn="11F.T12 P(4-Rrrinemim=6.1)17A7000771Rr.rri i/1;/7.014 Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS w: t' Detail by Entity Name New Florida Profit Corporation FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC. Filing Information Document Number P10000014180 FEI/EIN Number 271939392 Date Filed 02/16/2010 State FL Status ACTIVE Effective Date 03/01/2010 Principal Address 4530 15TH AVE. SW. NAPLES, FL 34116 Changed: 02/04/2013 Mailing Address PO BOX 990398 NAPLES, FL 34116 Changed: 02/04/2013 Registered Agent Name &Address DIEHL, MIKEL G 4530 15TH A\/P 5W NAPLES, FL 34116 Address Changed: 02/04/2013 Officer/Director Detail Name & Address Title P DIEHL, MIKEL G 4530 15TH AVE. SW. NAPLES, FL 34116 Annual Reports Report Year Filed Date 2012 01/08/2012 .. _ _ . i ',/1'1/'1111 A Detail by Entity Name Page 2 of 2 2013 02/04/2013 2014 01/26/2014 Document Images Home Contact Us E-Filing Services Document Searches Forms Help 01/26/2014 --ANNUAL REPORT View image in PDF format 02/04/2013 --ANNUAL REPORT View image in PDF format 01/08/2012 -- ANNUAL REPORT View image in PDF format 04/28/2011 --ANNUAL REPORT View image in PDF format 02/16/2010 -- Domestic Profit View image in PDF format Ocvr c ht©and Privacy Pniides State of Florida,Department of State • , 1/11/' C1A aa s Fyn .r y ... T OF TREASURY TREASURY 1�✓EPA-_ "t=om REVENUE SERVICE CThCD NATI OH 45999-0023 Date of this notice: 02-19-2010 Employer Identification Number: 27-1939392 Form: SS-4 Number of this notice: CP 575 A FLORIDA HARDSCAPES & PAVER MAENTENMNCE INC 6300 JANES LN STE 4 For assistance you may call us at: NAPT,FS, FL 34109 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT .HE 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 27-1939392. This EMT 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 yn„ ,ass yo r RTN and comvlete 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 EMT. If the inform tiro i a not rnrrer-t 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 Lh. 5211 iz g f,-arm(') by th,r. rRntr( ) %brown Form 941 04/30/2010 Form 940 01/31/2011 Form 1120 03/15/2011 If you have questions about the torm(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 fruit 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 TINT 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 with-in 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. sr` zt'1-a ,Y„ilJr3 i (IRS USE ONLY) 575A 02-19-2010 FLOR B 9999999999 SS-4 If you are required to deposit for employment taxes {Forms 941, 943, 940, 944, 945, CT-1, or 1042) , excise taxes (Form 720), or income taxes (Form 1120) , you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (rsr'rYS) . A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or LCpresentative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes and Publication 4248, iiiS (Brochure). If you need to make a deposit before you receive your Welcome Package, please visit an IRS taxpayer assistance center to obtain a Federal Tax Deposit Coupon, Form 8109-B. To locate the taxpayer assistance center nearest you, visit the IRS Web site at http://www.irs.gov/localcantacts/index.html. Note: You will not be able to obtain Form 8109-B by calling 1-800-829-TAXFOR14S (1-800-829-3676) . The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Piuviders, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT RR IDSRS: * Keep a copy of this notice in your permanent records. ibis notice is issued only one time and the IRS will not be able to generate a duplicate copy for you_ " Uuc Win EIN and yuu3 Lisa= c tuLly .xcs ate), y x aL I l it Lup ul LLie uvLlue uii all your tederal tax torms. * Refer to this EIN on your tax-related correspondence and documents. If you have quwationa about r EIN. you c;ui call uo at the phone number or write to us at the address shown at tht top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Thank you for your cooperation. Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please CP 575 A coi� ct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 02-19-2010 ( ) - EMPLOYER IDENTIFICATION NUMBER: 27-1939392 FORM: SS-4 NOBOD DAN HENTHORNE PRECAST 5500 Taylor Road 239-594-7508 Naples, Florida 34109 239-594-7608 fax February 27, 2014 City of Naples 295 Riverside Circle Naples, FL 34102 To Whom It May Concern: Mr. Mikel Garrett Diehl has been installing, cleaning and sealing concrete brick pavers for Dan Henthorne Precast for the past 3 years. He has provided excellent installation services for our company. If you have any questions, please feel free to contact me at (239) 594-7508. Sinccrcly, D 1,3.C - \ 4) WA ,R. enthorne Ownei VERIFICATION OF CONSTRUCTION EXP_.._ . ERIEENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: if\(il , k e t Q1 rr it+ -Pi eJi I Certificate Category Requested: -4-1 3 OC 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 vorking 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 efficient to demonstrate required trade experience. The person verifying trade experience must provide the following nformation: Jame, Title and license number of the person signing below and verifying Applicants relevantexperience: �ja dame: pcx'- C`�1TYOC`-,,y-,.lZ F(Q c<t 'itle: 0 t, .cvc License Number(if applicable): 1 Igo 2 lame of Business: 0.n \'1ey e r n.p p,, ,,,,,c1- ;usiness Address: ) 5i)t` To 1 N,-- k c,t j k { i "., ; 1L c3L//19 l :usiness Phone:�3g`5-9%1-.7533 The Applicant's years of experience from to r.he applicant's scope of work (specific duties)included: Try Si-' (.t 44, try, 0: 1- tint v.tt� b l o cl_S 1 dditional Comments: ' iI�lfylug any Ian motion pjuti�lded herein only Jubjcctyour llectf:�c to r 1Tfa ion fl Ji tJLA 1 ) Sigiialw e Print Name: n F--• He*- 0 -et C ate of Florida )unty of Collier S ic)le re oing instrument was acknowledged before me on this day of 7i ei.-ta _. 2t�PV uwho is personally kno n.w me or produced identification and who did not take an oath. bii....,to.A.....4 ,.... Wendy S.Henthome ' '.= '''< NOTARY PUBLIC Signature/Qf otary g., STATE OF FLORIDA �►'4`4-0` Comm#EE105832 00E191 Expires 6/23/2015 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER , am a resident of County, • T c- P90 (State) and have resided here for more than five (5) years. firing the last five years I have known OQ. G • (Applicant). I have had opportunity to observe his or her business and personal dealings and find him or her to be a person of nesty, integrity and good character. (Signature) ,i_'!' A t �'. (Name) I J) 'Xi 1. -- 1 f. 1 C i (Address) 11 I 0 !-f( (c-'Oa() Telephone) (gY.) 1-1'1 ( " STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this N'ttl .,,_ I by (Date) M.1 1 D z e h who has produced F r�",- SQ Q k e?e,,c.Y i"•; (name of person anlcnnwlnrlring) (Ty` ••f i luniifieation) as identification and who did not take an oath. rR Wor y S:Hertfrerne NO AIRY Rua ' SIGNA " ' OF NOTARY d STATE OF FLORIDAr ,,�,,, Comm#I.EE1d�32 Expires 6/23/2015 '��; NOTARY'S SEAL (PRINTAME OF NOTARY) NOTARY.PUBLIC 10 R FLORJ-3 OP 1D:RL A C 4.......--- CERTIFICATE OF LIABILITY INSURANCE j °"TEI"'"D°rY'"Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER.14 THiS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TH.- ?OLICIES 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 ADO(TIONAL INSURED,the policies)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 endorserrient(s). PRODUCER coNTACT Progressive Insurance Agency Nate ppee PHONE Naples,FL 34109 e- �s1: (AAA Rol Richard Larach ADDRESS: NISLIR ER(B)AFFCRCING COVERAGE MAC S die s 'N A:Progressive Express Ins Co 10193 INSURED Florida Hardscapes d N Florida Pavers, Inc SURER S-Cy_press Property&Cas Ins Co 10953 453015th Ave SW INSURER C Naples,FL 34116 INSURER O: INSURER E: NSURER 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, AIR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TIe I TiFE CF INSURANCE .I u�}p(QI PQL�Y NUMBER SP.. EFF peLicY O P GENERAL umurY LASTS EACH OCCURRENCE $ 100,000 S X CoeRCIAL GENERAL LIABILITY GFL-1023441 04/24/2013 04/2412014 PrreAGE ENTED RErISE574 acaxrenca} S 100,000 CLAIMS-WOE 1 X I OCCUR LED EXP(Any one Perms) 5 5,000 PERSONAL E ADV INJURY _S 100,000 GENERAL AGGREGATE S 200,00( —1 GEM.AGGREGATE UNIT APPLIES PER PRODUCTS-COt !OP AGG $ 200,000 POLICY rig: 7 LOC - i COMBINED AUT01I0 LL1ffiLltY SINGLE LAST • A $ ANY AUTO 08379915-0 01/04/2014 01/04/2015 EMILY INJURY(PerPenon} $ 10,009 � OWNED X SCHEDULED AUTO NON-OWNED BODILY INJURY(Per acckenn S 20,000 HIRED AUTOS AUTOS PROPERTY DAMAGE S 10,000 JPER ACCIDENT) UMBRELLA LL{8 - S OCCUR CACI I OCCURRENCt a EXCESS LIAS CLAIMS-MACE I AGGREGATE S Lieu acTOMOil 3 AND Bleu:NE W LIABILITY WC STATU-. OTH- ANY PROPRIETOPoPARTNr_RrEXECUTNE YIN TORY LIMITS ER CfFlC ERiUEMBEft EXCLUDED? n N!A EL EACH ACCIDENT 5 Olen InInfv In NHI liyw;urry iAtw C.LDIMAS& NH Shirty Tr.c, D6IICI96'Tt©w Dr orcn,i-iorjo L.l., EL D EASE-POLICY Llar $ i 1 , �morurnau/If ar�rninlseln t 1 — , IN).4 014 r yaNN.ue waitron wuutw 101,Addrderlei gomulir Suluslah It wwr*Pow N IlklavW) CERTIFICATE HOLDER CANCELLATION COLL1-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractors THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Licensing Board ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N.Horseshoe Drive AunioR¢EU REPRESENTaTNE Naples,FL 34104 Richard Larach I --------- -------__—. ---_---------__- ®1985-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • NOTICE OF ELECTION TO BE EXEMPT li 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: Mikes G Diehl State Driver's License Number: State ID Number: State: FL d400547844210 Date of Birth: 11/21/1984 Social Security Number(last four digits): 7141 - Email Address: Mgdiehll3 @gmail,corn Section 2: CONSTRUCTION INDUSTRY APPLICANT($50 FEE REQUIRED) Officer of a Corporation (Construction) Corporate Title: PRESIDENT Section 3: This section should be completed with information specific to your corporation or to the limited liability company in which you are a member.The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations. Name of Corporation or LLC: Florida hardscapes and paver maintenance FEIN: 27-1939392 IF YOU NEED TO APPLY FOR A FEIN,CLICK HERE Business Name (DBA): Phone: (239)877-6536 Applicants Address of record: 4b30 15th ave sw City Naples State: FL Lip 34116 County: Collier Click on the arrow(s) next to the text box(s)to view a list of available Scope classifications/trades for the form type chosen in �et;tlun 2. Click on the appropriate scope to select. If you are unsure as to will Oh cla$$i icailoti/ti'W.ttle to ctiu e, please contact your workers'compensation insurance carrier_ If you do not have a workers'compensation insurance policy, contact the National Council on Compensation insurance(NCCI) at 1-800-622-4123 option 5 to obtain a classification code. Scope 1: 05221 Concrete or Scope 2: SCope 3: Scope 4: uerrient warx•i mars, Driveway Section 4: The corporation of which you are an officer or limited liability company of which you are a member must be registered and in ACTIVE status with the Florida Division of Corporations.Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with the Florida Division of Corporations. List the document number on file with the Florida Division of Corporations. P10000014180 Section 5: Pursuant to Chapter 489, F.S. (contractor licensing law), list certified or registered licenses related to the scope of business or trade listed in Section 3 held by the applicant or the certified or registered license numbers held by the qualifier for the corporation or limited liability company listed on this application.The business name listed on the license MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations and on this Notice of Election to be Exempt. No DBPR License Listed Section 6: If you have submitted an electronic payment for this application, the transaction confirmation number is listed in the following space: Confirmation Number: 189839100 Application Number: E00200855 Section 7: N/A Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which this application applies? Name: FEIN Name: FEIN Name: FEIN Section 8: CONSTRUCTION INDUSTRY AND NON-CONSTRUCTION INDUSTRY LLC MEMBERS ONLY To be eligible for a construction industry exemption or a non-construction limited liability company exemption, an applicant must have the required ownership of the corporation or limited liability company. i am a shareholder owning at least ten percent(10%)of stock of the corporation listed on this application. Section 9: I certify that any employees of the corporation or members of the limited liability company listed in Section 3 are covered by workers'compensation insurance. Please identify the workers'compensation insurance carrier that covers any non-exempt employees. Carrier Name: My business does not have any non-exempt employees Section 10: FRAUD NOTICE A. Any person who knowingly and with intent to injure, defraud, or deceive the department or any employer or employee, insurance company or any other person,files a Notice of Election to be Exempt containing any false or misleading information is guilty of a felony of the third degree.` B. Attestation of applicant—By providing my name below, I attest that I have read, understand and acknowledge the foregoing notice. I C. Acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any affiliated corporations as provided in Section 440.02, Florida Statutes. `= First Neme Mikrl Last Name' Diehl Note.The Division has 30 days to review your application to determine if it meets the eligibility requirements for the issuance of an exemption.The Division will either issue a Certifi:ate 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 httpl/www.myfloridacfo.com/wcto print your certificate. %.:// 10-06-2011 - 4ao_a JEFF A TWATErR STATE OF FLORIDA CREFF+NANCIALCFRCER DEPARTMENT OF FiNANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE. OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * NON-CONSTRUCTU INDUS .'-EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers—Compensation law. • EFFECTIVE DATE: .09122/2011 EXPI TION_D.ATE:. N/-A.s PERSON: DIEHL MIKEL G .. FEIN: 271939392 BUSINESS NAME AND ADDRESS: FLORIDA HARDSCAPES & PAVER MAINTENANCE INC • P 0 BOX 990398 NAPLES FL 34116 SCOPES OF BUSINESS OR TRADE: pp 1- PRESSURE,CLEANING 17 e p! ( Ot'l 0.`-c1/4 v et25 • IMPORTART; Pars:sot to Chapter 440 . 05(141. F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender this section may not recever benefits or compensation ender this chapter: Psrsoant to Chapter 440.05{121, F-S., Certificates of electioa to be exempt-_ apply oily witeia the scope of tht business or trade listed on the notice of election to be exempt. Persians to Chapter 440.051131. F.S.. Notices of election to be exempt and certificates al efectlaa to be exempt shall be subject to rexecatioe if, at any time atter the filing of the notice,or the issuance of the certificate. the persoa named an the colic, or csrtfficue so Wager meets the regelremeets of this section for issuance of a certificate. The depantaeet snail revoke a certificate at any time for failure if the persoa used on the certificate to sett the requirements of this section. QUESTIONS? (8501 413-1609 OWC-252 CERTIFICATE CF ELECTION TO BE EXEMPT REVISED 01-11 • • • PLEASE CUT OUT THE CARD BELOW AND RETAIN f011 I-UTUftt REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERViCES RM810N OF WORKERS'CQMPINSATlON p.,,Y'z' Pursuant to Chapter 4-40.05114). F.S. an officer of a corporation who zta. N0N-t71NSTRIlCTTnN T1 111STRY ?r elects exemption from this Chapter by tiling a certificate of election Ltt2tlFiCATEOF ELECTION TO BE F�C£MPT FROM FLORIDA '�� L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW `mss+ D chapter. EFFECTIVE 09/22/2011 EXPIRATION DATE: N/A Pursuant to Chapter 440.05(12). F.S. Certificates of election to be PFR¢r1N• MIKEL G DIEHL H exempt.. apply only withitt the scope of the business or trade listed on FEIN 271939392 the notice ct eiectIOn 13 se exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13). F.S.. Notices of election to be exempt FLORIDA HARDSCAPES ` 'AYER MAINiEN''ICE !NC and certificates of election to be exempt shall be subject to revocation P 0 ROX 990398 - If. at any time after the filing of the notice or the issuance of the RAKES. FL 34116 certificate. the person named on the notice or certificate no longer meets • the requirements pf this section for issuai..:e of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE - person named on the certificate to meet t"e requirements of this 5- PRESSURE CLEAN:uc. sectiOn. CUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion f or your rt -.);d:-. • • • • , �!T U 7 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: 4 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: FLORIDA HARDSCAPES & PAVER MAINTENANCE, INC FEDERAL ID: 27-1939392 CURRENT STATUS: ACTIVE PRINCIPAL(S): MIKEL G. DIEHL TITLE: PRESIDENT DATE INCORPORATED: 02/16/2010 Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 7/04 03/30/15 14:45CT [SUBJECT] ISSN' [BIRTH DATE] DIEHL, MIKEL G. 0010. 141 11/84 - - [CURRENT-ADDRESS]- -------------- [DATE-RP-T D]4530 SW. 15TH AV. , NAPLES FL. 34116 9/07 [FORMER ADDRESS] 5111 PALMETTO WOODS DR., NAPLES FL. 34119 7/04 8505 NW. 2ND PL. , GAINESVILLE FL. 32607 M O D E L P R O F I L E ***FICO CLASSIC 04 SCORE +611 : 039, 018, 013, 005 *** C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=0 COL=0 NEG=0 HSTNEG=6-48 TRD=6 RVL=1 INST=5 MTG=0 OPN=0 INQ=2 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE INSTALLMENT: $18.1K $ $18.5K $0 $216 TOTALS: $18.1K $ $18.5K $0 $216 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 FEDLOAN E 2CN2006 11/11 $3500 111M37 6/14 54555543111X I01 502111145FD00001 12/14A $0 $172 05 1XX111111111 I STUDENT LOAN $3333 36 0/ 1/ 7 FEDLOAN E 2CN2006 11/11 $6000 118M80 6/14 54555543111X I01 502111145FD00002 12/14A $0 $397 05 1XX111111111 I STUDENT LOAN $6574 36 0/ 1/ 7 FEDLOAN E 2CN2006 6/12 $4101 118M52 6/14 54555543111X I01 502111145FD00004 12/14A $0 $262 05 1XX111111111 I STUDENT LOAN $4335 29 0/ 1/ 7 FEDLOAN E 2CN2006 6/12 $3500 111M37 6/14 54555543111X I01 502111145FD00003 12/14A $0 $172 05 1XX111111111 I STUDENT LOAN $3333 29 0/ 1/ 7 FEDLOAN E 2CN2006 9/12 $1000 111M10 6/14 41555543111X I01 502111145FD00005 12/14A $0 $50 05 1XX111111111 I STUDENT LOAN $968 26 0/ 1/ 6 BK OF AMER B 1597029 1/07 $770 7/08 111111111132 RO1 2133 8/10A $500 $0 05 211111211324 I CREDIT CARD 8/08C $0 CLOSD BY CRDT GRANTOR 26 4/ 2/ 3 I N Q U I R I E S DATE SUBCODE SURNAME TYPE AMOUNT 3/30/15 ZNP6284423(FLA) MERIT CREDIT 3/04/14 ZMI0630273(FLA) CREDIT CHECK C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION FEDLOAN EL2CN2006 (800) 699-2908 POB 60610 HARRISBURG PA. 17106 BK OF AMER_—_--- BC1597.029 - — PO BOX 982235 EL PASO TX. 79998 CREDIT CHECK Z 0630273 (877) 616-5556 3017 EXCHANGE COUR WEST PALM BEAC FL. 33409 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. ' Premier Profile-FL HARDSCAPES &PAVER MAINTENANCE,INC • •• • Subcode: 970135 Ordered:03/30/2015 15:04:45 CST `r1: Experian- Transaction Number: 0500793253 `• • • Search Inquiry: FLORIDA HARDSCAPES&PAVER MAINTENANCE, INC/4530 15th ave A world of insight sw/NAPLES/FL!34116/271939392 Model Description: Intelliscore Plus V2 Business Name r''�"'. FLORIDA HARDSCAPES & PAVER c ® Business Identification Number .: ---, 739533422 MAINTENANCE, INC. °a Less Doing Business As: FLORIDA PAVERS Phone: (239)254-8600 Primary Address: 4530 15TH AVE SW Tax ID: 27-1939392 NAPLES,FL 34116-5140 This business is the ultimate parent. illSee the corporate hierarchy by clicking here TOP 0 Risk Dashboard Risn k Sr..and Credi LimttRfi om mend tiovn in Da's Se af a f S"w' 4 w` gd ^^^" 7 Intelliscore Plus Financial Stability Risk Company DBT Original Filings High Risk Alerts ill HIGH RISK HIGH RISK 105 4 2 Score range: 1 -100 percentile Credit Limit Recommendation: N/A TOP 0 Business Facts Years on File: 14(FILE ESTABLISHED 11/2001) SIC Code: CONCRETE WORK CONTRACTORS-1771 State of Incorporation: FL HIGHWAY&STREET CONST,EXC ELEV HWYS-1611 Date of Incorporation: 02/16/2010 CONSTRUCTION MACHINERY&EQUIPMENT-3531 Business Type: Profit NAICS Code: Contacts: MIKEL DIEHL-PRESIDENT Poured Concrete Foundation and Structure Contractors-238110 Highway,Street,and Bridge Construction-237310 Construction Machinery Manufacturing-333120 Number of Employees: 6 Sales: $1,806,000 TOP 0 Commercial Fraud Shield Evaluation for:FL HARDSCAPES&PAVER MAINTENANCE,INC,4530 15TH AVE SW, NAPLES,FL34116-5140 ,Business.,44.1,01" lerts• s ,� �- #c'1 - '44 ' t ..""" „4 mil/`,gge . Active Business Indicator: V 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 ADDRESS IDENTIFIED AS RESIDENTIAL Business Victim Statement: • I No victim statement on file TOP 0 Credit Risk Score and Credit Limit Recommendation Credit Risk Score: Intelliscore Plus Current Intelliscore Plus Score: 2 Risk Class: 5 Premier Profile-FL HARDSCAPES&PAVER MAINTENANCE,INC 1/5 2 • HIGH RISK 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 . lowest risk. 0 10 25 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 1%of businesses indicate a higher likelihood of severe delinquency. > NUMBER OF COMMERCIAL ACCOUNTS WITH NET 1-30 DAYS TERM > NUMBER OF COMMERCIAL ACCOUNTS WITH HIGH UTILIZATION > BALANCE OF COMMERCIAL ACCOUNTS AT WORST DELINQUENCY• * # 1,s` a t Quarter) Sc2�re rends � sr+ ,.�'a •,v�� a.-rs,.° ,.,K .....�,.,�,.,.,w:.:....,ra,.,�»...-ss..a.wu....:�o......,....a �,.s F�, .uw...&: 9f ,. Quarterly Score Trends 1007 g0 80 70 j The Quarterly Score Trends provide a view of the 6 80 likelihood of delinquency over the past 12 months for this 50 -r' ; business.The trends will indicate if the score improved, remained stable,fluctuated or declined over the last 12 months. 30 ` + 20 10 0 e�� � SE aGtA C } 1Cre it IskScore Financial Stabile Ri sk . q . � Current Financial Stability Risk Score: 3 Risk Class: 5 HIGtt RISK High .., ..• -::� Low The risk class groups scores by risk into ranges of similar R isk ) Risk performance.Range 5 is the highest risk,range 1 is the lowest risk. 0 .3 10 30 F„ 100 This score predicts the likelihood of financial stability risk within the next 12 months. The score uses tradeline and collections information, public filings as well as other variables to predict future risk. Higher scores indicate lower risk. Factors lowering the score Industry Risk Comparison > PERCENT OF TOTAL COMMERCIAL BALANCE SERIOUSLY DELINQUENT 2%of businesses indicate a higher likelihood of financial stability risk. > PAST COMMERCIAL DEROGATORY BALANCE > NUMBER OF COMMERCIAL DEROGATORY PUBLIC RECORDS > RECENT COMMERCIAL ACCOUNT DELINQUENCY iCredit Li t`me H.,..., 6 n>?�3.., , n zMk x• 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 0 Payment and Legal Filings Summary Premier Profile-FL HARDSCAPES 8 PAVER MAINTENANCE,INC 2/5 PaF ent Performance ,Trade and Collection Balance - .. y ;-,-.,:;:Lega I Filings'' ,`. Current DBT: 105 Total trade and collection(6): $16,700 Bankruptcy: No Predicted DBT: N/A All trades(6): $16,700 Tax Lien filings: 3 Monthly Average DBT: 105 All collections(0): $0 Sum alingn: 1 Y 9 ( ) Sum of legal filings: $9,282 Highest DBT Previous 6 Months: 105 Continuous trade(4): $16,700 UCC filings: 0 Highest DBT Previous 5 Quarters: 105 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended: $9,200 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 - of businesses--. .-- . 80%` 11% 9','. DBT Range 0-5 6-15 16+ ■ TOP Q Payment Trending DBT Trends q fg Monthly DBT Trends Quarterly DBT Trends 105 105 105 105 105 105 105 - 105 105 105 105 105 100 - 1o0 75 75 a 50 50 (""'"iRa e F, 3 �y,p•",,. b 1..fie '3'ap ,-c"-N 25 25 - i i AO Ai A QNaCCth 4�‘����a,PN‘54��15cUtitg AO13 1py.� sO\a laNA oPLN` o thl ra men Trends 'ii3`>x ,, ' -bf,. ,- ' q ,w. �#tf } 4 "l '"ag .a " .,. Payment Trends Analysis Account Status CONCRETE WORK CONTRACTORS-1771 Days Beyond Terms Date Reported Industry Business Balance Cur 1-30 31-60 61-90 91+ Cur DBT DBT CURRENT 90% 7 105 $16,700 100% FEB15 90% 7 105 $16,700 100% JAN15 --' 89% 7 105 _-_- $16,700 ---_-- ------ 100% DEC14 88% 7 105 $16,700 100% NOV14 89% 6 105 $16,700 100% OCT14---^ — 90% 6 105 ---------$16,700 --- —.- 100% SEP14 89% 6 105 $16,700 100% Quarts) a e rends , 3/5 Premier Profile-FL HARDSCAPES&PAVER MAINTENANCE,INC Payment History-Quarterly Averages Account Status Days Beyond Terms Quarter Months DBT Balance Cur 1-30 31-60 61-90 91+ Q4-14 OCT-DEC 105 $16,700 100% 03- 14 JUL-SEP 105 $16,700 100% Q2-14 APR-JUN 105 $16,700 100% Q1 -14 JAN-MAR 105 $16,700 100% Q4- 13 OCT-DEC 105 $16,700 100% TOP a Trade Payment Summary Trade Line Type Lines Reported DBT Recent High Balance Current 01-30 31-60 61-90 91+ Credit Continuous 4 105 $17,500 $16,700 100% New Combined Trade 4 ' 105 W 7+0' - § ' �J '- 1,00°1,0. Additional 2 $0 Total Trade 6 = - -_;,. , fl - $17,500', $1 � A y . ,-4,1 . 100/o TOP Q Trade Payment-New and Continuously Reported Trade Details (Trade Lines with an after r the date are newly reported) Payment Experiences �'7cco �� �� � 'T l � ) Y P �� Days Be i� .- ^fi -� , A:*'+' :`� -):,'1 , Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Cate•or Resorted Sale Terms Credit BLDG MATRL 02/2015 02/2011 CREDIT $9,200 $9,200 100% FINCL SVCS 01/2015 12/2009 CONTRCT $800 $0 OFFC SUPPL 03/2015 02/2011 CREDIT $900 $900 100% CHARGE _ _ _ __ _ __ OFF PRNTG&PUBL 03/2015 VARIED $6,600 $6,600 100% TOP 0 Trade Payment Additional Trade,Details ? i - -,4-4 ,,1 :, Payment Experiences 'AccountStatus 4 ," . (Trade Lines with an after the date are newly reported) Days Be and Terms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Cate•o Resorted Sale Terms Credit CRED CARD 03/2015 01/2010 REVOLVE $0 CHARGE OFF OFFC SUPPL 02/2014 08/2005 CREDIT $0 ACCTCLOSED TOP Q Legal Filings File Date Filing Type Status Amount Filing Number Jurisdiction 04/24/2014 State Tax Lien Filed $1,201 4973192 COLLIER COUNTY CIRCUIT COURT Filed by: STATE OF FLORIDA 01/30/2013 State Tax Lien Filed $1,037 4792762 COLLIER COUNTY CIRCUIT COURT Filed by: STATE OF FLORIDA 10/12/2011 State Tax Lien Filed $300 4615441 COLLIER COUNTY CIRCUIT COURT Filed by: STATE OF FLORIDA File Date Plaintiff Status Amount Filing Number Jurisdiction 05/31/2012 TRICIRCLE PAVERS INC Filed $6,744 12CC001727 LEE COUNTY CIRCUIT COURT Premier Profile-FL HARDSCAPES&PAVER MAINTENANCE,INC 4/5 TOP 0 Additional Business Facts t .+ rk x� +4 ,+ - - A a ra *K y ? re',i a+` �: t e ,x5 .bs 'rl -C a, s-• ,. i '.+a% ,. - THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA.THE DATA IS CURRENT AS OF 03/30/2015. State of Origin: FL Date of Incorporation: 02/16/2010 Current Status: Active Business Type: Profit Charter Number: P100000141 Agent: DIEHL MIKEL G Agent Address: 4530 15TH AVE SW NAPLES, FL TOP 0 Corporate Linkage .& ...uj � � y . ac's'" , c T „a ".. x fir " Business Name ��� � r�� Location 3 � � � '� The inquired upon business, FL HARDSCAPES&PAVER MAINTENANCE, INC,is the Ultimate Parent FL HARDSCAPES &PAVER MAINTENANCE, INC 4530 15TH AVE SW-NAPLES,FL 739533422 Branches of the inquired upon business: FLORIDA HARDSCAPES&PAVER MAINTENANCE, INC 6261 W ATLANTIC BLVD STE 107-MARGATE,FL 740138389 FLORIDA HARDSCAPES&PAVER MAINTENANCE,INC 6300 JANES LN STE 4-NAPLES,FL 988606526 FLORIDA HARDSCAPES&PAVER MAINTENANCE,INC 6421 EGRET TER-COCONUT CREEK,FL 993088625 TOP O 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.Privacy policy. Experian and the Experian marks herein are service marks or registered trademarks of Experian. Premier Profile-FL HARDSCAPES&PAVER MAINTENANCE,INC 5/5 Co1l.ft r CoyuHty Growth Management Division Planning & Regulation Operations Department Licensing Section March 23, 2015 Yanira I. Tejada 9/ Paradise Landscaping of Florida, Inc. th 4/41 1885 47 Ave NE Naples, FL 34120 RE: Review of credit Mrs. Tejada, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, April 15, 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 (Or) (239) 252-2909. Sincerely, Joann Greenberg Customer Service Specialist Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 Growth Management Division*Planning&Regulation*2800 North Horseshoe Drive*Naples,Florida 34104*239-252-2400*www.colliergov.net ! r Findings of Fact, Conclusions of Law and Decision of the Board Collier County Contractors' Licensing Board For Applications Submitted to the Board for Review Type of Application: X Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity Other (specify) THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on October 15, 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 Yanira I. Tejada. (the "Applicant") has submitted an application to the Collier County Contractor Licensing Supervisor or his designee for a Certificate of Competency as a specialty contractor and based on the credit reports supplied by the Applicant the Licensing Superviser determined a review of the credit by the Board is necessary. 2. That pursuant to Section 22-184(b) of the Code of Laws and Ordinances of Collier County, as amended, applications which do not appear on their face to be sufficient require referral to the Board for a decision regarding approval or denial of said application. 3. That the Board has jurisdiction over this matter and that Yanira I. Tejada was present at the public hearing on October 15, 2014, and was not represented by counsel. 1 345395.1 11/7/2014 4. All notices required by the Code of Laws and Ordinances of Collier County, as amended, have been properly issued. 5. The facts in this case are found to be: a. Applicant has some credit issues which were of concern to the Board. b. It is appropriate for the Applicant to be subject to a probationary license and further credit review. CONCLUSIONS OF LAW 1. Based upon the foregoing facts, the Board concludes that the applicant has not met the standard set out in Code of Laws and Ordinances of Collier County, as amended. 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 Code of Laws and Ordinances of Collier County, as amended, by a vote of 7 in favor and 0 opposed, a unanimous vote of the Board present, the Applicant's credit report is not approved and he shall be issued a probationary license as follows: a. Six month probationary license with a credit review in six months; ORDERED by the Contractors Licensing Board effective the 15th day of October, 2014. (G TRACTOR'S LICENSING BOARD OL IE' COUNTY, FLORIDA ,` 44. A (A )_.1_, By: Patrick White, Chairman 2 345395.1 11/7/2014 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 / th day of /- >' , 2014. Secret ntractor's Licensing Board 3 345395.1 1117/2014 Co he-v CoitHty Growth Management Division c 1S NW dv Growth anagement Division Planning & Regulation r �oft�`Y� Operations Department = Licensing Section ; 2'' September 25, 2014 Yanira I. Tejada °8/611/1"4 i Paradise Landsca in g of Florida, Inc. 1885 47th Ave NE Naples, FL 34120 RE: Review of credit • Mrs. Tejada, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, October 15, 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 (Or) (239) 252-2909. Sincerely, Q.72/ti(A) Jason Bridwell Administrative Supervisor Licensing/Operations 2800 North Horseshoe Drive Naples, FL 34104 Growth Management Division*Planning&Regulation''2E00 North Horseshoe Drive*Naples,Florida 34104''239-252-2400"www.colliergov.net Yanira Tejada 1885 47t Ave NE Naples, Fl 34120 September 24, 2014 Dear Sir or Madam, Subject: Application for Landscaping Restricted license I am writing to provide explanation of my credit report obtained by your office in connection to my landscaping restricted license application. My credit is poor because I was going through a rough financial time the last couple of year. My source of income was greatly reduced and I could not keep up with my payments. Large part of my income went into paying my mortgage and keeping my house. I could not keep up with my credit cards payments so I did not pay them. Unfortunately, I was unable to continue to keep paying my house and it went into foreclosure. All this time I was trying to sell my house on short sale so at least I would not have a foreclosure on my credit. I just sold it on short sale on September 5th, 2014 so now I can concentrate on working with the other credit companies to come to a payment agreement or a payoff amount. I had a tax lien but that is all paid. Also a dispute with a insurance company, that is all paid. Target put a lien and that was also resolved when I did the short sale on the house. I have attached a copy of the insurance and the tax lien matter concluded. I know and understand that that is not the only things on my credit, I need to go through it all and call the companies and figure what I owe them. Please understand and take into account that foremost on my mind was my house and now since it just recently was resolved I am just trying to start again. I am requesting the Landscaping license so that I can work in Collier county with all the needed permits, licenses and insurances. Then when I have all my paperwork in order, hopefully I can start working and work towards my goal of having a clean credit and a better financial future. Thank you, Y a Tejada 1 gill k� •.`" I �� Department of the Treasury Notice CP39 ilf ;nternal Revenue Service Tax Year 2006 IRS'bey PO Box 621501 Atlanta, GA 30362-1501 Notice date June 11,2012 Social Security number To contact us Phone 1-800-829-0922 Your Caller ID 307916 053988.976920.0241.004 1 AT 0.374 643 Paget of 2 rilrll,iririldrrlifillllrll hdoillilrrillllll"Pplidhl YANIRA I TEJADA -t 3715 3911-I AVE NE ..F,-.:< NAPLES FL 34120-7546 a r 053988 We applied a 2011 overpayment to tax you owe for 2006 Amount due: $0.00 We applied the $1,010.27 overpayment Billing Summary from your 2011 tax return to the amount Amount owed on 2006 tax return $1,010,27 owed on the tax return you filed in 2006. Overpayment applied from 2011 41,010.27 As a result, the amount you owe for 2006 Amount due $0.00 is $0.00. What you need to do You don't need to respond to this notice. Continued on back , to. , YANIRA I TEJADA Notice CP39 3715 39TH AVE NE Notice date June 11, 2012 NAPLES FL 34120-7546 IRS Social Security number eigan ,. i ti kgiktict 1,1 ' If your address has changed, please call 1-800-829-0922 or visit www,irs.gov, 111 �� ill 13 Please check here if you've included any correspondence.Write your Social Security number(154-90-0720), the tax year(2006), and the form number(1040)on any Contact information correspondence. f1 a.m. ❑a.m. OA.:mr......... ❑ m Primary phone Best time to call Secondary phone •Best time to call INTERNAL REVENUE SERVICE KANSAS CITY, MO 64999-0204 T"0 1.11r111inu Ill'1tl,ilgllllIIIIhIlt'I11111111,„Il,l 3,54900720 KQ TEJA 30 0 200612 LAW OFFICES GARY KORNFIELD,P.A. EMERALD HILLS EXECUTIVE PLAZA 4601 Sheridan Street,Suite 222 Hollywood.Florida, 3302] Gary Kornfield Admitted to Practice Broward (954)241-0440 in Florida and Pennsylvania Facsimile (954)241-0441 September 3, 2008 Yanira I. Tejada 3715 39Th Avenue NE Naples, FL 34120 Re: Seminole Casualty Insurance Company a/s/o Cruz vs. Trejada and Pena Our Claim No. : S0602164 Date of Accident • February 16, 2006 Our File No. 08-270 Dear Ms. Tejada: Enclosed herewith is the recorded Satisfaction of Judgment. This maybe used to reinstate your driving privileges. Your insurance company paid the claim in full. This matter is concluded. Sincerely yours, LAW OFFI ,-3V. R°Ir IELD, P.A. Ga Kornfield, Esquire GK/ci • rte. 99y GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive ,1 l Naples, FL 34104 _ • i 4 - 1 01 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: (' 1. Exact Corporate/Business Name: Irak/a lc 4 W /. O4 PbriI nc Fiction Name/DBA: Qualifier Name: &(A 1 Physical Address: 1 C�c3c- 91141 Pw c ME_ •es R. `30 2 (Number & Street) t City) �((SS'(State) (Zip Code) Mailing Address: P� lido K. I I 23I N 1P S 'fit 9/0 r (Number & Street) (City) (State) (Zip Code) Telephone: Q.-% 061.110 3118'64 7a E-Mail: 'P4fa-d'1Se. t-' CON 1• cl HA., TYPE OF LICENSE: Cl General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ S itnming Pool $230.00 ❑ Roofing $230.00 O Specialty $205.00 Specialty trade:1-0.:t4 5C'�Qt I�C.SI • 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. tely�.rb kit L0 1 / l $8c `114` /1 €- Pc, �sa..Oles l# 3't w, 259 3Y�' \- 4.4At 1:e.3CLA 1 %) p 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. ,411Ark ,i4 LUELW 4 );7e 3. List all debts you or any company(s) associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. • AFFIDAVIT I,5C((/l I 1 ad-a—certify that the foregoing is true and correct to the best of my knowledge. Authorize fficer of the Firm STATE OF FLORIDA , • COUNTY OF 6v/L,e-,2 The foregoing instrument as acknowledged before me this (Sy-lull b e_r Ji'1t'1` 20 1 4 (Date) By (In 1 Y'(A —5_,‘fi‘AN of . ParCLA t St Land SCG4 ) J b'7 F 24 DA (Name of officer, le/agent) (Name of Corporation) J a T.&O12A fJ fN Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced br( VeX5 L1 Ca. identification and did not take an oath. (Type of identification) NOTARY'S SEAL _k_A-Q: .-''"'ee:'-, EDIS A AREVALO (SIGNA OF NOTARY) n ).1 MY COMMISSION #FF005369 'N'i a,°, EXPIRES April 4,2017 (407)398-0753 FlorldallotaryService.com Page 2 of 4 QUALIFIER INFORMATION: Name: 1& Address: , D � 141 � �l 4°1 Ck12`e5 t • 3-/ 12'0 (Number& Street) (City) (State) (Zip Code) Telephone: 2i 3 314 ftS111 ZS Date of Birth: 02-- (C1 r( 'i 79 S.S. #: 000-00- ti7V) E-Mail: 30,,,i 5 S' C. &OI •C 6)W. Driver's License: -e36 - 96 9-79° S C 1. Type of Certificate of Competency for which application is made. IrzvVc-SCAY Ivn Yes ki-c-ce-col 2. The names and telephone numbers of two persons who will know your whereabouts. Aim IL t 2-39 (6.31-5-91 5 •)1'1 a- T jc , 1-39 -o0 U 7/ 3. Have you ever been convicted of a crime related to Contracting? 6 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? NO 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. 9. List your business or work experience during the past ten years. 411,1011 Se-Alak (T450 Cap 4t-e pAtittic) Fed)/ J 10. Statement of any formal training you have had in the area for which the application is made. 826+ MQ A-14 Gla,SS, r Lcett. ``iblocktp"/icceeta 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. ' ' \t} & ¶ 4 - s. 9PLICANT(PLEAS 3RINT) t /b01(k■ GraS a—ROI-062— SAME OFCOMPANY S NATURE i PLICANT STATE OF FLO DA COUNTY OF ' Ole..(" The foregoing instrument as acknowledged before me thispki'Y1 b-e.-r ?rh �° (� (Date) By Q n't ((X TP V)L G-- who has produced b Y�J€ L LU'`5 CG (Na a of person acknowietiging) (Type of identification) as identification arid did not take an oath. NOTARY'S SEAL I EDIS A AREVALO (SIGNATI. ' OF NOTARY) c � 1 !'`'- MY COMMISSION#FF005369 \S-....i;;Oti EXPIRES April 4,201.7 (407)388.0153 FlorldaNCtaryServICe.corh Page 4 of 4 Licensee Information - A Licensee Number Q17635 — Description. Type Property Alert Name YANIRA I TEJADA I - Type 1 Contractor El 1. Status i Open E. View Master Project View All Activities for this Licensee Add a new person or business to Address Book Examination Results . . ' A 1..A0.0-Exaril34stift.. Link __ Exam/Test Type I_ Date of ExamTest City Score received ExamiTest result BUSINESS AND LAW 07/12/1997 NAPLES 75.50 --------1 -- --- --— -— ---- - _ . 1 • ____ • TREE CONTRACTOR. 03/03/2007 NAPLES 176.40 —7. _ . - 4 4 l , _ TREE CONTRACTOR 02/10/2007 FT.LAUDERDALE-BROWARD C 57.00 ( Show Morefields I I Hide or.Clear Fields I Charge Exam Fee r1 Exam Code I ' .. .. , . ..._ Sponsoring County 1 Sponsorship App Date -. . Sponsorship Expiration Date 1 7, Testing Facility • 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. SIi NATURE OF •e'PLICANT OrrA4 h4,1 to,/ - 46 :USINESS NAME DATE 3EFORE ME this day personally appeared C iV l Yt■ Ti..Kid&- who affirms and says that he las less than one employee and does not requ± Workmen's Comnsation understands that at any ime he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA ;OUNTY OF he foregoing instrument was acknowledged before me this `L t1 j t° y� )(-141-2-01L1 (Date) Y ����'� 1 who has produced \V Z� LA C9-4,4 c- ame of person ac nowledging) . (Type of identification) s identification and who did not take an oath. 1 : SIGNATURE I OTARY Q-)1/Gi . NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC ", e' EDIS A AREVALO MY COMMISSION #FF005369 i ' '�1�, EXPIRES April 4,2017 (407)"g8.0153 FlorldalloteryServics,com 4 I • VERIFICATION OF CONSTRUCTION EXPERIENCES GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: t I CA_ 're Certificate Category Requested: kCIt1ZJ�t"&,P1 &3 &chic The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the person signing below and verifying Applicants relevant experience: Name: ,Q V 1.& 0l i-k-b Title: T License Number(if applicable): `0 657V 9• •Name of Business: P•'l ix4`k /4?SSC&flui$ A/W OW ct. ./ Business Address: 'i'l U c 4 ' SW/ La/'Lc 6 �� -e 331 )3 Business Phone:23Qc ar113( The Applicant's years of experience from ef4 to ;10 44 The applicant's scope of work (specific duties)included: t1 '- -gt'ii.t..A3LiiS It t , LL(s t OW U uta ` Vt h t� 6NJJ3 eaid 14.41 cCi11. o-t1 ta.4.011 woin fe.wrah.c am. Additional Comments: hJ a[jl j LE.6// 6at es r Ca"--/a-P6- - Falsifying any information provided herein may subject your license to revocation. � A fe Signature ` Print Name: a � �CY1.- State of Florida County of Collier The foregoing instrument was acknowledged before me on this /O' day of --_' S 4 r ` >t t Do 1 L-1 by AN Tv` nto who is personally known to me or produc-• V1-✓5 Ut^C.QM as identification and who did not take an oath. Signature of Nota "ANY �' °- A E ' MY COMMfSSION EDIS AR #FF00VAL05359~~ 7 aF F��P`'' EXPIRES April 4,2017 (407)3964153 Flo rldallotaryServlce.cam �' • t.VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 '(�., e Applicant's Name: Q�1 Y okcip,..... Certificate Catego quested: _ A O •'., .1 At. r1� c The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name, Title and license number of the person signing below and verifying Applicants relevant experience: Name: --J d5C . 0 , e.-`0,...3�-��' Title: 1 '( _ €_ v license Number(if applicable): C 67) C /cI�,, Name of Business: d\/A- . C O 11 5 C-1 1 O Y1 e T 63iO4, w j-" 1v r 1Gt'_A , ✓tc . Business Address: ear g* 5+ s W 'i t4l-.�S -O. 3 Y/i 7 a-53-013) '^ Business Phone:2-30) The Applicant's years of experience from a-0)3 f3 to g-o i V The applicant's scope of work(specific duties)included: 4:11(4-") /v6 T 1-0 Aakce & el2(.P /4 c 4424CA 6.4) l /l-r° ,CQi7 • ._ ---- i /t. /0-4- Ao twat J , - 1.•e int,/v r ff/ / ter 12>ki , Additional Comments: .5-1.-11/1A) rifitC "../4. /n /`( b '- 4'k. . /x--r€, `911 __�_,t`' G1/ D C mn-5 " (J Falsifying any in mation provided herein mayct.your licens• • revocatio•. r .ril: . / ' , t�/� Signat re ' Prin tame: 1 _T/ ■.� ' ...J. State of Florida County of Collier c The foregoing instrument wa acknowledged before ne on this � day of 1 ,0"1"• ,�O L y by .,'OSZ "re ( who is personally known to me or •roduced _,„,,,.., b i as identification and w'h6 did not take an oath. Oak k. Illbaii6 _ ■ Signature of Notary r.."�.,,•� EDIS A AREVALO ,,fire+�,.._...... "; i.; uT� i'i MY COMMISSION#FF005369 1.t'a;, oas EXPIRES April 4,2017 (407)398-0153 FlortdallotaryServtce,com AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, A K A-1 1 m c, ! t c0 i i\tta , am a resident of Q.v/1 ! k-r- County, [fir' di4 (State) and have resided here for more than five (5) years. During the last five years I have known (I:.r\t `r"'Cti l e \Ck_aO . (Applicant). I have had the opportunity to observe his or her busin s and personal deings and find him or her to be a person of honesty, integrity and good character. (Signature) llri►4 -'e ___. (Name) 40+40 k)y ) 14 A)`o/i 11 0 (Address) Pik g' r/4 d r Aimk Cie . iQripi,tS' c-1. 3 yi'5 Telephone) 0239' OO ' SO/ 0 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this WI` I Ott' 201 _I by (Date) 4)40.0 1 (iv c o) )i b who has produced (..e'Z. am .c (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIGNATURE (OF '�— OT: Y E I C A �` v,/ Ar L'y NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC r: EDIS A AREVALO ; :. r o MY COMMISSION#FF005369 For��si EXPIRES April 4,2017 (407)39;-0153 FiorldallotaryServIce.cdm 10 GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 MEMORANDUM Date: February 17, 2015 To: Applicant's for Certificate of Competency From: Michael Ossorio, Contracting Licensing Supervisor Subject: Collection of social security numbers. Pursuant to Chapter I-19, Florida Statutes and Collier County Contractor Licensing Ordinance 2006-46 Section 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 I-19, Florida Statutes, 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 I-19, Florida Statutes. CA • 00 V/A Oft V♦V)A 0l'0 OA 00 V/1l 01 V 0A . 00 V♦V/1A ' 0 .l ; < ; 1 ,<;1;"41)2( 111101144' 11,0141;�rO i IRO ► , ► i -■ .. i e. -4 ����. iJr vs 1 t Iv 0 �♦1 /� ■ s X110 .� u �VI 4 r ®rim lailtp. 0 rl- v) '`,7', C..) 4- .- r .. I , o j •. •<► r w O , ^c A t 4—a j o N ° cd L 04 ojo, N v t Q a • -A °' V 014 • II —� c\� � ° v iv 4 141 i b 74 c.) ---T- Fp L A� �Iej/ \ (-8 C � N �` �_ U cn .:;:,., .,.. ii:D-_:- ....4. . ,4-4 i 'v Jo .a. . ® 61 ���1��+�� cc3 cad '� " •- - 0 ♦ '� w � � **`4..1 Ot �� z L-� - • '� •r' p X01 in �/► 0� . 0 , "--' D i - O a' VJ v '� _ ,atrile0:46,114, ''-tr44 %Ai •ci `3 �, , °J f _ ••I► N b ,4 m #A�•„. 0•.:1:14P . ✓ E2 +, N up U 1 .• t6' c-i-( -c) •- <-8• 4*il AV C....) g ci) cu (-) 0 cit) V. ,0P1 v H cd 0 j H up o V i -&-tk W A f#A„• .:^® �. :# A 4 4`` A 44)+* A s+* A N+ A 4 * A 4411 tv' 'a.f., .. ta0 A e• : ta0 04, 00 *0 A oo . to 0,to . wit.A to . to 041, 00: Sep 11 1402:36p 239-277-0167 2392770167 p,2 • Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 7/97 09/11/14 13:08CT [SUBJECT] TSSN1 [BIRTH DATE] TEJADA, YANIRA I. -0720 7/78 [ALSO KNOWN AS] TEJADA,YANIS,I [CURRENT ADDRESS] [DATE RPTD] 3715 NE. 39TH AV., NAPLES FL. 34120 10/05 [FORMER ADDRESS] 2571 N. WILSON 8V., NAPLES FL. 34120 3715 N. 39TH AVE NE 2571 WILSON BV., NAPLES FL. 34120 [CURRENT EMPLOYER AND ADDRESS) [RPTD] YEM DRYWALL INC NAPLES FL [FORMER EMPLOYER AND ADDRESS] 3/02 VERTEZ DRYWALL - PARTNER S P E C I A L M E S S A G E S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESSES)*** MODEL PROF I L E * * * ALERT * * * ***FICO CLASSIC 04 ALERT: SCORE +509 : 038, 013, 010, 020 *** IN ADDITION ***TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S TOR Y PR=3 COL=S NEG=10 HSTNEG=4-98 TAD=19 RVL=11 INST=2 MTG=6 OPN=O INQ=4 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $392 $500 $0 $0 100% MORTGAGE: $466K $ $486K $65.0K $2805 CLOSED W/BAL: $13.0K $7014 $ TOTALS: $466K $500 $499K $72.0K $2805 PUBLIC RECORDS SOURCE DATE LIAB ECOA COURT ASSETS PAID DOCKET# TYPE Z 5064186 4/1OR $4179 I CI PLAINTIFF/ATTORNEY 101185C CIVIL JUDGMENT TARGET NATIONAL BANK Z 5064186 9/09R $5748 I RD 6/12 4340019 PAID FEDERAL TAX LIEN B4490P1859 Z 5064186 4/08R $6926 C CI 62726CC CIVIL JUDGMENT SEMINOLE CASUALTY INSU C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 10/13 $3589 CITIBANK SOUTH OAK 09B 8561447386 8/14A $3589 PLACED FOR COLLECTIO Sep 11 1402:36p 239-277-0167 2392770167 p.3 MIDLAND FUND Y 36ET009 I 1/12 $3673 CITIFINANCIAL 09B 8546202337 8/14A $5829 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 5/12 $3693 CHASE BANK USA N A 098 8550234426 8/14A $3693 PLACED FOR COLLECTIO PORTFOLIO RC Y 1KSE003 I 3/09 $1151 CAPITAL ONE BANK U 098 4862367128801448 8/14A $1151 PLACED FOR COLLECTIO FST NAT COLL Y 2C8C001 I 3/13 $211 11 DIRECTV 098 47300374 4/13A $211 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 TARGET/TD D 1ZX5002 8/04 $4179 RO9 435237670351 8/14A $3600 $4179 I CREDIT CARD 4/09F $4179 CLOSD BY CRDT GRANTOR SWISS COLONY D 4534003 11/08 $91 R09 71261766 10/13A $45 I CHARGE ACCOUNT 7/09F $91 UNPAID BLNC CHRGD OFF THD/CBNA B 26H3005 4/05 $2896 R09 603532017054 6/11A $3200 $1433 I CHARGE ACCOUNT 11/08F $2896 UNPAID BLNC CHRGD OFF CHASE 8 26QK001 9/06 $4368 R09 418587439659 3/09A $3263 $0 I CREDIT CARD 10/08F $e PURCH BY OTHER LENDER CAP ONE B 1DTV001 1/05 $1136 RO9 486236712880 3/09A $500 $0 I SLDTO PORTFOLIO R 3/09F $0 PURCH BY OTHER LENDER BK OF AMER B 1597629 12/07 $5870 R09 9214 2/09A $5000 $1357 I CREDIT CARD 11/08F $5870 CLOSD BY CRDT GRANTOR OCWEN LOAN B 813P004 9/05 $280K 360M1509 11/13 55555555 1105 7190341516 7/14A $65.0K $65.5 05 I CONVENTIONAL REAL $298K 8 0/ 0/ 8 ONEWEST BANK B 478A001 9/05 $280K 360M1509 4/08 555555555555 1105 6683001493265 11/13A $0 $8867 05 555555555555 I CONVENTIONAL REAL 11/130 $0 TRNSFRD: OTHER LENDER 48 0/ 0/47 SAXON MTG F 3324006 9/05 $70.0K 360M729 1/09 555555XX5555 1105 6242000548996 1/12A $0 $10.0 05 555555555555 I SECOND MORTGAGE 1/12C $0 TRNSFRD: OTHER LENDER 38 0/ 0/34 HOMEQ F 186F123 9/05 $70.0K 360M729 5/08 555554332111 MO5 693032497 10/08A $0 $2916 05 111111111111 1 SECOND MORTGAGE 10/08C $0 TRNSFRD: OTHER LENDER 26 1/ 2/ 6 ZALE/CBNA 3 215G001 4/07 $2510 111111111111 R01 603525106906 8/14A $500 $0 111111111111 I CHARGE ACCOUNT 3/09C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 WFHM B 82TE004 3/05 $186K 360M1296 10/08 111111111111 M01 Sep 11 140236o 239-277-0167 2392770167 p.4 7080197391949 8/14A $0 $6882 05 111111111111 C FHA REAL ESTATE M $187K 48 0/ 0/ 0 WESTLAKE FIN F 1T9Q001 8/10 $11,5K 45M402 111111111111 I01 1709468 1/14A $0 111111111111 I AUTOMOBILE 1/14C $0 CLOSED 39 0/ 0/ 0 ALLY FINCL F 259237L 9/06 $38.7K 60M645 111111111111 I01 29999297510 9/10A $0 111111111111 I AUTOMOBILE 9/10C $0 CLOSED 46 0/ 0/ 0 TARGET N.B. D 6476004 8/04 $424 11111111/111 RO1 29803 1/10A $500 $0 111111111111 I CHARGE ACCOUNT 10/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 AQUA FINANCE F 36VD001 10/05 $1263 X40040 3/09A $5200 $0 111111111111 R01 111/11111211 I LINE OF CREDIT 3/09C $0 ACCT CLSD BY CONSUMER 41 0/ 0/ 0 CHASE B 2642004 4/85 $940 426605030800 1/07A $500 $0 111111111111 R01 I CREDIT CARD 11/96C $0 CLOSD BY CRDT GRANTOR 1211110/ 0/ 0 CB/NPRTNWS C 1NZ8090 9/04 $392 585637338379 11/06A $500 $0 111111111111 R01 I CHARGE ACCOUNT 10/06P $0 I1i261110/11 26 0/ 0/ 0 GMAC MORT. F 2672002 9/05 $70.0K 360M729 11 292041697 5/06A M01 I SECOND MORTGAGE 5/06C $0 TRNSFRD: OTHER LENDER 4 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 9/11/14 ZNP6284423(FLA) MERIT CREDIT 9/27/13 BPT3541542(WAS) MAB8T RETAIL 9/27/13 NDY1263431(DAY) SYNCB 1/10/13 ZMI0651860(FLA) PREMIUM CB C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 800-888-4213 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION COLLIER CIR ZP5064186 (941) 774-8800 3301 TAMIAMI TRL E NAPLES FL. 34101 MIDLAND FUND YC36ET009 B875 AERO DR SAN DIEGO CA. 92123 (844) 236 1959 PORTFOLIO RC YCIKSE003 287 INDEPENDENCE VIRGINIA BEACH VA. 23462 (800) 772-1413 FST NAT COLL YC2C8C001 (800) 824-6191 610 WALTHAM WAY SPARKS NV. 89434 TARGET/TD DZ1ZX5002 PO BOX 673 MINNEAPOLIS MN. 55440 SWISS COLONY D24534003 1112 7TH AVE MONROE WI. 53566 THD/CBNA 8Z26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 • Sep 11 1402:36p 239-277-0167 2392770167 p.5 • CHOSE BC26QK901 P.O. BOX 15298 WILMINGTON DE. 19850 (800) 955-9900 CAP ONE BC1DTV001 POB 30281 SALT LAKE CITY UT. 84130 (800) 955-7078 8K OF AMER 8C1597029 PO BOX 982235 EL PASO TX. 79998 OCWEN LOAN BM813P004 (561) 682-8000 1661 WORTHINGTON R WEST PALM BEAC FL. 33409 ONEWEST BANK B8478A001 (800) 781-7399 6900 BEATRICE FSB KALAMAZOO MI. 49009 SAXON MTG FM3324006 (817) 215-7200 PO BOX 161489 FORT WORTH TX. 76161 HOMEQ FM1B6F123 P.O. BOX 13716 SACRAMENTO CA. 95853 (877) 867-7378 ZALE/CBNA JA2156001 PO BOX 6497 - SIOUX FALLS 5D. 57117 WFHM BM82TE004 (800) 288-3212 7255 BAYMEADOWS WA DES MOINES IA. 50306 WESTLAKE FIN FS1T9Q001 (323) 692-8800 4751 WILSHIRE BVLD LOS ANGELES CA. 90010 ALLY FINCL FA259237L (888) 925-2559 P.O. BOX 380901 BLOOMINGTON MN. 55438 TARGET N.B. DC6476004 PO BOX 673 MINNEAPOLIS MN. 55440 AQUA FINANCE FZ36VD001 (715) 848-5425 1 CORPORATE COVE WAUSAU WI. 54401 CHASE BC26QK004 P.O. BOX 15298 WILMINGTON DE. 19850 (800) 955-9900 CB/NPRTNWS CW1NZ8090 PO BOX 182789 COLUMBUS OH. 43218 GMAC MORT. FM2672002 (800) 766-4622 3451 HAMMOND AVE WATERLOO IA. 50704 MAB&T RETAIL B 3541542 216 W 2ND ST DIXON MO. 65459 SYNCB N 1263431 (866) 419-4096 C/0 PO BOX 965037 ORLANDO FL. 32896 PREMIUM CB Z 0651860 (800) 322-8825 2412 NW 87 PLACE DORAL FL. 33172 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR, PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 3 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE jk DIVISI0N OF CORPORATIONS b JI Federal Lien Registration Detail by Entity Name Fictitious Names Judgment Liens Florida Profit Corporation LLP/General Partnerships PARADISE LANDSCAPING OF FLORIDA, INC UCC Information Cable Franchise List Filing Information Document Number P14000074768 FEI/EIN Number NONE Date Filed 09/09/2014 Effective Date 09/08/2014 State FL Status ACTIVE Principal Address 1885 47TH AVE NE NAPLES, FL 34120 Mailing Address P.O. BOX 112831 NAPLES, FL 34108 Registered Aqent Name&Address TEJADA, YANIRA 1885 47TH AVE NE NAPLES, FL 34120 Officer/Director Detail Name&Address Title P RICO CASTANEDA, ALEJANDRO 1885 47TH AVE NE NAPLES, FL 34120 Title VP TEJADA, YANIRA 1885 47TH AVE NE NAPLES, FL 34120 Annual Reports No Annual Reports Filed Document Images 09/09/2014-- Domestic Profit View image in PDF format hap://search.sunbiz.org/Inquiry/uorporationSearch/SearchRe sultDetail?inquiryrype—En city... 3/23/2015 Detail by Entity Name Page 2 of 2 CoDVrlghtlo.and Privacy Policled State of Florida,Department of State http:/isearch.sunbiz.org/InquirylLorporationNearctvsearchxesululletail!inquiry type=t,ntity... i/L3/2U1 Electronic Articles of Incorporation P14000074768 FILED For September 09, 2014 Sec. Of State nhaney PARADISE LANDSCAPING OF FLORIDA, INC The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: PARADISE LANDSCAPING OF FLORIDA, INC Article II The principal place of business address: 1885 47TH AVE NE NAPLES, FL. US 34120 The mailing address of the corporation is: P.O. BOX 112831 NAPLES, FL. US 34108 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 100 Article V The name and Florida street address of the registered agent is: YANIRA TEJADA 1885 47TH AVE NE NAPLES, FL. 34120 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: YANIRA TEJADA P14000074768 FILED Article VI September 09, 2014 Sec. Of State The name and address of the incorporator is: nhaney YANIRA TEJADA 1885 47TH AVE NE NAPLES, FL. 34120 Electronic Signature of Incorporator: YANIRA TEJADA I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 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 ALEJANDRO RICO CASTANEDA 1885 47TH AVE NE NAPLES, FL. 34120 Title: VP YANIRA TEJADA 1885 47TH AVE NE NAPLES, FL. 34120 Article VIII The effective date for this corporation shall be: 09/08/2014 • y"�ylj TDC DEPARTMENT OF THE TREASURY +�p'1p 1- - INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 09-10-2014 Employer Identification Number: 47-1794847 Form: SS-4 \. Number of this notice: CP 575 A PARADISE LANDSCAPING OF FLORID PO BOX 112831 NAPLES, FL 34108 For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 47-1794847. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 941 01/31/2015 Form 940 01/31/2015 Form 1120 03/15/2015 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year) , see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue) . Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION FT.F.CTION: 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. • j„,_,,.;.:.4,:,:,',,_:_,;,,•,:, --!...y.., T4 Ugvt ..$ 'v'3_ `. r ,7 { ,: ter" '' ' - ,,x �`: r��r a .zZ - mwaa `` • ri4a+�3S_,.-1 a�e3mNFx�'ptl p1A�{E N .'Yd '43.AI :' M j: Y' •• • - .. - ACc Rr!'7." CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDFYYYY) 10/15/14 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: A All Casualty Insurance of Naples (A//cC,No,Ext): (239)348-7779 I (a: NQ), (239)348-7713 5425 Golden Gate Pkwy.Suite#6-E ADDRESS: oliviains@aol.com Naples, FL 34116 INSURER(S)AFFORDING COVERAGE NAIC# Phone (239)348-7779 Fax (239)348-7713 INSURER A: ASCENDANT COMMERCIAL INS CO INSURED INSURERS: PARADISE LANDSCAPING OF FLORIDA, INC. INSURER C: 1885 47 Th Ave Ne INSURER D: NAPLES, FL 34120- (239)287-7366 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. —i INSR ADDLSUBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS (MMlDD/YYYY) (MM/ODlYYYYL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 Q DAMAGE TO RENTED 100,000.00 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ ❑ ❑ GL-45560-0 [_y 5,000.00 CLAIMS-MADE Q OCCUR MED EXP An one person) $ A 09/15/2014 09/15/2015 — ❑ PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS $ 1,000,000.00 51 POLICY ❑ PRO- ❑ LOC $J — — _.._........ 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-aocldenq_,—- --__ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTIONS WORKERS COMPENSATION ❑TORY UNITS ❑ FOR AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERJMEMBER 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 (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) LANDSCAPING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COLLIER COUNTY LICENSING SECTION THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 2800 HORSESHOE DR ACCORDANCE WITH THE POLICY PROVISIONS. NAPLES, FL 34104 AUTHORIZED REPRESEN• TIV£ IOW ©1988-201•AC a`D CORFIORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name an• ••• are registered marks of ACORD • THE coo' nh JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** NON-CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 10/13/2014 EXPIRATION DATE: 10/12/2016 PERSON: TEJADA YANIRA FEIN: 471794847 BUSINESS NAME AND ADDRESS: PARADISE LANDSCAPING OF FLORIDA INC P.O.BOX 112831 NAPLES FL 34108 SCOPES OF BUSINESS OR TRADE: PARK NOC-ALL EMPLOYEES & DRIVE Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by thing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 Nfar 31 15 09:14a 2392770167 P.2• • Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUS] [INFILE] [DATE] (TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 7/97 03/31/15 09:26CT [SUBJECT] [SSN] [BIRTH DATE) TEJADA, YANIRA I. T-0720 7/78 [ALSO KNOWN AS] TEJADA,YANIS,I [CURRENT ADDRESS] [DATE RPTD] 3715 NE. 39TH AV. , NAPLES FL. 34120 10/05 (FORMER ADDRESS] 2571 N. WILSON BV. , NAPLES FL. 34120 1885 NE. 47TH AV. , NAPLES FL. 34120 (CURRENT EMPLOYER AND ADDRESS] IRPTD] YEM DRYWALL INC NAPLES FL 3/02 (FORMER EMPLOYER AND ADDRESS] VERTEZ DRYWALL - PARTNER M O D E L P R O F I L E * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +574 : 038, 010, 018, 013 *** IN ADDITION ***TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. CREDIT S U M M A R Y * * * T O T A L F I L E H I S TOR Y PR=2 COL=4 NEG=8 HSTNEG=2-56 TRD=17 RVL=11 INST=2 MTG=4 OPN=0 INQ=S HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $392 $500 $0 $0 100* MORTGAGE: $186K $ $1B5K $0 $1317 CLOSED W/BAL: $8857 $4298 $ TOTALS: $166K $500 $194K $4298 $1317 PUB L I C RECORDS SOURCE DATE LIAB ECOA COURT ASSETS PAID DOCCKETIFF/ATTORNEY TYPE Z 5064186 4/10R $4179 I CI 10/14 10118SC PAID CIVIL JUDGMENT TARGET NATIONAL BANK T Z 5064186 9/09R $5748 I RD 6/12 4340019 PAID FEDERAL TAX LIEN B4490P1859 C O L L E C T I O N S SUENAME SU3CODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 10/13 $3589 CITIBANK SOUTH DAK 09B 8561447386 3/15A $3589 ACCT INFO DSP 3Y CSM MIDLAND FUND Y 36ET009 I 5/12 $3693 CHASE BANK USA NA 09B 8550134420 3/15A $3693 ACCT INFO DSP BY CSM Mar 31 15 09:14a 2392770167 p.3 • FST NAT COLL Y 2C8C061 I 3/13 $211 11 DIRECTV 09B 47300374 4/13A $211 PLACED FOR COLLECTIO PORTFOLIO RC Y 1KSE003 I 3/09 1/15F $1151 CAPITAL ONE BANK U 09P 4862367128801448 1/15A SO SETTLED ( FULL BLNC T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 BK OF AMER B 1597029 12/07 $5870 R09 9214 3/15A $5000 $1357 I CREDIT CARD 11/08F $5870 ACCT CLSD BY CONSUMER THD/CBNA B 26143005 4/OS $2896 R09 603532017054 2/15A $3200 $2896 I CHARGE ACCOUNT 11/08F $2896 CLOSD BY CRDT GRANTOR SWISS COLONY D 4534003 11/08 $91 R09 71261766 10/13A $45 I CHARGE ACCOUNT 7/C9F $91 UNPAID BLNC CHRGD OFF CHASE B 26QK001 9/06 $4368 R09 418587439659 3/09A $3263 $0 I CREDIT CARD 10/08F $0 PURCH BY OTHER LENDER CAPITAL ONE B 1DTTVO01 1/05 $1136 R09 486236712880 3/09A $500 $0 I SLDTO PORTFOLIO R 3/09F $0 PURCH BY OTHER LENDER TARGET/TD D 1ZX5002 8/04 $4179 R9P 435237670351 3/15A $3600 $0 I CREDIT CARD 4/09F $0 SETTLED ( FULL BLNC OCWEN LOAN B 813P004 9/05 $280K 360M1509 11/13 555555555 M05 7190341516 8/14A $0 $65.5 05 I CONVENTIONAL REAL 8/14C SO CLOSED 9 0/ 0/ 9 ONEWEST BANK B 478A001 9/05 $260K ' 360M1509 6/08 555555555555 M05 6683001493265 11/13A $0 $13.3 C5 555555555555 I CONVENTIONAL REAL 11/13C $0 TRNSFRD: OTHER LENDER 48 0/ 0/47 ZALE/CBNA J 215G001 4/07 $2510 111111111111 RO1 603525106906 3/15A $500 $0 111111111111 I CHARGE ACCOUNT 3/09C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 WFHM B 82TE004 3/05 $186K 360M1317 10/08 111111111111 MO1 7080197391949 3/15A $0 $6882 05 111111111111 C FHA REAL ESTATE M $185K 48 0/ 0/ 0 WESTLAKE FIN F 1T9Q001 8/10 $11.5K 45M402 111111111111 101 1709468 1/14A $0 11":.111111111 I AUTOMOBILE 1/14C $0 CLOSED 39 of 0/ 0 ALLY FINCL F 259237L 9/06 $38.7K 60M645 111111111111 I01 29909297510 9/10A $0 111111111111 I AUTOMOBILE 9/10C $0 CLOSED 46 0/ 0/ 0 Mal-311.609149 2392770167 ar 31 r 09:14a 2392770167 p.4 TARGET N.B. D 6476004 8/04 $424 111111111111 RO1 29803 1/10A $500 $0 111111111111 I CHARGE ACCOUNT 10/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 AQUA FINANCE F 36VD001 10/05 $1263 111111111111 RO1 X40040 3/09A $520C $0 111111111111 2 LINE OF CREDIT 3/09C $0 ACCT CLSD BY CONSUMER 41 0/ 0/ 0 CHASE B 26QK004 4/05, $940 111111111111 RO1 426605030000 1/07A $500 $0 111111111 I CREDIT CARD 11/06C $0 CLOSD BY CRDT GRANTOR 21 0/ Of 0 CB/NPRTNWS C 11128090 9/04 $392 111111111111 RO1 585637338379 11/06A $500 $0 111111111111 I CHARGE ACCOUNT 10/06P $0 26 0/ 0/ 0 OCWEN/GMAC F 2672002 9/05 $70.0K 350M729 11 tI01 292041697 5/06A $0 I SECOND MORTGAGE 5/06C $0 TRNSFRD: OTHER LENDER 4 01 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 3/31/15 ZNP6284423(FLA) MERIT CREDIT 11/04/14 NNY1212732 (EAS) SYNCB/WALMRT 9/11/14 ZNP6284423 (FLA) MERIT CREDIT 9/27/13 BPT3541542 (WAS) MAB&T RETAIL 9/27/13 NDY1263431 (DAY) SYNCB C R E D I T R E P O R T S E R V I C E D B Y : 800-888-42 13 TRANSUNION 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.coin CREDITOR CONTACT INFORMATION (941) 774-8800 COLLIER CIR 2E5064186 3301 TAMIAMI TRL E NAPLES FL. 34101 MIDLAND FUND YC36ET009 (844) 236-1959 8875 AFRO DR SAN DIEGO CA. 92123 (800) 824-6191 FST NAT COLL YC2C8COO1 610 WALTHAM WAY SPARKS NV. 89434 (800) 772-1413 PORTFOLIO RC YCIKSE003 287 INDEPENDENCE VIRGINIA BEACH VA. 23462 BK OF AMER BC1597029 PO BOX 982235 EL PASO TX. 79998 THD/CBNA BZ26H3005 PO BOK 6497 SIOUX FALLS SD. 57117 SWISS COLONY D24534003 1112 7TH AVE MONROE WI. 53566 (800) 432-3117 CHASE BC26QK001 P.O. BOX 15298 WILMINGTON DE. 19850 (800) 955-7070 CAPITAL ONE BC1DTV001 POB 30281 SALT LAKE CITY UT. 84130 TARGET/TD DZ1ZX5002 Enrique Vasquez — D/B/A — SW Florida Painting Corp C.L.B. Case # 2015-02 Table of Contents E-1 through E-2 —Administrative Complaint E-3 through E-4— Case Summary E-5 through E-7 — Formal Complaint E-8 — Signed Notice of Hearing E-9 through E-10 — Collier County Certificate of Competency E-11 through E-12- Corporation Detail E-13 through E-14- State of Florida, Department of Financial Services Division of Workers' Compensation 2010 Stop Work Order E-15 through E-16 — Collier County Code Case details for Case # CEMIS20150004385 E-17 through E-19- Arrest Report E- 20 through E-21 — Collier County Ordinance 90-105, as amended, Section (6) & (7) E-22 through E-23 — Florida State Statute 440.105. E-24 through E-37 —2012 Reinstatement Packet for License #32213 BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, V. Case Number: 2015-02 License Number: 32213 Enrique Vasquez D/B/A—SW Florida Painting Corp Respondent. ADMINISTRATIVE COMPLAINT Collier County(County) files the Administrative Complaint against Enrique Vasquez ( Respondent), a Collier County licensed Painting Contractor( license#32213), and states the following facts and allegations in support of the cited violations below: 1. The Respondent is currently licensed by Collier County as a Painting Contractor with License number: 32213. 2. Under the provisions of Collier County Ordinance 90-105, as amended,Section 22-201,the following actions by a holder of a Collier County/Certificate of Competency shall constitute misconduct and grounds for discipline pursuant to Section 22-202. A. On March 4th, 2015, it was discovered that, at an active jobsite at 4221Crayton Rd Naples, FL, Enrique Vasquez, qualifier of SW Florida Painting Corp, had employees (4) performing painting services while company was under an active 2010 State of Florida, Division of Financial Services Stop Work Order. Said violation of Florida Statute 440.105(3) (b)8., which constitutes a violation of Collier County Ordinance 90-105, as amended, Sect 22-201 (6), B. Upon review of Enrique Vasquez's application for re-instatement for his painting license (32213) dated July 315`, 2012, Mr.Vasquez did not list any debt, including the debt owed to State of Florida in the amount of$21,746.50 on question number 3 which states to list all debts you or any company(s) associated with you refused to pay and the reasons for the refusal to pay.Which constitutes a violation of Collier County Ordinance 90-105, as amended,Sec 22-201 (7) C. Thereafter, pursuant to Collier County Ordinance 90-105, as amended, section 22-202 (b) and section 22-202 (c),the complaint was investigated and found sufficient cause to file formal charges. 3. Collier County brings the following charge in this formal complaint against the Respondent. COUNT I A. Collier County Ordinance 90-105, as amended,Section 22.201(6) Disregards or violates, in the performance of his contracting business in Collier County, any of the building, safety, health, and insurance or Workers' Compensation laws of the state of Florida or ordinances of this County. Count II B. Collier County Ordinance 90-105,as amended,section 22.201(7) Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a Certificate of Competency under this Ordinance. WHEREFORE, the Petitioner asserts the above facts and charges are grounds for disciplinary action under Section 22-201 of Collier County Ordinance 90-105, as amended, and WHEREFORE, in consideration of the foregoing,the Petitioner respectfully requests the Collier County Contractors' Licensing Board to find the Respondent guilty of the violations charged. Dated: Signed:,i� Collier County Contractors' Licensing Supervisor or Designee C.L.B. Case# 2015-02 Enrique Vasquez D/B/A: SW Florida Painting Corp A Collier County Painting Contractor #32213 Violation of Collier County Ordinance 2006-46, as amended, section 4.1.6: Disregards or violates, in the performance of his contracting business in Collier County, any of the building, safety, health, insurance or Workers' Compensation laws of the State of Florida or laws of this County. 4.1.7: Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a Certificate of Competency under this Ordinance. On Tuesday March 4th, 2015, during a joint workers compensation and licensing compliance operation, I was on site at 4221 Crayton Rd Naples, FL with workers' compensation compliance officers Tom Atkinson and Tiffany Greene and Detective Ralph Guarniero. Four workers were present at jobsite performing exterior painting on a newly constructed single family home. The workers confirmed that they were employees of SW Florida Painting Corp / County License #32213, a locally licensed painting contractor. I proceeded to call the qualifier of the company Enrique Vasquez who did confirm that the workers were employees of his company SW Florida Painting Corp, license number 32213. 6- 3 Conducted research with workers' compensation officer Tiffany Greene revealed that SW Florida Painting Corp / Enrique Vasquez was under a 2010 State Stop work Order issued by Jack Gumph, which confirmed to still be an active stop work order with a active balance of $21,746.50 owed to the State of Florida. I proceeded to call Enrique Vasquez and advised that he needed to come to jobsite. Mr. Vasquez came to the jobsite in which I asked him about the 2010 stop work order. Mr. Vasquez responded that he was aware of the stop work order but it was too much work to get everything the state needed. Mr. Vasquez was then placed under arrest by Detective Dewayne White with the State Fraud Division and charged with violating the 2010 State Stop Work Order. After obtaining the application for the painting license which was applied for on July 315t, 2012, Mr. Vasquez did not list any debt, including the debt owed to the State of Florida in the amount of $21,746.50. A Notice of Hearing for the April 15th, 2015, Collier County Contractor Licensing Board was signed for by Mr. Vasquez on March 10th, 2015. Contractors' Licensing Board 2800 North Horseshoe Drive Naples, Fl. 34014 Complaint Number: 2015-02 Complainant: Any person that believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90-105, as amended, may submit a sworn complaint to the Contractor Licensing Supervisor, or his/her designee.The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor.The complainant shall pay a fee of$50.00 to defray the costs of administering the complaint,at the time of filing the complaint.The complaining party shall state with particularity which section(s)of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Date: March 31st, 2015 Against: Contractor's name: Enrique Vasquez Phone: 239-353-5345 Business name:SW Florida Painting Corp License number if known: 32213 Collier County Competency number: 32213 Contractor's business address: 4580 28th PL SW Naples, FL 34116 Filed By: Name: Collier County Contractors' Licensing/Thomas Keegan Address: 2800 N. Horseshoe Dr Naples, FL 34104 Business phone: 239-252-2468 Address where work done: 4221 Crayton Rd Naples, FL County: Collier Date of contract: N/A Date job started: N/A Date job completed or new home occupied: N/A Were there plans and specifications? N/A Is there a written contract? N/A If yes, amount of Contract? N/A Has Contractor been paid in full? N/A If Contractor has NOT been paid in full, what amount is paid? N/A Was a Building Permit obtained?Yes Building Permit number if known: N/A Have you communicated by letter with the licensee? Yes Date: March 10th, 2015 Do you have a reply? N/A Please attach to this form all copies of the purchase agreement, building contract, home improvement contract, copies of receipts and /or cancelled checks available and any additional evidence to substantiate your allegations. List any subsections of Section 4 of Collier County Ordinance number 90- 105, as amended, which, in your opinion, have been violated by the contractor which is the subject of this complaint, (list subsection): Section 22.201(6). Disregards or violates, in the performance of his contracting business in the county, any of the building, safety, health, and insurance or workers' compensation laws of the state or ordinances of this county. Section 22.201(7). Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a Certificate of Competency under this Ordinance Please state the facts which you believe substantiate your charge of misconduct against the subject contractor. List facts separately for each subsection number above: On March 14th,2015, it was discovered at an active jobsite located at 4221 Crayton Rd Naples, FL, Enrique Vasquez, qualifier of SW Florida Painting Corp, had employees (4) performing painting services while company was under a 2010 State of Florida, Division of Financial Services Stop Work Order. Said violation of Florida State Statute 440.105(3) (b)8 constitutes a violation of Collier County Ordinance 2006-46, as amended, 4.1.6. Mr. Vasquez also misrepresented material fact in his 2012 application, as he did not list the 2010 Stop Work Order by the State of Florida, Department of Financial Services in which a fine of$21,746.50 was owing to the State of Florida. C9 (Comp ainant's signature) State of: E;ac,c& County of: C.,i1,tr Sworn to (or affirmed) and subscribed before me this day of 1 2015. By (signature of person making statement). (signature of Notary Public) P:1':• �% JOANN GREENBERG * MY COMMISSION/EE 066562 Print, type or stamp name of Notary Public: N 111 EXPIRES:April 8,2015 '`FOF Fl° BOn ed Ihru Budget Notary Services Personally known ` JncJi \,nr.: r produced identification. Collier County Growth Management Division / Planning and Regulation Operations Department/ Licensing Section CERTIFIED MAIL# RETURN RECEIPT REQUESTED Date: March 10w, 2015 RE: Complaint filed against you by Collier County Contractor Licensing,regarding a violation of Collier County Ordinance 2006-46, as amended, sect(s) 4.1.6. &4.1.7. On(date of violation)March 5th, 2015 Dear: Enrique Vasquez D/B/A- SW Florida Painting Corp 4580 28th PL SW 34116 A complaint has been filed against you by the above referenced individual. A hearing of this complaint will be held by the Contractors' Licensing Board on April 15th, 2015 at 9:00 AM in the Board of County Commissioner's Room,Third Floor,Administration Building(W. Harmon Turner Bldg.), at 3301 East Tamiami Trail,Naples, Florida. Your presence before the Contractors' Licensing Board is required at this time. The packet you will receive marked composite exhibit"A"will be delivered to the members of the Contractors' Licensing Board one week prior to the hearing. If you wish to prepare a defense packet and have it delivered in conjunction with composite exhibit"A",you must make fifteen copies and have them in our office by 8:00 AM on Wednesday, one week prior to the hearing. In your packet,you may give a summary of events. At this meeting,you may present evidence and be represented by an attorney of your choice. In the event the Contractors' Licensing Board finds you in violation of Section number(s)of Ordinance# 2006-46, as amended, the range of disciplinary sanctions which may be imposed are from an oral reprimand to a suspension or revocation of your Collier County Certificate# 32213. Sincerely, Thomas Keegan Licensing Compliance Officer Phone#239-252-2468 /m / View Master Protect View All Activities for this Licensee Add new person or business to Address Book Licensee Information f New Licensee (current project) New Licensee (no project) Licensee Number IC32213 Status Hold v Name/ Description jSW FLORIDA PAINTING CORP Start Date ' Type Contractor End Date I �' Inspector Submitted On I Jurisdiction Collier County Department 'Operations Activity Description All Certificates from CDPIus: 32213 3/4/2015: State "STOP WORK ORDER" Failure To Obtain Coverage. Owes $21,748.50. Per(TK) Suggest Mailing Address I Add this Mailing Address as a Location ] Add Contact Number Street Mailing Address 14815 Whistlers Green Cir #4 Type Contact Number Ext. Primary (239) 353-5345 Address Line 2 r Cell (239) 601-2562 Address Line 3 1 Fax (239) 348-1699 City/State/Zip 'NAPLES FL34116- Country Email 1 Show More Fields [ Hide or Clear Fields I Contractor Attributes A Contractor Type!Business DOB Drivers License Number Sponsorship Appliction Date Workers Compensation Business Tax Receipt? Yes El Expiration Date Location At Add Related Parcels and Addresses 1 Add a Location To link a location to this Licensee,enter location information below. CityView will suggest possible matches as you type: Description Type ( Property Alert -Primer!? Display? Contacts A Add a_Contact.. To link a contact to this Licensee,enter contact information below. CityViewwill suggest possible matches as you type: ENRIQUE G. VASQUE.Z, Address:4580 28TH PLACE SW, Phone:(239) 353-5345 Go] Link Type Description End Date [Primary?( Display? ._ ..... Qualifier ENRIQUE G.VASQUEZ,Address:4580 28TH PLACE SW,Phone; E 0 _ Applicant SW FLORIDA PAINTING CORP,Address:4815 Whistlers Green C 12 0 ' 2- 9 Licensee Information A Licensee Number C32213 Description Type Property Alert Name SW FLORIDA PAINTING CORP Type Contractor Fri Status Hold View Master Protect View All Activities for this Licensee Add a new person or business to Address Book Classifications A Generate Defaults Add a Classification To add a classification to this Licensee,entertext below. CityView will suggest possible matches as you type: PAINTING CONTR.. Link Type Date Entered Status Status Date PAINTING CONTR. 06/03/2011 Inactive 03/05/2015 I Show More Fields ) 1 Hide or Clear Fields Unique Identifier 155618 contractor Lkensing A Renewable' A License Category Local -Specialty License Issuances Attach Driver License Photo Add Issuance Link Type Status Date Issued Issuance Number Expiration Date PAINTING CONTR. Hold 08/01/2012 32213 0S/30/2015 Comments F3/4/2015: State Issue"STOP WORK ORDER" Failure To Obtain Coverage. Owes $21,746.50. Per (TK) [ Show More Fields 1 Hide or Clear Fields I License Category 1-11;;T:-Specialty 11 Renewable? ° Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE .xz_ DIVISION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation SW FLORIDA PAINTING, CORP. Filing Information Document Number P07000034101 FEI/EIN Number 208658115 Date Filed 03/16/2007 Effective Date 03/10/2007 State FL Status ACTIVE Principal Address 4815 WHISTLERS GREEN CIRCLE UNIT 4 NAPLES, FL 34116 Changed: 04/30/2012 Mailing Address 4815 WHISTLERS GREEN CIRCLE UNIT 4 NAPLES, FL 34116 Changed: 04/30/2012 Registered Agent Name &Address VASQUEZ, ENRIQUE G 4815 WHISTLERS GREEN CIRLCE UNIT 4 NAPLES, FL 34116 Address Changed: 04/30/2012 Officer/Director Detail Name & Address Title P VASQUEZ, ENRIQUE G 4815 WHISTLERS GREEN CIRCLE UNIT 4 NAPLES, FL 34116 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 3/3 1/2015 Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2013 06/11/2013 2014 04/29/2014 2015 02/03/2015 Document Images 02/03/2015--ANNUAL REPORT View image in PDF format 04/29/2014--ANNUAL REPORT View image in PDF format 06/11/2013--ANNUAL REPORT View image in PDF format 04/30/2012 --ANNUAL REPORT View image in PDF format 05/17/2011 --ANNUAL REPORT View image in PDF format 05/20/2010 --ANNUAL REPORT View image in PDF format 08/24/2009--ANNUAL REPORT View image in PDF format 09/10/2008 --ANNUAL REPORT View image in PDF format 03/16/2007-- Domestic Profit View image in PDF format Copyright Ci and Privacy Policies State of Florida,Department of State i http://search.sunbiz.org/Inquiry/CorporationSearch/S earchResultDetail?inquirytype=Entity... 3/31/2015 STATE CAP FLORIDA,DEPARTMENT OF FINANCIP' SERVICES IVISION OF WORKERS' COMPENSATE 1 EMPLOYER NAME: SW FLORIDA PAINTING, CORP. STOP-WORK ORDER No.: 10-136-D7-S FEIN: 208658115 ISSUANCE DATE: 6/3/2010 EMPLOYER ADDRESS: 4580 28TH PL SW CITY: NAPLES STATE: FL ZIP: 341167840 WORKSITE POSTING ADDRESS: 1059 SPYGLASS LANE CITY: NAPLES STATE: FL ZIP: 34102 INDUSTRY OF EMPLOYER: • Construction Non-Construction ? Agriculture STOP-WORK ORDER Pursuant to Section 440.107, F.S.,the above-referenced Employer is hereby ORDERED TO CEASE ALL BUSINESS OPERATIONS FOR ALL WORKSITES IN THE STATE based on the following violation(s): L✓J Failure to secure the payment of workers'compensation in violation of sections 440.10(1),440.38(1), and 440.107(2)F.S., by: 171 failing to obtain coverage that meets the requirements of Chapter 440, F. S.,and the Insurance Code; materially understating or concealing payroll; materially misrepresenting or concealing employee duties so as to avoid proper classification for premium calculations; materially misrepresenting or concealing information pertinent to the computation and application of an experience rating I1 modification factor. Failure to produce required business records within 5 business days in violation of section 440.107(7)(a), F.S. pi Failure to produce required documents within 3 business days in violation of section 440.05(11), F.S. THIS STOP-WORK ORDER MAY BE AMENDED TO INCLUDE ADDITIONAL VIOLATIONS AND SHALL REMAIN IN EFFECT UNTIL THE DIVISION ISSUES AN ORDER RELEASING THE STOP-WORK ORDER FOR ALL WORKSITES, CONDUCTING ANY BUSINESS OPERATIONS IN VIOLATION OF THIS STOP-WORK ORDER CONSTITUTES A FELONY OF THE THIRD DEGREE AND A PENALTY OF$1,000.00 PER DAY FOR EACH DAY OF VIOLATION SHALL BE ASSESSED. ORDER OF PENALTY ASSESSMENT: A penalty against the Employer is hereby ORDERED in an amount: (r„71 Equal to 1.5 times the amount the employer would have paid in premium when applying approved manual rates to the employer's — payroll during periods for which it failed to secure the payment of workers'compensation required by this chapter within the preceding 3-year period, or$1,000,whichever is greater. Section 440.107(7)(d), F.S. �Up to$5,000 for each employee who the Employer misclassified as an independent contractor. Sections 440.10(1)(f) and _ 440.107(7)(f), F. S. LIEN NOTICE Pursuant to Section 440.107(11), F.S.,the Department may initiate lien proceedings to collect any penalty due that has not been paid. In addition,the Department may refer any unpaid penalty that is due to a collection agency for the initiation of proceedings to collect the unpaid penalty. Please see the Notice of Rights on the reserve side that pertains to your rights regarding this action. CERTIFICATE OF SERVICE Pursuant to section 440.107(4), F.S., JACK GUMPH served a true copy of this Stop-Work Order: /I By posting at the Worksite: DATE: 4i13/2dr O TIME: ) �+ �'�- SERVER: f'ijBy hand delivery: DATE: 6/3/3a.r v TIME: 11 �S A- SERVER: (411.._._ LJ ]By certified mall: DATE: TIME: ARTICLE: October 2009 fl NOTICE OF RIGHTS You have a right to administrative review of this action by the Department under sections 120.569 and 120.57, Florida Statutes. To obtain review, you must file a written petition requesting review. if you dispute a material fact contained in this action, you are entitled to a hearing under Sections 120.569 and 120.57(1), Florida Statutes, at which you may be represented by counsel, present evidence and argument on the issue(s), examine witnesses, submit a proposed recommended order, and file exceptions to the recommended order of the Administrative Law Judge, if you do not dispute a material fact contained in this action,you are entitled to a hearing under section 120.57(2), Florida Statutes, at which you may be represented by counsel, present documentary evidence, and present a written statement in opposition to this action. A petition for a hearing under sections 120,569 and 120.57, Florida Statutes, must conform to Rule 28-106.2015, Florida Administrative Code. The petition shall contain a)the name, address, and telephone number,and facsimile number(if any)of the petitioner; b)the name, address,and telephone number, and facsimile number of the attorney or qualified representative of the petitioner(if any)upon whom service of pleadings and other papers shall be made;c)a statement requesting an administrative hearing identifying those material facts that are in dispute. if there are none, the petition must so indicate; d) a statement of when the petitioner received notice of the agency action;and e)a statement including the file number to the agency action. You must file the petition for hearing so that It is received by the Department within twenty-one(21)days of your receipt of this agency action.The petition must be filed with Julie Jones, DFS Agency Clerk, Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0390. FAILURE TO FILE A PETITION WITHIN THE TWENTY-ONE(21)DAYS CONSTITUTES A WAIVER OF YOUR RIGHT TO ADMINISTRATIVE REVIEW OF THE AGENCY ACTION. • Mediation under section 120.573,.FloridaStatutes, Is not available. ISSUING AGENCY NAME AND ADDRESS Division of Workers'Compensation, Bureau of Compliance: }\gees t".tELD c F !E g 99_ V 1CrbaiA _Actle--Nlu $cA i1 1 b3 2 rcicr iVtYLi2.S cL 90 Attn: LA hi.04 , Telephone: . 39— y6 I - • October 2009 Notice of Rights Updated 11/23/2009 rX c -:aergou.net Report Title: Code Case Details Date: 3/31/2015 7:49:35 AM Case Number: CEMIS20150004385 Case Number: CEMIS20150004385 Status: Preliminary Review Case Type: Misconduct Date&Time Entered: 3/6/2015 8:19:17 AM Priority: Normal Entered By: ThomasKeegan Inspector: ThomasKeegan Case Disposition: Case Pending Jurisdiction: City of Naples Origin: Field Observation Detail Description: misconduct-county painting contractor/SW Florida Painting Corp/Qualifier: Enrique Vasquez Location Comments: 4221 Crayton Rd/City of Naples/1600088007 M � - e r v .: n = . v-➢ Y iw r V>.._ .ry a r vn!«>�.i"f'+*' .T� u, a ..., s. .r,i .. b.. ... ar.`nn+et:' Property 16000880007 Contractor SW FLORIDA PAINTING CORP Qualifier VASQUEZ, ENRIQUE Violator VASQUEZ, ENRIQUE 1 Business Management& Budget Office Code Case Details Execution Date 3/31/2015 7:49:35 AM Desc Assigned Required Completed Outcome Comments Preliminary Investigation ThomasKeega 3/6/2015 3/6/2015 Needs 3/14/15-on site with workers compensation n Investigatio agents Tom Atkinson and Tiffany Green-SW n Florida Painting Corp, a Collier County Painting Contractor that is qualified by Enrique Vasquez/CC#32213 had employees (4)painting the exterior of a single family residential home-the workers comp angents spoke to the workers who stated they were employees of SW Florida Painting Corp and supplied a business card. Research by the workers Compensation Agents revealed that Mr.Vasquez was issued a stop work order by the Department of Financial Services on 6/3/10 by Inv.Jack Gumph for a jobsite @ 1059 Spyglass Lane for which Mr.Vasquez failed to have workers compensation coverage for employees on jobsite.The stop worker is still active with a balance owing $21,746.50... I proceeded to call Mr.Vasquez to come to the jobsite to discuss the issue. Mr.Vasquez arrived at site in which I said to him that he has an active stop work with the state from 2010 and he said he knows but it was to much work to get the state everything the state requested. I advised Mr.Vasquez that his painting contracting license will be put on hold and he will need to appear before the licensing board and that I will be in touch with him... Mr.Vasquez was then placed under arrest by State Fraud Detective Dewayne White for violating the 2010 state stop work order... Mr.Vasquez will be charged by County Licensing Department sections 4.1.6. &4.1.7. of ordinance 2004-46. Need to set up meeting with Mr.Vasquez next week to issue notice. Investigation ThomasKeega 3/10/2015 Pending n Cont. Investigation ThomasKeega 3/10/2015 Pending n Violation Description Status Entered Corrected Amount Comments 4.1 Misconduct-County/City Open 3/6/2015 $0 violated sect:4.1.6&4.1.7 Certificate of Competency Title Reason Result Compliance Fine/Day Condition 2 Business Management& Budget Office (Co From: 03/06/2015 09:53 #334 P.002/004 PART I `000V31NPq,,F' I SUMMONS ti4f J,,,1Y o fiertf � cfflee a° o ,^ ICLERKS CASE NO I t� BOOKING /ARREST - L I JUVENILE REFERRAL COLLIER COUNTY NAPLES, FLORIDA °,,„ z`'' INCIDENT NUMBER `xcvw s a'° L5-3 79 Agency ORI Number A DEPT.OF CORR NO. BOOKING NO. ARRESTING.SC IAGENCY AA A adult D A - 15;74 nil J juvee A > OBTENO 1 FS .INO. FDLENO N • LAST NAME FIRST NAME MIDDLE RACE SEX DATE OF BIRTH AGE P e,S " .„c IV.fi° 6 Ua .4:21e,r_ H /fit ( 6—(-,2— 78-_ 33 AKA Al(L, First,Middle) AKA DOB AKA a2(Last,First,Middle) MA DOE, ' SOCIAL SECURITY HAIR STYLE FACIAL HAIR EYES SKIN(LGT.MED.DRK) D _9. /art _ era i/7 ,/14,e4 F ADDRESS CITY STATE ZIP RESIDENCE PHONE E u tiv't l is3 I er- r;re•en Cr-; I�`p'�/� -s / �� 36f/iG (235` ) C�C�r - 2S�� N STATE SCARS/MARKS/fATTOO'S CITY OF BIR H D // `` I`t �.nY 1 ( A t7b1043ro,�0. 1Y f`�14C7LU)U X, N RESIDENCE L-Local JUVENILE 1 Warn/Dismiss MARITAL STATUS CITZENSHI OCCUPATION STATUS C-Oul of County / DISPOSITION 2 Turned Over to HRS T 3 Jail/Detention a/ I1�'vM/ "fr 5.OutotState /�Ia•r7'y re4•4 er EMPLOYER ADDRESS CITY STATE PHONE SC\� �+',,,e( t,e j, )„,),,,:c_11 .., crt ,i (e'4 ri. (231-) ‘-01 ` NEXT OF KIN/GUARDIAN v ADDRESS f CITY PHONE RELATIONSHIP L.eoAc r �°ul/P� S '10I w\r�LIrr C;t e4_ /(lc /e, (zj )G°' `a5 .2 V'� ✓ BOOKING DATE TIME JAIL RC'D. ( BOOKING OFFICER I ID I NCIC FCIC LOCAL 3/L4/15 Tel I I IN CUSTODY(Y•N) RELEASE DATE TIME BONDING DEPUTY/OFFICER BOND AMOUNT BOND TYPE:(SURETY.CASH) D E T CASH BUNG NO. ADDRESS E RELASED?(Name of Bondsman I Depositor) N T I HOLD(Y-N) HOLD FOR ARRAIGNMENT(Felony) ARRAIGNMENT(Misdemeanor) O Time: N Date: Time: Date: VICTIM NAME ADDRESS CITY STATE PHONE ) ( tVi t -11 ORIGINAL-Clerk CANARY-CCSO PINK-SAO GREEN-Public Defender GOLD-Defendant F or Ili 104A Rev 07110 Frorn: 03/06/2015 09:54 #334 P.003/004 CHARGE PART II eriff s 3 (1)ffke LAST}NAME FIRST NAME en �.. #��/T�'(� COLLIER COUNTY ,C • NCIOENT NUMBER ��7 `e v I° NAPLES.FLORIDA \fen 0)- Agency ORI Number FL 0110000 1 5 `. 7 9" ARRESTING AGENCY ARREST DATE TIME ARREST LOCATION _ _ _y_ 1Z:26- 11 lay, t .•A'a -' A GECORAPHIC ARREST W-Warrant CRIME LOCATION C'ME DATE R INDICATOR TYPE O-On SIte I / 6 R Probable Cause l� Li 2 Z f (,.�rca •. • _ E OFFICER/WITNESS ID OFFICER/MINES' / ID S 0 • .. f. •e.,r . A . - . k' Le, 8 c,r l-'ectt.A 3 ._ • VEH.DISPOSITION IT :.by:l MAKE MODEL YEAR TAG STATE CHARGE DESCRIPTION FLA,STATUTE BOND �,l pv0 `0\A{•+07/ „ ,• e� • . er- Li r. 05 ( ) , . " 2 � • ►'a±:' WARRANT NO DATE OF WARRANT STATE LEVEL M-Mladamraror C-Caunny OrtananCe F-Felony I.-Municipal ONhince O GENERAL OFFENSE CHARACTER DRUG TYPE DRUG UNIT WEAPON Z A-Amphetamine ), idiom 01-Handgun CC ci y B-Barbiturate ,1/ 2 Mailgram 02-.Rate • L-Carpiary b Ateenrpl F-Fadlkate I-Accessary AFTER the FAc / C-Cocain y/(( .]Kilogram 03-Shotgun CO M-Acaeuary to Attempt P-Prir rA tI N-Not AooliCa41e D-pack 4 Ounce M-Firearm ■ O-Principal to Attarp S-Sdkihtlon E-Herrin 5 Pound 05-KM* W A-Attempt T-Maw - H-FYlluclnogan a Ton 08-Blunt Instrument (h 8-Assault X-Aid and Abet M-Marijuana 7 Liter 07-Harda.F to etc 4 C-Ccnectrahy V-Acceseo y BEFORE the Fact O-Op d n 8 Millimeter 08-Poison I ACTIVITY P-ParapnerroM/ 9 Dose/Und 09-E.olook'e ✓ EouPnI item 10-Fire,incendiary F-Forgery T-Traffic E-Use S-Synthetc t t-Threat ntimidation I 14 0-Cburterte8 R-Sammie K.- Dispense/ U-Unknown VALUE/QTY. 12-Slnotated Weapon A-FTC P-Poetess Obtribur I-Omer 13-Dods 2-Embacbrrrrd S-Sete 61-ManN./Produce/ N-Not Applicable 88-Unerwwn 99-Ottrr X-Staten Property 8-Buy O-OMAN N-Not Appecshte 00-N/A t.HAq(`,E DESCRIPTION 1FLA STATUTE {BOND WARRANT NQ {DATE OF WARRANT 1STATE 1 LEVEL M-Iwdamaadna n C-County Ordinance F-Felonry L-Municipal Ordnance O GENERAL OFFENSE CHARACTER DRUG TYPE DRUG UNIT L WEAPON A-Amonetamine I Dom 01-Handgun OB-Barbiturate 2 Milligram 03-Rifle� m l-Cwlento y to Atten ti F-Facilitate 2-Accessary AFTER Ur Fact n C..Coaster 3 KIa ism ` hi-Accessory to Altertpt P-Prtnefpsl N- At>Prlo�de D-pack 4 Ounce 04-Firearm W p-Principal to Attempt S-Sollelelbl E-Heroin 5 Pound 05-Knife A-Attempt T-Threat H-W .Y'wen 8 Ton 08-Muni Instrument G B-Assault X-Aid and Mat 07-Hands,Fir eta. M-Mar Warr 7 tier Q C-Conspiracy Y-Accessary BEFORE the Fact O-°alum 8 Milometer 08-Raison VACTM'TY P Eaubnere la/ g Item /UM D-Fire,incendiary F-Forgery T-Traffic E-Um S-Synthetic t t-Three,Intimidation O-CounterMt R-Smuggle K-Olapsnss/ U-Unknown VALUE/QTY. 12 Simulated WFeoch A-Fraud P-Posaaa Okrbdte Z-Otter _ Z-Em bas latrenl 5-SeA M-Mena/Clock=/ N-Not AMAMI b 80-Unknown X-Stern Property 8-Clary Fate W-N/5A 0-Delkss N-Not Wessels CHARGE DESCRIPTION 1FLA.STATUTE • 1BOND VARRANT NO. DATE OF WARRANT STATE LEVEL e rn C-County Orolna ce F-Felonry l-Municipal Ordnance O GENERAL OFFENSE CHARACTER DRUG TYPE' DRUG UNIT �'- WEAPON 1 Z A-Amdrtankne I Gram 01-Hen 1` O 02-Rife 1.-Conspiracy to Mimi* F-Friable, I-Accaaeory AFTER ohs Fail B- rase 3 Kilografrl 03-Btdtgwn COcalne T. M-knelt WO b Attempt P-Prirc4tal N-Not AppllCabb D-pack 4 Ounce 04-Firesrm W Q-Prelcpal to Aherela S-Soliceatte E-Heroin 5 Pound 06-Knife C d� T-Throat H-IWkicirogen 8 Tan Xi-810nt erbUme d El-M 11 x-Ate and Abel M-Maljuena 7 Liter 07-Hands,Het Inc Z• C-Coraotrcy Y-Accessory BEFORE me Fed 0-Opum 8 Milan,eten 08-Pkoco I ACTMTY P-Pareeeemalla/ 9 Doss i UM 09-Elploane U item 10-File.incendiary Egtioneret 7-Trellis E-Use S-Syothn5, I i-Threat intimidation F-Fdp8y 12-Simulated Waeoon A-Freud et R-P Snmagle ooeea K-Otapnre/ Z-Cater VALUE/QTY. 13-fkole A-Freud S-dSeeeeaa O erect/ 2-N t A 88-Unknown Z-Embeabnrnt S..Sete M-Merest/Produce! N-Not Appikabla 90-Omer X-SIdYn Prnpetty B--Os. Not AId 00-WA D-OMkrr N- AmWrabie N •0 I understand that should I willfully fail to appear before the court as required by This notice to appear that I may be held in contempt SI court and o a warrant for my arrest shall be issued. Furthermore. I agree that notice concerning the time, date, and place of all court hearings should be sent T to the aforementioned address.I agree that it is my responsibility to notify the Clerk of the Court anytime that my address changes. C0 I hereby promise to be and appear in the appropriate court at the time and the place designated in this notice. E COURT: ❑ County ❑ Circuit ❑ Juvenile U ADDRESS: DATE: TIME: A ❑ Defendant can pay a fine in lieu of a Court Appearance Fine p Sworn to and subscribed before me this Signature of Defendant/Juvenile P E A day of 20 6,/ir r.2.,'°� R Signature nt Pam*d AN Defendant of .3 Notary/Deputy ------ From: L 03/06/2015 09:55 #334 P.004/004 • 1'A 1 1 1 f{1 tierif 's1 I;ffire 1-A`ZKAME FIRST NAME COLLIER COUNTY NAPLES,FLORIDA `�r�k �' 'NOIDe"Tr eER lency OR Number FL 0110000 i 4 -,3 ;'5 ARRESTED CO-DEFENDANTS: ■ DEFENDANT OID THE FOLLOWING ACT(S)WHICH CONSTITUTE A VIOLATION OF THE LAW(ELEMENTS OF THE CRIME/ PROBABLE CAUSE STATEMENT): A - 01/© Lt [∎r k .rder. - - 1 , -O75 . 1:.i (.4L/ 6'4 i it y tai G� \J1/Cr![ rid r C,JYY 11'BV•6 40.fr J 1 V ! ' �5 r ;� 'LQridtA Pr.4 7,4 74`,,c4 LL C--.c Corpo;c•Je_ C)��P," .5ytrt)!e. Pay eS. , GA 3/-/ Z01,5 / o u,,,r J d 4'/f 4 ,„,04."-is- �('GYI r+ a/1.5 G Al, �d 1 L %c R' o ,..,-..4.,-, ' erft'I '( /��' 71+r _5 �G rvrcvlO1atoI 1%Irk eri !'ir7 l_'Gi/ J e ca.---i �'rry1.S74rr,c JJc■i i!'1 CILI Ln 1014 f;. _.5 i \.✓4S G1..1ke--G b, c__,,,,M( ' e et,`-)-.'tvC IC/✓r+ 71-/k,,,, - i 0.0 ci. f[Ny oene 2 __Lk�� /` k'F Cte.oil fo ,Gr '1 Cray Olen 4-4 44 tot Cr�✓1C+n mtl ct 1 f?r r.tlr,n 1✓ r r`an rah F+r r 1. �� I'<�l�•�c•L Pe4i ✓n /" V al°14ib•/'� aC -!' ,_ 70/0 Ckr u r k...�./G7�� { W i�tr�"f� w A.5 Git.')P}"n.a_ 'kJ 3J;// Ye— kg,ICI l 0\ 10C.Ical+CJe n ‘ , Zr i 74,-(0. o mired -la -f/a _141-6, S t"lc.i a4, . ,44. -pig sir!v+, rc Cam)!I'ec- _ 2C&,,1'. '11'Gc�s. Cam,»/J'V'�r c c er- -T L7c4.�, I /4 CC�CAA f (/t�^1-! ve 1/f4J(/L/ Ovir,' e,;' S.14,. er;o+4f ( arsCt ii;t+ 1 re. -7Cor- . h4A0 kk -1-r, -1-1,1.. (/Cr+/�n resa+41 3ab .5,' _ tAstven 4044 11n4 1'- 1,ri./1 I iAl %11re5.4 3c4 U\1- 6vv Inc4ci I` .&vCicJ IA:en cl 34. kv'a� k fir o)ec f bIJ-i, 41iall-- No•.- v\R•. . ,'s lG IS Cs412 w+rh ,. rer 11;c -17 ikAe (1rcCris �,ii.Xv/1 be) Lp(.;,,e,r1 ui elAr- at-res 1- 'cur ✓cur".4 ktrr, Lrd 0, -"`Y' wur•k c�.r'J—, 41e eS Curesed rcV ! OO 1 vii,;o1� 1 a.-- e-1/ so e• a it*2u04/ aet r �1 c■J2' 'CIO naw+e a JIV e,,,cS2l3 SG+-,ICII ee • PP,Ve-5 \AIC+t 4'h4� ►ten •1 CI y- U r' l • f f c�. T� 1 �� t . `-u� L u t r .Qr i��Jed,. 40 •Sworn to and subscribed before me this THE ABOVE STATEMENTS ARE TRUE TO THE BEST ill'hday of i��ifSe 20/� 6I/ q OF MY KNOWLEDGE,INFORMATION OR BELIEF. / ii at l , f .:ii GIGEK. I o.NO. Page j 1 -54 .3 PM 104C 10/89 § 22-201. Misconduct—Collier County/city certificate of competency, Division 3. Standa... Page 1 of 4 eLaws I eCases I Florida State I Florida Administrative Code I Florida Courts I Counties&Cities of Florida I Code of (Search Code Sign In Sign Up 7 Collier County Code of Ordinances a Part I. Code Chapter 22. Buildings And Building Regulations Article V. Building Trades At Division 3. Standards Of Conduct And Discipline 22-201. Misconduct—Collier County/city certificate of competency Latest version. Latest Version Updated Versions The following actions by a holder of a Collier County/City Certificate of Competency shall constitute misconduct and grounds for discipline pursuant to section 22-202: (1) Knowingly combining or conspiring with an unlicensed contractor by allowing one's Certificate of Competency to be used by an unlicensed contractor with intent to evade the provisions of this Ordinance. When a licensed contractor acts as the qualifying agent for any firm without first making application under this Ordinance to represent said firm, such act shall constitute prima facie evidence of intent to evade the provisions of this Ordinance. When a certificate holder allows his certificate to be used by one or more companies without having any active participation in the operations, management, and control of such companies, such act constitutes prima facie evidence of an intent to evade the provisions of this Ordinance. Active participation requires job site supervision, knowledge of and participation in the business operations of the company(s), including all contractual matters. a. If any individual qualifying any business organization ceases to be affiliated with such business organization, he shall so inform the Board. In addition if such individual is the only certified individual affiliated with the business organization, the business organization shall notify the Board of the individual's termination and shall have no more than sixty (60) days from the date of termination of the individual's affiliation with the business organization in which to affiliate with another person certified under the provisions of this article. In any event, the business organization shall not enter into any new contracts and may not engage in any new contracting until such time as a qualifying agent is employed. g . c 0 bff,.//it,»;Prt'.nnntv_eregulations.us/code/coor pti_ch22_artv_div3_sec22-201 3/31/2015 § 22-201. Misconduct—Collier County/city certificate of competency, Division 3. Standa... Page 2 of 4 (2) Contracting to do any work outside of the scope of his/her competency as listed on his/her competency card and as defined in this Ordinance or as restricted by the Contractors' Licensing Board. (3) Abandoning a construction project in which he/she is engaged or under contract as a contractor. A project may be presumed abandoned if the contractor terminates the project without just cause, or fails to notify the owner in writing of termination of the contract and basis for same, or fails to perform work for ninety (90) consecutive days without just cause and no said notice to the owner. (4) Diverting funds or property received for the execution of a specific contract project or operation or diverting funds earmarked for a specified purpose to any other use whatsoever. (5) Departing from or disregarding in any material respect the plans or specifications of a construction job without the consent of the owner or his duly authorized representative. (6) Disregards or violates, in the performance of his contracting business in Collier County, any of the building, safety, health, insurance or Workers' Compensation laws of the State of Florida or ordinances of this County. (7) Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a Certificate of Competency under this Ordinance. (8) Committing mismanagement or misconduct in the practice of contracting that causes financial harm to a customer. Financial mismanagement or misconduct includes, but is not limited to, any of the following: a. The contractor fails to fulfill his/her contractual obligations to a customer because of inability, refusal or neglect to pay all creditors for material furnished or work or services performed in the operation of the business for which he/she is licensed, under any of the following circumstances: 1. Valid liens have been recorded against the property of a contractor's customer for supplies or services ordered by the contractor for the customer's job; the contractor has received funds from the customer to pay for the supplies or services; and the contractor has not had the liens removed from the property, by payment or by bond, within 30 days after the date of such liens; 2. The contractor has abandoned a customer's job and the percentage of completion is less than the percentage of the total contract price paid to the contractor as of the time of abandonment, unless the contractor is entitled to retain such funds under the terms of the contract or refunds the excess funds within 30 days after the date the job is abandoned; la 3. The contractor's job has been completed, and it is shown that the customer has had to pay more for the contracted job than the original contract price, as adjusted for subsequent change orders, unless such increase in cost was the result of circumstances beyond th e -mil Lai._.ii,.,.,,;o—- ,,t , PrPO„lat;nnc ns/code/coor Dti ch22 arty div3 sec22-201 3/31/2015 Statutes & Constitution :View Statutes :->2007->Ch0440->Section 105 : Online Sunshine Page 1 of 4 Select Year: 12007 V I Go The 2007 Florida Statutes Title XXXI Chapter 440 View Entire Chapter LABOR WORKERS' COMPENSATION 440.105 Prohibited activities; reports; penalties; limitations.-- (1)(a) Any insurance carrier, any individual self-insured, any commercial or group self-insurance fund, any professional practitioner licensed or regulated by the Department of Health, except as otherwise provided by law, any medical review committee as defined in s. 766.101, any private medical review committee, and any insurer, agent, or other person licensed under the insurance code, or any employee thereof, having knowledge or who believes that a fraudulent act or any other act or practice which, upon conviction, constitutes a felony or misdemeanor under this chapter is being or has been committed shall send to the Division of Insurance Fraud, Bureau of Workers' Compensation Fraud, a report or information pertinent to such knowledge or belief and such additional information relative thereto as the bureau may require. The bureau shall review such information or reports and select such information or reports as, in its judgment, may require further investigation. It shall then cause an independent examination of the facts surrounding such information or report to be made to determine the extent, if any, to which a fraudulent act or any other act or practice which, upon conviction, constitutes a felony or a misdemeanor under this chapter is being committed. The bureau shall report any alleged violations of law which its investigations disclose to the appropriate licensing agency and state attorney or other prosecuting agency having jurisdiction with respect to any such violations of this chapter. If prosecution by the state attorney or other prosecuting agency having jurisdiction with respect to such violation is not begun within 60 days of the bureau's report, the state attorney or other prosecuting agency having jurisdiction with respect to such violation shall inform the bureau of the reasons for the lack of prosecution. (b) In the absence of fraud or bad faith, a person is not subject to civil liability for libel, slander, or any other relevant tort by virtue of filing reports, without malice, or furnishing other information, without malice, required by this section or required by the bureau, and no civil cause of action of any nature shall arise against such person: 1. For any information relating to suspected fraudulent acts furnished to or received from law enforcement officials, their agents, or employees; 2. For any information relating to suspected fraudulent acts furnished to or received from other persons subject to the provisions of this chapter; or 3. For any such information relating to suspected fraudulent acts furnished in reports to the bureau, or the National Association of Insurance Commissioners. http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=... 3/5/2015 Statutes & Constitution :View Statutes :->2007->Ch0440->Section 105 : Online Sunshine Page 3 of 4 3. Fail to secure workers' compensation insurance coverage if required to do so by this chapter. (b) It shall be unlawful for any person: 1. To knowingly make, or cause to be made, any false, fraudulent, or misleading oral or written statement for the purpose of obtaining or denying any benefit or payment under this chapter. 2. To present or cause to be presented any written or oral statement as part of, or in support of, a claim for payment or other benefit pursuant to any provision of this chapter, knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim. 3. To prepare or cause to be prepared any written or oral statement that is intended to be presented to any employer, insurance company, or self-insured program in connection with, or in support of, any claim for payment or other benefit pursuant to any provision of this chapter, knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim. 4. To knowingly assist, conspire with, or urge any person to engage in activity prohibited by this section. 5. To knowingly make any false, fraudulent, or misleading oral or written statement, or to knowingly omit or conceal material information, required by s. 440.185 or s. 440.381, for the purpose of obtaining workers' compensation coverage or for the purpose of avoiding, delaying, or diminishing the amount of payment of any workers' compensation premiums. 6. To knowingly misrepresent or conceal payroll, classification of workers, or information regarding an employer's loss history which would be material to the computation and application of an experience rating modification factor for the purpose of avoiding or diminishing the amount of payment of any workers' compensation premiums. 7. To knowingly present or cause to be presented any false, fraudulent, or misleading oral or written statement to any person as evidence of compliance with s. 440.38, as evidence of eligibility for a certificate of exemption under s. 440.05. 8. To knowingly violate a stop-work order issued by the department pursuant to s. 440.107. 9. To knowingly present or cause to be presented any false, fraudulent, or misleading oral or written statement to any person as evidence of identity for the purpose of obtaining employment or filing or supporting a claim for workers' compensation benefits. (c) It shall be unlawful for any physician licensed under chapter 458, osteopathic physician licensed under chapter 459, chiropractic physician licensed under chapter 460, podiatric physician licensed under chapter 461, optometric physician licensed under chapter 463, or any other practitioner licensed under the taws of this state to knowingly and willfully assist, conspire with, or urge any person to fraudulently violate any of the provisions of this chapter. (d) It shall be unlawful for any person or governmental entity licensed under chapter 395 to maintain or operate a hospital in such a manner so that such person or governmental entity knowingly and willfully i-Q3 1,4+..•//.inin: inn '+o+a ofm'?AInn mnrla=Tlicnlav StatlitPRrSParr.h String= 1/5/2015 • ,.. . i Zen v :i't.. .3 J i f '.; y ' `` t: Bis /./ ' CDES Operatio R S & Regulatory Management ce . ing Section. /fOosDnve. •(es, Ft 3.4104 C c, r 2c-�4 / A.�� Aliff PLICATION FOR �,w'� L R.:,. ' M /CITY OF NAPLES/CITY OF MARCO 4,ctj kp FIRM INSTRUCTIONS: us#plication must be typewritten or legibly printed. The application fee must accompan`�y tl `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: _ i Ekact Corporate/Business Name: ,tats ' r c i a . c. .1 l j 0 Co(Fiction Name/DBA: S LOP F/Ori(1a Pain ii, ?y' ( if. Qualifier Name: I'll1 O UO:S70 eZ Physical Address: t31)/ WI?/57//Pr 5 CGrP, Gi f e L / z / (Number& Street) (City) (State) (Zip Code) r Mailing Address: • 5 t.1 eYS , ; " '. ' r g 0 ' .'S p/. 3 // , (Number 8; Street) (City) (State) (Zip Code) Telephone: 23f 6O/:-,s E-Mail: TYPE OF LICENSE: U General $230.00 ❑ Electrician $230.00 Building $2.30.00 0 Plumber $230•00 0. Residential $230.00 ❑ Air Cond. $230.00. Q Mechanical $230.00 ❑ vi(mming Pool $230.00 ❑ Roofing $230.00 . _. ® Specialty $205.00 Specialty trade: ._/, rN Er ... �- 1 Q - ENRIQUE G. VASQUEZ C GE OF.STATUS; REINSTATEMENT$205.00 ( Reinstatement ( ) From One Business to Another RENEWAL W/ LATE FEE 2010 -2011 $185.00 r 1 RENEWAL W/ LATE FEE 2011 -2012 $185.00 e-D- Page 1 of 4 RENEWAL 2012-2013 $125.00 • • • • 1. The names, titles, home address and phone numbers of all Officers/Managing Members of tho Firm. • 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. /t/one AFFIDAVIT 1, e r7 r fa 1/l_7,.b: Lig?certify that the foregoing is true and correct to_t - •: ,•f my knowledge. Authorize:'•/cer of the Firm STATE OF FLORID COUNTY OF '©Ill ' • The foregoing instrument as acknowledged before me this U ), 2. 012 (Date) By £ )f'C L/e G L v E., i of `_?u GL's, f/c';t,;C C /?ai°n i i'l cif P (Name of officer, title/agent) (Name of Corporation) a r Corporation on behalf of the corporation. (State or Place of Corporation) . He/She.has-produced DL Z26--ZD7--7i3 24Z-O identification and-did not take an oath. • (Type of identification) • NOTARY'S SEAL "* TRANQUILINA A FLORES ;� SIGNATURE OF NOTARY) . MY COMMISSION#EE058A18 • = EXPIRES January 25,2015 ' UALIFIER INF'OR I`1UN: .. Name: a , C) � � � �P� / � / , tr ee' Ci r Address: j 1S 1i 15/415 it � (State) (Zip Code) Addre (C y) (Number& Street) C 60/-0:25 4. Date of Birth: 0G' 0, f C6 Telephone: � E-Mail: 6r7ri��a " i,��t.5 ful•'Z cj�1Q/�rir���tccir1 S.S. #: 000-00- . Driver's License: 1. Typ e of Certificate Competency te of Competenc for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. 3 'n rzz______________ 3. Have you ever been convicted of a crime related to Contracting? �`' O. (If yes attach extra sheet with explanation) firms you have been associated with ever filed bankruptcy? 0 7. Have.you or any y any(s)associated with you refused or failed to pay and reasons why. 8. List all debts yo o an co P . 9. List your business or work experience during the past ten years. ]]� `` i 5�.0 , s h 1 irl i ? f 2 5 ra ci ad e t �cl► /)i�? I toat'ton is made. 10. Statement of any formal training you have had in the area for which the appi i 6 ---„)- (40 , i Page 3of4 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(P •SE PRINT) o NAME 0 COMPAN SIGNA RE OF APPLICA■ STATE OF FLORlj 7 A�� COUNTY OF 1 C The foregoing instrument as acknowledg?d before me this �- ( U/ U6. 1 ; � ., � � (Date).. 2 C ho has produced r;/--,4 By (Name of person acknowledging) (Type of identification) as identificatioro4 did not % pj th. V 22-6 ,:76 7 P-7-e;2-6 e ' MY COMMISSION t EE 144104 � EXPIRES:December 1,2415 d''rfs ov oe`�� Bonded Thru Budget Notary ServicU NOTARY'S SEAL ) • SIGNATURE OF NOTARY) Page 4of4 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. SIGNATtJ o F APPLICANT BUSINESS NAME ' / • DATE BEFORE ME this day personally appeared who affirms and says that he has less than one employee and does not require Workmen's Compensation and understands that at anytime he employs one or more persons he must obtain said Workmen's Compensation insurance. STATE OF FLORID /, COUNTY OF L' L�C // �/ The foregoing in ment was acknowledged before e this ��c C:c . / st > / (Dat�}� . �'7J'Ca- -�Le� Vcr�1 �n V b o has rod ed / - /.722 L�p 1 (name of person acknowledging) (Type of Identification) as identification and who did not take an oath. ' Akz (2- C) / ""Y°"6'e c LINDA C.WOLFS SIG ATURE OF NOTARY NOTARY SEAL MY COMMISSION J EE 144104 , .�. =t_,c T.' EXPIRES,Deader 7,2015 NOTARY PUBLIC '+rsoF toe" Bonded lhru Budget Notary Services • If, et V# *t ,# H •' 1z,#olk ♦ wr0 4) , tkif#t.._ e.V1 ♦ ► .s► 1 • 0 4 01p4 * 0 11 ♦ n l .410(04 O "V C �,<H ; 11,,p( '0 '� —r/D cu ct �A� i , Pr kok ;...4 A.404 Q o •4e is fit V (/) •;; C.) -+-' A,0 4 �0.47 w � °' - ♦ .y al t OW • .� N : eye/h V 1) al Itil t�ip r1 r0 x ° i ct kd 1, 4! e . ari 'Cj U Ailso 0.l 1 Cd I: 's Of 7r-'V•& w z "CI i •0(1 o . i i .02 Ali/ Ili i 1 ; , �._ o V" N' g ‘ An Is rn X N • r) O +.,Q . .♦.vo . 0 ,4)0 xf O ) 0( 0 v a OA A� f i v ° N A m• at 1 ,.c. , Hp e wit .4+ H 0(t te . . , .� �v4 '.1:010 ,•► 401110• > ♦ t, r04 4 .� ♦ t .. 0 • r ; /14tI4 ♦ ,1 AA X1A�• • A A . to ♦ 1l1 �t/A 0(1/ 1t/ ���0(1/ 4c/ V 410 A'170 4110 • AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER } 9 I, rcw � c C(",am a resident of /l/ , 5 'c',-( 0,(/1 I- ounty, 'F-lc, T ; et (State) and have resided here for more than five (5) years. During the last five years I have known bur :et. e- U G\Z. u. r---7 applicant). I have had ie opportunity to observe his or her business and personal dealings aizd find him or her to be a person of )nesty, integrity and good character. (Signature) ..ii../ 1 (Name)A Ai.,--)N. c.L,..) t t (c.'...., ‹_r 5,cr (Address) /4 a 7 ? l_' c G itia A-5 e u c_ -v,,ter, / 3q (oAi Telephone) a 3 Cf-, c( ` 7 C 53 STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this -3P.'/)k ei 3tab/ by ;7 _ (Date) J i11%/r/ '1 ii/kii)/2t'i_ /'t . who has produced T%Oi'l'/a %V (name of person acl nowledging) (Type of identification) as identific$ aQ411,..#. .," 'd not take an oath. jFob.7,2016 tr e,(Z .c. No.if 167425 == SI /ATURE OF NOTARY i �� 5 ptlB1.�G \Ola 1 '%rgrF a f�o�;,fi�'� /%/17J' 7i9 ;/L./,37ZXT..... NOTAkrOft3E21 (PRINT NAME OF NOTARY) NOTARY PUBLIC s { ,. 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 2/12 07/30/12 15:02CT [SUBJECT] S N VASQUEZREYES, ENRIQUE [CURRENT ADDRESS] [DATE RPTD] 4200 WASHINGTON LN. , NAPLES FL. 34116 2/12 S P E C I A L M E S S A G E S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES) *** M O D E L P R O F I L E ***FICO CLASSIC 04: NOT SCORED: INSUFFICIENT CREDIT *** C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=0 COL=0 NEG=0 HSTNEG=0 TRD=0 RVL=0 INST=0 MTG=0 OPN=0 INQ=4 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 7/30/12 ZNP6284423(FLA) MERIT CREDIT 3/18/12 BCI5375857 (NTL) CAP1/HSBC 2/02/12 UNC5875087 (FLA) VERIZON WIRE 2/01/12 UCH0002569(CHI) AT&T SERVICE C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION CAP1/HSBC B 5375857 (800) 695-6950 PREV HELD BY HSBC CAROL STREAM IL. 60197 VERIZON WIRE U 5875087 (615) 315-8243 618 GRASSMERE PARK NASHVILLE TN. 37211 AT&T SERVICE U 0002569 (866) 718-2011 P.O. BOX 1167 ARLINGTON TX. 76004 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: CREDIT DATA SERVICES, INC/EXPERIAN EXPERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 07/30/2012 15:05:28 -AN3 REPORT 404 SW FLORIDA PAINTING, CORP BIN: 888763171 4815 WHISTLERS GREEN CIRCLE UNIT 4 DATE INCORPORATED: MAR. 2007 NAPLES FL 34116 PHONE: 239-601-2562 TRADE PAYMENT INFORMATION TRADE PAYMENT EXPERIENCES (TRADE LINES WITH AN (*} AFTER DATE REPORTED ARE NEWLY REPORTED) RECENT ACCOUNT STATUS HIGH -DAYS PAST DUE- BUSINESS DATE LAST PAYMENT CREDIT BALANCE 1- 31- 61- CATEGORY REPTD SALE TERMS $ $ CUR 30 60 90 91+ COMMENTS PRNTG&PUBL 07-12 VARIED 800 800 100% PAYMENT TOTALS CONTINUOUSLY REPORTED( 1) : 800 800 100% DBT: 105 COMPANY BACKGROUND INFORMATION THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. HISTORY : BUSINESS INCORPORATED ON MARCH 10, 2007 AS A FOR-PROFIT CORPORATION. FEDERAL TAX ID IS 208658115. CHARTER NUMBER IS P070000341. CURRENT STATUS : ACTIVE BUSINESS. AGENT IS VASQUEZ ENRIQUE G LOCATED AT 4815 WHISTLERS GREEN CIRCLE #4, NAPLES, FL. PRINCIPAL(S) : ENRIQUE VASQUEZ TITLE: PRESIDENT INQUIRIES BUSINESS 2012 2011 CATEGORY JUL JUN MAY APR MAR FEB JAN DEC NOV INSURANCE 1 TOTALS 1 THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INFORMATION SOLUTIONS, INC. , NOR ITS SOURCES OR DISTRIBUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE LIABLE FOR YOUR USE OR RELIANCE UPON IT. COPYRIGHT 2012 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **END REPORT** www.sunbiz.org - Department of State Page 1 of 2 FLORIDA DEPARTMENT OF STATE T DIVISION OF CORPORATIONS w ►`' � � Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search No Events No Name History Submit i Detail by Entity Name Florida Profit Corporation SW FLORIDA PAINTING, CORP. Filing Information Document Number P07000034101 FEI/EIN Number 208658115 Date Filed 03/16/2007 State FL Status ACTIVE Effective Date 03/10/2007 Principal Address 4815 WHISTLERS GREEN CIRCLE UNIT 4 NAPLES FL 34116 Changed 04/30/2012 Mailing Address 4815 WHISTLERS GREEN CIRCLE UNIT 4 NAPLES FL 34116 Changed 04/30/2012 Registered Agent Name & Address VASQUEZ, ENRIQUE G 4815 WHISTLERS GREEN CIRLCE UNIT 4 NAPLES FL 34116 US Address Changed: 04/30/2012 Officer/Director Detail Name &Address Title P VASQUEZ, ENRIQUE G 4815 WHISTLERS GREEN CIRCLE UNIT 4 NAPLES FL 34116 Annual Reports Report Year Filed Date 2010 05/20/2010 2011 05/17/2011 nra/scripts/onrdet-exe?action=DETFIL&ina doc number=P070000141 .-. 7/11/2017 • ® ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YYYY( `...----- 07/31/2012 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 Dan Cunningham PHONE I FAX J.MILLER INSURANCE GROUP HON o,Eat); (239)643-6840 IA/c,�_(941)240-2148 E-MAIL dan.c©jmigi.com 2664 AIRPORT RD.S. • ADDRESS: — ..._.__...__ INSURER(S)AFFORDING COVERAGE NAIC U Naples FL 34112 INSURER A: ASCENDANT INSURANCE CO.Y — _ INSURED INSURER B: _^.•_, �......__....._.•SW FLORIDA PAINTING CORP INSURER C: _-.�... ---- 4580 28 PL SW INSURER D: INSURER E: '----- Naples FL 34116 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER IMM!DDIYYYY} (MM1DDJYYYTI GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 DngAGS T D RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ OCCUR CLAIMS-MADE XJ MED EXP(Any one person) S 5000 _ a GL-35097 07/06/2012 07/06/2013 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE _ s 1,000,000 — GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 °- --`-- 7 POLICY r i JECT pi LOC s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _Age accident 5,,,,_,,,_, BODILY INJURY(Per person) S ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) S __ AUTOS AUTOS NON-O PROPERTY DAMAGE S HIRED AUTOS AUTOS UTOS ED _per accident)" _ -- $ UMBRELLA UAB OCCUR EACH OCCURRENCE S .,, — _„ EXCESS UM) CLAIMS-MADE AGGREGATE ^—` S OED RETENTIONS WC STATU- OTH- WORKERS COMPENSATION __ _ TORY LIMITS T i AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ • If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Painter to— °--ji.--( . CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractors Licensing Board THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2800 North Horseshoe Drive Naples,Florida 34104 AUTTHORIZEDREPRESENTATIVF Fax(239)252-2469 cio V ? 3 f /2 _ I ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. II ri hts reserve . The ACORD name and logo are registered marks of ACORD • . "'1 SWFLORI-03 JAJI ACORO•' CERTIFICATE OF LIABILITY INSURANCE DATE(MMI0DIYYYY) `� 7130!2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Automatic Data Processing Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 ADP Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Roseland, NJ 07068 INSURERS AFFORDING COVERAGE NAIC# INSURED SW Florida Painting Corp INSURER A:NorGuard Insurance Company 11111 Enrique Vasquez INSURER 8: 4815 Whistlers Green Circle Unit 4 INSURER C: Naples,FL 34116- INSURER 0: I INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE IMMIDDIYYYYI DATE IMMIDD!YYYY) EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE 10 RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY S GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ —I POLICY n jFt° fl LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY S. (Per parson) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EACH OCCURRENCE $ EXCESS I UMBRELLA LIABILITY 7 OCCUR CLAIMS-MADE AGGREGATE $ 5 _ _ $ DEDUCTIBLE $ I RETENTION ..qs WC gTATU- OTH• WORKERS COMPENSATION X I TORY LIMITS I ER 1 OO,OOd AND EMPLOYERS'LIABILITY Y I N �`WAAIr A ANY PROPRIETORIPARTNERIEXECUTIVE SW+'C360480 7/2012012 7/20!2013 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / E.L.DISEASE-EA EMPLOYEES 100,000 If yes,d (Mandatory In NH) / 500,000 It yes,describe under E.L,DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER i \` DESCRIPTION OF I'ERATIONS 1'jOCATIONS I V NICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - 3c CERTIFICATE I{OLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN • Collier County NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Licensing Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2800 N Horseshoes Dr REPRESENTATIVES. Naples,FL 34104- AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD (0 N N 0 0 c O •d: N .. CV 4 o co W N z MN m a ko Z J c•F) a.. m - :o E 11.1 CO N� Z •Z . 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