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CLB Agenda 09/16/2015 Co er County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA SEPTEMBER 16, 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: August 19, 2015 V. DISCUSSION: VI. NEW BUSINESS: (A) Orders Of The Board (B) Charles K. Singletary Jr., Hardcore Concrete, Inc. —Waiver of Exam(s) (C) David M Jones, Love Landscape Inc. —Waiver of Exam(s) (D) Victor Rodriguez, Vic&C Painting Inc. —Credit Review (E) Joong J. Kim—Lhop Contractors, Inc. —Credit Review (F) Benjamin T. Mading, Adria Group, Inc.-Waver of Exam(s)/ Review of Credit VII. OLD BUSINESS: (A) Janet Ramirez, Castaway Flooring Service, Inc.- Review of Credit (B) Jim E. Skelton, Skeltons Construction Inc—Review of Probation-Waiver of Exam(s) VIII. PUBLIC HEARINGS: (A) Case: 2015-03- Louis Bruno IV-d/b/a Bruno Air Conditioning of SWFL/CAC1817131 (B) Case: 2015-06-Antonio Galindez-d/b/a High Wind Aluminum Corp./ License#33352 IX. REPORTS: X. NEXT MEETING DATE: WEDNESDAY, OCTOBER 21, 2015 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 August 19.2015 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING August 19, 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 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 Rob Ganguli — Collier County Licensing Compliance Officer 1 August 19,2015 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; eight (8) voting members were present. II. AGENDA—ADDITIONS OR DELETIONS: Deletions: Under VI, "Old Business," the following were withdrawn by the County: • B. David M Jones —Waiver of Exam(s) o Will be rescheduled. • F. Bradley G. Johnson—Review of Credit o Was granted a license due to improved credit report. III. APPROVAL OF AGENDA: Richard Joslin moved to approve the Agenda as amended. Gary McNally offered a Second in support of the motion. Carried unanimously, 8—0. W. APPROVAL OF MINUTES—JULY 15, 2015: Corrections: • Page 6— 5th Paragraph (1st sentence): Changed "Gary McNally" to "Terry Jerulle." All other references to Gary McNally were changed to Terry Jerulle in subsequent sentences. • Page 14—last paragraph: Changed "Vice Chairman White"to "Vice Chairman Lykos." Vice Chairman Lykos moved to approve the July15, 2015 minutes as amended. Gary McNally offered a Second in support of the motion. Carried unanimously, 8—0. V. DISCUSSION: (NONE) VI. NEW BUSINESS: A. Orders of the Board Richard Joslin moved to approve authorizing the Chairman to sign the Orders of the Board. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. 2 August 19,2015 (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. David M. Jones —Waiver of Exam(s)— Withdrawn per amended Agenda] C. Octavio E. Calderon—Verification of Experience (d/b/a "All in 1 Drywall& Painting, Inc.") Michael Ossorio referenced the definitions under Section 22 — 162 of Collier County Ordinance #90-105, Section 6.1: General Contractor requires 48-months of experience with a passing grade on an approved test, and a Business and Law test, and means a Contractor whose services are unlimited as to the type of work which he/she may do, except as provided in this article or in the Florida Statutes. He continued: • Mr. Calderon applied for a General Contractor's license and has applied to be a State registered General Contractor; • He has a licenses for Dry-Wall and Painting; • He was referred to the Contractors' Licensing Board due to lack of affidavits regarding his previous experience. Mr. Ossorio noted the Scope of Work for a General Contractor is "unlimited" and the State of Florida expects each candidate to provide detailed proof of his/her experience in several areas: supervision, commercial/multi-story building jobs, and residential construction. Chairman White noted the materials provided by Mr. Calderon did not sufficiently detail his experience. Kyle Lantz requested specifics regarding the type of structural work experience and the time required for each component. Michael Ossorio responded the State accepts W-2s to verify employment and has become stricter on the content of the affidavits. He stated the County follows the State's lead. He reiterated to become a General Contractor, the Candidate must prove that he/she has unlimited skills and the skill level required by the County includes commercial/multi-story construction experience, residential construction experience, the ability to pull appropriate permits, and supervision experience. He confirmed both the State and the County accept payroll records as proof that a Candidate had worked for a General Contractor. Kyle Lantz noted Mr. Calderon appeared to have very limited structural experience. He asked if there was a specific requirement for structural experience, in particular. Michael Ossorio confirmed a Candidate's structural experience should be mentioned in an affidavit. He stated it was a difficult license to obtain and the County verifies the information contained in each affidavit. 3 August 19, 2015 He continued that Mr. Calderon has been a licensed Dry-Wall Contractor and a licensed Painter for several years. He will need to testify to the Board concerning the extent of his experience. Chairman White questioned the Applicant: Q. Can you tell us whether you have experience in the construction of or supervising the construction of and the permitting for buildings of three stories or more that are either of a single-family, residential-type construction or a commercial construction of a condo or something like that? A. I have worked in residential construction for a builder; I have done remodeling including a lot of experience in framing and dry-wall installation and tile. I have not been able to pull a permit because I did not have a license. Q. We understand that and we are glad to hear that you didn't try to. But the point is to be able to do that as a Registered General Contractor, we need to hear from you because it is not in the papers that you have given us that you have experience with construction of buildings of three stories or more and, in particular, the structural aspects of those. Framing is framing—but when you do commercial construction of three or more stories, there are a lot of structural plans and other kinds of reviews and construction techniques that you have to be familiar with— and because the type of license that you are asking us to give you would allow you to do those things. A. I have been working on trusses—I know how to do roofing trusses and how to read plans. Everything is in the plans when you are building houses—everything is in the plans they give you—what kind of materials you need. With the plans, you do not need to be 100% structural to be able to build. I didn't have that much experience in building but I will be learning, little by little. Q. Well, there's the thing— once you have the license, the assumption is you're not going to do on-the-job training. The assumption is that in order to get the license, you spent four years—48 months—on the job working for someone else who was a licensed General Contractor and you learned how to do those things and you were under their"umbrella" or protection so that they helped you to do those things. I would be very uncomfortable approving a license for someone who was telling me they would learn how to do the job once we give him a license. A. I have been working in construction sites for more than 15 years. I never built a house by myself because I never had an opportunity to do that. But if I do have a license, I know for sure ... Q. But here's the point I'm trying to make—you're not asking us for a type of General Contracting approval for a license that's limited to just residential construction. You're asking us for a type of Registered General Contractor's license that allows you to build anything—anything. And you haven't yet. A. I don't understand what I need. Terry Jerulle questioned the Applicant: Q. You said you have done framing before? A. Yes, I have. 4 August 19, 2015 Q. Okay. But by the time you get to the framing aspect of a house, or a building, the structural aspect of it—the concrete structural aspect of it is pretty much complete, correct? A. Yes. Q. So you're not on-site observing how they do the structural concrete aspect of the building. You are coming in after that point. I'm not confident you understand what to do or how to build a structural component of the building with concrete because you haven't shown any experience. If you have experience, explain it to us but I'm not sure that you do—compared with the information that you have provided. A. No, I don't—I don't have experience with concrete. Q. So you've never installed pilings? You don't know what a deep foundation is? A. I know what it is but I've never done it. Q. You've never done it. You've never poured footings? A. No. Q. Never formed or poured footings? Never installed steel in the footings or had inspections completed with the footings? A. I've never done it but I've been in the house where ... Q. Do you know what a sheer wall is? A. Yes, I know what it is. Q. What is a sheer wall? A. Sorry—I can't explain it. Q. I'm not sure you have the structural experience with a concrete structure to give you a license, as Mr. White said, for a three-story building or more. There is a lot of difference between doing a single-family home and a three-story structure that requires a deep foundation. A. Let me explain to you the reason why I tried to do a General Contractor license is because I have many customers already who ask me to replace the front door, or to replace windows, or do tile and remodel the bathroom—things like that. I want to be able to have one license to cover me for all that. I am not planning to build a high-rise or house and that's why I decided to take that test. It is a very hard test and it took me a long time to do it but I passed. I know it's not easy to learn everything about building a high-rise or a house—nobody learns it in five years or ten years it takes longer than that. But you will get that experience everyday learning little by little in the field. In the book or if somebody else tells you, you're not learning that. You learn by practice. Q. Well, the license you are applying for is a license that gives you the authority to build a three-story building unless we restrict it somehow. A. I understand that part, but my dream was, you know—I do have a Painter's Contractor license and Dry-Wall but I was only allowed to do framing and light metal framing but I have many customers who ask if I can replace their front door. I know to replace a front door, I have to pull a permit; to replace a window, I have to pull a permit. Q. That's correct. A. You know, and I know when I need a permit or not. That is the reason—you know, I say I need each license to do carpentry or windows—it's too many licenses so I decide to take only one license to be able to cover everything. 5 August 19,2015 Chairman White asked Mr. Calderon why if the things that he wanted to do were limited to residential buildings he asked for a Registered General Contractor's license as opposed to a Residential Contractor's license. Octavio Calderon replied when he read the book, he thought he should go for the bigger license rather than the Residential Contractor's license. It took him two years of studying to be able to pass that test. He stated he knew his language was "not that good" and he had to translate everything but he did it. He further stated it was a good challenge for him. Chairman White: We are certainly pleased that you have the desire to do these things—we're confident that what you have shown us, you probably would be very good at doing a single-family residence. But the point is, you are the one who has chosen to be in a place where you are asking to build, essentially, anything. And we're hearing from your testimony— at least I am—that you do not have any experience in one aspect of that which is very critical ... in particular, the structural components. And so, given that you are supposed to have forty-eight months of that type of experience, I'm not sure how you can expect us to approve considering the amount of experience you do have is enough. It's certainly not enough for an unlimited Registered General Contractor's license. That's why we're asking if all you are intending to do is residential work, why didn't you just ask for that license? Mr. Calderon: The thing is with residential, I cannot be able to work on high-rise buildings or condominiums—most of my customers live in high rises or condominiums. That is the reason. If I go residential, I can only go two-stories high to work. Chairman White stated he understood Mr. Calderon's reasoning. He further stated it seemed clear that Mr. Calderon understood the differences in the various license categories. Terry Jerulle stated what Mr. Calderon wanted was a Residential General Contractor's license and a Carpentry license which would allow him to replace windows and doors, and build single-family homes. The Carpentry license would allow him to work in the high-rises as opposed to a Building Contractor's license. He could work up to three stories. Kyle Lantz stated he would be reluctant to approve that since Mr. Calderon does not have the structural component. Vice Chairman Lykos agreed, stating you must be able to understand wind loads when installing windows in high rises. There is a lot of structural—even just doing windows and doors. When you enclose a lanai in a condo, you must know the Fire Codes and sprinkler systems. There is a reason a General Contractor's license is hard to get—a more broad-based amount of information is needed. Kyle Lantz stated he appreciated Mr. Calderon's efforts to study and take the test. He recognized Mr. Calderon seemed to know a great deal about the administrative portions of the test. He suggested Mr. Calderon work for a licensed General Contractor, even if it is just part-time, to obtain the experience he needs. He acknowledged Mr. Calderon would not make as much money working for someone else versus what he could make on his own, but it is part of his educational program. 6 August 19, 2015 Kyle Lantz moved to deny Octavio Calderon's application to obtain a Registered General Contractor's license. Richard Joslin offered a Second in support of the motion. Chairman White asked Mr. Calderon if he wanted one last opportunity to convince the Board to grant his application. Octavio Calderon replied he knew he could not prove his experience to become a General Contractor. He asked what he should do next. He stated he passed the test and had his own business which would make it difficult for him to work on a part-time basis for a General Contractor. Chairman White concurred that working for a General Contractor was a helpful suggestion and stated Mr. Calderon should confer with the Licensing Office to discuss what other options he may have for a different type of license. He concluded although the Board admired what he did, they could not get him to the place he wanted to be yet. He stated just passing the test was not enough—Mr. Calderon needed to demonstrate good credit and 48 months of experience. The Board was not convinced that the amount of experience or the type of experience that Mr. Calderon possesses was enough. He must either obtain the required experience or apply for a different type of license. He reiterated Mr. Calderon should speak with the Contractors' Licensing Office to discuss his options. Chairman White called for a vote on the motion. Carried unanimously, 8— 0. D. William Orr- Contesting Citation #09365 Citation: #09365 ("Unlicensed Advertising") Date Issued: July 15, 2015 Fine: $2,000.00 (2nd offense) Description of Violation: Engage in the business or act in the capacity of a Contractor, or advertise self or business organization as available to engage in the business of or act in the capacity of a Contractor, without being duly registered or certified. Chairman White asked Mr. On to explain why the Board should consider not upholding the Citation. William Orr stated: • He never intended to do anything illegal and it was not willful; • He met with the two Licensing Compliance officers, Joe Nurse and Reggie Smith; • He stated he only received the packet of information prior to the meeting; • He referenced the Verona Walk website which he stated was a private website; • He maintained he never received a call from the website for his services, never had any business or inquiries 7 August 19,2015 Chairman White reminded Mr. On the Citation was issued for unlicensed advertising which did not require anyone to enter into a contract, or give him money. It was the simple act of advertising to provide a scope of services for which he was not licensed. Mr. Orr responded that he understood the charge. Chairman White noted it was reminiscent of a situation which occurred in 2012 when a Citation was issued. William Orr explained the previous situation was about an unlicensed contractor who claimed he had a license to do work he was doing— and he was only there to stop a fight. He stated the Licensing Compliance Officer asked his name and decided to also issue a Citation to him. He stated everything was on record. The permits had been pulled by an electrical contractor—he only supplied the fixtures, wiring, and the conduit to the electrical contractor. He further stated he spoke to Michael Ossorio at that time because he wanted to oppose the Citation but, since he didn't want to get other people into trouble, he was advised to pay the fine. He decided to pay the fine since it was "the easy way out," and concluded by stating the Board could check the record. Chairman White advised Mr. On the record presented to the Board was contained in the information packet. Mr. Orr reiterated he was working for a different company in 2012 and he explained the only reason why he paid the fine was to not get people into trouble and to stop a fight that was going on within the Association. Chairman White stated the previous Citation was issued for unlicensed electrical contracting. William Orr stated there was a record in the County's office which shows that the electrical contractor was licensed and the only thing he did was to supply the wiring, the conduit and the boxes to the contractor. He further stated he happened to be on the job site when the Citation was issued. Richard Joslin asked Mr. On why he furnished the materials for the job—if the electrical contractor was licensed, why didn't the contractor buy the materials. Mr. Orr replied, "That's what I was doing." Richard Joslin: You were acting as a contractor. William Orr: No, I'm entitled to sell fixtures. I am entitled to sell things. I don't do any work. He's the one who peuuitted the job; he was paid for the job—I was paid for supplying the wiring. I didn't do any labor on that job at all. Chairman White: Okay—that goes more toward the idea that we might—we are pelniitted to do any one of three things: • If you have abated a violation before appearing before the Board, we can dismiss the Citation. • Our second option is to uphold the Citation at the dollar amount that was issued. • The third option we have is to increase the amount of the fine for the Citation. William Orr: I did abate it. Chairman White: In working through any one of those three outcomes, understanding what the prior violation was and the facts related to that Citation, is 8 August 19,2015 important to ensure that — as far as the second and third options are concerned—those things don't happen. William Orr: What I wanted to say was —when you addressed what happened on the first violation—I don't know if it was abated or corrected ... it went through the permitting process and it was fine—it was not an issue after that. Chairman White: The verb we have in our files is "Cited." It doesn't tell us necessarily what the disposition of the matter was —it may have been abated. It may have been paid. All it says is that you were cited. William Orr asked the Chairman if he could address the current citation and the response was, "I certainly do." William Orr explained: • He met with both Compliance Officers. He was infoimed the low-voltage outside lighting which was required to be plugged-in was acceptable but interior low-voltage lighting was "not okay." • He immediately removed the advertising after meeting with the Officers on July 15`h • He spoke with a woman in the office who was in charge of posting— she was not in but he left a message for her to call him. • Regarding the reference to ecofriendlyelectric.us was also removed. • There is nothing on the website. • He sent a letter to a Mr. Norris explaining that both situations had been resolved. • Everything was accomplished within 24 hours of receiving the Citation. • He is retired and lives on a restricted income. • He was trying to supplement his income by selling the fixtures. • He stated he did not realize he was doing anything wrong. • He stated he did not receive a call from anyone regarding purchasing the fixtures so there was nothing to reverse concerning a consumer. Chairman White asked if he was claiming that no one (i.e., a consumer) was harmed and Mr. Orr's response was, "Yes." Richard Joslin asked William On if he had applied for an Electrical Contractor's license. A. I have the packet to review and apply; as soon as I accumulate some money, I will decide but currently, I am looking for work. Chairman White reminded Mr. On the nature of the violation was the advertising— it was not the performance of any work. In order to abate that type of violation, it would not be necessary for him to apply for a license. He noted the penalty had been increased from $1,000 to $2,000. He asked Michael Ossorio for conf utnation. Michael Ossorio stated it was only valid for a first offense. Mr. On had applied at the State level to take the exam. Mr. Orr confirmed the application was "in process" because he had not completed the paperwork. 9 • August 19, 2015 Michael Ossorio: But the State has your information? William Orr: Yes. Michael Ossorio: And how long has that process (of applying) been in effect? When did you apply or process this application on the State level? William Orr: I guess a couple of months ago — I couldn't give you a specific date because I didn't complete the process. Richard Joslin referenced the date of 07-15-2015 on the paperwork. William Orr replied he received the Citation on that date. Kyle Lantz referenced the information packet, specifically a copy of the website Eco Friendly Electric and asked what it was. William Orr: It was a site that was supposed to have been removed two years ago. If you look on top, you will see "LLC"—that was dissolved in 2013. It was closed in 2012 but officially dissolved in 2013. It was a voluntary dissolution and I have a record of it. It was supposed to have been taken down. I didn't know until I got the Citation but if you go on the site now, you will see it's a blank page. I own the website but I didn't know there was anything left on it. It was supposed to have been removed. Chairman White summarized: • Mr. Orr's request for the Board to dismiss the Citation is based upon the fact that he had, prior to the hearing, removed any and all advertising that would be for activities which required a license. William Orr: All advertising, period. Chairman White: I'm trying to keep it specific to the license issue. William Orr: Yes. Chairman White asked the Board if anyone had any questions or concerns regarding that aspect of Mr. Orr's request. Kyle Lantz referenced Mr. Orr's business card which stated that"Maintenance contracts [were] available" and requested an explanation. William Orr: It was basically a continuation of the guarantee of the lighting fixture if I sold it. In other words, if I sold you a low-voltage lighting fixture—so I can charge you if you want me to maintain it. Meaning, if it's knocked over, I can stand it up. If it doesn't work, I can replace it because my manufacturer is guaranteeing it. I put it in terms of"maintenance." But it's not applicable because I've even thrown out my cards. I'm not doing it. Kyle Lantz: Theoretically, if I bought a fixture from you ... William Orr: I'll maintain it. Kyle Lantz: .... installed it and it was broken or defective—would you replace it by giving me a new fixture in box or would you come to my house or job site; unwire the old fixture and wire in the new fixture? William Orr: If it was a low-voltage—the intention was that if it was a low-voltage which, according to the Compliance Officers, I was legally able to do for outdoor 10 August 19,2015 because it was a plug-in—I never even intended for indoor—for outdoor— I would then put it back in the ground for you. If I sold you a light, I would replace the fixture but you would need to have an electrician install it. I have electricians come to my house when I want something done — I don't do it myself. Terry Jerulle also referenced Mr. Orr's business cite, specifically the website: www.ecofriendlyelectrical.us. He asked if it referred back to the website. William Orr: Which is down. Terry Jerulle: It's down now, but before it was down—it went back to the website? William Orr: Yes. I didn't think it did—I thought it was down. Terry Jerulle: But it says right on the card. William Orr: No, I'm saying the website itself—there was nothing on it—that was my impression when I closed the LLC in early 2013. Chairman White: So what was your understanding of where this web URL would lead someone if you typed it in and hit "enter?" William Orr: I never went ahead—when I typed it in, it did not come up. Chairman White: It just gave you an error message—"bad URL?" William Orr: "Bad URL" or"under construction." Because now if you go into it, you'll see the flag but you'll see a blank frame. What happens with "Go Daddy," is that they give you a website with your domain. So it was never really completed because my card had the American flag and I put that on in the very beginning. But there's nothing—all advertising is down, gone, non-existent. Chairman White expressed his concern: If the Board dismissed the Citation, two months later, you are out there advertising for something you don't have a license for. Then you get a third Citation—that time, you would not come before this Board, you would appear in Court. The point is your defense would be "well, I took it down before I got here today." We have gotten into this cat and mouse game where it's up/it's down— William Orr: But it was down within 24 hours of... Chairman White: I understand your point. Do you understand mine? The concern is that you are not learning from these experiences —that you go back and repeat the behavior—you put something up and advertise for a Scope of Services that you do not have the licensure for. William Orr: Mr. White, in all due respect and I'm not trying to be argumentative, I never had any intention of doing anything wrong. You can believe me if you want. I am telling you the truth. There was no intention and as soon as I found out there was something that was wrong, I immediately took it down. Chairman White: The point I am making, Mr. On, is it is ignorance of the law. You have done what I think needs to be done in order to abate the violation. That puts you in a position where the Board should and could be able to dismiss the Citation. What I am not hearing you say is that you completely understand now what the rules are and you still have no intention of violating them in the future. That is what I am looking for. William Orr: What I am saying is I will not do it—I understand what you're saying thoroughly and I have no intention of doing anything illegal without a proper license. 11 August 19,2015 Terry Jerulle: From the evidence in front of me: a business card that states Eco Friendly Electric and gives a website on the bottom—there's proof that there was a website—and on the website, it says that you "design and install." Chairman White: I'm not suggesting that on the date the Citation was issued, that those weren't indeed the facts —that those facts weren't correct. But we are at the point where his testimony is—and there's nothing that says otherwise —that none of that advertising remains. Since the nature of the violation was, essentially, impermissible advertising—he's abated the violation in my mind because he has taken it down. That's why I was concerned about his going back and putting up some advertising and taking it down—because we would be in the same situation with what he has technically complied with by abating the nature of the violation prior to the hearing. So we could dismiss. Terry Jerulle asked if Mr. On had documentation from the website that it was down permanently. He asked Mr. On if he had written a letter to "Go. William Orr: No, I went to "Go Daddy" and told they told me what I had to do—I removed every bit of advertising on that website. Terry Jerulle: You don't have any proof—whether it's down permanently or temporarily. William Orr: I don't know if I can remove it as long as I own the domain. If you can tell me how to remove it permanently, I will be more than happy to do it. Terry Jerulle: My question was—do you have documentation that you took it down the site permanently? William Orr: No. Chairman White: I don't know how anyone could provide that. Terry Jerulle: At least a letter asking them to take it down or an email. Chairman White: He owns the URL—owns the domain name—he has access to the website. He did what I believe was necessary to abate it by taking down any information that, if you go to that URL, shows there is advertising. We have his testimony even though he may not have written documentation. Terry Jerulle: An email to "Go Daddy" asking them to take it down would suffice for me. Chairman White: But it's his. William Orr: But I've done it. Chairman Whitc: He's not hiring somebody to do those services for him. As I understand how"Go Daddy" works, it's a very straight forward relationship—he is effectively his own contractor for the purposes of doing the web page maintenance. And his testimony is that he has taken it down. William Orr: There is no written information on that page at all. Richard Joslin: In other words, it's a blank page. William Orr: It's a blank page—the only thing that you might see is the American flag in the back. Richard Joslin: Okay. William Orr: But everything where the content was—it's blank. And it will remain blank until everything is done with the domain and then I guess they take it off Kyle Lantz: You've testified that you never had any intention of breaking the law— it was a mistake—you were ignorant of the law and you didn't understand. My eyes 12 August 19,2015 keep going to the website where "We do design and install service maintenance." But the little words in quotations where it says "licensed electrician"—my eyes keep bringing me to that which, to me, shows—you would write "licensed electrician" if (a) you didn't think you needed it or—that leads me to intent. It makes it hard for me — it is a very good argument that you are presenting and I appreciate it. But my eyes —I don't think I can get over that one—that's like me writing "licensed doctor" next to my name. I just wouldn't do it. William Orr: Two things: there was an "s" on the electrician—it said "licensed electricians"—but the idea is that the site itself was from a site that was dissolved and I thought it was down and, based upon this Citation, I definitely—I called and found out from "Go Daddy" what to do —they told me that I could change it—and I changed all the wording to "zero" wording, so I did correct the advertising immediately. With any advertising that was out there, I eliminated or destroyed. Chairman White: The violation was for unlicensed advertisement. There were two ways he could have cured it—one was to get a license and the other was to get rid of the advertising. In my mind, I think there is sufficient evidence that he had done the latter of the two. If there are no other inquiries, I'd like to move us along. William Orr referenced Florida Statutes and said that if it was not willful or intentional, and the intent was to remove the violation—from the State Legislature versus fining people. That's what it says in the Statutes. Chairman White: I am familiar with seeking to gain compliance versus the idea of imposing a penalty. William Orr: I appreciate that. Vice Chairman Lykos referenced the web page, "Eco Friendly Electric, LLC," and noted the report from the Florida Department of State which confirmed that Eco Friendly Electric, LLC had been voluntarily dissolved in 2012. Kyle Lantz: But if you look at the business card, it refers you to that website. Vice Chairman Lykos: Mr. Orr dissolved Eco Friendly Electric, LLC —he wasn't maintaining that website because the LLC as a company did not exist anymore— that's his argument. Kyle Lantz: He also used that same website on his application for Verona Walk. Chairman White agreed there were other pertinent facts but asked if they were relevant as to whether or not Mr. On abated the asserted violation prior to the hearing —not what his intention was on July 14th or what the facts were on July 14th but rather what he did effective July 16th or after, up until today. And what he had basically done, as I understand it, was anything and everything he could do to remove the advertising. His only other option was to apply for the appropriate license which he made an application for but has not yet completed. And I heard him say he will not do it again. Chairman White asked Michael Ossorio if the County had a recommendation. Michael Ossorio noted on Mr. Orr's application to Verona Walk Services which he initialed on February 8, 2015 —he put his website or URL number on it. The County would not issue a Citation if it was not a valid Citation. 13 • August 19, 2015 Chairman White stated he did not question the validity of the Citation—rather his whole scope of inquiry was whether or not the Board was in a position to consider that Mr. On abated the Citation such that it could be dismissed. That was what Mr. On was asking the Board to do. Kyle Lantz directed his question to Michael Ossorio: Q. Mr. On read something from the State's Statutes that said the Board could dismiss the violation if it was not willful, and has been abated since. Is that "willful" because, to me, when you write "licensed electrician" makes it willful. Is that "willful"not part of the County's Ordinances or is that separate from the State's Statutes? Chairman White asked James Morey, the Board's attorney, for the precise regulation. Attorney Morey cited from Florida Statute 489, Section 127, entitled "Prohibitions and Penalties" as follows: "3. If the person who was issued the Citation, or his/her designated representative, shows that the Citation is invalid or that the violation has been corrected prior to appearing before the Enforcement or Licensing Board or designated Special Magistrate, the Enforcement or Licensing Board or designated Special Magistrate may dismiss the Citation unless the violation is irreparable or irreversible." Chairman White noted the word"willful"was not part of the Section. He stated the "willful" component usually pertained to peimitting violations, i.e, a licensed contractor who knew he/she should have obtained a permit but failed to do so. Michael Ossorio stated Attorney Morey had cited the Statute which applied most often to unlicensed activity on the local level. He noted there was a difference between a local licensing board and the State's regulatory board. Attorney Morey confirmed that the advertising was the nature of the Citation. Questions from the Board to Mr Ossnrin• Q. Do you need a license to install low-voltage landscaping lighting. A. You do. Q. You do need a license? A. You do. Q. What license is it? A. The State has a couple of difference licenses. Unless you are just going to plug it in and even then, the State is pretty stringent about plugging into a some type of a transformer ... on a local level, we will probably refer it to the State and the State does have a license for low-voltage. The answer is "Yes." William Orr: Because there's a dispute between the State and local, and what people think. The Compliance Officers here said that low-voltage landscape lighting— outside low-voltage lighting—if you plug it into an outlet, you don't need an 14 ' August 19,2015 electrical license to do that. There's some conflict now with the State that even if you do that—there may be. So that's why I'm not doing any of it anymore. Because there's still an issue as to whether just to "plug and play" is legal or not ... I don't know what the answer is ... because you get different answers from different people. So I'm not doing it. It's done. Richard Joslin: What about the sale of electrical items? Retail license? William Orr: I am allowed to do that—I have a Business Tax Certificate and a fictitious name—so I can sell fixtures but I don't install them. None of that stuff— none of that. Kyle Lantz moved to approve dismissing Citation #09365 as issued. Chairman White offered a Second in support of the motion. Motion carried, 7— "Yes"/1 — "No." Terry Jerulle was opposed. E. Cesar Franco —Review of Credit (d/b/a "Finishing By Franco, Inc.") Cesar Franco stated he had applied for a Carpentry license. Chairman White noted there were some concerns regarding his credit and asked Mr. Franco to explain. Cesar Franco: • In 2006, the country went into a recession due to overbuilding. • Over 7 million people have lost their houses. • He was still in the process of foreclosure. • He has been a carpenter for 30 years. • When his income started to go down, he lost his truck—and he was divorced in 2006. He is still a single father and raising his daughter. • It has been a difficult situation for him due to his finances. • He is working with the Bank of America on a modification and he is making payments to the IRS -- $100 per month for the next three years. Chairman White: Q. As far as the outstanding negative credit—the bad credit on your report—you have told the Board you are making payments to the IRS and you are trying to work through a foreclosure—was there anything else about the items on your credit report that can be shared with the Board? A. There was an another one from Rooms-to-Go from 2007—but the main one was the house which I am keeping—I have been working with the bank for seven years—made a couple of modifications and the other one was the truck that I gave up and they put a 1099-C which showed in March, 2015 ... and I talked to the IRS and made an agreement to pay $100 per month until I pay off the back taxes that I owe. They sent me a letter and I'm working on it. I have had steady work for the last two years almost for Raymond Builders. Before I worked for 15 August 19, 2015 Newberry North in the late 90s and Homes for many years until 2010. And finally the Divorce Court said "thank you for everything." Q. There were two references to Comcast on your credit report—the amount of the balance seems to be $73.00. I know it's not a huge amount, but the point is ... A. When I got all these papers put together, I didn't go through every single one but $74.00 is payable. I didn't notice. Q. You similarly have some from Wells Fargo and Citibank—they are $2,000 and $1,000 and $1,200 amount. Are those related to what you were telling us about before as part of the foreclosure? Are they credit cards? A. At that time, yes. Q. But they are still out there. They have been verified—as of a few months ago as still being ... A. They are still there ... Q. ... out for collection. Do you have any intention to contact them—to pay them— to try to work something out—to ... A. I started to work with the Bank of America which was the huge debt and with the IRS in March ... all these are small numbers which I didn't see and the others ones are workable with them. Q. I'm glad to hear that you worked things out with the IRS but it doesn't seem—at least from a credit reporting perspective—to be a concern. The IRS never filed a lien against you—you are satisfying what they have asked you to do—that's great. We are dealing with the stuff that is still on the credit report and that's why you are here. Whatever your intentions are with those things that are still on there and how you are going to conduct your personal credit going forward—that's what we need to know. A. I am going to start working on these to pay them off. Q. How long do you think it will take you to do that? A. Well, the small number—the $74.00—I can pay. I will make an agreement with Wells Fargo and Shell—both are workable. Q. How long do you think it might take you to do that—three months, six months? A. I can consolidate—put them all together in one amount and start to pay them ... but the small amounts of$74.00 and $200, I can pay off tomorrow or today. Q. Would three months be enough to clear these things up and come back before us? We may give you a probationary license but ask you to come back with an improved credit report. We want to give you enough time to do the things you need to do. A. Give me ninety days and I'll work on it. Richard Joslin said he would like to see more than just the $74.00 charge paid before Mr. Franco returned. Chairman White: You may go in and make an arrangement with them tomorrow but it may not show up on your report—if you come back within 90 days and your credit report still shows it—but if you have made a payment, you need to bring the checks to show payment. Kyle Lantz asked the Chairman if he requested Mr. Franco to set up payment plans or he pay just the four small amounts. 16 August 19, 2015 Chairman White replied he wanted an improved credit report to be provided to the Board and a determination could be made at that time. He stated if Mr. Franco could pay the small amounts, it would be the best possible scenario. Mr. Franco confirmed he could pay the small amounts. Chairman White noted every debt that was removed from the credit report increased Mr. Franco's chances to be taken off probation. Richard Joslin noted Mr. Franco did not have a Workers' Compensation insurance policy and asked if he was working alone. A. No, I am working only for Raymond Builders. Q. If your license application is approved, will you have men working for you? A. At that time, I will. I spoke to Collier County—when you hire your first employee, you must have Workers' Comp. Q. The policy you have presented has expired. A. I have to re-apply the next time. Kyle Lantz noted Mr. Franco had an exemption which was good until the following year for Workers' Compensation insurance. Kyle Lantz moved to approve Cesar Franco's application for a Carpentry License but that the Board issue a probationary license for a period of six months; he is to appear before the Board to present a new credit report verifying the payment of the following debts: Midland Fund(balance: $1,522), Portfolio RC(balance: $1,236), LTD Financial Services (balance: $1,258), Comcast ($74.00). The debts are to be removed from the new credit report or Mr. Franco is to present a letter stating each debt has been paid in full or a copy of each cancelled check. Chairman White offered a Second in support of the motion. Chairman White noted the companies may decide to settle the debts for less than the amounts owed. Mr. Lantz clarified the goal was to remove the items from the new credit report. Chairman White explained to Mr. Franco that he would be issued a license but it would be probationary fora six-month period. At the end of the six months, he will will be reviewed to determine if they had been satisfied. Mr. Franco said he would work on them. Kyle Lantz suggested he could amend his motion to include if Mr. Franco paid off the specific debts earlier than six months, he could provide proof to the Contractors' Licensing Office and his probation could be terminated administratively. Michael Ossorio confirmed if an applicant's credit score was "close to the 660 threshold"—but noted Mr. Franco's credit score was 520. He stated even if he paid the five items mentioned, his score would improve enough. He recommended that the applicant appear before the Board at the end of the six-month probationary period. Vice Chairman Lykos requested that Mr. Franco also provide proof of his agreement with the Bank concerning his mortgage. It would be attached to the information packet that will be provided at that time. 17 August 19,2015 Cesar Franco stated he instituted an automatic payment to the bank from his checking account. Mr. Lykos reiterated the documentation could be added to the information packet to be provided when Mr. Franco returns at the end of the six-month period. Kyle Lantz amended his motion to include Vice Chairman Lykos'suggestion. Chairman White offered a Second in support of the amended motion. Carried unanimously, 8— 0. [F. Bradley G. Johnson—Review of Credit— Withdrawn per amended Agenda] G. Thomas Locke—Reinstatement of License (C30407) (d/b/a "L.C. Stoneworks") Thomas John Locke, Jr. presented the Board with his business credit report and a personal credit report. He stated he tried to obtain the documentation within the two- week timeframe but was unable to do so. He noted the Experian credit report noted issues with medical charges from the past. He stated he has obtained counsel to dispute some of the charges but will pay what is valid. Chairman White requested an explanation of why there were two signatures in some places on Mr. Locke's application and why they were necessary. Mr. Locke stated he had signed his application before appearing before a Notary. He was requested to re-sign the document in the presence of the Notary. Michael Ossorio: • Mr. Locke has applied to reinstate his license under a new business without being required to take an exam • He has applied for a Cabinet Installation Contractors' license which only requires taking a Business and Law test • If the Board chooses to reinstate him, the reinstatement fee will be $760 plus the renewal fee of$125 • Mr. Locke's credit score was 614 • If there are issues with medical payments, the Contractors' Licensing Office would not have a problem issuing a license to Mr. Locke • The Board must waive the exam requirement and Mr. Locke must prove that he has continued to work in his trade of cabinet and millwork. John Locke: • Has a Cabinetry and Millwork License which enables him to template, install, and do restoration work on natural stone and man-made quartz products. • Has been in this field since July, 1997 • Took a year and one-half off to become a certified Pella door and window installer (late '98 to '99); he then went back into the industry • For the past three years (since his license lapsed), he has been employed by Classic Stone 18 August 19,2015 When asked why he stopped working for Classic Stone, Mr. Locke replied that he had become ill. He took specialized OSHA training and is required to wear a respirator when he works. Kyle Lantz moved to approve both the application of Thomas John Locke, Jr. to reinstate his license and his request to waive the testing requirement. Gary McNally offered a Second in support of the motion. Carried unanimously, 8— 0. BREAK: 10:20 AM RECONVENED: 10:35 AM VII. NEW BUSINESS: (Note: With reference to the cases heard under Section VII, the individuals who testified were first sworn in by the Attorney for the Board.) • Teodor Danilov—6 Month Review of Credit (d/b/a "Custom Flooring Design, Inc.") Mr. Danilov was not present. The Chaimian requested to continue the case and hear it later in the proceedings if Mr. Danilov returned. • Abel Arredondo—Review of Probation (d/b/a "Superior Woodworking,Inc.") Abel Arredondo requested to provide the Board with copies of a newer credit report than the one in the information packet. The new report was dated August 18, 2015. He stated it reflected the latest update on his credit and documented his progress. The credit report contained in the information packet was submitted two weeks ago. Chairman White asked Mr. Arredondo if his credit score had improved from the previous score of 633. Mr. Ai edondo replied his current scorc was 647 which was an improvement from his original score of 594. He stated his credit report of six months ago showed 17 accounts; 11 of the 17 were delinquent. His open accounts have been reduced to seven with only one remaining as "outstanding." He further stated there are no open collection accounts on his credit report; he paid one account in full and obtained settlements on five other collection accounts. Two other collection accounts were removed from his credit report. He stated he hired counsel to help him remove certain items from his credit report because it was very difficult to deal with the credit reporting agencies. He concluded by stating he appreciated the opportunity the Board had given him to accomplish what he had. The Board reviewed the new information provided by Mr. Arredondo. 19 August 19,2015 Mr. Arredondo stated he had copies of his transactions with two of his creditors (for Verizon - paid in full; and a collection company, "EOSCCA," also paid in full) who had yet to send letters confirming the accounts had been paid. He further stated that regarding the account with Chase Bank, he was "probably a couple of paychecks away from calling them to obtain another settlement." He stated it would leave him with six "positive" accounts on his credit report. Kyle Lantz commended Mr. Arredondo on his progress. Mr. Arredondo stated the new license will mean a better job. Kyle Lantz moved to approve removing Abel Arredondo from probation and issuing a full license to him. Terry Jerulle offered a Second in support of the motion. Carried unanimously, 8—0. VIII. PUBLIC HEARINGS: Michael Ossorio and Kevin Noell, Assistant County Attorney, requested to withdraw Case 2015-05: Michael Paul Taillefer, d/b/a "Imperial Homes, Inc." (CBC-1257228) from the Agenda. He stated the Qualifier decided to come into compliance. Chairman White stated that, during his review of the information presented to the Board, his concern was that the Board may not have had jurisdiction over the matter and would have been more appropriately handled by the Board of Adjustments and Appeals due to the various rejection comments and the requirements for the permit application to come into compliance. Michael Ossorio noted the Building Official interprets the Florida Building Code and if a Contractor wishes to challenge an interpretation, the correct Advisory Board is the Board of Adjustments and Appeals. He confirmed if the Contractor did nothing, the Building Code violation would still remain. He cautioned "if you work without a building permit, this is what happens." (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 #2015-04: Board of County Commissioners vs. Joseph Brown, d/b/a "Anything in Doors,LLC." (C-31217) Chairman White outlined the order of the proceedings: • The Public Hearing will be opened, witnesses will be sworn in, and accept any evidence from the parties; • The County will present its "Opening Statement," followed by the Respondent's "Opening Statement;" • The County will present its "Case in Chief," followed by the Respondent's defense; • The County may offer any rebuttal; • The Public Hearing process is then concluded. 20 • August 19,2015 • After closing the Public Hearing, 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 members will base their decision. • During deliberations, the Board members may ask for additional information and clarification from either of 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. o If the Respondent is found guilty, the Board will 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. Richard Joslin moved to open the Public Hearing. Terry Jerulle offered a Second in support of the motion. Motion carried, 8— 0. Rob Ganguli, Licensing Compliance Officer, requested to enter the County's information packet in Case #2015-04 into evidence. Vice Chairman Lykos moved to approve accepting Case #2015-04: Board of Collier County Commissioners vs. Joseph Brown, d/b/a "Anything in Doors, LLC" into evidence as County's Exhibit#1. Richard Joslin offered a Second in support of the motion. Carried unanimously, 8— 0. Rob Ganguli presented the County's "Opening Statement:" • Joseph Brown is the license holder of Collier County Certificate 31217 for Glass and Glazing. • Two Citations were issued to Mr. Brown: one for commencing work outside the scope of his licensure, and the second is for commencing work that required a Building Permit. Chairman White asked if anything had happened since the issues of the Citations that would affect the County's position. Mr. Ganguli replied Anything in Doors, LLC retained the services of a General Contractor who submitted an application for a permit for the job site in question and the permit had been issued. Respondent Joseph Brown was requested to provide his "Opening Statement"but he declined. Chairman White asked the Respondent if his position was that he was innocent or guilty of the charges. A. I am guilty of them. Yes. 21 August 19,2015 Chairman White asked the Respondent to explain his actions since the time the Complaint had been filed. A. I immediately went down to the Building Department and had a General Contractor pull a peirnit and paid for it in full. Thomas Brown appeared as a witness for the Respondent and stated: • Originally with did pull a penult with the County and followed the process. • It went into review; everything was accepted and we paid for it. • Two weeks later, we were called to pick up the Permit and when I did, I was told there was a problem with the license and we should not have filed for the permit. • No one from the County had mentioned any problem when the application was filed. • On the page of the Permit when we filed, had a viewer in the door—an eye viewer which is UL-rated—and we thought that would classify as glazing in that door. • There was a technicality concerning the eye viewer in the door and the County told us that we couldn't do it. Rob Ganguli presented the County's "Case in Chief:" • In July 2015, the Contractors Licensing Office received a complaint from Marguerite Webber, the property owner of 1400 Misty Pines Circle, Unit #202,Naples, Florida 34105. • The complaint involved the unpertnitted installation of a human access door in a separate garage structure performed by Anything in Doors, LLC. • Upon investigation, it was noted that Joseph Brown, holder of Collier County License #31217 (Glass and Glazing Contractor) and Qualifier for Anything in Doors, LLC, had submitted Permit Application#PRB-0617136 for a door installation. • Initial contact was made with Mr. Brown who claimed the work was never performed, stating he had submitted a cancellation for the permit application. The cancellation, dated October 27, 2014, was discovered in the County's data • On August 20, 2014, a"hold" had been placed on the Scope of Work applied for in the permit by the Contract Licensing Supervisor after a determination had been made of insufficient licensure by Anything in Doors, LLC. • The property owner verified that the Contractor had been paid in full and photos were taken of the completed work. • Documentation provided by the Complainant included two installment checks made payable to Anything in Doors, LLC, with the final payment check dated October 2, 2014. • The timeline indicated the work was completed while the August 20, 2014 hold on the permit was still in place. • On July 16, 2015, a meeting was held with Tom Brown, partner of Joseph Brown, and the violations were explained to him. He was requested to relay the information to Joseph Brown, his partner and son. 22 • August 19,2015 • During the meeting, a Notice of Hearing to appear before the Contractors' Licensing Board on the August 19th was issued to Joseph Brown for having violated Collier County Ordinance #90-105, as amended, Section 22-201(2) for contracting to do any work outside the scope of his competency as listed on Joseph Brown's Competency Card as defined by this Article or restricted by the Contractors' Licensing Board, and for violating Section 22-201(18) by proceeding on any job without first obtaining applicable permits or inspections from the City's Building and Zoning Divisions or the County's Building Review and Permitting Department. • Tom Brown received the Notice for the Qualifier and a second copy was sent via Certified Mail to the business address on record. • Tom Brown stated his intention to find a licensed Contractor to take over the job and obtain the required permitting prior to the Hearing. • Certified General Contractor, All American Impact LLC, CGC-1514255, submitted an application for and obtain a permit for the job site and the door installation. Chairman White asked if the homeowner suffered any economic hardship and Rob Ganguli stated, "None." Chairman White asked if the County had a position concerning the permit that was obtain—had the violation been abated. Rob Ganguli stated that as far as he was concerned, the violation had been abated. Terry Jerulle asked Mr. Ganguli when the penult had been applied for and the response was "The abating permit was notarized on July 28, 2015." Q. No, I meant the original peiinit. A. June. Q. The original permit was applied for in June and the County denied it in August? A. On August 8th, it was reviewed by the Licensing Supervisor who determined that the Glass and Glazing License was insufficient to do that Scope of Work. Q. When was the work done? A. I don't know the exact date of the work, but the final installment check may payable to the Contractor was dated October 2, 2014. Chairman White asked if there was any factual evidence of whether the work had been done prior to or after the hold was placed in August. A. Not factual—just based on the payment. Chairman White asked the Respondent if he had any questions for the County. Respondent: Why wasn't I allowed to pull the peiiuit when there was glass in the door? Richard Joslin referred to County Exhibit E-22 and asked if it was a photo of the door that was actually installed and the Respondent replied, "Yes." Mr. Joslin noted that he did not see any glass in this door and Rob Ganguli concurred. 23 August 19,2015 Michael Ossorio referenced Section 22-162 of the Ordinance, as follows: "Glass and Glazing Contractor requires 24-months of experience, a passing grade on an approved test, and a passing grade on a Business and Law test, and means those who are qualified to select, cut, assemble, and install all makes and kinds of glass and glass work, and execute the glazing frames, panels, sash and door and holding metal frames ..." Richard Joslin: If the door would have had glass in the panes (Exhibit E-22) ... Michael Ossorio: If the door had glass in it, then he would have been qualified to install it. He could do it. But just because a door has glass in it means he was qualified to install it. One of the things we have to deal with—the Building Official determined it was not a glass door—it was a rated door which was outside the Scope of Work. And the Respondent was notified. Questions from the Board: Q. Was this a replacement door? It was not a new installation? It was replacement of a door that was there? Respondent: Size to size, yes. Michael Ossorio: Size to size in a commercial building. I think the Association was doing all the doors—or some of the doors. Respondent: The actual doors were not part of the structural building—they were across the street—the carports were enclosed. When we applied for the permit, the fee was $150 from the Building Department, but then the Fire Department wanted another $150 but it was not a structural building, so then they resubmitted it and said it was only $50—the pricing was really bad. I don't know—still trying to figure it out. Chairman White asked the Respondent if the County had sufficiently answered his question and the response was, "Vaguely." Michael Ossorio: What was the question? Respondent: If I can install a door that has glass in it—like the peep hole. Michael Ossorio: You can install glass doors. How you want to interpret that—I just read the definitions section—you can install glass doors. Chairman White: Which is different in my mind than a door with glass in it. Kyle Lantz: In Lee County and Cape Coral where you work, can you—I know the licensing is different—but can you get permits and install doors? Respondent: As long as there is glass in it, correct. That's why I put the peep hole in there—it's glass ... but I didn't install the door. Vice Chairman Lykos: The picture doesn't show a peep hole. Respondent: Yes, that's because I didn't install the doors or supply the doors. Chairman White: It was installed under the new permit. Respondent: The door was under the old permit—the one I pulled. Chairman White: The photograph is of the door under the old permit or the new? Respondent: The new permit. 24 August 19,2015 Kyle Lantz: So you were contracted for a door but you hired someone else to do the install? Respondent: Correct. They hired somebody—I didn't. I supplied the door. Vice Chairman Lykos: But you were paid to install the door? Respondent: Correct. And I did not get paid for that. Richard Joslin: I'm still confused about the peep hole. The photograph is of the door that was installed under the new permit by the other Contractor? Respondent: Yes. The one I was going to install had a peep hole. Vice Chairman Lykos: Q. What do you mean, the one you were going to install? A. The door that I was going to install had a peep hole in it. The photograph shows one that did not have it. Q. Let's take a step back. Please look at Exhibit E-8 of the infouuation packet. A. I see it. Q. Is this your contract? A. Correct. Q. Is this for providing and installing a door? A. Yes, it is. Q. The total cost is $625 —correct? A. Correct. Q. You received one check for $300 and another check for $340 ... A. Correct. Q. ... which is more than $625. A. It was for a handset—some kind of hardware issue ... maybe stainless steel hinges or something ... I don't know. Q. This says: "Balance due—after inspection" which in my mind implies that the work has been done and it has been inspected. And you received that payment. A. Correct. Q. So did you put a door in? A. No, I supplied a door. Q. You did not install a door? A. No. Q. Why did you get the second payment? A. For supplying the door to All American Impact, LLC who pulled the peimit. Q. On your behalf? A. He's the one who installed the door that I provided. Q. The payment was in October, 2014. A. Right. Q. The new permit was pulled this year. A. Correct. The work was done way prior to that—when I tried to pull the permit the first time, the work was already done. We just pulled the permit within the last few months. The work was already done on behalf of All American Impact, LLC. Chairman White: Q. When was the door installed? A. Two years ago—I don't know—a year ago ... it was a long time ago. 25 • August 19,2015 Q. Before or after August 20, 2014? A. After. Q. And before October 2, 2014 when the payment was made? A. Pretty sure. Q. Before? A. It was before, yes. Vice Chairman Lykos: Q. And then somebody came in and put in a different door? A. No. We pulled the pennit after-the-fact because there was a complaint. Kyle Lantz: Q. Who physically removed the old door and put in the new door? A. All American did it. I just supplied the door. Q. But you were paid $640 to supply a door. Who paid All American? A. I paid All American—I cut a check to him. Vice Chairman Lykos: Q. Then you subcontracted the installation out to another company? A. Correct. Yes, correct. Vice Chairman Lykos expressed his displeasure with the Respondent's attitude and lack of forthcoming in his answers because he omitted pertinent details. The Vice Chairman stated he did not appreciate the Respondent's playing games and cautioned him to be completely honest when answering the Board's questions. Terry Jerulle: Q. When you said you didn't install the door but you hired somebody to install the door, you installed the door. A. No, I ... Q. For all practical purposes, you hired somebody to install the door— so from a Contractor's standpoint, you installed the door. That's what Mr. Lykos is getting at ... and it is frustrating because I am trying to follow this at the same time. Chairman White requested a"straight-forward" answer from the Respondent: Q. There were two doors ... two different doors? A. No. Q. Just one door? A. One door. Q. And it was a Code-compliant door from the perspective of the subcontractor who installed it. When did they install it—before October 2nd but after August 20th? A. Right. Q. And that was after you were aware of the fact that the peep-hole door was not going to be Code-compliant or not licensure compliant in terms of what it was that you were entitled to install? A. Correct, yes. 26 August 19,2015 Vice Chairman Lykos: Q. So if this [photograph] is the door that you managed the installation of—where's the peep hole? A. Because I didn't install the door ... Richard Joslin: Q. But you furnished the door—didn't you furnish a door with a peep hole? A. I supplied the door ... but if he was going to install the door ... the peep hole doesn't come with the door ... you have to drill a hole to put it in. Terry Jerulle: Q. But if you're supplying it, why didn't you drill the hole, put the peep hole in and give it to him to install? A. Because it would cost more to put it in. He didn't want to pay more. Q. But you're responsible for it, though. You got paid directly from the client ... so you're responsible for a peep hole to be in that door. So what you're saying is you took money from the client the client to put in a peep hole but your subcontractor didn't put it in and you're saying it's his fault and not yours? A. Umm ... no ... Q. We're asking the question ... where's the peep hole? Kyle Lantz stated the issue was that it was not part of his contract to install the peep hole. Vice Chairman Lykos: The reason he thought his license would apply was because it had a peep hole in it. Kyle Lantz: Right. Vice Chairman Lykos: Q. So if you didn't put the peep hole in—how did you think your license was going to apply if you didn't put the peep hole in there? If you buy a door without a peep hole and you put a peep hole in it, do you know whether or not it affects the Code- compliance of that door in terms of being UL-rated? A. Umm—it shouldn't if it's a UL-rated door. Q. Do you have an NOA with you to show that it doesn't happen? A. With me ... I don't think so. It's just a UL-rated peep hole—I mean, there is no NOA for it. Q. But doors —pre-hung doors are rated as an entire system ... the jamb, the hinges, the hardware, the door ... everything. So if you alter that system, how do you know that the altered system is still Code compliant? A. Because of the size of the hole—it's not a big hole. Q. Did you engineer it? And you tested it after you cut a peep hole in it? A. Absolutely not. Chairman White: Q. I guess your position, Mr. Brown, is that from a common sense perspective —you think that it wouldn't lose the UL-rating. But you don't have any factual infoiuiation to support your position? A. Yes. 27 August 19,2015 Kyle Lantz: As an aside, I failed an inspection because I put a peep hole in a door. Respondent: Really? Kyle Lantz: In Fort Myers Beach and I had to replace the door. Respondent: Wow ... that's a good reason for not putting the peep hole in it. Vice Chairman Lykos: His whole argument was that the peep hole made it comply with his license. And then he didn't put the peep hole in. Chairman White: Given that we have an admission of the violations for each of the two counts and, hopefully, we have worked through the timeline, the chronology, and the factual aspects of this. Is there a concern remaining—contrary to what the County said, and absent the consumer being present—that there was some impact or harm to the consumer? Because to me, that's the pertinent area of inquiry and relative not so much to the violations, but as we move on to the Sanctions. Michael Ossorio stated he spoke with the homeowner. He stated he knew the Building Department had taken strides in ... when a Contractor decides to cancel a permit and say, "I didn't do it—I want my money back—I want a refund and I want to cancel the pellnit." He further stated an inspector went out and verified the work had been done. The homeowner was notified and she came in—she was worried that she had an unpeimitted door which could affect her ability to sell her place because the cancellation of the permit or the inspection of the permit history on her ... so she was concerned enough to file a complaint and make sure that her door was inspected to prove it was Code compliant so she would have the ability to sell her place in the future. Chairman White: But there were no concerns about the discrepancy in dollar value? Michael Ossorio: No. Chairman White: With or without a peep hole? Michael Ossorio: No. Richard Joslin: Q. If this is the contract—nowhere in here did it say the door was to have a peep hole. A.: Right. Q: But it did say it was going to have stainless steel hinges. A. Correct. Q. But in your testimony, you said it might have been hinges that cost extra—I'm just wondering where the extra money came from? A. It probably was a hand-set. Q. You don't know? A. I don't have a recollection. It could have been a hand-set or a dead-bolt or hinges or a sweep on the bottom—I'm not sure. It was an extra something that she wanted ... maybe a hanger on the inside ... I don't know. I'm not sure. Richard Joslin asked Michael Ossorio if the door had a peep hole in it, would the case have come before the Board and his response was, "Yes." 28 August 19,2015 Mr. Ossorio further stated it was because the door was not a glass door and that a peep hole in a door did not make it a"glass door." Chairman White asked the Respondent if he had anything to present in his defense since he admitted his guilt and the response was, "No." Terry Jerulle asked if the property was a condominium. Rob Ganguli: It is but the garage area was detached from the dwelling and that's where the human access door was installed. Mr. Jerulle noted the contract stated "Prices based on 10 or more units" and asked if the Respondent had installed doors in other units. Michael Ossorio stated the Respondent had applied for multiple permits but only one complaint was made. He further stated the Respondent was in the process of permits for those doors. Respondent: I applied for five of them and I paid for all of them— a full $150 each without getting any money back. Michael Ossorio: You applied for five and were denied for five due to the licensure issue. What is the status—have those five door been installed? A. No, only two of them are in. Chairman White: If the County has any intention in the future of bringing forward a complaint based on any of the other owners, I would suggest that the conversation should end. Chairman White moved to approve closing the Public Hearing. Vice Chairman Lykos offered a Second in support of the motion. Carried unanimously, 8—0. Chairman White declared the Public Hearing was closed. Chairman White noted there was a Finding of Guilt for both counts, based on the Respondent's admission. Attorney Morey noted the Respondent is the holder of a Collier County Certificate of Competency. If after the Hearing, the Contractors' Licensing Board tinds that there has been misconduct, the Board may, but is not required to, impose any of the following Sanctions, either alone or in combination: 1) Revocation of a Collier County (or City) Certificate of Competency, 2) Suspension of a Collier County (or City) Certificate of Competency, 3) Denial of the issuance or renewal of a Collier County (or City) Certificate of Competency, 4) Imposition of a period of probation, not to exceed two years in length, during which time the Contractor's contracting activity shall be under the supervision of the Collier County Contractors' Licensing Board, and may be revoked for cause; 5) Restitution; 6) Imposition of a fine not to exceed $5,000, 7) Issuance of a public reprimand, 29 August 19,2015 8) Requirement for re-examination or participation in a duly-accredited program of continuing education directly related to the Contractor's contracting activity, 9) Denial of the issuance of Collier County or City building peunits or requiring the issuance of such permits with specific conditions, and 10) Recovery of reasonable investigative costs incurred by the County for the prosecution of the violation. Attorney Morey further advised the Board that, when imposing any of the possible Disciplinary Sanctions on a Contractor, the Contractors' Licensing Board may consider all the evidence presented during the Public Hearing as well as: 1) The gravity of the violation; 2) The impact of the violation on Public Health/Safety or Welfare; 3) Any actions taken by the violator to correct the violation(s); 4) Any previous violations committed by the violator, and 5) Any other evidence presented at the Hearing by the parties relevant to the Sanction which is appropriate for the case, given the nature of the violation(s) or the violator. Chairman White stated: • An after-the-fact permit was obtained. • There was no testimony of any prior violation. • The impact to the public's health, safety and welfare was minimal given the door that was installed was UL-rated and complied with the Permit. • The gravity of the violation is one that goes in part to the intent and the awareness that the Respondent had relative to what the Code may or may not have been. • The limited amount of testimony presented regarding the fact that there may be other similar circumstances that are in the process of being resolved that may or may come before the Board. (It was noted that Kyle Lantz left; quorum remained with seven voting members) Chairman White asked Michael Ossorio if the County had incurred any costs in the prosecution of the matter before the Board. Michael Ossorio stated the amounts of the investigative costs were $250 each for Count I and Count II, for a total of$500. Chairman White asked Michael Ossorio if the County had any recommendation concerning any Sanctions. Michael Ossorio: • Regarding Count II (lack of a building permit), the recommendation was to assess a fine of$1,000 to be paid within thirty days of the Court's Order. • Regarding Count I (working outside the scope), the recommendation was to assess a$2,500 fine to be paid within thirty days of the Court's Order. • The investigative fees incurred by the County in the total amount of$500 were to be paid within thirty days of the Board's Order. 30 ' August 19, 2015 • • Restitution was not necessary. The homeowner was pleased that a building peuuit had been obtained and the work had passed inspection. • There was no recommendation for probation or for a public reprimand. • The Board would detelinine the Respondent should attend a program of continuing education. • If the fines and investigative fees were not paid within the allotted timeframe, the Respondent's license will be revoked. Discussion: Terry Jerulle stated a program of continuing education should be imposed because it appeared there was a discrepancy between what the Respondent thought he could do and what he was allowed to do, pursuant to his licensure. Gary McNally requested to add a one-year probation period which would require the Respondent's future jobs to be monitored by the Contractors' Licensing Office, i.e., he would be required to notify the Contractors' Licensing Supervisor of his jobs on a weekly basis. Michael Ossorio noted there was a new test for Glass and Glazing Contractors based on the new Florida Building Code. He was not aware of any continuing education for Glass and Glazing Contractors. He further stated the Board had recently approved the use of a new testing company for the County, i.e., "Prov." Mr. Ossorio explained any reporting of jobs would be only the jobs within Collier County since the Respondent worked primarily out of Lee County. He noted if the Respondent did not comply with the reporting requirement, he would be scheduled for a hearing before the Board and would be given legal Notice. Chairman White asked the Respondent if he understood the Sanctions that the Board had discussed. Joseph Brown stated that he did understand and thought he had done due diligence by attempting to pull the required permits. He further stated he tried to do what was right. Michael Ossorio stated the reason why the fine requested for Count II was $1,000 w s because he knew the Respondent had already paid penalties to obtain the after- the-fact permit. Chairman White noted there were differences between the two Counties and with implementation of the new Building Code, there may be some value in requiring the Respondent to be re-take the Glass and Glazing test as administered by Prov for that license. He suggested the Respondent should be allowed three months to take and pass the test. Michael Ossorio noted a Prov testing facility was available in Lee County. He stated the passing grade for the test is 75%. There was no further discussion concerning the previously suggested Sanctions among the members of the Board. 31 August 19,2015 Chairman White moved to approve imposing the following Sanctions upon the Respondent, Joseph Brown who is the holder of Collier County Certificate of Competency #31217, d/b/a "Anything in Doors, LLC,"based on the findings of guilt regarding Counts I and II of the County's Administrative Complaint in Case #2015-04: • Count I: imposition of a fine of$2,500 to be paid within thirty days of the Board's Order; • Count II: imposition of a fine of$1,000 to be paid within thirty days of the Board's Order; • The Respondent is to reimburse the County for investigative fees incurred in the prosecution of the matter in the total amount of$500 ($250 for each Count) to be paid within thirty days of the Board's Order; • If the fines and investigative fees are not paid as required, the Respondent's license will be revoked; • The Respondent is required to take and pass the Glass and Glazing test as administered by Prov Testing within ninety days of the Board's Order; • If the Respondent does not comply with the testing requirement, he will be schedule for a hearing before the Board and will receive timely Notice of the date; • The Respondent will be placed on probation for a period of one year; he is required to report all Collier County jobs to the Contractors'Licensing Office on the Monday of each week during the 12-month period; • If the Respondent fails to report his Collier County jobs to the Contractors' Licensing Office, he will be scheduled for a hearing before the Board and will receive timely Notice of the date. Vice Chairman Lykos offered a Second in support of the Motion. Michael Ossorio clarified: • If the fines and investigative fees were not paid within thirty days of the Board's Order, the Respondent's license would be revoked. • If the Respondent does not take and pass the Glass and Glazing test within three months of the Board's Order, he will be scheduled for a hearing before the Board. • If he does not report his Collier County jobs on a weekly basis during the probationary period, the Respondent will be scheduled for a hearing before the Board. Chairman White called for a vote on the motion. Carried unanimously, 7— 0. Chairman White stated the Board's written Order would be rendered as quickly as possible. Chairman White asked Joseph Brown if he had any questions. Joseph Brown replied he did not understand why he was being required to take the test again that he had taken and passed. He understood the need for continuing education but questioned the need to retake the test. 32 August 19,2015 Chairman White responded there appeared to be a lack of clarity either in Mr. Brown's mind or the mind of his installer concerning what is and is not permitted; and the particular scopes of work allowed under the license; and what would affect the permitting, i.e., Mr. Brown was not aware that the addition of the peep hole with glass could affect the penulitting. He stated he wanted Mr. Brown to be fully aware of the requirements of the new Florida Building Code. He further stated the testing requirement was not intended to be punitive— it was intended to be helpful. Chairman White noted the final item on the Agenda was under"New Business," • Teodor Danilov—6 Month Review of Credit (d/b/a "Custom Flooring Design, Inc.") Chairman White asked Michael Ossorio if the County had a recommendation concerning how the Board should proceed. Michael Ossorio replied the recommendation was to revoke Mr. Danilov's Certificate. He stated Mr. Danilov could petition the Board if he chose. Chairman White noted there was little difference between the new credit report submitted to the Board and the prior report. There was not a great deal of change between the items specifically listed in each and there was no improvement in the FICO score. He stated there was no explanation from the license holder concerning his absence from hearing. Vice Chairman Lykos requested an explanation from Michael Ossorio of the difference between a"revocation" and a"suspension" of a Contractor's license and the requirements to reinstate in each case. Michael Ossorio: • He preferred to use the term "cancelled" in place of"revoked" • Mr. Danilov was already on probation with the Licensing Board; o He had been advised of the meeting date; o He provided a credit report that had no substance to it • The County recommended cancelling Mr. Danilov's Certificate. Vice Chairman Lykos asked if Mr. Danilov would be required to complete an entirely new application and petition the Board; the response was, "Yes." Michael Ossorio stated he and Attorney Morey had discussed the "un-revoking" of a license because once a license has been revoked. If a Contractor wanted to reinstate the license, he would be required to pay all fees owed. He stated it was a matter of semantics. The preferred teini was "cancelled" instead of revoked or suspended. Vice Chairman Lykos moved to approve the immediate cancellation of the probationary license that had been issued to Teodor Danilov, d/b/a "Custom Flooring Design, Inc." Richard Joslin offered a Second in support of the motion. Carried unanimously, 7— 0. 33 August 19,2015 IX. REPORTS: • Michael Ossorio noted it was renewal time for the County. Each County licensed Contractor will receive notification of the renewal of his/her license. • Approximately 3,200 renewal notice will be sent next week. • He also noted the State instituted a "grandfathering" clause for Division 1 and Division II (Electrical) Registered Contractors. • The loss of Registered Contractor renewals should not adversely affect the Contractors' Licensing Office budget. • He stated due to the efficiency and customer service provided by the front office personnel, a number of Registered General Contractors and Registered Plumbers come through the office. X. NEXT MEETING DATE: Wednesday, September 16, 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 12:00 Noon. COLLIER COUNTY CONTRACTORS' LICENSING BOARD PATRICK WHITE, Chairman The Minutes were approved by the Committee Chair/Vice Chair on , 2015, "as submitted" [ OR "as amended" F 1. 34 col ,- coKr-ty Growth Management Department Planning & Regulation Operations Division Licensing Section August 7, 2015 Charles K. Singletary Jr. Hardcore Concrete, Inc. 1462 Everglades Blvd. N. Naples, FL 34120 RE: Waiver of Exam(s) Mr. Singletary, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, September 16, 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) 252-5572. Sincerely, j , `Samantha Roe 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 Report Viewer Page 1 of 1 • 1 /1 100% La" 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: 8/3/2015 EXPIRATION DATE: 8/2/2017 PERSON: SINGLETARY CHARLES K FEIN: 474506648 BUSINESS NAME AND ADDRESS: HARDCORE CONCRETE INC 1462 EVERGLADES BLVD N NAPLES FL 34120 SCOPES OF BUSINESS OR TRADE: MASONRY NOC CONCRETE CONCRETE OR CEMENT CONSTRUCTION NOC WORK-FLOO 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 • wthrn 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 electors lobe 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 08-13 QUESTIONS?(850)413-1609 https://app s 8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D 7Q 3 gH6TER6e... 8/7/2015 • ,, 1-7 .1-1 .7---,.717,Y S 3a YiN v Ril Si-17; 2015 Charles Singletary 1462 Everglades Blvd. N. Naples, Fl. 34120 Collier County Licensing Board 2800 N. Horseshoe Dr. Naples, FL. 34104 Collier County Licensing Board: My name is Charles Singletary and I have lived in Collier County for 43 years. I owned my own company, Singletary Specialty Masonry, Inc. from 2002-2007. My Specialty is installing Architectural Precast, Cultured Stone, and Decorative Concrete & Block work. I worked with reputable companies such as Dan Henthorne Pre-Cast, Pre-Cast by Design, Ogden Brothers Construction and LJ Hayes Construction & BCBE Construction. Unfortunately, when the economy slowed down so did my business. I am looking forward to starting my business again and helping serve Collier County's needs for an experienced Contractor. Sincerely, C,ii rl s Si letary 1 % ..,or County iii GRID Operations & Regulatory Management Licensing Section n 2800 North Horseshoe Drive BY:_(a.21.;:1,:Z.a.. Naples, FL 34104 2 ) irj 2 i 34 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUTIONS: This application must be typewritten or legibly printed. The application fee must be paid upon approval and is not refundable. All checks should be made payable to: Collier County Board of County Commissioners. For further infolination, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: Exact Corporate/Business Name: ('--ICiir C,t C 0 1' r C ci',e- i ( k , `1 pc Fiction Name/DBA: Qualifier Name: \�CC i 1 ( `, .,, keti f i!�.� 'J j(. Physical Address: ) r~f 1 L I �J(v j cif `� ff ll.)d, jt...; . it)t.l 2P--- ; it `?C//`` l (Number& Street) j (City) (State) / (Zip Code) Mailing Address: I ctf '2 lr' () <' i /47 c ; j.3ivO i , /L Oe <,.; / (_ . 1i�_- . (Number& Street) (City) (State) (Zip Code) Telephone: �`; .5 6i/ S ,� t � � cam` 6 i, c :J, '�` a E-mail: t ht-� 0� A ; ,t1t,'�� (,ei1 . 3 t 3 �S -0vc) - ((cif - ,,au,-) TYPE OF LICENSE: General $230.00 Electrician $230.00 Building $230.00 Plumber $230.00 Residential $230.00 Air Conditioner $230.00 Mechanical $230.00 imming Pool $230.00 Roofing $230.00 Specialty $205.00 ../C't Jr r' �-i C 3 i;fr: Specialty Trade: / 6/8/2015 Reinstatement Fee= $205.00 3 Year Fees= $555.00 CHANGE OF STATUS,,: New License Fee=$205.00 (Reinstatement ( L)From One Business to Another i *Different fees may rppl�* Total=$965.00 prf.U`-,=J'C'S' ?1Z'- 11 Page 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. [ 4; ' :h6 4 !f<. - sired ' eo 1 Nrt_c_,J I i4 /r 1(1) V - 8C:jiCIei'l 4 L' , (i.t f:1 v<1 i lei f.. (L:1) / e CG c:i; f�► d.i:,t• !Ll c 2 c 0,Y/ //G7,/�� , :1.',-/'//.. 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years (i.e. held a license for or been a partner). Attach extra pages if needed.• .� i ►�,ti. jf 4(7,r y `)i)ee i (ii l y Ill 6Soit? y j yjc__ 3. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. AFFIDAVIT Under the penalties of perjury I declare that I have read t e fore tying application and that the facts stated in it are true. / `,, 4 i Authorize. Of cer of ty- Firm il The foregoing instrument as acknowledged before me this `'"( c0 en �' /� (Date) , t v by edIA2L-S 51 I1J6L--(5%:'f/Z>1 of ki prR"D co(6- (sonee4e_1 ..11 C-- (Name of Officer, Title/Agent) (Name of Corporation) a n._00_1 61R\ Corporation on behalf of the corporation. (State or Place of Corporation)J He/She has produced P, 4 _ � /LU2tit9�'- identification and did not take an oath. (Type of•' entification) NOTARY'S SEAL ;.fl 1) II' /l ,'• !2 JUDITH T FRYE yi(SIGNATURE OF NOT Y) i.: MY COMMISSION#FF147462 f. NoFF,o'' EXPIRES August 3,2018 Page 2 of 4 (407)398-0153 FloridallotaryService.com QUALIFIER INFORMATION: Name: ( \'1 c' )e 'S f3: )_scd ,( y Address: ' t <. ( /Gt J kz_ f t.'cl = � f= ``L ` �' i (Number& Street) (City) (State) !" (Zip Code) 1 Telephone: cam' } ' c` (.)` l CN I. Date of Birth: 1 /2. ;// / 7 j/ i SS#: _ E-mail: lC ` >�t )( t :0- ( c4� ./Alb/ (. �Yt� Driver's License#: ( 1. Type of Certificate of Competency for which application is made. Mit id 2. The names and telephone numbers of two persons who will know your whereabouts. ��.i iI/ lay - )3 2 — // (4. • 3. Have you ever been convicted of a crime related to Contracting? 1V( (If yes,attach extra sheet with explanation.) 4. Have you or any firms you have been associated with ever filed bankruptcy? l -' 5. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay and reasons why. 6. List your business or work experience during the last ten years. L ��". \ ?�� i. G,,11,t E{f ��.Y r`i r t}."�'✓.� c;jlUl_.,� - I t 2 i9 C iy ci 7. Statement of any faunal training you have had in the area for which the application is made. J 2 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County No. 2006-46, as amended, and under penalties of perjury. I declare that I have read the foregoing qualifier information and that the facts stated in it are true. 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/she will be held strictly accountable for any and all activities involving his license. Any willful falsification of any infoumation contained herein is grounds for disqualification. Applicant (please print) I- tii CI(OiF ( Ca1 (jC/ _ ) i i , Name of Compan ./., (L./ - Signature of Appli t State of Florida County of 0aI lie r The foregoing instrument as acknowledged before me this c7 /17 /a 01 (Date) by (z/¢i 2 LLB S I iu6 L e1/ 2'J who has produced el/L/00-4661f k;17Lge,./f u (name of person acknowledging) (type ontification) as identification and did not take an oath. NOTARY'S SEAL ...-----f f// (SIGNATURE OF NOTARY) o'jtip•_ JUDITH T FRYE (/; Cy�,,F�+ OMY COMMISSION#FF147462 ' .�r`-) 1 EXPIRES August 3. 2018 4 of 4 (.107)398.0153 FloridallotaryService.com AFFIDAVIT It is understood and acknowledged by the Collier County Contractor's 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 m '}tific to of jompe e y. Signature of Applicant v ` n tli v (" L v C t c.41 f el( 1 -1,'`�-- Business Name ? lii 1/5- Date BEFORE ME this day personally appeared C l-(d-�1 l L 65 3■ IV 6 L bT/4 62 who affi�nis and says that he/she has less than one employee and does not require Workmen's Compensation and understands that at any time he/she employs one or more persons he/she must obtain said Workmen's Compensation Insurance. State of Florida County of G O T H `2(' The foregoing instrument as acknowledged before me this _ILA L—y I 1 20 l 5 (Date) by C h k-r 1-es 51 vv c1 k .--q who has produced ()er5z,no, +l i �l✓�pc0 (name of person acknowledging) U (type of identification) as identification and did not take an oath. NOTARY'S SEAL ' CteAA / -- __,t-el--e.--- I _.,:.. °e4, (SIGNATURE OF NO'T ARY) ` ',p � ,�. JUDITH T FRYE s MY COMMISSION#FF147462 1 •.,Far�.d":1 EXPIRES August 3,2018 (4071.398-0153 FloridallolaryService.corn • VERIFICATION OF CONSTRUCTION EXPERIENCE', GMD Operations & Regulatory Management Department Licensine Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: c 3L (i.li l�+6-CC) Certificate Category Requested: �j The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate,the applicant must verify their experience within this trade. You are being requested to provide information that will aid the applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described,but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name: �t �'c L.) Title: re C License Number (if applicable): Name of Business: L pS � �j G r1� `jS G'( I U L Business Address: L 1 0 34- dz,V CC', C" L 3 Business Phone: X39 t� T © S'47 ( The applicant's years of experience from 1 9q to k y r-e_s-'.rl\' The applicant's scope of work(specific duties) included: 11—d On t Additional comments: Falsifying any information provided herein may subject your license to revocation. Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. T Oi�.. Signatge j Prin Name State of Florida I County of do /jeer The foregoing instrument as acknowledged before me this '� Il q /Z-01 5— / (Date) by C/a r /-e5 S i n9,/&°r"ar r who has produced 0 7Olic?/ A�� n (name of person acknowledging) ii (type of identification) as identification and did not take an oath. NOTARY'S SEAL 7G/J.2if,1— / (SIGNATURE OF OTARY) I 4.0' '��-: JUDITH T FRYE A„ MY COMMISSION#FF147462 0;oj,` EXPIRES August 3, 2018 0107)398-0153 FloridallotaryService.com AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF FIorict c COUNTY OF Collier I, b ' ) C V " +O ,having been first duly sworn, state and affirm: I am a resident of C Q (( C !/ County, ( O Y CI S.. (State) and have resided here for more than five (5) years. During the last five years I have known 4 <, C ( t � Sl" C�r y (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 4 7Lf x1 6/e/171-‘j- Name e J- 77- 3-.7t/-2,sa .riress Telephone The foregoing instrument as acknowledged before me this 1 ck*h < 06 by (t)- (;l `:V who has produced (7C( 11)C---A-)r• (Date) (name of p rson acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL (SIGNATURE OF NOTARY) �• ".;;V,"‘.,.„ MICHELLE KLINK ;3`;`.1 Notary Public-State of Florida . r My Comm.Expires Mar 21,2017 -< ;:•• Commission#FF 001556 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF R or i d 'i COUNTY OF Collier I, Te o G 1 e vn� having been first duly sworn, state and affirm: I am a resident of Co I<< C V' County, lo r i d 4 (State) and have resided here for more than five (5) years. During the last five years I have known A r C TU/ 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 tOn\-C-k_ -- Name Address 23 X37---(,) A C� Telephone The foregoing instrument as acknowledged before me this q cI5 by T(�-- 1.a who has produced P-Q() c con Ci V—(\cur\ (name of person acknowledging) (type of ident fication) as identification and did not take an oath. NOTARY'S SEAL 1 1 LLLLL)r (SIGNATURE OF NOTARY) ;"v"z!,,,�; MICHELLE KLINK Notary Public-State of Florida if My Comm.Expires Mar 21,2017 P$ Commission #FF 001556 Licensee Information Licensee Number Q21023 Description _ Type Property Alert Name CHARLES KEITH SINGLETARY JR. Type Contractor ■ Status Open v View Master Project View All Activities for this Licensee Add a new person or business to Address Book Examination Results A Add Exam Result Link I Exam/Test Type Date of ExarrQTest City Score received _ Exam/Test result MASONRY 06/03/2000 FT. MYERS 56% Fail BUSINESS AND LAW 06/03/2000 FT. MYERS 79.6% Pass MASONRY 01/05/2002 NAPLES 79.6% Pass • Show More Fields I Hide or Clear Fields Charge Exam Fee [_] Exam Code I Sponsoring County I Sponsorship App Date I — Sponsorship Expiration Date I — Testing Facility I Jun 24 15 10:58a 2392770167 p.1 1• 11� Merit Credit Phone:1-239-277-3202 or 1x8800-3713348 Secure. 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. Jun 24 15 10:59a 2392770167 p.2 Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNICN CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] (I) Z NP6284423 MERIT CREDIT 16 NP 6/90 06/10/15 09:38CT [SUBJECT] f GGNI SINGLETARY, CHARLES K. JR. [BIRTH DATE] [CURRENT ADDRESS] 0006 11/71 1462 N. EVERGLADES BV. , NAPLES FL. 34120 [DATE RPTD] [FORMER ADDRESS] 4/15 3770 NE. 35TH AV. , NAPLES FL. 34120 4760 NE. 22ND ST. , NAPLES FL. 34120 10/12 [CURRENT EMPLOYER AND ADDRESS] [VERF] [RPTD] SINGLETARY SPCLY MASONRY [FORMER EMPLOYER AND ADDRESS] 10/07 10/07 SINGLLTARY SPEC MASONARY 2/06 MODEL P R O F I L E * * * ALERT * * ***FICO CLASSIC 04 ALERT: SCORE +685 : 040, 010, 008, 014 *** 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=2 NEG=0 HSTNBG=O TRD=11 RVL=5 INST=4 MTG=2 OPN=O INQ=6 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $4373 $9500 $3454 $0 INSTALLMENT: $29.2K $81 64% $ $23.5K $0 $1141 MORTGAGE: $218K $ $218K $0 TOTALS: 8252K $9500 $1543 $245K $0 $2764 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR ACCOUNT# VERIFIED MOP GRANT&WEBER Y 847Y003 I 10/09 1/14F $290 CE MEDDICAL 6905530 1/14A 09P $0 PAID COLLECTION HSP CLOT SVC Y 67LL002 I 10/09 12/13F $126 MEDICAL 1902245 1/14A 09P $0 PAID CO'-.,LECTION 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 30/50/90 CAPITAL ONE B 1DTV001 4/15 $848 MIN25 6/15A $3000 $0 1 RO1 I CREDIT CARD $33 1 0/ 0/ 0 WESTLAKE FIN F 1T9Q001 1/14 $14 .3K 42M483 111111111111 I01 6/15A $0 111 I AUTOMOBILE $10.4K 15 0/ 0/ 0 Jun 24 1510:59a 2392770167 p.3 BRCLYSBANKDE B 1ZZB001 5/15 $0 5/15A $2000 RO1 I CREDIT CARD $0 $0 WELLS FARGO B 908N664 12/13 $569 MIN25 5/15A $500 111111111111 RO1 I CREDIT CARD $0 1111 $465 16 0/ 0/ 0 TRD/CBNA B 26H3005 5/15 $2956 MIN30 5/15A $4000 R01 I CHARGE ACCOUNT $0 $2956 DAKOTA W CU Q 1BUV001 4/15 $10.6K 24M482 5/15A I01 I AUTOMOBILE $0 $10.2K CAPITAL ONE B 1DTV001 3/14 $1233 5/15A $1251 111111111111 RO1 I CREDIT CARD 5/15C SO $0 1 ACCT CLSD BY CONSUMER 13 0/ 0/ 0 EVERHOME MTG F 704R001 3/15 $218K 360M1543 5/15A Mdl I CONVENTIONAL REAL $C $218K ONEMAIN FI F 2DCM001 7/14 $4202 36M176 4/15A 111112111 I01 $0 C AUTOMOBILE $2899 9 0/ 0/ 0 CRESCENT B&T B 922P004 2/06 $19.3K 42M685 3/10A 111111111111 IO_ , $0 1121911 C AUTOMOBILB 3/_OC $0 CLOSED 19 0/ 0/ 0 OCWEN/HOMEWA F 1946001 4/04 $157K 360M1960 5/07A 1 P901 C CONVENTIONAL REAL 5/07C $0 CLOSED 1 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNA E 6/10/15 ZNP6284423 (FLA) MERIT CREDIT TYPE AMOUNT 5/02/15 BWL3390354 (WI ,) BRCLYSBANKDE 4/07/15 BPC2699824 (NTL) CAP ONE 2/09/15 FCO1207005 (CAL) CREDCO 11/19/14 QCH4288533 (CHI) REGION MORTG 12/15/13 BPC2699824 (NTL) CAP ONE 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.transunior_.com CREDITOR CONTACT INFORMATION GRANT&WEBER YC847Y003 861 CORONADO CENTE HENDERSON NV. 89052 (702) 366-7008 HSP CLCT SVC YC67LL002 (775) 333-4255 816 S CENTER Si' RENO NV. 89501 CAPITAL ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 WESTLAKE FIN FS1T9Q001 (323) 692-8800 4751 WILSHIRE BVLD LOS ANGELES CA. 90010 BRCLYSBANKDE BZ1ZZB001 (866) 370-5931 P.O. BOX 8803 WILMINGTON DE. 19899 WELLS FARGO BC908N664 (800) 642-4720 CREDIT BUREAU DISP DES MOINES IA. 50306 THD/CBNA BZ26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 DAKOTA W CU QU1BUVC01 (701) 842-6484 329 N MAIN ST WATFORD CITY ND. 58854 EVERHOME MTG FM!704R001 (800) 669-9721 301 WEST BAY STREE JACKSONVILLE FL. 32202 ONEMAIN FI FZ2DCM001 (800) 922-6235 6801 COLWELL BLVD IRVING TX. 75039 CRESCENT B&T BZ922P004 (504) 525-4381 1100 POYDRAS ST NEW ORLEANS LA. 70112 OCWEN/HOMEWA FM1946001 (877) 304-3100 1525 S BELTLINB COPPELL TX. 75019 BRCLYSBANKDE B 3390354 (866) 370-5931 PO BOX 8803 WILMINGTON DE. 19899 CAP ONE B 2699824 (800) 955-7070 PO BOX 30281 SALT LAKE CITY UT. 84130 CREDCO F 1207005 (800) 523-0233 PO BOX 509124 SAN DIEGO CA. 92150 REGION MORTG Q 4288533 (856) 627-5800 815 EAST GATE DR MOUNT LAUREL NJ. 08054 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. • VIM X11 Merit Credit Fast, Accurate & Secure. MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800-371-3348 OR 239-277-3202. COMPANY NAME:SINGLETARY SPECIALTY MASONRY INC FEDERAL ID: 74-3071527 CURRENT STATUS: INACTIVE BUSINESS PRINCIPAL(S): NICOLE SINGLETARY TITLE:VP CHARLES SINGLETARY TITLE: PRESIDENT DATE INCORPORATED:12/15/2002 s rc 'j,,:c) C it- o co—: ,-: Premier Profile-SINGLETARY SPECIALTY MASONRY,INC _. .. • Subcode:970135 Ordered:06/10/20151326:38 CST •: ::Ex erian- Transaction Number:C500878098 •il•• • : Search Inquiry:SINGLETARY SPECIAL/PO BOX 12182/NAPLES/FL/34101/US/N/A/737028496 Aworld of insight Model Description:Intelliscore Plus V2 Business hlarn' `z 6..sres, 'lent',icaticn rtur-ieer SINGLETARY SPECIALTY .MASQNRY, INC. .e ‘? 7370.28496 • Primary Address: PO BOX 12182 Tax ID: 74-3071527 NAPLES,FL 34101-2182 ilk This business is the ultimate parent. See the corporate hierarchy by clicking here TOP 0 Risk Dashboard Risk Scores and Credit Limit Recommendation Days Beyond Terms Derogatory Legal Fraud Alerts Intelliscore Plus Financial Stability Risk Company DBT Original Filings High Risk Alerts HIGH RISK �. .. 1 HIGH RISK O . _f.;: I ti_... - -. .; . Score range:1-100 percentile Credit Limit Recommendation:$2,100 j�1�516 TOP 0 f�a-�M'�i�S.oF�X�'3a�arAcA..-sere.., .,.. . .,. .... ._;.�.r�J•,.- Years on File: 13(FILE ESTABLISHED 02/2002) SIC Code: CONCRETE WORK CONTRACTORS-1771 State of Incorporation: FL NAICS Code: Date of Incorporation: 03/18/2002 Foundation,Structure,and Building Exterior Contractors-238100 Business Type: Profit Contacts: CHARLES K SINGLETARY-OTHER THAN LISTED top 0 Commercial Fraud Shield v?;uatcr for.SINGLETARY SPECIALTY MASONRY,INC,PO BOX 12182. NAPLES.FL34101-2182 Business Alerts Verification Triggers Active Business Indicator II) Experian shows this business as active INACTIVE DOMESTIC CORPORATE FILING FOUND Possible OFAC Match: MI No OFAC match fourd Business Victim Statement: No victim statement on file ICJ TOP a Credjt Risk Score and Credit Limit Rec.on?EnPndatrion Credit Risk Score:Intellscore Plus Current Intelliscore Plus Score:6 Risk Class: 5 I ,, 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-SINGLE-ARY SPECIALTY MASONRY,INC 1/4 Jun 11 15 09:00a • 2392770167 102 • i r High Low Risk Risk 0 10 25 50 75 100 This score predicts the likelThood 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 severe delinquency. NUMBER OF COMMERCIAL ACCOUNTS WITH NET 1-30 DAYS TERM r BALANCE OF COMMERCIAL ACCOUNTS AT WORST DELINQUENCY NUMBER OF COMMERCIAL COLLECTION ACCOUNTS Quarterly Score Trends Quarters'Score Trends 100 90 • e0 70- The Quarterly Score Trends provide a view of the 60 - likelihood of delinquency over the past 12 months for this • 50- business.The trends will indicate if the score improved, remained stable,fluctuated or declined over the last 12 40- .. • months. 30 20 .. to__ •. _ _•-- s-t Sip• v � �.EEB v.e` �{ Credit Risk Score:Financial Stability Risk Current Financial Stability Risk Score: 1 Risk Class: 5 t ••""fitl3fi'RISIro"" .High sepetsfiams 1 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 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 COMMERCIAL COLLECTION ACCOUNTS 0%of businesses indicate a higher likelihood of financial stability risk. NUMBER OF ACTIVE COMMERCIAL ACCOUNTS >PERCENT OF TOTAL COMMERCIAL BALANCE SERIOUSLY DELINQUENT >PAST COMMERCIAL DEROGATORY BALANCE Credit Limit Recommendation Credit Limit Recommendation This recommendation compares this business against similar businesses in the Experian business credit database.It is based on trade information,industry,age of business and the Intelliscore $2,100 Plus.The recommendation is a guide.The final decision must be made based on your company's business policies. TOP Payme/Vtz,anci �e�al-Filings Sumr ry, , • Premier Profile-SIN'GLETARY SPECIALTY MASONRY,INC 214 Jun 11 1509:004 2392770167 p.4 •Payment Performance Trade and Collection Balance Legal Filings Current DBT: 0 Total trade and collection(4): $4,515 Bankruptcy: No N!A All trades(2): $2,100 Tax Lien filings: 0 Predicted DST: ( ) Judgment filings: 0 Monthly Average DBT: 0 All collections(2): $2.415 Sum of legal filings: $0 Highest DBT Previous 6 Months: 0 Continuous trade(1): $0 UCC filings: 0 Cautionary UCC filings: No Highest DAT Previous 5 Quarters: 0 6 month average: NIA Payment Trend Indication: Highest credit amount extended: N!A 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 0.SO%of businesses have a DBT range of 0-5. DBT for this business:0 e• 1 % of businesses 'n°'_• 1 • • DBT Range 0-5 6-15.16+ TOP . Date Status Original Outstanding Date Agency Agency Phone Placed Balance Balance Closed CITI-HOME DPT (800)3�2-7010 C1612009 Open Account $353 $353 COLLECTIONS CITI-HOME DPT 06/2009 Open Account $2,062 $2,062 COLLECTIONS (800)392.7010 TOP: Recent High Balance Current 01-30 31-60 61-90 91+ Trade Line Type Lines Reported DBT Credit Continuous 1 $0 New 0 Combined Trade 1 $0 Additional 1 $2,100 $2,100 100% Total Trade 2 $2,100 $2,100 100% TOP 0 Ira d.e,Pl'a,}t.rq-ent-,Kew 4.41.17 C911414qu11y,f3„eipo¢te4d Trade Details • Payment Experiences Account Status (Trade Lines with an(")after the date are newly reported) Days Beyond Terms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Category Reported Sale Terms Credit RENTALS 02/2015 NET 10 $0 TOP 0 }Trade fla .ment,-Add iot? l Tdue,ail ,,, . • Payment Experiences Account Status (Tr ade Lines with an(4)after the date are newly reported). . Days Beyond Terms Business Date Last Payment Recent High Balance Cur 1-30 31-60 61-90 91+ Comments Cat o Re orted Sale Terms Credit BLDG MATRL 02/2014 03/2006 CREDIT $2,100 $2,100 100% TOP.fir p A,da►tio Il:BusiJ1 %Facts - • , • Premier Protde-SINGLETARY SPECIALTY MASONRY,INC 3f 4 Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE _~' DIVISION OF CORPORATIONS Detail by Entity Name Florida Profit Corporation HARDCORE CONCRETE, INC. Filing Information Document Number P15000057721 FEI/EIN Number NONE Date Filed 07/06/2015 Effective Date 07/04/2015 State FL Status ACTIVE Principal Address 1462 EVERGLADES BLVD N NAPLES, FL 34120 Mailing Address 1462 EVERGLADES BLVD N NAPLES, FL 34120 Registered Agent Name & Address SINGLETARY, CHARLES K, JR 1462 EVERGLADES BLVD N NAPLES, FL 34120 Officer/Director Detail Name &Address Title P SINGLETARY, CHARLES K, JR 1462 EVERGLADES BLVD N NAPLES, FL 34120 Title VP SINGLETARY, NICOLE L 1462 EVERGLADES BLVD N NAPLES, FL 34120 Annual Reports No Annual Reports Filed htt»•//caarr•h cnnh;v nrrr/Tnmi;ru/l nrrinratinriCaarrh/CaaYr•hKac111fTlata;19;nm,;r,7t,ma—R,,t;1-,, 1/Z1 /7/11 C Detail by Entity Name Page 2 of 2 Document Images 07/06/2015 -- Domestic Profit View image in PDF format Oj yri(iht and Priv.).y State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/31/2015 Electronic Articles of Incorporation P15000057721 FILED For July 06, 2015 Sec. Of State tburch HARDCORE CONCRETE. 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: HARDCORE CONCRETE, INC. Article II The principal place of business address: 1462 EVERGLADES BLVD N NAPLES, FL. 34120 The mailing address of the corporation is: 1462 EVERGLADES BLVD N NAPLES. FL. 34120 Article III The purpose for which this corporation is organized is: MASONRY Article IV The number of shares the corporation is authorized to issue is: 1 Article V The name and Florida street address of the registered agent is: CHARLES K SINGLETARY JR 1462 EVERGLADES BLVD N NAPLES, FL. 34120 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: CHARLES SINGLETARY P15000057721 FILED Article VI July 06, 2015 Sec. Of State The name and address of the incorporator is: tburch CHARLES SINGLETARY 1462 EVERGLADES BLVD N NAPLES, FL 34120 Electronic Signature of Incorporator: CHARLES SINGLETARY 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 CHARLES K SINGLETARY JR 1462 EVERGLADES BLVD N NAPLES, FL. 34120 Title: VP NICOLE L SINGLETARY 1462 EVERGLADES BLVD N NAPLES, FL. 34120 Article VIII The effective date for this corporation shall be: 07/04/2015 Jun 11 15 09 OOa 2392770167 p.5 1 Corporate Registration THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE CF FLORIDA.THE DATA IS CURRENT AS OF 06/10;2015. State of Origin: FL Date of Incorporation: 03/18/2002 Current Status: Inactive Business Type: Profit Charter Number: P020000311 Agent: SINGLETARY JAMES K A..o.,$Aridirace! 1988 46 STREET SW NAPLES,FL ACOR°® CERTIFICATE OF LIABILITY INSURANCE 7/30/2015 `--� 7/30/2015 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 Gulf Coast Insurance, LLC PHON: Angela Allen 7795 Davis Blvd Suite 205 ((A/C,No,Ext):239-403-3940 FAX No).239-403-3943 Naples FL 34104 E-MAIL an ela cimail.com P ADDRESS: 9 @g INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Southern-Owners Insurance 10190 INSURED INSURER B: Hardcore Concrete Inc INSURER C 1462 Everglades Blvd N Naples FL 34120 INSURER o; INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:69246720 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE .INSD END POLICY NUMBER (M MIDD/YYYY),(M MIDD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY 20206819 7/30/2015 7/30/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE= X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP Any one person) $10,000 I PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $2,000.000 POLICY PRO- -_ JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE—LiMrt $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ I L 0,A/1\11 D SCHEDULED Hill OS AUTOS BODILY INJURY(Per accident) $ NON OWNED PROPERTY DAMAGE HIRII 0 AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE, I AGGREGATE $ DED RETENTION$ , , , _ - - $ WORKERS COMPENSATION ' PER ' OTH- ' Y/N, STATUTE ER ONFICER MEMBER/EXCLUDED?ECUTIVE N/A E.L.EACH ACCIDENT $ AND EMPLOYERS'LIABILITY (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under -- - - ---- - --- — DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Contractor Licensing Board ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N Horseshoe Dr Naples FL 34104 US AUTHORIZED REPRESENTATIVE ' . (.r 1.-.' ,. tf ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NOTICE OF ELECTION TO BE EXEMPT If this application contains incomplete or inaccurate information, it may cause a delay in the issuance of your exemption.An officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under this chapter. Section 1: APPLICANT INFORMATION First& Last Name: Charles K Singletary Jr State Driver's License Number: State ID Number: State: FL S524151714240 Date of Birth: 11/24/1971 Social Security Number(last four digits): Email Address: kcsingletary9@gmail.com Section 2: CONSTRUCTION INDUSTRY APPLICANT($50 FEE REQUIRED) Officer of a Corporation (Construction) Corporate Title: PRESIDENT Section 3: This section should be completed with information specific to your corporation or to the limited liability company in which you are a member. The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations. Name of Corporation or LLC: Hardcore Concrete Inc FEIN: 47-4506648 IF YOU NEED TO APPLY FOR A FEIN,CLICK HERE Business Name (DBA): Phone: (239)398-0406 Applicant's Address of Record: 1462 Everglades Blvd N City Naples State: FL Zip 34120 County: Collier Click on the arrow(s) next to the text box(s)to view a list of available Scope classifications/trades for the form type chosen in Section 2. Click on the appropriate scope to select. If you are unsure as to which classification/trade to choose, please contact your workers'compensation insurance carrier. If you do not have a workers'compensation insurance policy, contact the National Council on Compensation Insurance (NCCI)at 1-800-622-4123 option 5 to obtain a classification code. Scope 1: 05213 Concrete Scope 2: 05022 Masonry Scope 3: 05221 Concrete or Scope 4: Construction NOC NOC Cement Work-Floors, Driveway Section 4: The corporation of which you are an officer or limited liability company of which you are a member must be registered and in ACTIVE status with the Florida Division of Corporations.Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with the Florida Division of Corporations.List the document number on file with the Florida Division of Corporations. 500274046365 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: 253662150 Application Number: E00368972 Section 7: N/A Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which this application applies? Name: FEIN Name: FEIN Name: FEIN Section 8: CONSTRUCTION INDUSTRY AND NON-CONSTRUCTION INDUSTRY LLC MEMBERS ONLY To be eligible for a construction industry exemption or a non-construction limited liability company exemption, an applicant must have the required ownership of the corporation or limited liability company. I am a shareholder owning at least ten percent(10%) of stock of the corporation listed on this application. Section 9: I certify that any employees of the corporation or members of the limited liability company listed in Section 3 are covered by workers' compensation insurance. Please identify the workers'compensation insurance carrier that covers any non-exempt employees. Carrier Name: My business does not have any non-exempt employees Section 10: FRAUD NOTICE A. Any person who, knowingly and with intent to injure, defraud, or deceive the department or any employer or employee, insurance company or any other person,files a Notice of Election to be Exempt containing any false or misleading information is guilty of a felony of the third degree. B. Attestation of applicant—By providing my name below, I attest that I have read, understand and acknowledge the foregoing notice. C. Acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any affiliated corporations as provided in Section 440.02, Florida Statutes. First Name: Charles Last Name: Singletary Note: The Division has 30 days to review your application to determine if it meets the eligibility requirements for the issuance of an exemption. The Division will either issue a Certificate of Election to be Exempt or notify you that your application is incomplete. The Division reviews and processes exemption applications in the order they are received. Exemption information is reflected on the Proof of Coverage database the day following the issuance of the exemption.Visit the Division's website at http://www.myfloridacfo.com/wc to print your certificate. I RS INTERNNALNREVENUEESER ICERY CINCINNATI OH 45999-0023 Date of this notice: 07-13-2015 Employer Identification Number: 47-4506648 Form: SS-4 Number of this notice: CP 575 A HARDCORE CONCRETE INC 1462 EVERGLADES BLVD N NAPLES, FL 34120 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 47-4506648. 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 ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. (IRS USE ONLY) 575A 07-13-2015 HARD B 9999999999 SS-4 Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please CP 575 A correct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 07-13-2015 ( ) - EMPLOYER IDENTIFICATION NUMBER: 47-4506648 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE HARDCORE CONCRETE INC CINCINNATI OH 45999-0023 1462 EVERGLADES BLVD N lllll n11'11111 NAPLES, FL 34120 (IRS USE ONLY) 575A 07-13-2015 HARD B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042) , excise taxes (Form 720) , or income taxes (Form 1120) , you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT REMINDERS: * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write 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 HARD. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. 7/13/2015 EIN Individual Request-Online Application ` IIRS.gov EIN Assistant 5.EIN Confirmation Summary of your information Please review the information you are about to submit.If any of the information below is incorrect.you will need to Start a new application Click the"Submit"button at the bottom of the page to receive your EIN. Organization Type:Corporation Corporation Information Legal name: HARDCORE CONCRETE INC County: COWER State/Territory: FL Date Corporation started or acquired: JULY 2016 Closing month of accounting year: DECEMBER State/Territory where artides of organization FL are(or will be)Ned: Addresses Physical Location: 1462 EVERGLADES BLVD N NAPLES FL 34120 Phone Number: 239-352-9183 Responsible Party Name: CHARLES KEITH SINGLETARY JR SSN/TIN: XXX-XX-0006 Principal Business Activity What your business/organization does: CONSTRUCTION Principal products/services: CONCRETE Additional Corporation Information Owns a 55,000 pounds or greater highway motor vehicle: NO Involves gambling/wagering: NO Involves alcohol,tobacco or firearms: NO Files Form 720(Quarterly Federal Excise Tax Return): NO Has employees who receive Forms W-2: NO Reason for Applying: STARTED A NEW BUSINESS We strongly recommend you print this summary page for your records as this will be your only copy of the application.You will not be able to return to this page after you click the"Submit" button. Click"Submit"to send your request and receive your EIN. Submit Once you submit, please wait while your application is being processed.h can take up to two minutes for your application to be processed. COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION • ��, 2800 N. Horseshoe Drive,Naples,FL 34104 _; aitiro< Make Check Payable to: Collier County Tax Collector ��..•�'� Phone: 239-252-2477 Fax: 239-643-4788 Website: www.colliertax.com �'kou �1µ`••`'' 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.sunhiz.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 pa)able (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 tee made payable to:Collier County Tax Collector.(239-252-2477) Copy of Motor Vehicle Repair Registration Certificate from Department ofAgriculture.(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 ofAgriculture. 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 - H (lv c ( c'r' Q �- L}-1C.. t'(' I ( , 16 iL la) DBA NAME - lb) BUSINESS OWNER OR QUALIFIER'S NAME - ( Cl('ty I r S 2) PHYSICAL ADDRESS - (No P.O. Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - I/ Yes No 3) BUSINESS MAILING ADDRESS- )q1c,? (,,t'i c/fr(- es (.,l U(') %L). /)47 k(iS - Street City Zip yy/C� 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - 1' /L' 2 Cf bid , 5) TELEPHONE -Business: ? (bid ; Home: )3/- 3)‹.;) -- 9/cy 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership poration LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 8) OFFICE WITHIN CITY LIMITS OF NAPLES- 1, Yes No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLO,.,Y/�`l E(R� IDENTIFICATION NO. /W 7 - SO *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: y 10) NUMBER OF EMPLOYEES -Including number of owners: 11) FILL IN THE APPROPRIATE AREAS- a)Rental units(motel/hotel/apts.)Number of units: b)Seating Capacity(rest./cafes,etc)Number of seats: c)Number of coin-operated machines owned by business or individual: 12) STATE LICENSE OR CERTIFICATION NUMBER- 'Iust have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERT RX, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: DATE: F .E I0 N A. B. \Ni) C FOR OFFICE UM:, 0:\ 1. THIS SECTION TO BE FILLED OUT BY CONTRACTORS/BCC LICENSING BOARD SECTION A Classification of Contractor: County Certification Number: Department Supervisor Date: THIS SECTION TO BE COMPLETED BY PLANNING SERVICES SECTION B Business is an in-home occupation and the applicant has agreed to adhere to the requirements as set forth in the Collier County Zoning Ordinance. PROPERTY Business DOES COMPLY with the Collier County Zoning Ordinance. ZONED Signed: Title: Date: Comments: THIS SECTION TO BE COMPLETED BY THE HEALTH DEPARTMENT SECTION C Business DOES COMPLY with the local and/or State requirements. Signed: Title: Date: * In accordance with Florida Statute 205.0535(5), we require you to provide us with either a Federal Employer Identification Number (FEIN) or a Social Security number. . Cot County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GRO+Fi T H: MANAGEMENT DIVI ICI4 ``.ALES, FLORIDA 54164 "".".3e` 2 2-24'O Gds Y (2 2E_E:250 LAND USE AND ZONING CERTIFICATE: ROME OCCUPATION LDC section 5.02.00 & subsection 10.02.05 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): ( F\ t Telephone: t2 S. 4 t Of:, Cell: `j" • G /`C 6 Fax: r.:t i `> ) C--. E-Mail Address: BUSINESS & USE INFORMATION Business Name(If any): '- (.(C i/t. ( _ -.�1i(. c k Phone Number: - --� r . /r -� Address: /`f C, c_ r"�,t`' ' `( z.' : e`j F-44..kit4': `t ty/` State: I ZIP: [ C c,. d Description of the type of business or use: 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 A co�firer County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GRCWTH H MANAGEMEN DR;sICN NAPLES, FLORiD.A C.4134 w w.rnllier�ni_net (2 9 ?52-2 O0 FAY !2?9) ?E2_ '85 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 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". Applicant Signature Date The following to be completed by County Staff: Zoning: Property ID #: Date: Approved I Hold Denied Comments/Restrictions: Staff Reviewer Date Tax Collector Staff: Clerks Initials: 7 Horseshoe T Greentree Business Tax License#: 1/14/2014 Page 2 of 2 • ■ j. 4 CO lk Y CO-purity Growth Management Department Planning & Regulation Operations Division Licensing Section August 19, 2015 David M. Jones Love Landscape, Inc. 860 6th Ave S. Naples, FL 34102 RE: Waiver of Exam(s) Mr. Jones, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, September 16, 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) 252-2930. Sincerely, Jason Bridwell Licensing Administrative Supervisor 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 LOW IfirlDSOPt HELPING PFOPL£LOVE THEIR LANDSCAPE April 22,2015 Collier Licensing Board 2800 N. Horseshoe Drive Naples, FL 34104 To Whom It May Concern: Thank you for your consideration of the reinstatement of my landscape contractor license. It has been an honor to serve Collier County in the realm of landscape over the past 30 years. Most recently,my experience included becoming Landscape Manager for the City of Naples. Prior to that I had been promoted to Operations Manager for Smallwood Design Group. In both of these positions, I had the privilege of learning under some of the greatest minds in landscape and horticulture that I have ever known. They have taught me much in regard to the marriage of beautification and respect for our fragile ecosystem. It is my intention to take this wealth of knowledge that has been given to me and respect for our most precious environment to promote ecological wellness and beauty in our community through responsible agronomic planning and regionally appropriate landscape design implementation. Respectfully, cd-Lez2,/ David Jones Love Landscape,Owner 860 6TH Avenue S.,Ste.2353 I Naples,FL 34102 239.398.4614 David Jones-Owner I David.LoveLandscape@outlook.com DAVID MICHAEL JONES 860 6th Ave.South#2353 Naples, FL 34102 1 239.398.4614 I David.LoveLandscape @outlook.com SUMMARY Professional landscape experience in Southwest Florida since 1989 in a variety of venues from residential and commercial to municipal settings. Specialize in environmental impact,sustainable practices,and safety. Degree in Agriculture 3.8/4.0,and multiple certifications and advisory board positions over last 30 years in industry. PROFICIENCY Agronomic Planning • Environmentally responsible practices to maximize overall health of landscape material and minimize impact on fragile ecosystem Plant Identification&Sustainable Purposing Practical application of native and exotic plant material,salt tolerant,cold hearty,sun and shade,life cycle,environmental impact,and integrated pest management(IPM) practices for sustainable planning and design implementation. Water Impact Considerations •Sensitivity to erosion,run-off,consumption,drought,and excess precipitation issues particular to the climate of Southwest Florida. EXPERIENCE 08/2011-Present Project Manager, Big Cypress Landscape • Design,Implement,&Maintain landscape and hardscape projects for both residential and commercial applications 09/2007—07/2011 Facilities Maintenance Supervisor, City of Naples •Supervised maintenance of 100+municipal buildings and surrounding landscapes in the City of Naples including oversight of purchasing and procurement of subcontracts for all landscape maintenance and hardscape projects performed in the City of Naples Obtained grants and oversaw implementation for water conservation practices of 1.3 million gallons of water annually •Certified National Playground Safety Inspector 09/1999—02/2005 Operations Manager, Smallwood Design Group Supervised 117 employees responsible for safety practices,equipment training,plant identification training,fertilization training,pest management training Supervise design,implementation,&maintenance of landscape and hardscape projects for residential,commercial,&municipal applications 06/1994—08/1999 Owner-Operator, Sandy's Lawn&Garden • Lawn Maintenance(Weekly mowing,cutting,cleaning) Design,Implement,&Maintain landscape and hardscape projects for both residential and commercial applications 05/1989—05/1994 Project Supervisor, Zenobi Landscaping • Design,Implement,&Maintain landscape and hardscape projects for both residential and commercial applications EDUCATION, ADVISORY BOARD POSITIONS, & ADDITIONAL CERTIFICATION 1985 Associates Degree of Agriculture, Cuyahoga Valley,OH—GPA 3.8/4.0 2000 Florida Certified Horticultural Professional, (FNGA)Florida Nurseries&Grower Association 2002-2004 Advisory Position for Institute of Food and Agriculture Sciences, University of Florida Cooperative committee with the University of Florida to identify and solve problems relating to disease,water,insects and other environmental impacts for Southwest Florida. 2009 Certified Playground Safety Inspector, National Recreation&Park Association Responsible for providing proper supervision of children on playgrounds,design age appropriate playgrounds,provide proper fall surfacing on and around playgrounds,and properly maintain playground equipment. 1-1 o -r GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive ``I „�' Naples, FL 34104 ✓ = DO X =DO NOT DO ,i 14' ;-� - -(.L) 1' i i CHECKLIST APPLICATION (complete and notarized) VERIFICATION OF 75% PASSING SCORE must-\- e r approved and recognized throughout the State of Florida,as provided in Section 2.7 of the Contractor's Licensing Board Ordinance) o Copy of letter from testing facility, or o Letter of Reciprocity from the county of sponsorship is required REPORT (Must come from enclosed list of credit bureaus and CANNOT be over 60 days old) Individual (License Holder) f- c!Y Firm (If more than one year old)' + '."J .0-O r/COMPANY NAME (Sunbiz.org) o Articles & Certificate of Corporation/Incorporation �f o Fictitious Name C 3 0- Gr"�('._-1 ) 1r CERTIFICATE OF GENERAL LIABILITY INSURANCE o Collier County Licensing Department must be listed as a Certificate Holder with the above mailing address. o Bodily Injury per person$100,000 minimum, Property Damage $25,000 minimum (NOTE: If registered with the state,must carry the amounts required by DBPR). Ef CERTIFICATE OF WORKER'S COMPENSATION INSURANCE o Collier County Licensing Department must be listed as a Certificate Holder with the above mailing address. o NOTE: Qualifier(s)"License Holder"Are Required To Be Listed On The Policy As *INCLUDED* Or*EXCLUDED*. o State Worker's Compensation Construction Exemption(s): Are Filed On Line At: WWW.Myfloridacfo.com. NOTE: If you are a"sole proprietor"(an individual or with a fictitious name),you are not eligible for an exemption and MUST carry Worker's Compensation insurance. Tlf STATE REGIS RATION The following ades must register with the State Dept. of Business,rand Professional Regulation before the competency card is co sidered active for business(DO NOT mail this appl. ation until license is approved). General Co tractor Master PI ber Building ntractor Roofmg Residents Contractor H.A.R. -Class A&B Swimmi g Pool Class-A,B,C Master lectrician Mechan. al Contractor Burgl /Fire Alarm NOTE: If you eady registered with the DBPR,please submit a c py to Collier County Contractors' Licensing. 1-2 E FEDERAL TAX NUMBER o IRS Form SS-4 (File online at IRS.GOV) o Incorporated or have more than 1 managing member of the LLC. If you are the ONLY managing member of an LLC, use your SSN. VERIFICATION OF EXPERIENCE b J�`"' T-LL _(34Affidavits for Verification of Construction Experience (Must be signed and notarized by 3 different people) i.) ')t-;' d `f-9- ) Affidavits for Integrity & Good Character "" (Can be signed by any 2 of the 3 people you have chosen for Verification of Construction Experience) NOTE: The affidavits must state the type of work done,the persons knowledge of the trade,length of time in the trade,etc. MAJOR TRAD . o T P r E (3)Notarized Original letters on t it company letterhead stating years of ex.-rience in that trade, types of work d e, the persons knowledge of the trade a d Integrity & Good Character. d BUSINESS TAX RECEIPT/OCCUPATIONAL LICENSE o Collier County Business Tax Receipt (if located in Collier County) OR o Business Tax Receipt from where office or business is located. NOTE: Contact Business Tax for fee amounts at(239)252-2477. V ZONING/PLANNING CERTIFICATE o Zoning approval for home occupation or business location is in Collier County. NOTE: Please contact Zoning Department for fee amounts at(239)252-5250. COPY OF DRIVER'S LICENSE IS. COPY OF CITATION o If bmitting application to abate citation issued within 45 days of the date of t e issuance of the citation. If you have any questions, please feel free to contact us at: GMD Operations and Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 Main: (239) 252-2431 Fax: (239) 252-2469 1-3 PROOF OF EXPERIENCE 1.8.1 When determining if the applicant possesses the required experience, the Contractor's Licensing Board Supervisor or his/her designee shall accept the following as proof of experience: A. Affidavits/notarized letters from former employees with specifics as to the number of years of experience, work performed and any other relevant infoiniation. B. Copies of other certificates of competency, if any, held in other counties, cities. C. Affidavits from any building director in locations where the applicant has worked. D. Affidavits from any union organization of which the applicant has been a member, relative to the trade for which the applicant has made application. E. Affidavits from any other reasonable source as approved by the Contractor Licensing Supervisor within the trade applied for. 1.8.2 Education at an accredited school may be utilized to satisfy a portion of the experience requirements of this section. Specifically, each full year of school level work in the field for which the application is made shall be credited to the applicant as .75 years experience, but such credit shall be for no more than one-half of the total experience required. CREDIT BUREAUS FROM THE YELLOW PAGES OF THE NAPLES PHONE BOOK Merit Credit, Inc. (239) 277-3202 meritcreditservices.com Credit Check, Inc. (877) 616-5556 creditcheckin.com Licenses Etc. (239) 777-8321 licensesetc.com USA Credit Bureau (888)474-2270 usacreditbureau.com Credit Bureau Services, Inc. (866) 561-1400 elicensereport.com NOTE: You can use any bureau that is nationally recognized & reports a full 7 year history. Rev. 05/2014 GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive ( ;' �) i11 Naples, FL 34104 APPLICATION FOR COLLII-{'.R COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUTIONS: This application must be typewritten or legibly printed. The application fee must be paid upon approval and is not refundable. All checks should be made payable to: Collier County Board of County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: Exact Corporate/Business Name: L /k— rJ/2(ii.4 - Fiction Name/DBA: Qualifier Name: ,IC..JR-,/'c'e /1/7,-(e- -/e C.- 0/N./ET Physical Address: ewe s _-,Z 4-'2 :s" (Number&Street) (City) (State) (Zip Code) Mailing Address: �j9 /"► c (Number&Street) (City) (State) (Zip Code) Telephone: 2��" v��"y�� E-mail: D91/,` C.UVtlfl a-vpt octayokcek. TYPE OF LICENSE: General $230.00 Electrician $230.00 Building $230.00 Plumber $230.00 Residential $230.00 Air Conditioner $230.00 Mechanical $230.00 Swimming Pool $230.00 Roofing $230.00 Specialty $205.00 Specialty Trade: 69-1.12‘0,410c-- gatfricifeci G h 3/6/2015 Reinstatement Fee= $205.00 VANGE OF STATUE Ciege/`o c`/213 2 New License Fee= $205.00 Reinstatement (v ) From One Business to Anothe 3 Year Fees= $555.00 *Different fees may aaoly` Total=-$965.00 Page 1 of4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm i� '�_� ,�c r s `).4 :a _)', , :> , ----, ; 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years(i.e. held a license for or been a partner). Attach extra pages if needed. R /v1/q // / - •eat°° e; TV' e,� � ;, • . ,A-7- /2,/ e4--. �d ° ° e 3. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. - A/6 dome AFFIDAVIT Under the penalties of perjury I declare that I have read the for oing application and that the facts stated in it are true. R e.:,--t-, c.--"( CA---,A,--3 Au orized Off f the Firni - j(,t VA The foregoing instrument as acknowledged before me this �/Z Z/ 0 i5 (Date) //�� X�1�/1'— by JC_/,4[v c. JUi`'.°S �/r'f` of o ti e ��'r-�.(C' �e I C. (Name of Officer, Titl Agent) (Name of Corporation) a ��/ `c3(.,- .. Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced Fl�'`1*r ':�'rar�: '" ii_�f F r- *PA'' 'id o f cation and did not take an oath. (Type of identification) NOTARY'S SEAL , a tiU(i.lifiki,),Rte._ (SIGNATURE OF NOTARY) r°s •P:Be/o SAMANTHA LYNN ROE Page 2 of 4 * _S * MY COMMISSION#EE 875239 "' 11 EXPIRES:Fakery 17,2017 N,glEpp 0,e Bonded Thru Budget Notary Services tr QUALIFIER LNFDRRLkTIO iii: Name: Address: � ,� d �. � /�?.. '`�', �� "/�� (Number&Street) (City) (State) (Zip Code) Telephone: 2 s'c, 7 Date of Birth: , /, 9r SS#: E-mail: Driver's License #:� 1. Type of Certificate of Competency for which application is made. e 2. The names and telephone numbers of two persons who will know your whereabouts. I/P L e eq. ,3C — 9��'S 62.0 Y 9 3. Have you ever been convicted of a crime related to Contracting? ,&Jr) (If yes,attach extra sheet with explanation.) 4. Have you or any filnis you have been associated with ever filed bankruptcy? yU Q 5. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay and reasons why. 6. List your/business or work experience during the last ten years. C' ir.'/V C> '/0-1J9-0e s!!�...\ �1, ' #37.**--::: �.° 7. Statement of any formal training you have had in the art&for hick the application is made. l Z` prcv- (4.D ^M "C ° /7 °fY1 41J Eo ._ 12 df 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County No. 2006-46, as amended, and under penalties of perjury. I declare that I have read the foregoing qualifier infoi cation and that the facts stated in it are true. 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/she will be held strictly accountable for any and all activities involving his license. Any willful falsification of any infouriation contained herein is grounds for disqualification. Applicant (please print) 4,tie(c--(..,ve° in i .. Name of Company Signature of A 'cant State of Florida County of C U,2 `d-?f The foregoing instrument as acknowledged before me this j u i t .. 2 -i , 1015 (Date) by {`t �'� 1�'� who has produced P�..' Y (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL t1r `f it (SIGNATURE OF NOTARY) ♦�Y PuBG SAMANTHA LYNN ROE * c MY COMMISSION#EE 875239 * !j EXPIRES:February 17,2017 4 of 4 NTArFOF FS Bonded Thru Budget Notary Services AFFIDAVIT It is understood and acknowledged by the Collier County Contractor's 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 Certifi too Competency. Signature of Applic rt" Le c,>2 Vii(;; Business Name Date BEFORE ME this day personally appeared �v� ; fo."/ES who affirms and says that he/she has less than one employee and does not require Workmen's Compensation and understands that at any time he/she employs one or more persons he/she must obtain said Workmen's Compensation Insurance. State of Florida { �r County of C n The foregoing instrument as acknowledged before me this � �:tYl t_ L Zt 'LL) (Date) by ck U,a j3 C! ) who has produced L�l (name of person acknowledging) (type of identification) as identification and did not take an oath. r NOTARY'S SEAL Q 01�Y PO�i SAMANTHA LYNN ROE (SIGNATURE OF NOTARY) a MY COMMISSION#EE 875239 * t_S_ ii: EXPIRES:Febntary 17,2017 d4rzoF,F`Op`Or Bonded Thru Budget Notary Services k:''.;/ ON THE SI eHq GULF 1...41 � F ..mesa HUMAN RESOURCES TELEPHONE(239)213-1810 • FACSIMILE(239) 213-1845 735 EIGHTH STREET SOUTH • NAPLES, FLORIDA 34102-6796 June 25, 2015 Re: David Jones To Whom It May Concern: This letter will verify that David Jones was a full time employee with the City of Naples in the Community Services Department from 9/17/07 to 7/22/11. During his employment he held positions such as Landscape Tech II, Landscape Tech III, Landscape Tech Senior & Facilities Maintenance Supervisor. If you have any further questions, please do not hesitate to contact me at(239) 213-1810. ncerely, Robin Dennis Human Resources Generalist ra,eJ<G/LC '6 66744... 446 LK,.. C666 GttlG 1 6 CGl eV;-�26F C ) CITY OF NAPLES /,<;771-3, s. 1.------4 litol: ,, ,,r,pi.-fi,,,,,,,,,,r=v,,mr-,---r,-,,,,-,-,-r-r,„—,,t::,,.,--,- , --.-r-7,,-.67'7 as..r-7P7.4,711,,r4''''s...:r.rt'l'a,",:,7.4 `,.-- N, :,,, i.;: :pERFoRmANdt EvALLIATioN&PLANNING FORPit:Supertisenyi Mariageriar' - ' it Emplo ee Name: JONES, DAVID i Review Period: Ma 10,2010—November-401 2010 Position: Supervisor, Facilities Maintenance se: i Evaluation T FY'10 PROB. PERE EVALAI.).111)14 Department/Division: Communit Services—Facilities Maintenance ,..., . . , . . PERFORMANCE FACTORS I! RATING: Please CHOOSE one 1. COMMENTS: REQUIRED . . , 1. Dependability: Extent to which : David is dependable, punctual and can be employee can be relied upon to be both at } gone h a above to and beyond ht w ao yo work to on o ensure time. . D & work a David has work and on time(e.g.attendance — Z Z . punctuality); Where applicable, the extent to : — which employee can be relied upon to i been completed within a timely manner. complete work within the deadline prescribed. Exceeds Expected Unsatisfactory i , . ,. . . . . . . . . . . 2. Job Knowledge: Understanding, David continues to learn his job, his role, and competency and compliance with all required , job knowledge&skills of incumbent's job, the 7 Z ri : the cities rules, regulations, policies and City, and its rules,regulations,policies and . procedures. • procedures;Exhibits self-initiated willingness, ' Exceeds Expected Unsatisfactory desire and commitment to learn all aspects of ' position and follow through in a complete and thorough manner. 3. Quality of Work: Thoroughness,accuracy, : David is able to plan and organize work and productivity(quality vs. volume)of work;Ability " - strives to provide quality in his work to plan and organize work;Ability to achieve -:' 111 Z E ,, assignments. the highest quality in all work assignments, duties and areas of responsibility. Exceeds Expected Unsatisfactory , . , . 4. Customer Service Skills: Applies . David applies the cities ABC's and utilizes the externally and/or internally;Responsiveness to ' Blue Ribbon Service strategy. others'needs; Timely handling of reasonable requests and inquires;Extent to which 0 Z E employee uses Blue Ribbon Service Strategy, ABC's and Fundamentals;Ability to treat all Exceeds Expected Unsatisfactory customers,contracted instructors, co-workers, . . • visitors,staff,supervisors,etc., with the utmost courtesy and professionalism;Ability to show respect for everyone's opinions. 5. Communication Skills(Oral&Written): David communicates well with supervision Ability to communicate ideas&concepts in " : both verbally and in writing. verbal and written forms and to interact with all , Z Z 0 4 employee levels and customers in an effective manner;Comprehension of communications; Communicates fully with supervisors, Exceeds Expected Unsatisfactory administrators,co-managers,staff,instructors and customers on a daily basis. 6. Attitude&Initiative: Willingness to gain& , David is always willing to gain and maintain • maintain respect of customers/fellow . employees,and work harmoniously with them; , 17 Z El -. respect from co-workers and subordinates. Positive reactions to criticism and suggestions; -• .; David is acceptant of supervision and has a ..• Acceptance of supervision and desire to ' Exceeds Expected Unsatisfactory r- desire to perform the best job possible. • perform best job possible;Ability and willingness to initiate work activity with • . minimum suiervision. :-" 7.Teamwork: Works interdependently when David works both interdependently and necessary to coordinate activities toward the pursuit of a common goal;Lead by example 0 Z 0 independently when necessary. He leads by and is a positive team leader and team , example and is a positive team leader. - member;Motivate others to be a part of the • Exceeds Expected Unsatisfactory team;Does not,at any time,spread gossip and ill-will among customers,co-workers, city . . employees and the entire community. . , .. . . . I 9/09 ' ""� "� CITY OF NAPLES t ` t ') .n ``v f rret Plrfr sk €te s - ` 1t' i 41 4.ri 4,r�ri: " 7,:-'''''"'", � , ` PE F EVALUATIONS f LANN(N EO2N s�pervi I Managerial..i ; , , Employee Name: JONES, DAVID, Fac.Maint.Supervisor Review Period: May 10,2010-Nov.10,2010 PROB.PERF.;7.VAL. i PERFORMANCE FACTORS RATING Please CHOOSE one COMMENTS: REQUIRED f; a .�.u. ;: David 8. Stress Tolerance: Maintains composure maintains composure and an even f and an even temperament;Acceptance of , temperament. David is able to mentor staff in unavoidable tension and pressure;Works well , I ' under pressure;Ability to detect stress and/or ❑ ® u a positive manner. stressful situations in subordinate staff and I mentor appropriate resolution. Exceeds Expected.......Unsatisfactory 4 i 9. Safety: Extent to which employee ' David follows all rules and safety € ensures that the rules of safety on the job are i ' requirements. followed in accordance with policies and 11 ® El I, procedures(If Applicable). ' : I: Exceeds Expected Unsatisfactory 10. Leadership: Lead by example;Inspires David demonstrates the ability to motivate and work effort to achieve the goals of the work unit;Demonstrates the ability to motivate and ® ❑ gain cooperation, support and loyalty from his gain cooperation,support and loyalty; staff. Objectively and wisely lead/direct/mentor all full/part time staff,contracted instructors and Exceeds Expected Unsatisfactory • volunteers in a positive and effective manner. 11. Planning&Organization: Ability to David continues to work on a good foundation develop appropriate goals and identify he identifies resources needed to accomplish resources needed to accomplish them; Effectively schedule own work and work of Ell El goals. David sets logical priorities and utilizes others;Anticipate and prepare for future his time wisely. assignments;Set logical priorities and use Exceeds Expected Unsatisfactory time wisely and efficiently. 12. Fiscal Management: Develops and ) David will continue to work with supervision on manages City budge and assigned CIP, this performance factor. Present long-term needs effectively and ❑ ® n . recommends alternatives;Provide effective management of purchase orders,purchasing cards,contracts,line item accounts,RecWare Exceeds Expected Unsatisfactory Safari,etc. 13. Training&Development: Teaches job David teaches job skills to subordinates so as skills and develop subordinates to achieve their best effort;Coaches and provides to achieve their best effort. appropriate feedback;Uses the performance ❑ ® [1]evaluation&plan as a development tool;, Present requests/direction to staff in a positive,accomplished and professional Exceeds Expected Unsatisfactory manner, and in a way the employee can buy into the direction. 14. Staff Management: Selects, develops, 1 David displays effective delegation skills and and evaluates staff;maintains controllable ❑ ® ❑ controls the work flow adequately. staff continuity;Displays effectiveness in delegating and controlling staff workflow; Effectively manages conflict and brings to a r Exceeds Expected Unsatisfactory quick and satisfactory resolution;ensures staff understanding&compliance with all required rules, re.ulations,policies and.rocedures. • 15. Energy Conservation: Extent to which David continues to identify energy employee and subordinates conserve energy, ® conservation areas and implements them resources, and materials(no idling,recycling, E. climate control, etc.) accordingly. Exceeds Expected Unsatisfactory ' 2 9/09 • - CITY OF NAPLES ribtrAti +co— po,V=V- ;' -,• • • = r. 4 E•,tiitY%.1 ! 5 - 9,1 ," 9 pr,,, = wan= -•-'4•‘' Employee Name: JONES, DAVID, Fac.Maint.Supervisor : Review Period: May 10,2010—Nov.10,2010 PROB. 27AL. • GOALS&OBJECTIVES I RATING: Please CHOOSE one I COMMENTS: REQUIRED [ #1. Planning and Organization I Continue to identify and implement an effective filing system. Organize a master Facility El spreadsheet to include all lighting/air conditioning/plumbing inventories. Exceeds.. ....Expected Unsatisfactory #2. Training David has obtained the State Obtain State Certification for Playground Safety. Fl certification for playground safety. Exceeds Expected Unsatisfactory • #3. Licenses David has maintained all required Maintain C.E.U.'s and license requirements for licenses, ceu's and certifications. ; Limited Lawn and Ornamentals,Best Management Practices, Class"B"license and Playground Safety Inspection Certification. Exceeds Expected Unsatisfactory #4. Field Training David has not implemented this goal Schedule at least 8 hours with each individual staff due to an excessive work load. member in the field so as to identify the most effective use of time and resources. Exceeds Expected Unsatisfactory MM. sommilo- TOTAL RATING: Expected Overall Evaluator Comments: David has done an outstanding job with gaining staffs trust he leads by example and his staff appear to have respect for his leadership. David continues to learn his role and all aspects of his job all while leading the crews on a daily basis. Overall David has done a great job during his probation period and I look forward to working with David on next years goals. Overall Employee Comments: 3 9/09 •— � CITY OF NAPLES ' " Pt Ch 1k is '"( A 1 A �. . III FORIup�stv�po�1ut'anayer>ia ,.. .. .:..,..x.. .,.,.., x:,<..,, ,_,.r --t-a: -rc+c:.z msx.• :.,--_-+� , -.< .:.«xM...+ >...... .,,-_.. ar-�,-.+. ..r ,,r^�,. Employee Name: JONES, DAVID, Fac.Maint.Supervisor s'. Review Period: May 10,2010-Nov.10,2010 PRO3. P RF. EvAL PERFORMANCE EVALUATION SIGNATURES I;. e t ■ ......,,.......7-- ,,,,,,,, (7/ixpervisor's Signature Date: Next Level Spervis• s Signature Date: € ,j • / , (a Departmeiit a:'s Signature Date: , --/K:2-0/4.475,----- /�� Human„R sources Signature Date: %/ i Employee's Sigr(attire: /acknowledge that this Performance Plan&Evaluation has been discussed with me and that I have been given a reasonable opportunity to respond in the Employee Comments section. Date: 4 9/09 ) CITY OF NAPLES - PERFORMANCE EVALUATION & PLANNING FORM: Supervisory/Managerial Em•lo ee Name: JONES, DAVID, Fac.Maint.Supervisor Review Period: May 10,2010-Nov. 10,2010 PROB.PLAN . PERFORMANCE PLAN SIGNATURES k Su•ervis•is Signatur• Date: ( r Next "ev¢I Supery sor's ,na I • Dat . Department Head's Siigna re Date: ;,,,, 11/310.65/ Human,lreso cesSi•ng,turq / Date: j ( ' A 0,-c ("i_c-' f I , Empl• ,ee's Signat : /ackn le 'tfiat this the Performance Plan has been discussed with me and e7' ! that t ese are the goals and pert rmance factors that I will be evaluated on at the end of the Performance Review Period. Date: 5 9/09 • CITY OF NAPLES -) ' PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY +%.saw a ...crx-.r.-.xm9vm*.�T.ravt .r rr:r... «c r.:..:,.. ,c....^m;,a'tv..v-�z.:.rtrtxwr.:^s°.r�`.�n'.xra:^r.^m.: �r�v�.•s::.?r;':..,.....r...,.a�., .-.o..«, ,,...,.r.f. : ... _r. . . - Employee Name: DAVID JONES I Review Period: 2/18/09 to 9/30/09 Position: Sr. Landscape Technician I Evaluation Type: Annual FY'09 PERFORMANCE EVAL. De•artment/Division: Comm.Services/Parks & Parkwa s ')i;1 , :.I;: 1 PERFORMANCE FACTORS II RATING: Please CHOOSE one II COMMENTS: REQUIRED I 1. Dependability: Extent to which David is dependable and can be relied upon employee can be relied upon to be both at to take charge and move forward with minimal work and on time(e.g.attendance& ❑ ® 11 g punctuality). Where applicable, the extent to supervision in his daily duties. which employee can be relied upon to Exceeds Expected Unsatisfactory e complete work within the deadline prescribed. 2. Job Knowledge: Employee's competency David is unequivocally knowledgeable. He 1 concerning required job knowledge&skills; ex Extent of understanding about incumbent's ® III El has 20+ years experience and has a degree job, the City, and its policies and procedures. in Agriculture. He has a thorough and Exceeds Expected Unsatisfactory complete understanding of his job. ,i 3. Quality of Work: Thoroughness,accuracy, David continues to strive for quality. He works productivity(quality vs. volume)of work. with the daily to assist them. He Ability to plan and organize work. ❑ ® ❑ e s Y organizes, plans and coordinates daily duties Exceeds Expected Unsatisfactory '! with a minimal of supervision. a 4. Customer Service Skills: Applies David complies with Blue Ribbon Service externally and/or internally;Responsiveness to Policies and Procedures. others'needs; Timely handling of reasonable ❑ ® 1-1 ; requests and inquires. Extent to which 9 employee uses Blue Ribbon Service Strategy, Exceeds Expected Unsatisfactory t ABC's and Fundamentals. 5. Communication Skills(Oral&Written): David communicates orally and in writing ,Ability to communicate ideas&concepts in dail He guides our staff in the daily ' employee levels and customers in an effective ' completion of their duties. He interacts well , manner.Comprehension of communications. 1 Exceeds Expected Unsatisfactory ' with employees, customers and supervision. e, I i .. A t1•- &I t .t •=. Wily • - to•ai & i • David keeps a"can do" positive attitude. He I maintain respect of customers/fellow a ' has assisted his supervisor in the organization employees, and work harmoniously with them; ' p 9 Reactions to criticism and suggestions; i ® ❑ ❑ ! and maintenance of 100+additional sites Acceptance of supervision and desire to during this reporting period. He is always perform best job possible;Ability and Exceeds Expected.......Unsatisfactory willing and shares his knowledge and skill with willingness to initiate work activity with minimum supervision. 1 our staff. 7. Teamwork: Works interdependently when i '' David works with our Landscape Techs, Sr. necessary to coordinate activities toward the pq ❑ Landscape Tech, Irrigation staff, and Facilities pursuit of a common goal. i ❑ personnel daily. He has a thorough ) Exceeds Expected Unsatisfactory understanding of our goal to maintain premier ;i facilities for our citizens and guests. 8. Stress Tolerance: Maintains composure David tolerates the many stressful situations -i and even temperament;dp ressure.acceptance of -J unavoidable dable tension and pressure. ❑ ® ❑ daily in a positive, congenial manner. Exceeds Expected Unsatisfactory 9. Safety: Extent to which employee David complies with Safety Policies and ,complies with rules of safety on the job in 1-1 ® ❑ Procedures. accordance with policies and procedures. Attends safety training. Maintenanbe and care of equipment and tools Of Applicable)'. Exceeds Expected Unsatisfactory ' l 8/07 • ,,....:7.;;..,. CITY OF NAPLES - `• PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY Em•lo ee Name: DAVID JONES Review Period: 2/18/09 to 9/30/09 Ann'I FY'09 PERF.EVAL. GOALS & OBJECTIVES RATING: Please CHOOSE one I COMMENTS: REQUIRED 11 #1. Plant Knowledge Identification fication David can identify plant material and apply - Ability to identify proper grades and 11 ® 1-1 . current grades and standards. He will not standards for plant materials. accept poor quality plant material. Exceeds Expected Unsatisfactory #2. Instructions/Leadership + David has provided daily training with our OBJECTIVES: staff. He has assisted them with fertilization - Ability to receive oral instruction by supervision and carry out daily i equipment calibration, planting techniques, assignments effectively and , proper watering, and disease and pest efficiently and provide leadership to .% control. He meets with his supervisor and • co-workers. n ® n staff daily and is in communication at all - Turn in to Supervisor on a daily basis a report on task completions t times. for assigned staff. Exceeds Expected Unsatisfactory - Provide leadership and direction on a daily basis to in-field staff. - Provide in-field training on proper `' fertilization techniques,and athletic field maintenance. , #3.Training , David maintains his licenses as required. OBJECTIVES: q - Maintain BMP(Best Management Practices)Certification,and LLO (Limited Lawn&Ornamental) L ® E r Pesticide License and all other y required certifications/licenses, Exceeds Expected Unsatisfactory t'. including maintaining Class"B"CDL License with Air Brakes endorsement. y #4. Administrative . David completes his assigned administrative OBJECTIVES: duties. - Maintain Pesticide Application Log. - Accurately complete and turn in to your Supervisor,all required reports (Daily Work Logs,Weekly 111 ® El Equipment inspection Forms, Landscape Problem Forms, Pesticide Application Forms, and Exceeds Expected Unsatisfactory 4 Payroll Exception Forms). F - Maintain inventory of athletic field materials—sand,clay,topsoil, crimson stone,chaulk, paint and MVP wet and dry. #5.Coordinate Fleet and Equipment David provides monthly equipment/tool Inventory ' inspections. depended p OBJECTIVES: ® p ctions. He can be de ended u on to - Assist Supervisor with maintaining monitor the use and location of our accurate inventory data of Exceeds Expected Unsatisfactory nj equipment. equipment and vehicles. , 1► TOTAL RATING: EXPECTED 2 8/07 ,� : ;l CITY OF NAPLES PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY liEmplo ee Name DAVID JONES , Review Period: 2/18/09 to 9/30/09 Ann'I FY'09 PERF.EVAL. GOALS &OBJECTIVES ( RATING Please CHOOSE one I COMMENTS: REQUIRED y Overall Evaluator Comments: • E Overall Employee Comments: ts i Employee Name: DAVID JONES I Review Period: 2/18/09 to 9/30/09 Ann'l FY'09 PERF.EVAL. PERFORMANCE EVALUATION SIGNATURES 1 6 • i ri, r j 1 x Su•ervgrir Si nature Date: (TheipiripAllir r 1 �yNext el $ pervi or's '■nat 1 e Da e: �� :1 /C t>.C, �� Department' ead's Signature Date: r%{ 22 e d��S/Dq k a Human Resources Signa ure Date. 1 ac--,,,9„,,,,, i Employee's Sign I acknowledge that this Performance Plan&Evaluation has been discussed with me and that I have been given a reasonable opportunity to respond in the Employee Comments section. Date: 3 8/07 CITY OF NAPLES PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY Em•to ee Name: DAVID JONES Review Period: 2/18/09 TO 9//30/09 Ann'I PLAN PERFORMANCE PLAN SIGNATURES 1— ut3.....„.4 v ' 1 Sup'rvisor's Signat ire •• Date: r '' dfl Next Level.Supervisor'3 Signature Dat : A✓ l .) /'t/ ' r Department Head's Signature Date: Human ources Signature Date: (->eiG.e d Crirlife:10_,/ /7 ,/,/& L Employee's Signature'facknowledge that this Performance Plan has been discussed with me and that el these are the goals and performance factors that I will be evaluated on at the end of the Performance Review Period. Date: 5 8/07 CITY OF NAPLES j '-• PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY r'y I Em•to ee Name: DAVID JONES { Review Period: 8/18/08 TO 2/18/09 Position: Sr. Landsca•e Technician ; Evaluation T •e: Probationa Performance Eval..- i D- •1:111' - I ' • . C @J ill lb. - "At K -1if l .€,. .1 1'' j- PERFORMANCE FACTORS II RATING: Please CHOOSE one 11 COMMENTS: REQUIRED 11 Dependability: Extent to which , David is very reliable. He has a positive"can l employee can be relied upon to be both at `; do" attitude and consistently strives to twork and on time(e.g.attendance& punctuality). Where applicable, the extent to n ® complete assignments ahead of schedule. which employee can be relied upon to i` Exceeds Expected.......Unsatisfactory complete work within the deadline prescribed. • 2. Job Knowledge: Employee's competency ; David is extremely knowledgeable. He is concerning required job knowledge&skills; competent and consistently studies to be Extent of understanding about incumbent's ® aware of City policies and procedures. job, the City, and its policies and procedures. i y P p Exceeds Expected Unsatisfactory k 3. Quality of Work: Thoroughness,accuracy, v David is thorough and accurate. He strives for ' productivity(quality vs. volume)of work. ® n ;, quality performance and works with minimal F Ability to plan and organize work. supervision. Exceeds Expected Unsatisfactory 1 4 # i 4 4. Customer Service Skills: Applies David complies with Blue Ribbon Service externally and/or internally;Responsiveness to expectations. others'needs; Timely handling of reasonable requests and inquires. Extent to which s employee uses Blue Ribbon Service Strategy, Exceeds Expected Unsatisfactory ABC's and Fundamentals. a i A. Communication ommunic to Skills(Oral&Written) I He commune ates well with his subordinates.skills.ates. 1 Ability to communicate ideas&concepts in ? verbal and written forms and to interact with all n ® 0 ` He completes required written forms time) employee levels and customers in an effective p q timely manner;Comprehension of communications. Exceeds Expected Unsatisfactory 1 and accurately. 6. Attitude&Initiative: Willingness to gain& David has an excellent attitude. He is positive maintain respect of customers/fellow = in his daily duties. He consistently strives for employees, and work harmoniously with them; ;I , Reactions to criticism and suggestions; ( ® n excellence in his performance. Acceptance of supervision and desire to perform best job possible;Ability and Exceeds Expected Unsatisfactory ? willingness to initiate work activity with y minimum supervision. i 1 a 7. Teamwork: Works interdependently when ' David is a team player. He coordinates necessary to coordinate activities toward the pursuit of a common goal. 0 ® ❑ .a assignments with his supervisor and t ,, consistently accomplishes his assignments. Exceeds Expected Unsatisfactory i 8. Stress Tolerance: Maintains composure David understands the tensions involved in his .. and an even temperament;acceptance of unavoidable tension and pressure. ❑ ® 0 daily performance. He needs to always remember this is what we do. -' Exceeds Expected Unsatisfactory • 9. Safety: Extent to which employee David adheres to safety policies and complies with rules of safety on the job in ❑ ® procedures. accordance with policies and procedures. Attends safety training. Maintenance and care tl of equipment and tools(If Applicable). Exceeds Expected Unsatisfactory 1 8/07 CITY OF NAPLES 'i PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY iu Emplo ee Name: DAVID JONES ' Review Period: 8/18/08 to 2/18/09(Prob. Pert Eval.) GOALS & OBJECTIVES I RATING: Please CHOOSE one COMMENTS: REQUIRED l',. #1. Plant Knowledge Identification ; David has excellent plant identity skills. OBJECTIVES: - Ability to identify proper grades and i ❑ ® ❑ standards for plant materials. Exceeds Expected Unsatisfactory #2. Instructions/Leadership David carries out all assignments efficiently OBJECTIVES: Ability to receive oral instruction by and effectively. He provides training and supervision ❑ ® n leadership to his fellow employees. upervision and carry out daily assignments effectively and efficiently and provide leadership to Exceeds Expected Unsatisfactory f co-workers. • a #3. Training David has acquired and maintains all of his , OBJECTIVES: licenses, including his CDL Class B License. ` - Maintain BMP(Best Management Practices)Certification,and LLO (Limited Lawn&Ornamental) Pesticide License and all other El ® ❑ required certifications/licenses, A t including obtaining a Class"B"CDL Exceeds Expected Unsatisfactory License with Air Brakes endorsement within a 90 day period or on or before November 18,2008. #4. Perform in a Leadership Capacity David provides daily guidance to the in-field OBJECTIVES: staff. He is dedicated and pursues excellence - Provide leadership and direction on 4 a daily basis to in-field staff. I I ® I I ; from himself and others. Exceeds Expected Unsatisfactory d i 1 #5.Coordinate Fleet and Equipment • David assists his supervisor in the daily Inventory monitoring and physical equipment and OBJECTIVES: - Assist Supervisor with maintaining ' ❑ ® Fl = vehicle maintenance. accurate inventory data of A equipment and vehicles. Exceeds Expected Unsatisfactory 1 8111111111i11111• messio. TOTAL RATING: EXPECTED Overall Evaluator Comments: Overall Employee Comments: s 2 8/07 r• CITY OF NAPLES e'• PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY [Em••to ee Name: DAVID JONES F Review Period: 8/18/08 to 2/18/09(Prob. Perf. Eval) PERFORMANCE EVALUATION SIGNATURES i, C- - 4&..ei (4- ! ZT z yl- Oc-, Supervi ors Signa Date: Next bevel Supervisor's Signature D e: Department Head's Signature Date: e Huma e urces Signat�fre Date: /Y et,-4 e&._ cvt,...9--D (3/Lik .--/ Employee's Signatur : acknowledge that this Performance Plan&Evaluation has been discussed with me and that I have been even a reasonable opportunity to respond in the Employee Comments section. Date: 3 8/07 CITY OF NAPLES ' y` PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY Em•to ee Name: DAVID JONES Review Period: 8/18/08 to 2/18/09 (Prob. Perf. PLAN) PERFORMANCE PLAN SIGNATURES ACM,Su• :Ms•is Si.natu > Date: 9�C `,� • ' Y 4//—OS/ Next evel Su•ervisor's i•nature Date: De•artment Head's Si•nature Date: o % Human - - ources Si•nature Date: - A / Employee's Sign. e: /acknowledge that this Performance Plan has been discussed with me and that ,i 0///(,e these are the goals and performance factors that I will be evaluated on at the end of the Performance Review Period. Date: 4 8/07 CITY OF NAPLES .,) PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY' Employee Name: JONES, DAVID ' Review Period: 3/17/08 TO 8/18/08 Position: Landscape Technician III _Evaluation T ••e: Promotional Perform. Eval. t De•artment/Division: Comm.Services/Parks& Parkwa s Promoted from LTlll to Sr. LT on 8/18/08 1 PERFORMANCE FACTORS 11 RATING: Please CHOOSE one (i COMMENTS: REQUIRED C • 1• . Dependability: Extent to which David is punctual and complezted his assigned ; 'employee can be relied upon to be both at € work and on time(e.g.attendance& , III El ❑ duties on schedule. punctuality). Where applicable, the extent to which employee can be relied upon to ` Exceeds Expected Unsatisfactory ' • c• omplete work within the deadline prescribed. „ vim... 2. Job Knowledge: Employee's competency David constantly strives to increase his concerning required job knowledge&skills; ❑ ® ❑ knowledge of plant material and soil Extent of understanding about incumbent's job, the City,and its policies and procedures. ' rocedures. conditions. He does well at monitoring his Exceeds Expected Unsatisfactory assigned areas. 3. Quality of Work: Thoroughness,accuracy, ' David exceeds expectation on the quality of productivity(quality vs. volume)of work. ® ❑ 0 _ his performance. He strives consistently for Ability to plan and organize work. • excellence. ' Exceeds Expected Unsatisfactory l David complies with 6 a. customer service skies: Applies lee Ribbon Service externally and/or internally;Responsiveness to Policy. others'needs;Timely handling of reasonable ❑ ® ❑ requests and inquires. Extent to which employee uses Blue Ribbon Service Strategy, Exceeds Expected Unsatisfactory ABC's and Fundamentals. ' 5• . Communication Skills(Oral&Written): David communicates with the supervisory staff ;'• Ability to communicate ideas&concepts in r_11 ® 111 and the field personnel daily. • v• erbal and written forms and to interact with all employee levels and customers in an effective i manner;Comprehension of communications. i Exceeds Expected Unsatisfactory : 6. Attitude&Initiative: Willingness to gain& David has an excellent attitude. He reacts in maintain respect of customers/fellow a positive way to supervisor's guidance. He employees, and work harmoniously with them; Reactions to criticism and suggestions; 3 ❑ ® ❑ completes his work with minimum guidance. , Acceptance of supervision and desire to perform best job possible;Ability and 7 Exceeds Expected Unsatisfactory , willingness to initiate work activity with minimum supervision. 7. Teamwork: Works interdependently when `1 David utilizes his organizational skills well to , necessary to coordinate activities toward the pursuit of a common goal. ❑ ® ❑ accomplish his assigned goals. ff Exceeds Expected Unsatisfactory _: • 8. Stress Tolerance: Maintains composure David has an even temperament and gets and an even temperament;acceptance of .❑ ® El along well with others. unavoidable tension and pressure. Exceeds Expected Unsatisfactory ;. 9. Safety: Extent to which employee David complies with safety policies and complies with rules of safety on the job in ❑ ® ❑ ' accordance with policies and procedures. procedures. Attends safety training. Maintenance and care of equipment and tools Of Applicable). Exceeds Expected Unsatisfactory 1 8/07 CITY OF NAPLES \ PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY Emplo ee Name: JONES, DAVID ;i Review Period: 3/17/08 TO 8/18/08 Prom. PERF. EVAL. _. .... ,.:r.. .v ,.s*+ .§w*MN..#4T0.'APn^fcF.S , .rr. e r _v,m+.e:✓YNP.,. ., i'n.. e.w.,'gx�4'rt.T. ..✓«:v . 1 GOALS & OBJECTIVES I RATING: Please CHOOSE one I COMMENTS: REQUIRED ll #1. Plant Knowledge Identification David can identify plant materials. OBJECTIVES: - Ability to identify proper grades and ❑ ® ❑ standards for plant materials. Exceeds Expected.......Unsatisfactory #2. Instructions/Leadership David completes tasks assigned. He plans OBJECTIVES: ' and coordinates with his subordinates to - Ability to receive oral instruction by supervision and carry out daily ❑ ® ❑ complete tasks timely and efficiently. assignments effectively and efficiently and provide leadership to Exceeds Expected Unsatisfactory co-workers. • #3.Training ' David has maintained his required licenses. OBJECTIVES: - - Maintain BMP(Best Management ) Practices)Certification, and LLO ❑ ® ❑ (Limited Lawn&Ornamental) Pesticide License and all other .Exceeds Expected Unsatisfactory J required certifications/licenses, • including Driver's License. al■s1114110 ow+ TOTAL RATING: EXPECTED Overall Evaluator Comments: • iA -.. ,. Overall Employee Comments: PERFORMANCE EVALUATION SIGNATURES I (1 , r" _I i 9/i o�� Su•ervi or' Signa • -- Date: / i g r / • _A A ,, IA d8` Nex eve/ }u} p t$or'- mature D e: Department Head 's Signature Date: Human Resources Signature Da e: 5,-- Employee's Signait e: I acknowledge that this Performance Plan&Evaluation has been discussed with me and that I have been given a reasonable opportunity to respond in the Employee Comments section. Date: 2 8/07 <'� .. CITY OF NAPLES ', PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY Em lo ee Name: JONES, DAVID Review Period: 3/17/08 TO 9/30/08 Ann'l Prom. Plan PERFORMANCE ANCE PLAN SIGNATURES '. L.1,1,,, • 6 (--*--C"'ql , er Su p v , or's Signature ,,� r Date: ,oJ a;3' Next' /eve/Supervisor's Signature Date: -,. . t Department Head's Signature Date: r Huma - _sources Signature Date: Employee's Signa ffe: I acknowledge that this Performance Plan has been discussed with me and that II— /&A C� these are the goals and performance factors that I will be evaluated on at the end of the Performance Review Period. Date: 3 8/07 CITY OF NAPLES ` fl PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY Em•lo ee N.me: JON S DAVIT I , - - -• • 1 1 • -1 . i Position: Landsca•e Technician II I Evaluation T •e: Probationa Performance Rev. i D- , , ' • . • - - . s. rr . - ' PERFORMANCE FACTORS 11 RATING: Please CHOOSE one II N COMMENTS: REQUIRED 1. Dependability: Extent to which Mr. Jones has performed all of his duties in a employee can be relied upon to be both at satisfactory manner. He can be relied upon to a work and on time(e.g.attendance& punctuality). Where applicable,the extent to 111 ® El l complete assigned tasks. which employee can be relied upon to Exceeds Expected Unsatisfactory complete work within the deadline prescribed. 2. Job Knowledge: Employee's competency , has exceeded expectations on his job concerning required job knowledge&skills; knowledge. He is currently studying to obtain Extent of understanding about incumbent's ® ❑ ❑ g y y g job, the City,and its policies and procedures. ` : his ISA(International Society of Arboriculture) Exceeds Expected Unsatisfactory ` Certification. j 3. Quality of Work: Thoroughness,accuracy, t Mr. Jones quality of work meets expectations productivity(quality vs. volume)of work. ®^ ❑ Ability to plan and organize work. I J and he continues to strive for excellence. Exceeds Expected Unsatisfactory 4. Customer Service Skills: Applies . Jones complies with the ABC's of externally and/or internally;Responsiveness to Customer Service. others'needs; Timely handling of reasonable El Ell ❑ requests and inquires. Extent to which employee uses Blue Ribbon Service Strategy, .. Exceeds Expected Unsatisfactory ' ABC's and Fundamentals. . C. 1 .t • Sk II- (0 .1&W e ): _ . Mr. Jones performs his communication skills Ability to communicate ideas&concepts in El ® El in an exemplary manner. He consistently verbal and written forms and to interact with all employee levels and customers in an effective strives for excellence. manner;Comprehension of communications. Exceeds Expected Unsatisfactory 6. Attitude&Initiative: Willingness to gain& Mr. Jones consistently strives to complete his maintain respect of customers/fellow assigned tasks with a minimum of supervision. A employees, and work harmoniously with them; ® El Reactions to criticism and suggestions; Acceptance of supervision and desire to perform best job possible;Ability and Exceeds Expected Unsatisfactory willingness to initiate work activity with minimum supervision. 7. Teamwork: Works interdependently when Mr. Jones works well independently or with necessary to coordinate activities toward the El El El others. pursuit of a common goal. Exceeds Expected Unsatisfactory ' 8. St = - T.l: . :. M./ t-/ c. .•s re s Mr. Jones handles the stress of his position in and an even temperament;acceptance of ❑ ® ❑ a competent manner. unavoidable tension and pressure. Exceeds Expected.......Unsatisfactory se 9. S-f E t- ft. .1..-. Mr. Jones complies with safety standards and - complies with rules of safety on the job in ❑ ® ❑ regulations. accordance with policies and procedures. Attends safety training. Maintenance and care of equipment and tools(If Applicable). Exceeds Expected Unsatisfactory t 8/07 . , ) CITY OF NAPLES -, ) PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY I Emplo ee Name: JONES, DAVID , Review Period: 9/17/07 TO 3/17/08(Probationary) GOALS & OBJECTIVES I RATING: Please CHOOSE one I COMMENTS: REQUIRED li #1. Acquire LLO(Limited Lawn& David has obtained his LLO License. Ornamental Pesticide License) OBJECTIVES: I - Obtain LLO License within 6 months of employment. Exceeds Expected Unsatisfactory #2. Acquire BMP(Best Management David has completed the BMP training and , Practices Certification) obtained certification. OBJECTIVES: , - Obtain BMP Certification within 6 . I I Z 1-1 months of employment , Exceeds Expected Unsatisfactory 'esilasmants.. Awl 11111111111111+ IIIIIIIIIIII. TOTAL RATING: EXPECTED Overall Evaluator Comments: 1'. i Overall Employee Comments: / PERFORMANCE EVALUATION SIGNATURES I , . 0 tv.cl•c \,\. di/Vd 1 Su•erviso, s S'•natu;'- ,.., Date: ., MUT 6 -64 Nex -vel S rt-rvisor's Si•nature at . ir Department Head's Signature Date: , , ..... ,...i.-..st. / ' )42-enli-t 17V0er I Human -.22 rces Si•nature Date: EMpiOyeet'SI e nature: 0 -crinowle-•ge that this Performance Plan&Evaluation has been discussed with 9 f 14 ' 1 me and that I have been given a reasonable opportunity to respond in the Employee Comments section. Date: ,i' ---' 6 , 4AR I I Tiv 4.-1,,,,, .11114 2 8/07 • 0 1 CITY OF NAPLES .) - , PERFORMANCE EVALUATION & PLANNING FORM: NON-SUPERVISORY [ Employee Name: JONES, DAVID Review Period: 9/17/07 TO 3/17/08(Probationa il PERFORMANCE PLAN SIGNATURES I h NM 4 -2 --0 2— Superisois Sign ature ....,.-./...1..1 2 (/...7•.. 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', - '.k. - . -;.-.,Y,---•;--..t.-.-5 .--- • . .. - 1 . , / 1 - ,, " , ::.• ., - ,•;,... -_, ,.. , ... ,....,) „ ,,'•';,, '..-=2. 1 -------r- _ ,---- , :--' 4 ■ o ' ..... ._. (-D ....... ,,. , -.1.-. _.. --t- , # eD , \ ',--t r 14% \ : -.-T -.......-4 ,LI i -1' , ;• a - r - , ,- > ,-+ :(;::D. ;3.,...::_.1.,:J. e07:. • 2.) ..,,.'...1 t,.) ! A '''' *.” r.1). < (I) ' i ' r., ' " t...) 0 ; w ,_t ,,,,-,-, _.1 -4 ri- • „ ,,„ ---' --- ,-r c. , 4 k7-1 =-) ''..' -,, .....7 =,:'.= ..,% tr,.. In rD ,!:i 0 r..4 e-1- -1.. °' '. .' r1) ,A, ., r't M i.-+ C.. ' -., --”' (j) _,,,,,Av i 1., y a ;...,1 ..,\ ,.. e--r 41)3 i s...• a C,.,741 • r.d. I j ,•, --ri C 1 1 T:14;0 .--i- / i *,.. o (.....) ....) ---, 1 _, - : 0) --, •■4 :: --' ■.... r IN' ,,--t- , -.,. ,..,) (D F- s..... __ --- ... ---•:. Cl) ..-.-'.., , ...... ,., -7: co i 1 1 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER t i`rtele t c 1J t iY) I, . ` ).. Qty , am a resident of COL-LA F _ County, c'UO‘L\i—\ (State) and have resided here for more than five (5) years. During the last five years I have known l�h,L-) \ 0 dc:-)to e✓ 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. �j °14 .4% (Signature) ►ki,!► (Name) k :titi bit A A (Address) 29 ci ' 6(91-\--k ��- kk)L c 1 \1/473-L.- 34-VDS Telephone) c2- ) (69)7-—OD 4 STATE OF FLORIDA COUNTY OF � The foregoing instrument was acknowledged before me this L/ bl Di/5— by NI X7.lam 0_rr a tv .e .who has produced as identification and who did not take an oath. SIG ,ATURE OF N• ARY r`:•�` • MELISSA JEAN DAVIDSON NOTARY'S SEA/ . *0 y Pllella'NI!°I F1otda RINT NAME OF NOTARY) 1 kV 0°4115."Pt"NI! 11,—." OTARY PUBLIC '' Co�pllg*•Fi 118655 1 �E. . 9 RESOLUTION OF AUTHORIZATON WHEREAS uk 1 i C irwe: ' °proposes to (Name of Business Entity) engage in contracting as j-°� C.O P in (Type of legal entity:corp.,partnership, etc. Collier County,Florida, according to Collier County Ordinance 2006-46, as amended; and WHEREAS U O\J v �� F v-1( proposes to (Name of Business Entity) �-- qualify for a Certificate of Competency with 'DPW J 1D J 01Q f J (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned 0 Rv 1 ()fv EC-) of (Officers, Owners,Partners) vw e, LiActJ t C s k .i`''( - hereby resolve and represent to the Collier County (Name of Business Entity) Contractors'Licensing Board that the qualifying agent, Pc KSf S ,is active (Name of Individual) _ in all matters connected with the contracting business of ,E>�J L�d4N(>.cc Pl= ,and (Name of Business Entity) We further resolve and represent that tAN)I� O�t-c is Names of Individual) legally empowered to act for ")I lci\�( i A (.in all matters connected with its (Name of Business Entity) contracting business,and has the autority to supervise construction undertaken by (Name of Business Entity) DULY PASSED AND ADOPTED THIS ice day of 0,:a.,COL (Officers,Partners,Owners–with / • e e ignation underneath) kiwis Grrrc !� &vpr.rwl / Corporate Seal(if Applicable) Or Notary Public Certificate Sworn to and subscribed before me thinVilday of :api,d___016 by t kfI 10'1 CLS (I) Notary Public Name Printed No« Public S.LI,. e Commission Number _ _ _ _ _My Commission exii ire ollt DAVIDSON 4' 1 .1 Notary Public•State of Florida f t y •,`v gi My Comm.Wires May 11,2018 %•;!,NaI�d• Commis**0 FF 116655 COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 MEMORANDUM DATE: November 29, 2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number (SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statues. , . 1.'-' 4t so a* - tt Credit Report Prepared For: DAVID JONES Report as Of: 6/25/2015 Personal 8, Cordidenti I Please keep in a safe place Sor your records. -�� ~« �~ N�@�� ---------____—___�__- ` porreuma4 iln, mma.iom u Report Summary Bankruptcy aCourt duognienxp o Credit inquiries 6 Credit Cards,Leans Other Debt Credit Score w | _ _ ___-_ Here you find your pe;sona9 inrormad�,n,i,_lud„ig yoi.v .'ame(s),year of birth,currently and previous addresses,and currant and previous ,employers. Profile L. , Name DAVID JONES DAVID JONES DAVID JONES (Also Known As)AKA DAVID M JONES DAVID MICHAEL DAVID M JONES JONES Year of Birth 1966 1966 1966 Address(es) 240 JUNG BLVD W. 240 JUNG BLVD W. 240 JUNG BLVD W. NAPLES,FL 34120-3335 NAPLES,FL 34120-3335 NAPLES,FL 34120-3335 Current Employer CITY OF NAPLES CITY OF NAPLES CITY OF NAPLES Previous Employer SMALLWOOD DESIGN Personal Statement This space is reserved for statements of dispute.For most consumers,no information appears in this section. Personal Information Page 1 of 1 Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Credit Score _.): :i ,)iii Here you I.■iill iinJ a summafy of all your open and closed accounts,including any delinquencies.Open accounts contain current balances at the time the report was pulled. Account totals,including total debt,are found at the end of this section. - _ _- — — _— —..r-_, 1 Real Estate Balance $255,257.00 $0 .00 $255,257.00 Current Account(s) Current 0 0 0 Delinquent 0 0 0 Other 0 0 0 Revolving Count 15 13 13 Balance Current Account(s) Current 12 25,975.00 105,975.00 105, 536.00 Delinquent 0 0 0 Other 0 0 Installments Balance $67,532.00 $67,532.00 $67 ,532.00 Current Account(s) Current 8 8 8 Delinquent 0 0 0 Other 0 0 0 Other Balance $0 .00 $327,745.00 $72,488.00 Current 0 2 3 Delinquent 0 0 0 Other 0 0 0 Collections Balance $0 .00 $0. 00 $0.00 I Current Account(s) Current 0 0 0 Delinquent 0 0 0 Other 0 0 0 I. - .: 1 Experian Et t�itax All Accounts Count 26 24 26 I Balance $427,112.00 $421,252.00 $426,973.00 Current Account(s) Current 20 20 21 Delinquent 0 0 0 Other 0 0 0 Personal Information Report Summary Page 1 of 1 Bankruptcies Credit Inquiries Credit Cards&Loans Credit Score ":.?,-...-..,', ,-.-:::),';.:3,2:7/•:',')1--:, H?,:i!you v,;;11'jiici Er:y Con i •,,'");=3";..E.:1 iAr..,;(,]:J11:1;1_i:;:1,_1;T:,:-L.1,0"I'r.T1.;:iLi:-.,'-'3:,,',::_:i.S.:-..:::-±,: CC L-I:.','Ca:AVI i,FiCC,',f3,:,.t.,„1:-:UF,:i°!S,MOnaiar,i kJill,j,-ii:.:-:ii,,,alld'.1120i-iir, Suppor":.payNTSW:S.Rernsmbar,b.,,,n!;rtiptc-s.s 1-,--,.:41T.il or;ycw r.:-.:!-,nr;:•-.7'7- li) 1.,:37-,T•,:. fi'— - - —-—-—--------------1 1 v i 1 There are no Public Records on yOLIF crethi report ai itls brae. - -, Personal information Repori Summary Bankruptcles Pagel of I Credit Inquiries Credit Cards&Loans Credit Score Here Vou9 v iii iinci i re names those rwho ha _ ce) ,211r faparl, ,_^d._, Remem'ieF, _y a re-;of i for u,. e 2 years. APPFOLIO INC Business Name APPFOLIO INC inquiry Date 6/6/2015 PktVIa Business Type Tenant Screeners(Reseller) DR GOLETA,CA 93117 b r SUNCOAST CREDIT UNION L] !at I iztri • Business Name SUNCOAST CREDIT UNION Inquiry Date 6/4/2015 IWO Business Type Credit Unions HILLSBOROUGH AVE TAMPA,FL 33610 • CDK/GERMAIN TOYOTA NAP L.z°Fxperiari Business Name CDK/GERMAIN TOYOTA NAP GERMAIN TOYOTA NAPLE Inquiry Date 12/14/2014 12/14/2014 E. � Business Type Automobile Dealers,New Automobile Dealers,New 13315 TAMIAMI TRL N NAPLES,FL 34110 ALLY FINANCIAL "! „,e•.�`EX OI It-t'[l Equifax Business Name ALLY FINANCIAL Inquiry Date 12/14/2014 1163; Business Type Auto Financing Companies BYMAILONLY PO BOX 12699 GLENDALE,AZ 85318 ,.`�d a-�•_: Here you vAl`fiso: the nerves of th,Dse noro r ve ohteIned e coops of your credit Ge13..r t.incio d ,g r-_rlCi�� isnc I,.a:�W _�i sf.�eo p!overs.Remember,iri:I`tiril _ DJ-1 fep+att for i?)to 2; s. • CAPITAL ONE AUTO FIN Business Name CAPITAL ONE AUTO FIN CAPITAL ONE COAF i Inquiry Date 12/14/2014 12/14/2014 12/14/2014 Business Type Auto Financing Companies Auto Financing Finance,personal 3905 N DALLAS PKWY PLANO,TX 75093 r-- WEBBANK/DFS .a :�- riri Business Name WEBBANK/DFS inquiry Date 1/29/2014 Business Type All Banks-non specific 1 DELL WAY ROUND ROCK,TX 78682 SYNCBITJX CO i.. =Experiati Business Name SYNCB/TJX CO Inquiry Date 12/17/2013 11631 Business Type Bank Credit Cards PO BOX 965015 ORLANDO,FL 32896 SYNCB/DILLARDS "D EXperian Equifax Business Name SYNCB/DILLARDS inquiry Date 12/15/2013 Business Type Complete Department Stores PO BOX 965024 ORLANDO,FL 32896 '17,7 ?_ :i ' _ _;i f " V o•-■ n-p?G,..� :I d Business Name ALLY FINANCIAL Inquiry Dale 9/9/2013 Btrsinezz Yype Auio Financing Companies BYMAILONLY PO BOX 12699 GLENDALE,AZ 85318 CHRYSLER CAPITAL Business Name CHRYSLER CAPITAL f Inquiry Date 9/9/2013 Business Type Auto Financing Companies PO BOX 961275 FORT WORTH,TX 76161 • CDK/NAPLES DODGE INC '1 -Experial-t Eq uif„Y: Business Name CDK/NAPLES DODGE INC NAPLES DODGE,INC. Inquiry Date 9/7/2013 9/7/2013 Business Type Automobile Dealers,New Automobile Dealers,New BYMAILONLY 4075 TAMIAMI TRL N NAPLES,FL 34103 WFB BD CRE :Li Exper an Equifax Business Name WFB BD CRE Inquiry Date 6/6/2013 � I Business Type All Banks-non specific 100 W WASHINGTON AVE PHOENIX,AZ 85003 Here you vrili find the names c those;ho rose obtained,.1 copy of;;our credit report,including lenders,Isd6;oids,and .n .n7 : . e..,,�s o 7w inqu,is. +ad'ii d,1 on fnu7 report iror up to 2 years, REALPAGE Business Name REALPAGE INC I inquiry Date 6/9/2015 � .: Business Type Miscellaneous Reptg.Agencies REALPAGE INC .x,, , E-neIir Business Name REALPAGE INC Inquiry Date 6/4/2015 IWO Business Type Miscellaneous Reptg.Agencies Otte; VERIZON WIRELESS-FLA '°ee:=Experian Business Name VERIZON WIRELESS-FLA Inquiry Date 4/10/2015 Business Type Telephone Companies MAIL ONLY 618 GRASSMERE PARK SUITE 14 NASHVILLE,TN 37211 COMCAST CABLE 490 FT ` ,.i=Experian Equixa Business Name COMCAST CABLE 490 FT 3/7/2015 Business Type Miscellaneous Utilities 12641 CORPORATE LAKES DR FORT MYERS,FL 33913 Here you clt find iafimes of those who have obtained e copy ct your crecft report,tiiCIurtng lenders,landlords,and employers.Remember,inquiries remain on your report for up to 2 v;r.a:s. JFMRGAN CHASE ANK - Business Name JPMORGAN CHASE BANK Inquiry Date 12/14/2014 6 ,:;I Business Type All Banks INDEPENDENCE PARKWAY TAMPA,FL 33634 SOUTHEAST TOYOTA FIN a -r.pet lal"I Business Name SOUTHEAST TOYOTA FIN Inquiry Date 12/14/2014 11 Business Type Auto Financing 120 NW 12TH AVE MAIL DROP WOFDF115 DEERFIELD BEACH,FL 33442 BB &T DEALER FINANC 'rl.Experit n ttipireix Business Name BB&T DEALER FINANC Inquiry Date 9/9/2013 I WO Business Type All Banks 7701 AIRPORT CENTER DRIVE SUITE 2300 GREENSBORO,NC 27409 ANCHOR ASSOC ..TFExpenan Equifax Business Name ANCHOR ASSOC Inquiry Date 6/23/2015 Business Type Employment 3940 RADIO ROAD #112 NAPLES,FL 34104 Hare you v 3 fud spe+J3.'.=rnrur radon on each account you opened,including current status and any past due information.Positive credit information remains on your report rode rntte'7 Cre-di .r contact information has been provided in order to make it easier for you to resolve any issues. Account Name ALLY FINANCIAL Current Closed Account# Account Type Auto Financing Companies Balance $0.00 CTR Account t Opened Close 010 �"r, Account Status Closed DETROIT,MI 8243 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $0.00 Limit $0.00 Terms 48 Months Comments 24itilo Payment History 2012 2013 Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Experian ALLY FINANCIAL 7,,-Exper iar Account Name ALLY FINANCIAL Current Account# Account Type Auto Financing Companies Balance $37,069.00 200 RENAISSANCE CTR Past Due $0.00 DETROIT,MI 48243 Date Opened 9/1/2013 Account Status Open Mo.Payment $724.00 Payment Status Current High Balance $0.00 Limit $0.00 Terms 75 Months Comments 24/Mo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian _ Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 1 of 29 Credit Score • Hare you i9`119i`tl 19 ., is ;, I ;rtailJs� ,,i '�:. +?:. DC vs_'; ; ,"t.+1f�d;al _�1 i,1 J1`; ...1'm,. .,.._a; iov_.°!Stl fail` _. 4�ii;! 1 o_..: i'z nVU' : a ihY tepoft ]u lCat.flnl',-i�.t eein,.JV conL...i,;`tlioriPdatls7n has been provided in order to f71a!:_ L.DY ,'L�..� :7 _ Account Name Current Account t) Account Type Balance 74271i Pest Due 8D08 8O BOX 717871 /a Date Opened Account Status FORT LAUDERDALE,FL 33329 Ago,payment Payment Status High Balance Limit Terms Comments 241 tolo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian i AMEX . xper'ail Account Name AMEX Current Account# Account Type Bank Credit Cards Balance $0.00 08742717 Past Due $0.00 80 80 874 297871 Date Opened 7/1/2004 FORT LAUDERDALE,FL 33329 Account Status Open Mo.Payment $0.00 Payment Status Current High Balance $23,925.00 Limit $0.00 Terms 1 Month Comments 24/Mo Payment History 2009 2010 2011 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Experian Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 2 of 29 Credit Score Fiere you will find specific information on each account you opened,Including current ste Us and any past Clue i i ormauon.Posi ive 1r.dil r eino.ns on your repc','f indefinitely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. Big OF AE Account Name BK OF AMER Current Account# Account Type Bank-Mortgage Department Balance $255,257.00 Past Due $0.00 ED04516362 Date Opened 7/1/2007 1800 TAPO CANYON RD Account Status Open SIMI VALLEY,CA 93063 Mo.Payment $1,890.00 Payment Status Now past due 30 days,was past due 60 days High Balance $0.00 Limit $0.00 Terms 360 Months Comments 24/Ma Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian BK OF AMER :• Experian Account Name BK OF AMER Current Account# Account Type Bank-Mortgage Department Balance $72,488.00 8 Past Due $0.00 004516362 Date Opened 7/1/2007 1800 TAPO CANYON RD Account Status Open SIMI VALLEY,CA 93063 Mo.Payment $409.00 Payment Status Current,was past due 30 days two times High Balance $72,588.00 Limit $72,588.00 Terms Revolving Comments 241Ma Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian ,. Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 3 of 29 Credit Score Here you will rind speci i;information on each account you opened,includinu current status and any past due information.Positive credit information remains on your report in 1eAiiieiy.Creditor contact information has been provided in order to make it easier for you to resolve any issues. CAPITAL Ou 9E BANK USA N Account Name CAPITAL ONE BANK USA N CAPITAL ONE BANK USA Current Closed Account# 51780523XXXX Account Type Bank Credit Cards All Banks Balance $0.00 $0.00 Past Due $0.00 $0.00 8009557070 Date Opened 11/1/2003 11/1/2003 15000 CAPITAL ONE DR Account Status Closed Closed RICHMOND,VA 23238 Mo.Payment $15.00 $0.00 Payment Status Current Pays account as agreed High Balance $519.00 $519.00 Limit $500.00 $500.00 Terms Revolving M Comments 2$/Mo Payment History 2006 2007 2008 Month FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN Experian Equifax 1 • CAPITAL ONE BANK USA N ; =Experian `' �� `'=' Account Name CAPITAL ONE BANK USA N CAPITAL ONE BANK USA ,, Current Closed Account# 48623624XXXX f.aP, Account Type Bank Credit Cards All Banks Balance $0.00 $0.00 Past Due $0.00 $0.00 8009557070 Date Opened 9/1/2004 9/1/2004 15000 CAPITAL ONE DR Account Status Closed Closed RICHMOND,VA 23238 Mo.Payment $0.00 $0.00 Payment Status Paid satisfactorily Pays account as agreed High Balance $2,568.00 $2,568.00 Limit $2,500.00 $2,500.00 Terms Revolving M Comments 24/Mn Payment History 2008 2009 2010 Month OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP Experian Equifax Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 4 of 29 Credit Score •H,J1 "JOU si,5ni3 and;Dril,pee'i in;r01-01:000.pcc2.,ii;v9 r.,001F.;,,,0,-,,:forjr rapoit Ctedito:-.ctontict rmwi3 Le pin:ilrded in order to meYs it ess:er to; o to resolve air;issues. LF,A1 . i..XiCitar:Name CBNA Current Closed Account Account Type Retail,Not Elsewhere Classified Balance 90.00 Past Due $0.00 • B%12J1A IL ONLY Date Opened 8/1/2007 PO BOX 6497 Account Status Closed SIOUX FALLS,SD 57117 Pao.Payment $0.00 Payment Status Paid satisfactorily High Balance $3,807.00 • Limit $2,501.00 Terms Revolving Comments - • 24/Mo Payment History 2009 2010 2011 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Experian CHASE lz_X pet'at) Account Name CHASE Current Account# Account Type All Banks-non specific Balance $8,662.00 Past Due $0.00 8003366675 Date Opened 5/1/2013 PO BOX 901003 Account Status Open FT WORTH,TX 76101 Mo.Payment $509.00 Payment Status Current High Balance $0.00 Limit $0.00 Terms 42 Months Comments 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Experian Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 5 of 29 Credit Score • • . Here you wit find specific ni'ocroati,Dri on each account you opened,including g c u'i nt status and any past due information.Positive,credit iniof Yn a(ion I en-ra'. indefinitely.Creditor contact informs?ton has been provided in order to make it easier for you to resole,:any issues. CHASE CARD Account Name CHASE CARD Current Account# Balance $0.00 Past Due $0.00 8004323197 Date Opened 5/1/2010 PO BOX 15298 Account Status Open WILMINGTON,DE 19850 Mo.Payment $30.00 Payment Status Current High Balance $5,656.00 Limit $5,700.00 Terms Revolving Comments 24/Mo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian CITI Experian Account Name CITI Current Account# Account Type Bank Credit Cards Balance $4,800.00 Past Due $0.00 BYMAILONLY Date Opened 3/1/2012 PO BOX 6241 Account Status Open SIOUX FALLS,SD 57117 Mo.Payment $143.00 Payment Status Current High Balance $4,800.00 Limit $6,600.00 Terms Revolving Comments 241Ma Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian ) ;' Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 6 of 29 Credit Score I Hare you wit find specific information on each account you opened,including current status and any past due Li fonuation.Positive c=-edit information remains on your report indefinitely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. CONVERGE-HT RECOVERI Account Name CONVERGENT HC RECOVER! Unknown Account# Agencies Balance $5,860.00 8668670179 Date Opened 4/1/2015 121 NE JEFFERSON ST STE Account Status PEORIA,IL 61602 Mo.Payment $0.00 Payment Status Seriously past due date/assigned to attorney,collection agency,or credit grantor's internal collection department High Balance $0.00 Limit $0.00 Terms 1 Month Comments 24/Mo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian CO DISCOVER FIN SVCS LLC ,; ` xperiari " ds «T Account Name DISCOVER FIN SVCS LLC Current Account# Account Type Bank Credit Cards Balance $0.00 Past Due $0.00 BYMAILONLY Date Opened 4/1/2012 PO BOX 15316 Account Status Open WILMINGTON,DE 19850 Mo.Payment $135.00 Payment Status Current High Balance $5,150.00 Limit $8,000.00 Terms Revolving Comments 24/Mo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian ,. Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 7 of 29 Credit Score Hare ou 1,1]:;`i lJ-ed a sciiic on each acc uni you opened,rincinding current status and any p si due into rn.tion.Positive c ed'st information l ernaarns on your r oci efinftetj Creclicr con act information has been piovI_. :1 rn order .n r'iaL ":eager for you to resolve a fy issues. Account Name KOHLS/CAPOLE Current Closed Account t- Account Type Complete Department Stores Balance $0.00 Past Due $0.00 600564574,5 Date Opened 12/1/2003 1156 W 17000 RIDGEWOOD DR ,account Status Closed MENOMONEE FALLS,WI 53051 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $122.00 Limit $1,500.00 Terms Revolving Comments 2411 Mr,Payment History 2011 2012 2013 Month APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Experian MAZDA AMER CR ` , =Experian Account Name MAZDA AMER CR Current Closed Account# Account Type Auto Financing Companies Balance $0.00 Past Due $0.00 8009456000 Date Opened 12/1/2002 9009 CARUTHERS PKWY Account Status Closed FRANKLIN,TN 37067 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $0.00 Limit $0.00 Terms 48 Months Comments 24/Mo Payment History 2003 2004 2005 Month NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT Experian . Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 8 of 29 Credit Score Here you wit rind screcAc ini3ooA:o on each ctS53113't l inckielng ciffr I . pF,St due .,;11;1;:12. t Ld113 indefinitely.Creditor centeci information his been p1 ou'.d er !i i a _let to meize it ec!ot Si ic71 you to raar_&3 any ga DA A ` ER R' Account Name MAZDA AMER CR Current Closed Account# Companies Balance $0.00 8009456000 Past Due $0.00 9009 CARUTHERS PKWY Account t Opened us Closed 998 Account Status Closed FRANKLIN,TN 37067 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $0.00 Limit $0.00 Terms 53 Months Comments 24/Mo Payment History 2003 2004 2005 Month OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP Experian ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND NORDSTROM FSB Experizol Account Name NORDSTROM FSB Current Account# Balance $9,007.00 Past Due $0.00 8009354210 Date Opened 12/1/2012 PO BOX 6565 Account Status Open ENGLEWOOD,CO 80155 Mo.Payment $901.00 Payment Status Current,was past due 30 days High Balance $9,462.00 Limit $10,000.00 Terms Revolving Comments 24/Mo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 9 of 29 Credit Score Here you Will find epeciic information on each account you opened,including current status and any past due information.Posiike credit information remains on your report indefinitely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. Rl:sADLOAN S Ct'_ 1 Account Name ROADLOANS.COM Current Closed Account# Account Type Personal Loan Companies Balance $0.00 8008799756 Past Due $0.00 5201 RUFE SNOW DR STE 40 Date Opened Close 07 Account Status Closed NORTH RICHLAND HILLS,TX 76180Mo.Payment $0.00 Payment Status Account transferred to another office High Balance $0.00 Limit $0.00 Terms 72 Months Comments 24/Mo Payment History 2008 2009 Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Experian SANTANDER CONSUMER USA Experian Account Name SANTANDER CONSUMER USA SANTANDER CONSUMER U Current Closed Account# 3000014985629XXXX ' Account Type Personal Loan Companies Auto Financing Balance $0.00 $0.00 8669239282 Past Due $0.00 $0.00 8 Date Opened 4/1/2007 4/1/2007 PO BOX 961245 Account Status Closed Open FT WORTH,TX 76161 Mo.Payment $0.00 $496.00 Payment Status Paid satisfactorily Pays account as agreed High Balance $0.00 $28,896.00 Limit $0.00 $0.00 Terms 72 Months M 72M Comments 24/Mo Payment History 2009 2010 2011 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experian ND Equifax Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 10 of 29 Credit Score Here you will iiud specific information on each account you opened, including current status and any past due information.Positive credit information remains on your report indefinitely.Creditor contact information has been provided in order to make ft easier for you to resolve any issues. SEARSICBNT Account Name SEARS/CBNA Current Closed Account# Department Stores Balance $0.00 YMAILONLV Past Due $0.00 B B BOX 6282 Date Opened 8/1/2007 Account Status Closed SIOUX FALLS,SD 57117 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $5,917.00 Limit $6,000.00 Terms Revolving Comments 24)Ma Payment History 2009 2010 Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Experian • SUNTRUST BK CENTRAL FL ....'Experian Account Name SUNTRUST BK CENTRAL FL SUNTRUST BANKS OF FL a. Current Closed Account# Balance $0.00 $0.00 Past Due $0.00 $0.00 4078587250 Date Opened 9/1/2005 9/1/2005 PO BOX 4986 Account Status Closed Open ORLANDO,FL 32802 Mo.Payment $0.00 $625.00 Payment Status Paid satisfactorily Pays account as agreed High Balance $0.00 $33,243.00 Limit $0.00 $0.00 Terms 72 Months M 72M Comments 24/Ma Payment History 2005 2006 2007 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Experian Equifax Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 11 of 29 Credit Score - . e[C,CDUrii o• s3 3d ]noludhg cufrent siFiZuo and E;ny pas P33aiv6 cred4 310 mai 31 raciFii-ij;of,you, ,?,pori C;rediOr ha:3 053 oukl.l . 03J0io ina:,:e es:=3:.sr-kw you to r?;c.o1,7; Account Name SYNCB/GAPDC Current Closed Account# Account Type Bank Credit Cards Balance $0.00 Past Due $0.00 8664504467 Date Opened 8/1/2009 PO BOX 965005 Account Status Closed ORLANDO,FL 32898 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $2,293.00 Limit $0.00 Terms Revolving Comments 241M.O.Payment History 2011 2012 2013 Month AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL Experian SYNCB/TJX COS DC * Experian TP Account Name SYNCB/TJX COS DC Current Account# Account Type Bank Credit Cards Balance $4,282.00 Past Due $0.00 8009266299 Date Opened 12/1/2013 PO BOX 965005 Account Status Closed ORLANDO,FL 32896 Mo.Payment $137.00 Payment Status Paid as agreed High Balance $4,282.00 Limit $5,750.00 Terms Revolving Comments 24/Mo Payment History 2013 2014 2015 Month JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Experlan Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 12 of 29 Credit Score • Here you Oil Mind specific information on each account you opened,including current status and any past due information.PosvtiVe credit onion rFaiion remains on your s erpori: indefinitely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. IfifFFNEMATTRESS MANI Account Name WFF NB/MATTRESS GIANT Current Closed Account/I Account Type Home Furnishings-non specific Balance $0.00 8006355585 Past Due $0.00 80 80 BOX 94498 Date Opened 9/1/2010 Account Status Closed LAS VEGAS,NV 89193 Mo.Payment $0.00 Payment Status Paid satisfactorily High Balance $1,907.00 Limit $2,300.00 Terms Revolving Comments 24/Mo Payment History 2012 2013 2014 Month MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB Experian WORLD OMNI 4; =Experian Account Name WORLD OMNI Current Account# Account Type Auto Financing Companies Balance $21,801.00 YMAILONLY Past Due $0.00 B B BOX ONLY Date Opened 12/1/2014 Account Status Open MOBILE,AL 36691 Mo.Payment $469.00 Payment Status Current High Balance $0.00 Limit $0.00 Terms 60 Months Comments 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Experian Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 13 of 29 Credit Score _p \.,. .J b,,:,--,L,sly \i.IJ �! ., ,—Lice u,I , —!.JL�.— 1 J.31'2'1, Here you wit find specific information on each account you opened,including citrreni status and any past due information.Positive credii information hs.ivaiis oil your report indefinitely.Creditor contact information has been provided in order to Hulce it easier for you to resolve any issues. ALLY FNATi' Ct. L Account Name ALLY FINANCIAL ALLY FINCL Current Account# Balance $37,069.00 $37,069.00 8889252559 Past Due $0.00 $0.00 P 0 BOX 380901 Date Opened 9/9/2013 9/9/2013 Account Status Open Open BLOOMINGTON,MN 55438 Mo.Payment $724.00 $724.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $49,292.00 $49,292.00 Limit $0.00 $0.00 Terms M 75M 75 Months Comments 241Mn Payment thstory 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax ND ND ND Transunion ALLY FINANCIAL I.:-Expel ian t3,mn Account Name ALLY FINANCIAL ALLY FINCL Current Account# personal Balance $0.00 $0.00 8889252559 Past Due $0.00 $0.00 P 0 BOX 380901 Date Opened 12/31/2010 12/31/2010 Account Status Open Closed BLOOMINGTON,MN 55438 Mo.Payment $589.00 $589.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $28,308.00 $28,308.00 Limit $0.00 $0.00 Terms M 48M 48 Months Comments 24/Mo Payment History 2011 2012 2013 Month DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV Equifax Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 14 of 29 Credit Score Lei's: r a9 al:onnation on each CCCOUi1t YOU opened,including current status and any past due information Positive C Cdii information remains on,,,,our r-.00h o e lltei co: a information has been provided in order to make it easi3i i01 you to resolve any /7A rFl aJC Arl Account Name AMERICAN EXPRESS AMEX Account - Balance $6,886.00 $6,747.00 8003742717 Past Due $0.00 $0.00 Date Opened 3/3/2007 3/3/2007 P.O.BOX 981537 Account Status Open Open EL PASO,TX 79998 Mo.Payment $0.00 $0.00 Payment Status Paid as agreed Paid as agreed High Balance $6,886.00 $6,747.00 Limit $7,000.00 $7,000.00 Terms M Comments 24/ 10 Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Transunion AMERICAN EXPRESS ; Experian Egoifa, Account Name AMERICAN EXPRESS Current Account# - Balance $0.00 8008742717 Past Due $0.00 800874 P.O.BOX 981537 Date Opened 7/1/1993 Account Status Open EL PASO,TX 79998 Mo.Payment $0.00 Payment Status Pays account as agreed High Balance $1,324.00 Limit $0.00 Terms Comments 24/Mo Payment History 2008 2009 Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Equifax �," Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 15 of 29 Credit Score i ra— :o_'t _ffII I Hera you uiii'Inc;spe.7f:o info rnation on each account you opened,including current StCIUS a F11,1,Iasi iirl• 1.., ,jo; _,,1+fi indefinit&y.Creditor contact info-oration has been provided in order to niche ii easier for yc t i et-Dni.Ani issues. OF AMERICA, KA , Account Name BANK OF AMERICA,N.A BK OF AMER Account# Ls 8006696609 Balance $255,257.00 $255,257.00 450 AMERICAN ST Past Due $0.00 $0.00 .50 AMERICAN N T3065 Date Opened 7/31/2007 7/31/2007 Account Status Open Open Mo.Payment $1,890.00 $1,890.00 Payment Status Open Open High Balance $290,350.00 $290,350.00 Limit $0.00 $0.00 Terms M 30Y 360 Months Comments FANNIE MAE ACCOUNT 24IMo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Transunion BANK OF AMERICA, N.A ' .,.- xi)erilri • Account Name BANK OF AMERICA,N.A Account# Balance $72,488.00 Past Due $0.00 8006696607 Date Opened 7/31/2007 450 AMERICAN ST Account Status Open SIMI VALLEY,CA 93065 Mo.Payment $409.00 Payment Status Pays account as agreed High Balance $72,588.00 Limit $72,588.00 Terms M Comments CREDIT LINE SUSPENDED 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 16 of 29 Credit Score .'J l-..,iu_ `. 2.-4 L-11,3 _2(31;Li a PJ 4.9if Here you anti find speciiic information on each account you opened,including current status and any past due information.Positive,credit information remains on your reoori indenniiiely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. CHASE BANK USA, N Account Name CHASE BANK USA,NA CHASE Current Account# Balance $0.00 $0.00 8009559900 Past Due $0.00 $0.00 !/DE1-1027 Date Opened 5/5/2010 5/5/2010 801 N.WALNUT ST WILMINGTON,DE //DE Account Status Open Open Mo.Payment $0.00 $0.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $5,656.00 $5,656.00 Limit $5,700.00 $5,700.00 Terms M Comments 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax , Transunion CITICARDS CBNA ;. } +?t it as +l== Account Name CITICARDS CBNA CITI Potentially Negative Account# Banks and S&Ls Balance $4,800.00 $4,800.00 ONLY Past Due $0.00 $0.00 MAIL Date Opened 3/9/2012 3/9/2012 701 E ONLY ST N IBS E 60TH DISPUTES NES Account Status Open Open Mo.Payment $143.00 $143.00 SIOUX FALLS,SD 57104 Payment Status Paid as agreed 30 days past due High Balance $4,800.00 $4,800.00 Limit $5,600.00 $5,600.00 Terms M Minimum Comments 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 17 of 29 Credit Score • Here you wit/fio specii info'mat on on each account you opened,including current status and any past due information.Positive credit information rerimains on your report index?tnitaig.Creditor contact information has been provided in order to make it easier for you to resolve any issues. [ I& ,o!ER BA Account Name DISCOVER BANK DISCOVERBANK Current Account# Balance $0.00 $0.00 8003472683 Past Due $0.00 $0.00 80® PO 34 X15316 Date Opened 4/24/2012 4/24/2012 Account Status Open Open ATT:CMS/PROD DEVELOP Mo.Payment $0.00 $0.00 WILMINGTON,DE 19850-5316 Payment Status Pays account as agreed Paid or paying as agreed High Balance $5,150.00 $5,150.00 Limit $8,000.00 $8,000.00 Terms M Comments 24/Mo Payfnettt History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Transunion JPMORGAN CHASE BANK - xperi011 Account Name JPMORGAN CHASE BANK Current Account# Account Type All Banks Balance $8,662.00 5165744676 Past Due $0.00 600 COMMUNITY DRIVE Date Opened 5/4/2013 Account Status Open MANHASSET,NY 11030-3847 Mo.Payment $509.00 Payment Status Pays account as agreed High Balance $21,400.00 Limit $0.00 Terms M 42M Comments 24/Mo Payment History 2013 2014 2015 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Equifax Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 18 of 29 Credit Score -la u 1 I l i E J •s i,t,e re,-r?c ._¢d."Jr,: e : J' ye-_,eta 1,.1.:., • _f d of SiE,LLI5,alid r,.i1, p. , ._ 4d,eL. ..n. a 1-s,].,cr.edit iaii aril]i3Oi1 serf ldi ,U o'i-'U d "i a 6nde i,,,<ly.Cra.jP sr conic :.,1 orineipG1 has been p,cdk vi i'il., i;.,rum,.:'s ii CS15.e; for',ou to res+ ,i'i,. G i,e• . Account Name KOHLS/CAPITAL ONE KOHLS/CAPONE Current Account 0 Account Type Compete Dept.Siores Department,variety,local,regional, and national chains Balance $0.00 $0.00 MAIL ONLY Past Due $0.00 $0.00 PO BOX 3115 Date Opened 1 12/19/2008 12/1199 /2003 MILWAUKEE,WI 53201-3115 Account Status Open Closed Mo.Payment $0.00 $0.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $122.00 $122.00 Limit $1,500.00 $1,500.00 Terms M Comments 24.ilio Payment History 2011 2012 2013 Month MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB Equifax Transunion MATTRESS GIANT -790 �c- 7.(34?tletrl ; 1? .,1 Account Name MATTRESS GIANT-790 DNB-MATTRESS 1 , �.; Current Closed Account# Account Type Furniture,Etc. Finance,personal Balance $0.00 $0.00 MAIL ONLY Past Due $0.00 $0.00 Date Opened 9/9/2010 9/9/2010 CSCL DISPUTE TM-MAC N8235-0Atibount Status Closed Closed PO BOX 14517 Mo.Payment $0.00 $0.00 DES MOINES,IA 50306 Payment Status Pays account as agreed Paid or paying as agreed High Balance $1,907.00 $1,907.00 Limit $2,300.00 $2,300.00 Terms M Comments ACCOUNT CLOSED BY CREDIT GRANTOR 24/Ma Payment History 2012 2013 2014 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Equifax Transunion Personal Information Report Summary Bankruptcies Credit inquiries Credit Cards&Loans Page 19 of 29 Credit Score CI: Here you wiii find specific in orrnaiion on each account you op +red,including current status and any past du Iniarmatidn.Positive credit ttormat n fern i .nu'/n;u. report indefinitely.Creditor contact information has been provided in order to male it easier ior you to resolve any i__sues. MAZDA AMERICAN CREDO , Account Name MAZDA AMERICAN CREDI Current Account# Account Type Auto Financing Balance $0.00 8009456000 Past Due $0.00 P.O. 8009456000 542000 Date Opened 12/1/2002 OMAHA, 542000 68154 Account Status Open Mo.Payment $452.00 Payment Status Pays account as agreed High Balance $20,475.00 Limit $0.00 Terms M 48M Comments 24)hero Payment History 2003 2004 2005 Month OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP Equifax NORDSTROM FSB °a.°.-Expert try i Account Name NORDSTROM FSB NORDSTROMFSB Current Account# Balance $9,007.00 $9,007.00 Past Due $0.00 8009641800 12/20 8502 EAST PRINCESS DRIVE Date Account Status Open 2012 Open 2012 Account Status Open Open SUITE 150 Mo.Payment $901.00 $901.00 SCOTTSDALE,AZ 85255 Payment Status Pays account as agreed Paid or paying as agreed High Balance $9,462.00 $9,462.00 Limit $10,000.00 $10,000.00 Terms M Minimum Comments 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax 1 Transunion :, Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 20 of 29 Credit Score Here you e„vill`find specific iniormation on each account you opened,including current status ar;d any past due informeiion.Positiva,credit infornia'i.bn raarneins on your ri;Dor t indefinitely.Creditor contact inormation has been provided in order to make it easier for you to resolve any issues. SEARSICBN Account Name SEARS/CBNA SEARS/CBNA Current Closed Account# variety,local,regional, and national chains $0.00 Balance $0.00 MAIL ONLY Past Due $0.00 $0.00 133200 SMITH RD CLEVELAND, R 44130 Date Opened 8/3/2007 8/3/2007 Account Status Closed Closed Mo.Payment $0.00 $0.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $5,917.00 $5,917.00 Limit $6.000.00 $6,000.00 Terms M Comments 241Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Transunion SYNCB/GAP DC xE l i 1n sa `'' Account Name SYNCB/GAP DC SYNCB/GAPDC Current Account# Credit Card Cos. Banks and S&Ls Balance $0.00 $0.00 Past Due $0.00 $0.00 MAIL ONLY Date Opened 8/12/2009 8/12/2009 4125 WINDWARD PLAZA Account Status Open Closed ALPHARETTA,GA 30005 Mo.Payment $0.00 $0.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $2,293.00 $2,293.00 Limit $1,024.00 $1,024.00 Terms M Comments 24/Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax Transunion , Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 21 of 29 Credit Score ,,you 'ii i s,3,..nit in-moada,n on each aCCOLfilt you opiinad,including current e nt Status and any past duE,'lrltOOrri ,3n.Pocu,_credit iiitormatuon remains on your rapport ;ods n2i.al .:,0i-editor;Con i,irbi r,iatiOn has.,aeit provided dl.oEler L make li easier for you to resolve.any issues. d 1 J _- : i ti -L:L - Current Account Name YaSr BaS $4,282.00 $4,282.00 Date Opened 12/17/2013 12/17/2013 MAIL ONLY Account Status 4125 WINDWARD PLAZA Mo.Payment $137.00 $137.00 ALPHARETTA,GA 30005 Payment Status Current Current High Balance $4,282.00 $4,282.00 Limit $8,750.00 $8,750.00 Terms Monthly Monthly Comments Paid as agreed Paid as agreed 24/rho Payment#istt try 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Equifax ND ND ND ND ND ND Transunion ■ THD/CBNA ;:$ E ppt i n ¢_$ ; r Account Name THD/CBNA THD/CBNA Current Account# Account Type Personal Loans Cos. Banks and S&Ls Balance $0.00 $0.00 Past Due $0.00 MAIL ONLY $0.00 Date Opened PO BOX 6497 Account Status 8/13/2007 l Open se SIOUX FALLS,SD 57117-6497 O Closed 0 Mo.Payment $0.00 $0.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $3,807.00 $3,807.00 Limit $2,501.00 $2,501.00 Terms M Comments 24/Mn Payment History 2011 2012 2013 Month FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JA Equifax , Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 22 of 29 Credit Score re;:•.7,-i ii i'C'- i'ii'i-.:7^':-:2,?,i:i' iij L=2,ii.--Z5Li 1_. Here you itt id speac informatbn on each aCC011ilii you opened,inciuding current status and any past dua informasn.Posifs Ori3'ili:jr“i;) iiii) ii.Fii:ii:'-:..0iii indelinite'ry.Creditor contact information has been provided in order to make it easier for you to resolve any issues. VW GREIF NC Account Name WY CREDIT INC Current Account# Balance $0.00 Past Due $0.00 8473714310 Date Opened 6/1/2009 2333 WAUKEEGAN RD Account Status Open DEERFIELD,IL 80015 Mo.Payment $595.00 Payment Status Pays account as agreed High Balance $21,429.00 Limit $0.00 Terms M 36M Comments 241Mo Payment History 2008 2009 2010 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Equifax WORLD OMNI FINANCIAL * EXperi..0 n tquifax Account Name WORLD OMNI FINANCIAL WORLD OMNI F Current Account# Balance $21,801.00 $21,801.00 Past Due $0.00 $0.00 8005332650 Date Opened 12/14/2014 12/14/2014 P.O.BOX 991817 Account Status Open Open MOBILE,AL 36691-1817 Mo.Payment $469.00 $469.00 Payment Status Pays account as agreed Paid or paying as agreed High Balance $23,432.00 $23,432.00 Limit $0.00 $0.00 Terms M 60M 60 Months Comments 241 Mo Payment History 2013 2014 2015 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Equifax ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 23 of 29 Credit Score Here you wfl find s peckc information on each account you opened,d,ini udinci current status and any past due information.Positive credit information remains on your report indefinitely.Creditor contact information has been provided in order to make it easier for you to r=solve any issues. AMEX Account Name AMEX Current Account# Balance $0.00 Past Due 8008742717 $0.00 Date Opened P.O.BOX 981537 O12n2004 Account Status Mo.Paymment ent $0. EL PASO,TX 79998 $0. 0 00 Payment Status Paid or paying as agreed High Balance $23,925.00 Limit $0.00 Terms Comments 24/Mu Payment History 2009 2010 2011 Month APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Transunion ND ND ND ND ND ND ND ND ND ND ND ND ND , t+`- AMEX y..; r i erian Account Name AMEX Current Account# Account Type Banks and S&Ls Balance $0.00 8008742717 Past Due $0.00 Date Opened P.O.BOX 981537 Account Status Open $0.12004 EL PASO,TX 79998 Mo.Payment 0 $0.00 Payment Status Paid or paying as agreed High Balance $57,083.00 Limit $0.00 Teens Comments 24/Mo Payment History 2005 2006 2007 Month DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 24 of 29 Credit Score •-;.; Here you 1'I find specific inibmattion on each account you opened;inducting current status and any past due information. -'osiHHVe credit information mation remains on your report rt indefinitely.Creditor contact inforrortiijn has been provided in order to mane it easier for you to resolve any issues. 42 r sic"oust Name BK OF AMER Current Account# ast Due $0.00 1800 TAPO CANYON Date Opened 7/31/2007 Account Status CA6-914-01-91 Mo.Payment $409.00 SIMI VALLEY,CA 93063 Payment Status Paid or paying as agreed High Balance $72,588.00 Limit $72,588.00 Terms Minimum Comments 241Mo Payment History 2013 2014 2015 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Transunion • CAPITAL ONE b.a xperi Account Name CAPITAL ONE Current Closed Account# Account Type Banks and&s Balance $0.00 8009557070 Past Due $0.00 Date Opened POB 30281 Account Status Mo. ed 4 Clo SALT LAKE CITY,UT 84130 lo 0o.Payment $0.00 Payment Status Paid or paying as agreed High Balance $2,568.00 Limit $2,500.00 Terms Comments 24/Mo Payment History 2008 2009 2010 Month SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG Transunion , Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 25 of 29 Credit Score Here you sp :E r iii i nntiOn accouii y d opened,.laid z� l l 3 . � ._ C, ; 3_ aprd indeFnitely.Creditor conic; i-ri o'nation has bran providad in order to ma,:e L sass, �.;, } to revolve Account Name CAPITAL ONE Current Closed Account# Account Type Banks and S&Ls Balance S0.00 8009557070 Past Due $0.00 Date Opened POB 30281 p Closed SALT LAKE CITY,UT 84130 Account Status $0.00 Mo.Payment $0.00 Payment Status Paid or paying as agreed High Balance $519.00 Limit $500.00 Terms Comments 24/Mlo Payment History 2006 2007 Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Transunion CHASE AUTO "° a >periar i Account Name CHASE AUTO Current Account to Account Type Banks and S&Ls Balance $8,662.00 8003366675 Past Due $0.00 P.O.BOX Date Opened 5/4/2013 CREDIT O. O 901003 BUREAU DISP Account Status Open Mo.Payment $509.00 FORT WORTH,TX 76101 Payment Status Paid or paying as agreed High Balance $21,400.00 Limit $0.00 Terms 42 Months Comments 24/Mo Payment History 2013 2014 2015 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 26 of 29 Credit Score . • Y:w�a pap��xoUT: ux�com ' Here you will find ovoomc information vn each account you opened,mcmciiwmnent statLiS and any pest due inforn ton.Positive credit mmnnuonremamaon»a«r ew»x/ooenilitely.cremuurcomtammmmamnxmsbeenpmvideumome,mmakaueasie,mryovmreomnanvisomes. IVIAErif- AMER �� 'Fl�/ar1 c.� Account Name Current acmseu Account# ��co�mwen Account Type Finance,personal Balance ' *nno oo �osoon peu�ou8009456000 Date Opened 12/11/2002 poao*unon Account Status OMAHA,' Mo.Payment $452.00 ayment Status Paid or as agreed High Balance $20,475.00 Limit -�-- $0.00 Terms � 48 Months Comments 241 Mn Payment History 2003 2004 2005 rranoww«m OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 27 of 29 Credit Score • Here you will rind specific,.information on each account you opened,including current status and any past due information.Positive credit information remains on your report indefi rely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. SANTANDER Account Name SANTANDER Current Closed Account# Account Type Finance,personal Balance $0.00 8669239282 Past Due $0.00 Date Opened PO BOX 961245 Account Status Closed 007 FORT WORTH,TX 76161 Mo.Payment $496.00 Payment Status Paid or paying as agreed High Balance $28,896.00 Limit $0.00 Terms 72 Months Comments 24/Mo Payment History 2009 2010 2011 Month JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 28 of 29 Credit Score ,1,1J o!lLi a E if.y04.:op3su,:i,, Clitse:fl siei.tis a:Jo an;i)Eisi.ans 0,1A0la csd inlorrnsition sns oil your raport COWEiZ,`,;. 1iO 055;"1 orclar O rciafre I epsiar r&-7,;o1,25'.•;any isSU8S. cont Name CCO int Type Banks and S&Ls Balance $0.00 Past Due $0.00 0775965407 Date Opened 9/30/2005 PO SOX 85526 Account Status Closed RICHMOND,VA 23235 iNo.Payment $625.00 Payment Status Paid or paying as agreed High Balance $33,243.00 Limit $0.00 Terms 72 Months Comments 24,1 hi 0 Payment 1-listury 2005 2006 2007 Month Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 29 of 29 Credit Score Here you will iu specilic information on each account you opened.including current staius and any pact die information.Positive-credit information rermain 3 on your indefilVely.Creditor contact information has been provided in order to make ii easier for you to izErolve Flny iSE1L! C R rE D Account Name VW CREDIT Current Account# Balance $0.00 Past Due $0.00 8479481934 Date Opened 6/29/2009 2333 VVAUKEGAN RD Account Status Open DEERFIELD,IL 60015 Mo.Payment $595.00 Payment Status Paid or paying as agreed High Balance $21,429.00 Limit $0.00 Terms 36 Months Comments 24/Ma Payment History 2008 2009 2010 Month MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR Transunion Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page 29 of 29 Credit Score - : UusT-„,4,;Pd1 ::Ass5);, sy-ssAdk: 2i; Here you triiil find specific information on each account you opened,including current status and any past due 01.3rmat;on.Positive credi information remains on your report indefinitely.Creditor contact information has been provided in order to make it easier for you to resolve any issues. Payment History Legend Current 30 Days Late •"j=, Key Derogatory** ID No Data * 60 Days Late LT Repossession or Foreclosure 90 Days Late PP Payment Plan 120 Days Late Account Status Legend Current Current Closed Unknown ,tit,o Potentially Negative Potentially Negative Closed Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Page Legend Credit Score Vow-Orf3dfi.Sc:ore is a rinrile-iESZd representaV.cm 0 your creciif Worthiness that'is used by most lenders and credif card issuers.Reniember,Experian,Equifax,and eac.ri have Meir on set of daa hi your°Fedi:file.That's why CrerIt Scores may vary between bureaus, 'S,07E751Tiv . _ - - - - - . . What this means to you: raaaiial affiri , Dy' ,Ln= ft-A al; FILO inn,181. nnnnng of:A- ol def.r-10) c,r iwwirer Inny use a :Ta-;cde Jusi reimembe! dh ai.your associal:ed no;:,1,evel f-ftc,si, guni:-.,er not.For SCIMe hOn;E,Vein the ii,ST PIS3eSZnii.-=,.nt FICC, neani score used by sur ender.The statememe hal g COre- -_h -h - an-f u•seci Si ba3l.un dilvd-pDriy study yersior, modal. floin (i50. isis aorE-as,iepreseni greater 14:eliood pay ban:',you cieb-L3 as you sic viewed as being a!ower uesiri riek ts, A FIC:!7.)SCC,i tC,i 'inn H There sf,=; nlajnA CleCrn reixorting ageqcieo----E7,erign. as your FAC,7)Sccre i7;bo:sed On ih8 innarilinft,Dn VOLIV a fj,,s ai vaiy tfa.,L ag,ono..;to agei Icy ht:,.nnuSe some lowiers i:--dc-it p-our credii sad!y to only sae si las-cube agencies.So. -ososs oa,1 rue le: nninin "in,i; nirw oharige -.G.. 7 Your Creciii Score is a numerical Y epC sentai on of y,Dur c.Y d5 rr- i a o.. anc: .-.,e .:�;a , 1 ra,�ya„if�JJ;I fi7a f�„own set of dc,,e,.i,�your crea9:'ills.That's,„io( V�,�I r's4,1.v._may '�,C_IL,.,;.»Q 9 .,'l!d��, _. 679 64 ." ,;„2 Your FICO® Score Powered by Experian Explanation What factors RAISE your FICO° Score: What factors LOWER your FICO() Score: Your FICO®Score measures the age of your oldest account and the Your FICO®Score evaluates your revolving credit balances in average age of your accounts.Your FICO®Score was helped relation to your credit limits on those accounts.In your case,this ratio because you have a relatively long credit history and you haven't of balances to credit limits is too high. recently opened many new accounts. If you missed a payment,your FICO®Score evaluates how recently that missed payment occurred.In general,the more recent the missed payment,the more impact it has on your score.In your case, The absence of public records(such as a bankruptcy or tax lien) your last missed payment happened recently. and/or collections are powerful predictors of future payment risk The recency of a public record(such as a bankruptcy or tax lien) and/or a collection is a powerful predictor of future payment risk.If this item is valid,satisfying the public record or paying off the collection will not remove it from your credit report.The fact that it occurred is still predictive of future payment risk and will be considered by your FICO e Score.However,as the item ages and falls off of your credit report,its impact on your score will gradually decrease.Most public records and collections stay on your report for no more than seven years-though there are certain items that could remain longer • Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Credit Score Page 1 of 3 P.E:;-or = €12.512C,15 Your Credit Score is a our i -:l representation of your credit worthiness that is used by most lenders and c edit card issuers.Remember,E;tperran,Equifaw:,and Tran.tJa_ioti has its o wn set of data in your credit file.That's why Credit Scores may vary between bureaus. 679 649 685 btu' Your Equifax FICO® Score Explanation What factors RAISE your FICO® Score: What factors LOWER your FICO® Score: Your FICO®Score evaluates your revolving credit balances in relation to your credit limits on those accounts.In your case,this ratio The presence of a serious delinquency or a derogatory description is a powerful predictor of future payment risk-people with previous late payments are much more likely to pay late in the future.However,as these items age and fall off of your credit report,their impact on your FICO®Score will gradually decrease.Most late payments stay on your report for no more than seven years. of balances to credit limits is too high. Your FICO®Score takes into account missed and late payments in a few ways.These include the number of late payments,how late they were and how recently they occurred.Your score was hurt because your credit report shows one or more accounts with missed payments or derogatory descriptions. If you missed a payment,your FICO®Score evaluates how recently that missed payment occurred.In general,the more recent the missed payment,the more impact it has on your score.In your case, your last missed payment happened recently. Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Credit Score Page 2 of 3 Your Credit Score is a numerical f iosi representation of your credit worthiness'Mai is used by most lenders and credii card issuers.Remember,Experian, Ee'iui`!c°t,;;,and r ran Vnion has its own set of data in your credit file.That's why Credit Scores may vary between bureaus. 679 649 685 CH edit Catoi.;t_Fr Your TransUnion FICO® Score Explanation What factors RAISE your FICO® Score: What factors LOWER your FICO® Score: Your FICO®Score measures the age of your oldest account and the Your FICO®Score evaluates your revolving credit balances in average age of your accounts.Your FICO®Score was helped relation to your credit limits on those accounts.In your case,this ratio because you have a relatively long credit history and you haven't of balances to credit limits is too high. recently opened many new accounts. If you missed a payment,your FICO®Score evaluates how recently that missed payment occurred.In general,the more recent the missed payment,the more impact it has on your score.In your case, your last missed payment happened recently. • Personal Information Report Summary Bankruptcies Credit Inquiries Credit Cards&Loans Credit Score Page 3 of 3 q tl _ J;-J y 2976,F RI`> i eJ ' t: Dad('kr J'h H.,0612, 9-H"M-3250 072-L .a .:a=,P I 5 73;0 L-n 'cei r g : ' s due 7 23% yo 03/14 CE;14 P csr3ege vi c2:-,tiroa payinad,3 Eri ui cieet 4 I .io 11ati n to 1I'odit/( M PavoT:.=.11 Ire onthly Payment ent f onds table. Date z::;l ¢ t:y�to29 `31-7,f)l F37 0;n= f1 i w'.9 EST N19 Y600 100% 0% 0;:-i, 0% 06/14 $600 100°! 0% 0% 0% 09/14 $600 99% 1% 0% 0% 0% 12/14 ;500 99% 1% 0'% ;( 0°-n 0. 03/1E5 5800 99% i 0% 0% 0% Continuous Pa ent Trends Insufficient information to produce Combined Pa ent Trends l00% - Newly Reported ted Payment Trends 100% chart. eo% 60% } 60% } 60% 40% 40% 20% 20% 0% 0% Currentl-30 31-8081-90 >90 Currentl-30 31-6061-90 >90 *Continuous distribution with DBT. *Combined distribution with DBT. Number of Accounts: 1 Number of Accounts:0 Number of Accounts: 1 Present Balance:$700 Present Balance:$0 Present Balance:$700 Highest Balance:$800 Highest Balance:$0 Highest Balance:$800 *The information herein is furnished in confidence for your exclusive use for legitimate business purposes and shall not be reproduced. Neither Experian nor its sources or distributors warrant such information nor shall they be liable for your use or reliance upon it. ©2015 Experian Information Solutions Inc. ©2015 Experian Information Solutions,Inc.All rightsremraecl. Experian CreditScore(sm)Report Page 2 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS !csinittz rINAI;n1j by Entty' Florida Profit Corporation LOVE LANDSCAPE, INC. Filing Information Document Number P15000036548 FEI/EIN Number 47-3445828 Date Filed 04/22/2015 Effective Date 04/20/2015 State FL Status ACTIVE Principal Address 860 6TH AVE. S. 2353 NAPLES, FL 34102 Mailing Address 860 6TH AVE. S. 2353 NAPLES, FL 34102 Registered Agent Name &Address JONES, DAVID M 860 6TH AVE. S. 2353 NAPLES, FL 34102 Officer/Director Detail Name &Address Title P JONES, DAVID M 860 6TH AVE. S. NAPLES, FL 34102 Annual Reports No Annual Reports Filed .C D ART e `1T' O THE TREASURY aSU�-t`= V i1 _ 11I 1 FiR� U REVENUE SERVICE CINCIN=I OR uG- Data of this notice: 03-18-2015 Employer Identification Number: 47-3445828 Form: SS-4 Number of this notice: CP 575 A LOVE LANDSCAPE % DAVID JONES 860 6TH AVE S For assistance you may call us at: NAPLES, FL 34102 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 47-3445828. 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 ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. iC' fR f ��[ ~`F.L i!V-P.tr s°i'-t.F, a l; [ E/ -..-L a L W k. i'ta LsuL--,1'I .':1 -__ ___.— _.. ( -.__ I. . PRODUCER �� THIS CERTIFICATE IS ISSUED AS A PATTER OF INFORM ION()MX ( LANE INSURANCE T CE GROUP i ND CONFERS NO RIGHT UPON`t tiEs CERTIFICI' E RPL DE .TM ,I 21108 DESIGN PARC LANE CERTIFICATE DOES NOT AMEND,EXTEND O6 L:ER l US CO�fERP TIE ESTERO, FL 33928 FFORDED EY THE POLICIES BELOW. Phone: (239)947®74 74 Fax: (877)635-4342 INSURERS AFFORDING COVERAGE TT -- INSURED INSURER A: Lloyds of London Love Landscape, INC INSURER B: — — 860 6th Ave S suite 2353 __,_ INSURER C: Naples, FL 3 102 INSURER D: Phone: (239)692-3698 INSURER E: COVERAGE ' T E POLICIES OF INSURANCE LISTED B LOW HAVE BEEN ISSUED TO THE INSURED NAM D ABO E OR TH POLICY PERIOD-— --- INDICATED.NOTHWITHSTANDING 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDD/YY) DATE IMM/DDIYY) GENERAL LIABILITY EACH OCCURANCE $ 1,000,000 ]COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100,000 CLAIMS MADE El OCCUR MED EXP(Any one person) $ 5,000 A CYBEL0021695 07/09/2015 07/09/2016 PERSONALANDADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYf PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED AUTOS (ea accident) $ SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS (Per person) NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE 6 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT '$ I ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURANCE S a OCCUR❑CLAIMS MADE AGGREGATE $ $ 1 DEDUCTIBLE RETENTION $ ■ S WORKERS COMPENSATION AND ....IWC STATUTORY EMPLOYERS UABILITY LIMITSf n 1OTHER E.1—EACH ACCIDENT S E.LDISEASE-EA EMPLOYEE $ ELDISEASE-POLICY UMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDROUSMENT/SPECIAL PROVISIONS Landscaping; Use of subcontractors; CERTIFlCATE HOLDER I 'ADDITIONAL INSURED:INSURED LETTER: I ]CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAILJA DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ON UABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. Resort Management c/o Tony Zannone AUTHORIZED REPRESENTATIVE 2685 Horshoe Dr. S Suite 215 Naples, FL 34104 Faxed to: ,4 ,„) ,,,;, 2 ACCORD 26-S(7197) ACORD CORPORATION 1988 tJr. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION �m e+**CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW it :ONSTRUC B ION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 7/22/2015 EXPIRATION DATE: 7/21/2017 PERSON: JONES DAVID MI FEIN: 473555828 BUSINESS NAME AND ADDRESS: LOVE LANDSCAPE 860 6TH AVE. S NAPLES FL 34102 SCOPES OF BUSINESS OR TRADE: LANDSCAPE GARDENING &DRIVERS Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 ^a# $ +,-`4 - ..- ,' COLLIER COUNTY BUSINESS TAX RECEIPT � E3 � APPLICATION ems! 2800 N.Horseshoe Drive,Naples,FL 34104 '�11� Make Check Payable to Collier County Tax Collector Phone: 239-252-2477 Fax: 239-643-4788 Website: www.colliertax.com `,4°Z)WE',Is, p�T�sc`° 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# Q [VA 5 License Amount 1) CORPORATE NAME- e, 1.__jj10-rAC,kpC la) DBA NAME - ib) BUSINESS OWNER OR QUALIFIER'S NAME - hA'J ID T n 2) PHYSICAL ADDRESS- (91,c6 ion' . L , j\) . 1 2- (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - Yes X, No 3) BUSINESS MAILING ADDRESS- (7 L9-1-L-} poi E , S S 5 iu - �. p-� Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- 1Q2� ._�-�� l��JC 1O- +1 Z) ,%i 02- 5) TELEPHONE -Business: V9) 3acb \.4- Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership A Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 8) OFFICE WITHIN CITY LIMITS OF NAPLES- x Yes No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: LAN)L CARP E C v.) 1 Y2-- .CAD Q 10) NUMBER OF EMPLOYEES-Including number of owners: l 11) FILL IN THE APPROPRIATE AREAS - a)Rental units(motel/hotel/apts.)Number of units: b)Seating Capacity(rest./cafes,etc)Number of seats: c)Number of coin-operated machines owned by business or individual: 12) STATE LICENSE OR CERTIFICATION NUMBER- Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: DATE: (Owner and/or representative of business)TITLE: ****THIS LICENSE IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE**'''''' -w. • COLLIER COUNTY GOVERNMENT C� 2800 NORTH HORSESHOE DRIVE ZONING & LAND DEVELOPMENT REVIEW . �,4 �� NAPLES, FLORIDA 34104 WWW COLLIERGOV.NET%ZONING PHONE: (239) 252-2400 EXT. 5603 CV,° FAX (239) 530-6286 LAND USE AND ZONING CERTIFICATE HOME OCCUPATION Please take the time to fill out this form as completely as possible. Remember that only someone actually living at the address given below may engage in the home occupation described. Customers, or employees not living at this address are prohibited from traveling to and from the residence if visits are related to this home occupation. The applicant is the person in whose name the occupational license will be issued, and the applicant's signature must appear on this form. Verification as property owner or lessee in the form of a Valid Florida's Driver License or Florida Identification Card and/or copy of valid lease agreement is required ��s f c—r- ,4C CPre' -- 3 APPLICATION DATE C,-7?- / ZONING CERTIFICATE# APPLICANT'S PHONE z t3 c - S9 / /, APPLICANT'S NAME 1 /9(- n�ic.,E'S APPLICANT'S HOME ADDRESS b r1/ Dl ' ° C TYPE OF BUSINESS TO BE CONDUCTED �i✓,,e3z .6el° BUSINESS NAME (IF ANY) /, the undersigned, hereby affirm that/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/ have read, understood, and agree to abide b the provisions of LDC Section 5.02.00 "Home Occupations"(see back of application). APPLICANT SIGNATURE ( G/ cr-- DATE 6-72- 1 FEE: $50.00 CHECKS PAYABLE TO: "COLLIER COUNTY TAX COLLECTOR" TO BE COMPLETED BY COUNTY STAFF ZONING: PROPERTY ID# DATE REVIEWED BY APPROVED HOLD DENIED COMMENTS/RESTRICTIONS: Must comply with Section 5.02.00 of the LDC (see back of application). cru-krty Growth Management Department Planning & Regulation Operations Division Licensing Section August 27, 2015 Victor Rodriguez Vic & C Painting Inc 5400 29TH PLACE SW Naples, FL 34116 RE: Review of Credit Mr. Rodriguez, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, September 16, 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, Sara lson 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 c 0),,p,c)))91hr 131% runty GRID Operations & Regulatory Management Licensing Section l' 2800 North Horseshoe Drive Naples, FL 34104 'J - 7 APPLICATION FOR "`f COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUTIONS: This application must be typewritten or legibly printed. The application fee must be paid upon approval and is not refundable. All checks should be made payable to: Collier County Board of County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: V -7 Exact Corporate/Business Name: 1 " �'L?'�`` 1 Fiction Name/DBA: Qualifier Name: v t C ti ,Th n o Y t Physical Address: 5`-4 o c 3,0‘ -''-' V".- -=u..' 0: y 1 t`�, `L5- 34 !\i, (Number&Street) (City) (State) (Zip Code) Mailing Address: 54 CO ,.('i-“Th i s , (Number&Street) (City) (State) (Zip Code) Telephone: 23c\-- .ci 3, — O s 3'.;; E-mail: 0-e' t tik t e ;& �j� ( f:L: ya L&A TYPE OF LICENSE: General $230.00 Electrician $230.00 Building $230.00 Plumber $230.00 Residential $230.00 Air Conditioner $230.00 Mechanical $230.00 Swimming Pool $230.00 Roofing $230.00 ). Specialty $205.00 Specialty Trade: -1'i i n h ;1C1 CHANGE OF STATUS: ( )Reinstatement ( )From One Business to Another ( )Dormant License to Active Page 1 of 4 i. The names,rifles,home address and phone numbers of all Ofiicers/Manag ng Members of the Finn. - �i~; _0, ri cr .: . ' 1C t C CCUViC 'Lc r *u_.,,(;' f- O k,-e --(- 7)4.. \\Q 2 c t -- Vci 2 C A r.: t' t` ,, \1� U�_1.--\ �I fl'-f �C'.\irk �.�.\(1N lC! !� t� �r •fir s-� :., a-;; 'i'1 2. List all businesses,firms,entities or contracting businesses you have been associated with during the last ten years(i.e.held a license for or been a partner). Attach extra pages if needed. \')G4\c% 3. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. - \i\C i,\ t? meEthAVIT Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. Authorized- ffCcer ofthe-Firm The foregoing instrument as acknowledged before me this t;9-.L; i :y Q i ---5--' - (Date) by \,j 'i r- VV-�`6.f('C,_∎°,, t— of �,1I .r '.1 V t:1 , Nil .7.11---,C_ (Name of Officer, Title"/Agent) (Name of Corporation)-' a 1 \c Y(ccc,_ Corporation on behalf of the corporation. (State or Place of Corporation) . He/She has produced'ri,'i *.. identification and did not take an oath. (Type of identification) NOTARY'S SEAL / f s. 7 Pao PAOLA UROUIZO 4 eo —.k : Notary Public-State of Florida (SIGNATURE OF NOTARY)` • My Comm.Expires Jul 26,2017 ; '� .��. , Commission#FF 003875 Page 2 of 4 '4'c`•°p‘` Bonded Through National Notary Assn. 1 QUALIFIER INFORiMATION: Name: \I ' ' ' 9_ Address: `; `--kniC %°11'x' 3'4 (Number&Street) (City) (State) (Zip Code) Telephone: 2) t_''" t 3 Date of Birth: CH- el- V1(.-(0 C) SS#: . E-mail:��LtV 1r 1 t C Driver's License#: !.'`'`, 1. Type of Certificate of Competency for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. q (Ai kcx C\e\ ECk t c \fl 3. Have you ever been convicted of a crime related to Contracting? (If yes,attach extra sheet with explanation.) 4. Have you or any firms you have been associated with ever filed bankruptcy? u 5. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay and reasons why. C.t—'\ C\ CC `mil; C\tY`�(C\T C\4, 6. List your business or work experience during the last ten years. q_ j1 1 idi_ Y— t�s r� 1 S�f_Lf C1 tscafl7 ``ZCj ~ Ott en. C f 7. Statement of any formal training you have had in the area for which the application is made. 2-0 `-rLf'(V 3 O ? ,Y e Er kt!1'1f' cc,; 4-, �(f, 3 of4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County No. 2006-46, as amended, and under penalties of perjury. I declare that I have read the foregoing qualifier information and that the facts stated in it are true. 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/she 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. C �`` � G�_f c}L,c7 Applicant(please print) \._l i\...% c rci; Name of Company Signature of Applican State of Floridan County of `C-;, The foregoing instrument as acknowledged before me this (Date) by \,1 i ed, ( cZ who has produced 9 i ; (name of person acknowledging) (type of identification) as identification and did not take an oath. NO i �,,mn,,,, PAOLA UROUIZO � ( %' `O4PRY PVd i�'i ;_* „`�; Notary Public-State of Florida (SIGNATURE OF NOTARY) t ` My Comm.Expires Ju126,2017 .' iitl .3-.= Commission#FF 003875 ,,,; Bonded Through National Notary Assn. 4 of 4 AFFIDAVIT It is understood and acknowledged by the Collier County Contractor's 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,,1/ �, i t,i Signature of Applicant _ ` I C, f: P c \,r,. cysr\ i.oU,. Business Name .=I I:4 I Date BEFORE ME this day personally appeared \ i CAS C. Q. 9_0 6'2y Oc"c- -z- who affirms and says that he/she has less than one employee and does not require Workmen's Compensation and understands that at any time he/she employs one or more persons he/she must obtain said Workmen's Compensation Insurance. State of Florida County of (){t∎.Cy The foregoing instrument as acknowledged before me this ::=4:11 )_ \,' . (Date) by \i 1 C.,* n C PLC Z who has produced T--1., h L _ (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTAR - PAOLA UROUIZO , i' h ---- (.,� 1 fly 1 ,," ry ) ��- a'--P (1.1: Notary Public-State 01 Florida i. ,}'- ;.1; My Comm.Expires Jul 26,2017 (SIGNATURE OF NOTARY) 'r; «r, ,"!, ��. o, Commission#FF 003875 '''°'1 Bonded Through National Notary Assn. RESOLUTION OF AU"THOR.IZATION • WHEREAS 1. i C1 Yr i at" n`'s -'—f1C, • proposes to engage (Name of Business Entity) in contracting as 'V \ C/ - C t n i r)(7., 3.1.4--‘c • in (Type of legal entity:`corp.,partnership,etc.) Collier County,Florida,according to Collier County Ordinance 2006-46,as amended:and i- WHEREAS \j i C L- rC i(")'—.\n C l proposes to qualify (Name of Business Entity) for a Certificate of Competency with \[t C.211-2 P ()CIL CA __ (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned v e G rO ,t l"t C:�t, , tk Ckl'i(1 Ck‘ CC:i nACii (Officers,Owners,Partners) •1,r s �' ?(�l' -'41( . hereby resolve and represent to the Collier County (Name of Business Entity) Contractor's Licensing Board that the qualifying agent, V t C1)Q tier C(`?k C a.:C? ,is active (Name of Individual) in all matters connected with the contracting business of 'f i C.` = C- C;; '�`+ 'j = ,and (Name of Business Entity) We further resolve and represent that '11 is (Name of Individual) Th Legally empowered to act for\'i G "'Gi:t t", :roc. in all matters connected with its (Name of Business-Entity) contracting business,and has the authority to supervise construction undertaken by 11 C 4,43 n L;nc)) 0c (Name of Business Eitfity) _ DULY PASSED AND ADOPTED THIS DAY OF •.3 t �t C (Officers,Partners,O hers-with designation underneath) Witness "' Witness `Z . - PAOLA URUUIZO Notary Public-State of Florida • • V*•_ My Comm.Expires Jul 26,2017 Witness` Corporate Seal(if applicab10,t .+;-Pul:Oinr iitift&F 003875 �„, , ,,•,,• Bonded Through National Notary Assn. Sworn to and subscribed before me this 22-k day of ,.:`1a , 2C-'S by ! � �'1 ;', .ice The foregoing instrument as acknowledged before me this =-±-1 y . 4: Cr�0: (Date)•by L.C)(, who has produced ). (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SE f PAOLA UROUIZO F �� ( '� ",,. (SIGNATURE OF NOTARY) z,�.�; Notary Public-State of Florida '_•; ' ;• My Comm.Expires Jul 26,2017 � � •`' Commission#FF 003875 "•�iFOt it��•••• •,,,,,,,,,,, Bonded Through National Notary Assn. GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report July 2, 2015 Official Score Report: Candidate Information: Name—Victor Rodriguez Candidate#: 60601270R Testing Site: Ocala, FL Final Score Result: Business Procedures Score: 82% 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 July 2, 2015. If you have any further questions,please do not hesitate to contact us. Sincerely, . ow eis er 'resident PO Box 831127 Ocala,Florida 34483-112 997 2129 Voice(352)369-GITS —Fax(352)387-2443 800 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report June 22, 2015 Official Score Report: Candidate Information: Name—Victor Rodriguez Candidate#: 60601270R Testing Site: Ocala,FL Final Score Result: Painting Contractor Score: 78% Business Procedures Score: 42% These results represent the grade that has been achieved on the Painting Contractor examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on June 22, 2015. If you have any further questions, please do not hesitate to contact us. Sincerely, E. owPx-N-ile,i-s4-e c Jay E. Bowermeister President PO Box 831127 Ocala,Florida 34483-1127—Voice(352)369-GITS –Fax(352)387-2443 800 997 2129 l e-ro�.i.- -tty GMVID 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 1-19, 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 1-19, Florida Statutes. 886110`Ave.N.Suite#6,Naples,FL 34108 Phone:239.777.1028 Co ii 4 Fax: 877.275.3593 www.LicensesEtc.com PERSONAL CREDIT REPORT(Compiled From National Records) <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> (I) P NP7771028 LICENSES ETC 16 NP 9/95 08/06/15 07:39CT <SUBJECT> <SSN> <BIRTH DATE> RODRIGUEZ, VICTOR 0629 4/60 <ALSO KNOWN AS> RODRIGUES,VICTOR <CURRENT ADDRESS> <DATE RPTD> 5400 SW. 29TH PL. , NAPLES FL. 34116 11/08 <FORMER ADDRESS> 828 AGNES AV. , LEHIGH ACRES FL. 33971 6/07 2191 SW. 41ST ST. , NAPLES FL. 34116 <CURRENT EMPLOYER AND ADDRESS> <RPTD> COMMERCIAL PAINTING 8/06 <FORMER EMPLOYER AND ADDRESS> STAR LITE PAINTING 12/05 M O D E L P R O F I L E * * * A L E R T * * * ***FICO CLASSIC O8 ALERT:SCORE+627 : SERIOUS DELINQUENCY, AND PUBLIC ***RECORD OR COLLECTION FILED; LENGTH OF TIME SINCE DEROGATORY PUBLIC RECORD ***OR COLLECTION IS TOO SHORT; TOO FEW ACCOUNTS CURRENTLY PAID AS AGREED; ***LACK OF RECENT INSTALLMENT LOAN INFORMATION *** IN ADDITION TO THE ***FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S CREDIT ***FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY,STATE AND FEDERAL LEVELS PR=1 COL=10 NEG=5 HSTNEG=3-32 TRD=24 RVL=19 INST=1 MTG=3 OPN=1 INQ=7 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $597 $2300 $169 $0 $46 93% MORTGAGE: $114K $ $113K $0 $881 CLOSED W/BAL: $3429 $3429 $ TOTALS: $115K $2300 $117K $3429 $927 P U B L I C R E C O R D S SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064186 5/10R $3429 I CI 10494SC CIVIL JUDGMENT CHASE BANK USA NA 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 3/11 $9776 CITIBANK USA N A O9B Page 1 of 4 7/15A $14.3K PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 5/12 $3814 HSBC BANK NEVADA N O9B 7/15A $5205 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 1/10 $12. 9K CITIBANK O9B 7/15A $18.5K PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 5/11 $4144 CITIFINANCIAL O9B 7/15A $6010 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 6/11 $4777 CITIBANK SOUTH DAK O9B 7/15A $7258 PLACED FOR COLLECTIO CNVRGT HTHCR Y 439E001 I 4/15 $765 MEDICAL O9B 7/15A $765 PLACED FOR COLLECTIO CAVALRY PORT Y lYNA008 I 10/11 $23.4K 08 BANK OF AMERICA O9B 7/15A $39.9K PLACED FOR COLLECTIO EOS CCA Y 49XV008 I 8/12 $921 10 AT T MOBILITY O9B 6/15A $921 PLACED FOR COLLECTIO PARAGON REV Y 47VQ001 I 1/14 $1049 MEDICAL O9B 3/14A $1049 PLACED FOR COLLECTIO FST NAT COLL Y 2C8C001 I 6/11 $338 11 DIRECTV O9B 7/12A $338 PLACED FOR COLLECTIO T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CHASE B 26QK004 12/02 $6508 R09 10/13A $3400 $3429 I CREDIT CARD 5/10F $3429 CLOSD BY CRDT GRANTOR BK OF AMER B 1597029 3/08 $23.4K R09 10/11A $22.OK $0 I LINE OF CREDIT 11/08F $0 PURCH BY OTHER LENDER CITIFINANCIA F 7212001 7/04 $4144 R09 5/11A $3500 $0 I CHARGE ACCOUNT 8/10F $0 PURCH BY OTHER LENDER SYNCB/JCP D 235058D 11/07 $185 R09 7/10A $200 $0 I CHARGE ACCOUNT 3/10F $0 PURCH BY OTHER LENDER HSBC/BSTBY B 2EF9006 10/07 $3814 10/10 555432111111 R05 1/11A $2300 $0 $304 05 111111111111 I CHARGE ACCOUNT 7/10C $0 PURCH BY OTHER LENDER 38 1/ 1/ 4 SYNCB/JCP D 235058D 3/15 $123 MIN21 1111 RO1 7/15A $800 $0 I CHARGE ACCOUNT $21 4 0/ 0/ 0 CAPITAL ONE B 1DTVO01 11/14 $474 MIN25 1111111 R01 Page 2 of 4 7/15A $500 $0 I CREDIT CARD $148 7 0/ 0/ 0 SYNCB/JCP D 235058D 3/06 $174 111111111111 RO1 7/15A $1500 $0 111111111111 I CHARGE ACCOUNT 4/07C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 SYNCB/MERVYN D 235060R 9/96 $0 111111111111 ROl 4/15A $400 $0 111111111111 I CHARGE ACCOUNT 9/08C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CAPITAL ONE B 1DTV001 2/14 $254 111111111 RO1 12/14A $500 $0 I CREDIT CARD 12/14C $0 ACCT CLSD BY CONSUMER 9 0/ 0/ 0 CCB/ELDORADO H 1NZ8238 11/14 $0 RO1 11/14A $1000 $0 I CHARGE ACCOUNT $0 WFHM B 82TE004 10/08 $114K 360M881 9/10 111111111111 MO1 7/14A $0 $5184 05 111111111111 C FHA REAL ESTATE M $113K LOAN MOD NON GOVT 48 0/ 1/ 8 BK OF AMER B 4275002 6/07 $193K 360M1090 4/09 555555X55555 MOl 7/10A $0 $4360 05 555432111111 I CONVENTIONAL REAL 7/10C $0 FORECLOSURE,CLTRL SLD 36 1/ 1/15 TARGET N.B. D 6476004 10/07 $177 111111111111 RO1 2/10A $500 $0 111111111111 I CHARGE ACCOUNT 2/08C $0 ACCT CLSD BY CONSUMER 27 0/ 0/ 0 CAP1/BSTBY D 1DTV057 1/06 $1390 111111111111 RO1 7/09A $2300 $0 111111111111 I CHARGE ACCOUNT 11/07C $0 ACCT CLSD BY CONSUMER 41 0/ 0/ 0 BK OF AMER B 1597029 11/07 $2138 RO1 1/09A $3300 $0 I CREDIT CARD 12/08C $0 CLOSD BY CRDT GRANTOR 13 0/ 0/ 0 BK OF AMER B 1597029 11/03 $0 ROl 12/08A $200 $0 I CREDIT CARD 7/06C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 BK OF AMER B 6331059 7/05 $0 XXXXXXXXXXXX ROl 12/08A $4000 $0 XXXXX1 I CREDIT CARD 4/07C $0 ACCT CLSD BY CONSUMER 41 0/ 0/ 0 CHASE B 26QK001 8/06 $4500 11111111111 001 8/07A $0 I CREDIT CARD 4/07C $0 ACCT CLSD BY CONSUMER 11 0/ 0/ 0 CITI B 64DB002 4/05 111111111111 RO1 5/07A $2200 $0 111111111111 I CREDIT CARD 4/07C $0 ACCT CLSD BY CONSUMER 25 0/ 0/ 0 BK OF AMER B 6331213 1/06 $65.3K 111111111111 CO1 2/07A $115K $0 I HOME EQUITY LOAN 1/07C $0 ACCT CLSD BY CONSUMER 12 0/ 0/ 0 Page 3 of 4 CAPITAL ONE B 1DTV205 1/06 $0 11111111111 RO1 12/06A $1000 $0 I CREDIT CARD 12/06C $0 CLOSED 11 0/ 0/ 0 BK OF AMER B 427S002 3/06 $171K 360M XXXX11 MOl 10/06A $0 I CONVENTIONAL REAL 10/06C $0 CLOSED 6 0/ 0/ 0 WORLD OMNI F F 2729006 5/04 $25.6K 72M438 111111111111 I01 3/06A $0 111X111111 I AUTOMOBILE 3/06C $0 CLOSED 22 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 8/06/15 PNP7771028 (FLA) LICENSES ETC 4/08/15 FCH5008547 (CHI) EMBRACE HOME 11/11/14 BPC2699824 (NTL) CAP ONE 8/22/14 ZHO0285278 (SCT) CBCINNOVIS 2/18/14 ULA4098644 (SCT) CENTURY TEL 2/06/14 BPC2699824 (NTL) CAP ONE 1/11/14 NNY1212732 (EAS) SYNCB/WALMRT END OF REPORT Page 4 of 4 v.',. , \ .- \ _, '% \''.. .'- S \ \ ---- ' ,s.S . 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FLORIDA F,l i -Lit( Home Contact Us E-Filing Services Document Searches Forms Help Detail by Entity Name Florida Profit Corporation VIC & C PAINTING INC Filing Information Document Number P15000057663 FEI/EIN Number NONE Date Filed 07/06/2015 State FL Status ACTIVE Principal Address 5400 29TH PL SW NAPLES, FL 34116 Mailing Address 5400 29TH PL SW NAPLES, FL 34116 Registered Agent Name&Address RODRIGUEZ, VICTOR 5400 29TH PL SW NAPLES, FL 34116 Officer/Director Detail Name &Address Title P RODRIGUEZ, VICTOR 5400 29TH PL SW NAPLES, FL 34116 Title VP YADO, MARIA DEL CARM 5400 29TH PL SW NAPLES, FL 34116 Annual Reports Coovright©and Privacy Pokes State of Fonda,Department of State of 3 07/13/15 9:59 AM Electronic Articles of Incorporation F30057663 For July 06 2015 Sec. Of'State vherring VIC & C PAINTING 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: VIC & C PAINTING INC Article II The principal place of business address: 5400 29TH PL SW NAPLES,FL. 34116 The mailing address of the corporation is: 5400 29TH PL SW NAPLES, FL. 34116 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: ONE HUNDRED Article V The name and Florida street address of the registered agent is: VICTOR RODRIGUEZ 5400 29TH PL SW NAPLES, FL. 34116 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: VICTOR RODRIGUEZ P15000057663 FILED Article VI July 06 2015 Sec. Of State The name and address of the incorporator is: vherring VICTOR RODRIGUEZ 5400 29TH PL SW NAPLES FL 34116 Electronic Signature of Incorporator: VICTOR RODRIGUEZ 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 VICTOR RODRIGUEZ 5400 29TH PL SW NAPLES, FL. 34116 Title: VP MARIA DEL CARM YADO 5400 29TH PL SW NAPLES, FL. 34116 IRSDEPARTMENT OF THE TREASURY liliJ INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 07-13-2015 Employer Identification Number: 47-4497852 Form: SS-4 Number of this notice: CP 575 A VIC AND C PAINTING INC 5400 29TH PL 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 47-4497852. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 940 01/31/2016 Form 944 01/31/2016 Form 1120 03/15/2016 It you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year) , see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue) . Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. ' (IRS USE ONLY) 575A 07-13-2015 VICA B 9999999999 SS-4 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042) , excise taxes (Form 720) , or income taxes (Form 1120) , you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay A11 Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents (payroll service providers) are available to assist you. Visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT REMINDERS: Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax-related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write 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 VICA. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. Gic GIC Underwriters. P.O.Box 558810 Miami,FL 33255-8810 J N D E R W R I T E R S www.gicunderwriters.com Nww.gicundervvriters.com Tel:(305)554-0353(800)392-9966 Fax:(305)662-3914 Insurance Carrier.Granada Insurance Company-A Florida Admitted Company r} Quote Summary as of 7116/2015 3:49:54 PM Quote Number Quoted Online Status:Active Date Quoted:7/16/2015 Expires On: 8/15/2015 Named Insured And Address Agent Name And Address VIC&C PAINING Epperson Insurance Group,Inc. (4748) 5400 29TH PL SW 1924 Santa Barbara Blvd#3 Naples, FL 34116 Naples,FL 34116 Phone: (239)331-7141 Request To Bind The agent has no authority to bind coverage.The Agent has no right to make,alter, modify or discharge any contract or policy issued on the basis of this application. Any person who knowlingly and with intent to injure,defraud,or deceive any insurer files a statement of claim or an application containing any false,incomplete,or misleading information is guilty of a felony of the third degree. To Request To Bind:Check the box,place an effective date,sign and fax this form to(305)662-3914 or email it to bind(granadai nsurance.com Please Bind 0 EFFECTIVE DATE OF BIND: Agent's Signature Date Note:All requests to bind are subject to final approval by the Underwriting Department of GIC Underwriters.Coverage is not effective until bound. Payment Information-In order to bind coverage the Down Payment or Full Payment must be submitted with binder request HOW WOULD YOU UKETO PAY? BANK DEBIT(AGENCY'S OR INSURED'S ACCOUNT) 0 Personal Checking Account 0 Savings Account 0 Business Account NAME OF BANK/CREDIT UNION ABA ROUTING NUMBER BANK ACCOUNT NUMBER CREDIT CARD(AGENCY'S OR INSURED'S CREDIT CARD) 0 Visa 0 Mastercard o American Express CREDIT CARD NUMBER EXP.DATE(MMIYYYY) WHAT AMOUNT WOULD YOU LIKE TO PAY? ❑ Minimum Down Payment$129.70(Balance in 9 Monthly Installment) ❑ Pay in Full$798.00 0 Other Amount greater than Down payment$ By providing the bank account or credit card information above,you authorize GIC Underwriters Inc to process a one time payment as soon as the same day. If the Initial payment by check or credit card is returned by the bank because of"PAYMENT DISHONORED BY BANK',coverage will be null and void from inception. Page 1 /3 GI C Quote: -VIC&C PAINTING-Quoted On:7/16/2015 3:49:50 PM VMO@RWAiTEfIS Form of Business: CORPORATION coverage summary Commercial General Liability Coverages: $773.00 Policy Fee $25.00 Total Premium: $798.00 PLEASE REVIEW THIS QUOTE CAREFULLY AS COVERAGES, LIMITS, ENDORSEMENTS AND DEDUCTIBLES MAY DIFFER FROM THOSE REQUESTED ON ANY SUBMITTED APPLICATION OR OTHERWISE. Individual Coverages General Liability Limits for General Liability General Aggregate Limit(Other than Products/Completed Operations): $2,000,000 Products/Completed Operations Aggregate Limit $2,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit: $1,000,000 Fire Damage Limit(Any One Fire): $100,000 Medical Expense Limit(Any One Person): $5,000 Location Address Location:1 5400 29TH PL SW Naples,FL Classification Schedule :Location Classification Description Code Coverage Exposure{ aril g Deductible Deductible Type ;.i Painting—interior or Painting 1 exterior buildings or 98304 Premises and 20,000 payroll $500 Propel Damage structures three stories or Products Deductible Per Claim less in height Basic Coverage Premium: $773.00 Attached Endorsements Premium: $0.00 Total General Liability Premium: $773.00 Summary of User's Qualifying Responses Answers.. [Does applicant perform or engage m any work or operation other than those listed in the classification schedule of this application? NO 1 • Any new building construction operations performed on single-family units including residential condominiums;multi-unit homes,trail NO housing,subdivisians,to nhouses,or apartment bullrings within subdivisions or projects where there are five(5)or more total units? Forms and Endorsements Forms and Endorsements Applicable To This Coverage Part Where"0"appears for Location and Building,the described endorsements ap•I to all Buildin.s and all locations. Form ocatton Building Date r Description Premium do Number .i O 0 CG 00 01 12-07 Commercial General Liability Coverage INC O 0 CG 00 68 05-09 Recording&Distribution of Material or Infor INCL O 0 CG 02 20 03-12 Fla Chgs-Cancellation&Nonrenewal INCL O 0 CG 0300 01-96 Deductible Liability Insurance INCL O 0 CG 21 01 11-85 Exclusion-Athletic or Sports Participants INCL 0 0 CG 21 07 05.14 Exclusion-Access or Disclosure of Confidential or Personal Information and INCL Data-Related Liability-Limited Bodily Injury Exception Not Included Page 2/3 IC Quote: -VIC&C PAINTING-Quoted On:7116/2015 3:49:50 PM UIDERYPR€TtRS O 0 CO 2132 05-09 Communicable Disease Exclusion INCL O 0 CG 21 36 03-05 Exclusion-New Entities INCL O 0 CG 21 39 10-93 Contractual Liability Limitation 1NCL O 0 CG 21 43 12-04 Exclusion Explosion,Collapse,Underground INCL O 0 CG 21 46 07-96 Abuse or Molestation Exclusion INCL O 0 CG 21 47 12-07 Employment-Related Practices Exclusion INCL O 0 CG 21 50 00-89 Amendment of Liquor Liability INCL 6 0 0 CG 21 67 12-04 Fungi or Bacteria Exclusion INCL O 0 CG 21 86 12-04 Exclusion-Exterior Insulation&Finish System INCL O 0 CG 21 96 03-05 Silica or Silica-Related Dust Exclusion INCL 0 0 CG 2233 07-98 Exct Testing or Consulting Errors&Omissions INCL O 0 CG 22 79 07-98 Exclusion-Contractors-Professional Liability INCL O 0 CG 22 94 10-01 Exc-Damage to Work by Subcontractors your beh INCL O 0 GICGL832 04-14 Amendment Of Employee Definition INCL O 0 GIC GL 3003 01-97 Punitive Damages Exclusion INCL O 0 GIC GL 3004 04-95 Professional Services Exclusion INCL 0 0 GIC GL 3005 07-95 Exclusion-Lead INCL O 0 GIC GL 3007 06-96 Exclusion-- Roofing Operations INCL O 0 GIC GL 3008 09-96 Classification Limitation Endorsement INCL O 0 GIC GL 3011 01-97 'Insured"-Family Member Exclusion INCL O 0 GIC GL 3018 03-97 Two or More Coverage Forms or Policies Issued INCL 0 0 GIG GLAB 03-97 Exclusion-Asbestos INCL 0 0 GILAP7851 06-98 Exclusion Pollution INCL O 0 IIP-NOTICE 04-01 Important Information About Your Privacy INCL O 0 IL 00 03 04-98 Calculation of Premium INCL O 0 IL 0017 11-98 Common Policy Conditions INCL O 0 IL 00 21 09-08 Nuclear Energy Liability Exclusion End. INCL O 0 REV 601 02-09 JACKET INCL 0 0 1 IBC RMP 03-28 Risk Management Program INCL Page 3/3 Granada Insurance Company P.O.Box 558810 a Miami,FL 33255-8810 Phone:(800)392-9966 GRANADA Fax:(305)662-3914 INSURANCE COMPANY www.gicundenvriters.com "The Agent Partner Company-"` Direct Bill Payment Plan Pay In FM: $798.00 9 Monthly Installment fawn Payment $129.70 trnstaliment 1 589.30 installment 2 588.18 installment 3 $87.06 installment 4 585.94 Installment 5 $76.85 Installment 6 $75.84 installment 7 574.84 installment 8 $73.83 installment 9 $72.83 This is a Monthly Installment Plan. Please send each Monthly payment seperatety. The 9 Monthly Installment option includes a total installment interest charge of 546.37. One Time$10.00 Service Charge included in the Down Payment Late Fee of$10.00 will be applied to any installment payment received after due date. Page 111 Granada Insurance Company RECURRING ELECTRONIC FUNDS TRANSFER PAYMENT J AUTHORIZATION AGREEMENT EMAIL OR FAX TO: 305-662-3914 or autopay @granadainsurance.com The following conditions apply to the recurring payments program: • No additional charges for payments processed via recurring payments. • All future installment payments will be processed via recurring payments unless you notify the company in writing. • All normal installment fees will apply. • An information only reminder will be sent to the email provided below for all installments due. The information notice will indicate the due date and the amount to be withdrawn from the bank account. • You will receive a renewal offer letter for future renewal policies.The payment for the renewal policy will be processed via recurring payments according to the payment plan for the expiring policy unless you notify the company prior to the renewal effective date. • This signed form replaces any previously sign recurring payments authorization. • Allow up to 20 days for setup changes,or termination of electronic payment withdrawal to ensure time before your next withdrawal. • If the due date falls on a date that is not a business day,the applicable date shall be the following business day. • If any payment is refused by a bank you are no longer eligible for recurring payments program. I(we)authorize Granada Insurance Company(or its affiliates)to debit my bank account identified by account number and routing number shown below for the future installments and renewal payments due on my policy.I(we)understand that my policy will be subject to cancellation if the debit transaction is refused by my bank. I(we)understand that I(we)will not be eligible for recurring payment processing in the future if any debit is refused. I(we)understand that I(we)might be subject to late payment and/or NSF fees if any attempted debit is refused. I(we)understand that any refunds due on the policy listed below will be refunded by check and not through electronic transfer. I(we)understand that if renewal policies are issued,that this authorization will extend to that policy term unless I(we)provide written notice to Granada Insurance Company of a request to terminate this authorization Quote Number: Quote Online Name on Policy: VIC&C PAINTING Name on Checking Account: Cell phone for text message confirmation—Notification (Required) Email for payment confirmation-Notification: (Required):A Valid Email Account necessary to register for Auto Pay Reason for submitting form: I(we)wish to set up a new REFT account- I(we)need to change my current REFT account. Please cancel my REFT account 4300ODODOO • OQCOOCOOQ* Routing Number Account Number Routing #: Account#: This Authorization will remain in effect until I(we)provide written notice to Granada Insurance Company of its termination. I(We)understand that all changes must be in writing and I(we)will not dispute any recurring billing,as long as the amount corresponds to the terms indicated above in this authorization agreement. Signature Date: AutoPayAA(12-14) 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: 7/15/2015 EXPIRATION DATE: 7/14/2017 PERSON: RODRIGUEZ VICTOR FEIN: 474497852 BUSINESS NAME AND ADDRESS: VIC&C PAINTING INC 5400 29TH PL SW NAPLES FL 34116 SCOPES OF BUSINESS OR TRADE: PAINTING NOC&SHOP OPERATIONS 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 shaft revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 -ERIFICATION OF CONSTRUCTION EXPERIENCE Operations &Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: \ \C-4 C Q C do_ CAL - Certificate Category Requested: R C k n 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: VA t U -t to4 tM, TI`Z IA c.s-A 1 �n1 Title: fit=S . License Number(if applicable): CGC 0 t 4 ■,■Q Name of Business: lt o o i W 01M t=S its Business Address: SyO.S TAN I_OIt 12.01 STk +5 Business Phone: 2:3et-ZS \•-■9,2 C. The applicant's years of experience from 206 Z.to ZQ 0 to The applicant's scope of work(specific duties)included: A LL Ph-Aces o a 7'i4∎ N It t'V.; t•-rEiz 1,02 A EITEfz■o2 - RCS I ic,flv% L Wo rtt - - o a Lk) Additional comments: b E Pii -RR t C.- ErA P LG - cc— - Falsifying any information provided herein may subject your license to revocation. Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. Signature irk %_L C Print Name State of Florida County of co . fey.. The foregoing instrument as acknowledged before me this S IS �✓ (Date) by W who has produced (name of person ackno4ledging) (type of identification) as identification and did not take an oath. NOTAFY'S-tRA L.JONES State of Florida v-�� Notary Public, (SIGN OF NOTARY) My comm expires Nov 29,2016 Comm No. EE 854792 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STA l)✓ OF f COUNTY OF C j / 1 i Q r I, %ncf re S e , having been first duly sworn, state and affirm: I am a resident of (ri,t I I i County, l 1 r(O (State) and have resided here for more than five(5)years. ' -PDuring the last five years I have known Gr k t l;rt ja (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. f 7,:' -A Signature C Name Address Telephone The foregoing instrument as acknowledged before me this U q / ate) by P i 4t 4 r 010 r- i ru Z who has produced i 2 ' _- (name of person acknowledging) (type of idetification) as identification and did not take an oath. Nt raga Jt1AREi Notai y Public-San al MOM (SIGNA OF N GARY) My Comm.Expires 4w$,Iii? r;4;;,; Commission/R INN A1+EIDAVIT OF INTEGRITY AND GOOD CHARACTER STAIE OF F(Dri d 0., COUNTY OF Ciil he r I, mictr w T I i.s /YlQ r -;tbC Z , having been first duly sworn, state and affirm: I am a resident of Lo i(i,er County, nor; d q (State) and have resided here for more than five(5) years. During the last five years I have known VI U v r R0151 f i Lz Z (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./'/v�-"- c Lov74,, e..1 Signature ,r,(pt/2/4_ i .tl./aed.Je2 Name 020/ ' /4 •-.C7/ h-940, 14-7 3y/J. Address Z 3 — .0(— c j-- Telephone The foregoing instrument as acknowledged before me this '8 /f f Ii S (Date) by Oleo y,-{r-csti Mar-f;rvz. who has produced Perspra.L (name of person acknowledging) (type of i tification) as identification and did not take an oath. NOT F ' ROSA JUAREI e .,.. ' , r t"' Notary P,,miC-State d (SIGNA ' NOTEI ' s1i_ INy Cnmm =rs4res AWL 207 COLLIER COUNTY BUSINESS TAX RECEIPT o� ' APPLICATION to 2800 N.Horseshoe Drive,Naples,FL 34104 Make Check Payable to Collier County Tax Collector '. • Phone:239-252-2477 Fax:239-643-4788 Website:www.colliertax.com wE 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 ofAgriculture.(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- V i C Pc i fl -;Co C . la) DBA NAME- lb) BUSINESS OWNER OR QUALIFIER'S NAME- U i C 2) PHYSICAL ADDRESS- 540 0 2-q (\Q .01 ,S C... 3y 11tc' (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE- ' Yes No 3) BUSINESS MAILING ADDRESS- 3CA m C\. o: Cn c\/t Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS- C tr` :_c: o NC i 5) TELEPHONE-Business: 2 LQ — ' 13(.4 . Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership ).----Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED- 1 \(s? t 5 8) OFFICE WITHIN CITY LIMITS OF NAPLES- L--'Yes No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL JEM�EMPLOYER IDEENTIFICATION NO. - �Y"t T S f.'sec back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: r 10) NUMBER OF EMPLOYEES-Including number of owners: L 11) FILL IN THE APPROPRIATE AREAS- a)Rental units(motel/hotel/apts.)Number of units: b)Seating Capacity(rest./cafes,etc)Number of seats: c)Number of coin-operated machines owned by business or individual: 12) STATE LICENSE OR CERTIFICATION NUMBER- Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: DATE: • Cote,. County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GROWTH MANAGEMENT DIVISION NAPLES, FLORIDA 34104 www.collierciov.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): C. .I t ' t...r Telephone: - '`�, "C 7/ I -ik7 Cell: Fax: , E-Mail Address: -, / BUSINESS& USE INFORMATION Business Name(If any): t+ L. t- %� ` �h Phone Number: C i`1— �� (11' - /7.7# •( Address: �_.: 1 ( �(�=C ) , City: 1`�-`c_, �? <� i State: ZIP: .) I k- " Description of the type of business or use: 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 theho _e_occupation than 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 . . 7.4' • 1 , ' - - I • : 11(4)4 :411T"- ttiacen022orat ' any.0.6,1„..0",.. consgat °pension of a gneser _ _ AUG 1 7 2015 4C-43 e-r GMD Operations & Regulatory Management �_ R ---' Licensing Section 2800 North Horseshoe Drive 4/'10(5- aV10 Naples, FL 34104 AL5- &.5&O1 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUTIONS: This application must be typewritten or legibly printed. The application fee must be paid upon approval and is not refundable. All checks should be made payable to: Collier County Board of County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: Exact Corporate/Business Name: LHOP Contractors, INC. Fiction Name/DBA: Qualifier Name: Joong J. Kim Physical Address: 5200 Egglestone Ave. #406 Orlando FL 328110 (Number&Street) (City) (State) (Zip Code) Mailing Address: 5200 Egglestone Ave. #406 Orlando FL 328110 (Number&Street) (City) (State) (Zip Code) Telephone: 318-422-9406 E-mail: simonkim050169 @gmail.com TYPE OF LICENSE: General $230.00 Electrician $230.00 Building $230.00 Plumber $230.00 Residential $230.00 Air Conditioner $230.00 Mechanical $230.00 Swimming Pool $230.00 Roofing $230.00 X Specialty $205.00 Specialty Trade: Floor Covering Contractor CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page l of 4 D 3013E7,3 L AUG 122015 BY: 1. The names,titles,home address and phone numbers of all Officers/Managing Members of the Firm. Joong J_Kim Eun H. Ko 5200 Egglestone Ave. #406 5200 Egglestone Ave. #406 Orlando, FL 32810 Orlando, FL 32810 2. List all businesses, fines, entities or contracting businesses you have been associated with during the last ten years(i.e.held a license for or been a partner). Attach extra pages if needed. None 3. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. None AFFIDAVIT Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. -44111°. ed •fficer of the Firm The foregoing instrument as acknowledged before me this /9v‘�f% /Z-, 2 27f (Date) by Joong J. Kim of LHOP Contractors, INC (Name of Officer, Title/Agent) (Name of Corporation) a Florida Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced /7.Zyh...-4 identification and did not take an oath. (Type of identification) NOTARY'S SEAL (SIGNATURE OF NOTARY) �� ,,, JOSEPH FX GALEWSKI =o,► Notary Public-State of Florida Page 2 of 4 .1, i.1 My Comm.Expires Oct 7,201$ � per Commission AF EE�134200 '�'F 8n��0' Bowed Through National MU QUALIFIER INFORMATION: Name: Joong J. Kim Address: 5200 Egglestone Ave. #406 Orlando FL 328110 (Number&Street) (City) (State) (Zip Code) Telephone: 318-422-9406 Date of Birth: 05/01/1969 SS#: 3169 E-mail: simonkim050I69 @gmail.com Driver's License#: 010981170 (LA Issue) 1. Type of Certificate of Competency for which application is made. re 697/ 2. The names and telephone numbers of two persons who will know your whereabouts. Stephen Cho 407-234-7349 Andrew Kim 813-406-1185 3. Have you ever been convicted of a crime related to Contracting? NO (If yes,attach extra sheet with explanation.) 4. Have you or any firms you have been associated with ever filed bankruptcy? NO 5. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay and reasons why. NONE 6. List your business or work experience during the last ten years. Worked as supervisor for carpenters for I.J. Remodeling, LLC. 7. Statement of any formal training you have had in the area for which the application is made. On the job training. 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 July 27, 2015 Official Score Report: Candidate Information: Name—Joong J. Kim Candidate#: 01981170K Testing Site: Ocala, FL Final Score Result: Business Procedures Score: 78% 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 July 27, 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 No. 2006-46, as amended, and under penalties of perjury. I declare that I have read the foregoing qualifier information and that the facts stated in it are true. 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/she 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. Joog J Kim Applicant(please print) LHOP Contractors, Inc. Name of Company r .ign. re of Applicant State of Florida County of caifier- L�� The foregoing instrument as acknowledged before me this ,4!4,4 )% /1, Z /S-. vv((lfate,)) /3,4�' by �c "' / "P? who has produced /7 4o- 4-,cc (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL �� `4p;l,T,� JOSEPLIII;lv,,T,„, K� (SIGNATURE OF NOTARY) •20 —.��¢% Notary PubFlorida�; • My Comm. .2015,, d Commis 200 4 of 4 '' ,°,`,V ie�' Bonded Tlrery Assn. AFFIDAVIT It is understood and acknowledged by the Collier County Contractor's Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. ,r of Applicant LHOP Contractors, Inc, Business Name Date BEFORE ME this day personally appeared 3;4, " k)141 who affirms and says that he/she has less than one employee and does not require Workmen's Compensation and understands that at any time he/she employs one or more persons he/she must obtain said Workmen's Compensation Insurance. State of Florida County of C 66,i The foregoing instrument as acknowledged before me this /94I4/ /2- ,L.0/5- (Date) by p°� � l`—/11-1 who has produced G,C'e /7 (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL �*,,,w.uy,,' OSEPH fX GALEWSKI NATURE OF NOTARY) r Notary Pubiic-$fate of Honda . •? My Comm.Expires Oct 7,2015 !y\? . / Commission EE 134200 :ftr _�:''4 Bonded Through Nand Notary Assn ;VERIFICATION OF CONSTRUCTION EXPERIENCE' GNU) Operations & Regulatory Management Den artment Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: .300 t1� ��—•�+Y� Certificate Category Requested: f d LS 00 a Ff - "°t..� 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 t following info tic , Name: ceN. et hp, cr,,•C Title: License Number(if applicable): Name of Business: 1f re e4.fp•e Business Address: ,4- ,L_ I Business Phone: .5-4.i ( q4 The applicant's(years of experience from c 6C. to t'( The applicant's scope of work(specific duties) included: i'*4 Additional comments: Falsifying any information provided herein may subject your license to revocation. Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. S}gatur � 1.P.e1/4 Print Name State of Florida County of Le The foregoing instrument as acknowledged before me this (Date) by °° g / who has produced 47 yarp,►ya+ AtOrez.. GrC,.et,' (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL I I JOSEPH �Ai,EWSKI (SIGNATURE OF NOTARY) e NM ary Pe -Eats of Florida . Nc• My Canin.this Oct 1,201 4 #EE134200 EIPIN1111M.MOW flotar∎ • `VERIFICATION OF CONSTRUCTION EXPERIENCE' CND Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Dove Naples,FL 34104 Applicant's Name: JOJJ( K t//) ,�F Certificate Category Requested: woo]) F�t 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 foil wing information: Name: J� 4 //2/4 " Title: License Number(if applicable): Name of Business: 7:4 yaK ,l L7 Business Address: ? /u-y6-7;2- Business Phone: -562`-1140 The applicant's years of experience fromaC04to 0*/ The applicant's scope of work(specific duties) included: fA.004 /4"...17 L64,7 Additional comments: WO/e, -4 i3 Xs ie_e- to /V J m,/1 4S 2 Falsifying any information provided herein may subject your license to revocation. CCtt)Seb) Under the penalties of perjury I declare that I have read the foreg•' g applicatio and that th/acts stated in it are true. �r / A A S e U/ / Print Name State of Florida County of (el The foregoing instrument as acknowledged before me this /t'/.t/S' /Z, 24.915— (Date) by c c�Yl� ' ►M who has produced ,07 7.I-, l4C.3.14: - (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL ` �---� (SIGNATURE OF NOTARY) JOUR NI Warn t ipbty PYiM•1W M NOM N Cosa bias Oil SIN A' NON iMNrN NOW kis. AFFIDAVIT OF LNTTCPTTY atiD GOOD f RAR CTFR STATE OF rG- ' COUNTY OF (�I, gb8 M(/MN/ , having been first duly sworn, state and affirm: I am a resident of G--- County, ,c(0/24AA (State) and have resided here for more than five (5) years. During the last five years I have known CVA) K/ (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. / / z /Aiti .1 :.40", Signature +/ '005 /lei ` Name /i W-R Cad &-7-6 /#ted n ge PAX,e-agY Address 023 -.i//jQ9 Telephone The foregoing instrument as acknowledged before me this ,g C.1-417.. /1, z®/J by 7�c9 G� ,, 1 (Date) y who has produced Co .ys, i1--/9 41 "vfit- L4L6.4 (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL C '_ (SIGNATURE OF NOTARY) ..,,,w,, JOSEPH FX OALEWSKI Natary Public-St$ti O1 FlOdd*iliz.v-t:N My Comm.Expins Oct 1,2015 I ,;,1--T7'` Commission d►EE 134200 4 `t.1,: wild Through NOM Nary Ape. AFFIDAVIT OF I1 TEGRIT-` ADD GOOD CHARACTER STATE OF /7/ COUNTY OF L-e-e r �A t,ti f�4 �.� having been first duly sworn, state and affirm: I am a resident of ' County, F(0 (State) and have resided here for more than five (5) years. During the last five years I have known 00 TA VV.' (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 ` (� LC.�c2.\ Q .�1t Name t (43 2s' sk t4e/I- Address _3 t— 6472-s gr Telephone The foregoing instrument as acknowledged before me this /7l/' !/f/ /Z., Z"/S" (Date) by jo a Yt C / //1-7 who has produced e pv. s 1 4r �� 4z-C , (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAT. f` JOSEPH fX OAtEVMSKI (SIGNATURE OF NOTARY) 1 Notary Public-Stato 01 Florida AripMy Co mm.I*es Oct i,2015 _ <� Commis***EE 134200 norms Wm Ann. 1 • „,�. 8ondo110r�11 ,aarirt, t 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 1-19, 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 infoiniation. 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. Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 15 LA 1/92 08/12/15 10:40CT [SUBJECT] [SSN] [BIRTH DATE] KIM, JOONG J. 3169 5/69 [ALSO KNOWN AS] KIM,JUNG,J KIM,JOONGJ [CURRENT ADDRESS] [DATE RPTD] 4519 SHED RD. , BOSSIER CITY LA. 71111 8/13 [FORMER ADDRESS] 2233 FAIRGLENN WY. , WINTER PARK FL, 32792 4709 DISTRIBUTION CT. , #2. ORLANDO FL. 32822 [CURRENT EMPLOYER AND ADDRESS] [VERF] [RPTD] AVOCADO CALIFORNIA ROLL A 7/15 6/15 [FORMER EMPLOYER AND ADDRESS] RED BUG CLEANERS M O D E L P R O F I L E * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +554 : 038, 010, 013, 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 SUMMARY * * * T O T A L F I L E H I S T O R Y PR=2 COL=4 NEG=4 HSTNEG=0 TRD=7 RVL=3 INST=2 MTG=0 OPN=2 INQ=7 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $0 $1000 $0 $0 100% INSTALLMENT: $22 .2K $ $22.0K $0 $507 CLOSED W/BAL: $5818 $5818 $ TOTALS: $22.2K $1000 $27.9K $5818 $507 P U B L I C R E C O R D S SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064175 4/12R $4631 I CI 11SC001481 CIVIL JUDGMENT DISCOVER BANK Z 5064315 12/10R $1017 C RD 20100715947 FEDERAL TAX LIEN B10147P5699 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS PORTFOLIO RC Y 1KSE003 I 10/14 $592 CAPITAL ONE BANK U 09B 5178057615553190 8/15A $592 PLACED FOR COLLECTIO ONLINE COLL Y 1SG2001 I 9/11 $71 10 PROGRESS ENERGY 09B 3/15A $71 PLACED FOR COLLECTIO CREDIT COLL Y 1GZD005 I 9/13 $84 06 ESURANCE AN ALL O9B 12/14A $84 PLACED FOR COLLECTIO CREDIT MGMT Y 523B001 I 5/10 $269 11 BRIGHT HOUSE NE O9B 8/10A $269 PLACED FOR COLLECTIO T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 DISCOVERBANK B 9616003 12/91 $4631 R09 7/15A $3900 $4631 I CREDIT CARD 7/10F $4631 UNPAID BLNC CHRGD OFF CAPITAL ONE B 1DTV001 11/11 $592 R09 PORTFOLIO R 10/12F $0 PURCH BY OTHER LENDER GLOBAL PYMT F 1VXV001 9/12 $100 009 KIMJ 12/12A $100 I ELDORADO RESORT C 12/12F $100 UNPAID BLNC CHRGD OFF VERIZON U 1R2W002 3/99 $1087 O9B 7/15A $1087 I TELECOMMUNICATION 10/13F $1087 PLACED FOR COLLECTION CAP ONE AUTO F 1W2K001 5/15 $22.2K 72M507 1 I01 7/15A $0 I AUTOMOBILE $22.0K 1 0/ 0/ 0 HORIZON CARD F 2AZV001 8/14 $0 1111111111 RO1 7/15A $1000 $0 I CREDIT CARD $0 10 0/ 0/ 0 CAP ONE AUTO F 1W2K001 8/05 $19.9K 73M392 111111111111 101 9/11A $0 111111111111 I AUTOMOBILE 9/11C $0 CLOSED 47 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 8/12/15 ZNP6284423 (FLA) MERIT CREDIT 6/17/15 BPC2699824 (NTL) CAP ONE 5/27/15 FET3569234 (SCT) GLOBAL LENDI 5/27/15 FPC1246538 (NTL) COAF 5/22/15 ALA4241826 (CAL) ORR NISSAN 2 9/05/14 BPC2699824 (NTL) CAP ONE 8/26/13 NNY2135844 (EAS) SYNCB/PPEXTR C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE, P. 0. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION SEMINOLE CI ZP5064175 (407) 323-4330 301 N PARK AVENUE SANFORD FL. 32771 ORANGECOMPTR ZP5064315 (407) 836-5115 109 E CHURCH ST ORLANDO FL. 32801 PORTFOLIO RC YCIKSE003 (800) 772-1413 287 INDEPENDENCE VIRGINIA BEACH VA. 23462 ONLINE COLL YC1SG2001 (252) 757-2101 POB 1489 WINTERVILLE NC. 28590 CREDIT COLL YC1GZD005 (603) 570-4784 PO BOX 9134 NEEDHAM MA. 02494 CREDIT MGMT YC523B001 (877) 741-7302 4200 INTERNATIONAL CARROLLTON TX. 75007 DISCOVERBANK BC9616003 (800) 347-2683 POB 15316 WILMINGTON DE. 19850 CAPITAL ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 GLOBAL PYMT FZ1VXV001 (877) 215-8117 PO BOX 61158 CHICAGO IL. 60666 VERIZON UR1R2W002 (800) 852-1922 NATIONAL RECOVERY MINNEAPOLIS MN. 55426 CAP ONE AUTO FA1W2K001 (800) 946-0332 CREDIT BUREAU DISP PLANO TX. 75025 HORIZON CARD FZ2AZV001 (800) 251-6144 1707 WARREN RD INDIANA PA. 15701 CAP ONE B 2699824 (800) 955-7070 PO BOX 30281 SALT LAKE CITY UT. 84130 GLOBAL LENDI F 3569234 (678) 215-0761 FIVE CONCOURSE PKW ATLANTA GA. 30328 COAF F 1246538 (888) 396-2623 3905 N. DALLAS PAR PLANO TX. 75093 ORR NISSAN 2 A 4241826 (318) 752-3000 2323 VIKING DR BOSSIER CITY LA. 71111 SYNCB/PPEXTR N 2135844 (866) 300-6432 PO BOX 965005 ORLANDO FL. 32896 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 2 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. 1)E P R r i t ° 01 41 ,E I) IVISI(1\ X11' CORPOR 11 I() S Detail by Entity Name Florida Profit Corporation LHOP CONTRACTORS, INC. Filing Information Document Number P15000066453 FEI/EIN Number NONE Date Filed 08/06/2015 Effective Date 08/01/2015 State FL Status ACTIVE Principal Address 5200 EGGLESTONE AVE. #406 ORLANDO, FL 32810 Mailing Address 5200 EGGLESTONE AVE. #406 ORLANDO, FL 32810 Registered Agent Name &Address KIM, JOONG J 5200 EGGLESTONE AVE. #406 ORLANDO, FL 32810 Officer/Director Detail Name &Address Title P KIM, JOONG J 5200 EGGLESTONE AVE. #406 ORLANDO, FL 32810 Title VP KO, EUN H 5200 EGGLESTONE AVE. #406 ORLANDO, FL 32810 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 8/12/2015 Detail by Entity Name Page 2 of 2 Annual Reports No Annual Reports Filed Document Images 08/06/2015-- Domestic Profit View image in PDF format Copyright c;and Privacy Polices State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationScarch/SearchResultDetail?inquirytype=Entity... 8/12/2015 DEPAR:MENT OF THE TREASURY 41 IR SINTEANAL REVENUE SERVIGE CINCINNATI ON 45599-0023 Oate of th.Ls rctica! OS-14-20:b Employer Identi;:ication Number! 47-4798037 Form: SS-4 Number of this nctic : CP 575 A LMOP CONTRACTORS 5200 CLSTCN AVE ORLANDO, EL 3281C For assistance you tfl ( call us at; 1-SC0-829-4933 ' IF VOL. WR:TE, ArtACA rmE STUB AT THE EN C OF T.irS NOTICE, WE ASSICNIT YOU AN EMPLOYER ICENTIFICATION N-JMBER Thank you for applying for an Employer Identification Number (EIN . fl • assigned you EIN 47-4798037. This EIN will identify you, your business accounts, rotlains, and documents, even it you have no employee*. Please keep this notice in :"our Ivrmanent records. When filing tax documents, payments, and related correspondence, $ery important that you use your ZIN and complete name and address exactly as Shown above. Any variation may cause a delay in proce**img, result in incorrect information in yolvr ac , or even cause you to be assigned more than one EIN. If the information is not corntt. as shown above, please make the correction using the attached tear off stub and retur• it to us. Based on the information received from you or your representative, yo , 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(*) shown, you 45n call us eit the phone number or write to us at the address shown at the top of tn.:. noti;e. If vou need help in determining your annual accounting period (tax year) , see. Publi:ation 538, Accounting Pero dS and Moahods. We assigned you tax classification based oa intormation obtainec frog you or your representative. It is aot a legal determination of your tax classifiction, and is not binding on the IRS. If you want a legal determination of your tax cla.isificition, you may • request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 0R.B. 1 (or superseding. Revenue Procedure for the year at issue) . Note: Certain tax classification elections car, be requested by filing Form 8E32, Etity CZassinication Election. See Form 8832 and its instructions for additional Lnformation. IMPORTANT /NFORNATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corperatLDn, an election to file a Form 1120-S must be made within certain timeframes and t;n: corporation most meet certain tests. All of this information is incIlJdf.id fl :he instructions for Form 2553, Rlocticm by a Smelt Business Carporation. z .- - y DONOR 5193 12392751185 1Avalon 04:33:31 a.m. 08-13-2015 1 /1 CERTIFICATE OF LIABILITY INSURANCE DATE(MWDO/YYYY) 08!12!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 olio )es the terms and conditions of the policy,certain policies may require an endorsement.A statement this certtiiffiica a does not confer rights)to the certificate holder in Iieu of such endorsement(s). PRODUCER - - CONTACT NAME- Avalon Insurance Group,Inc. I PHONE 1 Arr-Nn,F:f (239)275-3888 FAX - 7370 College Parkway ) rArc.Na►:(239)275.1185 Suite 312 ADDRESS: Ft.to 312 FL 33907 INSURERtS)AFFORDING COVERAGE NAIC# INSURED WSUBER,A; Cypress Property&Casualty Insurance INSURER B: LHOP Contractors,Inc. _ _ INSURER C; - 1117 Amber Lake Court INSURER D:-Markel insurance Company_- Cape Coral FL 33909 INSURER E: COVERAGES INSURER F: 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 CONDII lON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - - DDL-11BA POLICY EFF PO TYPE OF INSURANCE POLICY NUMBER POLICY EXP n COMMERCIAL GENERAL LIABILITY P.•►11I•! M !�!saAU _ LIMITS A •■ CLAIMS-MADE I X I OCCUR EACH ETORENTEDy 1 000 000 DAMAGE TO RENTED 100 000 ■ FGL 5002653 00 08/1212015 08/12/2016 MED EXP An one.wean $5 000 GENL AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY 1 000 000 ©POLICY n JE I LOC GENERAL AGGREGATE S 2 000 000 OTHER PRODUCTS-COMP/OP AGG $2 000 000 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT $ ■ ANY AUTO U III ALL OWNED ■ SCHEDULED BODILY INJURY(Per person) $ IIII INIAUTOS AUTOS BODILY INJURY(Per accident) 5 HIRED AUTOS NON OWNED _ AUTOS PROPERTY DAMAGE S UMBRELLA ma OCCUR III EXCESS LIAR III CLAIMS-MADE EACH OCCURRENCE $ OED RETENTION; AGGREGATE S WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY PER �( OtH_ ANY PROPRIETOR/PARTNER/EXECUTIVE�YIN D OFFICEWMEMBER EXCLUDED? 1 ' I N 1 A MWCD083359-01 E.L.EACH ACCIDENT $100,000 (Mandatory Ni NH) 08/12/2015 08/12/2016 (yyeapt dencrtbe under E.L.DISEASE-EA EMPLOYEE $100,000 DHSCRIigligi t)F OPERATIONS below _ E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mare space is required) CERTIFICATE HOLDER - - - -CANCELLATION N COLLIER COUNTY CONTRACTOR'S LICENSING BOARD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2800 NORTH HORSESHOE DRIVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NAPLES,FLORIDA 34104 J� AUTHORIZED REPRESENTATIVE `LLCS> 1_ L ACORD 25 2014!01 ©1988-2014 ACORD CORPORATION. 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 issuanco of yoi it exemption. An officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under tli s chef t?r, Section '-------ir--n------""'"'"----7T-----"•". - . . . ... ..• 'First INFORMATION , .. . , . 'First&Last Name: Joong . •,j : Kim ,:. :', •,:: , . . State Driver's License Number: State ID Number: . •• . State: LA • • . . . 010981170 . , .., Date of Birth: 5/1/1969 . . . . . , „. . . . .. ,,. .. . Social Security Number(last tour digits): 3169 .. .. , .. , • . ....:. , Email Address; simonkim06:10grnaiLcorn H... .; „ . ....., Section 2: •.,,:. ..:, ',•:.•••:• ., ,... . , ••. . :.., CONSTRUCTION INDUSTRY APPLICANT($5Q FEE ::I • , . „,. Officer of a Corporation (Construction) i. - - ..... .,. . . .... Corporate Title: PRESIDENT . .. ffilii ....101•11111.Mff.illIMINIMMIIIMINENI,........... ........., 1.,91111111M■ — ,.IMIIIMIN1111.9117110■111/rminionswww....... ,w... „...,.........____________ Section 3: • This section should be completed wilt'fit,forrri ation specific to your corperiation or to the limitecf fiabilipi.cornr ny in which you are a member. The name of the corporatioeOr.liMited liability company listed'bri this application•MUSt 7 iiateh CI to name of the corporation or limited liability coTbany esjegistered witnthe.,Florida DiVision of Corporations. .:.. ,... ... . . Name of Corporation or LLC:, LI-10P contractors, Inc. •, .:.:• FEIN: 4.7-479,1037 . , .. . . IF YOU NEED TO APPLY FOR A ION,.4.16k HERE . . .. .. • :, .. . . .. . ., . . , ..., Business Name (DBA):,;LHOP Contractiors „ i. Phone: ( 18)4g' •9406 , •• .! •• , Applicant's kidrese,of Record 5200 Eggleston AVE 4406..) . . ' City Orlando',:' iiip:,:; ". •••State: FL Zip .. 219 Courtly: I\1.; ,. .. .r.,•,.. .i ,.„:...• , .. ... Click on the arrow(a),next to the text box(s)to View alist of available Scope clatsificationsitrades for he for r type chosen in Section 2. Clicko on the appropria*;#opel0,•sele4. If you are unsure.as to which classification/trade •o choc Ev,please contact your workererclompensatIon insiOnce•caffilvelt you do not have a.Viorkieise compensation insurance policy, contact the National Council:on CompensatiOn lnsu4ncelSiCCI) at 1-800-6224123 option 5 to obtain a classification c:de. •• ;:; , • SCopet: (15478 Floor Covering S6Ope 2 05437 03,PeriVy- 'Scope : Scope 4: Iiibtallativn-Resiiiel., :.,... . . . 'installation of ' . ! Flo ”,:'::. ':!' •'::,* cabiriot work 1) ::.. Section ,• .i::i'' •.:.;:: The corporation of whi:Otti you are an offideir or limited liability ccimpany of which you are a member must be registered 3 i i in ACTIVE status with the Florlda.lpOion.qf Corporations,Applicants applying aa:pri officer of a corporation must be listed as an(dicer c'the Corporation with the Florida Divi,kliditoCQP*traticris, List the docugiem;humber on tile with the Florida Division of Corporations " P15p00066454 ,; .i..;:: ,::.... - Sect*5: '... '1. 1; ,,„ ..::.... ,. ::. c., ,: . . .,.. Pursuarit4 Chapief4S9, F.S. (contraCtor licensing law), list certified or registered licenses related to the so )e of business or trade listed In Section 3 held by the.appiipant,'ipr the certified or registered license numbers held by J,e dual f ier for the corporation Or limited liability company lid on this application, The business name listed on the license Mil r match the name of the oorporat(pn or limited liability company as registered with the Florida Division of Corporations a-id on ;r is Notice of Election to be Exempt. 20150003104 -------______-----.............................--------.......__,.............._ _ _ _—_ ili..••■■•MIGIMIA.L.. NOTICE OF ELECTION TO BE EXEMPT If this application contains incomplete or inaccurate information, it may cause a delay in the issuances of yc Lr exemption. An officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under tfi.'S•cha;ter. Section 1s e N. - ,,,: __,_-__ APPLICANT INFORMATION First & Last Name; Eun , State Driver's License Number: State ID Number. Stapew,•I.A;,.. 010961247 ., Date of Births 1/22/1968 . Social Security Number(last four digits): 2743 . Email Address; sirnonkim0501@grnall.com Section 2: -- - NON-CONSTRUCTION INDUSTRY APPLICANT(NO' 'EE REQUIRED) Corporate Title: SECRETARY Section 3: , • This section should be completed with infbrrnatipn specific to your corporation;orto the limited liability corpi limy in which you are a member.The name of the corporation or Iittslited liability company liste i.on this application MUST match t la name of the corporation or limited liability company ae registered with the Florida Divisiissp of Corporations. Name of Corporation or LLC: LI-lOP Contractors, Inc. • . . .I=EIN;,,:••,17-479 037 IF YOU NEED TO APPLY FOP A FEIN;,QLI k(MERE Business Name (DEA): Ll-QP,,gontracticrs Phone: i318)4.:v.-6408 Applicant's Address of Record:,,5200 Egglestorn;AVE #4Q4. City Orlando �, su;State: FL Zip 32810'x. Coutity: iliA is Click on the arrow(py•ne}t to the text bax(s)ibryjevVit list of available Scope classifications/trades for the for i I type chosen in Section 2. Click on t e appropriate scope;,to select. If.'you are unsure as•to which.classification/trade! »choi t e, please contact your workers'•°compensation insuraw a carrier, It q i do not have a workers' compensation insurance!polio), contact the National Cpunipit;on CompensatiorOnsuranci (NCI) at 1.800-622-4123 option 5 to obtain a classification c c de. Scope �, b8bt.,o CLERICAL S0.ppe 2 ;' Scope 3: lWiee EMPLOYEES ScoF a3 4. op Section The corporation of whiphtyou are an oilier or limited liability cort7pany of which you are a member must be reg.Etered a:9 in ACTIVE status with the Florida Divisioh of Corporations:,t iplicants applying''! s an officer of a corporation must be listed as an,FFfioer t I the Corporation with the Florida Division of C ; orations. List the document number on file with the Florida bivision of Corporations. P15000 664a3i Section 6. �.�,... Pursuant to chapter 4$ F.S. (contractof`licensing Iaw), list certified or registered licenses related to the so)x of business or trade listed In Section,held by the aeplicark,or the certified or registered license numbers held by'the Y' qual tier for the corporation•pr limited liability campatily. ted i7 this application. The business name listed on the license MI 1ST match the name of the cerpoildion or limited liability company as registered with the Florida Division of Corporations and on'I is Notice of Election to be Exempt,' ir 20150 003104 Co e,- Co c.t f-�ty Growth Management Department Planning & Regulation Operations Division Licensing Section August 28, 2015 Benjamin T. Mading Adria Group Inc 2720 Pinetrail Ct. Bonita Springs, FL 34135 RE: Waiver of Exam(s) / Review of Credit Mr. Mading, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, September 16, 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) 252-5572. Sincerely, Samantha Roe 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 Collier County Licensing Board 2800 N. Horseshoe Dr. Naples, FL 34104 A.LJG 2 8 2015 {I BY: To Whom It May Concern: Please see attached for my application for reinstatement of my Collier County Electrical License (Q17651). Assuming that the license is granted reinstatement, I would like to remove my license from Integrity Electrical Services, Inc. and qualify this license with Adria Group Inc. Please note that during this time that the license lapsed in 2010, I was going through a very difficult time in my life. There were several illnesses in my family, which resulted in a few deaths. In addition, I was going through a divorce, which caused some financial troubles and a hardship in my life. This is ultimately the reason why my license fell into a null and void status. However, please know that I have my life back on track. I have surrounded myself with friends and family and I am at a good place in my life. My greatest wish and hope now is to have my Collier County Electrical license reinstated, so I can continue working in the electrical field, as I am very passionate about this. If you have any further questions, I would be happy to answer them. Thank you for your consideration, 1QJJ , ' Benjamin T. M.M.i g ER13013615 Q17651 , O'- ce) \25,1K Cc31.Cie-r C..ou -sty GMD Operations & Regulatory Management 0 3 r Licensing Section � � 2800 North Horseshoe Drive �� i 33 � Naples, FL 34104 BY:...... APPLICATION FOR COLLIER COUNTY?CITY OF NAPLES/CITY OF MARCO FIRM INSTRUTIONS: This application must be typewritten or legibly printed. The application fee must be paid upon approval and is not refundable. All checks should be made payable to: Collier County Board of County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: gdria Group Inc. Exact Corporate/Business Name: Fiction Name/DBA: Qualifier Name: Benjamin T. Madin: Physical Address: 27120 Pinetrail Ct., Bonita S.rin:s Estate) (Zip Code) (Number&Street) (City) 27120 Pinetrail Ct., Bonita Springs, FL 34135 Mailing Address: (City) (State) (Zip Code) (Number&Street) Telephone: (239) 200-6959 E-mail: Ben.Gemled @gmail.com TYPE OF LICENSE: ; y Electrician General $230.00 !_' Building $230.00 8/2412015 Reinstatement Fee=$230.00 Residential $230.00 3 Back year fees=$615.00 I` Mechanical $230.00 New License Fee=$230.00 $230.00 wily' Total=$1075.0Q �� Roofing *Different fees may wily' Specialty Trade: CHANGE OF STATUS: ($)Reinstatement t`s) From One Business to Another ( ) Dormant License to Active "I" CO-Pi U D Page 1 of 4 ,261``1/0 I. The names. titles. home address and phone numbers of all Officers/Managing Members of the Firm. Joti Projkovski, President 10928 Knine Drive Bonita Springs, FL 34135 (239) 231-0316 2. List all businesses.firms. entities or contracting businesses you have been associated with during the last ten years(i.e. held a license for or been a partner). Attach extra pages if needed. AFC Electric Inc.; Integrity Electrical Services, Inc.; Metro Electric Construction, Inc. 3. List all debts you or an company(s) associated with you that you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. Please see attached documentation for items reflected on my personal credit report. These items have either already been satisifed or are in the process of being paid off. AFFIDAVIT Under the penalties of perjury I declare that I have read the foregoing as plication and that the facts stated in it are true. A orized Affic: of the Firm The foregoing instrument as acknowledged before me this (D te) by Joti Projkovski of Adria Group Inc. _. Game of Officer, Title/Agent) (Name of Corporation) a nnt4. Corporation on behalf of the corporation. Place of Co (State or P Corporation) r ^ He She has produced brifre /tee n 5.e_ identification and did not take an oath. S (Type of identification) NOTARY'S SEAL *91:•h, SEAN DINNEEN O.tflamee>••1r s ARY) * * MY COMMISSION t EE 856916 EXPIRES:yDecember 6,2018 9 Page 2 of 4 Nom" Bonded T Budget Notary Sefllkeb QUALIFIER INFORMATION: Name: Benjamin T. Mading ddress• 27120 Pinetrail Ct., Bonita Springs, FL 34135 ,,Number& Street) (City) (State) ■,Zip Code) Telephone: (239) 200-6959 Date of Birth: 05/28/1973 ' ,-s E-mail: Ben.Gemled @gmail.com Driver's License : ' 1. Type of Certificate of Competency for which application is made. Electrical 2. The names and telephone numbers of two persons who will know your whereabouts. to sS--c.l Lc,-d,i L ."3ct ‘-k os bat 3. Have you ever been convicted of a crime related to Contracting? No (If yes,attach extra sheet with explanation.) 4. Have you or any firms you have been associated with ever filed bankruptcy? N/A 5. List all debts you or any company(s) associated with you that you refused to pay and the reasons for the refusal to pay and reasons why. Please see attached documentation and letter explaning these items. I was going through a divorce,which caused some financial issues. I am dedicated to satisfying all debts in their entirety. 6. List your business or work experience during the last ten years. Vice President of AFC Electric,Inc.from 12/1999-12/2012(became President in 2012),Qualified Employee at Integrity Electrical Services,Inc.from 9/2006—9/2010; Sales and Service Manager at Metro Electric Construction,Inc,10/2013-Present. 7. Statement of any formal training you have had in the area for which the application is made. On the job training 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County No. 2006-46, as amended, and under penalties of perjury. I declare that I have read the foregoing qualifier information and that the facts stated in it are true. 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/she 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. Benjamin T. Mading Applicant (please print) Adria Group Name of Company .Q■ /YI Signature of Ap i ant State of Florida County of G o ile i The foregoing instrument as acknowledged before me this G 7 Z� ate) by Benjamin T. Mading who has produced ,D/ / S 4,z,e,,,,,s 42-- (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL .4.7,41S SEAN DINNEEN �"'�� * - * MY COMMISSION t EE 856916 l 1 --RE O= a∎I " nc EXPIRES:December 6,2016 Ji14.a rse Bonded 11wu Budget Notary Services 4 of4 AFFIDAVIT It is understood and acknowledged by the Collier County Contractor's 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. Z.AA Signature of At icant Adria Group Inc. Business Name Date BEFORE ME this day personally appeared Benjamin T. Mading who affirms and says that he/she has Iess than one employee and does not require Workmen's Compensation and understands that at any time he/she employs one or more persons he/she must obtain said Workmen's Compensation Insurance. State of Florida County of (b//E r The foregoing instrument as acknowledged before me this tZ� -Date} by Benjamin T. Mading who has produced /J/I i2-ek? (name of person acknowledging) (type of identification) as identification and did not take an oath. o SEAN DINNEEN 04 PIRES:December6,2016 44,Fnce Bonded Tin Rudest way swam (SIGNATURE SF ) AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF Florida COUNTY OF Collier L James Snyder . having been first duly sworn, state and affirm: I am a resident of Collier County. Florida (State) and have resided here for more than five (5) years. During the last five years I have known Benjamin T. Mading (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. Signatur James Snyder Name 6084 Tower Center Cir. Naples, FL 34119 Address 239-227-4974 Telephone The foregoing instrument as acknowledged before me this 6 V L k ie J (Date) L by GA—C-5 Sew 2-� who has produced C .fit! 5 v f'LS–C (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL / VIIIIIIIIIIIIM (SIGNATURE OF ') so imt SEAN DIIKE *9; •. MY COMOSSION It EE 856916 ,r =,(_?` T EXPIRES:eD.ecember 6,2016 �' OF��Ce g dThn dgetNoy Se,*es RESOLUTION OF AUTHORIZATION WHEREAS Adria Group Inc. proposes to engage (Name of Business Entity in contracting as Corporation in (Type of legal entity: corp., partnership,etc.) Collier County, Florida, according to Collier County Ordinance 2006-46.as amended: and WHEREAS Adria Group Inc. proposes to qualify (Name of Business Entity) for a Certificate of Competency with Benjamin T. Mading ^_F (Name of Individual) NOW, THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned Officers —of (Officers.Owners,Partners) Adria Group Inc. hereby resolve and represent to the Collier County (Name of Business Entity) Contractor's Licensing Board that the qualifying agent. Benjamin T. Mading is active (Name of Individual) in all matters connected with the contracting business of Adria Group Inc. ,and (Name of Business Entity) We further resolve and represent that Benjamin T. Mading is (Name of Individual) Legally empowered to act for Adria Group Inc. in all matters connected with its (Name of Business Entity) contracting business, and has the authority to supervise construction undertaken by Adria Group Inc. . (Name of Business Entity) DULY PASSED AND ADOPTED THIS 2Y DAY OF O ^ I AO (Officers. Partners,Ow -r • ' designation underneath) Azii .gtr_________—,... / Air Witnes — Witness Witness Corporate Seal(if applicable)or Notary Public Certificate Sworn to and subscribed before me this? day of4 ay/ , 20/.5-- Of by�J / / 60ItkOdSki . The foregoing instrument as acknowledged before me this�Z 7-- `J (Date) / by Benjamin T. Mading who has produced � (//2..eti S� (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL ""_ RY) *9 •�11Y•�"P ett. SEAN DI NEEN * _; * MY COMMISSION t EE 856816 �� 4 EXPIRES:December 6 2016 �7r,cM1de Ba JedlleBedyetN i atri mic+es 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 1-19, 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 1-19. 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 1-19, Florida Statutes. FLORIDA DEPARTMENT c STATE DIVISION OF C0Rl' 0 A"llo S Detail by Entity Name Florida Profit Corporation ADRIA GROUP INC Filing Information Document Number P15000053952 FEI/EIN Number NONE Date Filed 06/19/2015 Effective Date 06/19/2015 State FL Status ACTIVE Principal Address 10928 KNINE DRIVE BONITA SPRINGS, FL 34135 Mailing Address 10928 KNINE DRIVE BONITA SPRINGS, FL 34135 Registered Agent Name & Address PROJKOVSKI, JOTI 10928 KNINE DRIVE BONITA SPRINGS, FL 34135 Officer/Director Detail Name & Address Title P PROJKOVSKI, JOTI 10928 KNINE DRIVE BONITA SPRINGS, FL 34135 Annual Reports No Annual Reports Filed Document Images 06/19/2015 -- Domestic Profit View image in PDF format rs0 Department of Treasury Notice e date CP261 Internal Revenue Service Notice July 27,2015 IRS Ogden UT 84201-0038 Employer ID number 47-4329430 To contact us Phone 1-800-829-0115 Page tof3 000985.580435.19967.23075 1 MB 0.439 530 III11!'rll ll'l lllrlllitIii Ill1ll l'ItIIiIIuI111lhd1I1'Ilr'IIIIIIl ADRIA GROUP INC F: 10928 K NINE DR ti` BONITA SPGS FL 34135-6861 000985 We've accepted your S corporation election You will be treated as an S corporation starting June 19, 2015 We've accepted your S corporation election. As What you need to do a result,your tax year will end in December, and you will be treated as an S corporation You don't need to take any action. starting June 19, 2015. Review this notice to understand some of your obligations and responsibilities as an S corporation Continued on back... ADRIA GROUP INC Not_ce CP261 10928 F 148,tE DR BON T ASP:4 Ft 34135.6861 Notice date July 27,,2015 IBS Employer ID number 47-4329430 If your address has changed,please call 1-800-829.0115 or visit vvww.irs.gov. Contact information n Please check here if you've included any correspondence. Write your Employer ID number(47-4329430)on any correspondence. 0 a.nt. C p.m. E p.m. Primary Phone Best time to call Secondary Phone Belt time to cal INTERNAL REVENUE SERVICE OGDEN UT 84201-0038 I IIIl llrlryl yl lll.mtl lt.ilydhllnl llllllll1l1*tIIIUll,IJll 474329430 UI 00 2 000000 Collier County Contractor Licensing 2800 N. Horseshoe Dr. Naples, FL 34104 RE:Judgment/Collection Items on Personal Credit Report To Whom It May Concern: When reviewing my personal credit report, you will notice that a judgment in the amount of $3,146 is listed, as well as seven collection items. Please note that when these items occurred, I was going through a divorce, which caused some financial issues. However, please know that I am in the process of satisfying all of these items in full. Attached you will find supporting documentation which shows: ➢ There is a payment plan in place for the collections with Midland Funding, showing my first $100.00 payment has been submitted as of 08/14/2015. • There is a payment plan in place for the judgment with Barclays Bank, which shows a $100.00 payment has been submitted as of 08/14/2015. ➢ Full payments have been made and satisfied for the collections listed as: Forest Recovery Services, Century Link, and Progressive Insurance. Please see attached for proof of payment. This should be everything that you will need in order to verify that each item has either already been satisfied, or,that there is currently a payment plan in place. Should you require any additional information, please contact my associate Lisa Adams at (239) 777-8321. Thank you for your consideration, Benjamin T. Mading ER13013615 - - I CO ',-7i , a ^ 0 CI i .5 ‹; 0 : 1 , 1 * (A I ; ; 1 f to ct i I i .... Law Offices of Stanley B.Erskine,Esquire • Erskine & Fleisher Shera Erskine Anderson,Esquire •`t Andrew D.Fleisher,Esquire`• Suite 100 Mindy Rennard, Esquire "" 1351 Sawgrass Corporate Parkway Sunrise, Florida 33323 Member of the Florida&Texas Bar (954)384-1490 Member of the Florida&N.J.Bar Fax(954)384 4088 Member of the Florida Bar Toll Free No.(800)397-9345 Please Refer to Our File No.85360766.001/341 August 7,2015 BENJAMIN MADING 27313 GASPARILLA LA DR BONITA SPRINGS,FL 34135 Re: BARCLAYS BANK DELAWARE vs. BENJAMIN MADING LEE COUNTY-CASE NUMBER: 2010-SC-004199 Post Judgment Installment Agreement This communication is from a debt collector. Dear MR. MADING: The purpose of this letter is to memorialize a post judgment agreement to pay the Judgment entered against you in favor of our client BARCLAYS BANK DELAWARE on February 28,2011 concerning the above case. The judgment balance was in the amount of$3496.87,and is accruing interest at the statutory legal rate of interest,(less credits for any payments or adjustments made by you after the judgment date,if any),plus court costs for the total sum of $3496.87. You agreed to make a down payment of$100.00,on 08/14/2015. Thereafter you will make a Month payment of$100.00, for 1 month, and thereafter the sum of$100.00,Month,on the like day of each month until the total sum due including statutory judgment interest described hereinabove has been paid in full. All payments shall be forwarded to the Law Offices of Erskine and Fleisher, Suite 100, 1351 Sawgrass Corporate Parkway, Sunrise,Florida 33323. All checks shall be made payable to Erskine and Fleisher Trust Account. The above payment schedule is subject to review in ,months(or at the discretion of the Plaintiff same may terminate this payment schedule without notice in that the Plaintiff is attempting to accommodate the Defendant given the financial status represented to same by the Defendant),from the date hereof to determine as to whether the Defendant can pay additional sums under this agreement, in order to amortize the debt due. By virtue of your representation to enter into a payment schedule and maintain same per our agreement you do not have to produce any post judgment discovery if any is outstanding,If you fail to continue with the above payment schedule,you have agreed to provide all discovery previously requested by us on or before 30 days after your last payment without further notice,unless you have already provided same. In advance thank you for your anticipated cooperation in this regard,I remain. Sincerely Yours, Th: La Offices of ER c i� E&/, EISHER __ 1 ST LEY B.I • .KINE,Esquire For The Firm Law Offices of Erskine & Fleisher Suite 100 Stanley B.Erskine,Esquire • 1351 Sawgrass Corporate Parkway Shera Anderson,Esquire"' Andrew D.Fleisher,Esquire•• Mindy Taran,Esquire""' Sunrise,Florida 33323 Toll Free(800)397-9345 (954)384-1490 •Member of the Florida&Texas Bar Fax(954)3644088 •• Member of the Florida 8 N.J.Bar Email:Customerservice@Eflaw.net ""` Member of the Florida Bar Please Refer to Our File No.85360766 August 7,2015 BENJAMIN MADING 27313 GASPARILLA LA DR BONITA SPRINGS, FL 34135 Dear MR. MADING: RE : Payment Slip Book You will find enclosed payment slips as a convenience as it pertains to your account.As you make payments and you require more payment slips please let our office know. Please make the check or money order payable to the above firm in accordance with the instructions on each payment slip.If at any time you are able to Settle your Account for a Lesser Amount, Call us at our toll free number to discuss your options.If you have any questions or disputes about the billing please drop us a note(with a daytime phone number)and we will follow up on your request or call us at our toll free number above. Your cooperation on this matter would be greatly appreciated. We suggest that you put our file number on your check or money order(your file number is 85360766),to insure proper credit against your account in case the slip you return below is lost in processing. Per our records your current installment payment is in the amount of: $100.00.Thank you very much for your cooperation in this regard.If you have any issues please call us.If you do not call us or keep us informed about concerns relative to your account we will have to pursue appropriate resolutions which we would prefer to avoid. We will not send you a payment slip every month nor are we required to under the circumstances.This notice is an attempt to liquidate and collect a debt due your creditor BARCLAYS BANK DELAWARE by the above named debt collector(Law Firm)and any information obtained from you during that process will be used for that purpose. Thank you The Law Offices of Maria Ext 282 ERSKINE&FLEISHER PS: You can send in your payment.Via regular mail,make the check or money order payable to the above firm. To insure proper credit make sure your file number is included on the memo section. D270CB/2010 PAYMENT SLIP._..~-. PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE PAYMENT SLIP PLEASE ENCLOSE THE PAYMENT IN THE AMOUNT OF $100.00 MAKE THE PAYMENT TO:Erskine&Fleisher Trust Account MAIL CHECK TO SUITE 100,1351 SAWGRASS CORPORATE PARKWAY,SUNRISE,FLORIDA 33323 PLACE ON THE CHECK OUR FILE NUMBER 85360766 ENCLOSED PAYMENT DUE FROM: BENJAMIN MADING EF#85360766 PAYMENT FOR BARCLAYS BANK DELAWARE .... $ &I il. . e.u3ii 418m i ; CO cs, CI ,.., 1 C .1/4.1 a 72, 0 to 0 as" 1 o 1 1 0 , . 1 , kit i '. ..... 1 i \.) 7" 4 ....., , 't 04 c■I CO a.0 _. . ..._ _ ,.....______...„..... . : BENJAMIN T MADING 1091 27313 GASPARILLA DR BONITA SPRINGS,FL 34135 63-8281/2631 Date to the 1— Order f.-.5+ ?....e.GO aerj .e...r t);e-4- 6 d..LC- I $ 4.‘ 0 .---, sck-i ----PAN- _________ .-.. --- bt,b Dollars Suncoast • Credit Union TAMPA.RORIDA 336104110 For 9 ck_Tr.eAT4- :1,At Pa ii BENJAMIN T MADING 1089 27313 GASPARILLA DR 63-8281/2631 BONITA SPRINGS,FL 34135 i St-ILI-15- Date Pay to the .0- Order of L.,e...IA-u rj L.:At k I 'Two In vvva rg-e) CiaJZ 5 ig 41•- St-V‘....A.) "--------"7.7.2o Dollars Ikele Suncoast , w Credit Union TAMPA,FLOIODA 336104110 For 11/11.enrn- ivy RA( 1 ,.....___ P00d Casks 1 BENJAMIN T MADING 1090 27313 GASPARILLA DR 63-8281/2631 BONITA SPRINGS,FL 34135 Date , Pay to the D_ _ l I $ 01(Ck(•CI(:) ...90 #. SWAM:, —rw 0 srt u Ve3r4-0 ct_AJ c) S'I-*C.:6i -- 0.pt€_... jgro Dollars ail Femur.% , a Suncoast , ,illir Credit Union TAMPAAORIDA 336104110 For ec.... m.e.A.,..)- .-,./ ,./1 1 - i 886 110th Ave. N. Suite#6, Naples, FL 34108 Phone:239.777.1028 AI Fax: 877.275.3593 www.LicensesEtc.com PERSONAL CREDIT REPORT(Compiled From National Records) <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> (I) P NP7771028 LICENSES ETC 16 NP 1/93 08/06/15 13: 47CT <SUBJECT> <SSN> <BIRTH DATE> MADING, BENJAMIN TRAVIS -6066 5/73 <CURRENT ADDRESS> <DATE RPTD> 27120 PINETRAIL CT. , BONITA SPRINGS FL. 34135 2/06 <FORMER ADDRESS> 27608 PULLEN AV. , BONITA SPRINGS FL. 34135 5/98 26331 NOTTINGHAM LN. , BONITA SPRINGS FL. 34135 <CURRENT EMPLOYER AND ADDRESS> <RPTD> DIRECT BENEFITS 5/05 <FORMER EMPLOYER AND ADDRESS> AFC ELECTRIC INC 10/01 M O D E L P R O F I L E ***FICO CLASSIC 08 SCORE +519 : SERIOUS DELINQUENCY, AND PUBLIC RECORD OR ***COLLECTION FILED; TOO FEW ACCOUNTS CURRENTLY PAID AS AGREED; NO RECENT ***NON-MORTGAGE BALANCE INFORMATION; NUMBER OF ACCOUNTS WITH DELINQUENCY *** C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=1 COL=7 NEG=9 HSTNEG=1-6 TRD=14 RVL=8 INST=2 MTG=3 OPN=1 INQ=2 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE CLOSED W/BAL: $5427 $5256 $ TOTALS: $ $ $5427 $5256 $ P U B L I C R E C O R D S PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY,STATE AND FEDERAL LEVELS SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064207 2/11R $3146 I CI 10SC4199 CIVIL JUDGMENT BARCLAYS BANK DELAWARE 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 11/09 $775 GE MONEY BANK 09B 7/15A $1371 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 8/11 $777 CHASE BANK USA N A 09B 7/15A $1057 PLACED FOR COLLECTIO MIDLAND FUND Y 36ET009 I 5/11 $5222 TARGET NATIONAL BA 09B 7/15A $7641 PLACED FOR COLLECTIO Page 1 of 3 MIDLAND FUND Y 36ET009 I 5/12 $1211 CHASE BANK USA N A O9B 7/15A $1211 PLACED FOR COLLECTIO EOS CCA Y 49XV008 I 10/14 $267 10 CENTURYLINK CEN O9B 12/14A $267 PLACED FOR COLLECTIO CREDIT COLL Y 1GZD005 I 1/14 $261 06 PROGRESSIVE INS O9B 4/14A $261 PLACED FOR COLLECTIO FORESTRECVY Y 2EC8001 I 8/13 $65 MEDICAL O9B 12/13A $65 PLACED FOR COLLECTIO T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CAPITAL ONE B 1DTV001 5/05 $591 R09 8/15A $500 $364 I CREDIT CARD 11/09F $364 CLOSD BY CRDT GRANTOR FST PREMIER B 41PF045 11/01 $388 R09 2/13A $250 $388 I CREDIT CARD 7/09F $388 UNPAID BLNC CHRGD OFF CHASE-PIER1 B 247V026 5/04 $776 R09 9/11A $650 $0 I CREDIT CARD 2/10F $0 PURCH BY OTHER LENDER TARGET N.B. D 1ZX5001 5/03 $5221 R09 7/11A $4400 $0 I CREDIT CARD 10/09F $0 PURCH BY OTHER LENDER BRCLYSBANKDE B 1ZZB001 9/07 $3224 R09 1/10A $2300 $3142 I CREDIT CARD 12/09F $3146 CLOSD BY CRDT GRANTOR CHASE B 26QK001 4/04 $2091 R09 10/09A $817 $0 I CREDIT CARD 10/09F $0 PURCH BY OTHER LENDER FST PREMIER B 41PF018 4/05 $287 R09 8/09A $250 $120 A CREDIT CARD 6/09F $287 UNPAID BLNC CHRGD OFF FRD MOTOR CR F 3796761 5/04 $40 . 1K 65M I09 7/09A $0 C SLDTO CBV COLLECT 7/09F $0 PURCH BY OTHER LENDER VERIZON U 1R2W002 3/12 $1242 O9B 7/15A $1242 I TELECOMMUNICATION 4/14F $1242 PLACED FOR COLLECTION KAY JEWELERS J 722D62X 11/03 $1969 12/09 111115543211 ROl 7/10A $1969 $0 $185 05 211111111111 I CHARGE ACCOUNT 5/09C $0 CLOSD BY CRDT GRANTOR 48 2/ 1/ 3 MORTGAGE LEN B 1RZM001 11/05 $496K 360M3271 111111111111 MOl Page 2 of 3 3/07A $0 11 I CONVENTIONAL REAL 3/07C $0 TRNSFRD: OTHER LENDER 14 0/ 0/ 0 NUVELL CREDT F 79PG006 12/01 $21 . 7K 66M525 111111111111 I01 1/06A $0 111111111111 I AUTOMOBILE 1/06C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 4275002 4/05 $280K 360M M01 12/05A $0 I CONVENTIONAL REAL 12/05C $0 CLOSED 7 0/ 0/ 0 HSBC/MS F 235197C 4/05 $78 . 6K M741 1111 MOl 12/05A $0 I HOME EQUITY LOAN 12/05C $0 CLOSED 4 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 8/06/15 PNP7771028 (FLA) LICENSES ETC 4/09/14 ZTN0620207 (SCT) CIC CREDIT END OF REPORT Page 3 of 3 886 110th Ave. N. Suite#6, Naples, FL 34108 joi Phone: 239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com BUSINESS CREDIT REPORT as of: 08/28/15 2:08 ET Integrity Electrical Services Inc. Fed Tax ID# 22-3936741 Address: 16880 Gator Rd Ste 108 Key Personnel: Victor 0 Tianga Fort Myers, FL 33912-5903 Nelly Tianga United States Chouinard Donald Phone: 239-344-7925 SIC Code: 1731-Electrical Contractors Website: integrityelectricalservices.net NAICS Code: 238210-Electrical Experian BIN: 832183142 Contractors And Other Wiring Installation Agent: Spiegel & Utrera, P.A. Contractors Agent 1840 SW 22ND ST Business Type: Corporation Address: Miami, FL Experian File Established: November 2006 Family Linkage: Experian Years on File: 9 Years Ultimate Integrity Electrical Services Inc Years in Business: 10 Years Parent 16880 Gator Rd Ste 108 Fort Myers, FL Total Employees: 10 Branches/ Integrity Electrical Services Inc Sales: $1,880,000 Alternative 18233 Hawthorne Rd Locations Fort Myers, FL United States Filing Data Provided by: Florida Date of Incorporation: 06/30/2006 Page 1 of 2 Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. /Bankruptcies: 0 Liens: 0 /Judgments Filed: 0 /Collections: 0 END OF REPORT Page 2 of 2 ACORD 08/26/ CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 08/26/2015 1 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 Margie Tann NAME: g Zehner&Associates PHONE 239 433-2325 F PHONE E Ext); (239) (NC,No): (239)433-1058 5268 Summerlin Commons Way Ste 502 ADDRESS: margie @zehnerassociates.com Fort Myers,FL 33907 INSURER(S)AFFORDING COVERAGE NAIC# Phone (239)433-2325 Fax (239)433-1058 INSURER A: Ohio Security Insurance Co INSURED INSURER B: ! Adria Group Inc INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS Q COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000.00 _ ❑ CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED 300,000.00 PREMISES(Ea occurrence) $ EI MED EXP(Any one person) $ 15,000.00 A ❑ Y BLS(16)56791970 07/09/2015 07/09/2016 PERSONAL&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ❑ POLICY 'I ECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000.00 (Ea accident) $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ A ❑ AUTOS D AUTOS BAS(16)56791970 07/15/2015 07/15/2016 ❑ HIRED AUTOS ❑ NON-OW NED PROPERTY DAMAGE $ AUTOS (Per accident) ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑STATUTE ❑0OTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEn OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Licensing Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2800 North Horseshoe Dr Naples FL 34104 AUTHORIZED REPRESENTATIVE `I _ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01)QF The ACORD name and logo are registered marks of ACORD �°►CG Oo® CERTIFICATE OF LIABILITY INSURANCE DATE$/26/ZO15rr) 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 SUNZ Insurance Solutions, LLC. ID: (BIOGA) CONTACT Ginger Price c/o Business Insurers of Georgia, Inc. PHONE FAX 110 Mansell Circle, Ste. 203 (A//C,No,Ext): 678-886-4716 (ac,No): Roswell, GA 30075 ADDRESS: gingerp @insourcees.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: SUNZ Insurance Company 34762 INSURED INSURER B: Aspen Re-London-Best Rating"A" Business Insurers of Georgia, Inc. 110 Mansell Circle, Suite 203 INSURER c: Catlin Syndicate Lloyds Best Rating"A" Roswell GA 30075 INSURER D: "Brit Syndicate-Lloyds-Best Rating"A: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 26116660 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF ! POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ' DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ ! MED EXP(Any one person) $ 1 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: '1 GENERAL AGGREGATE _ $ -,I POLICY PRO- I LOC j PRODUCTS-COMP/OP AGG $ OTHER: $ 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 (Per accident) $ j UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED I RETENTION$ $ A WORKERS COMPENSATION WCPE0000010205 6/1/2015 6/1/2016 ✓ STATUTE OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ _ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Workers'Compensation This is for informational purposes C Excess Coverage and nothing shall create any right D I under such reinsurance. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of:Sunshine Workforce,LLC Client Effective Date:8/11/2014 Coverage provided for all leased employees to client Adria Group from Sunshine Workforce,but coverage does not extend to Adria Group employees. CERTIFICATE HOLDER CANCELLATION 2723743 Collier County Licensing Baord SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . Y g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 N. Horsehoe Drive ACCORDANCE WITH THE POLICY PROVISIONS. Naples FL 34101 AUTHORIZED REPRESENTATIVE .//.`A 4 I Glen J Distefano ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 26116660 1 Master Certificate I Karin Franzoso 1 8/26/2015 11:57:14 AM (ADT) I Page 1 of 1 1:31:46 PM 8/28/2015 Licensee Details Licensee Information Name: MADING, BENJAMIN T (Primary Name) INTEGRITY ELECTRICAL SERVICES INC (DBA Name) Main Address: 10920 K NINE DRIVE BONITA SPRINGS Florida 34135 County: LEE License Mailing: LicenseLocation: 10920 K NINE DRIVE BONITA SPRINGS FL 34135 County: LEE License Information License Type: Registered Electrical Contractor Rank: Reg Electrical License Number: ER13013615 Status: Delinquent,Active Licensure Date: 10/18/2006 Expires: 08/31/2014 Special Qualifications Qualification Effective Collier 10/18/2006 Alternate Names View Related License Information View License Complaint 1940 North Monroe Street,Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer.Copyright 2007-2010 State of Florida.Privacy Statement Under Florida law,email addresses are public records.If you do not want your email address released in response to a public-records request,do not send electronic mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1),Florida Statutes,effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one.The emails provided may be used for official communication with the licensee.However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public. Please see our Chapter 455 page to determine Metro Electric Construction Inc. 5269 30th Ave Sw. Naples, Fl. 34116 August 20, 2015 Name: Benjamin Travis Mading Company Name: Metro Electric Construction Inc. Title: Service Technician I Sales Business Address: 5269 30th Ave Sw Naples, Fl. 34116 Business Phone number: 239-280-9867 Time Frame of employment: February 2014 - Present Scope of work: Estimating and Service Technician Signature: � •� Date Print Name: `) k) C u I-v A NOTARY SEAL and Signature / Is-- PERSONALLY KNOWN X eirlfirs BEN MADINO 'As MY COMMISSION*EE148284 • '• r EXPOS November 22.2,015 (W7)age4153 Floridallo .ca^ 2012 FOR PROFIT CORPORATION AMENDED ANNUAL REPORT FILED DQCUMENT# P97000100855 Secretary of of State Entity Name: AFC ELECTRIC, INC. Current Principal Place of Business: New Principal Place of Business: 10550 ABERNATHY ST. BONITA SPRINGS, FL 34135 Current Mailing Address: New Mailing Address: 10550 ABERNATHY ST. BONITA SPRINGS, FL 34135 FEI Number:59-3481558 FEI Number Applied For( ) FEI Number Not Applicable( ) Certificate of Status Desired(X) Name and Address of Current Registered Agent: Name and Address of New Registered Agent: QUINN, MICHAEL SHEFFIELD, ROBERT J 10550 ABERNATHY STREET 27645 ROSLIN DRIVE BONITA SPRINGS, FL 34135 US BONITA SPRINGS, FL 34135 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: ROBERT J SHEFFIELD • 10/17/2012 Electronic Signature of Registered Agent Date OFFICERS AND DIRECTORS: Title: CEO Name: SHEFFIELD, ROBERT J Address: 27645 ROSLIN DRIVE City-St-Zip: BONITA SPRINGS,FL 34135 Title: PRE Name: MADING,BEN Address: 27120 PINE TRAIL COURT City-St-Zip: BONITA SPRINGS, FL 34135 Title: VP Name: FETZNER,TODD R Address: 620 NW 2ND TERRACE City-St-Zip: CAPE CORAL,FL 33993 Title: VP Name: QUINN,MICHAEL Address: 27654 ROSLIN DRIVE City-St-Zip: BONITA SPRINGS, FL 34135 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 I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: ROBERT J SHEFFIELD CEO 10/17/2012 Electronic Signature of Signing Officer or Director Date Collier County Contractor Licensing 2800 N. Horseshoe Dr. Naples, FL 34108 To Whom It May Concern: Please see attached for the application for a Lee County local business tax receipt for Adria Group Inc. Please note I am aware that this reinstatement application requests a copy of the company's Lee County local business tax receipt. However, please note that in order to apply for a local business tax receipt in Lee County,they require that the license be issued before applying for the local business tax receipt, which is why this has not been applied for yet. We understand that Collier County does this differently; however, as our business is located in Lee County, we must abide by their regulations. Please see attached for a copy of the local business tax receipt that we will file after our license has been reinstated with Collier County. This should be everything that you will need in order to verify that a local business tax receipt will be in place with Lee County upon issuance of the license in Collier County. Thank you for your assistance, Benjamin T. Mading , veeCots Local Business Tax Account Application vgeC•okiny Lee County Tax Collector Tax Co tor Tax Co for P.O.Box 1549 sr �6m Ft.Myers,FL 33902-1549 ware of 00"are of 001 239.533.6000 (Return application,fees,and corresponding documents to the Lee County Tax Collector for processing.) 1. Type of Business: Construction - Electrical 2. Business Name(DBA): Adria Group Inc. EIN/SSN: 47-4329430 NOTE:Indicate below why you are exempt from filing for a Fictitious Name Registration/DBA(Doing Business As) IN Business name indicates my full legal name ❑ Business name is a registered trademark ❑ Business name is the corporate name ❑ Business name is the limited liability partnership name E l Business name is the general partnership name ❑ Attorney,Dept.of Health,Dept.of Business&Professional Regulation 3. Owner/Professional/Qualifier Name: Mading Benjamin T. (Last) (First) (Middle Initial) 4. County/State license or certification number: (Professional, Contractor&Restaurants, etc. Enter license number and attach a copy of your current license or certification) License#: 5. Physical Address: 10928 Knine Drive Strap#: (Zoning approval is required-see below and back of this application.) City: Bonita Springs State: FL Zip: 34135 Mailing Address(if different): 10928 Knine Drive City: Bonita Springs State: FL Zip: 34135 6. Business Phone Number:(239) 200-6959 Alternate Phone Number: ( ) 7. Business located in: ❑ Residential 21 Commercial Property 8. Is the physical address located within a city limit? ❑ Yes:If yes, attach a copy of your city local business tax receipt ® No:If no,see zoning requirements below&on reverse side 9. Date business actually began at this location: 06/19/2015 IMPORTANT:IF TRANSFERRING A BUSINESS TAX RECEIPT CHECK EACH TYPE OF CHANGE BELOW (Current Lee County Business Tax Receipt must be attached to this application)TRANSFER FEE:$3.00 ❑ Business Name(DBA) p Physical Address ❑ Occupation ❑ Owner Name El Mailing Address CURRENT RECEIPT#: El Ownership(example:purchase of existing business,include a copy of the Bill of Sale Existing receipt transfers may require one of the following:County/State license or certification,zoning approval. Business Tax Fee(Includes a$20.00 Hazardous Waste Surcharge per Resolution 94-07-14) Full Year Fee 1/2 Year Fee(April-June) r4 Year Fee(July-Sept) Business Tax Receipt Fee: $50.00 $25.00 $12.50 (Payment required at time of application.) To obtain fees for Flea Markets,Special Events,Transient Merchants or Going Out of Business/Fire Sales call 239.533.6000. Signatures: Und- penaltie• o p 1.ju ,I hereby declare the statements above are true and correct to the best of my knowledge. Owner/Qualifier: P$ LI Date: o g / g / ao),S- r"-- Owner: 4 Date: 0 g l c-g / v2O A R ZONING APPROVAL IS REQUIRED FOR BUSINESSES LOCATED IN UNINCORPORATED LEE COUNTY. R E E County Zoning Department must complete this section prior to local business tax receipt Q issuance,or attach a copy of the LOCATION Certificate of Use or Certificate of Occupancy. Q U I HOL-USE or COM# : 1 R Strap Number: R E E D Approved By: Title: Date: D Form#151 REV 06/2010 Make checks payable to:Lee County Tax Collector,P.O.Box 1549,Fort Myers,FL 33902-1549 ' Application Instructions Line 1 Nature(type)of Business: Please describe the type of business that will be conducted. Line 2 Business Name(DBA):The business name is the name that the business will be using when conducting business,advertising, and for identification purposes. If the business is operating under a name other than the owner's full legal name,a Fictitious Name Registration is required.The business is exempt from filing a fictitious name registration if it is one of the following:a corporate name; registered trademark; limited liability company;or general partnership,each of which should be registered with the State of Florida. If the business is in fact exempt from filing a fictitious name registration, place an"X"in the box that best indicates the reason for exemption. EIN/SS#: Employer Identification Number(EIN)is also known as a federal tax identification number. In accordance with Florida Statutes,social security numbers are collected only if the business is operating as an individual,and are used for governmental purposes only. Line 3 Owner/Professional/Qualifier Name:The business owner(s)name would consist of one of the following:a person's name if owned by a sole proprietor;two or more persons'names if owned by a partnership;or a corporation name. Line 4 County/State License or Certification(Professionals,Contractors,Restaurants,etc.): Businesses or professions that are regulated by county or state agencies are required to provide a copy of the current license or certificate.Agencies and examples of the types of businesses/professions they are responsible for regulating are as follows: Agency Type of Business/Profession Phone Lee County Contractor Licensing Contractors 239.533.5895 Florida Department of Health Nurses,Therapists, Day Care,etc. 850.488.0595 Department of Agriculture Auto Repair,Fitness Studio,etc. 800.435.7352 Bureau of Entomology and Pest Control Bug and Pest Control 850.921.4177 Department of Business and Professional Regulation CPA, Real Estate Agent, Hotel,etc. 850.487.1395 Important:The name on this application and on the county/state license or certificate must match exactly,including middle initials,in order for the application to be processed. Line 5 Street Address of Business:The physical address is the actual location of the business as approved by either county or city zoning.A P.O. Box is not acceptable as it is not adequate for zoning purposes. Mailing Address: Include the mailing address if it is different from the physical address.This address can be a P.O. Box. Line 6 Business Phone Number:The business phone number would be the actual phone number customers would utilize. Alternate Phone Number:The alternate phone number would be one of the following:the sole proprietor;an owner in a partnership;or an officer of the corporation. Line 7 Place an"X"in the appropriate box to indicate whether the street address is a residential or commercial property. Line 8 Place an"X"in the appropriate box to indicate whether the street address is located within the city limits. Line 9 Date business began or will begin accepting payment for services: • Businesses located in Lee County indicate the date the business started taking payment for services. • Businesses located outside of Lee County, please indicate the date the business started operating within Lee County. Businesses located within the city limits of Fort Myers.Cage Coral.Sanibel or Fort Myers Beach z 0 Obtain a city local business tax receipt from the cities indicated above before submitting an application for a Lee 0 N County local business tax account. Fort Myers Beach provides a city local business tax receipt for a very limited N amount of business types. Please contact their office for all zoning and business tax receipt requirements. Zoning for Businesses Located in Unincorporated Lee County: N County ordinance 07-02 requires all businesses to have zoning compliance.Applicants can call Community N Development at 239.533.8329 for zoning requirements and fees. G Business Tax Fees(Includes a$20.00 Hazardous Waste Surcharge per Resolution 94-07-14) Full Year Fee 1 Year Fee(April-June/ 1/4 Year Fee(July-Sett/ Local Business Tax Fee $50.00 $25.00 $12.50 (Payment required at time of appplication) To obtain fees for Flea Markets,Special Events,Transient Merchants or Going Out of Business/Fire Sales contact the Lee County Tax Collector at 239.533.6000. Form#151 REV 06/2010 ©� . .•ycr « ,r /\: \. y« :< .« \ \ \ \ \ \ y - t \ t . . . . .�_ . K»\� : � � : x«aft\ y . w s�. y y. . •. �� , �� 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 March 18, 2015, 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 Janet Ramirez (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 ..'•-■ - - . •- -. ■ •- :.. • .- - -• 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 Janet Ramirez was present at the public hearing on March 18, 2015, and was not represented by counsel. 1 364328.1 4/4/2015 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 8 in favor and 0 opposed, a unanimous vote of the Board present, the Applicant's credit report is not approved and she shall be issued a probationary license as follows: a. Six month probationary license with a credit review in six months, provided however that if the Applicant demonstrates that her credit FICO score reaches 660 on or before six months from the date of this order the Applicant's application shall be approved without necessity of appearing before the Board; ORDERED by the Contractors Licensing Board effective the 18th day of March, 2015. 2 364328.1 4/412015 <CQNTRACTOR'S LICENSING BOARD COLLIER cQUNTY, FLORIDA \, ) / hh ?� • By: Patrick White, Chairman I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorio, Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this 1 : • • of March, 2015. Secretary/Contractor's Licensing Board 3 364328.1 414/2015 • �I —Th, I GOf tV e-v ' I -n.ty • GMD Operations & R: �I tc# Management 1 F f•. Licen S i. (�y 2800 No h-,t-1. . s;. oe Dr,W\---. /),--=/-1 ,/ A P P . C ,, COLLIER CO .i 'TV, Th,O , S/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: . `--j - a , ) 4 1 Fiction Name/DBA: Qualifier Name: jOrt_Q-A- I,Q ryvi 2 Physical Address: �,Cl� ) fin l V I�C,I_1 DLO Z �l ' '� �1_� F 3._." _ �G, (Number & Street) (City) (State) (Zip Code) Mailing Address: OCl ----) 1 ,�fits TO f ra(vii to �1 L �( �� p( 3(/// (,_ (Number & Street) (City (State) (Zip Code) Telephone: C 3G) (06 - 13 9 E-Mail: QG 5 1cub( -. r)cc i'i f s Yv I UD _,)n C TYPE OF LICENSE: (:41i)(..:().CC ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 'Specialty $205.00 Specialty trade: 11�Y' CO-1)Q-rvr-(, en 3G3 CHANGE OF STATUS: — 2015 ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to A e FEB Page 1 of 4 BY: ............... i r 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. C rlas (cc5tor dC cff1QQ(z 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. nonO 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. pi f.d hcitod + , AFFIDAVIT I, ' ivi 4J rvOr-e7 certify that the foregoing 's true and correct to the best of my knowledge. OAS ) Authorized O �r o)the Firm STATE OF FLOF�MI 1 k9 COUNTY OF • The foregoing instrument as acknowledged before me this A/ / ! / (late) By of OncL , Inc_ (Name of officer, title/agent) (Name of CCorptora jbn) a. 1-10y Ida Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced ' ^ identification and did not take an oath. (Type of identification) NOTARY'S SEAL CLAe Jar vas Notary Public State of Florida °� Patricia A Reed (SIGNATURE OF NOTARY)• • < Icy Ccia A. EE0821 12 / Expires 04122!2015 r� Page 2 of 4 QUALIFIER INFORMATION: Name:<<jd/ f Address: e---/?m TJvra<' ' T4-Z I V 5 3q/1(.(0 (Number& Street) (City) (State) (Zip Code) Telephone: Ca3c) 8(DG— /3 9 Date of Birth: s.s. #: 000-00- - - E-Mail: tKJvl -. L 1 @ U0066 ,C67y7 Driver's License:J?( 1. Type of Certificate of Competency for which application is made. FJ(D' Oja Q l ty) Ufa cf r 2. The names and telephone numbers of two persons who will know your whereabouts, !� . ad. YI „ _ e f>r one 4Orlyyth? (a�9) LLSO - 2713 3. Have you ever been convicted of a crime related to Contracting? f16 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? 06 8. List all debts you or any companyy(s))associated with you refused or failed to pay and r asons why. i 9. List your business or work experience during the past ten years. FLOM' .QO OftSbUd 51-01M7te/ti 10. Statement of any formal training you have had in the area for which the application is made. 01CnJ 61, lit Page 3 of 4 Score Report Page l of 1 Score Report I r `# Al*pr r®,,,,,,. ., Ramirez,Janet Name: Janet Ramirez Test: Business and Law•(FL08100) Sponsor: Collier County Date: 11/17/2014 ID M. Test ID: 903561788 Score: 78 Result. Pass I Unanswered Questions: 0 Module Subject Area Status LOW CulScore HIGH FLBO Business Organization F linigininnigiaingEMENEMBE FLLIC Licensing P FLLIEN Lien laws F FLTL Tax Laws P liiiniliMMIMMIIIIMINE111.51 1111 - i FLSRR Safely Reporting Regulations F FLLL Labor Laws P FLCM Contract Management P FLPM Project Management F iiiiiiINNOMMIIIIN FLE&B Estimating€Bidding P FLFM Financial Management F FLRM Risk Management F iiiiMMIESEMIMMEMENEMINIENNIE ce. tl %A file:///C:/Users/TanaT/AppData/Local/Temp/Arkiv/-fFC5BBOP8.htin 11/17/2014 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. �1 .0Y3Z APPLICANT(PLEASE PRINT) e X LU VVXY'v n9 NAME 0 COMPANY / 'SIGNATURE OF APPLI1 ANT STATE OF FLORIDA J �� COUNTY OF The foregoing instrument as acknowledged betore me this A/5j* (Date) By J a/'l x'11 who has produced p L , (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL Notary Public State of Flcnda (SIGNATURE OF NOTARY) r O Patricia A Reed MyCommisson EE062 2 { °or n Expires 04/22/2015 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 APPISI ANT AO .1 L. i BUSINESS N IE f--JV 5161 i X015 DATE BEFORE ME this day personally appeare kj Q K1a � D2- who affirms and says that he J� 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 instrume t was acknowledged before me this c)--/e i5 // (Date) . L by W* lAe� Z - • ; . -- - - - I (name of person acknowledging) ('Type of identification) as identification and who did not take an oath. ovxr pt,„ NOW./Public Stale of" ✓l/"'" "�'� -{. CY " Patricia A Read '%;;� My Commission 406211? S GNATURE OF NOTARY Ojr/C/4 a ,ke-rd NOTARY'S SEAL (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC 4 • COLLIER COUNTY GOVERWENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION . 2800 N.Horseshoe Dr. 4 Naples. Florida 34104 • 239-403-2400 • ITAX 239-403-2334 • . MEMORANDUM • DATE: November 29, 2007 TO: Applicant's • FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. AIamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office, Al[ Contractor Licensing personnel. i • • 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 Clmapter 119, Florida Statues ind as may otherwise be authorized by law. We-are fully committed to safe-guarding and protecting your SSN and office collected, will be maintained as ;onfidential and exempt under Chapter 119,Florida Statues. • • VERIFICATION OF CONSTRUCTION EXPERIENCE `- GIVID Operations & Regulatory iVlanagement Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name. di hiyuria, Certificate Category Requested: F/Cr orizgviry 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: ' ,ij YI•el Si OS —1-"?.. Title:1JJ (a.tIa,OS jylLLY14 y Ck- License Number(if applicable): WA Name of Business:"(4.41 b e. LIM/eS Flop H CpVAy►!NQ Business Address: 7c 5 I s 11 fpf V �'h 1 V e. F*. mtt.J.{J e_rs Fl, 33 9l z Business Phone: .Z39-.2 47.P a 0 The Applicant's years of experience from to The applicant's scope of work (specific duties) included: _._ /!y I , -- - _ .� ! �� - _ _ j. _�l_ .' i i. -� - 41/41 .. Additional Comments: Falsifying any information provided herein may subject your license to evocation. 6 ►"' d til Si nature 9-int Name: 1- [VU 2 State of Florida County of Collier The fo going in lrumef�was acknowledged before me on this day of ` n� " c AO by 0-I. ll_rr f.(C' - who is personally known t or produced as identification and who did not take an oath. a 1-%....--- 62-46_,C.0_,ZQ ostY°c4,... ignature of Notary .,-,A, ^ Pair cia A Public Reed1Q of Ronan 0 ` 1y Commiss on EEo621 12 ./or n� EXDIl06 04!22/ZO15 'I ICATyON • CON ' UC ION-..A_ .__ • GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples, FL 34104 Applicant's Name:Alat Certificate Category Requested: ! 1(.(JY l;OUQ'fY' CQ{ YQC of 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 in formation: Name, Title and license number of the person signing below and verifying Applicants relevantexperience: Name: Nor) Cc ( Title: License N umber(if applicable): c, Name of Business: HT-2_ 1)1( - Business Address: (Lib 2_ Tl49j(al ?caw) 1) La - Business Phone: (9‘3 ) 2.5 - 17 The Applicant's years of experience from ff )/U to ,%�j(J/ The applicant's scope of work (specific duties) included: _l ,//1ju "C(.(,64-ial cif ail ,-(core - �/. 1._ �.[ /► _ ^!LL_. _I. i #! I • 1 _ . 'T 0,v/GL '1) .tx Additional Comments: Falsifying any information provided herein may subject your license to revo ration. Signature (� Print Name: t? \e. C Z State of Florida County of Collier [' The - r going in trument was acMowledged before me on this 51 day of I ei� by J - ( Y JICIY), f ece 2--' who is personally known to • - or produced as identification and who did not take an oath. / 6. r P<",„ Notary Public State of Florida Signature of Notary Patricia A Reed :r� gyp' My Cornmiss!on EE062112 Expires 04/22/2615 IVERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N. Horseshoe Drive Naples, FL 34104 Applicant's Name: Y lQ Ica Julia Certificate Category Requested: F�L0( 0.6U12(103 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: -k,1 A \ r ic)1 ce� lJ o�e 'e_ >, t Al"1C., � Title: 1CC7S 1ClLil License Number(if applicable): C`�k.Qt." }'1 C1' \1 3" Name of Business: .X\ L NVWS ` � C `U\ti t L I 1. .i ', Business Address: —It -3 J �� SLv .\(1∎ (1 PCB'�--s ric Business Phone:�,3rt– i��" �� The Applicant's years of experience from �C� %S to ()Os, The applicant's scope of work (specific duties) included: c c f C _QC1(\ci CSC Cc,c k_-•-)vcci GLtY6 1`L� �� Additional Comments: Falsifying any information provided herein may subject your license to revocation. Signature -/- Print Name: C9A ri/E /' State of Florida County of Collier �j r The regoin iu3/strume t was acknowledged before me on this A day of � !� o by �D/'l� 10- J Uhf)e I who is personally known : or produced as identification and who did not take an oath. r}°State of Florida 4t ova N°tan pub Reed Signature of Notary _° `1, Patricia A er00:2 ` '�l ExPir°s Dona 4r ,,f of I,o AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I I, /? R =' .D Ece 12 am a resident of Lee County, FL- - (State) and have resided Wnhere for more than five (5)years. During the last five years I have known J FAr1�-1-- K> 1 T.12.17- Z (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) I- ( 41"1/4-) .()-2 c ..e (Address) /-/57 0 t41.2K (2 1 D k-P ('nom Pr- /x'1.7--7-f f--( - Telephone) ''' ,3 5-3 yU o2 ) )5' 1 STATE OF FLORIDA i COUNTY OF r�`" foregoing ' strument was acknowledged before me this / Ij J by 2 i E C'�-�'1C'C,, �1� D (Date) who has produced (J L - (name of person acknowledging) (Type of identification) as identification and who did not take an oath. 0 ' / 0,1,--/ ,rf'�.A NATURE Oil'NO'I'r 5. PRT Pie, Notary Public Sloe r,1 Florida V ///�� Patricia A Reed ^ ^ (/ 9. J My Commission0EE3 2112 , "/1 Z:61- f f l ; , ,.,/','\F..,;. (PRINT NAME OF NOTARY)` NOTARY PUBLIC ,,,P°T'c,a Notary Public Slate of Florida P. Patricia A Reed y: , 4' My Commission EE062112 l'eo r,d, Expires 04/22/2015 . V'. 10 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, CAM EL P..)DS y am a resident of LEE County, FL , (State) and have resided here for more than five (5) years. During the last five years I have known �AM aT KE.Z (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) CL.61^ i Rt1s fir, (Address)3 7/6 - /. .1L . W Le..A ,F/. Telephone) 2?9 -3416-22& 9 STATE OF FLORIDA COUNTY OF �/ , / / The foregoing instrument was acknowledged before me this 1 l 0 Y'41/ o2 1 `�' by J (Date) who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath-. / , IGNATURE OF NOTARY d NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC Zoc►R'Dyer Notary Pubtic Slate o1 Florid? Patricia A Reed 1„;-.07:1 tdy Commission EE0621 12 Expires 04/22/2015 886 110th Ave. N. Suite 116, Naples, FL 34108 "t: Itti— _ Phone: 239.777.1028 Fax. 877,275.3593 www.LicensesEtc.com BUSINESS CREDIT REPORT as of: 02/03/15 16:58 ET Castaway Flooring Service Inc. Fed Tax ID# 80-0828321 Address: 2951 47th Ter SW Apt 2 Key Personnel: Ramirez Janet Naples, FL 34116-7792 Castaneda Carlos United States Business Type: Corporation Experian BIN: 961428401 Experian File June 2012 Established: Agent: Ramirez Janet Experian Years on File: 3 Years Agent 2951 47TH Terrace SW Years in Business: More than 3 Years Address: Naples, FL Filing Data Provided Florida by: Date of Incorporation: 06/22/2012 Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS, 0 Bankruptcies; %7 Liens: 0 V Judgments Filed: 0 V Collections: 0 END OF REPORT Page 1 of 1 Statement of business or work experience during the past ten years. I Janet Ramirez for the past ten years plus have locally lived and worked in the city of Naples my entire life. I have worked in the hospitality business as a server, early childhood education as a teacher and currently flooring installation. I have experience with many different types of flooring materials, installation methods and also precisely measuring building layouts for project estimate cost. List of all debts you or any company(s) associated with you refused or fail to pay and reasons for its refusal to pay. The following is a list of all the debts my business or I have failed to pay AT&T, Sprint,T-mobile, Verizon, Capitol One, Comcast, Physicians Regional, Suncoast Credit Union, Century Link and Iberia Bank. The reason for the delay in payment on these debts, is due to insufficient income needed to pay them all. I know I am capable of settling these debts accordingly, once I can establish enough work to help pay them all. 886 110th Ave. N. Suite 116, Naples, FL 34108 Phone: 239.777.1028 di Fax: 877,2753593 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 2/04 02/03/15 15 : 56CT <SUBJECT> <SSN> <BIRTH DATE> RAMIREZ, JANET -2625 1/86 <CURRENT ADDRESS> <DATE RPTD> 2951 SW. 47TH TE. , NAPLES FL. 34116 4/08 <FORMER ADDRESS> 11346 PO BOX 11346, NAPLES FL. 34101 6/08 241 NE. 10TH ST. , NAPLES FL. 34120 <POSITION> <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> ALDO SALES NAPLES FL. 4/08 4/08 M O D E L P R O F I L E * * * ALERT * ***FICO CLASSIC 08 ALERT: SCORE +571 : SERIOUS DELINQUENCY, AND PUBLIC ***RECORD OR COLLECTION FILED; TOO FEW ACCOUNTS CURRENTLY PAID AS AGREED; ***PROPORTION OF BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR ***OTHER REVOLVING ACCOUNTS; LENGTH OF TIME SINCE DEROGATORY PUBLIC RECORD ***OR COLLECTION IS TOO SHORT *** IN ADDITION TO THE FACTORS LISTED ABOVE, ***THE NUMBER OF INQUIRIES ON THE CONSUMER' S CREDIT FILE HAS ADVERSELY ***AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS PR=0 COL=11 NEG=7 HSTNEG=0 TRD=22 RVL=19 INST=2 MTG=0 OPN=1 INQ=4 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $1103 $1800 $0 $0 100% INSTALLMENT: $10 . 8K $ $ /863 $0 $337 CLOSED W/BAL: $11 . 9K $11 . 9K $ TOTALS : $11 . 9K $1800 $19.7K $11 . 9K $337 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS ENHANCRCVRCO Y 26MT002 I 8/14 $285 11 SPRINT 09B 1/15A $285 PLACED FOR COLLECTIO f CAVALRY PORT Y lYNA008 I 5/11 $321 08 BANK OF AMERICA 09B �,` 1/15A $517 PLACED FOR COLLECTIO PORTFOLIO RC Y 1KSE003 I 11/09 $1655 HSBC BANK NEVADA N 09B 1/15A $1655 PLACED FOR COLLECTIO AFNI Y 96ER007 I 8/14 $1627 10 AT T MOBILITY 09B Page 1 of 4 10/14A $1627 PLACED FOR COLLECTIO CONVERGENT Y 57X0001 I 5/14 $376 COMCAST 098 8/14A 8376 PLACED FOR COLLECTIO CAPIO Y 2C6V001 I 5/14 $6812 MEDICAL 09B 7/14A $6812 PLACED FOR COLLECTIO CREDIT COLL Y 1GZD005 I 12/12 $1629 06 PROGRESSIVE INS 098 4/14A $1629 PLACED FOR COLLECTIO AVANTE Y 2C43001 I 1/14 $1492 MEDICAL 09B 3/14A $1492 PLACED FOR COLLECTIO L////' ARS Y 2BQ4002 I 11/12 $813 MEDICAL 096 V 1/13A $813 PLACED FOR COLLECTIO ENHANCRCVRCO Y 26MT002 I 1/12 $83 08 SUNTRUST BANK 098 / 2/12A $83 PLACED FOR COLLECTIO MIDLAND MCM Y 36ET002 I 11/10 3/11F $426 TARGET NATIONAL BA 09P 8/11A $0 PAID COLLECTION T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CAP ONE B 1DTV001 4/07 $2715 R09 1/15A $1500 $4844 I CREDIT CARD 5/09F $4844 CLOSD BY CRDT GRANTOR AMEX B 21W8001 6/07 $739 009 2/14A $739 I CREDIT CARD 2/09F $739 CLOSD BY CRDT GRANTOR AMEX B 21WB001 5/07 $1138 R09 12/13A $1100 $1138 I CREDIT CARD 2/09F $1138 CLOSD BY CRDT GRANTOR BK OF AMER B 1597029 10/08 $321 R09 5/11A $500 $0 I CREDIT CARD 3/09F $0 PURCH BY OTHER LENDER SUNCST CU Q 298Q007 10/07 $5752 R09 4/11A $5000 $5214 I CREDIT CARD 1/09F $5214 TRANSFERD TO RECOVERY TARGET N.B. D 6476004 5/08 $426 R09 4/11A $200 $0 I CREDIT CARD 4/09F $0 PURCH BY OTHER LENDER HSBC BANK B 2EF9002 1/08 $1655 R09 8/09A $1000 $0 I CHARGE ACCOUNT 6/09F $0 PORCH BY OTHER LENDER CHASE AUTO B 8251008 6/13 $10. 8K 48M337 111111111111 I01 12/14A $0 111111 I AUTOMOBILE $7863 18 0/ 0/ 0 Page 2 of 4 DSNB MACYS D 2A5T001 2/07 $94 111111111111 RO1 12/14A $200 $0 111111111111 I CHARGE ACCOUNT 9/07C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 VW CREDIT F 2943003 4/08 $25 . 1K 60M419 11/08 X11111111111 I01 5/13A $0 $837 03 111111111111 C AUTOMOBILE 5/13C $0 CLOSED 48 0/ 0/ 0 CHASE B 26QK001 11/06 $1197 111111111111 RO1 6/10A $1100 $0 111111111111 I CREDIT CARD 3/10C $0 CLOSD BY CRDT GRANTOR 42 0/ 0/ 0 CAP1/BSTBY D 1DTV057 5/07 $46 111111111111 RO1 9/09A $1800 $0 111111111111 I CHARGE ACCOUNT 9/07C $0 ACCT CLSD BY CONSUMER 27 0/ 0/ 0 CAP1/0FMAX D 1DTV093 11/05 $310 111111111111 RO1 9/09A $300 $0 111111111111 I CHARGE ACCOUNT 9/09C $0 CLOSED 45 0/ 0/ 0 CAP1/BSTBY D 1DTV057 1/05 $749 111111111111 RO1 7/09A $800 $0 111111111111 I CHARGE ACCOUNT 12/05C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CHASE-PIER1 B 247V026 5/07 $0 111111 RO1 12/07A $300 $0 I CREDIT CARD 9/07C $0 ACCT CLSD BY CONSUMER 6 0/ 0/ 0 FIA CS B 1597185 12/04 $1103 111111111111 RO1 12/07A $1500 $0 11111 I CREDIT CARD 11/072 $0 ACCT CLSD BY CONSUMER 17 0/ 0/ 0 CB/EXPRESS C 8349001 2/04 $0 111111111111 RO1 9/07A $300 $0 111111111111 I CHARGE ACCOUNT 12/05P $0 ACCT CLSD BY CONSUMER 43 0/ 0/ 0 CAP ONE B 1DTV205 6/07 $59 RO1 7/07A $300 $0 I CREDIT CARD 7/07C $0 ACCT CLSD BY CONSUMER CHASE-PIER1 B 247V026 8/05 $199 111111111111 RO1 5/07A $1000 $0 111111111 I CREDIT CARD 12/05C $0 ACCT CLSD BY CONSUMER 21 0/ 0/ 0 CHASE B 26QK001 6/05 $0 111111111111 RO1 12/06A $2000 $0 11111 I CREDIT CARD 10/06C $0 CLOSD BY CRDT GRANTOR 17 0/ 0/ 0 CAP ONE B 1DTV205 1/05 $542 RO1 8/06A $500 $0 I CREDIT CARD 8/06C $0 ACCT CLSD BY CONSUMER CHASE B 26QK001 3/05 $259 111111 RO1 10/05A $3500 $0 A CREDIT CARD 6/05C $0 ACCT CLSD BY CONSUMER 6 0/ 0/ 0 I N Q U I R I E S Page 3 of 4 DATE SUBCODE SURNAME TYPE AMOUNT 2/03/15 PNP7771028 (FLA) LICENSES ETC 11/14/14 FPC1246538 (NTL) COAF 6/06/14 BPC2699824 (NTL) CAP ONE 3/24/13 UWA374ll 26 (WAS) T-MOBILE END OF REPORT Page 4 of 4 , Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT'OF*STATE t e VISIO'N,:Q1'.+CORPO.It' ill 1ONS . 51#012 Detail by Entity Name Florida Profit Corporation CASTAWAY FLOORING SERVICE INC. Filing Information Document Number P12000056300 FEI/EIN Number 80-0828321 Date Filed 06/22/2012 State FL Status ACTIVE Effective Date 06/21/2012 Principal Address 2951 47TH TERRACE SW APT#2 NAPLES, FL 34116 Mailing Address 2951 47TH TERRACE SW APT#2 NAPLES, FL 34116 Registered Agent Name & Address RAMIREZ, JANET 2951 47TH TERRACE SW APT#2 NAPLES, FL 34116 Name Changed: 04/27/2013 Officer/Director Detail Name & Address Title President RAMIREZ, JANET 2951 47TH TERRACE SW APT#2 NAPLES, FL 34116 Title Director CASTANEDA, CARLOS 2951 47TH TERRACE SW APT#2 NAPLES, FL 34116 Ilttp://seareh.sunbiz.org/Inquiry/CorporationSearchl SearchResultDetail?inquirytype=Entity... 2/4/2015 Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2013 04/27/2013 2014 04/28/2014 Document Images 04/28/2014 --ANNUAL REPORT View image in PDF format 04/27/2013 --ANNUAL REPORT View image in PDF format 06/22/2012 -- Domestic Profit View image in PDF formal State of f I'n id�i,Crf:ai tnignt of Srni, http;//search.sunbiz.org/Inquiry/CoiporationSearch/SearcliResultDctail?inguiiytype=Entity.,. 2/4/2015 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MEUDOr YYO C2b936C'S u PRODUCER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY TROPICAL INSURANCE OF BONITA SPGS, INC AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 11680 BONITA A BEACH ROAD #401 CFRTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE BONITA SPGS, FL 24135 AFFORDED BY THE POLICIES BELOW. (239) 947-4004 INSURERS AFFORDING COVERAGE NAIL ld INSURED: INSURER A AMERICAN RELIABLE INSURANCE COMPANY CASTAWAY FLOORING SERVICES INC 2951 47TH TERR SW APT B NSURER B NAPLES, FL 34116 I,suIERC INSURER D (239) 860-1389 INSURER E _ ____ I COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OF CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXVLUSIONSAND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUECED BY PAID CLAIMS _ INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMJOOIYY) DATE IMM1ODMf) LIMI IS _ A GENERAL LABILITY EACH OCCURRENCE 5 1,000,000 X COMMERCIAL GENERAL LIABIL II'I IGL 014884-1 7/16/2014 7/16/2015 DAMAGE IS TO RENTED $ 100,000 rec<s+J _— CLAIMS MADE L-I I --I OCCUR MED EXP(Any one person1 S 5,000 PERSONAL E ADV INJURY S 1,000,000 GENERAL AGGREGATE $2,000,000 I GENE AGGREGATE LIMIT APPLIES PER PRODUCT•COMP/GP AGO 5 2.000.000 X PRO• POLICY JECT LUC AUTOMOBILE LIABILITY COMBINED SINGLE LMIf $ - ANY AUTO (ER acedrnlI ALL OEMIED AUTOS 110011 Y INJURY $ - SCHEDULED AUTOS (Per rH so411 - AIRED AUTOS 130011Y INJURY $ - NONOVAIE)AUTOS (Per Acudect) _ DRUPE 121Y DAMAGE $ , iPc AG:o;enll GARAGE LIABILITY A1)10 ONLY•EA AC,(;IUI.H I 5 ANY AU/0 01Hf:N THAN CA 000 $ AUTO ONLY AGO S EXCESS/UMBRELLA LIABIUTY EACH OCCURRENCE 77 OCCUR CI.A9,IS MADE AGGREGATE S • - DEDUCTIBLE _ S _ - RE IENIION S _ $ WORKER'S COMPENSATION AND WC STATU. CI I li EMPLOYER'S LIABILITY IOW,'1.11,1115 ER ANY PROPRIE TOR/PAR INF R■EXE1.III IVE L, EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' E I DISEASE •EA EMPLOYEE S I'res aescr4,e unden -- --- --- SPECIAL PROVISIONS ber e F L DISEASE•POLICY LIMIT S ---' O I l l E H DESCRIPTION OF OPERATIONSILOCATIORS NEHICLES)EXCLUSIOIIS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CLASS COOE(S).[11 91341 •Carpentry Interior: 121 99746-TIle Installation-Inlenor; 191 94569-Floor Covering Installation-Not Ceramic Tile or Slone LOCATION(S).FLORIDA CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY LICENSING BOARD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2800 N HORSESHOE DR ' BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL NAPLES,FL 34104 ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE.CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 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' ' "''',' '-.':'' -- ''' DRIVER LICE 524}-V . . -.- DR A 0)n-30- •''''' '.. ." ' '' D562"4" ;." ir_ :;".;.,,-,: -•,, J.,...,1..,-4,--: ,., . ._ . . :-_..:4' ',:.i: -.',;74,.=--7„.1,:::-;.7t.'.:or.i.••.- 2 .I. AmiREZ Y .--- ENDO .. ', .:::',=,..i,..,--, 46"t--r- .-.- . ..-:. '31;t,----.-4--,-;,,,--::'',.-:-. , : ' '•-:-*"'' .,-.4,'---,. --'1". ---"`r'-. 1''': ..":: AR: Ay.fi.,.....tk ,,,. 1 0 dr,.,„,- ... d b e „4 .,, .,,,,,,,"°-.C... .r.,-; ,-t etuqur , f'.ii iI v ,..-;:c:,',,'_:::7'.''-ii.7•"xt';:,:-- „brier to ,..„t I.anY 5 :400, 2 - fi.ic4 c'onst ;j902-1- „logo+Y Fjp7ef alio"Qf 4 11/2312011 22: 39 2394958720 PAGE 01/02 � O I — ..._. ri-; Co ///: c n.._,C .701- ... i . ./‘ , 7 c..4, .'--61.../17.. ..../Z...e_l_ .v. e,s_i, ..A."/. ._... ... ....V.te.A..z../Ti_sz.4/..._........._. / of 4. TX.d...-, C.... . ',.. .-F3..,..Z.4&As,. 0 . '1/ *4. / , .0v.4, /`>z i.C .� r ._ ,e .... _. ... . ....___.._..,.. . .. _. N. 1 1 ' A-5 I) C.aZZ. 1. . 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 March 18, 2015, 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 Jim E. Skelton d/b/a Skelton's Construction, 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 specialty contractor- carpentry. 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 Jim E. Skelton was present at the public hearing on March 18, 2015, 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 not adequately 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, however, the testing requirement should not be waived in this instance. CONCLUSIONS OF LAW Based upon the foregoing facts, the Board concludes that the applicant has not met the standard set out in the Code of Laws and Ordinances of Collier County, Florida, and that the testing requirement is not waived. 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 Section 22-184(b) of the Code of Laws and Ordinances of Collier County, Florida, by a vote of 8 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 denied, however, the Applicant shall be given a six month probationary license during which time he is to take the required tests. Upon passing 2 i the required examinations the probationary period shall end and the Applicant shall be granted a full license. ORDERED by the Contractors Licensing Board effective the 18th day of March, 2015. (GQNTR A CTOR'S LICENSING BOARD `\,COLLIE BOUNTY,FLORIDA By: Patrick White, Chairman I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorio, Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this 18th da of March, 2015. aft S- /Contractor's Licensing Board 3 t _ 0 G1N _ _ a�� r f SKELTON'S CONSTRUCTION 41 q� p rO G Dear Sir or Madame, Mti� 4,> s I come before this CLB Board to ask for reinstatement of my u ies h o nse. sfyti During the time of my lapse in license, I was going through sevepal trying problems in my life. My family is first in my life and have had a difficult couple of years. I had to devote much time to helping with my mother-in-law who had Alzheimer's Disease. I also had shoulder surgery and developed a pulmonary embolism which left me hospitalized. My mother-in-law passed away in July of last year and I was then diagnosed with lung cancer. After going through chemotherapy and radiation treatments, I am now in remission. I am feeling well again, and I would like to get back on my feet and get my business affairs back in order. I respectfully seek your approval in the reinstatement of my license. Respectfully yours, E. Skelton 17950 Castle Harbor Dr. Fort Myers, FL 33967 (239)689-0549 4G0I ei- 0114.n t CDES Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, Fly 34104 � 11 i ct RE +I NST ; 3 APPLICATION FOR IOW COLLIER CO fig ITY 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;.5A n l l o/J-T Fiction Name/DBAS/-c7 v/�� 60"--',--1-1-/S)U`( Qualifier Name: V rA Physical Address: 1 .7 9 S. U �F'�7 /�_� _f�a fc:!7/777y(7,-- � J (Number & Street) (City) / (State) (Zip Code) Mailing Address:/ 7 7 5 / L-,,s r� "?. (Number & Street) (City)/ (State) (Zip Code) Telephone: 20 O � 7 / 61 t4 6,0 TYPE OF LICENSE: ❑ General ❑ Electrician ❑ Building ❑ Plumber ❑ Residential ❑ Air Cond. ❑ Mechanical ❑ Swimming Pool ❑ Roofing © Specialty //�� MAR 2 0 2015 l: Specialty trade: u.rf e.A4c l I CHANGE OF STATUS: RENSTATEMENT FEE $205.00 ( X) Reinstatement RENEWAL FEES 2013/14 &2014/15 $250.00 ( ) From One Business to Another LATE FEES 2013/14 &2014/15 $120.00 ( ) Dormant License to Active TOTAL= $575.00 FEES MAY VARY IF RECEIVED AFTER 9,'3012015 Paae 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. (--' l Jt 7 r C' r �� ,� /re) k eJ r !0 1/ 6 4 ( Lipp ✓ .�3 G 0 J l 7(IS G (.:p.54 A- /�,v)1 1 Q j2- 1..),- r /--::;,r,t1'12y,e K: f- /. ''3; 567 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. / e• d SON /-0locs11.- y 4_ilUt✓/`/cti 130 ; 1 1 c) IA/7, , f r/cc..- ± C.,d✓(l 3. List all debts an or ou company(s) associated with you refused to pay and the reasons for the refusal to pay. Y any compan Y Attach extra pages if needed. f AFFIDAVIT I, /h, ,S /CPS // ' -' certify that the foregoing is true and correct to the best of my knowledge. . 5;/72/6 / Qualifier STATE OF FLORIDA COUNTY OF Leg The foregoing instrument as acknowledged before me this 1 C,d AK cis 3 (Date). (Name of officer, title/agent) (Name of Corporation) a F/ok, /!A Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced Ai ee,z / 1{,., identification and did not take an oath. (Type of identification) NOTARY'S SEAL / / J O. A.1.411. T' ` 'GN' '` 1E OF NOTARY) 1 ,,,,,, i f ll�i �r C TAYLOR ■ !'Q �� $ Notary Public-State of Florida 4 t� ) My Comm.Expires May d.2018 1 V, i\c" Commission a FF 120101 tr ... \. -w — — .. — — — — .. 4 Page 2 of 4 QUALIFIER INFORMATION: Address: / 9 v (:;;1srh /-IA) 1,:?1 /27 "e 3rt (Number& Street) (City) (State) (Zip Code) Telephone: a.3`i r `J.5.1:// Date of Birth: /` / V---Z75 S.S. #: 000-00- ' E-Mai lt.l /710 Sc./ r»,,, Driver's License: ,� ---" / `( — 1. Type of Certificate of Competency for which application is made. 2. The names and telephone numbers of two persons who will know your whereabouts. A /< <, /f �: / -- _)35 6/ 0 3. Have you ever been convicted of a crime related to Contracting? No (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? Afo 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. NO A/ II-- 9. List your business or work experience during the past ten years. / e,. AYH 1 , L �: C- ,; vAJ/-'C'/� //�I,/, <Iz,LS '„ l e/l7) -1( /l//Cc- 10. Statement of any formal training you have had in the area for which the application is made. V " ci {5 h� -bc,'",/arto ,!-7L' / E' e 1✓ C7,/ n/? /�, •�; ! ( P?,0(iJ 1 f }, y1r J Pace 3 of 4 7,", V•3,•■.:7t*._,-.7 . ,;71,77,•77,7T, '. • •' • "1:%,`1*: 7!""!.„; • • - , ••,-* Gross Revenue/Sales Deposits and.Bonds Documents and Images Correspondence Vehicle Registration Insurance Background Check Licensee Information A Licensee Number Q11189 Description Type Property Alert Name JIM E. SKELTON Type Contractor Status Open [ 1 View Master Project View All Activities for this Licensee Add a new person or business to Address Book Examination Results Add Exam Result I Link Exarn/Test Type Date of ExanTest I City Score received I Examrrest result CARPENTRY 12/07/1991 :NAPLES :80.00 Pass More Fields J Hide or Clear Fields Charge Exam Fee 0 Exam Code I ------- Sponsoring County Sponsorship App Date I Sponsorship Expiration Date I Testing Facility Monday,Feb 02,2015 04:31 PM 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. 'NATURE OF APPLICANT S c ,n.) BUSINESS NAME DATE BEFORE ME this day personally appeared / 4' �' D r' 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 2 3 -j S (Date) who has produced c (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SIGNA / OF NOTARY Ch(11.5CUM- -i4)(t. (PRINT NAME OF NOTARBLIC) NOTARY PUBLIC NOTARY'S SEAL • 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. l/crL.. ` APPLICANT (PLEASE PRINT) NAME OF COMPANY $IS3 ATURE OF APPLICANT STATE OF FLORIDA COUNTY OF Le The foregoing instrument as acknowledged before me this 23 - 15 (Date) By f j n 40)J who has produced 4 , „c.h k4.r s (Name of person acknowledging) (Type of identification) as identification and did not take an oath. NOTARY'S SEAL (SIGNAir F NOTARY) Paoe 4 of 4 COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION INFORMATION C11189 Certification Information Collier County Board of County Commissioners Date: October 01, 2012 DBA: SKELTONS CONSTRUCTION, INC. ADDRESS: 17950 Castle Harbor Dr BONITA SPRINGS, FL 34135 • PHONE: 2399953594 CELL: 2395649300 FAX: 2394958720 LICENSEE NBR: C11189 QUALIFIER: JIM E. SKELTON TYPE: CARPENTRY CONTR. CLASS CODE: 4050 ISSUANCE NBR: 11189 INSURANCE: ORIG ISSD: EXPIRATION: General Liability December 28, 2011 September 30, 2013 September 06, 2013 Worker's Compensation December 31, 2012 NOTE: It is the Qualifier's responsibility to keep all business, licensing and requirements current and to provide .up to date copies for Collier county files. This includes all insurance certificates and any change of address information. Collier County • City of Marco * City of Naples Contractor Licensing CARPENTRY CONTR. Cert Nbr: Exp i Status: C11189 09/30/2013 Active SKELTONS CONSTRUCTION,'INC. JIM E. SKELTON 17950 Castle Harbor Dr BONITASPRINGS, FL 34135 Signed: AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, C 7 a' , am a resident of � � County, (State) and have resided here for more than five (5) years. During the last five years I have known fry) _C46)//23p1 (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) . MCP ,cam— (Name) 6-P---e9 (('h (Address) 7/ �/ 7 1'�P, hP1 l),C_ t vvy.,07t 12e y.7.0/ Telephone) 3 , 4,- D STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this I 13 `/S by (D t�) LO7-r43 S (\AA- _ who has produced S ` (name of person acknowledging) (Type of identification) as identification and who did not take an oath. At 4 ' - SIGNA /I R' 6F NOTARY Meg-671 -'/fiii; /Ye/ NOTARY'S SEAL (PRINT NAME OF NOT NOTARY PUBLIC 9 RESOLUTION OF AUTHORIZATON t" / , / WHEREAS '! / 1-,-> > /` . • U I proposes to (Name of Business Entity) engage in contracting as �_0 r,' rJ in (Type of legal entity: corp., partnership, etc. Collier County, Florida,according to Collier County Ordinance 2006-46, as amended; and WHEREAS)/r�, J�n i✓ s' C�,�✓�' .° T,, 1:6 proposes to (Name of Business Entity qualify for a Certificate of Competency with `( :jy, ,/ e /for (Name of Individual) NOW,THEREFORE, BE IT HEREBY RESOLVED THAT: r We the undersigned J /75/-) of L (Officers,Owners,Partners) J l�C f�,s' C�v,✓ /i%c f�. �r� hereby resolve and represent to the Collier County (Name of Business Entity) C`' Contractors' Licensing Board that the qualifying agent,0 /�.,, • _ /<e/ I Q)--- , is active (Name,of Individual in all matters connected with the contracting business of-1 k p/s , and (Name_of Busi less Entit y) We further resolve and represent that) /h-, . /F /t‘,•✓ is (Names of Individual) legally empowered to act for /741),!.>. �-�% �1/' in all matters connected with its (Name of Business Entity) o. tract}�,�busjnes , and l as the a--utl prity to supervise construction undertaken by C, (Name of Business Entity) q I1 DULY PASSED AND ADOPTED THIS 2 3 day of, , (/ / (Officers, Partners,Owners—with Designation underneath) , I Jf W $.s / (6itnenii (5/4e7/0.1 Witness Witness Corporate Seal (if Applicable) �j kb Or Notary Public Ce rtificate Sworn to and subscribed before me this✓day of ,�)1.� by 1 > ft , A.. /� je�c: `�I�' V Notary Public Name Printed Nota/Pub 'c ';tgnature Commission Number My Commission expires: 1 c`►"Y"'"a k C TAYLOR Nolary Public•Slits 01 Florida ( My Comm,Expires May 6,2011 1:'%lgt - Commission M FF 120101 c � • COLLIER COUNTY GOVERNMEY T COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. e Nopks.Florida 34104 • 239-403-2400 a FAX 239-403-2334 lam` MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamnar 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 he maintained as confidential and exempt under Chapter 119, Florida Statues. • • Feb 25 15 02:58p 2392770167 10,1 if " 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. 2392770167 p.2 Feb 25 15 02:58p Premier Profile-SKELTON'S CONSTRUCTION,INC 4 V4I 4 011.. Subcode:970135 Ordered:02125/2015 14:05.53 CST :: Experian' •0-1111.• Transaction Number;C5.00750414 • . Search inquiry:SKELTON'S CONSTRUCTION, INC/17950 CASTLE HARBOR OR/FORT A -ukl of insight MYERSIFU33967/USt239-564-93001740416753 Model Description:Intelliscore Plus V2 Busies Name g Bus ness IcentificaLon Number SKELTON'S CONSTRUCTION, INC. 740416753_ Primary Address: 17950 CASTLE HARBOR OR Phone: (239)564-9300 FORT MYERS,FL 33967-5472 This business is the ultimate parent. See the oor•-•r. - a • • ic 'I• he e To?0 Risk Dashboard • * ' • • • . z."RJk Scqres end CrodlttfmltRecomqiendatlon PO- Beyorictlerins .• Cierogetery Legal • ' rraud Alerts Intelliscore Plus Financial Stability Risk Company DST Original Filings High Risk Alerts 46 MEDIUM 12 tAREoislui,m 1 RISK Score range. 1-100 percentile Credit Limit Recommendation:$1,800 TOP et Business Facts • . . , Years on File: 20(FILE ESTABLISHED 04/1995) SIC Code: CARPENTRY WORK-1751 State of Incorporation: FL NAICS Cocie: Framing Contractors-238130 Date of Incorporation: 09/14/1998 Business Type; Profit Contacls: JIM E SKELTON-DIRECTOR TOP 0 Commercial Fraud Shield Evaluation tor:SKELTON'S CONSTRUCTION,INC,17950 CASTLE HARBOR DR,FORT MYERS,FL33967-5472 BuslneitSAtert:tc*;1•• • • Active Business Indicator: IV'I Experian shows this business as active susiNFss AnDREss IDENTIFIED.4,.S RESIDENTIAL Possible OFAC Match: No OFAC match found Business Victim Statement: No victm statement on file toil 0 , . • Credit Risk Score and Credit Limit Recommendation Credit Risk Score,Ititelliscom Ales., • . •• • • • • **• , • ,,* ' *- • *,s • Current Intelliscore Plus Score: 46 Risk Class:3 MEDIUM RISK' .• The risk class groups scores by risk into ranges of similar performance.Range 5 Is:he highest risk,range 1 is the Premier Proli.e.SKELTON'S CONSTRUCTION.INC i;4 • Feb 25 1502:58p 2392770167 p.3 lowest risk. 48 High Lou Risk �r Risk 0 10-'• Ls. JD — — 75 100 This score predicts the likelihood of serous credit delinquencies for this business within the next 12 months.Payment history and public recore along with other variables are used to predict future risk.Higher scores Indicate tower risk. Factors lowering the score Industry Risk Comparison r BALANCE OF AGED COMMERCIAL ACCOUNTS THAT ARE CURRENT 45%of businesses indicate a higher likelihood of severe deinquency. r RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY r LOW NBR OF COMMERCIAL ACCTS RPTD WITHIN THE LAST 12 MOS Quaitetiy Score Trends 1 Quarterly Score Trends teo - Qo; so - xa_ The Quarterly Score Trends provide a view of the 50 likelihood of delinquency over the past 12 months for this 50- F t business.The trends will indicate if the score improved,•` �{`$ i � remained stable,fluctuated or detained over the last 12 � w 5 � .V • ' L< , rnonths. 20— • • 10 pE6'hpR �tPt.�Vti PVO.O�t BQNi•�Pt Credit Rlsk8coreiF inanctalStabllltxRfsk i Current Financial Stability Risk Score: 12 Risk Class: 3 • 12: MEDIUM W5X_ • HRiigh sk i *- • Low The risk class groups scores by risk into ranges of similar 1. .r..— Ri sk performance.Range 5 is the highest risk,range f Is the 0 3 LU 3b 65 100 lowest isk. This score predicts the likelihood cf financial stability risk within the next 12 months. The score uses tradeline and collections information,public filings as well as other variables ro predict future risk.Higher scores indicate lower risk, Factors lowering the score Industry Risk Comparison r NUMBER OF ACTIVE COMMERCIAL ACCOUNTS 11%of businesses Indicate a higher likelihood of financial stability risk. r RISK ASSOCIATED WITH THE COMPANY'S INDUSTRY SECTOR r RISK ASSOCIATED WITH THE BUSINESS TYPE r EMPLOYEE SIZE OF BUSINESS Cr-edit Umlt Ree th tmgttdaUori. 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 erre the Inlelliscore $1,800 Plus,The recommendation is a guide.The final decision must be made based on your company's business policies. TOP{'j Payment and Legal Filings Summary Payment.Parfotritanca :. 'Ffat10dnst Caha4fioft t3�faric� LegatFfffnga Premier Profile-SKELTON'S CONSTRUCTION,INC 2J 4 Feb 2515 02:58p 2392770167 p.4 Current OUT: 0 Total trade and collection(1): $0 Bankruptcy. No Predicted DBT: N/A All trades(1): so Tax Lien filings: 0 Judgment filings: 0 Monthly Average DBT: 0 All collections(0): Sum of legal filings: SO Highest DST Previous 6 Months: 0 Continuous trade(1): SO UCC filings: 0 Highest DBT Previous 5 Quarters: 0 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: 1-lighest credit amount extended: N/A Payment trend Endicatcr not available Most frequent Industry purchasing terms: industry purchasing terms not available tndustijr C4�7AAaR+ Industry DBT Range Comparison The current DBT of this business is O.80%of businesses have a DBT range of 0-5. DBT for this business: 0 %n1 itttgrnes"ses' =80°!c fb°r DBT Range 0-5 6-15 16+ TOP 0 Trade Payment Summary . Trade Line Type Lines Reported DST Recent High Balance Current 01-30 31-60 61-90 91+ Credit Continuous 1 $0 New 0 SO Combined Trade f $0 Additional 0 $0 Total Trade 0 so 1OP 40 Trade Payment-New and Continuously Reported Trade Details PaYmeirtt xparienceo ' Atco'untStatus r do Lltte$witfi an(1 after days B syortd 7a rms . Business Date Last Payment Recent High Balance Cur 1-30 31-60 61.90 91+ Comments Category Reported Sate Terms Credit BLDG MATRL 02/2015 09/2006 CREDIT SO ACCTCLOSED TOP 0 Additional Business Facts. Corporate Registration o THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA.THE DATA IS CURRENT AS OF 02125/2015. State of Origin: FL Date of Incorporation: 09/14/1998 Current Status: Active Business Type: Profit Charter Number: P980000792 Agent: SKELTON JIM E Agent Address: 17950 CASTLE HARBOUR DRIVE FORT MYERS.FL TOPQ Corporate Linkage Business Name - Loc8tioti, i` BEN• The inquired upon business,SKELTON'S CONSTRUCTION,INC,Is the Ultimate Parent SKELTON'S CONSTRUCTION,INC 17950 CASTLE HARBOR DR-FORT MYERS,FL 740416753 Prernier Pronlo•SKELTON'S CONSTRUCTION,INC 214 • Feb 2515 02:59p 2392770167 p.5 Branches of the inquired upon business! SKELTON'S CONSTRUCTION,INC 10661 WWOOOCHUCK LN-BONITA SPRJNGS,FL 947000522 TO4 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#d for more information, End of report 1 of 1 report The information herein is furnished in confidence f r your exclusive vse(or legitimate business purposes and shall not 6u reproduced.Neither Experian information Solutions,inc.,nor their sources or distributors warrant such Wort-tuition nor shall they be fable for your use or reliance upon it. Experian 2015_All rights reserved.Ptivaryaefiz. Experian and the Experien marks herein are service marks or registered trademarks of Experian. Premier Profile-SKELTON'S CONSTRUCTION.INC 424 • Feb 2515 02:59p 2392770167 p.6 v M • erit Credit Fait,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:SKELTON'S CONSTRUCTION,INC FEDERAL ID:65-0866546 CURRENT STATUS: ACTIVE PRINCIPAL(S):JIM E.SKELTON TITLE:DIRECTOR DATE INCORPORATED:09/14/1998 Feb 2715 12:42p 2392770167 p.1 WOW 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 271512:42p 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 2/88 02/27/15 10:58CT [SUBJECT] [SSN] [BIRTH DATE] SKELTON, JIM E. 963 1/59 [ALSO KNOWN AS] 3IM,SKELTON [CURRENT ADDRESS] [DATE RPTD] 17950 CASTLE HARBOR DR., FORT MYERS FL. 33967 1/11 [FORMER ADDRESS] 10661 WOODCHUCK LN., BONITA SPRINGS FL. 34135 9/00 11232 SAN SEBASTIAN LN., BONITA SPRINGS FL. 34135 [CURRENT EMPLOYER AND ADDRESS] [RPTD] SKELTONS CONSTRUCTION INC 5/07 [FORMER EMPLOYER AND ADDRESS] CAROL CONSTRUCT M O D E L PROF I L E ***FICO CLASSIC 04 SCORE +520 : 038, 013, 010, 015 *** 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-8 NEG=1 HSTNEG=3-35 TRD=9 RVL=2 INST=5 MTG=2 OPN=O INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $271 $100 $114 $0 $25 0% INSTALLMENT: $67.5K $ $ $ CLOSED W/BAL: $4852 $0 $385 TOTALS: $67.8K $100 $4966 $0 $416 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS FFCC-CLVLAND Y 626V004 I 3/12 $268 MEDICAL 09B 2/15A $268 PLACED FOR COLLECTIO I FFCC-CLVLAND Y 626V004 I 5/11 $35 MEDICAL 098 2/15A $35 PLACED FOR COLLECTIO FFCC-CLVLAND Y 626V004 I 2/12 $447 MEDICAL 098 2/1SA $447 PLACED FOR COLLECTIO FFCC-CLVLAND Y 626V084 I 6/12 $204 MEDICAL 09B 2/15A $204 PLACED FOR COLLECTIO FFCC-CLVLAND Y 626V0 @4 I 8/13 $76 MEDICAL 098 2/15A $76 PLACED FOR COLLECTIO FFCC-CLVLAND Y 626V004 I 1/13 $267 MEDICAL 098 2/15A $267 PLACED FOR COLLECTIO ENHANCRCVRCO Y 26MT002 I 11/14 $274 11 AT T 09B 1/15A $274 PLACED FOR COLLECTIO . Feb 2715 12:42p 2392770167 p,3 ENHANCRCVRCO Y 26MT002 I 9/14 $2016 11 TMOBILE 09B 109425240 11/14A $2016 PLACED FOR COLLECTIO T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 HARLEY DAVID F 41LD002 10/06 $20.3K 84M385 109 2/13A $0 I AUTOMOBILE 11/11F $4852 UNPAID BLNC CHRGD OFF CB/LNBRYNT C 1NZ8175 12/91 $271 MIN25 12/13 211111121121 R01 2/15A $100 $0 03 132111111111 I. CHARGE ACCOUNT $114 48 6/ 1/ 0 WFDS/WDS F 839N077 4/07 $28.9K 72M612 7/12 111112111111 I01 10/13A $0 $675 03 1132221 I AUTOMOBILE 10/13C $0 CLOSED 43 4/ 1/ 0 WELLS FARGO B 908N714 4/07 $28.9K 74M612 111111111111 I01 2/12A $0 111111111111 I AUTOMOBILE 2/12C $0 CLOSED DUE TO TRNSFR 48 0/ 0/ 0 tJFHM 8 82TE004 8/06 $200K 360M 1/10 555555555332 M01 10/10A $0 $8290 05 221221222221 C CONVENTIONAL REAL 10/10C $0 SETTLED [ FULL BLNC 48 12/ 2/ 9 CB/LNBRYNT C 131P001 12/91 $521 111111111111 R01 9/08A $208 $0 111111111111 I CHARGE ACCOUNT 9/08C $0 PURCH BY OTHER LENDER 45 0/ 0/ 0 WFHM B 776W001 8/00 $125K 348M1418 11111111XX11 M01 9/06A $0 1111111 C CONVENTIONAL REAL 9/06C $0 CLOSED 19 0/ 0/ 0 FRD MOTOR CR F 3796761 4/01 $33.7K 68M732 1111 I01 7/05A C AUTOMOBILE 4 0/ 0/ 0 FRD MOTOR 7/05A C AUTOMOBILE 4 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 2/27/15 ZNP6284423(FLA) MERIT CREDIT C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at; http://www.transunion.com CREDITOR CONTACT INFORMATION FFCC-CLVLAND YC626V004 (800) 486-5500 24700 CHAGRIN BLVD CLEVELAND OH. 44122 ENHANCRCVRCO YC26MT002 (800) 496-8941 PO BOX 57547 JACKSONVILLE FL. 32241 HARLEY DAVID FZ41LD002 (702) 884-4466 - Feb 27 15 12:42p 2392770167 p,4 3850 ARROWHEAD DRI CARSON CITY NV. 89706 C8/LNBRYNT CZ1NZ8175 PO BOX 182789 COLUMBUS OH. 43218 WFDS/WDS FS839N077 P.O. BOX 1697 WINTERVILLE NC. 28590 WELLS FARGO 8A908N714 MAC 4031-080 PHOENIX AZ. 85038 WFHM BM82TE004 (800) 288-3212 7255 BAYMEADOWS WA DES MOINES IA. 50306 CB/LNBRYNT CS131P001 PO BOX 182789 COLUMBUS OH. 43218 WFHM BM776W001 (800) 288-3212 3480 STATEVIEW BLV DES MOINES IA. 50306 FRD MOTOR CR FA3796761 (800) 727-7000 P0B 542000 OMAHA NE. 68154 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Detail by Document Number Page 1 of 2 :FLORIDA DEPARTMENT ON STATE *At.IS10N,,:OF €ORPU'Ri TIONS f/In6r, Detail by Document Number Florida Profit Corporation SKELTON'S CONSTRUCTION, INC. Filing Information Document Number P98000079266 FEI/EIN Number N/A 5' 0 Date Filed 09/14/1998 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 03/15/2011 Event Effective Date NONE Principal Address 17950 CASTLE HARBOUR DRIVE FORT MYERS, FL 33967 Changed: 03/15/2011 Mailing Address 17950 CASTLE HARBOUR DRIVE FORT MYERS, FL 33967 Changed: 03/15/2011 Registered Agent Name & Address SKFLTON, JIM F 17950 CASTLE HARBOUR DRIVE FORT MYERS, FL 33967 Address Changed: 03/15/2011 Officer/Director Detail Name & Address Title D SKELTON, JIM E 17950 CASTLE HARBOUR DRIVE FORT MYERS, FL 33967 Annual Reports http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetai l?inquiryType=Docu... 2/26/2015 Detail by Document Number Page 2 of 2 Report Year Filed Date 2012 04/30/2012 2013 02/18/2013 2014 04/28/2014 Document Images 04/28/2014 --ANNUAL REPORT View image in PDF format 02/18/2013 --ANNUAL REPORT View image In PDF format 04/30/2012 --ANNUAL REPORT View Image In PDF format 03/15/2011 -- REINSTATEMENT View image In PDF format 05/02/2009--ANNUAL REPORT View image in PDF format 04/29/2008--ANNUAL REPORT View image in PDF format 07/02/2007--ANNUAL REPORT View image in PDF format 04/29/2006--ANNUAL REPORT View image in PDF format 04/27/2005 --ANNUAL REPORT View image in PDF format 04/29/2004 --ANNUAL REPORT View image in PDF format 04/23/2003--ANNUAL REPORT View image in PDF format 05/14/2002 --ANNUAL REPORT View image In PDF format 04/16/2001 -- ANNUAL REPORT View image In PDF format 04/13/2000 --ANNUAL REPORT View image in PDF format 07/22/1999 --ANNUAL REPORT View image in PDF format 09/14/1998-- Domestic Profit View image in PDF format Corwrlaht di and privacy Policies Slate of Florida,Department of State http://search.sunbiz.org/Inquiry/Corporation Search/SearchResultDetail?inquityType=Docu... 2/26/2015 2014 FLORIDA PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT# P98000079266 Apr 28, 2014 Entity Name: SKELTON'S CONSTRUCTION, INC. Secretary of State CC8573736847 Current Principal Place of Business: • 17950 CASTLE HARBOUR DRIVE FORT MYERS, FL 33967 Current Mailing Address: 17950 CASTLE HARBOUR DRIVE FORT MYERS, FL 33967 FEI Number: NOT APPLICABLE Certificate of Status Desired: No Name and Address of Current Registered Agent: SKELTON,JIM E 17950 CASTLE HARBOUR DRIVE FORT MYERS,FL 33967 US The abovo named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail Title D Name SKELTON,JIM E Address 17950 CASTLE HARBOUR DRIVE City-State-Zip: FORT MYERS FL 33967 I hereby certify that the Information Indicated on this report or supplemental report is true and accurate and that my electronic signature shag have the same legal effect as if made under oath;that l am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607,Florida Statutes;and that my name appears above,or on an attachment with all other like ompo»+eyed, SIGNATURE:JIM E. SKELTON CHAIRMAN 04/28/2014 Electronic Signature of Signing Officer/Director Detail Date . I\ ytt#si ," Florida Department of Revenue OR_ II Documentary Stamp Tax Return N.o: ; � For Nonregistered Taxpayers' 1 Unrecorded Documents Mail return and check payable t • FLORIDA DEPARTMENT OF REVENUE 5050 WTENNESSEE STREET • TALLAHASSEE FL 37J99 0160 This return Is for nonregistered taxpayers oat The return is due on theist and late after the 20th of the month following the collectioi month. For Office Use Only Collection Month: Dr}// 1 MO YEAR Taxpayer Name: Ske l ton ' s Construction, Inc . ' Street Address 11232 San Sebastian Lane 1 City Bonita Springs County Lee State FL zip 34135 FEIN: .6 C [ 6f ]4 1U or' L� SSN(if no FEIN):i! It 1 1 1 [1, inn Notes,Written Obligations to Pay Money,Unrecorded Deeds,and Other instruments Transferring Real Property Execution Date Lender/Grantee Borrower/Grantor_ Amount Financed/ Surtax*/Documentar} Consideration Stamp Tax • / 1 / . . / 1 Stocks and Bonds . Issuer Purchaser Amount of Bonds or Shares Date Issued Documentary Stamp Taa 5kcijon5 Cons{--mei0, 3-lm E. Ska. om. as Inc. ID- Is-18' 04 _ Clint C l Y n t G. Skcl• iyx 7-5 1 0- 1 1- 7 C( • 09 • Amount of Surtax Due $ • Amount of Do 11 - I : . - .. . — • Total Amount Due With Return $ • i 8 Tax Rates: Documentary stamp tax on notes,written obligations to pay money,stocks and bonds is$.35 per$100 or fraction thereof. Documentary stamp tax on unrecorded deeds,etc.,Is$.70 per$1e0 or fraction thereof except for Dade County which is$.60 per$100 and a Surtax of$,45 per 1$ 00. 4 /E........ , it:iqc.*. 1t- 4.125-3.59y / _9f e na, e o T: ,. ?' Title 1'•/ Phone Number Date P "=a attach a copy of this return to each document listed above and retain for your records. Any person who fait's to report,remit or pay the documentary stamp tax as required shall be subject to a penalty of ten percent(10%)per month of any unpaid tax,not to exceed fifty percent(50%). In no event shall the penalty be less than ten dollars($10)for failure to timely file a required tax return. Interest shalt accrue from the date the tax Is due until paid at the rate of one percent(1%)per month. *Any transfer of real property in a county imposing a surtax shall be Included on the Surtax line. NOTE: My person with five(5)or more taxable transactions per month Is required to register the location where taxable documents are kept with the Department and remit the taxes due directly-to the Department for all documents which will not be recorded. To register use Form DR-1DS, Application for Certificate of Registration, To request Form DR-1 DS,please write Florida Department of Revenue,5050 W.Tennessee Si., Tallahassee,FL 32399-0100 or call Taxpayer Services at 904-922-4826. Hearing or speech Impaired persons should call our TDD at 904 922-1115. Get documentary stamp tax forms quickly by FAX ON DEMANDI Call 24 hours a day,seven days a week, at 904-922.3676 using your fax machine handset and follow the Instructions. 0 e®® /1, e e r� (e iltIP/* tre IV sni -fat®s®/ ..fittikk tap/) 0 at 4*i r4►® ®i1:1.•►� ®4'0410 �ii.Yt0® ®i�.Yic►®,4i1.4 •+i ; 14y# tt • 4 • # tL4. :# : t loft y , � ® b,-y# 14, oa.• .s/ • #Au xtAtt a prov 0 le % ; 11,yo .,� ,�cn I .-, 14)1 °4 ••�►® to��® Q � � E'-' +.c.), � ®♦O tier. IL 04 iPir, 0 v) U { elk° '- w A $11 WO p ‘ (1) .� ¢ U ®�i� ® *Ild PP( c.) ro 1 U . l' s- c4 E-2' , q cd v01* -$ iLl '-))' •ri -,:: c-i-ta '4 t4-4' .• a' 4 AI 10i 0 1 -, . -r.: ,4 ,,,L) 1 g 0 ..Ni 1.„5 rillita w $--( �i N • ° Oft -9"c) '""--, - 0 ,. `..) 0 ' cci 414 ill■ IA cv .1.7i" i-ci v ,, ® o A It i°0 to ®e*10 .,.., ®f• ° to ' 0 ��' e r tY,v Ad 4 47:® rk` 0 44:4 0 44. tk 0 44. 0441. � #4 ® ' e` ®[s ®� �► ®�`t ♦♦®►. ♦ �• �k W . A s A ,® 1EAU . ®#A� a ® #A� 0A ® ® ® • EV tO474%. 04%f .'r14k, ouA%,0 Dille0 t/ A®�. ;, 1 Feb. 27. 2015 1 :06PM No. 6065 P. 2/3 /--") ® Policy Number: gate Entered: 4/21/2003 l3 A 'ORCERTIFICATE OF LIABILITY INSURANCE DATE(MMrODIrYYyy L,----- _2/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AF'FIRMATIVELY 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 poltoy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement on this certificate does not confer rights to tho certificate holder in Ilea of ouch endorsement(s). PRODUCER CONTACT —� Parlin Ineurance Agency LLff PO Box 366697 Bonita Springs, SL 34136 Hurv� ) 239 263 3141 P Hal,(299)2630696 24520 Production Cr., #4 ADDRrss: Bonita Springs, PL 34135 INSURER(&IAKFOR0IN000VERAGE J Nuc>F IHSURERA:LLOYD OP LONDON 0/0 AHELIA UNDISRWRXTBRB INSURED SxELTON'a CONSTRUCTION, INC. INSURER a: JIM G CLINT SKRLTOH Hama C: 17950 CASTLEHARBOR DR, INSURER D; FORT MYERS, FL 33967 1 IHSURERBr INSURER F I COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR A170L SUER POLICY EFF POLICY MCP OR TYPE OF INSURANCE •,. ,•• POLICY NUMBER 1AAY0s HWD c4 Y) LIMITS A �� cOMMERGALGENERALLIABIUTY EACH OCCUR MRCS $100,000 •01-A0SMAOE t4 OCCUR OISE 0012150 32/26/2015 72/26/2016 DAMAGE TO RENTED X00 000 en PAP MI5 FS(Fa aopifrcr) S f 4 LTMTTS AVE AS MEOE(P(Any one petted) s5,000 OF TNCEATTON PERSONAL.&AOVINJURY =100,000 GEHL AGGREGATE UMITAPPUEB PER: GENERAL AGGREGATE $200,000 Zi POLICY J T ( 1 LOC —' PRODUCTS-COMP/OPAGG 6200,000 8 OTHER: COUBINEO 51NGLl:LIMIT AUTOMOaILELU8ILITY r£ ea9] L S ANYAUTO 80GLY INJURY(Pee per;co) $ ALL OWNED SCHEDULED BODILY INJURY(Per aced eN) I AUTOS AUTOS HIRED AUTOS ANUOIT`I�YfNEO PR� NNOAMAOE PPeB 11 S UMBRELLAL(AII _OCCUR EAcrIOCCURRENCE 5 EXCESS LIAR CLAIMS-MADE AGGREGATE I LIED I I RETENTIONS S , WORKERSCOMPENSATION II AND EMPLOYERS'LIABILITY Y I I! I&TATUTF EORH_, ANY O JEETTORRIP aT �ECUTIVE ( N f A E.L.EACH ACCIOEHY s (Mund.rorylnNH) l E.L.DISEASE-EA EMPLOYEE $ If yyes FUFTIOe under DESCRIPTION OF OPERATIONS Leitch E.L.RSEASE•POLICY UMf1 S CARpBNTRYFOPE�SIDSNTIALHSIVEHICLES(ACORD tot.Aa4MOnOORemerke Schedule.tEybeA niched iffiem epees Iirsauhod) CERTIFICATE HOLDER . _ CANCELLATION -_ COLLIER COMITY CONTRACTORS LIORNsIN0 BOARD BHOULb AN OF THE ABOVE DESCRIBED POLICIES as CANCELLED BEFORE DEVELOPMENT SERVICES CRITTER THE EXPI•ATOt� DATErTHEREOFv_,�NOTICE W1UI. BE DELIVERED IN AGCORDAH E MR-HE PM,0YPROVISl9 8. 2800 N. HORSESHOE DRIVE NAPLES, rr, 3d104 smX (239) 252-2464 ~ A(rTHORRED REP' 9E' 0�`� I DBBD'• 1tTYrA1K �• ©198 • 14 AC • e COR•ORATION. AIrr ghts reserved. ACORO 25(2014101) Ths ACORO name and logo are registered marks ofAGORt Pfodr4ed who Fans B4s4 PIJSLUtxrro.WAw.Formee63e.00m krpressheP,ar:A g80o,a>61471 2/26/2015 10:57 AM FROM: 7276667637 TO: 2394370731 P. 2 Dale CERTIFICATE OF LIABILI TY INSURANCE 2/26/2015 Producer: Plymouth Insurance Agency This Certificate Is Issued as a matter of Information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. ThIs Certificate does not amend,extend Holiday, FL 34691 or alter the coverage afforded by the policies below, (727) 938-5562 Insurers Affording Coverage NAIC a Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Inwror D: Insurer E: Coverages The porkies of insurance listed betav have been issued to the insured named above for the(Nlicr pernd Indicated. Nel a/thstanding any requirement,term or rind ton of any contract or aver document eSh respect to which this certificate may be issued or may pena'n,the insurance afforded by Ore po'ides described herein is subtect to a9 the terns,e):d uslons,and oxrdibons of such rNddes. Agg,eg ale lints shorn may have been reduced by pod dams. INSR ADn1 Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Dale Date (MMIDD/YY) (MMIDD/YY) GENERAL LIABILITY Eadt Ocourence 5 Commercial General Liability Damage to rented promses(EA =Claims Made El Occur occurrenoa) 5 . tied Erp 5 Personal Adv Injury 4 General aggregate limit applies per: General Aggregate 5 D Policy E3 Project ❑ LOC Products-Con-p/Op Aqg S AUTOMOBILE LIABILITY Ccmbmcd Single Limit (EA Accident) i Any Auto Bcddy Inii.ry All OA red Autos _ (Pet Person) i Scheduled Autos ' Hired Autos Bodily Inir.ry Non-O-Aned Autos (Per Accident) > ■ Property Damage 1 (Per Acckent) i EXCESS/UMBRELLA LIABILITY Each Occurrence 9,Occur El Clams Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2015 01/01/2016 X I WC Statu- I 1 OTH- Employers'Liability Tory Limits ER Any proprietor/partner/executive officer/member E L.Each Accident 51,000,009 excluded? NO E.L.Disease-Ea Ernployee. St.oOO.ao If Yes,describe under specie)provisions below E.L.Disease-Policy Limits 51.000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB# 12616 Descriptions of Operations/LocationslVohicles/Exclusions added by Endorsement/Special Provisions: Client ID: 84-60-029 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Skelton's Construction,Inc. Coverage only applies to Injuries Incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s),while working In:FL. Coverage does not apply to statutory emp:oyee(s)or independent contractor(s)of the Client Company or any other entity, A ILst of the active employee(s)leased to the Client Company cart be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 02-26.15(EP) Begin Date 1/4/2012 CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY Should any or the above described policies be cancelled befcre the expiration date thereof,the issuing insurer wig endeavor to mat 30 days Britten notice to the cerbficste holder named to the left.but(agora to CONTRACTOR LICENSING do so shall Impose no obligation or lIattItty of any kind upon the Insurer,Its agents or ref msestaln'es. 1800 N.HORSESHOE DR. NAPLES, FL 31104 "a"4:.-44.7-,.........., �f ° 1 SP`Yf£. ;S f Yi Jf 4. R r '� 3 X '� J A e t s �I, N '--77.:,. �� As jam' �;: hJ N f%t � h " js+;�sx'srl a Y vm'detLV ctis+x scct);sntsaF;tts3ra,F77-77 by t BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, V. Case#2015-03 License# :CAC1817131/C.0#201200002211 Louis Joseph Bruno IV D/B/A—Bruno Air Conditioning of S.W.FL. Respondent. / ADMINISTRATIVE COMPLAINT Collier County(County) files the Administrative Complaint against Louis Joseph Bruno IV( Respondent), a State licensed Certified Air Conditioning Contractor( license#CAC1817131), and states the following facts and allegations in support of the cited violations below: 1. The Respondent is currently licensed by the State of Florida as a Certified Air Conditioning Contractor with License number CAC1817131. 2. Under the provisions of Collier County Ordinance 90-105, as amended, Section 22-201.1, the following actions by a holder of a Certified Air Conditioning Contractor's license shall constitute misconduct and grounds for discipline pursuant to Section 22-202. a. On June 11th, 2015 a complaint involving a possible unpermitted A/C installation for the jobsite located at 4180 10th Ave. S.E. Naples, FL. 34117 was investigated by the Collier County Contractors' Licensing Office. b. This investigation revealed that an installation of an A/C unit had been performed by Bruno Air Conditioning of S.W. FL. c. Database research revealed a permit application#PRHV20150618635 to be in "READY FOR ISSUANCE" status with fees owed prior to issuance. d. On June 18th, 2015 a secondary complaint involving a possible unpermitted A/C installation for the jobsite located at 12053 Collier's Reserve Dr. Naples, FL. 34110 was investigated by the Collier County Contractors' Office. e. This investigation revealed that an installation of an A/C unit had also been performed by Bruno Air Conditioning of S.W. FL. f. Database research revealed no submission of a permit application at the time of the instaila tion. g. Further database research revealed four(4) previously recorded incidents addressed by the Collier County Contractors' Licensing Office for commencing work without a building permit in issuance by Bruno Air Conditioning of S.W.FL. h. Thereafter, pursuant to Collier County Ordinance 90-105,as amended,Section 22-202 (b) and Section 22-202 (c),the complaint was investigated and found sufficient cause to file formal charges. 3. Collier County brings the following charge in this formal complaint against the Respondent. COUNT I 4. Collier County Ordinance#90-105, as amended,Section 22-201.1(2) states "Willfully violating the applicable building codes or laws of the State, City, or Collier County ". WHEREFORE, the Petitioner asserts the above facts and charges are grounds for disciplinary action under Section 22-201 of Collier County Ordinance 90-105, as amended,and 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:June 29th, 2015 Signed: Collier Count Contractors' Licensing Supervisor or Designee C.L.B. Case#2015 — 03 Louis Joseph Bruno IV D/B/A — Bruno Air Conditioning of S.W. FL. Table of Contents E1/E3 — Formal Complaint. E4 — D.B.P.R. State Licensing Information. E5 — Collier County Certificate Detail Report. E6 — Notice of Hearing sent via U.S.P.S. Certified Mail. E7 — U.S.P.S. Return Receipt received upon delivery. E8/E10 — Contract for A/C installation performed at 4180 10th Ave. S.E. Naples, FL. 34117. E11 — Permit Application #PRHV20150618635 for 4180 10th Ave. S.E. in "READY FOR ISSUANCE" status as of June 29th, 2015. E12/E13 — Photos of completed A/C installation at 4180 10th Ave. S.E. taken on June 16th, 2015. E14/E15 — Contract for A/C installation performed at 12053 Collier's Reserve Dr. Naples, FL. 34110. Table of Contents (continued) E16 -- Permit #PRHV201506195601 for 12053 Collier's Reserve Dr. applied for and issued on June 22nd, 2015. E17/E18 — Photos of completed A/C installation at 12053 Collier's Reserve Dr. taken on June 19th, 2015. E19/E20 — Case Detail Report outlining unpermitted A/C installations at 4180 10th Ave. S.E. Naples, FL. 34117 and 12053 Collier's Reserve Dr. Naples, FL. 34110. E21/E22 — Case Detail Report outlining previously addressed violation for an unpermitted A/C installation by Bruno Air Conditioning of S.W. FL. dated April, 2013. E23/E24 — Case Detail Report outlining previously addressed violation for an unpermitted A/C installation by Bruno Air Conditioning of S.W. FL. dated May, 2013. E25/E26 — Case Detail Report outlining previously addressed violation for an unpermitted A/C installation by Bruno Air Conditioning of S.W. FL. dated June, 2014. E27/E29 — Case Detail Report outlining previously addressed violation for an unpermitted A/C installation by Bruno Air Conditioning of S.W. FL. dated August, 2014. Table of Contents (continued) E30 — 2010 Florida Building Code Section 105.1 outlining permitting requirements. E31 — Collier County Ordinance #90-105, as amended, Section 22-201.1(2) outlining the violation of : "Willfully violating the applicable building codes or laws of the State, City, or Collier County." Contractors' Licensing Board 2800 North Horseshoe Dr. Naples, FL 34104 Complaint Number-2015 -03 Complainant:Any person who believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90-105, as amended, may submit a sworn complaint to the Contractor Licensing supervisor,or his/her designee.The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor. The complainant shall pay a fee of$50.00 to defray the costs of administering the complaint,at the time of filing the complaint.The complaining party shall state with particularity which section(s)of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Please print or type and return signed copies of the complaint. Date:June 29th, 2015 Against: Contractor's Name: Louis Joseph Bruno IV Phone: (239) 592-7866 Business Name: Bruno Air Conditioning of S.W.FL. License Number if known: #CAC1817131 Collier County Competency number:#201200002211 Contractor's Business Address: 28731 South Cargo Ct. Bonita Springs, FL. 34135 Filed By: Name: Collier County Contractors' Licensing Office Address: 2800 N. Horseshoe Dr. Naples, FL. 34104 Business Phone: (239) 252-2431 Address(s)where work done: 4180 10th Ave.S.E./12053 Collier's Reserve Dr. City: Naples, FL. County: Collier Date of contract:4180 10th Ave. S.E.—6/10/15, 12035 Collier's Reserve Dr.--6/17/15 Date job(s)started: Prior to permit issuances for both jobsites. Date job completed or new home occupied: Unknown. Were there plans and specifications? :Yes. Is there a written contract? : Yes. If yes, amount of Contract:4180 10th Ave.S.E./$10,460.00 12053 Collier's reserve Dr./$6.000.00 Has Contractor been paid in full ? :Unknown. If not,what amount? Was a Building Permit obtained?418010th Ave. S.E./No 12053 Collier's Reserve Dr./Yes, after completed installation. Building Permit number if known:4180 10th Ave.S.E.—#PRHV20150618635 (READY FOR ISSUANCE) 12053 Collier's Reserve Dr.-#PRHV2015061956501 Have you communicated by letter with the licensee ? :Yes. Date:June 23rd,2015. Do you have a reply? :Yes. Please attach to this form all copies of the purchase agreement(s), building contract(s), home improvement contract(s), copies of receipts and/or cancelled checks available and any additional evidence to substantiate your allegations. List ant subsections of Division 3 of Collier County Ordinance #90-105, as amended, which, in your opinion, have been violated by the contractor which is the subject of this complaint, (list subsection number) : Collier County Ordinance#90-105,as amended,section 22-201.1(2)states : "Willfully violating the applicable building codes or laws of the State, City, or Collier County." Please state the facts which you believe substantiate your charge of misconduct against the subject contractor. List facts separately for each subsection number above : In,June of 2015, Bruno Air Conditioning of S.W. FL. installed A/C units at two (2)separate jobsites located at 4180 10th Ave. S.E. Naples, FL.34117 and 12053 Collier's Reserve Dr. Naples, FL. 34110 without a building permit in issuance. Database research reveals four(4) previously addressed incidents of Bruno Air Conditioning of S.W. FL. installing A/C units without a permit in issuance.A review of all information by the Contractor's Licensing Office concluded that these repeated incidents of commencing work without a building permit in issuance were committed in a willful manner. ( Complainan ' ign.ture) op lire- ....--"'......-'-' State of: Fior .a County of:Co her Sworn to (or affirmed) and subscribed before me this 29th day of June, 2015, By Collier County License Compliance Officer, Rob Ganguli (signature of person making statement). 7-7 ,, ,,. 57/72�7,cr4-,: (signature of Notary Public) Print,type or stamp commissioned name of Notary Public: Alai-en E. C/elver -i c Personally known✓ or produced identification Q' `"7 ''.3.''.7(71"1.71 E.CLEME 11S ;: MY COIMMISSION#EE 882321 4 EXPIRES:March 27,2017 ��*it0 aondcdTtwNotaseubtnUndenaers e-3 'DBPR- BRUNO, LOUIS JOSEPH IV; Doing Business As: BRUNO AIR CONDITIONI... Page 1 of 1 3.27:35 PM 622/2016 Licensee Details Licensee Information Name: BRUNO, LOUIS JOSEPH IV (Primary Name) BRUNO AIR CONDITIONING OF SWFL (ABA Name) Main Address: 28731 S CARGO CT BONITA SPRINGS Florida 34135 County: LEE License Mailing: LicenseLocation: License Information License Type: Certified Air Conditioning Contractor Rank: Cert Air License Number: CAC1817131 Status: Current,Active Licensure Date: 05/21/2012 Expires: 08/31/2016 Special Qualifications Qualification Effective Class A 05/21/2012 - Construction Business 05/21/2012 Alternate Names View Related License Information View License Complaint 1940 North Monroe Street,Tallahassee FL 32399::Email:Comer Contact Center::Customer Contact Center: 850.487.139 The State of Florida is an AWEEO employer.Copyright 2007-2010 State of Florida.Privacy Statement Under Florida law,email addresses are public records.If you do not want your email address released In response to a public-records request,do not send electronic mall to this entity.Instead,contact the office by phone or by traditional mall.If you have any questions,please contact 850.487.1395V.*Pursuant to Section 455.275(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address If they have one.The emaiis provided may be used for oftidel communication with the licensee. However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.Please see our Chanter 455 page to determine If you are affected by this change. https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=ECB2C3D3EBBAEF07F... 6/22/2015 License Application Status - CityView Portal Page 1 of 2 GMD Public Portal License Application Status - License Application Summary Application Number: LCC20 1 2000489 1 Business Name: LOUIS BRUNO,LLC(DBA)BRUNO AIR CONOMONIUG OF SWFL License Type: Contractor Application Status: Active Description of Business: See Issuance notes Mailing Address: 27831 SOUTH CARGO COURT BONITA SPRINGS FL 34104 Locations: — Issuances Type Date Issued Date Expires Status Number ELECTRICAL CONTR.-CERTIFIED 12/29/2014 08/31/2016 Active 201400002431 A/C CLASS A-CERTIFIED 09/02/2014 08/31/2016 Active 201200002211 — Reviews There are no reviews for this license application. - Insurance Producer Type Policy Effective Date Expiry Date Limit Guifshore Insurance General Liability CPP2094842 11/21/2014 11/21/2015 $2,000,000.00 Naples Expiration Processed: No Producer Phone Number: 954-731-5566V AON RISK SERVICES, Worker's WC 034123292 07/01/2014 07/01/2016 INC.OF FLORIDA Compensation FL Expiration Processed: No Producer Phone Number: 954-731-5566V http://cvportal.colliergov.net/CityViewWeb/License/Status?licenseId=1.32160 6/26/2015 �� Collier County Growth Management Division / Planning and Regulation Operations Department/ Licensing Section Hand Delivery Certified Mail#7007 2560 0001 1485 6619 Date:June 23`d,2015 Louis Joseph Bruno IV d/b/a—Bruno Air Conditioning of S.W.FL./CAC 1817131 28731 S. Cargo Ct. Bonita Springs, FL.34135 RE: Complaint filed against you by the Collier County Contractors' Licensing Office. Dear:Louis Joseph Bruno IV 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 Wednesday July 15th, 2015 at 9:00 ANI 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#22-201.1(2)of Ordinance#90-105,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 issuance(N/A),and/or suspension or revocation of your permit privileges against your state license#CAC 1817131. Sincerely, Rob Ganguli Licensing Compliance Officer Collier County Contractors' Licensing (239)252-2914 • • =.U S Postal Service,m ',CERTIFIED-MAIL., RECEIPT - (Domestic Mail Only;No insurance Coverage Provided) 0 For delivery information visit our website at.www.usps.coms `; F C1A L USE Postage $ rR • Care/led Fee Postmark Return ei e Here CO Required) Q Restricted OelNery Fee (Endorsement Required) .!1 >-ri Total Postage&Fees rU r,-• ear 0 orPOB rNo. a57...;t ,t CQ /yb e �7ry, -te,21F#4 P$Form3B00 Augusi 2Qt16 See Reverse(orlrlstrUClIUOS? SENDER COMPLETE THIS SECTION" 'COMPLETE THIS SECTION ON DELIVERY -C7 fa'Coippfete Kerns 1,2,and 3.Also complete .A.31.n item 4 If Restricted Delivery is desired. a- / �,10 Agent■• Addressee • Print your name and addiess oh the reverse so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery • Attach this card to the.back of the mailpiece, or on the front if space permits. - - D. Is delivery address different from item 11 O Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No L-6)-1-5(S Rj(L►J1■30 , c r�t2-ism 3. Service Type • L ) � 0 Certified Mall ❑Express Mall ❑Registered 0 Return Receipt for Merchandise 3c4 4 2, 5 ❑Insured Mall ❑C.O.D. 4. Restricted Delivery?(Extra Fee) 0 yes 2. 700? 2560 0001 1485 6619 PS Form 3811,February 2004 Domestic Return Receipt 102595-024,1-i 54 0 • • LYNN ` invoice Bruno Air Conditioning of SWFL 06/10/15 28731 South Cargo Court#5 page 1 Bonita Springs, FL 34135 (239)592-7866 Fax: (239)333-0853 CAC1 817131 Steve' Grafford Steve' Grafford 4180 10th Avenue SE 4180 10th Avenue SE Naples, FI 34117 Naples, Fl 34117 Call Slip Number Invoice Date Invoice Number 119283 06/10/2015 S116790 Tech Date FELIX 06/10/2015 Brand Model serial # felix paperwork Brand: Trane Stages: Variable C/U: XV18 A/H: Tama Heater: Electric Parts warranty: 10 Years Labor Warranty: 10 Years Maintenance: 3 Years Install : - New 4 ton / 18 SEER high efficiency single stage condensing unit - new drain overflow protection switch - new secondary emergency drain pan - seal supply and return plenums - hurricane straps for outdoor. Unit - Install new copper line-set. - new WIFI Color Touch screen digital thermostat with humidity 1 control - upgrade breakers to proper size for new equipment as needed - includes permits, removal and disposal of old equipment, indoor/outdoor surge protection, (2) uv system sterilizers, corrosion inhibitor, all labor & all materials. - Add (1) 14" Return from Dinning Room area straight back to unit. - Installer to call Felix during install so we can calculate supply air. - Includes Trane Clean Effects. (advised customer that if he is not 100% satisfied with trane clean effects within 6 months we will return and remove clean effects and install a regular 5" Pleated �i�rmdom"okinc I nvoice Bruno Air Conditioning of SWFL 06/10/15 28731 South Cargo Court#5 Page 2 Bonita Springs, FL 34135 (239)592-7866 Fax: (239)333-0853 CAC 1817131 Steve' Grafford Steve Grafford 4180 10th Avenue SE 4180 10th Avenue SE Naples, Fl 34117 Naples, Fl 34117 Call Slip Number Invoice Date Invoice Number 119283 06/10/2015 S116790 (Mery 8) filter in its place and ref nd him S400. - Installation crew to bring out por able cooling tower to keep a section of home comfortable for the ,ets. - Estimated time -Frame for job comp' -tion is 1 full day for unit. We may have to return to install new supply grills. - Payment of $lo,000 is do upon comp et.ion of unit installation. Additional $460 for high velocity gr Its do upon completion of the grills. Qty Description Unit Price Amount (1) System Quote o.00 o.00 (1) stage 3. Biocide System Sterili .er 0.00 0.00 (1) Stage 2 Biocide System Sterili .er 450.00 450.00 (1) Hurricane straps o.00 o.00 (1) Digital Programmable Thermosta' 0.00 0.00 (1) Solder Low Voltage Lines with •ystem 0.00 0.00 Install (1) Clear Drain Lines - Chemically Clean 1 0.00 0.00 Year Warranty (1 visit) (1) Ceiling Saver (Primary & Secon•ary) o.00 0.00 (1) Full system Dehydration (300 Microns or 0.00 0.00 less) (1) Nitrogen Braze/Pressure Test 0.00 0.00 (1) New Lineset (up to 50 feet) 0.00 0.00 (1) Surge Protection outside 0.00 0.00 (1) surge Protection Inside 0.00 0.00 (1) Corrosion Inhibitor 0,00 0.00 (1) FPL Rebate 18 -402.00 -402.00 (1) Add 14" - 161p Return with cut In grill 0.00 0.00 You saved $402.00 as a maintenance c stomerl —a _3- Axolrt '� Invoice Bruno Air Conditioning of SWFL 06/10/15 28731 South Cargo Court#5 Page 3 Bonita Springs, FL 34135 (239)592-7866 Fax:(239)333-0853 CAC1817131 Steve' Grafford Steve' Grafford 4180 10th Avenue SE 4180 10th Avenue SE Naples, Fl 34117 Naples, Fl 34117 Call Slip Number Invoice Date Invoice Number 119283 06/10/2015 8116790 Description Amount Premium HE system 10435.00 MANUFACTURER REBATE -1100.00 Coupon Or Discount -446-00 DUCT MODIFICATIONS 425.00 Permit Fees 0.00 AS AGREED UPON 725.00 Coupon Or Discount -87.00 AS AGREED UPON 460.00 Terms:$30 charge for returned check. Bruno Air Conditioning is not sponsible for water damage. Payment in full is due at completion. I have authority to order work outlined above which has been sattsfact rity completed. I agree that Seller retains title to equipmendmatedals furnished until final payment is ma. It payment is not made as agreed, Setter can remove said equipmenVmatedals at Seller's expense and/0 impose a 2%liquidation fee an the entire amount contained In Seller/Buyer transaction.My damage resulting on)said removal shall not be the responsibility of Seller. Final amount due reflects all manufacturer,ye dor,and FP&L Rebates,Industry rebates are taken oft the price of the unit and matted to the dealer.By executin.this agreement lam acknowledging that I have read and agree to the terns and conditions printed above sign- re.Once Invoice Is accepted purchaser fs accepting arty and all production costs not limited to 5%restock fee, niidpatity or state permit fees,and deposits to service providers. LIMITED WARRANTY: All material,parts and equipment are wanant of by the manufacturers'or suppliers'written warranty only.All labor performed by Bruno Air Conditioning is wan. ed for 30 days or as otherwise indicated In writing. Bruno Air Conditioning makes no other warranties,express.r implied,and its agents or technicians are not authorized to make any such warranties on behalf of Bruno Al Conditioning. Thanks for being a part of the Bruno Air famityl As Agreed: 48.00 Misc: 10412.00 Authorized Signature Grand Total: 10460.00 PennittingActivities ,•': Permitting Activities _ ' rf _# }. } �.t , a c i'� "�"r fF >. '""!f> ;-4'�'X{'N t � R - A Ircatron Informatian 4 5 z 1 1 ��M a t _ i Application Number IPHV2015.0618,635 Descnphon E Type { Property Alert 41.100520009 t .Property. t Ntgh - ' Type`I`Mechanical I-�1,'; 4180 10th AVE SE Aress Sta. tatus Ready for Issuance :` 1,711 _ .Inspector, I-T,) 4 View Master Protect .' - - Add a new'person'or business toAddresseook Show Permits on this Aoolication •Activlt/Tracking ?..I : µ1 s'ere' {T-.. R g;-:: `71, .L.. Y ,.-,�,^ 3.._ i-S '�.��L . _,.: eY f...._ 6ur+.`_-t .._1 e..iu+4' Show Me All PermttFand I specttop Activities J y _ ( Gene`ate Email,, AddyAttvtty Go{Ltnkl._;: - -.:2<,Aehvrty :'a.! Assign 4To .{ ;Priority.! 'Date Required [ . : c:-Outcome [_ :-;Oetc Complete ' !303-A/C Change Out !Normal t {Pending ; - !All Fees Verified (Vito Congine —{Normal j--- --{Complete 1 06/12/2015 __ ..yfFEMA Review {Vito Congine {Normal 106/15/2015 !Not Applicable 106/12/2015 i..... final Review 1 Day Review Ti !Vito Congine I Normal 06/15/2015 (Gomplete (06/12/2015 - {.....jGenerate Application Fees !Vito Congine iNormai i 07/02/2015 iComplete 06!12/2015 —_ _ . (,.,..!Generate Default Reviews and 1 Vito Congine €Normal 10 6/1 2120 1 5 `!Complete j 06/12/2015 ! ;Generate Permit Fees !Vito Congine Normal 06/15/2015 !Complete (06/12/2015 -- - _ Mechanical and Gas Review Vito Congine !Normal i 06/15/2015 !Approved (06/12/2015 � Normal Pending is �1^r *1t r as I t c'r'y r c s ENarMa) s �"�.s�•? ' z64inigi ° ! r Q%2915 "r.h-- VenfY Per7�t}. �.-Viz, r , VttoCon9ine l#A b, :.� 1-...- . 0-■,,.4�.P t x,zr .: "^:' .-."'t'! F - Monday,Jun 29,2015 09,22 AM -- , . , rj:i17..'filliKr):',:v.(4-%'74_,i.' 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' ' :' Vi'-' .:,i.,...:V''''.':-.: , . •• ;-v ,,,.".,..z•;:,?,:-‘ii,7-..,--,-...,-. , - ..., .. _ ,, . :,,, ,. , , , _ . . . , , . ,... . 1 ...,.„.',-,,..,..'. \■■.ki4kZk .4..41‘44*44S.N.9‘44‘44 -.1".'..;:\t,:*.-,,:, '..k''',-..:...r... •::-, ',-,,.•., . •''... '' .f.-., ' , .\\:.\\.\\\\. ' ' k 1 -.--= -----j- - ''''''.'..''''' - . \\A . .-,,,,, .t:.,..,,,,,,,,,, ... . ,.. ..................:.:,, ,_.......„..,...„:„..,-....„,,,,,.,.....„,,,,....,... ...,.,..;„;_:. ....,.-7 ----,,:-...TAL,,, :,.,k,,c,-,41-siii... .... -,....- .,--. ... -:. ..-. ,.. ... . , . . _,. ...., -. ..;.-..:4- ,.n.?,...1:., ,. ....,,,,_,;., ..,,,.-:,. -; Invoice Bruno Air Conditioning of SWFL 06/17/15 28731 South Cargo Court#5 Page 1 Bonita Springs, FL 34135 (239)592-7866 Fax: (239)333-0853 CAC1817131 James Leader James Leader 12053 Colliers Reserve Drive 12053 Colliers Reserve Drive Naples, Fl 34110 Naples,Fl 34110 Call Slip Number Invoice Date Invoice Number 119300 06/17/2015 S117196 Tech Date CRISTOBAL 06/17/2015 Brand Model Serial # INSPKT 2 TON Bruno Air Conditioning of SWFL to install 2.5 ton comfort high efficiency system. Installation will include, flush and pressure test copper Ilneset, properly sized breakers, seal plenums, installation of primary and/or secondary ceiling saver overflow protection, high wind hurricane strapping protection, new digital thermostat, and seal liquid fittings. Install beyond county and state codes. 6/17/15 2.5 Ton Deluxe Trane System Honeywell 8000 5" Media - Extra Replacement Filter Ceiling saver Power cord- CU secondary Drain Pan surge Protection- CU Hurricane Straps Qty Description Unit Price Amount (1) Semi-Annual PTU 0.00 0.00 (1) Replaced motor 470.00 470.00 (1) FPL Rebate 16 -171.00 -171.00 • Invoice Bruno Air Conditioning of SWFL 06/17/15 28731 South Cargo Court#5 Page 2 Bonita Springs, FL 34135 (239)592-7866 Fax: (239)333-0853 CAC1817131 James Leader James Leader 12053 Colliers Reserve Drive 12053 Colliers Reserve Drive Naples, Fl 34110 Naples, Fi 34110 Call Slip Number invoice Date invoice Number 119300 06/17/2015 3117196 You saved $181.00 as a maintenance customer! Description Amount Maintenance Agr 0.00 Coupon Or Discount -470.00 Deluxe HE System 6171.00 Terms:S00 charge for returned Bieck. Bruno A1r Conditioning Is not responsible for wafer damage. Payment In lull Is due at completion. Maintenance Agreements are non refundable but are transferrable.I have authority to order work outlined above which has been setlsfactody completed. I agree that Saner retains title to equipment materials furnished until Mal payment fa made. If payment Is not made as agreed,Seller cart remove said equlpmentmatenals at Seiler'a expense and/or Impose a 2%Aquidatlon fee on the entire amount contained In Beier/Buyer transaction. My damage resulting from said removal shaft not be the responsibility of Softer. Final amount due reflects all manufacturer,vendor,and FP&L Rebates.Industry rebates are taken off the price of the unit and malted to the dealer.By executing this agreement I am acknowledging that I have read and agree to the terms and conditions printed above signature.Once Invoice's accepted purchaser Is accepting any end at production costs not Limited to 5%restock fee,municipality or state permit fees,and deposits to service providers. LIMITED WARRANTY:AA material,parts and equipment are warranted by the manufacturers'or supplers'written warranty only. All labor performed by Bruno Air Conditioning is warranted for 00 days or as otherwise indicated In writing. Bruno Air Conddioning makes no other warranties,express or Implied,and Its agents or technicians are not authorized to make any such warranties on behalf of Bruno Air Conditioning. Thanks for being a part of the Bruno Air family! • As Agreed: 299.00 M Is c: 5701.00 06/17/2015 02:26PM �/' � Grand Total: 6000.00 iii s/� .1 / Received: 8000.00 '/r Authorized Signature CC 14610 Auth:10236P$6000.00 Balance Due: - 0.00 6 - 15- -15- COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS PERMIT PERMIT#: PRHV2015061956501 PERMIT TYPE: IIV ISSUED: BY: APPLIED DATE: 06-22-15 APPROVAL DATE:06-22-15 MASTER#: COA: JOB ADDRESS: 12053 Colliers Reserve DR JOB DESCRIPTION: A/C REPLACEMENT OF 2.5 TON. JOB PHONE: 12053 COLLIERS RESERVE DR SUBDIVISION#: BLOCK: LOT: FLOOD MAP: ZONE: ELEVATION: FOLIO#: 27185004043 SECTION-TOWNSHIP-RANGE:22-48-25 OWNER INFORMATION: CONTRACTOR INFORMATION: LEADER TR,JAMES I&LYNN D LYNN D LOUIS BRUNO,LLC(DBA)BRUNO AIR LEADER REV TRUST UTD 11/24/99 CONDITIONING OF SWFL 12053 COLLIERS RESERVE DR 27831 SOUTH CARGO COURT NAPLES ,FL 34110- BONITA SPR iNGS,FL 34104- CERTIFICATE#:;Lcc20120004s91 PHONE: FCC CODE: CONSTRUCTION CODE: 0207 JOB VALUE: $6,000.00 TOTAL RES SOFT: 0.00 TOTAL COMM SOFT: 0.00 SETBACKS FRONT: REAR: LEFT: RIGHT: SEWER WATER: CONTACT NAME: CONTACT PHONE: Per Collier County Ordinance No.2002-01,as it may be amended,all work must comply with all applicable laws,codes,ordinances,and any additional stipulations or conditions of this permit.This permit expires if work authorized by the permit is not commenced within six(6)months from the date of issuance of the permit.Additional fees for failing to obtain permits prior to the commencement of construction may be imposed.Permit-tee(s)further understands that any contractor that may be employed must be a licensed contractor and that the structure must not be used or occupied until a Certificate of Occupancy is issued. NOTICE: PRIOR TO THE REMOVAL OF ASBESTOS PRODUCTS OR THE DEMOLITION OF A STRUCTURE,FEDERAL AND STATE LAWS REQUIRE THE PERMTTTEE(EITHER THE OWNER OR CONTRACTOR)TO SUBMIT A NOTICE OF THE INTENDED WORK TO THE STATE DEPARTMENT OF ENVIRONMENTAL PROTECTION(DEP).FOR MORE INFORMATION,CONTACT DEP AT(239)344-5600. In addition to the conditions of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. - l6 +. , ■ . . ' ' - ' 1 -,,,''. , -'''-;-3,2,..::,',..,... ' -, ,-, -'•-.. 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"..• ./,,..,. • - ", , .1 .... -- -•-% N .— t - V ' — ‘" a ,,,,: • .74\;•-•!...•--- - . ,- • _-- , y �:t � r• r4 �' . I :+ L'ij?'(..!.1 *-:,,.,„-'3'-,".-'':-"', - '-'-',:---',"*-- ",'. ..._.'....::: .,:. --• :.•,.:;_,..,-,- 7r.-:,:`,' :,',] ` ;,. .� 4 S � �k ' 7 , ` fit _ - ' " a { e.7� ' { i s E - / • le i ::•-,:-, , '!,. ''-'. .:: .,,i)... , -. '* '',' . * .s. ' ' I , '. ...',' -.4 . ._ - — \-\\\ .. fir : • cer8 ov.ner Report Title: Code Case Details Date: 6/26/2015 7:00:55 AM Case Number: cemis20150012151 Case Number: CEMIS20150012151 Status: Refer to CLB Case Type: Misconduct Date&Time Entered: 6/16/2015 9:21:59 AM Priority: Normal Entered By: RobinGanguli Inspector: robinganguli Case Disposition: Case Pending Jurisdiction: Contractor's Licensing Origin: Complaint Detail Description: Complaint received regarding possible unpermitted NC installation(s). Location Comments: 4180 10th Ave. S.E. Naples, FL.34117 12053 Colliers Reserve Dr. Naples, FL.34110 Address 12053 Colliers Reserve DR Property 27185004043 Contractor LOUIS BRUNO, LLC (DBA) BRUNO AIR CONDITIONING OF SWFL Property Owner GAFFORD, STEVEN A&ROBIN C Property Owner LEADER TR,JAMES J &LYNN D LYNN D LEADER REV TRUST UTD 11/24/99 Business Management& Budget Office 1 Code Case Details Execution Date 6/26/2015 7:00:55 AM Desc Assigned Required Completed Outcome Comments Preliminary Investigation robinganguli 6/11/2015 6/16/2015 Needs 6/11/15.Complaint regarding possible Investigatio unpermitted NC installation at 4180 10th Ave. n S.E.Naples, FL.34117.On site no activity observed. Database research reveals permit #PRHV20150618635 in READY FOR ISSUANCE status.Will make subsequent site visits for activity per M.G.O. Cont.Investigation RobinGangull 6/15/2015 6/16/2015 Complete 6/15/15.On site no activity observed. Business card left for property owner,Steven Gafford,requesting a call for information on status of installation. Cont. Investigation RobinGanguli 6/16/2015 6/17/2015 Complete 6/16/15.On site met with property owner, Steven Gafford,who advised NC installation had been completed by Bruno Air Conditioning of S.W.FL./CAC1817131.Photos taken of installation and copies of contract for work obtained.Verified with permitting technician,Theresa Potter,that permit #PRHV20150618635 still in READY FOR ISSUANCE status since 6/12/15.A.T.F.fees applied. Database research reveals several recorded incidents of unpermitted A/C installations and working outside the scope of licensure by Bruno Air Conditioning.Awaiting directives from M.G.Q. Cont.investigation RobinGanguli 6/18/2015 6/23/2015 Complete 6/18/15.Secondary complaint regarding unpermitted A/C installation by Bruno Air Conditioning of S.W. FL.received for jobsite located at 12053 Collier's Reserve Dr. Naples, FL.34110. Database research reveals no permit in issuance. Cont. Investigation RobinGanguli 6/19/2015 6/23/2015 Complete 6/19/15.On site observed what appears to be a newly installed NC condenser with Bruno Air Conditioning decals adhered.Photos taken.Still no permit issued in database. Cont. Investigation RobinGanguli 6/22/2015 6/23/2015 Complete 6/22/15.Contacted Bruno Air Conditioning office requesting copy of installation contract with property owner of 12053 Collier's Reserve Dr.,James Leader. Contract for work e-mailed to me by office.Database research at the end of the business day reveals permit #PRHV2015061956501 applied for and Issued. Investigation robinganguli 6/23/2015 6/26/2015 Refer to 6/23/15. Database research reveals two(2) CLB previous cases(#CEMIS20130005242& #CECV20130006837)against Bruno Air Conditioning of S.W.FL.for A/C installations without a building permit in issuance. Directives received from M.G.O.to prepare a case for CL.B.hearing for contractor having committed a willful building code violation. Schedule for CLB michaelossori 6/26/2015 Pending 0 Business Management&Budget Office 2 — '-O Ci 'rgov.t-ret Report Title: Code Case Details Date: 6/23/2015 7:02:36 AM Case Number: cemis20130005242 Case Number: CEMIS20130005242 Status: Closed Case Type: Misconduct Date&Time Entered: 4/11/2013 9:34:45 AM Priority: Normal Entered By: RobinGanguli Inspector: robingangull Case Disposition: Abated by Contractor Jurisdiction: Contractor's Licensing Origin: Complaint Detail Description: Complaint regarding unpermitted A/C installation by Bruno Air Conditioning of SWFL/CAC1817131 Location Comments: 6840 Beach Resort Dr.#2714 Naples, FL. 34114 Property 32420009882 Contractor LOUIS BRUNO, LLC (DBA) BRUNO AIR CONDITIONING OF SWFL Business Management& Budget Office 1 • Code Case Details Execution Date 6/23/2015 7:02:36 AM Desc Assigned Required Completed Outcome Comments Preliminary Investigation robinganguii 4/11/2013 4/11/2013 Needs 4/11/13.Complaint regarding unpermitted NC Investigatlo Installation by Bruno Air Conditioning of n SWFL/CAC1817131 at 6840 Beach Resort Dr.#2714 Naples,FL.34114.Contract obtained for work.No permits on file. Contacted qualifier Louis Bruno to advise of violation.A.T.F.fees applied.Meeting scheduled for signing of Notice of Noncompliance. Cont. Investigation RobinGanguli 4/19/2013 4/19/2013 Complete 4/19/13. Meeting with qualifier Louis Bruno for signing of Notice of Noncompliance.Advised him that case would be closed out upon permit issuance. Cont. Investigation RobinGanguli 5/10/2013 5/10/2013 Complete 5/10/13. Permit#PRHV20130511111 rejected. Called qualifier Louis Bruno who advised he submitted the Incorrect load calculation and was rectifying the issue prior to resubmittai. Investigation robinganguii 5/21/2013 5/21/2013 Settled 5/17/13.Permit#PRHV20130511111 now In ISSUE status.Violation abated by contractor. Enter Settlement Details robinganguli 5/21/2013 5/21/2013 Complete Generate Closure Documentation robinganguii 5/21/2013 5/21/2013 Complete Violation Description Status Entered Corrected Amount Comments 4.2 Misconduct State Certified Open 4/11/2013 $0 Contractors - Title Reason I Result I Compliance Fine/Day Condition Business Management& Budget Office 2 �r� C ergov.net Report Title: Code Case Details Date: 6/23/2015 7:01:05 AM Case Number: cecv20130006837 Case Number: CECV20130006837 Status: Closed Case Type: Code Violation Date&Time Entered: 5/1012013 2:36:42 PM Priority: Normal Entered By: clements_k Inspector: clements_k Case Disposition: Abated by Contractor Jurisdiction: Contractor's Licensing Origin: Complaint Detail Description: A/C unit installed no building permit.Work done by Bruno Location Comments: 71 Glades Blvd. Unit 2 Property 35242720003 Complainant ANONYMOUS PLEASE Contractor:Mechanical Bruno Air Conditioning Business Management&Budget Office 1 ��— 3 . Code Case Details Execution Date 6/23/2015 7:01:05 AM Desc Assigned Required Completed Outcome Comments Preliminary Investigation clements_k 5/10/2013 5/21/2013 Needs 5/10/13-Complaint-a/c unit installed, no Investigatio permit.Spoke to Homeowner Bernice n Harmyk, she said Bruno Air Conditioning installed the unit,(Louis Bruno). Did not pull permit,was not inspected.Needs to get permit.ATF FEES.Called Bruno Air, needs to come in and sign cease&desist. Cont.Investigation clements_k 5/21/2013 5/21/2013 Complete 5/21/13-closing case,permit ready to be picked up. PRHV201 3051 1 623 Enter Settlement Details clements_k 5/21/2013 5/21/2013 Complete 5/21/13-PRHV20130511623 ready for pick up. Generate Closure Documentation clements_k 5/21/2013 5/21/2013 Complete Investigation clements_k 5/21/2013 5/21/2013 Settled Bruno air need to pull permit for a/c unit this is a three unit building, this is the middle unit, Violation Description Status Entered Corrected Amount Comments Commencing Work Without A Permit Open 5/10/2013 $0 Title Reason Result Compliance Fine/Day Condition Business Management&Budget Office 2 ciallergvv.net Report Title: Code Case Details Date: 6/30/2015 3:23:04 PM Case Number: cemis20140010972 Case Number: CEMIS20140010972 Status: Closed Case Type: Misconduct Date& Time Entered: 6/2/2014 3:13:58 PM Priority: Normal Entered By: lanJackson Inspector: lanJackson Case Disposition: Abated by Contractor Jurisdiction: City of Naples Origin: Building Department Detail Description: Case referral from City of Naples Building Dept., unpermitted AC change out at 297 8th Ave S unit B Location Comments: 297 8th Ave S B I folio 8280000437 Property 8280000437 Contractor BRUNO IV, LOUIS J. Business Management& Budget Office 1 . Code Case Details Execution Date 6/30/2015 3:23:04 PM Desc Assigned Required Completed Outcome Comments Preliminary Investigation lanJackson 6/2/2014 6/2/2014 Needs 5/30/14.Case referral from City of Naples Investigatio Building Dept., unpermitted AC Install at 297 n 8th Ave S unit B.Found that Bruno Air Conditioning had installed ac system Installed 5/30/14.Per City of Naples,no permit issued as of 6/2/14.Advised qualifier,Louis Bruno (281-5443)of permitting violation.Advised City and Bruno of 2x fees.Will issue Notice of Noncompliance and close case when permit issued. Cont. Investigation lanJackson 6/6/2014 6/6/2014 Complete 6/6/14. Permit has been Issued.Will issue Notice of Noncompliance. Cont. Investigation lanJackson 6/10/2014 6/10/2014 Complete 6/10/14.Meeting scheduled for issuance of Notice of Noncompliance.Bruno unable to attend.Will reschedule. Investigation lanJackson 6/12/2014 6/13/2014 Settled 6/12/14.Permit Issued.NON in case. Enter Settlement Details lanJackson 6/13/2014 6/13/2014 Complete Generate Closure Documentation lanJackson 6/13/2014 6/13/2014 Complete Violation Description Status Entered Corrected Amount Comments 4.2 Misconduct State Certified Open 6/2/2014 $0 Contractors Title Reason Result 1 Compliance Fine/Day Condition Business Management&Budget Office 2 Cdtliergov.net Report Title: Code Case Details Date: 6/30/2015 3:23:37 PM Case Number: cemis20140016166 Case Number: CEMIS20140016166 Status: Closed Case Type: Misconduct Date& Time Entered: 8/15/2014 9:42:09 AM Priority: Normal Entered By: lanJackson Inspector: lanJackson Case Disposition: Abated by Contractor Jurisdiction: City of Naples Origin: Building Department Detail Description: Case referral from City of Naples Building Dept., unpermitted A install at 250 7th Ave S#103 Location Comments: 250 7th Ave S#103/folio 14800120008 Property 14800120008 Contractor BRUNO IV, LOUIS J. Business Management&Budget Office 1 Code Case Details Execution Date 6/30/2015 3:23:37 PM Desc Assigned Required Completed Outcome Comments Preliminary Investigation lanJackson 8/11/2014 8/15/2014 Needs 8/11/14. Case referral from City of Naples Investigatio Building Dept., unpermitted AC install at 250 n 7th Ave S#103 by Bruno Air, Found no permit issued for AC Install.At location,met w/ employee of Bruno Air,Casey,who was in process if installation. 8/12/14. No permit issued. 8/13/14.No permit issued. Installation will not meet requirement of emergency repair due to permit not being applied for business day after installation.Advised City of Naples that 2x fees may be applied. Spoke w/homeowner who verified that Bruno Air was contracted for install. Will review contractor history to determine course of action in this case. 8/15/14-9:50 am. Left message with"Laurie" at Bruno Air,asking that qualifier, Louis Bruno (592-7866/281-5443),contact me.Advised Laurie that violation had been established at location,250 7th Ave S#103. 8/18/14. No contact from contractor. Left message at 281-5443,which appears to be a direct number for qualifier. No return call.4:25 pm, message left for Contractor with"Laurie" at Bruno Air. 8/19/14.No permit applied for. have not had contact from contractor, Louis Bruno. Reviewed case with Ossorio. Determined that, due to previous violations,this case will be scheduled for CLB with charge of willful building code violation. 8/19/14.Spoke with homeowner,Anthony Hagan 615-684-3466,who will provide invoice for installation by Bruno Air. Cont. Investigation lanJackson 8/22/2014 8/22/2014 Complete 8/22/14. Have had no return call from Contractor.Per City of Naples, No permit applied for.Homeowner authorized entry into condo to review invoicing documents.While in condo,was on telephone w/condo owner, Frankie Hagan.Ms.Hagan asked if condo unit was cooling.Advised her that thermostat was set at 75 degrees,cooling,fan on auto and temperature was 85 degrees in condo unit.Photographed invoices and downloaded into case. Cont.Investigation lanJackson 8/25/2014 8/26/2014 Complete 8/25/14.Notice of Hearing mailed Certified Mail Return Receipt. Business Management& Budget Office 2 . i Code Case Details Execution Date 6/30/2015 3:23:37 PM Dose Assigned Required Completed Outcome Comments Cont. Investigation lanJackson . 8/26/2014 8/27/2014 Complete 8/26/14.Received call from contractor. Found that contractors permitting agent had told him there was a case pending with County. Made arrangement to meet on 8/27/14 to discuss case. Investigation lanJackson 9/8/2014 9/8/2014 Settled 9/8/14. Per M.Ossorio.No CLB Hearing. Notice of Noncompliance issued.Permit is issued. Enter Settlement Details lanJackson 9/8/2014 9/8/2014 Complete Generale Closure Documentation lanJackson 9/8/2014 9/8/2014 Complete Violation Description Status Entered Corrected Amount Comments 4.2 Misconduct State Certified Open 8/15/2014 $0 Contractors _ Title Reason Result Compliance Fine/Day Condition Business Management&Budget Office 3 )-c( _SECTION 105 PERMITS Page 1 of 7 105 SECTION 105 PERMITS 105.1 Required. Any owner or authorized agent who intends to construct, enlarge, after, repair, move, demolish, or change the occupancy of a building or structure, or to erect, install, enlarge, alter, repair, remove, convert or replace any electrical, gas, mechanical or plumbing system, the installation of which is regulated by this code, or to cause any such work to be done, shall first make application to the building official and obtain the required permit. 105.1.1 Annual facility permit. In lieu of an individual permit for each alteration to an existing electrical, gas, mechanical, plumbing or interior nonstructural office system(s), the building official is authorized to issue an annual permit for any occupancy to facilitate routine or emergency service, repair, refurbishing, minor renovations of service systems or manufacturing equipment installations/relocations. The building official shall be notified of major changes and shall retain the right to make inspections at the facility site as deemed necessary. An annual facility permit shall be assessed with an annual fee and shall be valid for one year from date of issuance.A separate permit shall be obtained for each facility and for each construction trade, as applicable. The permit application shall contain a general description of the parameters of work intended to be performed during the year. 105.1.2 Annual permit records. The person to whom,an annual permit is issued shall keep a detailed record of alterations made under such annual permit. The building official shall have access to such records at all times or such records shall be filed with the building official as designated. 105.1.3 Food permit. As per Section 500.12, Florida Statutes, a food permit from the Department of Agriculture and Consumer Services is required of any person who operates a food establishment or retail store. 105.2 Work exempt from permit. Exemptions from permit requirements of this code shall not be deemed to grant authorization for any work to be done in any manner in violation of the provisions of this code. Permits shall not be required for the following: Gas: 1. Portable heating appliance. . 2. Replacement of any minor part that does not alter approval of equipment or make such equipment unsafe. Mechanical: 1. Portable heating appliance. 2. Portable ventilation equipment. http://ecodes.iccsafe.org/icce/gateway.dILFlorida%20Custom/Buiid2004_FL/3/8?f=templat... 9/5/2008 E 36 ARTICLE V. BUILDING TRADES* Page 30 of 36 Sec. 22-201.1 Misconduct--State certified contractors. The following actions by state certified contractors shall constitute misconduct and grounds for discipline pursuant to section 22-202 of this article. (1) Failing or refusing to provide proof of public liability and property damage insurance • coverage and workers compensation insurance coverage as. required by Florida Statutes. (2) Wilfully violating the applicable building codes or laws of the state, city or Collier County. (3) If the CLB finds through its public hearing process that the contractor was found by another county or municipality within the past 12 months, to have committed fraud or a willful building:code violation and-the CLB finds that such fraud or other willful violation would have been fraud or a willful violation if committed in Collier County or within the respective city. (4) Fraud. (Ord. No. 94-34, § 4; Ord. No. 99-45, § 4.2-4.2.3, 6-8-99; Ord. No. 06-46, §.1(4.1.8.2)) Sec. 22-202. Disciplinary proceedings, including minor violations. (a) There are three categories of violations: (i) violations of subsection 489.127(1), F.S.; (ii) violations of subsection 489.132(1), F.S.; and (iii) other violations within the jurisdiction of the contractor's licensing board. (1) Subsection 489.127(1), F.S., is incorporated herein. (Lack of required license, certificate, or registration). The following are designated to enforce subsection 487.127 (1); f:S.: Collier County Building. Official,: all-license "compliance officers, -the,chief building inspector, chief electrical inspector, chief plumbing/Mechanical inspector, and/or • other inspectors .authorized ,from time=to-time by the building official: Procedures specified in this section shall apply except to the extent, if any, that Section 489.127 or Section 489.132, may require different procedure(s). The penalties for each uncontested violation of subsection 489:127(1) •and/or 489.182(1), F.S., are $304.00 for the•first uncontested violation and X500:00 for each subsequent uncontested violation by the same'individual or entity. Penalties for contested violations Of subsection 489.127(1), F.S., are as now.or hereafter specified in Section 489.127, F.S. Penalties for contested . violations of subsection 489.132(1), F.S.,.are as now or hereafter specified in Section 489.132, F.S. The citation form attached hereto as Exhibit "A" is-approved, which form may be amended from time=to-time by resolution of the board of county commissioners. (2) Minor violations: The contractor licensing supervisor or designee shall issue a "notice of noncompliance" as the county's first response to a minor violation of any provision of any regulatory law, including this section, when (i) it is reasonable for staff to assume that the violator, at the time of violation, was not aware of the.provision that was violated or it an be assumed that it was not clear to the violator how;to.coniply with the • Violated provision; and (ii) that violation has not then resulted in economic. harm or physical harm to any person; and :(iii) the violation.has neither adversely affected the public health, safety, or welfare,,nor created any significant threat of any sUch adverse affeOt: The notice of noncompliance should-identify. the specific .provision that was violated, should provide information. on .how to comply with that provision and should specify a reasonably time for full compliance. The notice of noncompliance shall not be accoMpanied with any immediate threat'of any monetary fine or any other disciplinary penalty, but may specify that failure of the violator.to correct the violation within the time specified in the notice for compliance may result in disciplinary proceedings. Each Antonio Galindez D/B/A High Wind Aluminum Corp. Case # 2015-06 Table of Contents El & E2—Administrative Complaint E3 through E5 — Formal Complaint E6 through E8 — Case Detail Report E9 — Notice of Hearing E10 & E11 — Certificate Detail E12 — Proposal / Contract E13 & E14— Hurricane Shutter/ Awning & Glass and Glazing Contractor Definitions E15 & E16— Collier County Ordinance 90-105, as amended, Section 22-201(2) E17 — Collier County Ordinance 90-105, as amended, Section 22-201(18) E18— 585 Pine Grove Lane Stop Work Order E19 through E26 — 585 Pine Grove Lane Photos E27 & E28— Case CEUL20110009258 / Unlicensed Glass and Glazing E29 & E30— Case CECV20110009262 / Unpermitted Window Installation BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, V. Case Number: 2015-06 License Number: 33352 Antonio Galindez D/B/A—High Wind Aluminum Corp. Respondent. ADMINISTRATIVE COMPLAINT Collier County (County)files the Administrative Complaint against Antonio Galindez ( Respondent), a Collier County licensed Hurricane Shutter/Awning Contractor( license #33352), 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 Hurricane Shutter/Awning Contractor with License number 33352. 2. Under the provisions of Collier County Ordinance 90-105, as amended,Section 22-201,the following actions by a holder of a shall constitute misconduct and grounds tor discipline pursuant to Section 22-202. a. The Respondent contracted with the homeowners at 585 Pine Grove Ln for installation of 14 windows and 6 sliding glass doors. Said contract was a High Wind Shutters/ High Wind Aluminum Corp. contract, a corporation qualified by the Respondent with a Collier County Hurricane Shutter/Awning Certificate of Competency.The installation of windows and sliding glass doors is not within he defined scope of Hurricane Shutter/Awning contractor, as per Section 22-162(16) of Collier County Ordinance 90-105, as amended.The installation of windows and sliding glass doors was substantially complete (one window remained to be completely installed) on 8/11/15 during the initial site visit. At the time of visit, no permit was applied for through The City of Naples. A Stop Work Order was issued, with a notation E_ to make site safe and secure. Certified General Contractor, William Nolen/ Nolen's Construction, Inc., submitted a permit application to The City of Naples on 8/12/15. b. Thereafter, pursuant to Collier County Ordinance 90-105, as amended,Section 22-202 (b) and Section 22-202 (c), the complaint was investigated and found sufficient cause to file formal charges. 3. Collier County brings the following charge in this formal complaint against the Respondent. COUNT I 4. Collier County Ordinance 90-105,as amended,Section 22-201(2) states"Contracting to do any work outside of the scope of his competency as listed on his competency card and as defined in this article or as restricted by the contractors' licensing board". COUNT II 5. Collier County Ordinance 90-105, as amended, Section 22-201(18) states "Proceeding on any job without obtaining applicable permits or inspections from the city building and zoning division or the county building review and permitting department". 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. /1 I Dated: ci 6 Signed: \ A� - Collier Coun y Contractors' Licensing Supervisor or Designee EL Contractors' Licensing Board 2800 North Horseshoe Drive Naples, Fl. 34014 Complaint Number: 2015-06 Complainant: Any person that believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90-105, as amended, may submit a sworn complaint to the Contractor Licensing Supervisor, or his/ her designee.The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor. The complainant shall pay a fee of$50.00 to defray the costs of administering the complaint, at the time of filing the complaint.The complaining party shall state with particularity which section(s) of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Please print or type and return signed copied of the complaint. Date: 9/2/15 Against: Contractor's name: Antonio Galindez Phone: 239-462-9471 Business name: High Wind Aluminum Corp. License number if known: 33352 Collier County Competency number: 33352 Contractor's business address: 819 Calvert Ave Lehigh Acres, Fl 33971 Filed By: Name: Collier County Contractor Licensing/Compliance Officer, Ian Jackson Address: 2800 North Horseshoe Drive Business phone: 239-252-2451 Address where work done: 585 Pine Grove Lane City: Naples County: Collier Date of contract: 5/31/15 Date job started: 8/4/15 +/- Date job completed or new home occupied: 8/12/15 +/- Were there plans and specifications?Yes Is there a written contract?Yes If yes,amount of Contract?$27,654.00 Has Contractor been paid in full? No If Contractor has NOT been paid in full, what amount is paid? $18,000+/- Was a Building Permit obtained? No Building Permit number if known: Have you communicated by letter with the licensee?Yes Date: 8/20/15 Do you have a reply?Yes Please attach to this form all copies of the purchase agreement, building contract, home improvement contract, copies of receipts and/or cancelled checks available and any additional evidence to substantiate your allegations. List any subsections of Section 4 of Collier County Ordinance number 90- 105, as amended, which, in your opinion, have been violated by the contractor which is the subject of this complaint, (list subsection): 22-201(2) and 22-201(18) a. Please state the facts which you believe substantiate your charge of misconduct against the subject contractor. List facts separately for each subsection number above: The Respondent contracted with the homeowners at 585 Pine Grove Ln for installation of 14 windows and 6 sliding glass doors. Said contract was a High Wind Shutters/ High Wind Aluminum Corp. contract, a corporation qualified by the Respondent with a Collier County Hurricane Shutter/Awning Certificate of Competency.The installation of windows and sliding glass doors is not within he defined scope of Hurricane Shutter/Awning contractor, as per Section 22-162(16) of Collier County Ordinance 90-105, as amended.The installation of windows and sliding glass doors was substantially complete (one window remained to be completely installed) on 8/11/15 during the initial site visit. At the time of visit, no permit was applied for through The City of Naples. A Stop Work Order was issued, with a notation to make site safe and secure. Certified General Contractor,William Nolen/ Nolen's Construction, Inc., submitted a permit application to The City of Naples on 8/12/15. ELI (complainant's signature) State of: County of: Sworn to (or affirmed) and subscribed before me this day of 2014. By (signature of person making statement). (signature of Notary Public) Print,type or stamp name of Notary Public: Personally known or produced identification. Lb C ergazuset Report Title: Code Case Details Date: 9/8/2015 8:27:57 AM Case Number. cemis20150016261 Case Number: CEMIS20150016261 Status: Refer to CLB Case Type: Misconduct Date &Time Entered: 8/14/2015 9:23:00 AM Priority: Normal Entered By: IanJackson Inspector: lanJackson Case Disposition: Case Pending Jurisdiction: City of Naples Origin: Building Department Detail Description: Case referral from City of Naples Building Department, unpermitted window I sliding glass door install at 585 Pine Grove Ln/High Wind Aluminum Corp./Antonio Galindez(462-9471) Location Comments: 585 Pine Grove Ln I folio 16053080003 Property 1 16053080003 I ContractorjANTONIO GALINDEZ 1 Business Management& Budget Office Code Case Details Execution Date 9/8/2015 8:27:57 AM Desc Assigned Required Completed Outcome Comments Preliminary Investigation IanJackson 8/11/2015 8/14/2015 Needs 8/11/15. Case referral from City of Naples lnvestigatio Building Dept., unpermitted window/sliding n glass door install at 585 Pine Grove Ln. Found a re-roof permit issued. At location, met with James Marsh and Dennis Clouse,who stated they are employees of High Wind Aluminum Corp. Both were installing a sliding glass door at rear of home. Found that all other windows and sliders had been replaced,with only this opening remaining. Found that High Wind Aluminum Corp is qualified by Antonio Galindez(cell 462-9471 / 590-9463)with a Collier County Hurricane Shutter/Awning Contractor Certificate of Competency. Made contact with Galindez who acknowledged employing the individuals and contracting for described work.Advised Galindez of permitting violation and issuance of SWO with instructions to make site safe and secure.Galindez indicated that he has a GC on payroll (William S.Nolen)who obtains permits for work not included in his scope of Hurricane Shutter/Awning. Arranged to meet Galindez 8/12/15 at Licensing Office to address violations. 8/11/15. In County database,found that Galindez was issued citations for unlicensed glass/glaze(CEUL20110009258)and commencing work with no permit (CECV20110009262)on 7/7/11 by County Licensing,Tom Keegan.Both citations were paid. 8/12/15. Researching William S.Nolen/ Nolen's Construction Inc.(561-739-6014/561 -319-3961)in County database,found 26 permits applied tor or issued for glass arid/or window installation.All applications had Nolen's Construction as company name, William S. Nolen as Qualifier,Anthony as contact name,Anthony Galindez's phone number as contact and highwindshutters @yahoo.com as contact email address. Payment receipts for all 26 permit applications show that permitting fees were paid by High Wind Shutters.Total declared value for 26 permits were $153,783.00. 8/12/15. Met with Galindez,who acknowledged contracting for the 585 Pine Grove Ln project with High Wind Aluminum. Galindez then explained that the contracts for the 26 County permits were under High Wind Aluminum,with Galindez as the point of contact on the permit to receive correction/ ��Business Management& Budget Office f 2/ Code Case Details Execution Date 9/8/2015 8:27:57 AM rejection letters and then paying for permits and utilizing High Wind employees for installation. Requested that Galindez provide the 585 Pine Grove contract and payroll records for William S.Nolen. Cont. Investigation lanJackson 8/17/2015 8/17/2015 Complete 8/17/15. Permit for windows/sliding glass doors was applied for 8/12/15.Contract between homeowner and High Wind scanned into case. Payroll record for William Nolen attached. Will be scheduling contractor for Hearing at CLB for violaiton. Cont. Investigation lanJackson 8/19/2015 8/19/2015 Complete 8/19/15.Arranged to meet with Galindez 8/20/15.Will issue Notice of Hearing. Cont. Investigation lanJackson 8/21/2015 8/21/2015 Complete 8/20/15. Notice of Hearing served by hand delivery. Cont. Investigation lanJackson 8/27/2015 8/27/2015 Complete 8/27/15. In communication with Galindez, have advised him that 585 Pine Grove contract has to be restructured to show homeowner in contract with CGC William Nolen and remaining balance on contract has to go to Nolen. NOH is served. Will begin preparing case for September CLB. Schedule for CLB michaelossori 9/4/2015 9/4/2015 Complete On agenda for 9/16/15 CLB 0 Generate CLB Notice of Hearing michaelossori 9/4/2015 9/4/2015 Complete Notice of hearing served 8/20/15. 0 Investigation lanJackson 9/7/2015 9/4/2015 Refer to CLB Enter Hearing Results michaelossori 9/16/2015 Pending 0 Violation Description Status Entered Corrected Amount Comments 4.1 Misconduct-County/City Open 8/14/2015 $0 — Certificate of Competency Title Reason Result Compliance Fine/Day Condition Business Management& Budget Office 3 L Collier County Growth Management Division / Planning and Regulation Operations Department/ Licensing Section Hand Delivery iAtir Date f Z6 IS Antonio Galindez D/B/A High Wind Aluminum Corp. 819 Calvert Ave Lehigh Acres, Fl 33971 Date: 8/20/2015 RE: Complaint filed against you by Collier County Contractor Licensing regarding a violation of Collier County Ordinance 90-105, as amended, Sections 22-201(2)and 22-201(18)on 8/11/2015. Dear : Mr. Galindez A complaint has been filed against you by the above referenced Collier County Division Section. A hearing of this complaint will be held by the Contractors' Licensing Board on September 16,2015 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) 22-201(2)and 22-201(18) of Ordinance# 90-105, 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# 33352 and/or suspension or revocation of your permit privileges against your state license #N/A . SinTe y Ian Tic 'en Lic,n i f Compliance Officer 'U phone.1!39-252-2451 /m t tvew Ll LetiSee iLUTreue ptUJeLL) I ` r+tw Licensee WU piUJeu} j Licensee Number 1C33352 Status Active Name/ Description THIGH WIND ALUMINUM CORP. Start Date 1 Type Contractor E', End Date 1 R Inspector Submitted On Jurisdiction 'Collier County Department Operations Activity Description All Certificates from CDPIus: 33352 . Suggest Maffing Address 1 Add this Mailing Address as a Location — Add Contact Number Street Mailing Address 1819 CALVERT AVE Type Contact Number Ext. Cell ;(239) 462-9471 Address Line 2 1 ( ) - Address Line 3 1 Primary (239) 590-9463 City/State/Zip jLEHIGH ACRES FL JJ133971- Country El Email 1AnthanyG @highwindshutters.com ( Show More Fields 11 Hide or Clear Fields Home Based Business 1 Sub-certificate Required J Contractor Attributes Contractor Type Business 11 DOB' Drivers License Number Sponsorship Appliction Date Workers Compensation { Business Tax Receipt? Yes Expiration.Date I El Location CAdd Related Parcels and Addresses 1 Add a Location 1 To link a location to this Licensee, enter location information below. CityView will suggest possible matches as you type: Description I Type ( Property Alert I Primary?I Display? Contacts t Add a Contact 1 To link a contact to this Licensee, enter contact information below. CityView will suggest possible matches as you type: ANTONIO GALINDEZ,Address:819 CALVERT AVE, Phone:(239) 462-9471 Go Link Type Description End Date Primary? Display? .. Qualifier ANTONIO GALINDE.Z,Address:819 CALVERT AVE,Phone:(239) i Applicant HIGH WIND ALUMINUM CORP.,Address:819 CALVERT AVE, Ph ' '- I C Licensee Number C33352 Description Type Property Alert Name HIGH WIND ALUMINUM CORP. Type Contractor Status Active View Master Project View All Activities for this Licensee Add a new person or business to Address Book Classifications Generate Defaults Add a Classification To add a classification to this Licensee,enter text below. CityView will suggest possible matches as you type: 1HURRICANE SHUTTER/AWNING CONTRACTOR Link Type Date Entered Status Status Date HURRICANESHUTTERAWNING CONTRACTOR 06/03/2011 Active . . . . ( Show More Fields 4 Hide or Clear Fields Unique Identifier 154704 Contractor Licensing Renewable 7:-:1 License Category Local - Specialty License Issuances A Attach Driver License Photo Add Issuance Link Type Status Date Issued Issuance Number Expiration Date HURRICANESHUTTER/AWNING CONTRACTOR Active 06/03/2014 33352 09/30/2015 Comments 7-19-11 Two citations were issued by TK on 7-7-11, only one was located in City View. A payment slip for #6359 was created in CD+ and. Both citations paid ini full. Icw Show More Fields Hide or Clear Fields License Category Local - Specialty Renewable? 1 Unique Identifier 154704 L..." 1 5582 Lee Street, Unit#2 • Leigh Acres. FL 33971 Mai t f<4,,v/W~EP 239 590 9483 • Fax 239-368-9802 SikilL/7-7-1EFLIF E-mail, hignwinoshutters4yahoc corn HURRICANE SECURITY on 8ETTER LIVING SALES AGREEMENT SALESMAN T6L,E. ,s"sio-4/4r DATE D/3 i/I/5 PAGE / OF/ ESTIMATED TIME OF INSTALLATION ( ubject to weather and factory lead times) CUSTOMER WOE f-6,(5.L.kJ 4!: * NI,' i. 721. S' A.4.:..) 71... 7 - HOME PHONE ADDRE,)SS L-.1 CELL PHONE CITY 4,04.pk'S STA' E F/ IP E-MAIL INSTALLATION ADDRESS Ci E---• CONDO NAME STATE CITY ZIP CONTACT PHONE --- GENERAL INFO: Single Family Home 1.---- Number of Stories / 5/ Condo -- Number of Floors ---- Installation Floor Level — Elevator Size— x — Requires Association or Architectural Review Committee Approval. Yes No "*:—.._-- OWNERS ARE REQUIRED TO SIGN OFF FOR ASSOCIATION REQUIREMENT IF NO Initial --The undersigned heralay ointly and separately aulhorze High Ohnd Shutters.Inc iseler to'urmsh and ,rat,ivI the following No Room Alum Size Sze Window Door =ram Egress Glass Glass _ow- Screens Gods Special Vinyl Widtt, Ha.ghl Type -pee Color Required -ype Cak‘,( E Needed A-V Y_N Y-N Y-N 1 *- V "7.4- 3e; HZ, 10,/- imp 6- zi. .K 2 K 3 V ?Cr (-'_02.-- SY?"' £i+- I _ f kir 3 K (c k/ 3t, 6.2- . ./4.- LL;?-1- , -ill,1 L-2., V y , Icic 4 i -5 . 14...A-t-' aliiil ' ''''"' 5 FAIII— EMMA . s . Mil i2q. NMI& f . , 6 0 ....1- 8 111 4 t) /Zia , 0.a...4 211 tr_ g • (- 1 1 WIIIIIIMIlltriaMIIIIIMI IIMMI MEMO. 12 f., a- 5711111MIIIMEI IMIII ismi 4.--, SPECIAL STRUCTIO S Customer to remove all curtains blind and pictures on effected wails P urniture is to be pulled away from window area and covered by owners High Wind Shutter employees will do their best to cover moors and clean up the construction site each day High Wind Shutters no will rot be responst,4 fur Vrtture. flooriro curtains an blinds lot ,emoved lay 1,- protected by Une owrirs Curng the installation of new windows some stucco and drywall may be damaged Employees will parch and repair drywall and stucco but will not paint TERMS TOTAL CONTRACT AMOUNT $ ..)-.7 e;59 e,--- , L (50%)DOWN.BALANCE ON COMPLETION DEPOSIT PAID WITH ORDER S 9, • ./157 I O 1/3 DEPOSIT, 1/3 ON SCHEDULE, 1/3 ON COMPLETION PAYMENT DUE UPON SCHEDULING$ O FINANCING, — i i ' BAILANCE DUE UPON f s ' ISTALLATION COMPLETION $ iel 13‘" 1,,,,, ',/,_ /, _ ..1;—,•,,,,,,, - ,,,.... PI/OTHER /11.0 bEtt...1-":,ii .T 14ifirV: '-' ‘ :.,'4't''."At"-' I I MAKE ALL PAYMENTS TO HIGH WIND SHUTTERS COMMENTS: Pi/ i,t;Pt,,N.",f-t; 5 (' 0- 5 ,v- .4 e:.:/&—i.: -" —Cr'', •5, .'i,r*- '' /L '1 T.-",-,' r..... BUYER fled/Le 114.__ __K, DATE 51-3/T5 SALESPERSON DATE BUYER DATE ACCEPTED BY DATE AN INTEREST CHARGE OF I 5r•,',PER MONTH WILL SE ADDED TO ACCOUNTS NOT PAID WITHIN TERMS ADDITiONAL TERMS AND C,ONOtTIONS ARE ON THE REVERE SIDE Cr 7..,1",',,_.:.t1 T RAS_1 ARTICLE V. BUILDING TRADES* Page 5 of 36 material by pump and which deposits the pumped material at a fill location in one operation. (15) Drywall contractor requires 36 months experience with a passing grade on an approved test and a passing grade on a business and law test and means those who are qualified to install gypsum drywall products to wood and metal studs, wood and steel joists, and metal runners in buildings of unlimited area and height. The scope of work shall include the preparation of the surface over which the drywall product is to be applied, including the placing of metal studs and runners and all necessary drywall • preparation trim and shall include the placement of fire safing and fire stopping materials as part of the overall drywall contract. (16) Hurricane shutter/awning contractor requires 24 months experience with a passing grade on an approved hurricane shutter installer test and a passing grade on a business and law test, and means, those who are qualified to install, maintain, repair or replace shutters and awnings that are designed to protect residential and commercial buildings from hurricane and storm force winds and windborne debris all in accordance with Collier County amendments to the Applicable Building Code, as amended from time to time. Any electrical work connected with the installation of the shutters or awnings must be done by a licensed electrical contractor. Only nonstructural adjustments to existing openings may be performed as part of the work. Contractors who hold current Collier County Aluminum Contractor Including Concrete or Aluminum license on the effective date of this amendment are not required to pass this test, but must apply for this Certificate not later than one year from the effective date of this amendment. (17) Epoxy stone contractor requires 24 months experience with a passing grade on a business and law test and means those who are qualified to batch and mix aggregates, epoxy, hardener, and gravel to specifications, or to construct forms and framework for the casting and shaping of epoxy and aggregate, or to pour, place and finish over concrete base. (18) Excavation contractor requires 36 months experience and a passing grade on an approved test and a passing grade on a business and law test and means any person who is qualified to excavate to obtain or remove materials such as rock, gravel and sand; to construct or excavate canals, lakes and levees, including the cleaning of land of surface debris and vegetation as well as the grubbing of roots; and to remove debris and level surface land incidental and necessary thereto in compliance with all environmental laws, the building code, and other applicable codes and regulations. Minor excavations, such as footings, backfill without compaction, and similar activities are exempt hereunder. The use of explosives is not included in this category. (19) Fence erection contractor requires 24 months experience and a passing grade on a business and law test and means any person who is qualified to install, maintain or repair fencing or decorative prefabricated walls on grade. (20) Floor coverings installation contractor requires 24 months experience installing the specific product and a passing grade on an approved business and law test and means any person who is qualified to install carpet, sheet vinyl and/or all types of wood. (21) Gasoline tank and pump contractor requires 48 months experience and a passing grade on an approved test and a passing grade on a business and law test and means those who are qualified to install, maintain, repair, alter, or extend any aboveground system used for the storing and dispensing of gasoline, kerosene, diesel oils and similar liquid hydrocarbon fuels or mixtures (not to include pollutant storage). (22) Glass and glazing contractor requires 24 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means those who are qualified to select, cut, assemble, and install all makes and kinds of glass and glass work, and execute the glazing frames, panels, sash and door and holding metal frames, http://lib ary r 2.municode.com/default/DocView/10578/1/36/41?hilite=2006 46; e - 1/16/2009 ARTICLE V. BUILDING TRADES* Page 6 of 36 ornamental decorations, mirrors, tub, shower enclosures, and portable partitions. The scope of work shall include the installation of hurricane shutters or devices that are integral with the window system. (23) Insulation contractor: a. All types, except buildings, requires 36 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means those who are qualified to install, maintain, repair, alter, or extend any insulation primarily installed to prevent loss or gain of heat, from internal or external sources on pipes, vessels, ducts, fire stopping materials, sprayed-on fire resistive materials, or built-up refrigerated boxes or rooms, and acoustical materials. b. Buildings, requires 24 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means those who are qualified to install, maintain, repair, alter, or extend any insulation primarily installed to prevent loss or gain of heat from rooms or buildings. (24) Irrigation sprinkler contractor requires 24 months experience and a passing grade on an approved test and a passing grade on a business and law test and means any person who is qualified to install, maintain, repair, alter or extend all piping and sprinkler heads used for irrigation, including any required connections to a water pump; however, such work does not include direct connection to potable water lines. (25) Landscaping contractor requires 12 months experience and a passing grade on a business and law test and means any person who is qualified to install and/or remove trees, shrubs, sod, decorative stone and/or rocks, timber and plant materials, and concrete paving units for sidewalks, patios and decks only, whether or not incidental to landscaping, prepackaged fountains, or waterfalls, provided same does not include connection to a sanitary sewer system, portable water line, or to any electrical installation, which tasks must be performed by tradesmen licensed in the relevant trade. Landscape contractors may contract for only removal and/or trimming of trees and/or other combination of the authorized services. All new applicants applying for landscaping license are required to obtain a passing grade on an approved exam pertaining to pruning and safety, in addition to the business and law exam. (26) Liquefied petroleum gas installation contractor means any person qualified and licensed pursuant to F.S. ch. 527 to install apparatus, piping and tubing, and appliances and equipment necessary for storing and converting liquefied petroleum gas into flame for light, heat, and power. Placement of fire safing and fire stopping materials shall be allowed by this section. (27) Marine, seawall, and dock construction contractor requires 36 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means those who are qualified to build and install bulkheads, revetments, docks, piers, wharves, groins, boathouses, lifts and davits, and to do pile driving. Electrical service and wiring must be provided by a licensed electrical contractor. (28) Masonry contractor requires 36 months experience, a passing grade on an approved test and a passing grade on a business and law test and means those who are qualified to select, cut, and lay brick and concrete block or any other unit masonry products, lay other baked clay products, rough cut and dress stone, artificial stone and precast blocks, glass brick or block, but who shall not pour or finish concrete. (29) Paving blocks contractor requires 24 months experience in the respective construction plus a passing grade on an approved test and a passing grade on a business and law test, and means those persons who are qualified to construct http://library2.municode.com/defaultJDocView/10578/1/36/41?hilite=2006 46; 1/16/2009 ARTICLE V. BUILDING TRADES* Page 27 of 36 (i) Any individual who fails to renew his/her certificate of competency prior to December 31 of the year following its expiration shall thereby automatically have a certificate of competency that is null and void. To acquire a valid certificate from the county the individual must pay the then applicable full application fee in accordance with the schedule of fees and charges adopted by resolution pursuant to section 22-182(a)(4) herein, and must submit an entire new application. If, as of the date of receipt by the county of said new application, three years have passed since the date of his/her most recent examination that the individual passed to acquire the former certificate, that individual must pass all then applicable testing requirements. If the request is to reactivate a dormant certificate, the re-testing requirement can be waived by staff if the applicant proves that he/she has been active in the trade in another jurisdiction, or has been active as an inspector or investigator in the trade; or for other valid reason that would render such re-testing superfluous. (Ord. No. 90-105, § 1.4; Ord. No. 92-61, § 1; Ord. No. 94-34, § 1; Ord. No. 97-68, § 1, 10-28-97; Ord. No. 99-45, § 1.4--1.4.9, 6-8-99) Secs. 22-192--22-200. Reserved. DIVISION 3. STANDARDS OF CONDUCT AND DISCIPLINE* *State law references: Discipline of contractors, F.S. §§ 489.129, 489.533. Sec. 22-201. Misconduct--Collier County/city certificate of competency. The following actions by a holder of a Collier County/city certificate of competency shall constitute misconduct and grounds for discipline pursuant to section 22-202: (1) Knowingly combining or conspiring with an unlicensed contractor by allowing one's certificate of competency to be used by an unlicensed contractor with intent to evade the provisions of this article. When a licensed contractor acts as the qualifying agent for any firm without first making application under this article to represent said firm, such act shall constitute prima facie evidence of intent to evade the provisions of this article. When a certificate holder allows his certificate to be used by one or more companies without having any active participation in the operations, management, arid control of such companies, such act constitutes prima facie evidence of an Intent to evade the provisions of this article. Active participation requires job site supervision, knowledge of and participation in the business operations of the company, including all contractual matters. a. If any individual qualifying any business organization ceases to be affiliated with such business organization, he shall so inform the board. In addition if such individual is the only certified individual affiliated with the business organization, the business organization shall notify the board of the individual's termination and shall have no more than 60 days from the date of termination of the individual's affiliation with the business organization in which to affiliate with another person certified under the provisions of this article. In any event, the business organization shall not enter into any new contracts and may not engage in any new contracting until such time as a qualifying agent is employed. (2) Contracting to do any work outside of the scope of his competency as listed on his E\ http://library2.municode.com/default/DocView/10578/1/36/41?hilite-2006 46; 1/16/20 09 ARTICLE V. BUILDING TRADES* Page 28 of 36 competency card and as defined in this article or as restricted by the contractors' licensing board. (3) Abandoning a construction project in which he is engaged or under contract as a contractor. A project may be presumed abandoned if the contractor terminates the project without just cause, or fails to notify the owner in writing of termination of the contract and basis for same, or fails to perform work for 90 consecutive days without just cause and no said notice to the owner. • (4) Diverting funds or property received for the execution of a specific contract project or operation or diverting funds earmarked for a specified purpose to any other use whatsoever. (5) Departing from or disregarding in any material respect the plans or specifications of a construction job without the consent of the owner or his duly authorized representative. (6) Disregards or violates, in the performance of his contracting business in the county, any of the building, safety, health, insurance or workers' compensation laws of the state or ordinances of this county. (7) Falsifying or misrepresenting any material fact in his application and supporting papers for the purpose of obtaining a certificate of competency under this article. (8) Committing mismanagement or misconduct in the practice of contracting that causes financial harm to a customer. Financial mismanagement or misconduct includes, but is not limited to, any of the following: a. The contractor fails to fulfill his contractual obligations to a customer because of inability, refusal or neglect to pay all creditors for material furnished or work or services performed in the operation of the business for which he is licensed, under any of the following circumstances: 1. Valid liens have been recorded against the property of a contractor's customer for supplies or services ordered by the contractor for the customer's job; the contractor has received funds from the customer to pay for the supplies or services; and the contractor has not had the liens removed from the property, by payment or by bond, within 30 days after the date of such liens; 2. The contractor has abandoned a customer's job and the percentage of completion is less than the percentage of the total contract price paid to the contractor as of the time of abandonment, unless the contractor is entitled to retain such funds under the terms of the contract or refunds the excess funds within 30 days after the date the job is abandoned; 3. The contractor's job has been completed, and it is shown that the customer has had to pay more for the contracted job than the original contract price, as adjusted for subsequent change orders, unless such increase in cost was the result of circumstances beyond the control of the contractor, was the result of circumstances caused by the customer, or was otherwise permitted by the terms of the contract between the contractor and the customer. b. The contractor's job been completed, and it is shown that the customer has incurred financial harm by having to seek a variance or other administrative remedy because of actions by the contractor. (9) Performing any act which assists a person or entity in engaging in the prohibited unlicensed practice of contracting, if the licensed contractor knows or should have known that the person or entity was unlicensed. 11c },44r,•//�i{�ro rcr'� m,,,,+nnau 11C^70/1/7L1A1 n1.:]:a..—'1 nnL A . „r,nnnn ARTICLE V. BUILDING TRADES* Page 29 of 36 (10) Failing to promptly correct faulty workmanship or promptly replace faulty materials installed contrary to the provisions of the construction contract. Faulty workmanship means work that is not commenced, not continued, or not completed in accordance with all specifications of the applicable written agreement. Faulty workmanship includes any material flaw(s) in the quality and/or quantity of the unfinished work product, including any item that does not function properly as a part of the entire project. If there is no written agreement provision regarding the specific faulty workmanship issue, faulty workmanship exists if the work, process, product or part thereof does not meet generally accepted standards in Collier County in relation to the entire project. Faulty workmanship does not include matters of aesthetics unless the aesthetically related item clearly violates a written contract specification directly related thereto. (11) Failure to maintain at all times, with an insurance company authorized to do business in the state, the limits of liability and other categories of insurance as required by this article. (12) Failing to claim or refusing to accept certified mail directed to the contractor by the contractors' licensing board, or its designee. (13) Failing to maintain a current mailing address. (14) Failing to appear in person or through a duly authorized representative at any scheduled hearing on a complaint filed against the contractor. (15) Being convicted or found guilty, regardless of adjudication, of a crime in the county which directly relates to the practice of contracting or the ability to practice contracting. (16) Allowing another to take a qualifying examination on the applicant's behalf. (17) Engaging in contracting business in the county or the city when prohibited from doing so by the contractors' licensing board. (18) Proceeding on any job without obtaining applicable permits or inspections from the city building and zoning division or the county building review and permitting department. (19) Failing in any material respect to comply with the provisions of this article as a contractor or as a qualifying agent for a business entity engaging in contracting. (20) Signing a statement with respect to a project or contract falsely indicating that the work is bonded; falsely indicating that payment has been made for subcontracted work, labor, or materials which results in a financial loss to the owner, purchaser, or contractor; or falsely indicating that workers' compensation and public liability insurance are provided. (21) Failure of a qualifying agent for a firm/legal business entity to comply with the requirements set forth in F.S. §§489.119 and 489.1195. (22) Falsifying or misrepresenting any material fact to another person with the intent or for the purpose of engaging in the contracting business, providing materials or services, or soliciting business for an employer, as a contractor, or as an employee, regardless of any financial consideration. (23) Failing or refusing to provide proof of public liability and property damage insurance coverage and workers compensation insurance coverage. (24) Misconduct in the practice of contracting (see section 22-201.1 below). (Ord. No. 90-105, § 4.1; Ord. No. 92-61, § 4; Ord. No. 94-34, § 4; Ord. No. 97-68, § 1, 10-28-97; Ord. No. 99-45, § 4.1--4.1.24, 6-8-99) http://library2.municode.com/default/DocView/10578/1/36/41?hilite=2006 46; 1/16/2009 DO NOT REMOVE R l.J _ , y p7rio,uep ( ON THE)C81 GU4�' Cx7 WOO 9447,44 s BUILDING ENT ALL PER FLORIDA BUILDING CODE 0 ADDRESS 5&" • R ASON fLiEJ r„, (4) I r V/ WARNING: CONTINUED UNAUTHORIZED WORK ON THIS PROJECT COULD RESULT ' IN SEVERE PENALTIES. 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Report Title: Code Case Details Date: 8/11/2015 4:09:27 PM Case Number: ceuI20110009258 Case Number: CEUL20110009258 Status: Closed Case Type: Unlicensed Date & Time Entered: 7/7/2011 2:40:41 PM Priority: Normal Entered By: ThomasKeegan Inspector: Thomas Keegan Case Disposition: Case Pending Jurisdiction: City of Marco Origin: Field Observation Detail Description: unlicensed glass & glazzing -(Antonio Galindez) Citation#6358 $300.00 Location Comments: 880 Huron Ct#2-205 Marco Island Property 24730520001 Violator HIGH WIND ALUMINUM CORP. 1 Business Management& Budget Office Code Case Details Execution Date 8/11/2015 4:09:27 PM Desc Assigned Required Completed Outcome Comments Preliminary Investigation ThomasKeega 7/7/2011 7/7/2011 Citation 7/7/11-Patrol at 880 Hron Ct(Marco Island) n Required revealed 2 employees of High Wind Aluminum#33352-Hurricane Shutter/ Awning Contractor installing windows in 2nd floor unit. 5 windows already installed/ homeowner not present- spoke to Felix Torres,officer of corporation who was on site- advised of licensing issue as well as building issue-no permit-2 windows not installed - SWO issued but ordered to calk windows- met with building insp.Kim -citations issued- photos downloaded. tk68 Issue Citation(Licensing) ThomasKeega 7/7/2011 7/7/2011 Complete #6358 issued- n Citation Paid/Contested clements_k 7/21/2011 7/19/2011 Payment Received Violation Description Status Entered Corrected Amount Comments Unlicensed Glass/Glaze Open 7/7/2011 $300 Title Reason Result Compliance Fine/Day Condition Business Management& Budget Office 2 Cr Tergov et Report Title: Code Case Details Date: 8/11/2015 4:10:43 PM Case Number: cecv20110009262 Case Number: CECV20110009262 Status: Closed Case Type: Code Violation Date & Time Entered: 7/7/2011 2:51:51 PM Priority: Normal Entered By: ThomasKeegan Inspector: ThomasKeegan Case Disposition: Case Pending Jurisdiction: City of Marco Origin: Anonymous Complaint Detail Description: unpermitted windows installed in condo unit High Wind Aluminum Corp#33352 Location Comments: 880 Huron Ct#2-205 Property 124730520001 ViolatorINIGH WIND ALUMINUM CORP. ca Business Management & Budget Office 1 • Coae Case Details Execution Date 8/11/2015 4:10:43 PM Desc Assigned Required Completed Outcome Comments Preliminary Investigation ThomasKeega 7/7/2011 7/7/2011 Citation 7/7/11-Patrol at 880 Huron Ct(Marco Island) n Required revealed unpermitted installation of windows in condo unit 2-205-work being done by High Wind Aluminum#33352(seperate case for licensing)-swo and citation issued for commencing work w/o a building permit-met inspector kim at site-will close case but monitor for atf fees. 7/20/11-checked with Marco Building Dept-permit 112967 issued- ATF#424.74 Issue Citation(Licensing) ThomasKeega 7/7/2011 7/7/2011 Complete citation#6359 issued n Citation Paid/Contested wolfelinda 7/21/2011 7/19/2011 Payment Received Violation Description Status Entered Corrected Amount Comments Commencing Work Without A Permit Open 7/7/2011 $300 no permit for window install in condo Title I Reason Result I Compliance Fine/Day Condition 3Q Business Management& Budget Office 2 BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA,CONTRACTORS' LICENSING BOARD Petitioner, V. Case Number: 2015-06 License Number:33352 Antonio Galindez D/B/A—High Wind Aluminum Corp. Respondent. ADMINISTRATIVE COMPLAINT Collier County(County)files the Administrative Complaint against Antonio Galindez( Respondent),a Collier County licensed Hurricane Shutter/Awning Contractor( license#33352),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 Hurricane Shutter/Awning Contractor with License number 33352. 2. Under the provisions of Collier County Ordinance 90-105,as amended,Section 22-201,the following actions by a holder of a shall constitute misconduct and grounds for discipline pursuant to Section 22-202. a. The Respondent contracted with the homeowners at 585 Pine Grove Ln for installation of 14 windows and 6 sliding glass doors.Said contract was a High Wind Shutters/High Wind Aluminum Corp.contract,a corporation qualified by the Respondent with a Collier County Hurricane Shutter/Awning Certificate of Competency.The installation of windows and sliding glass doors is not within he defined scope of Hurricane Shutter/Awning contractor, as per Section 22-162(16)of Collier County Ordinance 90-105,as amended.The installation of windows and sliding glass doors was substantially complete(one window remained to be completely installed)on 8/11/15 during the initial site visit.At the time of visit,no permit was applied for through The City of Naples.A Stop Work Order was issued,with a notation to make site safe and secure.Certified General Contractor,William Nolen/Nolen's Construction, Inc.,submitted a permit application to The City of Naples on 8/12/15. b. Thereafter, pursuant to Collier County Ordinance 90-105,as amended,Section 22-202(b) and Section 22-202 (c),the complaint was investigated and found sufficient cause to file formal charges. 3. Collier County brings the following charge in this formal complaint against the Respondent. COUNT 4. Collier County Ordinance 90-105,as amended,Section 22-201(2) states"Contracting to do any work outside of the scope of his competency as listed on his competency card and as defined in this article or as restricted by the contractors'licensing board". COUNT II 5. Collier County Ordinance 90-105,as amended,Section 22-201(18)states"Proceeding on any Job without obtaining applicable permits or inspections from the city building and zoning division or the county building review and permitting department". 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: et(1(1(1� Signed: - Collier County Contractors' Licensing Supervisor or Designee Contractors'Licensing Board 2800 North Horseshoe Drive Naples,Fl. 34014 Complaint Number: 2015-06 Complainant:Any person that believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90-105,as amended,may submit a sworn complaint to the Contractor Licensing Supervisor, or his/her designee.The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor.The complainant shall pay a fee of$50.00 to defray the costs of administering the complaint,at the time of filing the complaint.The complaining party shall state with particularity which section(s)of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Please print or type and return signed copied of the complaint. Date:9/2/15 Against: Contractor's name: Antonio Galindez Phone:239-462-9471 Business name: High Wind Aluminum Corp. License number if known:33352 Collier County Competency number:33352 Contractor's business address: 819 Calvert Ave Lehigh Acres,Fl 33971 Filed By: Name:Collier County Contractor Licensing/Compliance Officer, Ian Jackson Address:2800 North Horseshoe Drive Business phone:239-252-2451 Address where work done:585 Pine Grove Lane City: Naples County:Collier Date of contract:5/31/15 Date job started:8/4/15+/- Date job completed or new home occupied:8/12/15+/- Were there plans and specifications?Yes Is there a written contract?Yes If yes,amount of Contract?$27,654.00 Has Contractor been paid in full? No If Contractor has NOT been paid in full,what amount is paid?$18,000+/- Was a Building Permit obtained? No Building Permit number if known: Have you communicated by letter with the licensee?Yes Date:8/20/15 Do you have a reply?Yes Please attach to this form all copies of the purchase agreement, building contract, home improvement contract,copies of receipts and/or cancelled checks available and any additional evidence to substantiate your allegations. list any subsections of Section 4 of Collier County Ordinance number 90- 105,as amended,which,in your opinion,have been violated by the contractor which is the subject of this complaint,(list subsection):22-201(2)and 22-201(18) a. Please state the facts which you believe substantiate your charge of misconduct against the subject contractor.list facts separately for each subsection number above: The Respondent contracted with the homeowners at 585 Pine Grove In for installation of 14 windows and 6 sliding glass doors.Said contract was a High Wind Shutters/High Wind Aluminum Corp.contract, a corporation qualified by the Respondent with a Collier County Hurricane Shutter/Awning Certificate of Competency.The installation of windows and sliding glass doors is not within he defined scope of Hurricane Shutter/Awning contractor, as per Section 22-162(16)of Collier County Ordinance 90-105, as amended.The installation of windows and sliding glass doors was substantially complete(one window remained to be completely installed)on 8/11/15 during the initial site visit.At the time of visit, no permit was applied for through The City of Naples.A Stop Work Order was issued,with a notation to make site safe and secure.Certified General Contractor,William Nolen/Nolen's Construction,Inc.,submitted a permit application to The City of Naples on 8/12/15. \ , \f,:',.' 'k' ' ,',';in \I / (compiaina\t's ignature) State of: i 1 if County of: CO t iqr Sworn to(or affirmed)and subscribed before me this it-pqt day of 2015. By ( 1 -C- j .,''., K ;:..,,:j ) ' (signature of person making statement). ; - (signature of Notary Public) :. ' ,,,, .4so.r.:f.yi, SAMANTHA LYNN ROE * --,;(,cr.; * MY COMMISSICN a EE amp EXPIRES:February 17,2017 -"cfreof-n.' 01.9 POO d Div Si Notify Strylos Print,type or stamp name of Notary Public: . . Personally known or produced identification.