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CLB Backup 04/20/2016 Co er County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA APRIL 20, 2016 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: A. April 20, 2016 V. PUBLIC COMMENTS: VI. DISCUSSION: VII. REPORTS: VIII. NEW BUSINESS: A. Orders Of The Board B. Manuel Orosa-Orosa Custom Renovations, Inc.- Review of Experience C. Luis Ambriz- LA Tree Trimming & Removal Inc- Review of Credit IX. OLD BUSINESS: A. Matthew R. Rambo, Neapolitan Tree Service, Inc—6 mos. Review of Credit B. Teodor Danilov, Custom Flooring Design Inc— Review Of Credit X. PUBLIC HEARINGS: A. 2015-09—Karin R. Sacacian—Olde Naples Tile & Marble, LLC. —Cert#25598 B. 2016-01 —Steven William Cole- Below Cost Flooring Inc. Cert#36257 &36258 C. 2016-01 — Dennis Tome—D. &V. Customs LLC—Cert#26673 XI. NEXT MEETING DATE: WEDNESDAY, MAY 18, 2016 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, In Karin R. Sacacian D /B /A — Olde Naples Tile & Marble, LLC. Respondent. Case Number: 2015 -09 License Number: 25598 ADMINISTRATIVE COMPLAINT Collier County (County) files the Administrative Complaint against Karin R. Sacacian( Respondent), a Collier County licensed Tile & Marble Contractor ( license # 25598), 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 Tile & Marble Contractor under License number #25598. 2. Under the provisions of Collier County Ordinance 90 -105, as amended, Section 22 -201, the following actions by a holder of a Collier County Tile & Marble Certificate of Competency shall constitute misconduct and grounds for discipline pursuant to Section 22 -202. a.) Tom Arico the owner of the condo located at 4010 Ice Castle Way #5 Naples Fl., contracted with the respondent, Olde Naples Tile & Marble LLC, and was given invoice #640471 for approximately $1,950.00 for the installation of tile which was paid in full. b.) On August 10th, 2015 a complaint involving possible faulty work for Tile installation at the jobsite located at 4010 Ice Castle Way, #5, Naples, FL. 34112, was investigated by the Collier County Contractors' Licensing Office. 4 c.) On October 5th, 2015 the homeowner Tom Arico, Mike Ossorio and I met on job site with Mario Sacacian, Mario agreed that it was faulty work, Olde Naples Tile & Marble LLC., will correct the faulty work, and replace the tiles that need to be replaced. Mike Ossorio let Mario know that he had until October 16th, 2015 to correct the faulty work. d.) On October 12th, 2015 Mike Ossorio called Mario Sacacian to see if the faulty work was being corrected, Mario Sacacian stated that he was finished and was not going to repair or correct the faulty work, and walked off the job. e.) On October 13th, 2015, homeowner Tom Arico, Mike Ossorio and I, met in Mike's office and determined that Karin Sacacian of Olde Naples Tile & Marble LLC, would go before the Contractor Licensing Board on December 16th, 2015 for failing to correct faulty work by the agreed upon time of October 16tH 3. Collier County brings the following charge in this formal complaint against the Respondent, Karin R. Sacacian of Olde Naple Tile & Marble, LLC. COUNT Collier County Ordinance 90 -105, as amended, Section 22 -201. (10) states "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 or finished 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 esthetics unless the esthetically related item clearly violates a written contract specification directly related thereto ". WHEREFORE, the Petitioner asserts the above facts and charges are grounds for disciplinary action under Section 22 -201 of Collier County Ordinance 90 -105, as amended, and WHEREFORE, in consideration of the foregoing, the Petitioner respectfully requests the Collier County Contractors' Licensing Board to find the Respondent guilty of the violations charged. Dated: Signed: Collier County Contractors' Licensing Supervisor or Designee Ar\ is 6�v C;0 Cwou"ty X\1 Growth Management Department operations & Regulato]Y Management Division COMPLAINT FORAV`� PRELIMINARY COD Date: Comp``` lainant's Name: 11JI—Pil State: L p: � Address: C 'Business Phone: Home Phone: i—EL--l� COMPLAINT INFORMATION' Iik,-Alcense Number: Name: Company Contractor or Person in Charge: (if knoWn) .7 Address: Phone: Date of Contract' COMPLAINT DETAILS: (Attach additional sheets as necessary) I-,' f ."q-r. Contracts. checks, liens, permits) etc... all appropriate documents: . . ....... .. .... .... ......... Include copies 0 . ..... ...... ........ . siguatur op,.Ws&R,-,gdatorYWnagemMo�,r��o,,2800 North Hneshoe [Mve - Naples. ROMA 34144.23.252 -2400 0 del // A COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION INFORMATION C25598 Certification Information Collier County Board of County Commissioners Date: Se DBA: OLDE NAPLES TILE & MARBLE, LLC ADDRESS: 280 29TH STREET NW NAPLES, FL 34120 PHONE: 2392937061 CELL: 2395946878 FAX: 2395946878 LICENSEE NBR: C25598 QUALIFIER INSURANCE: General Liability August 31, 2016 Worker's Compensation January 01, 2016 TYPE: CLASS CODE: TILE & MARBLE CONTR. 4420 ISSUANCE NBR: 25598 ORIG ISSD: January 06, 2004 EXPIRATION: September 30, 2016 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 TILE & MARBLE CONTR. Cert Nbr: Exp: Status: C25598 09/30/2016 Active OLDE NAPLES TILE & MARBLE, LLC KARIN R. SACACIAN 280 29TH STREET NW NAPLES, FL 34120 Signed: l EI �J t k } Rik) IS, c d C�7 z H q t" �7 C" r r- n m y m m �o N P y iC b C b b y Oro i 'S] C O zz Cy y b r v n �o y L V �. A �\ yyyy iC b C b b y Oro i Form 940 for 2015: Employer's Annual Federal Unemployment (FUTA) Tax Return Department of the Treasury - Internal Revenue Service Employer identification number N _ a IE � 511:0 � I (EIN) Name (not your trade name) FOLDE NAPLES TILE & MARBLE LLC Trade name (if any) Address ( 1691 TRIANGLE PALM TERRACE NAPLES Suite or room number FL 1 34119 State ZIP code 850113 OMB No. 1545 -0028 ❑ a. Amended ❑ b. Successor employer ❑ c No payments to employees in 2015 Final: Business closed or d. stopped paying wages Instructions and prior -year forms are available at wwwJrs.gov1fo1,m940. 1b If you had to pay state unemployment tax in more than one state, you area multi - state employer . , 1 b ❑ Complete Schedule A (Form 940). If you aid We _ea in 8 state that is oub ` t 10 i VDU TION 2 ❑Check here. Complete y . � �- �ee_ - i��.. _ Schedule A (Form 94C 3 total ptltymorlit0 to all employeou 3 4 Payments exempt from FUTA tax. 4 ■ Check all that apply 4a ❑ Fringe benefits 4c ❑ Retirement/Pension 4e ❑ Other 4b ❑ Group term life insurance 4d ❑ Dependent care 5 Total of payments made to each employee in excess of $7,000 . . 5 6 Subtotal (line 4 + line 5 line 6) . . 6 7 Total taxable FUTA wages (line 3 - line 6 = line 7) (see instructions) . . 7 8 FUTA tax before adjustments (line 7 x.006 = line 8) . . 8� Determine Your adjustments. If any line does NOT apply, leave it blank. 11th --- iiibk FUT -a9 - -- -- -- - _-• - - - -- -- - •ua'- -•I-- -- --- -- y n H�� oT me ><axav�e ry I H wages yvu paia were excivaea rrom s><a><e unemWoymem ><ax, multiply line 7 by .054 (line 7 X.054 - line 9), Go to line 12 9 ■ 10 If SOME of the taxable FUTA wages you paid were excluded from state unemployment tax, OR you paid ANY state unemployment tax late (after the due date for filing Form 940). 10 complete the worksheet in the instructions. Enter the amount from line 7 of the worksheet ■ 11 If credit reduction applies, enter the total from Schedule A (Form 940) 11 ■ Determine your FUTA tax and balance due or overpayment. If any line does NOT apply, leave it blank. 17 ToW Ft ITA tex after adilratmantc hi — a, o � 110 t 1,11 - !me l v\ 13 FUTA tax deposited for the year, including any overpayment applied from a prior year 13 1 qNWW� 14 Balance due (If line 12 is more than line 13, enter the excess on line 14.) �i lino id is mnro fl— 'Pvvv Inn meet A.n—it v_n tan ■ If line 14 is $500 or less, you may pay with this return, (see instructions) 14 L ■ 15 Overpayment (If line 13 is more than line 12, enter the excess on line 15 and check a box below.) 15 ■ ► You MUST complete both pages of this form and SIGN it. Check one: ❑ Apply to next return. ❑ Send a refund. 17.-T= For Privacy Act and Paperwork Reduction Act Notice, see the back of Form 940 -V, Payment Voucher. Cat. No. 112340 Form 940 (2015) 850212 Name (not your trade name) Employer identification number (EIN) OLDE NAPLES TILE & MARBLE LLC 1 04- 3782186 16 Report the amount of your FUTA tax liability for each quarter; do NOT enter the amount you deposited. If you had no liability for a quarter, leave the line blank. 16a 1st quarter (January 1 -March 31) 16b 2nd quarter (April 1 - June 30) YR� �rw nuartnr / h J" i - qc t+ k.' QnN _ _ _ 16d 4th quarter (October 1 - December 31) . 16a 0 1 16b 16c .16d 17 Total tax liability for the year (lines 16a + 16b + 16c + 16d = line 17) 17 Mav we speak with vour third -Darts designee? Total must equal line 12. Do you want to allow an employee, a paid tax preparer, or another person to discuss this return with tho I- .% 00 e the etruetld for details. ❑ Yes. Designee's name and phone number Select a 5 -digit Personal Identification Number (PIN) to use when talking to IRS ❑ ❑ ❑ F7 ❑ ❑ No... die Sign here. You MUST complete both pages of this form and SIGN it. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that no part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments made to employees. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign your name here Date I I Print your name here I REFERENCE COPY PREPARED Print vour I nv n a vnU0 V r►n 10^M z+T r w title here ( a 1 rn 1 l.nr�n . aJV 11 V 1 r 1 Lci Best daytime phone Paid preparer's use only Check if you are self - employed . . ❑ Preparer's name I I PTIN Preparer's signature I I Date Firm's name (or yours if self - employed) I EIN I I Address Phone ) City I State F ZIP code Page 2 Form 940 (2015) Under penalties of perjury, I declare that 1 have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete. Signature ► REFERENCE COPY PREPARED BY PAYCHEX. Title ► DO NOT FILE. Form W -3 Transmittal of Wage and Tax Statements DO NOT FILE Date ► nn �... nF to Tr nee „r„ 2015 �,u,� „�a,w,, Internal Revenue Service YOUR FEDERAL W -2 & W -3 DATA IS FILED ELECTRONICALLY ,,, r AIW , a Control number For Official Use Only ► 33333 0903- 0903YP18 OMB No. 1545-0008 b 941 Military 943 944 i None apply 501 c non -govt. i Third -party sick pay Kind ® 0 : Kind ' Of Hshld. Me ware of Sta a ocat (Check if Payer CT -1 ejm"pj govt. emp. Employer non-401c State(loca1501c Federal govt. applicable) E (Check one) 0 t__I ❑ i (Check one) 7 � i E c Total number of Forms W -2 d Establishment number 1 Wages, bps, other compensation 2 Federal income tax withheld 3 lamas e Crnpivyer lu'eflulicau`vfl riumuer (ciivj 3 Social security wages 4 Social security tax withheld 04- 3782186 A01111100 _ f Lmployer s name $ Medicare wages and b 6 Medicare tax withheld OLDE NAPLES TILE & MARBLE LLC 0At1Ae11rA T VAMYXT O O^TV /.RC+T.fMVID w7t9\rra�.1['719 i \iY%1 L9 r .JVAJCJ itr V4A.;1L' Z% r oviiai oevuiity ups R Glinr•atnrl fine .. . ,..,,.. «...,. ..Y.. 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 g 10 Dependent care benefits 11 Nonqualified plans 12a Deferred compensation g Employer's address and ZIP code h Other IzIN used this year 13 For third -party sick pay use only 12b 15 State Lmployer s state number 14 Income tax withheld by payer of third -party sick pay 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax Employer's contact person Employer's telephone number Z. orpfficial Use Only SACACIAN KARIN (239) 216 -0557 0000/1124 Employer's fax number Employer's email address Under penalties of perjury, I declare that 1 have examined this return and accompanying documents, and, to the best of my knowledge and belief, they are true, correct, and complete. Signature ► REFERENCE COPY PREPARED BY PAYCHEX. Title ► DO NOT FILE. Form W -3 Transmittal of Wage and Tax Statements DO NOT FILE Date ► nn �... nF to Tr nee „r„ 2015 �,u,� „�a,w,, Internal Revenue Service YOUR FEDERAL W -2 & W -3 DATA IS FILED ELECTRONICALLY ,,, r AIW , mad a d Yw arc e1@t- tag eery sleds FA-4 masse aeAt (EIC). Yaw may be ark Wlakethe FIC to 2015 i(ymu adjmtM g-, Ptepamtim Wit— It 6 pssibk yow wile a Prepmr WE oct rageaa this case. The We c J- Nodmeabk ark pay (if-- gay. oa - hided i. boas 1, 3, a 5) "Ma ome (AGI) r aaa than. -am amwa. The amwa of asst a tamed -,come and family aim got --o' - PaP -Ikd rdum -. K -20% oaceeim m .teas WWen pmachuw paymats. Su Tuea" n the Farm 1040 aatr lk Waters whholl chidn, could gaaNy for a small, crest Yaw ad my polifying b6d= meat Bas IQ This moat iabds the V" dapmda t care bm2fiis that yom mpkw pill m yen a -. L- anlaxabkl pbyab..,RRAlu —Ay n (. yam have edit social aaur' -Ws SSN). 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See "(Mho Taxes', ae Famli&npen may use fie box to repxl"nfamatbn Call. slate dimdgty asumrceleoeea Alwcld. dm-, unto- pymena. heaph msu.nce pnmiva dducwd. nonaatle terra a Btw S e wet m the 0.96 Additiaml Med'cam Tu a ay d those Medkms wag. and tips above 1090 kawnac(kas. edacation:d:anisnmcr Pay.ots, a a mob, d the ckrgy'a P....ge aft— and adhiea. C- Taxabk caw d graptem Me mmma- ova S5Q(xq (u .lad a boxes 1, 3 (up -xial Railed mp y -.. the bee to report raboad Mk-- (RRTA) caepal ia, Tar I ax, Tae 2 Bart & The a loot a ad ,tided in bores 1, 3, A or 7. Fa infamatkm- IWW b rep- tips a sawmy Wage hoe), ad 5) ax Malik -rc tax and Ad&i W Mdleae I - laclade Iqa rep rtod by the eapbyae to the mpbya your tax Mart as yam I- 1090 iaaaliona. n,. xa.x..... e.. a,..»..,...n r:- a. D- FLc6ve ddmd, to a s <clioa 4011k) cmh a h(e,ad aamp— Al send. ddemb uohr a mar ad rctimm., (RR(A) conpennmkxi �.......... F-. ,,x� c.,..0 c.....a...,,4 ,.. "n..- ... .....................-a..... ..I...,_.- .r..- ,...,..- ........ .,.Y.,,",,... v.....,,... ..-". yea ,come tare Mum to regal m tat the eRowd tip moat aF yes ca ml" yes asiiti'i,t memo!accom temmpmt of eaectw E -@ells h(errab user a xotbo 4N(b) fi-Y relation agremot .... „ mom. Ibwever. m tap pa-r yowmeia aoaay ben�ik. keg. CopYC erns yes saga receiving aeenda,mega,.sues Lfyes have rands that show the actualmaul drip. yes .caved. p- Elective ddembedam a- i- 408(k)(6) Wary mduetioa SW wriW rusiN hew.fim.rynMwas lgae an gasses ,taws) -revert .roes ad/a eartdnga fen repel thw mesa arm if a e mae a bas than aedl -W to. Un Form 4137 yes wB cakobb, P-!i Wywn. Form W -2 Wage and Tax Statement 2015 I Tf4s Intofination Is tarn0 tumiehetl to the IMemtl Revenue SerNCe. Copy C, for employees records ll yob ere requited ro 1118 a tax eta n, a nag pe-Y a older manouon m be im Deed ou it thlm'naome I taxabl d Rif to Mon 1. d Can" numlbOr 0903- 0903YP18 0000000001- 000100 I Vold a Empby✓m mmm, mddrwa, Od ZIP ads OLDE NAPLES TILE & MARBLE LLC SACACIAN KARIN R SOLE MEMBER 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 DepOlment a Ume Tra -",y - .tend Revan- 8eracs ONO ft. 154&0009 b lmplaya "eWmY11wY- number .Em�la,,..'..amltl- aa«ymmmm.r - 04-3782186 11«h«ant Tlerkpaly Employ" Plan Prtr 1 Y /ag-, tip., Dram wnpmm -tan 2 FmmaN Income Ya rABmbNd a Ypw s. wetly wag- � 4 Bwml S-aNy, tax mfY t2 Sam —.1- mx 12 1 11 Otte s 6apbyw4m mm, mdtltasr, ad ZPwM KARIN SACACIAN 1691 TRIANGLE PALM TERR NAPLES FL 34119 4 Mews. wag- a- film 9 M"- tax vdumrd 7 mall security tlm a Albow.d Tip 19 Depadent oars bonam, It N- MarOed pone vatbelbn Coda is Yam Employ aye stab I.D. N.. to eWwag -, Ypq ark 17 state Income W 1B L -al ve9w, up. • re, t9 Loeb means t- 20 L-Alty -me Form W -2 Wage and Tax Statement 2015 Copy B, to be filed with employee's FEDERAL tax return d Control number 0903- 0903YP18 0000000001- 000100 I vad c fnwyw. am-, mdure -, au zip code OLDE NAPLES TILE & MARBLE LLC SACACIAN KARIN R SOLE MEMBER 1691 TRIANGLE PALM TERRACE - NAPLES FL 34119 IePerftent n t- Trwaury - fterrrtl Revaue 8ardw OUR NO.15460004 It Emplayer'.Idaae -on n—bor 0 . r nww-•. Read Rmanmy numb. 1 Wag-• tbs, older carrlPetmmYOrt 490 Z Fadecr iwor- m Mtlrbald 49WO 12 Smtumry Rraemeot ThkdpOq Employss pa akt PmY 5 Social Security wages 1� 4 Soc d Security m mAlhhdd 12 Sam farm. for Box 12 14 Oliver • 1 MO1mN'N WINNOW.- .adZiaaM KARIN SACACIAN 1691 TRIANGLE PALM TERR NAPLES FL 34119 5 kmdkem wages and up 4MeMeae tart ntum -(e also 7 saw S-mty Ylm 9 All -atoll rip 100N3emnkrmabr -t- 11H- W.Oumdpae V","W rCade 15 Sim ( Empbyw. Rom I.D. m. I 16 Site amp-, up, ale. I 17 State Ineoms bm f 14 Laa wages, Hags, aa. I 19 Loesl Moms m. ( 201 aeeRry name I Form W -2 Wage and Tax Statement 2015 d Cana nutrmer vad X a Empbyw. nor, mddm -, ad ZIP soda oeprmm -1 a um r,.-ay - mmmmt urns.. OMB N. 15430009 sa14- b Errploya's mantlflwtlon number a Employw's sow s aunty, number I vPO9ee, tq., ofita carOSneefien z Eder lrrmnts t- rt-tld 13 SlruWy Employ- P.Ommmmt pa Thar "M rat Pry 5 me4tl Sseur9y, wages 4 Bow Smomily tae rthhrd 12 See Ears, for mx 12 14 OOa s E.Ploy.W. tame, address, and ZIP cods s Moulton, wages a- tom s Umfl- tax W11"d 7 Room SeemMy OR 9 Alloctled TIP. 10 Dgardent nor beral- 11 Nm Itawwwd Pima vaeNb.d- Code is Stns - play.'. stns I.D. m. 16 Sete wages, elm, Mc. 17 Sloe Income mx 19 Local wages, film, an. 19 I-" Mom. ax 20 L.." name maudartYw an engbk .many crew. I F reed ra.-me sails /HC). Y- may be atle to fake the DC for 2015 if par dined 8rr'on ixono you ...,awn ...,...., ,,,..�,,.,.,.«,,,.,,,,.,.., » ... ...... .....,,.... prcPMi- software It n puebk y-a rawre m Prepay wB Ina roquNel Ude code. The code Y J- Nomaxable act my (ashmveion only. ea ircludedn boxes 1, 3, a 5) me n kss thin c.nain m-nL The annwnl d cmdl 0 ta-d tm wcome and family also Ina mad - papa- fled,suers K -20%- -fat -..- V" p- W- pay -nla See "Ciba Tries' n the F-e 1040 Workers n tb,W chiller -M q.Wy for s amdkr wait. Y- and not guodyog cWWru must Ilox 10. The amome rid don des I.W depeadeM care bind" the your -ploy- Ned m y- or ®dn4om'' L- SuhstNWd -pbyw b,heee rxp- nmb- non (nournom k) nnve. vent ,, W surety -mbm (SSN.). Ym amot Win the ©C if you nvaminnt ncomc to round on y-r ImImW (ricking mtamts from a ucton 12.5 (caftleria)16W. Any' amount ova RRTA mz m t cost d gr m ioemarca wu )rice prov y-wem ore tlmn the s fed mo,onl for 2015 or d imome n wend fa nrr i_ lied whit $.5,000 eso n nchded n b t 1. Compi-From 2401, Otild .W UepmdaLL Cam Fxpenea, m au-i 1040 i tr (forma mpbYres ono Sm'YNher'faxv"n de Form IMO ssQ000 (faf mp yon om no Inmee a a peril ioMLLbo. For 2013 ncume biro ant more nfrmnMOn, vast aww.lrxga/eiae evnpu4 any rxbk and mranxable mmunln N-Let . on,lion,. N- lbcdkcid b4dcan fat m ruble ct-t a grotptetm lie naunre wu 590,000 (f a n Ali. s. Puh SW, L d 1-Crdk Any HC that b ran then poor rx RabilRy Is Bra It T hi, In- e: (a) npmtd in boo 1 d it in a dntribminn -ado o you from a meq -ofd on r,my). S. "pha Taxes' in the Fam 1040 nerer i- M..ded to -vet, hat only K yee roe • Iax Mar. Cora If area m -ml sa.ty ell Mrdcae face aon Pub ddord canpaason or roollo aarnentd sector 457(b) pler ow (b) includd . h..3 aodw 3 it it w a poor yea Win-I unda a en loilified a sector 457(6) Plot the became mxabk fa sw W P- fialudabk rowing -pane -®bmscmema pod dnaty to employee (- -hid . boson 1, 3, or A and r.Bgt -s melt n. y- s.bjut 517. Soo W Saumy and pha IMormeim f. Morten d the (Tugy and Reh®oue Waken sec m* and Akdrme Won Iles. year becmen Ore w fm kmga a mb h ntW rek of fafolva Myrna Q- Nsmmxabk comber pay. Son ft nntrod s fa Form IMO- F 1040A for dials m Conetlla.e. if War one, SSN, or el J w is im orrat cared Coping R C. ad 2 and nk Yon right to Ow Q.furrd mwnt. Thn box sbook] rot h ued g yon had a deferral mod a dwmbMkm in the acre calndv yea- If y- rode a def." ad -ni a dinrituton m the same catmda yea. "h-uW Int -WIl thin m-M R- Fmpkrya c- ntnbuliems to you A,cher MSA Rapal on Fam gBS, Archon ASAS and employer b coral par employmmt read. Be sure bask the ewpbya o file Fam W -2c, aril y- are. w. be age 62 by the roil of the csknda yea. y-r empkrya file Form I-ong -Tam Cone Ineunna Cwfrxa. Cortatd Wagead Tu SfeemeM, wth the SwW Sav,ly Armneumon (SSA)ocmnct mY S-nx tine. SSN, -money amowr uror mjo,td W the SSA- Fam W -2,11 eve. gat yoar wpm SSA- 13I.Fmpkrya Report MSpam1 Wage Prymrnts. wdh the SawlSau,lY AdmInnlretipe ad 8- Empoyes,by Wectim cmbibdons -kra mnto-4QRp) SIMPLE prn(nm ockWWi box I) Fam W -7c from y-r mpoy'. for all anratkws mein s-y- may file dem wN Poor W nor. give Y. a COPY. T- Adaptor bemliti (rut nchdd o box 1). Compton, Form 8839. Qulificd Adop- E perosea, m If your mere ad SSN one axrut bra are non the name art shown m yaw s-W early evil you Box Il TM ftrhwag M expldnc the onion drown n bar 12. Yoo mry-od lAn tlamafion to compete ny tinbin ell nanznbk smarms. s1uMd set fa a oerz cad tic. dwpwys y-r comecW name a ray SSA df a by ceMg rompt. yarr W return Mr.6 ld-nin (-d. D. E F. and S) and dceigeeW Rah rorrketena V -1- from -ion d nonent-y stark FU W,) (irc.hrdd In born 1, 3 (up W sorml 14)Ip772- 1213. You may nbo nor the. SSA a www Ion Lxrmlir.V4- •."•::: :'�:.::'a:ge ';. ti: (rod. AA M and EE) uuder n,8 plww aft gm-illy k.W to- Want of SI8,000 ($12,50D d y- ony hone SIMPLE pha; 521.000 for Baton 403(6) plus i y-u gmNy for the 15 nor rule .piood to muvay wage bse), end 3). Sa Pb. 325 end inns -carne fw Scbdde D (From 1040) ra repMing 1144 -mms. F:- R:,.:u...', i:: »." � . p..:"..:'. 0`, oopo�> reportog n But 12 u.i g Cede DD, a the can d rmpbya- �orord "ankh -=v 'e w for prior Pub. 571). Defertan under ooh G en blAed ro Sl$OOO. Odenaw unda c-de H are linked to W- Finppbbnr c.0botUme (n.Ndog rim W the empbyce dxld m c-b- usn4. -tire irf- -ooy Tin meoawt reputed wft► Coh DD Ion rid t-W. pain earns t If yet had more lhm one empoyer io 2015 non more thot $],3a] a set W $7'O" kowwa. dy- was M kaae age W r 7013. }our ampbyer may hone emend n addtooe 125 (cafaan) n)1- Fleahb Smn Acroxml. -Fam 8889, Hedth Sav Aa-ds 125( . War •� rok under a salon 4d mmA ddmd c ion pin. I -aunty sails Tier 1 reload relirerant (rill. N taxes wen wtA1wW y- may h m+k W claim a a dined d up o 56,000 (53.000 Fa satin 401(k)(11) ad 40B(p) SIMPLE plonl. Thor addnmal 7' lm d tha f, 7 (come unda a nmquekfed dde.d compaaeri- pin lha fain m emnfy salon 409A TM ,mp ddare moon n era stdjrct Ip the ovaa8limt - ilea "n'e ddemn. Fa code G. ibe Nml - dative w ncndd n biz Il n r -omM i(PF mans See "pia rein nn the excaa.gnar y-r fdae blame mx a yes nod roan man -e r ®brad mpkyer roil ddernlx may h dghtr for the Wo 3 Yeas hdam yes mob rororm age. CaVict ytmr pW mnwot awn 1. sub to m add tat is qm IMO nsrwcriwa. Tats' n t.h.„e tie Ihn 54,321.80 n Tier 2 RATA fat won wtMdd, yoo ako may h abk o ckvn a credo. Sa yea rbrm 1040 m Fam 1040A extrvfiom rid PA. 305. Tat Wthhttdmg eat Entmed Ter .Son -tasty for IN valmm ixe, Amounts n excons d the o mill r1whn ddeae Grit met b 'F�or.1m AA- D1oNNm n.. ILth comoilmonix unda a antis 401(k) plan. _Wol in roams Sm the "Wage, SAW., Tips, -." Ire moro lump fa Font 1040. BB- Demnend Roth c- t -ulimw uda a -im 403(6) phu. L6trmetlow for E to en, mP y Nate. if a ymr/ollam rode D done8b H. S. Y, M. RR, or EE. y' --made a xmlaay prom ... n.., e:.... 7.,. e.- w.:11<....m,..,.;..n:mm...,;., r r- ,.�,,,..a.....,..,e....... DD -C. f empbycr- apor -d b." -orange. The ®wnt reputed wM Cade BD a nM _. Do. 1, Feder thi6awmMw the -8.k -d Yom W mean -^^_ �omilde,0-me.-..-firIII_ _......-.._..I)- .i.,,-_.-. ,i- ,.___, -_ leJmberonwed.Ilor marabJa rte yea,dpvR Sett Me current )na.Vroymresbwn. Ye --- �Dr This am -md�es Ina umR, Rah con,, Beal Finer rhw -1 on fdae huomeWwlhheW Gwayoa Wretvn mnpr'tnrfa -aeJm de aumntprr. W- riept r mntmmdaction457(6)plm. roorrd apply mcomridaom ilia elat.ecempt mgmiaem satin 457(b ) pkm Bus S Y- may be aqued o rep. the mount -Fam ".. Addk.W Marker. Tax. Son the A- LGcukcred -W aorly or RRTA 1st - It., I- hrdethe tat to Fam 1040. Sa "pb, Bar la If the "Renemmt pin' box a chwk.1 P. W Imes m.Y ePpy t-de m-e of vadai -e Fam IDW nb.ctona to doe - Y yea art liquid to -PW I- RM Totes', Nn, Form IMO estrucliwre. IRA counboamm yvm may ddmL See Pub. 590. ImdwW -I Munn m Meogmeou (DL4e). Bra C Ths moon ncWon the 1.45% k4dkan Tae wehbcld -ap Akdksn wagu ant tie ehavu p -1 netRaicd Akd'csro vx a rim. inchde dm trot -Fam IOq. Su "pha Taxes' o the Fan Bra 14 Lnpkrym mop on this boo to report nfotlnmim Rw.h m eme dimbiliy assurance Wee IN M. or,- dve. umiform lay- -, h.M imm- prmi mes dduaed, - bk Iron. n &w 3, ar well Ne the 0.3& AOdlierW Metka -TU -any d Wow .dome wages ad tip, above IMO iaoructiooe. edacekooi - stance prvmeMe, a a mmba d lb ekrgy's pp-eramage agowame otd etNeea. $XO,OW C- Taxabk oral d pr ptemn Me ionumrue ova S5(X000 (i kiwi i boxes 1, 3 (up m smut Raikmd mpoyae use thn boob rcpt m" raimm (RRTA) camP.eMen, Ti r I W. Tea 2 Boa IN, The mare in nol in,Wdn betas1, 3. 5 a 7. For.fon.tiom- h- omPr -ip.- enemy wage bee), and 5) fame Ak&-,- W AmitknW Medcne Tn. 1-kfde fps 7rtW by On,ampoyee to lhompkya Your W rd.. son y-r Porn IOW im mor".. D -Flame dderrela o a lion 401(k) c.b or deferred -promo Ali. mchda &(amok .der in marod -rx (RRfA) c- Pomeson Yo --rRo Fa,Ne4 /37, SrmidS -kyand Ahdcre Tar m t.imprted Tipl-IAN, . SIMPLE ,iemm saws,m n Next don nttw 40l(k) auamr- Nate: Vep Capp CafF W21wm k-3 d Ax v1-fAV)swrMOmwemx Your Income W ntum o report a lime the saocaled tip moat arks yes cm Prove the You E- FTecme drtrmek ode, a cation 403(6 )6) ream. However, to hip pmenrlyearmrid canny 6e,efds, keep Copy C mail no begin mm mg -- dasmall.... -tIf you tae nc.ds the slaw the actual smamt dti(e yon-record. F- Elective hfertak order a satin 40B(kx6) carry dfwtion SEP A ynderon SUI .arid sanity b- efm,JustnmmfA- u a gwooe above ourfvark nowd -V., cam g, hen re" thin amount n -m if t e amen lea hn the "mad tip;. Gn Form 4137 y- w. r k lore 1-*"I r )-_ Form W -2 Wage and Tax Statement 2015 I TWS information in, brgn lumtehed to the 111-1 Revenue WO, Copy C, for employees records If yon re rm led m bl� a tax re Uri, a net' ante pe eMy a other sanction a b im osed on for if this ir4 i d u lag to report it, it Control -,roar 0903- 0903YP18 0000000002 - 000100 Veld a Empbyah -rim, adMa•,.rrd ZIP -& OLDE NAPLES TILE & MARBLE LLC SACACIAN KARIN R SOLE MEMBER 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 Daparlrrrem of the T,sa.ury - MamNe Ftwantm 9rwea 011111 150500°. D Employer Id.nKK,.Km member - � 6 0 3782 . F ployw. nprl..e- rdy.wm.r Y Nlp.a, pis, otlmr oonpertntlo,t -11111ftli, 2 FedNe.l Income rr wemaald Am BMI --.Net rkkd.PrfY 13 Employee wet Nea pay a eeM.l See army era.. 4 8-W Bemnpy M e1On.lad WM 12 See tale. for Box 12 14 O#W NO B1pbyN'srlalm., mddtm». d ZPee Ib MARIUS SACACIAN 1691 TRIANGLE PALM T'ERR NAPLES FL 34119 5Illod me we@ . rW tips -wpm d Medicare ft. elf"d vim 7 Spots s.mmay tp. a Allocated I" 10 Depa'dent ere hm oft 11 NonquNepMd plane VvKloallon Code [15 BM• E- PI.Y.r..lre IA. r4, to BMYwellimis ell, 1784..In«m -W 18 land wmKae, Iba, me. 19 Local Inane tax wLxwaN one Form W -2 Wage and Tax Statement 2015 Copy B, to be filed with employee's FEDERAL tax return d Cm wo -Mnh•r 0903- 0903YPI8 000000002- 000100 I Vold 1 . Employer. Nome, aldrele, Next ZIP ton OLDE NAPLES TILE & MARBLE LLC SACACIAN KARIN R SOLE MEMBER 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 Dapartnwre a th. rf.rury - rta-at Raynor saw.. OMBd/o.15464M b Employer'. Wnssmw --mho • Emplwn'-dol Ity rr.m.r wp.s We o-.r oonparnl 2 FelwNe Iec-Neax w,thh aM 1a emu" E -Ploy- R.tnM -M pIar rnkd -pr,y .In" p" a SDCW Si m rkV nmR" ism 4 Sport 8 -iffy" amdft 12 See hmtrs. for Box 12 id ()Kral a E.PI.YW. reme, nndrom, orxt ZIP nods MARIUS SACACIAN 1691 TRIANGLE PALM TERR NAPLES FL 34119 I--- tip... 5 Main- mx wN*.m r«■+Br -rYKPe 9ASp«d.ara ��d 2 Fed" Im »Inv M will"d VarKk-lbn Cod. 15 $We E.Pi y.e. we I.D. No. 1s BM. wept, up., n,4. 17 SM. income to 75 Lood recite, KW, ark. If Local broom. tax 20 Limaty ram. Form W -2 Wage and Tax Statement 2015 d Control remtber Vold cEmployer. -, Wdrw•, Next ZIPmM Oeoarmne of the Trnaury - lomr1W Rwanw S.rvice X OMB Non, 1560008 b Employes ld.ne8calf. number d Employes anl•I eacurky ntxMw 1 Mein. Noe, other oar q- tietbn 2 Fed" Im »Inv M will"d 13 Brbgmy Rrkement TWrd -WW Employes Isla Mok Pw a Spot Sorority Mpw 4II.M f -Ity Nen will"d 12 W 2'rebe: fm 1114 it 14 Mdiw 6 10.' ref-kefrm, vaWN TyK`atiz- 11 MO � p �Imixot` , "'mod 7 _ -a4,pk 4 3/x%5•" tyP 3 S W _ SgdlKb 11 . � ,5 Bate Employee. srm I.D. No. I 1a St"or"m, 0", rc. I 17 amf. (rm-v rx I la Loa. n.pw.,"Me. � 19 Lace) n.om•tax I 20 Lemift renal. emakak d You are abvue ta.ry-w, Eamad beak areal (HC). I'm may be olds b take the EIC for 2015 if your .4..d gms "eukuk aaftwora It s pmdbk your wfus set . Preparer will not nqu as Ibis code The code a 1- Nonaxable silk pry (nformstou mly..at ock lud n boxes 1. 3, m 5) came (AGD is 4sa than a .areas aroma. The aroma of,,dk o bad m ne.ee ad f,.k size. not eatud m P- Per-fied Mums K -20% acne bx m excer grid® paaclakt pay-. See "Otter Taaea" in the Fom I(M Workers wa- chidren -W qualify for a smalls ,us[C You ad asy qualifying chiidem mud Box IS TM -art iacM� the trial deperdeot tae bmefka the your,upky, paid W you tt L-S b La L- SUbstmliaed cmpbyce bases expmce rembkraantma (naavtaable) hive vakd soul swarity nusubm (SSN,). You .mina take the PIC if your isloo -nt income is -keml m your behalf (ncldng kale. L, from a section 125 (mfderi.) pWO. My cans over M- takeolectd - 01. -ity a MA W m tuable coat of S..P-.m Mc a asuct over m .e than Mt sPwifwl anumt. Wr 2015 u f uuome o eared for aervka Pnwided while Ym were SS,ODO also is nctw A in Nix 1. r.,,pide Form 2441. QdM a W Dcpw4M C1tre EXpemm, to 550000 (fame .Jy). Ss "plot Taxes"new Form 1010 aauu.an, innate e, a Y irmUlkinm F e 2315 income Inks and more abmaun, vas www.ira. "Ielk. -slakes any 1-a'k and nodaxabk tmmMa Ian 8 e& tax curt ro gra¢Mm Ne naumne over 550.000 (forma N- Ibce9a* Me Aoo,a Pub VM, Fared Iaome Credit. .fay E2C Net b mare t►an your des nawNy b Res IL This amount is (al repartd in box 1 7 / o a doarbmiov made to you from a nmgmkfed o w is aalYy Sea "Qhe Taxce" a the Form 1040 inanctimn. a "Other eaf -ded Iu You, but m" It You Poe a lax Mum. ddmd -F-at- nr -V,e rso," sanw 457(b) pa or (b) nchdd n box 3 e".5 if d P- E."ble movag rap- mobacemkeb paid dbady b empbyee (rut btcluded is boos 1, 3. Clare sad ntlrms w.A- If you are not aboat b social security ad Medere taxes ace Pub n a pubs year defcrml uad, a "usffad . secton 457(6) plan the, became toaable for social .5) 517. Social Security ad Other Infome,aw f. Meabm d the Ck gy sari Rekgioue Wmkere eaurdy rind Med[ure taxes alp )ear 6ecauee throe n no loiter a subNantnl risk of fmfegrre of ymx Q- NMaxekk cmnbet pay. See the nvVUClions la Fttm 1040 re Form IlxgA for de1WS an C- 41oo. If your nape, SSN, .address is buconat, ..tact Copies R C, ad 2 sad ask your ngM b the deferral amtum. Thin box should not be used if yes had a &to" ad a disunha lv n the sure caknda year. If yes rode a defmal ad r ..had a disrribal- in the same "Wake y . rep.ling the mucarn4 R -Bnpby. .knakaov W your Archer MSA Report m Fom 8813, Archer MSAs and b cueect rot recd. Be curt to aak the tan file I- W.Z. couplers Yksa aopbym atMium Crxrecid Wage ad T. Staemcm, wkh des Socr Sawdy Admanhalim (99A) bcuroct my ••d You are. wiR ha age 62 by U. add 8rc caleder yar. Your amply, shodd fh Fom I.ongTerne Caro inru - Cmtmcts. S -Em rduclim emtnbeuns tuber a satun 408(p SIMPLE DbYe -salary plan (M ocNxld n box moue, SSN, m roomy roses error repmd b the SSA m Farm W -2. Be over to Sao yo. copies d SSA- 131. Employ, Reps) of Speed Wage Paymeaa, wkb the Socal Security Ad, inatmtuo and I) P.m W -2c from Your amply, fu all eaera: bas rode so yes may file then wkh you tae rW o, Poe Ym a copy. T -Ad ptim, beaeft, (m nchdd n box 1). Compkh Form 5639. Qualeid Adapbn E PMaea b If Yes• Mine and SSN arc crxrect but - are the ne.e a shown mYour -W eecarty cad you B. 12 The fo9avag ld cxplma the axls shown a hoc 12. Ym may veil M w.maion a compute any 1-ble ad n-s" amomts. sb.W ask for a vcw cod the display. Your coma mum M1 any SSA df a by cabg ckmpfe your tax Mum B¢twe deferrals (axles D. E F, std S) roil "gated Rah eoM1rbLLires V- Income from exereaed kmetaakory at 1, oVjuk(.) (achrRd o bone 1.3 (up b saw 1- SW772- 1213. You mry aao vole the SSA s (cads AA IS,, sal EE) ued, art Pboa are generady Will J b a I.W of SIR M ($n,3W 7 you m1y hoe SIMPLE Pass; $21,000 fm satinet 403(6) plan, f xis qua s f. the 15-year roil explained n r"':,::�e:- s,urky wag, bree), sod 51 Sao Pub. 525 rid waruc- fee sehMale D (Farm 1090) far reporting ualksommu. .,:.,.g C.& D, fob. aye a f w Wy- o po azd h kkk`Z -p j'vi.; Pub. 5771. Dd-I& under code G am kmkd to SIS.000. Deferrals under code fi me limed b Code te Me cad d f. your rep.bg n /2 heath rnveagc w%` W -Fmppbbyy - flooaae (ncktdog amouw We ampb)a chid to carkrbule osg a -6- DID isa-s t-bic $7,000. reported Cade DD Is ad Th. aroaat repined cramaax only. . Hal if a kat 5D n 2DI5, hove &-d an ddki.d mry Yon were age your ead 125 (ca(d ) pbo) to Your Husk Skump Are- Repot m Farm 8889, Health Savings Aao- (HSM)' 2DI5 lea Cndll far exosa taxes. If hd roue Uam one 2)i S axl more Ue 57,. n soil xce a do Yes, ess ware in ddms d up a $6.0110 (Si,000 f..ecrit. 901(k)(I I) rid qC®(p) SIMPLE plea). ddaawal 408( Y,-Defr.Mala °der a plan. erred fad ddmd 4l quefil de ho," tae 1 eecurkyad'.Tkr 1 mbemd retsemml (ARf Al revs ,'ere wkhMM You may be able; b cam a 7 Income uric ... qud'Ficd deferred cavpeuatim plan Ws fink b aatnfy ucelan 409A Tbie ddmd anmM1 o rot erinjat b the ov,aY Rmlt m dative dderMs. F. code G, the Rmb m dative e fie a Yen a bra I. It o subject to m addlana120'6 tax iMerea. Sea "Other creAl f. tee your Triad kwome.lax yes hd mom than one silos. m roil ddmd, may be Hagler f. the lea 3 yea, bdoro you roach rclbmsl age. Cunlat Y'1ar Plan mood plan - 10 T'axs" n 0r Fom 1090 arsrruabns. 1A. S .e Nan 54,321.80 in Tier 2 RRTA mx wr wkhhdd yaw also may d e,1k b .biro a crdiL See 32c 8 in Ter L yes. Form IW re Fom 1040A inaructiom old Put, 505, Tar W'ehhMin, std Eatnatd Tax nM1 umWo`r fm mare ieformiim Moouda to -.a of the.... elective deferral had mmt lee AA- D -gratd Ruth comribmuna ukde a -ukao 401(k) Pon. nddd n iruame See the "Wags, Salaries. Tqo, etc." lot ,stratum f. Form 1040. Bs- DsigvM1W Rath amn barka. °der a sactkw 403(6) Pen. IMxttnarfiotla for EnWi yea Nee. /f a yearfdfowr rode D ehurg6 H. S. 11, A4, BB. or EE, you made a mak-p P *aloe DO -Curt M mVI,), -prsu rd health ruump. The rror°t reported v Cade W 6 out sax L Faker this amount m the wa lined tae rturn ocntnbreaov for °Prior, a (,) whey you was n ndfituY aev(ce. To ftgu. wA,Aa win made ere, pa yon dq -slU, a"de, duce asmahfm I.)- A- mlthe-1 yea, if ro your ushown, she taxable. l - DsigMd RoN cardnMnions order .govammemal section 457(b)plan. Th. -, deco not Roe 2 Faker this amount m the federal iaome tax wKMea had yin. toe Tatra -.1s data -fur Wr.rmalyear. apply b contribnum °der a tax --.pl pri2eiev satire 457(h) Plan Rua S. Ym may be M I-W to report Mn am.am m From 8959. Addbuvel Mediae Tax. Sao the A- 1.4-loclW socel security. RRTA M on tps. 1whrds this ux m Farm 1040. Sm'Yxhar sae U If the "RM1eemmt Pas' box n cbmka sp,nl bas may apply to the mma of t- lillnd Fom 1010 in,(mctans to ddermar f You arc,"WW b campkk Form 898. Texas" n the Pam 1040 instruction, IRA covarikukuns you may dedsl Sce Pub. 590, fralaidal R."- AMmgmme (IRAs). bas 5 The snood nckdea the 1.45:, Mdkare Tax wthbdd m O MWI wages and Ipa shown B- U- 11actd Mdkaremx on lips Iwk de 0u, ra, m Farm 1040. Sao "Other Tax °" in the Fom S. ld Fanpkrym may use bla box to repro adumauo amh a sate donNMy insurance trs obbold. mass dos, undom psymeea hskh nmeance praniums dilated, roodusal k tams, a Bur,.-, s wdt s the 0.9& Akld -I Medicare Tae m sty M thou, hkdlcae wags o d ties above Ipp iM k tlom. 4200 Otl0 educational .mama Pap-. u a man,ba d the ckrgy'e parso��age dlwance and LLibt- C- Taxable cos of g-p-- lie aa- over $50000 (srluded n boos 1, 3 (up to eocad Bur & Thin sand in M achdal in trees 1. 3. 5 or 7. Fr efomraioa m his to report iqa m saucy lose b_), and 5) Rail, ad mpbyers use the bm 10 mpvt rW ra l moment (XWCA) compeastim. Tier I tin, Tar 2 tin, Medicare tax and Add'anrd Mullam Tai, Inckde I" Mportad by the ekkPIo) c to the MOa)W your tar Mora sea your Facts 1040 narueuma. _ D- Ekecnve deferrals b a asetun 401(k) cash re defemA arrangement Abo iecnds deferrals under n rdhwd Hormel (RRfA) cttnpnatim au.. r..,. r...... r.. rv,.,.. w. �e�" ,r..,w3.,.....,n..ra.,a....r.n. r... ru.......sr...,. r.,. yes kcomt••°•::y•u•"'W =:�Ort •~:,•'J•.:W:V....a lq am •: µyaucm prove Mymw a]IMPlb elranml eccmathae ptd s eactam N)1(k) -sea -, my Mum b r a least the located mot -I- Sat E-Eleethe ddeml under a scum 403(b) nlry rdwtaw egueerreat ream!H eoweverm� s he1P pMerr yaw °d ra'smY bea�ltr, tarp CopYC annlym f4;in reufving dvd.eromer , moue. lfym h. -aer Wes show Mesmlders -d t4• Yak -.ld, F- 6kcave defertak undersaatam 408(kl(6)adry redudao SFP raced s--.y � .jour ff- q lion about yk -A -d rode, eorWng, is usim tb ,nmd even f k e mare. leas than the allmsted W. Oa Farm 4137 you wB .*alike par.aWkr Yk'u Form W -2 Wage and Tax Statement 2015 TMe krtormation is being,umished to Me Internal Revenue Srvice. Copy C, for employees records Il yo e a requned ro,ke a lax return, a nagl ands p If . o hr aancbon m t rid on it l i t le 7 6 to MOM R. d Con" nun4 -r 0903- 0903YP18 0000000010 - 000100 I Vold . EmpbyW. Mo., vdd- e W ZIP Mil. OLDE NAPLES TILE & MARBLE LLC SACACIAN KARIN R SOLE MEMBER 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 Dapaamart of the Ttw.ury - Mona Rermm Oils No. 15450008 Srdq Is EmpkyW.IdonSN.othko -b or -3 8 86 °Erp1.yM•.°new- ur"Y "" °° �9 +'�' �"• ^�.mwn.atlon MW 2 r -.oral Incenr m edMnae 19 sbnaaey Ralenant E.P Y°. war Thbe9 as Pis 5 skew Security wags. 4 skew Security M °d 12 Book Intl- for Rox 12 14 OMs • Empay.W. nmr, add-, rid ZIP Daft DORIS SACACIAN 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 5 M-Aloam wW- rM d"Mft 6 Median tax wlMhol i T Skew gemmty 8P. a Nlaawea Tlp- -' -- 19 D.P.m«tt are bwmtla 11 Nongmitlad pyre Ver6bMlon Cad. 19 L..Y bmm. ire 16 Stab Erpayae. aeg -I.D. Nu,. 16 stab wpm, Bpi, rib. 17 8we Imam- tax 18 Lkml wages, tIM ark. V.11W.aM Cad. 19 Lora bk.la. M 16 8bts I Empayar. situ IA. Nil. A Locality mm. Form W -2 Wage and Tax Statement 2015 Copy Be to be filed with employee's FEDERAL tax return f CMaW mmMer I 0903- 0903YP18 0000000010- 000100 Vold c EmP"" nomew B I -d zW oaf. OLDE NAPLES TILE & MARBLE LL.0 SACACIAN KARIN R SOLE MEMBER 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 Dapartlrtenl of it* Te.wy • ktiwnr Revmua $erylp ove No. 15454M08 bftol" r•- Ideu5cation -bor 04-3782186 .E,nd•y.•wral....9YnaMba /Wt0 --tips. oMr n.Irpem.Wn 21a1wrincomeMd"Isid ib satub" RNbernea Tbkd -pm" Enpayke wan Mark p"' 5 akkw Security wegm Idow 4 Skkw S.etu,ty ax 12 Sae to". I. tl.x 12 1408mr a Bonsicukft twM.atlr-M, rd ZIP cad, DORIS SACACIAN 1691 TRIANGLE PALM TERRACE NAPLES FL 34119 5 Was- wMW end t4. 6Mooffi -M wbthdd 7 $.W Sksou" 9w a aboaetl Ter. ,o D.P.a k rt... bawg° 11 N."suffied Ph- V.dlaad.n Code 10 Rrts ak akw. kkatb I.D. too. 16 Slab w." ,.P -..b. 17 Stab 1.- M is Loom regm, lo-, -t.. 19 L..Y bmm. ire 20 Locality name Form W -2 Wage and Tax Statement 2015 d Cmrhol trundler void X . Empaya'e Make, addrkea, oud ZIPeod. Dapertnterrl a thus T,m.ary - alemN R.ymu. 096 No, 15450006 s.rwm Is Employs,'. IO.n05.°9on tombs s EmPloy"'a oocw aeeurity number t vrB.- tp, otlmr komp.r.aara 2 tacos 1- M rtldwe 18 Wait" E.ploves Rahatnanl par Thldlvrty alek Pay 2 Sudd B.mPbf -qua 4 spew smurky M wnthad 12 see Bern, to sox 12 1400- s Etnpayke'.mm-addns- ,rWZIPods 61 dI -wopok ant th. IM"-tan w18dMd 7 Seklf smur9y Bp. a NlmabU TIP. 10 Depoedent ears bwwft 11 MaptwOld 0- V.11W.aM Cad. 16 8bts I Empayar. situ IA. Nil. I 16 SM. wags, 6, t., I V State IrWetrt. bQ ( i6looM xatPt, ljls, ales � 19 Local In.kma M � W Loamy name i Detail by Entity Name Florida Limited Liability Company OLDE NAPLES TILE & MARBLE LLC Filing Information Document Number FEI /EIN Number Date Filed Effective Date State Status Last Event Event Date Filed Event Effective Date Principal Address 280 29th. St NW NAPLES, FL 34120 Changed: 04/06/2015 Mailing Address 7Rn ')a +h c+ NAN c..vv c_vu . va � • r NAPLES, FL 34120 Changed: 04/06/2015 L04000000942 04- 3782186 01/05/2004 01/01/2004 FL ACTIVE CANCEL ADM DISS /REV 01/04/2006 NONE Registered Agent Name & Address SACACIAN, KARIN R 280 29th. St NW NAPLES, FL 34120 Address Changed: 03/15/2016 Authorized Person(s) Detail Name & Address Title MGRM SACACIAN, KARIN R 280 29th. St NW NAPLES, FL 34120 Annual Reports Report Year 2014 2015 2016 Document Images Filed Date 02/13/2014 04/06/2015 03/15/2016 03/15/2016 -- ANNUAL REPORT View image in PDF format 04/06/2015 -- ANNUAL REPORT View image in PDF format 02/13/2014 -- ANNUAL REPORT View image in PDF format n1 /1 A/,)n1 i -- L1mKn w PPPOPT vio \Ai imonc in Dnr: fnrmof 1- / \I V V 1 ♦VI VI 1 VIV V1 IIIIUyV 111 1 ✓1 IVIIIIUI 01/04/2012 -- ANNUAL REPORT View image in PDF format 01/04/2011 --ANNUAL REPORT View image in PDF format 0110412010 -- ANNUAL REPORT View image in PDF format 04/14/2009 -- ANNUAL REPORT View image in PDF format 01/16/2008 --ANNUAL REPORT View image in PDF format 12/04/2007 -- ANNUAL REPORT View image in PDF format 01/05/2007 -- ANNUAL REPORT View image in PDF format A4 MA /AAAC �CIAICTATCIIAI -PIT \r_...:_____:_r.r.rc_____ V IIVIt /LVVU -- RCIIVJ I h I CIVICIV 1 VIE3w IFfIcigre III Pur IUIITldt 01/06/2004 -- Florida Limited Liability View image in PDF format CONTRACTORS LICENSING BOARD COLLIER COUNTY, FLORIDA ) BOARD OF COUNTY COMMISSIONERS ) COLLIER COUNTY, FLORIDA ) Petitioner, ) ) Case No: 2015-09 vs. ) License No. 25598 Karin R. Sacacian ) D/b/a Olde Naples Tile & Marble, LLC, ) Respondent(s) ) ORDER THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on April 20, 2016, for consideration of the Administrative Complaint filed against Karin R. Sacacian dba Olde Naples Tile & Marble, LLC, the "Respondent". Service of the Complaint was made in accordance with Section 22-202 of the Code of Laws and Ordinances of Collier County, Florida. The Board made a finding of fact that the service conformed with the requirements of the Code of Laws and Ordinances of Collier County, Florida. The Board having at said hearing heard testimony under oath, received evidence, and heard arguments respective to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law, and Order of the Board as follows: Page 1 of 6 452327.2 4/29/2016 FINDINGS OF FACT 1. That Karin R. Sacacian is the holder of record of Collier County License Number 25598, as a Tile and Marble Contractor. 2. That the Board of County Commissioners of Collier County, Florida, is the complainant in this matter. 3. That the Board has jurisdiction of the person of the Respondent and that Karin R. Sacacian was present at the public hearing and was not represented by counsel at the hearing on April 20, 2016. 4. All notices required by the Code of Laws and Ordinances of Collier County, Florida, have been properly issued, hand delivered and sent by certified mail in accordance with Section 22-202 of the Code of Laws and Ordinances of Collier County, Florida. 5. The evidence presented and testimony given established that the Respondent acted in a manner that is in violation of the Code of Laws and Ordinances of Collier County, Florida, as follows: failing to promptly correct faulty workmanship or promptly replacing faulty materials installed contrary to the provisions of the Construction Contract. 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. (Code of Laws and Ordinances of Collier County, Florida, Section 22-201(10)), and is the one who committed the acts. Page 2 of 6 452327.2 4/29/2016 6. That the Contractors' Licensing Supervisor and Staff presented sworn testimony, and the administrative complaint and exhibits thereto were admitted into evidence. The Respondent was afforded an opportunity to present sworn testimony, exhibits, and to cross examine the Contractors' Licensing Supervisor and witnesses. The Board was afforded an opportunity to ask questions of the witnesses. The Board determined that the allegations of fact as set forth in the Administrative Complaint are true and therefore such facts are hereby found to be supported by the evidence presented at the hearing. CONCLUSIONS OF LAW 1. The Conclusions of Law alleged and set forth in the Administrative Complaint as to Counts 1 were supported by the clear and convincing evidence presented at the hearing on April 20, 2016, and said conclusions of law are hereby approved, adopted, and incorporated herein, to wit, the Respondent violated Code of Laws and Ordinances of Collier County, Florida, Section 22-201(10) in the performance of her contracting business in Collier County by acting in violation of the section set out above with particularity. 2. Collier County has jurisdiction over this contractor. 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 the Code of Laws and Ordinances of Collier County, Florida, by a vote of 7 in favor and 0 opposed, Page 3 of 6 452327.2 4/29/2016 a unanimous vote of the Board members present, the Respondent has been found in violation as set out above. Further, it is hereby ORDERED, by a vote of 7 in favor and 0 opposed, a unanimous vote of the Board members present, that the following disciplinary sanction(s) and related order are hereby imposed upon the Respondent as holder of Contractor's License Numbers 25598: 1. The Respondent's License is hereby revoked. 2. Respondent is ordered to pay $6,725.55 as restitution to the homeowner. 3. Respondent is ordered to pay a fine in the amount of three thousand dollars ($3,000.00). 4. Respondent is ordered to pay $1,100.00 in administrative and investigative costs to the County. 5. The Respondent shall be given a public reprimand and the cost of publication thereof shall be borne by the Respondent. 6. Any reapplication for a license by the Respondent shall come before the Board. 7. Any amounts paid shall first apply to restitution to the homeowner, then investigative costs, then the fines, until each category is paid in full. The parties are further notified that upon the timely filing of a Notice of Appeal within thirty (30) days you may have the decision of the Board reviewed pursuant to the Page 4 of 6 452327.2 4/29/2016 procedure set out herein. The Respondent may appeal a decision of the Board to the Collier County Circuit Court. Such an appeal shall not be a hearing de novo but shall be limited to appellate review of the record created before the Board. Any appeal shall be filed with the Circuit Court and served on the parties within thirty (30) days of the mailing of the decision of the Board under the Code of Laws and Ordinances of Collier County, Florida, Section 22-202(g)(9). In the event that the Respondent elects to appeal, a verbatim record and transcript of the proceedings will be necessary. It shall be the sole responsibility of said party to ensure that a record is made from which a transcript may be prepared which includes the testimony upon which an appeal may be taken. Neither Collier County nor the Board has any responsibility to provide a verbatim record transcript of the proceedings. ORDERED by the Contractors' Licensing Board effective the 20th day of April, 201. Thomas Lykos, Chair/ an Contractors' Licensi t. Board 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 to the Respondent; and Mr. Michael Ossorio, Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103, on this 3, day of MAK , 2016. iW\ncretarY/Contractors' Licensing Board Page 5 of 6 452327.2 4/29/2016 Page 6 of 6 452327.2 4/29/2016 CONTRACTORS LICENSING BOARD COLLIER COUNTY, FLORIDA ) BOARD OF COUNTY COMMISSIONERS ) COLLIER COUNTY, FLORIDA ) Petitioner, ) ) Case No: 2016-01 vs. ) License No. 36257 & 36258 Steven W. Cole ) d/b/a Below Cost Flooring, Inc. ) ) Respondent(s) ) ORDER THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on April 20, 2016, for consideration of the Administrative Complaint filed against Steven W. Cole dba Below Cost Flooring, Inc., the "Respondent". Service of the Complaint was made in accordance with Section 22-202 of the Code of Laws and Ordinances of Collier County, Florida. The Board made a finding of fact that the service conformed with the requirements of the Code of Laws and Ordinances of Collier County, Florida. The Board having at said hearing heard testimony under oath, received evidence, and heard arguments respective to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law, and Order of the Board as follows: Page 1 of 7 452346.2 4/29/2016 FINDINGS OF FACT 1. That Steven W. Cole is the holder of record of Collier County License Numbers 36257 & 36258, as a tile, and marble & floor covering contractor, respectively. 2. That the Board of County Commissioners of Collier County, Florida, is the complainant in this matter. 3. That the Board has jurisdiction of the person of the Respondent and that Steven W. Cole was not present at the public hearing and was not represented by counsel at the hearing on April 20, 2016. 4. All notices required by the Code of Laws and Ordinances of Collier County, Florida, have been properly issued, hand delivered and delivered by certified mail in accordance with Section 22-202 of the Code of Laws and Ordinances of Collier County, Florida. 5. The evidence presented and testimony given established that the Respondent acted in a manner that is in violation of the Code of Laws and Ordinances of Collier County, Florida, as follows: Contracted to do work outside of the scope of his competency as listed on his competency cards; disregarded or violated, in the performance of his contracting business in the County, any of the building, safety, health, insurance or worker's compensation laws of the state or ordinances of the county pursuant to Section 22-201(6) of the Code of Laws and Ordinances of Collier County, Florida; and the work was completed and the customer had to pay more for the contracted work than the original contract price, and is the one who committed the acts. Page 2 of 7 452346.2 4/29/2016 6. That the Contractors' Licensing Supervisor and Staff presented sworn testimony, and the administrative complaint and exhibits thereto were admitted into evidence. The Respondent was afforded an opportunity to present sworn testimony, exhibits, and to cross examine the Contractors' Licensing Supervisor and witnesses but chose not to attend the hearing. The Board was afforded an opportunity to ask questions of the witness. The Board determined that the allegations of fact as set forth in the Administrative Complaint, as to Count I, Code of Laws and Ordinances of Collier County, Florida, Section 22-201(2); Count II, Code of Laws and Ordinances of Collier County, Florida, Section 22-201(6); and Count III, Code of Laws and Ordinances of Collier County, Florida, Section 22-201(8)(a)(3), are true and therefore such facts are hereby found to be supported by the evidence presented at the hearing. CONCLUSIONS OF LAW 1. The Conclusions of Law alleged and set forth in the Administrative Complaint as to Count 1, II, and III were supported by the clear and convincing evidence presented at the hearing on April 20, 2016, and said conclusions of law are hereby approved, adopted, and incorporated herein, to wit, the Respondent violated Code of Laws and Ordinances of Collier County, Florida, Sections 22-201(6), Sections 22-201(2), and 22- 201(8)(a)(3) in the performance of his contracting business in Collier County by acting in violation of the sections set out above with particularity. 2. Collier County has jurisdiction over this contractor. ORDER OF THE BOARD Page 3 of 7 452346.2 4/29/2016 Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and the Code of Laws and Ordinances of Collier County, Florida, by a vote of 7 in favor and 0 opposed, a unanimous vote of the Board members present, the Respondent has been found in violations as set out above. Further, it is hereby ORDERED, by a vote of 7 in favor and 0 opposed, a unimous vote of the Board members present, that the following disciplinary sanction(s) and related order are hereby imposed upon the Respondent as holder of Contractor's License Numbers 36257 and 36258: 1. The Respondent's Licenses are currently suspended and application for reinstatement must come before the Board; 2. Respondent is ordered to pay a fine as to Count I in the amount of one thousand dollars ($1,000.00) to be paid within thirty (30) days. 3. Respondent is ordered to pay a fine as to Count II in the amount of five thousand dollars ($5,000.00) to be paid within thirty (30) days. 4. Respondent is ordered to pay restitution to the consumer in the amount of $3,408.77 within thirty (30) days. 5. Respondent is ordered to pay $1,000.00 in administrative and investigative costs to the County within 30 days. Page 4 of 7 452346.2 4/29/2016 6. Respondent is to be subject to a public reprimend the publishing costs of which are to be borne by the Respondent. 7. Any amounts received shall first be applied to the restitution to the consumer, then to the $5,000 fine as to Count II, then to the fine as to Count I, then to investigative and administrative costs. The Respondent, any other party, the chairman of the Contractors' Licensing Board, the Contractors' Licensing Board as a body, or the assistant county attorney who tried the case may request a rehearing of any decision of the Contractors' Licensing Board. A request for rehearing shall be in writing and shall be filed with staff and a copy thereof should be delivered to all other parties within twenty (20) days from the date of mailing or other method of delivery to the Respondent(s) of the Board's written decision. A request for rehearing must be based only on the ground that the decision was contrary to the evidence or that the hearing involved an error on a ruling of law that was fundamental to the decision of the Board. The written request for rehearing must specify the precise reasons therefore. The decision of the Board that is the subject of the rehearing request will remain in effect throughout the rehearing procedure unless the Board orders otherwise. The Board will make a determination as to whether or not to rehear the matter and its decision shall be made at a public meeting, which will be reduced to writing and mailed to the interested parties within 21 days after the determination is made. If the Contractors' Licensing Board determines it will grant a rehearing, it may: Page 5 of 7 452346.2 4/29/2016 a. Schedule a hearing where the parties will be given the opportunity of presenting evidence or argument limited by the Board to the specific reasons for which the rehearing was granted; or b. Modify or reverse its prior decision, without receiving further evidence, providing that the change is based on a finding that the prior decision of the Board resulted from a ruling on a question of law that the Board had been informed by its counsel was an erroneous ruling and which ruling could affect the substantive decision. The parties are further notified that upon the timely filing of a Notice of Appeal within thirty (30) days you may have the decision of the Board reviewed pursuant to the procedure set out herein. The Respondent may appeal a decision of the Board to the Collier County Circuit Court. Such an appeal shall not be a hearing de novo but shall be limited to appellate review of the record created before the Board. Any appeal shall be filed with the Circuit Court and served on the parties within thirty (30) days of the mailing of the decision of the Board under the Code of Laws and Ordinances of Collier County, Florida, Section 22-202(g)(9). If there has been a re-hearing request granted, the appeal shall be filed with the Circuit Court and served on the parties within thirty (30) days of the mailing of the re-hearing decision under Code of Laws and Ordinances of Collier County, Florida, Section 22-205. In the event that the Respondent elects to appeal, a verbatim record and transcript of the proceedings will be necessary. It shall be the sole responsibility of said party to ensure that a record is made from which a transcript may be prepared which includes the testimony upon which an appeal may be taken. Neither Collier County nor Page 6 of 7 452346.2 4/29/2016 the Board has any responsibility to provide a verbatim record transcript of the proceedings. ORDERED by the Contractors' Licensing Board effective the 20th day of April, 2016. Thomas Lykos, Chair an Contractors' Licensin;- Board 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 to the Respondent; and the Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103, on this 2. day of 'WWI , 2016. cretary/Contractors' Licensing Board Page 7 of 7 452346.2 4/29/2016 CONTRACTORS LICENSING BOARD COLLIER COUNTY, FLORIDA BOARD OF COUNTY COMMISSIONERS ) COLLIER COUNTY, FLORIDA ) Petitioner, ) ) Case No: 2016-02 vs. ) License No. 26673 ) Dennis Tome' ) d/b/a D. & V. Customs, L.L.C. ) Respondent(s) ) ) ORDER THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on April 20, 2016, for consideration of the Administrative Complaint filed against Dennis Tome' dba D & V Customs LLC, the "Respondent". Service of the Complaint was made in accordance with Section 22-202 of the Code of Laws and Ordinances of Collier County, Florida. The Board made a finding of fact that the service conformed with the requirements of the Code of Laws and Ordinances of Collier County, Florida. The Board having at said hearing heard testimony under oath, received evidence, and heard arguments respective to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law, and Order of the Board as follows: Page 1 of 7 452357.1 4/29/2016 FINDINGS OF FACT 1. That Dennis Tome' is the holder of record of Collier County License Number 26673, as a carpentry contractor. 2. That the Board of County Commissioners of Collier County, Florida, is the complainant in this matter. 3. That the Board has jurisdiction of the person of the Respondent and that Dennis Tome' was present at the public hearing and was not represented by counsel at the hearing on April 20, 2016. 4. All notices required by the Code of Laws and Ordinances of Collier County, Florida, have been properly issued, hand delivered and or delivered by certified mail in accordance with Section 22-202 of the Code of Laws and Ordinances of Collier County, Florida. 5. The evidence presented and testimony given established that the Respondent acted in a manner that is in violation of the Code of Laws and Ordinances of Collier County, Florida, as follows: Contracted to do work outside of the scope of his competency as listed on his competency cards; commited mismanagement or misconduct in the practice of his contracting business that causes financial harm to a customer, and proceeding on a job without obtaind the applicable permits or inspections, and is the one who committed the acts. 6. That the Contractors' Licensing Supervisor and Staff presented sworn testimony, and the administrative complaint and exhibits thereto were admitted into evidence. Page 2 of 7 452357.1 4/29/2016 The Respondent was given an opportunity present testimony and submit evidence and to cross examine the County and witnesses. The Board was afforded an opportunity to ask questions of the witness. The Board determined that the allegations of fact as set forth in the Administrative Complaint, as to Count I, Code of Laws and Ordinances of Collier County, Florida, Section 22-201(2); Count II, Code of Laws and Ordinances of Collier County, Florida, Section 22-201(8); and Count III, Code of Laws and Ordinances of Collier County, Florida, Section 22-201(18), are true and therefore such facts are hereby found to be supported by the evidence presented at the hearing. CONCLUSIONS OF LAW 1. The Conclusions of Law alleged and set forth in the Administrative Complaint as to Count 1, II, and III were supported by the clear and convincing evidence presented at the hearing on April 20, 2016, and said conclusions of law are hereby approved, adopted, and incorporated herein, to wit, the Respondent violated Code of Laws and Ordinances of Collier County, Florida, Sections 22-201(2), Sections 22-201(8), and 22- 201(18) in the performance of his contracting business in Collier County by acting in violation of the sections set out above with particularity. 2. Collier County has jurisdiction over this contractor. 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 the Code of Laws and Ordinances of Collier County, Florida, by a vote of 7 in favor and 0 opposed, Page 3 of 7 452357.1 4/29/2016 a unanimous vote of the Board members present, the Respondent has been found in violations as set out above. Further, it is hereby ORDERED, by a vote of 7 in favor and 0 opposed, a unimous vote of the Board members present, that the following disciplinary sanction(s) and related order are hereby imposed upon the Respondent as holder of Contractor's License Number 26673: 1. The Respondent is hereby placed on probation for a period of two years; 2. Respondent is ordered to pay a fine as to Count I in the amount of three thousand dollars ($3,000.00). 3. Respondent is ordered to pay a fine as to Count II in the amount of one thousand dollars ($1,000.00) to be paid within thirty (30) days. 4. Respondent is ordered to pay restitution to the consumer in the amount of $1,000. 5. Respondent is ordered to pay the judgment rendered in the Small Claims Division of the Collier County Court in favor of the consumer in the amount of $5,000. 6. Respondent is ordered to pay $500.00 in administrative and investigative costs to the County. 7. Respondent is to pay all past due citations in the amount of $3,200 to the County. Page 4 of 7 452357.1 4/29/2016 8. The Respondent shall pay $5,000 to the total amount due within 30 days; $5,000 toward the total due on or before 60 days, and the balance on or before 90 days from the date of the Order. 9. If any payments are missed the Respondent's license shall be suspended and he will need to appear before the Board for reinstatement. The Respondent, any other party, the chairman of the Contractors' Licensing Board, the Contractors' Licensing Board as a body, or the assistant county attorney who tried the case may request a rehearing of any decision of the Contractors' Licensing Board. A request for rehearing shall be in writing and shall be filed with staff and a copy thereof should be delivered to all other parties within twenty (20) days from the date of mailing or other method of delivery to the Respondent(s) of the Board's written decision. A request for rehearing must be based only on the ground that the decision was contrary to the evidence or that the hearing involved an error on a ruling of law that was fundamental to the decision of the Board. The written request for rehearing must specify the precise reasons therefore. The decision of the Board that is the subject of the rehearing request will remain in effect throughout the rehearing procedure unless the Board orders otherwise. The Board will make a determination as to whether or not to rehear the matter and its decision shall be made at a public meeting, which will be reduced to writing and mailed to the interested parties within 21 days after the determination is made. If the Contractors' Licensing Board determines it will grant a rehearing, it may: Page 5 of 7 452357.1 4/29/2016 a. Schedule a hearing where the parties will be given the opportunity of presenting evidence or argument limited by the Board to the specific reasons for which the rehearing was granted; or b. Modify or reverse its prior decision, without receiving further evidence, providing that the change is based on a finding that the prior decision of the Board resulted from a ruling on a question of law that the Board had been informed by its counsel was an erroneous ruling and which ruling could affect the substantive decision. The parties are further notified that upon the timely filing of a Notice of Appeal within thirty (30) days you may have the decision of the Board reviewed pursuant to the procedure set out herein. The Respondent may appeal a decision of the Board to the Collier County Circuit Court. Such an appeal shall not be a hearing de novo but shall be limited to appellate review of the record created before the Board. Any appeal shall be filed with the Circuit Court and served on the parties within thirty (30) days of the mailing of the decision of the Board under the Code of Laws and Ordinances of Collier County, Florida, Section 22-202(g)(9). If there has been a re-hearing request granted, the appeal shall be filed with the Circuit Court and served on the parties within thirty (30) days of the mailing of the re-hearing decision under Code of Laws and Ordinances of Collier County, Florida, Section 22-205. In the event that the Respondent elects to appeal, a verbatim record and transcript of the proceedings will be necessary. It shall be the sole responsibility of said party to ensure that a record is made from which a transcript may be prepared which includes the testimony upon which an appeal may be taken. Neither Collier County nor Page 6 of 7 452357.1 4/29/2016 the Board has any responsibility to provide a verbatim record transcript of the proceedings. ORDERED by the Contractors' Licensing Board effective the 20th day of April, 20 0. ' K Thomas Lykos, Cha' man Contractors' Licensj g Board 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 to the Respondent; and the Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103, on this day of PA Pet , 2016. S retary/Contractors' Licensing Board Page 7 of 7 452357.1 4/29/2016