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CLB Agenda 12/21/2016 Coi ie-r County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA December 21, 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. October 19, 2016 V. PUBLIC COMMENTS: A. VI. DISCUSSION: A. VII. REPORTS: A. VIII. NEW BUSINESS: A. Orders Of The Board B. Michael P. Titus— Home Defense Pest Management& Irrigation,LLC —Waiver of Exams C. Jack R. Lewis— LJI Construction, LLC-Waiver of Exams D. Licia L. Rivera— Rivera& Company Corp— Reinstatement&Waiver of Exams E. Andrew L. Nichols—Airport Flooring & Cabinets LLC— Reinstatement&Waiver of Exams IX. OLD BUSINESS: A. X. PUBLIC HEARINGS: A. 2016-04—Jimmy M. Dean- D/B/A J. D. Design Construction, Inc. XI. NEXT MEETING DATE: WEDNESDAY, JANUARY 18, 2017 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONER'S CHAMBERS 3299 E. TAMIAMI TRAIL NAPLES, FL 34112 October 19. 2016 • MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING October 19, 2016 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: Thomas Lykos Vice Chair: Richard Joslin Members: Michael Boyd Elle Hunt Kyle Lantz Gary McNally Robert Meister Patrick White Excused: Terry Jerulle ALSO PRESENT: Ian Jackson — Supervisor, Contractors' Licensing Office Kevin Noell, Esq. — Assistant County Attorney James F. Morey, Esq. — Attorney for the Contractors' Licensing Board 1 October 19, 2016 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 Thomas Lykos opened the meeting at 9:01 AM and read the procedures to be followed to appeal a decision of the Board. Roll call was taken; a quorum was established; seven (7) voting members were present. II. AGENDA—ADDITIONS OR DELETIONS: Under Item VIII, "New Business," the following cases were withdrawn by the County: • D. —Brian K. Slavin, d/b/a B & K Tile and Marble, Inc. • E.— Stacy Fults, d/b/a Hector Mario Lawns, LLC. III. APPROVAL OF AGENDA: Vice Chairman Richard Joslin moved to approve the Agenda as amended. Patrick White offered a Second in support of the motion after clarifying the cases had been withdrawn by the County. Carried unanimously, 7— 0. IV. APPROVAL OF MINUTES—SEPTEMBER 21, 2016: Gary McNally moved to approve the Minutes of the September 21, 2016 meeting as submitted. Patrick White offered a Second in support of the motion. Carried unanimously, 7— 0. V. PUBLIC COMMENT: (None) VI. DISCUSSION: (None) VII. REPORTS: (None) VIII. NEW BUSINESS: A. Orders of the Board Vice Chairman 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, 7— 0. 2 October 19, 2016 • (Note: With reference to the following cases heard under Section VIII, the individuals who testified were first sworn by the Attorney for the Board.) B. Noel Sinclair— Reinstatement of License (d/b/a "Sinclair Electric, Inc.") Ian Jackson provided background information: • In 2008, Mr. Sinclair was issued an Electrical Contractor's license but was placed on probation and was ordered to return in six months for a review of his credit • October 21, 2009 —his probationary license was revoked for failure to comply with the June 18, 2008 Order of the Board • Noel Sinclair has applied to reinstate his Electrical Contractor's License without retesting Mr. Jackson noted there was a mathematical error on the first page of Mr. Sinclair's application concerning the amount of fees to be paid. He would address the issue with Mr. Sinclair. Noel Sinclair stated: • He had been ill and moved to West Palm Beach where he was involved in an auto accident and had been hospitalized • He contacted Michael Ossorio concerning being reinstated and was told "it couldn't happen" • He later contacted Ian Jackson who "walked him through the steps and told him to re-apply" Chairman Lykos requested clarification from Staff regarding why Mr. Sinclair's application was not considered as a"new" application due to the amount of time that had elapsed. Ian Jackson explained the Applicant chose to petition the Board to also waive re- testing. He stated too much time had passed and Mr. Sinclair would be required to test again before a license could be granted administratively. Chairman Lykos asked if Mr. Sinclair had been granted a license previously. Ian Jackson confiirned Noel Sinclair had been licensed from June 18, 2008 to October 21, 2009. (9:07 AM—Robert Meister arrived. Quorum was increased to eight voting members.) Michael Boyd asked if the Applicant had a State-registered electrical license. Ian Jackson replied that Mr. Sinclair had been registered with the State. Noel Sinclair stated he had applied to the State and was infoimed that if Collier County reinstated his Electrical License, the State of Florida would also reinstate him. He completed the paperwork with the State and paid the required fee. 3 October 19, 2016 Michael Boyd asked if the State requires proof of continuing education to renew a license. Ian Jackson confirmed it was a requirement of the State. Michael Boyd asked if Mr. Sinclair was current with the State's continuing education requirement. Noel Sinclair stated he was not current but had been advised by DBPR to apply to Collier County first and if he was granted a licensed, he could acquire the continuing education credits if necessary. Michael Boyd questioned the Applicant: Q. Your State-registered license is not current? Is that correct? A. Yes. I have re-applied and the status of Sinclair Electric, LLC is now "active." It is up to Collier County to grant my license back. I will send the paperwork back to the DBPR who will give me a new license and number. Ian Jackson explained Mr. Sinclair was applying to reinstate his Collier County license which was also registered with the State's DBPR. If he is not granted a license then he will have nothing to register with the State. Vice Chairman Joslin stated he thought all continuing education requirements had to be completed before a Contractor could register his/her license with the State. Ian Jackson concurred. Vice Chairman Joslin suggested the applicant should bring his continuing education requirements up-to-date before he applied to the Board. Ian Jackson explained that Mr. Sinclair must obtain his license from Collier County before he can complete the process and register his license with the State. He will be issued a new number by the State. He is also qualifying a new company—starting from scratch. Noel Sinclair further stated he had been instructed to obtain a fictitious name for his new business which he could then link with the name of his old company, Sinclair Electric, Inc. Patrick White asked Mr. Sinclair to clarify the names of his company and referenced a credit report for"St. Clair Electric, Inc." Noel Sinclair confirmed his old company was "St. Clair Electric, Inc." He explained since his was completing a new application, he opened his new company as "Sinclair Electric, LLC." The name will be linked to the old company. Patrick White: So your application today is for Sinclair Electric, LLC? Noel Sinclair: Correct. Michael Boyd asked if the last time Mr. Sinclair took a test was in 2008. Ian Jackson: Yes. Kyle Lantz questioned the Applicant. Q. Have you done any continuing education since 2008? A. Not at all. When I spoke with DBPR, I was told to check with Collier County first. Q. What have you been doing? Have you been working as an electrician? 4 October 19,2016 A. Correct. Q. For how long? A. I have been in this industry for twenty years. Q. But you were out for a while because you couldn't renew, so how long were you out of work? A. When the market fell down in 2008, I was out for roughly three years. But during that time, I was sick. Q. So, since roughly 2011 to the present, you have been working as an electrician? A. Correct. Q. And ... working for somebody else? A. Yes, a contractor. Q. What type of work have you been doing? A. Electrical. Q. Can you be more specific? A. I was laying out slabs, switch gears, you name it. Q. Industrial—commercial—residential? A. Commercial. Chairman Lykos asked for clarification of the company name. He asked Patrick White if the Board was being asked to qualify a different business name or a license. Patrick White explained the name of the company in 2008 was "St. Clair Electric, Inc." Mr. Sinclair has applied to reinstate his license and the new name of his company is "Sinclair Electric, LLC." He further stated one of the credit reports referred to "St. Clair Electric, Inc." Chairman Lykos questioned the Applicant: Q. In 2008, your business name was "St. Clair Electric, Inc." A. Correct. Q. And the license that you had was to qualify that business? A. Correct. Q. Now that we've moved forward eight years to 2016, you have established a new business called "Sinclair Electric, LLC."? A. Yes. I was told I could go ahead and change the name to "Sinclair Electric, LLC." Vice Chairman Joslin directed his comments to Ian Jackson: Q. This is a Collier County license only? A. Yes. Q. When he applied for a Collier County license, didn't he need to have all of his continuing education already completed and then this can be issued? A. No. Q. For a State-certified license, you have to have it before you can be certified. And then you go to the County. But, on the other hand, if you only have a County license, doesn't it reflect back to the County license and then all he would have to do is register with the State? Patrick White: There is a difference between "certification" and "registration" in the first place— let's make sure we are clear on that. 5 October 19, 2016 Q. A County license means he can only work in Collier County. A. Correct. Q. So you govern everything that he does? A. In Collier County. Q. And he can't work in any other County unless he registers in that municipality. A. Unless he obtains licensure in another municipality. Q. Correct. A. Not "registers." He is not a certified contractor registering his state license. He has to obtain licensure from every municipality that he wants to work in. Q. Correct. Okay. So, if he registers with Collier County -- in order to register his license in Collier County, he should have to have his continuing education done. A. He doesn't have to "register" with Collier County, he needs ... Q. He wants a license from Collier County. A. He needs a license from Collier County before he can register with the State. Q. Right. A. And whatever the State process is to register a County license — it is what it is — whether it's continuing education—it is whatever the DBPR requires to register the County license. Patrick White directed his question to Ian Jackson and Board Attorney James Morey: Q. Would it be possible for us to be able to provide a license that would be probationary with respect to having completed all of the requirements for continuing education before he can pull permits or do work? A. (Ian Jackson) This Board can issue a probationary license. He will not be current and active until he is registered with DBPR. Q. In order to register with DBPR, is it the same effect as what I was suggesting on his County license because he cannot do those things until the State registers him. A. Correct. Patrick White directed his comment to Vice Chairman Joslin: Hopefully, that addresses your issue because the State's regulatory process is that he can't work, regardless of whether he has a County license or not, because he doesn't have his continuing education completed with the State. Chairman Lykos: So he could get his license in Collier County but can't actually do any work until he is registered with the DBPR? Ian Jackson: Correct. Chairman Lykos: And he won't be able to register until he has his continuing education done? Ian Jackson: If that's the DBPR process which I believe it is. Patrick White: We could back it up by making doubly sure that he has to complete the required CE's. Vice Chairman Joslin: Either way, the CE has to be done before he would be able to go to work. Patrick White: That certainly seems to be the sense of this Board. Vice Chairman Joslin: I would say that—considering he had a license for only a year or there about—he was licensed in 2008 and we are almost in 2017, I could think the continuing education would be important. 6 October 19, 2016 Chairman Lykos: He had the license for only about a year, right? Ian Jackson: Sixteen months. Chairman Lykos: He was licensed for sixteen months -- that was eight years ago. And he hasn't had any continuing education since? Patrick White: The point is, from my perspective, the reason why he was originally on probation was for financial and to the extent that he has been working when he has been able to in the field, hopefully, that will provide him with the amount of educational experience so when he goes in for his CE, he will be able to pass them. The thing that protects the consumers in this County is that he cannot work in this County until he (a) has a license from us, and (b) is registered with the State which will only happen if he has completed all of his continuing education. Assuming for the sake of discussion, that we don't have any issues with his financial, we could choose to give him a probationary license for six months which become effective upon registering with the State and demonstrating that he has completed his continuing education. Vice Chairman Joslin: I don't think that will be necessary because if we grant him a license, then all he has to do is take a CE registration to the State and he can come back and get a license. Chairman Lykos: Here is what I would like to do. Mr. White has laid out a path of how this might work if we choose that option, but there are a couple of people on the Board who are familiar with electrical—Mr. Boyd and Mr. Lantz. Why don't we get some input from these two gentlemen? They know better about electrical and licensing and the scope of their work—let's get their input. Michael Boyd: I kind of think that if we grant him a license, he can still go to the State and register that license. The CEs are typically involved when you are renewing your certification. Kyle Lantz: He will have to do one full cycle of CEs in order to renew. Michael Boyd: But he's not renewing—he's registering as "new." So I don't think the CEs will come into play. He's not renewing—he's going to register a new license. So I don't think there's any testing involved with the State. That's where I have a problem. Elle Hunt: We're heard testimony that he has been working for the last few years but nothing within this package shows any support for that. The latest letter that we have here showing that he's done electrical work—shows employment through 2008, but nothing beyond that. Elle Hunt questioned the Applicant: Q. Do you have any verification that you have been doing electrical work from 2009 on? A. Maybe a paystub or something—but I've been working. Chairman Lykos: Technically, we're allowed to take his testimony as evidence. Elle Hunt: Agreed. Chairman Lykos: How much value you put in it is up to you personally, but technically, his testimony is evidence of that fact. 7 October 19, 2016 Elle Hunt: And I started off by saying, "other than his testimony ..." we don't have anything to validate any additional experience for the last eight years. Kyle Lantz questioned the Applicant: Q. So, have you been a guy in the field? Have you been running a crew? Have you been estimating? What type of work have you been doing for the last few years? A. Lead man position on a job; wiring up buildings —commercial buildings; Q. But what's your position? Are you the guy twisting joints? Are you the guy organizing five people? Are you the guy figuring out the costs? A. Organizing people. Q. So, are you dealing with the contracts? A. No, I'm not dealing with the contracts—that pertains to the office. They do all that stuff. I'm out in the field working as a regular employee. Q. So that leads me to the Business and Law area. If he doesn't have experience in Business and Law in the past eight years, I would have a hard time giving him a license without at least re-testing that portion of it. Elle Hunt questioned the Applicant: Q. Why don't you want to test? A. It's not the fact that I don't want to test—I was told that I was able to get my license back being that I took the tests and I've got my Journeyman's License with Collier County. I took my Electrical Contractor's License with Collier County and being that I had a neck injury, and had obtained my license for roughly six months to a year, on probation for a period of time, my license became denied because I had an injury. I was told I could go ahead and reinstate it back. So pretty much, I never got a fair chance of even working with my license. I was working for only about a year—six months to a year. I just got the license and then it was revoked. Kyle Lantz questioned the Applicant: Q. But that was your choice not to comply with the Board's order, not the County's choice. They gave you a fair shake —they told you to do this and do this— and you'll get your license moved from probationary to permanent ... it was your choice not to do it, not the County's. So it's hard to blame the County and say you didn't get a fair shake when you are the one who didn't comply with the Order. Right? A. I'm not really blaming the County but Mr. Michael Ossorio told me that I couldn't get it. And now you have this new guy—Jason—and Jason walked me through the steps and told me I should be able to get my license back. He told me to go ahead and file a new name and let's take it from there—take it up to the Board. Chairman Lykos: Q. I understand your situation. For me personally, I think one of the biggest issues that I have is all the time that has passed. Mr. Lantz brought up the business and law side of the business. Even if we were to accept your testimony that you have continued to work in the electrical side of the business for the last eight years, there are tax law changes, there's Workers' Compensation law, the business and 8 October 19, 2016 law side of running a business—rules change over the years, laws change over the years and if you have not maintained your Continuing Education, then how are we to be comfortable knowing that you are current on all of the different requirements that you need to meet to operate a business in Collier County? A. Well, I would say, sir, that's when you have the Continuing Education— like you say—to go to classes and get revised with those information. But— like he was saying earlier—the license has to be issued first. If you guys want to give me a probation period for some time to go ahead and do the Continuing Education, and then put them altogether and grant my license, no problem. Kyle Lantz: Q. You could take Continuing Education today. Ian could take Continuing Education today and he doesn't have a license. There's no requirement to have a license to educate yourself. A. That's what I'm saying. You say that I would have to do the business and law, et cetera, -- I was saying the Continuing Education comes into play with learning all these new laws that are going on ... with issues in the field, such as the new Code, et cetera. Q. One of the problems that I have with Continuing Education is that you get credit for showing up—there's nothing that says you learned it or you didn't. Whereas, when you take a test, it deteimines if you actually learned it or not. You can sit through 40 hours of Continuing Education while playing on your cell phone all day—I'm not saying this is you—but anyone can sit through it while playing on their cell phone all day and not pick up one thing they are saying. And there's no accountability for it. Whereas, if you take the test, then we know that it actually set in. Patrick White: Are you talking about the Business and Law exam or are you referring to ...? Kyle Lantz: Any of them, in general. Right now we're focusing on Business and Law. Patrick White: That's what I thought. Patrick White questioned the Applicant: Q. Mr. Sinclair, are you saying that you would be okay with us issuing a probationary license where you would have a license and be able to register with the State but you wouldn't be allowed to work until you met what otherwise are the requirements this Board would impose? For example, passing the Business and Law exam and getting in the cycle of Continuing Education? A. Honestly, it wouldn't really make sense because I've passed .... Q. Is that, "No"? A. No. Q. Your alternative, it would seem to me, is that you complete whatever the Continuing Education requirements are, take the Business and Law exam, and come back and see us again when you have those things done. It seems there are really only two options here. A. That's just pretty much as I would go and take the tests all over and apply for a Certified license, which here I have passed the tests already. 9 October 19, 2016 Q. I'm not trying to make the choice for you. A. Do you see what I'm saying, though? Q. Well, there's a difference between "certified" as well. Kyle Lantz: I don't know if you know this, but at the October 21, 2009 meeting, the Board made a recommendation to the State of Florida's Construction Industry Licensing Board that "... the Applicant be prohibited from contracting in the State of Florida without a full hearing on such matter." What happened with that? Did he have a hearing or is this his hearing? Ian Jackson: I don't think DBPR would conduct a hearing for a registered contractor. Kyle Lantz: So this would technically be his "hearing"? Ian Jackson: That's right. Chairman Lykos: I wasn't on the Board then—Mr. Joslin was. My sense was that the Board didn't want him to just go out, fill out some paperwork and get a license— this [Order] required him to come back before the Board before a license could be issued. He would not able to get a license without coming back before the Board. Vice Chairman Joslin: I have reservations because it has been so long— it has been since 2008. And like Mr. Lantz said, there are lots of laws that have changed. And you haven't done anything in that period of time to take any kind of CE courses or keep yourself abreast of what is happening in the electrical field. The electrical industry has made some significant changes I am sure. I know I see electrical contractors all the time who complain about the changes that have been made. Whether you are working in the field or not, if you are only doing the scheduling— that doesn't tell us that you really know the operation—you're just moving people who really do know the operation. I have some issues with granting a license at all without taking the test. Chairman Lykos: Credit is not an issue. That was the issue in 2008. Your credit [score] exceeds the minimum required by the State. This is really about the fact that your license has been dormant since 2009 and you have not maintained your education. Vice Chairman Joslin: If you would agree to be on a probationary license for six months like Mr. White said, and to be able to take your CE courses which you can do online, and then take the Business and Law test—that may be an option that we may be able to accept. Patrick White: Actually, given what I think of what I have heard, my sense would be three months because it certainly seems do-able ... probably within three weeks. If the concern is that he passes Business and Law, and he completes what would be the otherwise required cycle of Continuing Education, I wouldn't have an issue if he goes ahead and completes those two sets of tasks. Then his license would become effective. The three months would act as a time limit—and if he didn't have it done by then—his license would be suspended or revoked. He would not have a license. The point is—until he meets those two thresholds, he would not be able to pull permits or do work. Kyle Lantz: Why are we giving him a ... Patrick White: I'm just saying 10 October 19. 2016 Kyle Lantz: ... probationary license that's useless anyway? Why don't we just say Patrick White: It isn't useless ... Kyle Lantz: ... do "a," "b," "c," and "d" ... Patrick White: It isn't useless in the sense that it allows him during the same period of time he's taking care of these two sets of tasks, he can process through his paperwork with the State. It's an incentive to him, in my mind, to get the testing done and get the Continuing Education done, because when he's done with those things, however long it takes to be registered with the State and have a new number issued, those things would be occurring in parallel. So he has an incentive to do those things. That's the only thing that I would suggest. Chairman Lykos directed his question to Michael Boyd and to Kyle Lantz: Q. If you are out in the field, how would you feel about a person in this situation having a license considering that they have not been active for eight years? A. (Kyle Lantz) I wouldn't hire him. A. (Michael Boyd) No, and I wouldn't either. I think we're getting stuck in the Continuing Education—I would just say that he takes the Business and Law test and is done with it. I don't think the Continuing Education has anything to do with him getting a State license or a state-registered license. I'm sure Kyle can echo this, we have to take fourteen hours of Continuing Education every two years and out of that—I'll bet it's close to 70% now— has nothing to do with doing anything in the field. It's all business and law, Workers' Comp —all that sort of thing. Patrick White: Your sense is that passing the Business and Law exam would address ... be the equivalent of Continuing Education? Michael Boyd: Yes, I think it would. Kyle Lantz: I have a few more technical questions. Q. Who do you currently work for? A. I work for an agency—it's a guy named Tom. Q. What do you mean by an agency? A. Workforce. Q. Like a day laborer? A. No. It's not a day laborer—it's a guy who will actually send you out to different contractors. Q. For different electrical contractors? A. Correct. Q. How long have you worked for him? A. I have been with him for roughly two or three months. Q. And for the last two or three months you have worked for a bunch of different electrical contractors? A. No,just one. Q. Just one. And what contractor is that? A. Palmeroy Electric. Q. And that's on the other coast? A. Yes, correct. And that's also inside my application. 11 October 19, 2016 Q. So before two months ago, who did you work for? A. I worked for Bradford Electric. Q. How long did you work for them? A. One year. Q. Forty hours a week? A. Yes. Q. And how about before then? A. I don't remember exactly. Q. You testified that you have been working consistently for six years so I'm trying — since you don't have any documentation of it— I'm trying to have you explain to us so we can understand six years of electrical work. And so, someone who bounces around working for an electrical labor pool and another job for a year— show me some more time. A. It's all electrical work. I mean, regardless, I'm working for a contractor. This guys —he's sends me out to work for another contractor— it's all electrical work. Q. No, that's not the same because you don't own the job. If you're working on a job for a month or two months or just a little while, you don't own the job from the beginning to the end. So you're not a responsible party. A. I'm not going to be on these construction sites from the beginning to the end. They pretty much use you to cut the budget. They say, this guy makes "x" amount of dollars so I have to send him to another job or whatever the case may be because you have funds. Q. I understand completely. But what I want to see technically is that you were responsible for a job. You can run a job. So someone who is on a job for just a little while—if I bring someone to one of my jobs for just a little while—they may be the best electrician ever, but they are not going to be responsible for the job. They are going to be doing bits and pieces, and it's two different ball games. If you can show me that you've been technically skilled as an electrician— it means a lot more than bending pipe or running a few wires. It means looking at a print— looking at a design or designing a system and making sure it's correct. A. That's not a problem. I mean, you also can do service work, troubleshooting errors, landscape lights, put up fans— anything. It's not just necessary to run a big job— it could be maintenance work. So me having a company, it could be just me doing maintenance to help and service the community. Chairman Lykos: Q. The letter in your packet from Pomeroy said that your work with them ended in 2006. A. Correct. Q. So to Ms. Hunt's comment earlier, we have your testimony but we have no other written documentation that you have been active in the trade since—actually since your license. Vice Chairman Joslin: That's not true. There's another report in here from Craftstaff which says he worked from 2004 to 2006 and from 2006 to 2008. He has been in the business. Chairman Lykos: His license was issued in 2008. Since his license, we don't have any evidence of him being active in the trade after 2009 when his license was revoked. 12 October 19, 2016 Patrick White: Q. And the two to three months that you have been working for this agency and you report to Tom, the contractor that you've been work for is Pomeroy again? A. Correct. Q. And so they brought you back in and have had you working jobs for them wherever they may be for the past two to three months. A. Correct. Q. After you spent a year working for Bradford. A. Correct. Q. And what did you do at Bradford? A. At Bradford, I pretty much installed panels, I wired panels —you name it— all aspects of electrical. When you go on a job, it's pretty much the same thing. Chairman Lykos: Q. So, Mr. Sinclair, one of the factors that we take into consideration in deciding whether or not to issue you a license without having to take all the tests again is that you can testify for us—or through written documentation prove to us—that you have been active in the trade. You are an electrician. There couple of people on the Board who know electrical pretty well, but there are several of us who are not electricians. We need you to be very specific in your description of the type of work that you've done so you can prove to those of us who don't know about electrical work that you are very knowledgeable about electrical work. Right now, I am not convinced that you know a lot more about electrical than I do. And as Mr. Lantz would say, I'm just a dumb General Contractor. You need to give us a lot more detail about the kind of work that you've been doing to show us your expertise. Right now, you are on the podium—prove to us that you are an expert electrician. A. Like I said, you go on a job and you do the same thing ... install wires and make it work. That's pretty much what you do. I work for different contractors ... anyone could be pretty much a contractor. You could hire any guy and he could work on anything electrical— a guy with a license and put guys to work. I mean, you know, you don't have to have no electrical skills. Here you have a guy who has been in the trade for twenty years —from 2001 pretty much all the way until now. I said the market fell in 2008 and I wasn't working at that time. Patrick White: The Chairman's question to you was about experience—not about explanations. Noel Sinclair: I am getting to what he was asking. Like I said, you get in the building and look at the print and pretty much install what you see. You are being supervised by an employer—and pretty much, that's it. The more money you make, the bigger task you are gonna do on the job. A lot of time, you go work for the employer and they have their guys already, so therefore they want you to just switch gears and run a little crew and et cetera like that. Chairman Lykos: How do you decide if you need to use a#12 gauge wire or a#14 gauge wire—how do you know if you need ground-width wire or don't need it? How do you know about if you're going to put in ground-fault interrupters or if you're going 13 October 19. 2016 to do a ground-fault circuit breaker in the panel? Talk to me about— give me some electrical terminology. Noel Sinclair: For this stuff right here, you use a Code book if you need to refresh on things to install. For any little issue, you look on the blue print for the panel schedule to know if it's a#12 wire or a 3/4 conduit ... for whatever pipe you're running or whatever circuit that needs to be installed. Vice Chairman Joslin: What you are saying is— it's all on the blue print? Noel Sinclair: Correct. Everything is in the blue print. Chairman Lykos: You know what—you don't need to convince me. You need to convince Mr. Lantz and Mr. Boyd because I'm going to make my recommendation based on their comfort level. Kyle Lantz: Q. What else have you done for electrical work besides the last year and two months? A. I have helped out friends, pretty much. Q. But have you worked for electrical contractors? That's what convinces me because I understand you have a lot of experience, but there is a big difference between helping out friends and doing stuff like that and working for a licensed electrical contractor doing permanent jobs. They are two different things. When you help out a buddy to install a receptacle, you are probably not going to upgrade and put a fault breaker on that circuit. When it's a permanent job, you damn well better or you will fail the inspection. Who have you done .... ? A. After the market fell and I was injured, I worked for the City of Vero Beach maintenance. I helped out with the sprinkler and the electrical. I've also worked with SeaSpray Electric and I think after SeaSpray was Bradford. And after Bradford, then Tom. Q. How long did you work for Vero Beach? A. I think two years, roughly. For SeaSpray, about a year, I think Q. And you got paid on the books for you could provide paystubs? A. Correct. Patrick White: At what point in time is his prior considered sufficient to issue a license? Have there been changes to the regulations, to the requirements, to the way in which the work—the actual technical and mechanical work—is done where if he demonstrates that he understands those things—the experience is less of a factor for me. Chairman Lykos: But the Ordinance says that we can waive testing if, in our opinion, testing is extraneous. Well, if you can't prove— even by testimony —that you have been active in the trade for the last eight years, I don't think that trade testing at this point is extraneous. We can't get even the testimony— I'm not convinced by his testimony that he has been active in the trade to the point that he understands all the Code changes. Just think of the way technology has changed in the last eight years and how the electrical trade has been affected by the technology changes— low voltage and LED technology and all those things —if you've not been active for the last eight years, I think that's the point of the Ordinance. 14 October 19,2016 Patrick White: I think he's provided some testimony that he has been active. I don't know that it is at a level that may satisfy those on the Board with electrical licenses or others of us. My bigger concern here is how we either give him a path to getting what he needs to get done or we make a simple choice for him to have to go and complete the testing — both the Business and Law exam and the technical test. If that's the case, it's fine. Just trying to identify a path so we can ... Michael Boyd directed his question to Ian Jackson: Q. In 2008, when we granted him a license, was it strictly on experience or was there a test taken? I don't see the testing results in the packet. A. He tested to obtain that license in 2008. Q. Did we grant him a reciprocal from West Palm Beach? A. It was a Collier County license. Q. Okay. So it wasn't strictly on the experience—there was a test taken also? A. Yes. Elle Hunt: I have a question for the Board members who know electrical. We've heard a lot of testimony where Mr. Sinclair is talking about following drafts or following plans. If you have your Contractor's license, you are creating those and you are determining what to use—am I understanding it? Kyle Lantz: On a large job where an engineer is involved, the engineer will spec out a lot of stuff At lot of times, the guy in the field has to modify what they have spec- ed out because it doesn't apply to the conditions in the field. But on smaller jobs, on 90% of my jobs no engineer is involved, and I do it. Elle Hunt: And you do it? Kyle Lantz: I do the design myself. So personally, I would never hire someone who says to look at the blue print because you need someone ... Elle Hunt: That's my problem with the consumer ... I am not getting enough technical experience from his testimony to feel comfortable with that experience over the last eight years. Kyle Lantz: A lot of times, engineers give the "big picture" and then they rely on the Contractor to plug in the holes and fill in the details. Patrick White: Would it be helpful to have the Scope of Work read to us that the license allows? Chairman Lykos: Mr. Lantz and Mr. Boyd, do either of you have a strong enough opinion to make a motion? Michael Boyd: I've been saying all along that I'm not going to vote for anything that waives testing anymore for someone who has had their license revoked or let it lapse, especially after eight years. Michael Boyd moved to deny the application of Noel Sinclair for reinstatement of his Electrical Contractor's License until he takes and passes the Business and Law exam and the trade test. Kyle Lantz offered a Second in support of the motion. Discussion: 15 October 19, 2016 • Patrick White asked for clarification: If Mr. Sinclair were to pass both tests, would that mean his application, if still valid, would be reviewed administratively and we would not see him? Or are we, in a sense. saying you are being denied your request for reinstatement and you need to re-apply? I'm not sure what happens administratively from here and would he know what to do? • Ian Jackson explained if Mr. Sinclair took and passed both tests, and provided a complete application, it would be reviewed and if it met what was required, he would issue a license to Mr. Sinclair. • Chairman Lykos asked if Mr. Sinclair would still be required to appear before the Board and specifically if the current application would remain effective and just be updated with the testing results—or would a new application be required. • Ian Jackson stated Mr. Sinclair could still use this application with his new test scores. • When asked if he understood, Noel Sinclair stated it was an "ER" license and if he going to work throughout the State of Florida, he would be better off taking the tests and obtaining a State license. He further said it didn't make sense to take the tests for a County license when he could take the tests for a State license. • Michael Boyd noted there were two different tests. There is a big difference now—there is a big difference in the testing between a State-certified and going for a registered, County license. He thought the State-certified exam took two days or three days to complete. • Noel Sinclair stated the knowledge is all the same — it's all applied to electrical. • Kyle Lantz noted the State will not accept experience from eight years ago — only experience within the last six years. You'll have to make sure that you document your ... • Noel Sinclair stated he could show that he has about 8,000 credits and has "been through all the schooling." I did my Journeyman through you guys and also the County license. I don't see why I'm not able to get my license. Chairman Lykos asked if there was any further discussion on the motion. He then asked for a vote on the motion to deny. Carried unanimously, 8— 0. Chairman Lykos explained to Mr. Sinclair the Board determined he must take the Business and Law exam as well as the trade test to obtain a Collier County license. It was his choice to decide whether or not to take the State exam. The Board has stated that, based on his testimony and the information provided in his application, it was not comfortable issuing a license to him without additional testing. C. Jim Kalvin —Review of Credit/Reinstatement of License (d/b/a "Jim Kalvin, LLC.") Ian Jackson noted Mr. Kalvin became a Marine Contractor in 1997 but his license was not renewed in 2006 and it became null and void. In July and August, 2016, Mr. 16 October 19, 2016 Kalvin took the Business and Law exam, as well as the Marine exam. He submitted an application for a new license. There is a question concerning his credit report which is why the application was referred to the Board for review. Chairman Lykos: Mr. Kalvin took the tests again and passed, so the only issue before the Board is the credit issue. Ian Jackson: Correct. Jim Kalvin stated: • The federal tax lien which was explained in the packet. The issue was a 1099 that was sent to him years after a job had been completed. He stated he ignored it because he was not an employee but a Contractor on the job. • Two years later, the IRS did not ignore it and came after him for back taxes, fees, and penalties. • He hired U.S. Attorneys to try to resolve the issue but they could not. He was employed at the time as a project supervisor for Kraft Construction. It was suggested that he submit a payment to the IRS in lieu of having his wages garnished. • He submitted the payment plan and has been paying on the debt. • The economy has not been good. He is a boat captain and the past few years have been very difficult. • One year ago, he attempted to get an Offer in Compromise—he tried to use the equity in his home to pay the amount down but the bank would not release his equity line. • He noted, after the application was submitted to the County, he found a document sent to the IRS requesting a new payment plan after the bank refused to allow him to use the equity line. • He received a letter from the IRS stating it received his communication but was not prepared to respond and would contact him. He stated he never heard from the IRS again. • He continued to make payments as he could. His income for January, February and March of last year was a"wash-out." • He had been receiving calls from former clients about his returning to the trade, and he decided to return to Marine Construction after determining there was a market for him. • He has signed a new payment agreement with the IRS and will begin making payments on November 1, 2016 until the issue is resolved. (Copies of the agreement were provided to the members of the Board to review.) Jim Kalvin stated he was hoping he could make his old trucks keep working, and if he obtained his Marine Contractor's License, he would be able to pay off the lien in approximately two years. Vice Chairman Joslin asked how Mr. Kalvin how he could receive a 1099 when he was self-employed. Jim Kalvin replied the man who he contracted with—the Condo manager at that time —had died while everything was transpiring. Someone came in after and started sending 1099s. He was incorporated as a Subchapter "S" and the initial deposit and 17 October 19, 2016 all draws when through his company checking account. He stated when he received the 1099 he decided to ignore it. He has been dealing with this issue for approximately ten years. We have determined I can't pay it off in the trade that I am in and would like to get back into Marine Construction. Chairman Lykos: Do you have any sense of how long the IRS will take to respond to your offer? Jim Kalvin: They have responded. One of the notes in the packet was from last year. The one they did not respond to is from December, 2015. Patrick White: They have given him a payment plan and now, basically, owes $7K more than what he had paid down to. Chairman Lykos: They have accepted your offer and this payment plan. Jim Kalvin: Yes. Kyle Lantz: Personally, I would have no problem issuing a probationary license for a year and he could show Staff the record of payments made to the IRS. I don't think we need to see him again, provided he is making his payments. Patrick White: I would second that— if it's a motion. Chairman Lykos: Before we vote on that—your motion is to place him on probation for one year and all he is required to do is provide proof of his payments to the Contractors' Licensing Office. If he has, his probation is terminated. Kyle Lantz: If not, he will return to the Board. Chairman Lykos: Is that your understanding, Mr. White? Patrick White: It is. Chairman Lykos: I have a motion and a Second. Is there any further discussion on the motion? Chairman Lykos called for a vote. Motion carried unanimously, 8— 0. D. Brian K. Slavin—Review of Credit/Reinstatement of License (d/b/a "B &K Tile and Marble, Inc.") (Note: This item was withdrawn from the Agenda by the County.) E. Stacy Fults —Review of Experience (d/b/a "Hector Mario Lawns, LLC. ') (Note: This item was withdrawn from the Agenda by the County.) F. Manuel Orosa—Review of Experience (d/b/a "Orosa Custom Renovations, Inc.") Chairman Lykos noted Mr. Orosa had appeared before the Board previously. Ian Jackson confirmed Manual Orosa had initially appeared before the Board at the April 20, 2016 meeting to review his experience. 18 October 19, 2016 • Mr. Orosa had applied for a General Contractor's License. • The Board explained to Mr. Orosa that the Board would consider a Building or Residential Contractor's license or a restricted version of one of those licenses. • Mr. Orosa requested the Board vote on the issuance of a General Contractor's license but the Board denied his application. • Mr. Orosa passed the General Contractor's exam and has made a second application for that license. He has supplemented his experience with additional affidavits and understands that the Board may consider granting a Restricted General Contractor's license. Patrick White directed his question to Ian Jackson: Restricted— how? Do you have any specifics concerning the Scope of Work or type of construction? Ian Jackson: At the April meeting, there were specific structural questions that the Board asked. If we need to review the different Scopes of Work during the hearing, we certainly can to arrive at a decision. Chairman Lykos: In this situation, we could ask Mr. Morey to read the restrictions for each license. Chairman Lykos questioned the Applicant: Q. Can you please explain to the Board the new information in your packet— you have some new letters — and tell us more about your experience with regard to being a General Contractor. A. It is the same that I said the last time. We do commercial, residential, remodeling —we supervise on the construction. It is the same. Q. Okay. So saying that your testimony and your evidence is the same as before is not a good place to start because we already denied you a license based on your previous experience and previous evidence. Let's start over again, okay? You need to tell the Board what is different than last time. A. We started building my house. Q. Okay. So from April until now, you have experience in building a new house— A. Yes, my house. Q. Your own house—building it from scratch? A. Yes. We started from the underground. Q. I understand. What about any other work experience? Have you worked for anybody else doing any other kind of work? A. No. Q. Okay. Thank you. Attorney James Morey, Attorney for the Board, read from the Collier County Code of Laws and Ordinances, Article V—"Building Trades," as follows: "Residential Contractor: requires 48 months experience with a passing grade on an approved test and a Business and Law test. It means a Contractor whose services are limited to construction, remodeling, repair, or improvement of one- 19 October 19,2016 family, two-family, or three-family residences not exceeding two stories in height and accessory use structures in connection therewith." "Building Contractor: requires 48 months experience with a passing grade on an approved test and a Business and Law test. It means a Contractor whose services are limited to construction of commercial buildings and single-dwelling or multiple- dwelling residential buildings, which commercial or residential buildings do not exceed three stories in height, and accessory use structures in connection therewith or a Contractor whose services are limited to remodeling, repair, or improvement of any size building if the services do not affect the structural members of the building." "General Contractor: requires 48 months experience with a passing grade on an approved test and a Business and Law test. It 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." Chairman Lykos questioned the Applicant: Q. Did you hear the different descriptions? You probably understand exactly what you are coming into today, don't you? A. If you can give me the Residential one now, by next year, I can put more experience to the Building or a General. Q. If I remember the last time you were here, that was not an option you wanted to pursue. But now it is—right? A. Yes. Q. Okay. So based on your experience and based on what you have told us today, it sounds like the most appropriate license would be the Residential Contractor's License. It is one, two or three-family homes, up to two stories tall. It could be three stories if the ground floor is parking with two habitable stories above. Elle Hunt: It wasn't mentioned but his credit score is 592. I don't know if that is part of our conversation. Patrick White: It is for me. Chairman Lykos: Okay. Kyle Lantz: For some reason, I thought we vetted the credit in April. Elle Hunt: We may have. I just wanted us to re-discuss considering it is six months later—a"what have you done lately" conversation around the credit because even if we had given you a license, it would probably have been probationary. Manuel Orosa: We pay my all of my accounts— we pay at the bank all the time. My credit for the first time from my business to here has gone up. Chairman Lykos directed his question to Ian Jackson. Q. You did not list his credit as part of our consideration today. Do you have some insight on the credit side of this? A. Because Mr. Orosa has been incorporated for more than one year, I looked primarily at his business credit report, per our Code. Q. Okay. Ms. Hunt, are you comfortable with that? Okay. 20 October 19, 2016 Kyle Lantz questioned the Applicant: Q. Can you tell me how far along you are on your new house? A. At the end of this week, we do the tie-beam. Q. And what part of that did you do yourself? Any of the concrete? A. I do supervise and check everything is fine. I take care of all the plumbing —the underground plumbing. I waiting for the — I do it with my hands, anything. I stay here all the time, in person. Q. So you have subbed out the slab work? A. Yes. We subbed out on Saturday. We do the form and the concrete, everything. It is coming back. I am working my business, too. Q. And you subbed out the block work? A. Yes. Q. The same company? A. Is a different company. Q. How about the tie-beams ... same company as the block? A. We use the same company as do the slab. Q. And the plumbing? A. Is the same guy who did the finish. For the underground, the roof, and the trim — we use the same guy. Q. But you subbed out the plumbing? A. Yes. Q. And how is the electric work? A. We are not ready yet. Vice Chairman Joslin: You haven't finished the house yet? Manuel Orosa: No, the tie beam is coming ... we do the tie beam at the end of the week. Kyle Lantz: Q. So what are you doing to oversee and supervise? Are you inspecting any of the 7 A. Yeah. We check the blue print where the guy is doing—everything is good. Q. So as long as the Inspector says it's good, you're happy. A. Yeah. Chairman Lykos: Q. How often do you go by the construction site? Do you go every day or once a week? A. We do a little at a time, you know. It's in Golden Gate Estates and I live in Golden Gate City. After I leave here, I will go to there to check. Kyle Lantz: Q. So what is the slab — is it a slab on grade? A. Yes—we do the slab —we do the 18-inch with the center line. Q. Is the slab a fiber-mesh? A. So we do the fiber—yes. You need the fiber to do the slab. Q. Okay. And you have rebar? A. Yes. But when on the slab, no. What do you call ... the footers? 21 October 19, 2016 Chairman Lykos noted a translator was available if Mr. Orosa needed help. He admonished the Board to not help him along by supplying the vocabulary. Let's have Mr. Orosa tell us through his translator the words we want to hear. The translator, Katy Guerrero, was sworn in by the Board's attorney, James Morey. Kyle Lantz: Q. So is it a stem wall or a monolithic slab? A. What was the question to me? Q. Is it a stem wall or a monolithic slab? A. A monolithic slab. Q. Can you tell me how a monolithic slab works? A. I don't understand your question— say again. Q. I want you to describe to me what a monolithic slab is—maybe what the difference is between a monolithic slab and a stem wall. I want to make sure you understand. A. The difference—a stem wall, you need to do the foundation—on the bloc and on the top. It is different from the other one where you do the land and the slab after. I'm a little nervous and ... the language barrier. Q. You're doing good. Patrick White: Q. Can you explain how the rebar works from the foundation up to the tie-beam? A. Say again? Q. How does the rebar work between the slab and the tie-beam? A. The steel ... and the tie-beam, what's the difference? Q. How do they connect? What do they do? A. When you do the slab, you do the bar and you connect to the tie beam. My house —you do the "u-block" on the tie beam. That's how we do it. Vice Chairman Joslin: Q. How far apart are the bars spaced? The steel? A. I don't remember right now. We do the slab and we come today to finish the block. A. (Translator) I believe he just poured the foundation. Q. I understand that. I am asking him how far apart are the bars spaced? A. Seven— six foot. Sometimes, I don't understand the question. Patrick White: Q. We understand. We know you know what's out there in the field. A. Yeah. Chairman Lykos directed his question to Ian Jackson: Q. If we were to recommend restrictions on the license— let's say —my concern is if we give him a General Contractor's License with restrictions down to the limits of a Residential Contractor's License. What's the difference between that and just granting a Residential License? 22 October 19, 2016 A. I think for our system, and to regulate it efficiently and properly, if the Board chooses to issue a license, it should issue a Residential Contractor's License rather than a General Contractor with restrictions. It was noted the Board agreed the Applicant did not meet the qualifications for a General Contractor's License. Patrick White stated the difference may be that the Applicant could come back, administratively, if he were able to show the 48 months of experience in any of the more substantial categories. In my opinion, by making it a Residential license only, we are assured of seeing him again where we can evaluate his experience again at some point in time. Chairman Lykos: I understand it from the County's standpoint. I just need a motion. Vice Chairman Joslin asked the Applicant if he would be willing to accept a Residential Contractor's license and his response was, "Yes." Patrick White moved to approve granting a Residential Contractor's License to Manuel Orosa. Vice Chairman Joslin offered a Second in support of the motion. Discussion: • Kyle Lantz stated he was still leery concerning the Applicant's structural experience. He further stated he would vote against the motion. "I just feel if I have someone working on one of my jobs or on my house, I want someone who has done more than just schedule someone— I want some who will do more than show up and watch somebody else work. I want someone who will look at the job and know what is structural and what is not." • Vice Chairman Joslin noted if he is building a home, he will fail a lot of inspections if he doesn't know what he is doing. Chairman Lykos called for a vote on the motion. The motion carried, 6— "Yes"/2— "No." Elle Hunt and Kyle Lantz were opposed. Chairman Lykos addressed his comments to Mr. Orosa: You have a Residential Contractor's License. Go and work within the limitations of that license and learn more. Good luck to you. IX. OLD BUSINESS: (None) X. PUBLIC HEARINGS: (None) 23 October 19, 2016 NEXT MEETING DATE: Wednesday, December 21, 2016 BCC Chambers, 3rd Floor—Administrative Building '`F," Government Complex, 3301 E. Tamiami Trail, Naples, FL There being no further business for the good of the County, the meeting was adjourned by the order of the Chairman at 11:00 AM. COLLIER COUNTY CONTRACTORS' LICENSING BOARD THOMAS LYKOS, Chairman The Minutes were approved by the Chairman on , 2016, "as submitted" 1 OR "as amended" ( 1. 24 Cr Jai l ,� notiR. l o(J nJ'pI ► e y ��L T t-v5 i,J s R C'c),JrnY tart J'N COI t Cbv,orii R Piisr (2),,,;ao'- ,c.rrz -t- 6:79- 7Oonl 1=2vry 1 et 7 ow r L z. 13 (4-1- ix)1+10/ Tt1/�'1�^ (V10JrU T7) MX218n/ t.)Airy Prr►Q in.)d'a J D IN 13oi 4f-- Ft itLDJ PNo U1,) L- zoIS' AT GLJi-t7414 1iMe PU r >My C CIN S r{.. o)J 14-01 vJ 1-f) i1 S on/clip/I TO "rt m_ i-rfoL i GerU[ TO Coil I'm, eooNTyj . (wouto n ()P2a .1 Ariz ?1-1- off)e21vry 1 OetrI -r t3L)s S "-i2 SS iti1 CO t in, Cbu ir-i d x)ctz A-(519:tnlr 1:3-N C) -fir LoOK% N ;4 44 T O 3IDri& eu -1/34 �, -i> toren (5 c A+ TO pizaiOd (�-oLYo 1'1,-1 S ific ii- Colt I i2 11-1limte._ yid t./ 02 \/0 L3 tc CO bi Si oriibc 7'ron) i J'l ry cull Colkr -r County GMD Operations& Regulatory Management Licensing Section 2800 North Horseshoe Drive Q24387 Naples, FL 34104 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: ` xe #441---aked l ( 6' vot Le' Fiction Name/DBA: Qualifier Name: MICHAEL P. TITUS p Physical Address: /?/0 //mg Sa ) r /— l/7 (Number&Street) (Ci ) (State) (Zip Code) Mailing Address: (Number&Street) (City) (State) (Zip Code) Telephone: , ,V-37--009t E-mail: & 4': . (1C'72< 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 Irrigation Sprinkler Specialty Trade: *Back fees need to be calculated upon submittal* CHANGE-OF STATUS: (X)Reinstatement ( ) From One Business to Another ( ) Dormant License to Active 036044-.Expired 2013 Page 1 of 4 1. The names,titles,home address and phone numbers of all Officers/Managing Members of the Firm. ,f Yj,//eL , //>2 327z Oc fPL ,- /788 /7 ,i7L-5ee) / %., 77 2. List all businesses,firms, entities or contacting 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. �(7 A/.-rte ,,/bi ,01. Za�,� 1 ozs 0+ ei0(fier(huA5k4___cill � � G3. List all.debts you or any company(s)associated with you that you refused to y 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 the foregoing application and that the facts stated in it are true. i�_ r /Ii.._f Authorized Officer o be Firm The foregoing instrument as acknowledged before me this /7414L__A 3 ge3`6 c-Cy CLW 'Pe -r-7,4-us- (Date) by C L CL Q 7 c`4-u S g AxIse_,ofwt e 9 /y 4re gi (Name of Officer, Title/Agent) (Name of Corporation)4- V� a /i" I �L 1 , a C )les / icu Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced ,q ,j2 D 7 Liteil ir f.dePA'' identification and did not take an oath. (Type of identification) NOTARY'S SEAL c:%. i'c'e. (/_(:- ;44--S 7_J V a� LINDA DORSKI (SIGNATURE OF NOTARY) se = t Notary Public,State of Florida _ '� " Commission#FF130199 n—u Page 2 of 4 '��" My comm. expires June 5, 2018 QUALIFIER INFORMATION: Name: igil..JgeL-,_ /- b ia Address: / ?lo ///17 /4kc 277/7- (Number&Street) (City) (State) (Zip Code) Telephone:�.��i ''y77 rc. Date of Birth: E-mail: 64-. 6-/in;/41N&fball7q Driver's License#: 1. Type of Certificate of Competency for which application is made. i 6,1477oicl 6,%//�/�.2 2. The names and telephone numbers of two persons who will know your whereabouts. 6/4 kild(5 c2I2 9-0 70--Ci‘c2) actsri /, 5 . d2,-27?/‘ -12/6) 3. Have you ever been convicted of a crime related to Contracting? i(�`�) (If yes,attach extra sheet with explanation.) 4. Have you or any firms you have been associated with ever filed bankruptcy? Xia 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. NOWe 6. List your business or work experience during the last ten years. 7. Statement of any formal training you have had in the area for which the application is made. A --FD,cen. f 1 in: I /. ! `r tIA / tI t- I, i C( rO c91 ( (Iffy, nod Alder bag Ord / 1 ) r ri:Sjek. 3 of 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. Ai chaeL , /7-hs Applicant(please print) 14me , Name of Company diva(o6f'l/0/9- .7 )/j/brilfi Signature of Applicant State of Florida // County of C9 II/'Pr The foregoing instrument as acknowledged before me this ‘144.04. a6 (Date) // by 0M50) `T�c S who has produced @r Dyi (,fes C�Cc1S� (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL LINDA DORSKI (SIGNATURE OF NOTARY) r :P`$ Notary Public,State of Florida 2 e*1 " Commission#FF130199 ��'� My comm. expires June 5, 2018 4 of 4 A U'TTh A[7T'T 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. Signature of Applicant i?re , 1fl64ce , //‘1 -0,, r fr / ( Business Name VGG� 9'73// Date__ BEFORE ME this day personally appeared Kt I AdLtoj i S 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 (Ye) C!C Pr The foregoing instrument as acknowledged before me this - jt off- 20/6 (Date) by Yn `L,ONebei who has produced /low QC/ (,2PA (name of person acknowledging) (type of identification) as identification a.nddid not take an oath. NOTARY'S SEAL LINDA orate of (SIGNATURE OF NOTARY) a =N.; Notary Public,State of Florida Commission#FF130199 1!-4" My comm. expires June 5, 2018 CIL County Operations and Regulatory Management Division Growth Management Department Contractor Licensing Section 2800 North Horseshoe Drive Naples,FL 3410 Date: June 13, 2016 To: Applicants for Certificate of Competency From: Ian Jackson, Contracting Licensing Supervisor Subject: Collection of social security numbers Pursuant to Chapter I-19, Florida Statutes and Collier County Contractor Licensing Ordinance 2006-46 Section 2.1.1., all applicants are required to submit their social security number(SSN)for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 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. 1111 Qualifier _ a h Qualifier No First Name Middle Name Last Name Postfix 124387 1tMMICHAEL J . (TITUS 1 0 Detail 1 Addresses Associated Tables 1 Update Info 1 ID No. Description Exam Date Score Location Sponsor 13790 IRRIGATION SPRINKLER 6/712003 64 FT. MYERS COLLIER CO 13791 B�U-�SIIN�ESS�&&LAW. y 6/7/2003 58 FT. MYERS COLLIER CO Certificates 14010 IRRIGATION SPRINKLER 916/2003 74 NAPLES COLLIER CO 14011 BUSINESS &LAW 9/6/2003 70 NAPLES COLLIER CO 14527 BUSINESS &LAW 10/4/2003 76 FT. MYERS COLLIER CO h Examinations ' 1J p. '6 Record(s)-Examinations =riday,Sep 30,2016 08:32 AM ualiftr Certification Information 015 9.28 37AM 'R2307 rev. 9/22/2 ' Printed on 02 - Qualifier Certification Information tion County -Plus for Windows 2000/XP ERTNBR: 13192 QUALIFIER NBR: 2035028283 MICHAEL PAUL TITUS:. LASS CODE: IS SPRINKLER/IRRIGATION 'CONTRALTO _ TATE NBR: COUNTY COMP CARD: 13192 ORZG ISSD EXPIRES " RENEWAL :� , . . , STATE EXP LIAR EXP WC EXP9/30/2017 8/29/2016 2/8/2011 DBA: HOME DEFENSE PEST MANAGEMENT' WC EXEMPT: Y OL EXEMPT: N ADDRESS: 1:430.0 .NE 191ST STREET. CITY: FT.. MCCOY FL 32134 PHONE: 352-546-1297 FAX: 352-546-2669 CREDIT ASSURE Page 1 of 11 :0,..1.„„t„,_, CREDIT PLUSFC Potential Score Improvement File#: 35160387 '\ SCANNED t3 Y �.. Date: 7/25!2016 � �{REDITASSURE—) Company: HAMILTON GROUP FUNDING INC AIIERV'I'==OFc'= 7):PE.7INC. Applicant: MICHAEL P TITUS Experian TransUnion Equifax Bureau Scores 707 691 687 Potential Score +91ii= +161110 Improvement Credit Assure TM CREDIT ASSURE BENEFITS: Credit AssureTM looks for opportunities to help a borrower improve their Alerts you to opportunities credit score,typically by paying down balances. You might have overlooked Helps you approve more applicants Helps you make better offers and close more loans Current scores(called bureau scores)are provided by the credit bureaus.Predicted scores(called potential scores)and score changes(called potential improvements or score improvements)are provided by CreditXpert Inc.("CXI")and are not bureau or FICO scores or changes.Predicted scores and score changes simulated by CreditXpert(R)products are only estimates.CXI does not guarantee that scores from any other company will change by the same amount,in the same way,or at all,or that correcting credit report information will result in a score improvement.CreditXpert products are based on credit reports from the bureaus.CXI is not responsible for inaccurate results,including any due to incorrect,incomplete,or outdated credit report information or incorrect assumptions about the future.CXI is not a credit counseling or credit repair organization.CXI is not endorsed by Equifax,Experian,TransUnion or FICO. THE FOREGOING IS NOT INTENDED TO PROVIDE OR IMPLY WARRANTIES OF ANY KIND.CREDITXPERT PRODUCTS ARE PROVIDED ON AN"AS IS"BASIS,AND CREDITXPERT INC.AND ITS DISTRIBUTORS DISCLAIM ANY AND ALL WARRANTIES,EITHER EXPRESS OR IMPLIED,INCLUDING BUT NOT LIMITED TO ANY WARRANTY OF MERCHANTABILITY,FITNESS FOR A PARTICULAR PURPOSE,NON-INFRINGEMENT,SYSTEM INTEGRATION,NON-INTERFERENCE AND/OR ACCURACY OF INFORMATIONAL CONTENT. Copyright(OI 2000-2016,CreditXpert Inc.All rights reserved.CreditXpert(R)is a registered trademark of CreditXpert Inc. file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 CREDIT ASSURE Page 2 of 11 CREDIT PLUS1NC Add Product MERGED INFILE CREDIT REPORT 31550 WINTERPLACE PKWY, SALISBURY, MD 21804 Reporting Bureau certifies compliance contractual requirements Phone: (800)258-3488 governing check of public records with these results. Fax: (800)258-3287 Public Records Found For:E Applicant 0 Spouse FILE# 35160387 FNMA# DATE 7/25/2016 RQD'BY DAWN GURKA COMPLETED SEND TO HAMILTON GROUP FUNDING INC DATE ORDERED 7/25/2016 CUST. #10040948 REPOSITORIES XP/TU/EF PRPD'BY 93 KING ST PRICE $14.95 LOAN TYPE SAINT AUGUSTINE, FL 32084 REF.# 1607050774 PROPERTY ADDRESS APPLICANT CO-APPLICANT APPLICANT TITUS, MICHAEL P CO-APPLICANT SOC SEC# 11111111110 DOB SOC SEC# DOB MARITAL STATUS DEPENDENTS CURRENT 14300 NE 191ST ST, FORT MCCOY, FL 32134 LENGTH ADDRESS PREVIOUS LENGTH ADDRESS SCORE MODELS EQUIFAX/FICO CLASSIC V5 FACTA-MICHAEL P TITUS-1111111111 SCORE: 687 00038-SERIOUS DELINQUENCY, AND DEROGATORY PUBLIC RECORD OR COLLECTION FILED 00020-LENGTH OF TIME SINCE DEROGATORY PUBLIC RECORD OR COLLECTION IS TOO SHORT 00010-PROPORTION OF BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER REVOLVING ACCOUNTS 00014-LENGTH OF TIME ACCOUNTS HAVE BEEN ESTABLISHED TRANSUNION/FICO CLASSIC (04)-MICHAEL P TITUS-an= SCORE: 691 038-SERIOUS DELINQUENCY, AND PUBLIC RECORD OR COLLECTION FILED 020-LENGTH OF TIME SINCE DEROGATORY PUBLIC RECORD OR COLLECTION IS TOO SHORT 013-TIME SINCE DELINQUENCY IS TOO RECENT OR UNKNOWN 010-PROPORTION OF BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER REVOLVING ACCOUNTS EXPERIAN/FAIR, ISAAC (VER. 2)-MICHAEL P TITUS-1111111110 SCORE: 707 38-SERIOUS DELINQUENCY AND PUBLIC RECORD OR COLLECTION FILED 20-TIME SINCE DEROGATORY PUBLIC RECORD OR COLLECTION IS TOO SHORT 02-LEVEL OF DELINQUENCY ON ACCOUNTS 10-PROPORTION OF BALANCE TO HIGH CREDIT ON BANK REVOLVING OR ALL REVOLVING ACCOUNTS Request New Tradeline CREDIT E W DATE HIGH C H DATE OPENED CREDIT OR BALANCE PAST MO STATUS O 3 CREDITOR REPORTED LIMIT DUE REV 30 60 90+ A DLA ACCT TYPE TERMS SOURCE J B NATIONSTAR MORTGAGE 02/15 10/05 $160550 $152868 $0 30 0 0 0 M1 02/15 MTG 360$992 XP/TU/EF 599638921 CONVENTIONAL REAL ESTATE LOAN, INCLUDING PURCHASE MONEY FIRST file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 ' CREDIT ASSURE Page 3 of 11 B B CAPITAL ONE BANK USA 06/16 11/04 $2300 $2154 $0 99 0 0 0 R1 414709****** 06/16 REV MIN$55 XP/TU/EF J B AURORA BANK FSB 07/12 10/05 $160550 $0 $0 79 0 0 0 M1 3640031780968 06/12 MTG 360$0 XP/TU/EF TRANSFERRED TO ANOTHER LENDER; CONVENTIONAL REAL ESTATE LOAN, INCLUDING PURCHASE MONEY FIRST B B BANK OF THE WEST 09/10 03/07 $15112 $0 $0 43 0 0 0 11 168036269 09/10 INST 144$0 XP/TU/EF RECREATIONAL MERCHANDISE B B BK OF AMER 02/09 06/96 $20100 $0 $0 99 0 0 0 R1 79 04/01 REV $0 XP ACCOUNT CLOSED AT CONSUMER'S REQUEST; CHECK CREDIT OR LINE OF CREDIT B B CAP ONE 07/15 06/01 $300 $0 $0 99 0 0 0 R1 546641******6546 01/02 REV $0 XP/EF ACCOUNT CLOSED AT CREDIT GRANTOR'S REQUEST B B CAPITAL ONE BANK USA 07/16 09/00 $25000 $0 $0 99 0 0 0 R1 480213****** 05/12 REV $0 XP/TU/EF BUSINESS CREDIT CARD-REVOLVING TERMS J B CHASE CARD 06/10 11/95 $13000 $0 $0 99 0 0 0 R1 512257****** 09/07 REV $0 XP/TU/EF A B CHASE CARD 05/09 05/03 $6500 $0 $0 73 0 0 0 R1 426690****** 06/05 REV $0 XP/EF AUTHORIZED USER B B DISCOVER FIN SVCS LL 07/16 10/01 $500 $0 $0 99 0 0 0 R1 601100****** 05/07 REV $0 XP/TU/EF B B GTE FCU 06/08 10/04 $10530 $0 $0 43 0 0 0 11 724115920 05/08 AUTO 048$0 XP/TU/EF J B WFDS/WDS 04/14 09/09 $17145 $0 $0 54 0 0 0 11 517655130521 03/14 AUTO 060$0 XP/TU/EF COLLECTION ACCOUNTS E W DATE HIGH C H DATE OPENED CREDITOR BALANCE PAST MO STATUS O 0 CREDITOR REPORTED LIMIT DUE REV 30 60 90+ A E DLA ACCT TYPE TERMS SOURCE B B MIDLAND FUNDING 07/16 12/13 $4109 $4012 $4012 29 0 0 0 09 856244**** 01/12 OPEN 001 $4012 XP/TU/EF ACCOUNT INFORMATION DISPUTED BY CONSUMER; FACTORING COMPANY; ORIGINAL CREDITOR: CITIBANK N.A. J B AURORABANK 05/12 07/05 $420000 $0 $0 77 1 1 17 M5 3640031262256 09/10 MTG 360$0 XP/TU/EF Late Dates: 2/12-120, 1/12-120,12/11-120,11/11-120,10/11-120,9/11-120,8/11-120,7/11-120,6/11-120,5/11-120, 4/11-120,3/11-120,2/11-120,1/11-120,12/10-120,11/10-120,10/10-90,9/10-60,7/10-30 ACCOUNT PAID FOR LESS THAN FULL BALANCE file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 CREDIT ASSURE Page 4 of 11 B B CAC FINANCIAL CORP 04116 01/16 $358 $0 $0 1 0 0 0 09 169788** 03116 COLL 001 $0 XP/TU/EF ORIGINAL CREDITOR:MEDICAL PAYMENT DATA; MEDICAL OTHER CREDIT HISTORY *** NONE*** INQUIRIES (LAST 120 DAYS) ***NONE*** PUBLIC RECORDS ***NONE*** TRADE SUMMARY # BALANCE HIGH PAYMENTS PAST DUE CREDIT MORTGAGE 3 152868 160550 992 0 AUTO 2 0 0 0 0 EDUCATION 0 0 0 0 0 OTHER 1 0 0 0 0 INSTALLMENT OPEN 1 4012 4109 4012 4012 REVOLVING 7 2154 27800 55 0 OTHER 1 0 0 0 0 TOTAL 15 159034 192459 5059 4012 SECURED DEBT 152868 OLDEST TRADELINE 11/95 UNSECURED DEBT 6166 DEBT/HIGH CREDIT 84% DEROGATORY SUMMARY CHARGE OFFS: 0 30 DAYS: 1 INQUIRIES: 0 COLLECTIONS: 2 60 DAYS: 1 MOST RECENT undetermined LATE: BANKRUPTCY: 0 90 DAYS: 1 DISPUTES: 1 PUBLIC 0 OTHER: 0 RECORDS: EXPERIAN FRAUD SHIELD ***FRAUD SHIELD*** 1 -TITUS, MICHAEL P * FROM 04/01/16 INQ COUNT FOR SSN-0 *FROM 04/01/16 INQ COUNT FOR ADDRESS-0 * INPUT SSN ISSUED 1973- 1975 ALERT 1 -MICHAEL P TITUS YOB: 1964 EXPERIAN OFAC NAME MATCHING SERVICE: NO MATCH FOUND UNLESS OTHERWISE INDICATED MISCELLANEOUS INFORMATION -Instant View Password:AV-2638D231 -To verify the authenticity of this credit report, please visit https://credit.creditplus.com and click on the Instant View link. Enter Identifier#35160387 and password AV-2638D231 to view the report. For any inquiries regarding this report or services provided by CREDIT PLUS please contact us at(800)258-3488. SOURCE OF INFORMATION 1 EXPERIAN-PULLED ON: 07/25/16 NAME: ICHA P TITUS DOB: 08/31/64 SSN: ADDRESS:14300 NE 191ST ST, FORT MC COY, FL 32134-2604-REPORTED 09/10-10/12 ADDRESS: PO BOX 525, FORT MC COY, FL 32134-0525-REPORTED 11/10-07/11 ADDRESS: 591 9TH ST NW, NAPLES, FL 34120-2052-REPORTED 12/90-03/10 EMPLOYER: HOME DEFENSE PEST MANAG//14300 NE 191ST ST, FT. MCCOY FL-REPORTED 04/11 EMPLOYER: MIKES COMPLETE LAWNCARE//-REPORTED 12/97 2 TRANSUNION-PULLED ON: 07/25/16-INFILE DATE:09/01/83 NAME: MICHAEL P TITUS NAME: DOB: SSN:41111111111 ADDRESS: 14300 NE 191ST ST, FORT MC COY, FL 32134-2604-REPORTED 09/10 ADDRESS: 525 PO BOX 525, FORT MC COY, FL 32134-0525-REPORTED 11/10 file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 CREDIT ASSURE Page 5 of 11 ADDRESS: 591 9TH NW ST, NAPLES, FL 34120-2052-REPORTED 02/94 EMPLOYER: LANDSCAPE DIMENSION OF COLLIER CTY/PRESIDENT/ EMPLOYER: MIKES COMPLETE LAWN// 3 EQUIFAX-PULLED ON: 07/25/16-INFILE DATE:03/22/04 NAME: MICHAEL P TITUS DOB: SSN: ADDRESS: 14300 NE 191ST ST, FORT MCCOY, FL 32134-REPORTED 10/11 -07/16 ADDRESS: PO BOX 525, FORT MCCOY, FL 32134-REPORTED 11/10-10/11 ADDRESS: 591 9TH ST NW, NAPLES, FL 34120-REPORTED 11/98-07/16 EMPLOYER: MIKES COMPLETE LAWN CARE/SELF FL/ EMPLOYER: MITCHS COMPLETE LAWN CARE/OWNER/ EMPLOYER: SELF MIKES COMPLETE/OWNER/OPERATOR/ CREDITORS AURORA LOAN POB 1706, SCOTTSBLUFF NE 69363 308-635-3500 disc AURORA LOAN 601 5TH AVE, SCOTTSBLUFF, NE 69361 800-550-0508 SERVICES I AURORALOAN 601 5TH AVENUE, SCOTTSBLUFF, NE 69361 308-635-3500 bank of america 800-421-2110 BANK OF THE WEST 1450 TREAT BLVD,WALNUT CREEK CA 94597 800-843-2327 BANKONEDE CAC FIN COLL 2601 NW EXPRESSWAY SUITE 1000 EAST, OKLAHOMA CITY, OK 73112 800-319-2676 CAC FINANCIAL CORP 2601 NW EXPWY, OKLAHOMA CITY, OK 73112 800-319-2676 CAP ONE 26525 N RIVERWOODS BLVD, METTAWA, IL 60045 800-947-1000 CAPITAL 1 BK 11013 W BROAD ST, GLEN ALLEN VA 23060 800-955-7070 CAPITAL ONE PO BOX 5253, CAROL STREAM, IL 60197 800-947-1000 CAPITAL ONE auto PO BOX 85520, RICHMOND VA 23285 800-955-7070 CAPITAL ONE BANK USA , 800-955-7070 N CENTEX PO BOX 199111, DALLAS TX 75235 888-480-2432 CHASE 800 BROOKSEDGE BLVD,WESTERVILLE, OH 43081 800-945-2000 CHASE BANK USA, NA 201 N.WALNUT STREET,WILMINGTON DE 19801 800-955-9900 Credit Plus 31550 Winter Place Parkway, SALISBURY, MD 21801 800-258-3488 DISCOVER FINANCIAL POB 15316,WILMINGTON, DE 19850 800-347-2683 SERVI DISCOVER FINANCIAL PO BOX 15316,WILMINGTON, DE 19850 800-347-2683 SVC cus svc DISCOVR CD PO BOX15316,WILMINGTON DE 19850 800-347-5342 GTE FCU 711 DALE MABRY HWY SOUTH,TAMPA, FL 33609 813-871-2690 GTE FEDERAL CREDIT PO BOX 10550,TAMPA, FL 33679 813-871-2690 UNI GTEFINANCIAL 711 E. HENDERSEN, TAMPA, FL 33602 813-871-2690 MIDLAND FUND 2365 NORTHSIDE DRIVE SUITE 300, SAN DIEGO, CA 92108 844-236-1959 MIDLAND FUNDING 8875 AERO DR STE 200, SAN DIEGO, CA 92123 877.240.2377 Midland Funding LLC , San Diego, CA, 92123 800-265-8825 NATIONSTAR 350 HIGHLAND, HOUSTON,TX 77067 866-316-2432 NATIONSTAR 2828 N HARWOOD ST, DALLAS TX 75201 866-316-2432 MORTGAGE LLC WFS P.O. BOX 19752, IRVINE, CA 92623 800-289-8004 WFS FINANCIAL p#800-289- 8004 WFS FINANCIAL/ PO BOX 19752, IRVINE CA 92623 800-289-8004 western financial DISCLAIMER An asterisk(*)following the payment amount indicates the repositories have no payment data and that the amount was automatically calculated as a percentage of the account balance. file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 CREDIT ASSURE Page 6 of 11 This is a report containing information supplied by the repositories listed above. The merge process is automated and the report may include some duplications and/or omissions. Inquiries regarding any disputed items should be directed to the creditor reporting the item, or to the appropriate repository service center(s)listed below. EXPERIAN TRANSUNION EQUIFAX PO BOX 2002 PO BOX 2000 PO BOX 740241 ALLEN, TX 75013 CHESTER, PA 19016 ATLANTA, GA 30374 888-397-3742 800-888-4213 800-685-1111 www.experian.com/reportaccess transunion.com/myoptions www.equifax.com/fcra ***END OF REPORT 7/25/2016 2:41:43 PM*** ECOA KEY: B=BORROWER; C=CO-BORROWER; J=JOINT; U=UNDESIGNATED; A=AUTHORIZED USER; P=PARTICIPANT; S=CO-SIGNER CREDIT PLUS:31550 WINTERPLACE PKWY,SALISBURY,MD 21804(P)(800)258-3488(F)(800)258-3287 The information is furnished in response to an inquiry for the purpose of evaluating credit risks.It has been obtained from sources deemed reliable,the accuracy of which this organization does not guarantee.The Inquirer has agreed to indemnify that reporting bureau for any damage arising from misuse of this information,and this report is furnished In ret once upon that Indemnity.It must be held In strict confidence and compiles with the provisions of Public Law 91508,the Fair Credit Reporting Act.Reporting bureau certifies that all Residential Mortgage Credit Reports meet the standards prescribed by FNMA,FHMC,FHA,VA and the Farmers Home Administration. file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 CREDIT ASSURE Page 7 of 11 CREDIT PLUS'NC .40- 001 ID Plus Borrower: MICHAEL P TITUS Social Security Number: XXX-XX-3445 Address: 14300 NE 191ST ST Telephone Number: Not Provided City, State,ZIP: FORT MCCOY, FL 32134 Summary No Fraud Alert on File tfr No SSN Alert on File tg No Active Duty Alert on File No Address Alert on File ak No Notice of Credit Freeze on File ` ' No Other Alert on File Social Security Number Alerts SSN Check: PASSED Verified SSN with external information sources Verified SSN is consistent with Personal identifying information Address Alerts Address Check: PASSED Verified Address with external information sources ' ' Verified Address against known fraudulent activity 4, Verified Address against commonly associated fraudulent activity indicators Other Alerts Additional Alerts Check: No Additional Alerts Found Disclaimer.The above identified risk messages,alerts,and data are aggregated from creditors,data repositories,and other public sources including Experian Fraud Shield.Social Security Number verified against multiple databases including Experian File One and the Social Security Administration DeathMaster and Issuance database,Reporting bureau makes no representation or warranty as to the accuracy or completeness of this information.In accordance with the Fair and Accurate Credit Transactions Act of 2003,the information in this addendum must not be used to determine the credit worthiness nor solely relied upon to establish the identity of a consumer.This product is intended for the specific commercial use of the customer and may not be appropriate for direct consumer disclosure. file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 CREDIT ASSURE Page 8 of 11 HAMILTON GROUP FUNDING INC REPORT#:35160387 93 KING ST SAINT AUGUSTINE, FL 32084 9048102293 RETURN SERVICE REQUESTED MICHAEL P TITUS 14300 NE 191ST ST FORT MCCOY,FL 32134 Your Credit Score and the Price You Pay for Credit Your Credit Score Your credit score 691 Model:TRANSUNION/FICO CLASSIC(04) Source:TRANS UNION Date:07/25/16 Understanding Your Credit Score What you should know Your credit score is a number that reflects the information in your credit report. about credit scores Your credit report is a record of your credit history.It includes information about whether you pay your bills on time and how much you owe to creditors. Your credit score can change,depending on how your credit history changes. How we use your credit Your credit score can affect whether you can get a loan and how much you will have to pay for that loan. score The range of scores Scores range from a low of 309 to a high of 839. Generally,the higher your score,the more likely you are to be offered better credit terms. How your score Your credit score ranks higher than 40 percent of U.S.consumers. compares to the scores of other consumers Key factors that • SERIOUS DELINQUENCY,AND PUBLIC RECORD OR COLLECTION FILED adversely affected your • LENGTH OF TIME SINCE DEROGATORY PUBLIC RECORD OR COLLECTION IS TOO SHORT credit score • TIME SINCE DELINQUENCY IS TOO RECENT OR UNKNOWN • PROPORTION OF BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER REVOLVING ACCOUNTS Checking Your Credit Report What if there are You have a right to dispute any inaccurate information in your credit report.If you find mistakes on your credit report,contact the mistakes in your credit consumer reporting agency. report? It is a good idea to check your credit report to make sure the information it contains is accurate. How can you obtain a Under federal law,you have the right to obtain a free copy of your credit report from each of the nationwide consumer reporting copy of your credit agencies once a year. report? To order your free annual credit report: By telephone: Call toll-free:1-877-322-8228 On the web: Visit www.annualcreditreport.com By mail: Mail your completed Annual Credit Report Request Form(which you can obtain from the Federal Trade Commission's web site at http://www.ftc.qov/bcp/confine/include/requestformfinal.pdf)to: Annual Credit Report Request Service P.O.Box 105281 Atlanta,GA 30348-5281 How can you get more For more information about credit reports and your rights under Federal law,visit the Consumer Financial Protection Bureau's web information? site at www.consumerfinance.gov/leammore. file:///C:/Users/DAWN/AppData/Local/Temp/EncompassSC/758ab093-b302-4255-a2d5-4... 7/25/2016 eM,'; _= fi r.fq.. .. .�..:Nigi •,~D;WE•SPy FLORIDA DEPARTMENT OF STATE Division of Corporations August 19, 2016 MICHAEL TITUS 1280 11TH STREET SW NAPLES, FL 34117 The Articles of Organization for HOME DEFENSE PEST MANAGEMENT & IRRIGATION LLC were filed on August 12, 2016, and assigned document number L16000154460. Please refer to this number whenever corresponding with this office. To maintain "active" status with the Division of Corporations, an annual report must be filed yearly between January 1st and May 1st beginning in the year following the file date or effective date indicated above. If the annual report is not filed by May 1st, a $400 late fee will be added. It is your responsibility to remember to file your annual report in a timely manner. A Federal Employer Identification Number (FEI/EIN) will be required when this report is filed. Apply today with the IRS online at: https://sa.www4.irs.gov/modiein/individual/index.jsp. Please be aware if the limited liability company address changes, it is the responsibility of the limited liability company to notify this office. Should you have any questions regarding this matter, please contact this office at the address given below. Neysa Culligan Regulatory Specialist II New Filing Section Division of Corporations Letter Number: 416A00017598 • www.sunbiz.org Division of Corporations - P.O. BOX 6327 -Tallahassee, Florida 32314 A C,IFR1 CERTIFICATE OF LIABILITY INSURANCE 4 DATEIIALYODtrYYYI U 9/22/2016 TI-US 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 TETE COVERAGE AFFORDED BY THE POUCIES „. BELOW. TI-US 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 pallcy(les}must be endorsed. If SUBROGATION IS WAIVED,subject to r'. the termsand 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 License#L077730 i NAME: Nancy McCarrick Dawson a1 Florida,Naples " ezq-(239)280-3£r1�3 ,Fw"xc,No:(239}261.2803 NapI Willow Park4100 Drive#207 i AWL nmcearrlek@clalvsencom anles.cem 1 Naples,FL 54104 1 Ammess: p INSURER(S,AFFOROENG COVERAGE HAMS INSURER A:Auto-Owners Insurance Company 189,88 ' INSURED i,MEURER a: Home Defense Pest Mgmt d/b/a 1 MEURER c: C`' 143410 NE 191 a1 SI, i wanmeR D1 , Ft.McCoy,FL 32134 i lNSUAER E: r: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: +' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST•LD BELOW HAVE oeuN issue)TO THE_INSURED NAMED ABOVE FOR 1.TNIE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REC{JIRElilENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY LIE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THZ POLICIES OESCRI13:ED HEREIN IS SL JEC r TO AI.THE TE1iMS, EXCLUS IONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. trI:1URy1CP, INSR ADOC SUe10.'. .`.._.__! h 1JCY EFF POLICV EXP TY95 OE ... , LTR 'IN D!WYD POLICY NUMBER .IMMOONYYYI iYG17 R0NYNYL._ L1Lf1'T9 �.__. - -X COLIMERCIALGENERAL LtAerttrY 1EACHDCCUF4ENCE II 5 1,0004000 . X 20021143 Ot12912010 .01,29/2017PREL1EiESLEIxnrveca) S 300,000 CLAIMS-MADE OCCUR I ._. MED DM{Anrano Ninon) S 10,000 PERSONAL d AININJURY i$ 1,000,000 OVA ACIGREDATE LIUIF APPLIES PER , GENERAL/DCAEOATE... $ 2,000,000 PCL-CY 'LOC I .PRODUCTS..cavP,oP AGG S 2,000,000 0114.94., 3 AUTOMteZE LIABILITY 1 COMBINED SNCL.UNIT,$ 300,000 O8t2W2017 !Ea ocadanl) ALL MIMED x 3CHE'1:LgD• BCL7ILY V UR f Fw par'rny $ AUTOS AULO'" j { A ANY NUM '4394108100 C18A29l201 B I ,BODILY!V L.IRY{Pa aaldn�y i S ; I,MAN-OWNED :PROPERTY DIAUSSE $ r:.'. X HIRED Auto ` -AUTOS ,,Far aocYAM'GI $ I' UMBRELLA LIMB ! ' OCCUR EACH OCCURRENCE 1 S CXCESS UAC �.. CLAIMS-MACE ' i dutaittIGA1'E IS t' ,YORKE O CDN RETfi`ITICFrS. ..._..._. . - IS ,._..__--- Srh U'E I -EnR i`j$ . ._..- _.+... ....,..,..�.., kf'. COMPENSATION AHD EMPLOYERS'LIASaJT YIM; I AO PROPMETCR'PARTNERSSECUTTN M E.L.EACH ACCIDENT 1 3 1 'OFFRCERMEt6EJREXCLUDED? �NOA' 1r 1 �' E.L.DISEASE-EAE.IIPLCY:'E'' 5 tfae'>d in HN - DLlr Y.117,describe ednr EL,DI"1EA e-POLICY'Liver!, S 1 oCS�Crtll"LIC,4 or CM"C:lrhtlOfi'J pokes- �-_ I ' DE5CIUFTIONOFOPWrATIOh3/LOCAT10N51VEHICLES(ACC'AO1O1,Ad,r.HnalRemarks Stl,odule,maybe elegised elteal*IOW*iseoquina) �� Ik . II d' --.-- q: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t�. ' Collier County Contractors Chard THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN >> y n9 ACCORDANCE_WITH THE POLICY PROVISIONS, Development Services Center 2800 Horseshoe Dr N ----- ------ _— _____. _- Naples,F1.34104 AUTHORIZED REPRESENTATIVE r 'El 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The AGGRO name and logo are registered)marks of ACORD Proof of Coverage Page 1 of 1 JEFF ATVATER, CHIEF FINANCIAL OFFICER FLORIDA DEPARTMENT OF FINANCIAL SERVICES WC Mobile App WC Home WC Databases CFO home Exemption Detail Page This database was last updated Friday,September 23,2016 12:55 ANI. Return to Previous Page Exemption Details Name Title Effective Date 'Termination Date Exemption Typo '•Business Activities f Employer Name Click Here to View HOME DEFENSE MICHAEL P TITUS PR Feb 3 2012 Feb 2 2014 ConstructIon Activities Listed on PEST Exemption MANAGEMENT INC Click Here to View HOME DEFENSE MICHAEL P TITUS PR Feb 19 2010 Feb 3 2012 Construction Activities Listed on PEST Exemption MANAGEMENT INC Click Here to View HOME DEFENSE MICHAEL P TITUS PR Feb 20 2008 Feb 19 2010 Construction Activities Listed on PEST ExemptionMANAGEMENT INC Click Here to View HOME DEFENSE MICHAEL P TITUS PR Feb 20 2006 Feb 20 2008 Construction Activities Listed on PEST Exemption MANAGEMENT INC Click Here to View HOME DEFENSE MICHAEL P TITUS PR Jan 9 2004 Feb 20 2006 Construction Activities Listed on PEST Exemption MANAGEMENT INC Click Here to View HOME DEFENSE MICHAEL P TITUS PR Apr 8 2003 Jan 8 2004 Non Construction Activities Listed on PEST Exemption MANAGEMENT INC Click Here to view HOME DEFENSE MICHAEL P TITUS ME Aug 25 2016 Aug 25 2018 Construction Activities Listed on PEST Exemption MANAGMENT 8 IRRIGATION LLC *Termination may be through the revocation of the exemption,or expiration of the exemption. **The exemption only applies to the business activities listed on the exemption. Return to Search Page https://apps8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?pr person_id=000515431 9/23/2016 x;Of of Coverage Page 1 of JEFF ATWATER, CHIEF FINANCIAL OFFICER FLORIDA DEPARTMENT OF FINANCIAL SERVICES Employer Detail Page Return to Search Page :--7-,177;nwr,r • IHOMERIGATIODEFENSE PEST MANAGMENT& !LIMITED LIABILITY CO. IN/A IRN LLC toy Covefage History MICHAEL P TITUS icoi 11,io Oimier Eien.don of Cover-Ac,:?. Ls I HOME DEFENSE PEST MANAGMENT&IRRIGATION LLC I Legal 'Current Return to Search Page I ttps://apps8.fldfs.com/proofofcoverage/EmployerDetail.aspx?EmpID=X00148474 9/12/2016 IN Individual Request-Online Application Page 1 of 1 • EIN Assistant Your Prot?,,-.. 't, _nLo' °.AuthentiaLL. I.p^•'aIn 5.SIN Confirmation Congratulations!Your E1N has been successfully assigned. Help Topics 147at 41 do not have OC::55 E1N Assigned: 81-3839774 to a mutter at mos ane? Legal Name: HOME DEFENSE PEST MANAGEMENT& Can zcress thi totter at a IRRIGATION LLC later date? IMPORTANT: Save andlor print this page and the confirmation letter below for your permanent records. The confirmation letter below is your official IRS notice and contains important information regarding your EIN. Iielo with_anno and CLICK HERE ror Your EIN Confirmation Le:tor d �ino your.tetter Once you have saved or printed your letter.click"Continue to get additional Continue» information about using your new EIN. • laps://sa.www4.irs.gov/modiein/individuaUconfirmation.jsp 8/23/2016 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF l Ct COUNTY OF ( i I'64') I, &iia ri- U G i c tk a rcO , having been first duly sworn, state and affirm: I am a resident of (-)//,"air" County, f0 (State) and have resided here for more than five (5)years. AA�� During the last five years I have known (/1/ ,/G t l /Ai (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. &‘>6)fri-d41 72.z,?- /\ Signature a-L..0(2(0_ g Name 2` 31 ttc q.51,(id ri&-t Address 23 t 2 -3-O 32. x( Telephone The foregoing instrument as acknowledged before me this Q 1/&(7/0 G U n (Date) by Edwaect �, K t G CCk who has produced („4- (),r;ve,,. Li n S (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL 0513,°0e Fatly Ras e�, Notary Pubic int State of Florida (SIGNATURE OF NOTARY) MY COMMISSION FF 240429 Expires:June 15,2019 AFFIDAVIT OF nNTr;T::: .:r ,"+STT GOOD CHARACTER STATE OF \O C COUNTY OF G I, ,1J-}•& v e, Pr-T ej , having been first duly sworn, state and affirm: I am a resident of C o 1l 1 P—C County, ' <C 0 (State) and have resided here for more than five (5) years. During the last five years I have known /V\1G,I- ty.e,\ T IT V S (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. \s Aye, �v Address q7 Telephone The foregoing instrument as acknowledged before me this 0 J — C, (Date) by ?OPS who has produced FLoi 1 D,A, _Pg l V 25 (name of person acknowledging) (type of identification) as identification and did not take an oath. -+►4? KATHRYN M.MONDRY ' NOTARY'S SEAL ; = i- Notary Public.State of Florida ; , / . Q My Camm.Expires Sep 26,2016 I „� ,.o Commission p EE838499 \o. Bonded Thmu�b National NotarcAssnw (SIGN':TURF a F N TARY ( ,- . ( . • . VERIFICATION OF CONSTRUCTION EXPERIENCE1 .,,,....=..,_—..:-. - .......,..L...-=:=_:n-,77--7.----- -7-----i2– Collier County Contractor Licensing CIO Community Development 84,EuvirOlimental Services Division t 2800 N. florsesypq„Pqr , • Naples, FL% 34104 "•4: i 4./. Telephone: (941) 403443 or (941) 403-2432 : ,.., •....:. • •,;A .!' ., , ?!: Applicant's Name: •: t .. -:,.t-i 11 .)1. ,,....), .•*,;-, ..,i, ..,, Certificate Category Reques4.'e . ?IA .7.1(, 4 i . . .,•!...1( ,,4,•, •;• -•••'t. •, .' , ,.., . . •. • •., , The Applicant is seeking a collprOounty:Certificate of Competency ii.J.the trade indicated above. As part of the application for this certificatettiipplicant mut verify thek'bxperidice•within this trade. You are being requested to provide information tlW.,‘Tikaid thcl'I'Ai5plic'ant in meeting this requirement. You should verify time of active experience italetrade reqiie'steil. Time in a supervisory or administrative role should also be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying de experience must ppr.av,the following info ir ation: Name: )6.,V)q)-6 6 I ,79 2 60s)7 1, Title: ., .r_) A) ) ;License Number(if applicable): / ) -)6'0 CC ..) ) ET)-6 0• ,---g/ Name of Business: Business Address: LS-'--- / F' Business Phone: -3 q q - ( The Applicanes work experience from) 6-1 •, o The applicant's ac pe of work(specific duties) included: 0 .j Lr ,/12(pig/)At 6 74 j___A ii) ,0 ii.j7j.//Jpi% /1/i I lejlE .70 1 ib. j', P.,e1- A7 I(I lAi(Ai . 7 ki, N .../,. Wi' Additional Comments: it .1 Falsifying any information provided herein may subject y•uc /t r i •/se 6 re octioii. ,.: . . ., • , :.......„ . , (.4 ZA-a---- Si:nature i ,, i• , ......1 .". p,,....7y Printed.Nam94/i/(.../y- (,) /, ..)(i A-2)3 (....6 State of Florida , County of Collier i ,----, ,The foregtinstrument was acknowl4dged before me on this ID day of 1.--2x--c._.. , 200 3 by i•-•&td,-tri-e-A ( io(,...-q-,1.---,_ '.•who is personally known to me or produced ------- as identification and who did not take an oath • 7--)./2"..6,;:k.-•,.-De r.....--0--,/,..,—...., t...- • Signature of Notary..,,..,..,.... , • ..41:9,./4:,:i,3, ll;;A I..LOENVER My Comm Exp.3/16/04 .. ..,.// ...., NG.CC;919470 ......."' (Witert.vitv't/Itttowil !1 Other IA V '7.;' �RIFI ' —7 T OE CONSTRUCTION EXPERIENCE; Go�lic.i County Contractor Licensing C/O Community Development&Environmental Services Division 2800 N. Horseshoe Drive Naples, FL 34104 Telephone: (941) 403-2431 or (941) 403-2432 Applicant's Name:v /'/!li /iai/ -.!",- '-6441 Cert' kgate Category Requested: - .0 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 in the trade requested.Time in a supervisory or administrative role should also 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: C�ee..7r_t,—ct 5 L I c.:1,Lai /1".' ' ,� T License Number(if applicable): lel°C 47�Title: C !�+ / �+� Name'of Business: A/a p Cr .frei. `, k l(6,--) • Business Address: Z 1 3 +" D 1-)1(2,-- SI-- Business I--Business Phone: Z S a .31, c6 The Applicant's work experience from 19 M .to ZOO'3 The applicant's scope of work (specific duties)included: .L'A s4 a / I (— 15 01lrf Sys- GV1,` 2 Additional Comments: Falsifying any information provided herein may subject your licenseLto revocatio• 72....A n. JEFFREY WILL Signature fn uy .- f 0 MY COMMISSION f� DD 117701 g n� _ 2).<1k-c- rC�C '1.01 * . 'EXPIRES:July 8,2006 Printed Name: C.c curd ,) State of Florida 1.ewG+oTARY Fl.Not caySoM &Doming,Ina County of Collier The foregoing instrument was acknowledged before me on this I-`t day of i}t- -- , 2001 by fl' . ti,••,,v—i "2 ti .‘-k tA"3 who is personally known to me or prsuced O A-- as identification and who did not take an oath._^.r_,._.,—_.—.____ __4 f --- '..Signatur ,• 'wry " I . • ,-----CAI ''' . 4. / i / . A l •• • ( VITRIFICATION OF CONSTRUCTION EXPERIENCE•_ Collier County Contractor Licensing C/O Community Development& Environmental Services Division 2800 N. Horseshoe Drive Naples,FL 34104 Telephone: (941) 403-2431 or (941) 403-2432 Applicant's Name: /V/A- //7/ 5- Certificate /1Certificate Category Requested: . -0,7,4,9---y7/w/ . 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 in the trade requested.Time in a supervisory or administrative role should also be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying tr de experience ustp-r/ovvide the following information: Name: //5 -�j 1�//f/ -. /� esof./L7' License Number(if applicable): /55-3C Title: T -'- / �J/./IG' /J'- / t %0SC/9�//v� Name of Business: ," it Business Address: ‘0 /9 AZ i WOE" / 7frt?e) ic 4 (7W . Business Phone:r ) �.-- SZ-4/7;"--The Applicant's work experience frome0C to voo3 The applicanes scope of work(specific duties) included: L' o,- 77d� ,6-,/,, `S Avo P/'vS7-19ZGn-77 c" S-- • Additional Comments: ' • Falsifying any information provided herein may subject your licens-.to r�ti. , Signatur •nn Printed Name: ✓ ./471/ .,�M/fi1/e2er- State of Florida County of Collier /5 . • -trume ,,was acknowled lefer e-on this day of , 2003 � ie fore'_•' g , by l}/WA- whg-' personally known tome 97 produced as identification and who did not take an o tlr.-=—•--,_— —/ (- ARA ...._ CRE.. Siifia�ure of Notary ,,. '�0•F4)i A. CREEL . ,•t'1' ,..,•,• ,••• . '-'^ of Florida �, .t�:-/.I ,•;1�i:;s• • '/�.�r'.!{ -(g��i..�fiv..eI3�v�•,•:AaAt:.diL: o-...t•..-.��su' y ( •- " • : Cri,!.,il.:i.., i t(1•- 'i - ```1,0 SARAN A.. CREEL �R .hd,`' (jCp�.:at'',� ....i12• ..14,,,Am. .S .. :5 Notary Public - State at Florida h y t •_ ?''/Commission Expires Feb 1,2006 ' ech f4 C.,J•r n4ztlon A D0084176 'Y„q;,;t°•`° 13 —,0 G/iici:c, sliir..^ryPn_att. "1� I T IDAVITTT/1Z FP/ AFF The undersigned hereby makes application for Certificate of Competency under the provisions of Collier 2ounty Ordinance No. 90-105, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he will act only for himself or that he is legally qualified to act on behalf of the business organization sought to be certified in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or )rganization and that he will continue during this registration to be able to so bind said business organization. rhe qualifier license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification on any information contained herein is grounds for disqualification. .1 ic•thq-V 1 Gam. APPLICANT (Please Print) DeirreiviSiM 4f ai1 I 1 NAME OF COMPANY q)11'613*- P- SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 12 i 1 y0-5 by @ IG a,e? \ \- who has produced i SG+Z l (name of person acknowledging) (Type of identific tion) as identification and who did not take an oath. () JEFFREY WILL />1 ` ec MY COMMISSION;A DD 117761 A'� ` tOF Te EXPIRES:July 8,2005 SIGN URE NOTARY m 1-807-3-NOTARY FL Notary Sice a 8axing.Inc. , A J" r� NOTARY'S SEAL L2 ,( V(� L PRINT NAME OF NeTARY PUBLIC) NOTARY PUB• IC STAFF USE ONT.Y; - }}-- l Trade: \, r•• ^;%:�'�'l Score: / \ Taken on / n1/1/1/2-31 given in C - )W , sponsored by _4 f/9/17 '-,J�, . Business &Law: Score: 1_2? Taken on 1 n/'%-� (j 'venin, 1 DAC, , sponsoredbylop 4 ( jj 7� 1 3 ,` `K, t RIVE NSECL S E - MICI AELPAUL , ojr• iI1N�TIX�]I�V. 'w€.��.a 1'1'111= I t kr , NA -;-ES,F 3 1€20"Z F Et i DOB SDG 11 ` c t r c # 1 t r . j '�3r'r '` � �a�.�t^'r"rs:_, � ?�S i•:��aa#»r..,i�4..h- i„ 7. 4 '' pperauori ar"amota reh�cfa.ennstitucesconsenCto any.sabnstyT strequtred by.law._� 6� SSi tsi CLol1- gl,T • Fa ?; reae r.z ;i;report please review our -• Search inquiry:Home Defense Pest ;;c t McCoy;; •,ibis r. n L _.: — County <::.;SC3,,^,,8 C.+,..,...wi0i�5 J: �`J:.ic' Acidras.s: 591 9th St NW .4 ,i;Personnel: Olmer.IF'i4','ttaei P i itus INap!es.F1 34120-20.52 ..:.iter. nti'.ii3A Titus Lfrili��St_tes • ; �..;i•?: _.,iei�.._.`art`. r.7i3:'-'7i:-'oC;' __. .... 39_ 95-2, = oma_ c - •�-:: - lt�l c F:: er.a+t c3�_30� u�. u L•012 ._or Re_.Estate `seri: Titus Michael D Dro0? ftice3 C'( cc, ."•.�•optS And etc•:...vi:Gr2SS: 14300 NE 1.. ST„tile, _ _ _ .`-rte ..'3c0 ;y...- __ ,crt.on =on i;1cC .. r'trr . 9 18E2 Sas:Is for has been)operating as: Tills Sp-inkier"_'$c_.r!;^E3 Bus e: ir, 2 Mar.24 Years Home Defense Pest management Talai LErnolbyees: , Ltnhs Vie. 32ta : 000 Larca.. Dii: ,-.�r:3 Of az.. a: 59. Sit'St 'i%:i Date or.ncor;,o aticn: Naples,FL :enches..-..a, iati've Landscape-Dimells ons Oi C 'Icier County.:no Lc:at-oils 14300 NE 191st St Fan MC FL 'Jstited Siates Lands Dinner-..,._ _Cf Coiter Ca. SP i yin cape t4.N Naples FL Li!:it,:.:Steles Landscape Dimensions Of Collier County.Inc 14300 NE 191st Si Fort MC Coy.FL United Stares . :?see - . es.not yet have as estimate.? 13'.!S ..a., (.52:? i_,.. y Days Beyond Terms; t • Ea?rilrtu-:v.Tm::tdt:, Insufficient infcrmaticn to prcduc9 Quarterly Payment Trends Monthly Payment Trends chart. 1:31-i0 0 0 Q 5:15- .'.'1i- In- o 23'.i- • 'Percentage of on-lime payments by quarter Insufficient information to produce Quarterly Payment Trends-Recent Activity Monthly Payment Trends rabie. Date Up to 30= 31-60 OBT 61-90 DET >90 JBT ^E115 0% 0% 0% flu 0% 0..an 6 0% 0% 0% 0% 0% 12115 0% 0% 0% 0% n•%; 03115 0% 0% 0% 0% 0% 06/16 34% 66% 0% 0% . 0% insuifcient information to produce Insu/1rc„roi it ormalton io produce insufi�cient information io produce Payment Trends - Payment Trends - Payment Trends chart. chart. than in7de 1:7r: r,;;'-.forma t....3- Payment Experiences(Financia;Trades) Supplier Category Reported Date Activity Date Payment Terms Recent High Credit .c Up to 30 31-60 DBT 61-90 DST >90 DBT Comments Cred Cart 11;25/14 Rev Account Cl Cred Card 9/03/16 5/17;12 Rev 525.97 g Find Svcs 9123/15 12/23/08 Rev 5755 Fico:Svcs 6101:16 5.13'18 Ret Additional Tradeiine experiences(Aged Trades) Supplier Category Reported Date Activity Date Payment Terms Recent High Credit _ - !'..:••• Up to 30 i7c:': 31-6G DBT 61-90 DST >90 DBT Comments Chemicals 2/10/16 Varied li-Jgtl ri=z- Summary of inquiries Supplier Category 09/16 0311 07/16 06/16 G6/i6 04/96 03/96 02/i6 01/16 Insurance 0 0 0 0 0 e 0 0 Totals 0 0 1 0 0 0 0 0 0 'The information herein is furnished in confidence for your exclusive use for legitimate business purposes and shall not he reproduced,Neither Experlan nor its sources or distributors warrant such information nor shall they be!table for your use or reliance upon it. n 2016 Experian Information Solutions Inc. Google Site Stats learn more Gcsaact is __, a Hianner _acei isrtns Privacy C 2G96 Experian in.`ditnetion Soluiions Pio.Pi!rights ceserkgio. httns://mvaccount.sbcr.experian.com/report.aspx?rss1=1&fn=739872308&nnum=1005&day=27316&dnc=... 9/29/2016 Jack R. Lewis LJI Construction,LLC 3025 Driftwood Way, Unit 3202 Naples,FL, 34109 Cell(239)633-454 Email: Lewconstruction@aol.com November 10,2016 Attention: Collier County Board Members I have been in the carpentry trade since 1972 and have made this my life long career. After many years working in South Jersey as an established Carpenter Contractor,I relocated to Naples in 2001 and received a Collier County Carpentry License working for several reputable Builders in the area. As you all know,the recession was very bad in Collier County and I returned to NJ to build a custom home,along with framing and trim projects. In 2014 I returned to Naples and worked for Diversified Construction Services of FL as their Superintendent, in charge of the Carpentry Division for Interior/Exterior Trim and Trusses. Customers include BCB Homes, Waterside Builders (Mike Assad)and London Bay Homes. Most of the work was west of 41, including Port Royal,Moorings and Old Naples area. I have decided go back in business on my own. I currently hold a Lee County License and looking to re-establish my Collier County License. Sin •r`= Jack R. Lewis, Owner LJI Construction, LLC , , v'_& -.43e r Cc+rnty •61; .........,...,........„.„..........._ ef .. ....... GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive 0 Lf a '7Ss' Naples,FL 34104 g 01 (j!-' Y C1 1��"° 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: L�� Exact Corporate/Business Name: o4/sTRueT/oiV, L Z e Fiction Name/DBA: Qualifier Name: ..1.4e1( , . / c)/S Physical Address: .3025 7)ri//tvoo/ Way 48 3ZD2 /44/.45,1"i egy/6,9 (Number&Street) (City) (State) (Zip Code) Mailing Address: .3o 26" n 1iwaaa' Alai , /4051 3202- /17,4kS, /ZX300 7 (Number&Street) (City) (State) (Zip Code)'"' Telephone: (23?).3/6-/06V E-mail: /e'eM/srirueT/DA)I�,4OL.gD47 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 i Specialty Trade: CHANGE OF STATUS: (X) Reinstatement (X)From One Business to Another ( )Dormant License to Active Page 1 of 4 4, . j 1. The names,titles,home address and phone numbers of all Officers/Managing Members of the Firm. "" (23)6,33-�sgi ..3426" 2),./4404014) y, ,O/ /f�� zoz ' 44 /L OO'' l/09 /ACBE /L1• Lewis 639)2/6-3/2s— ,..1425- .n*f wooJJ/dA y1/Of izaz 4/470,s, LG .o9 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. Lewis fp ier fah ses o f iL ,.Tive. 1TS �o NsrgiteT o,1) , 4,4 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. /V// AFFIDAVIT Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. u er o the Finn The foregoing instrument as acknowledged before me this :0/1 1( (Date) by r(/ i c of (--71:--T C vic.4rL c 4r c.� Lc- (Name c-(Name of Officer, Title/Agent) (Name of Corporation) a FL— Corporation on behalf of the corporation. (State or Place of Corporation) He/She has produced til` t_ identification and did not take an oath. (Type of identification) NOTARY'S SEAL sy Et Johnson 4* 'a 10 State of " " 9 MY August Florida 1I IGNATURE OF NOTARY) os ' `�,0142of4 QUALIFIER INFORMATION: Name: ✓QC'K X'. LE/v/S Address: / (5/ e511 4YE,t1Pe , .4016,e, /Y.r Dcf3/8 (Number&Street) (City) (State) (Zip Code) Telephone: (239) b33- V5 Date of Birth: //' SS#: - E-mail: Lio eeNs nvecr7/042 /4Dl.ep y Driver's License#: Laga ► 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. 1RE,c>E ,ZF,u//S (2239) 2/6-3/25- R/s71E,IEt ( o40s (239) (33-3/75- 3. Have you ever been convicted of a crime related to Contracting? /Yp (If yes,attach extra sheet with explanation.) 4. Have you or any firms you have been associated with ever filed bankruptcy? /vp 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. // ENstb 4,5 C®aJ ipA 'Tte y 7. Statement of any formal training you have had in the area for which the application is made. -�A/4aE OP,Eie4-74 4 41(1NEb A C;oasreuero,J go/n/icy c9MJt ' /91fs fR,d n,e �yF#16 t/s7,eecgmi0,t), S,vs e2 /A/7ii3O/Z %ei,✓/ 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. aie,r ,C�vv� Applicant(please print) f.( A)s-rnee 70 . Name of Company Signature-of_Ap• t State of Florida County of 6i -' The foregoing instrument as acknowledged before me this k 1 (;€ I (Date) by who has produced M (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL: 6i%JMMfoonState of Florida J MY COMMISSION 141441 ( ISG ATURE OF NOTARY) °`" Writ.August 3,2010 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. Signa = • A:: '-ant / ,Ci/ 6 / ke ri aAi/C'. Business Name /O//a//b Date BEFORE ME this day personally appeared (� ✓t S 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 /r--'_ The foregoing instrument as acknowledged before me this 1 k (Date) by r S who has produced M 1\L- (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL 43407% State of Florida Ede Johnson AW 4 i d`. MY COMMISSION#FF 147441 IGNATURE OF NOTARY) %nit Expires;A 312018 ,.- ` c County &Ailed rfforlia BOARD OF COUNTY COMMISSIONERS John E.Manning District One Cecil L.Pendergrass District Two LarryKiker September 21,2016 District Three Brian Hamman District Four COLLIER COUNTY CONTRACTOR LIC Frank Mann 2800 N HORSESHOE DRIVE District Five NAPLES,FL 33942 Roger Desjarlais County Manager Richard Wm.Wesch County Attorney Donna Marie Collins Hearing Examiner LETTER OF RECIPROCITY This letter is to verify that JACK R LEWIS took the Thompson Pro Metric examination, sponsored by Lee County. BUSINESS &LAW: 76.0% DATE: 08/04/2001 Carpentry Contractor-CP: 80.0% DATE: 08/04/2001 The applicant needed to prove four years experience in the trade at the Licensing Board appearance. JACK R LEWIS has had a Carpentry Contractor License in Lee County since 11/17/2008. If you have any questions or if I can be of further assistance,please contact Contractors Licensing at(239) 533-8895. Sincerely, ifie./40 David Paschall Contractor Licensing P.O.Box 398,Fort Myers,Florida 33902-0398 (239)533-2111 flicltrrcp.rpt Internet address http://www.lee-county.com AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER IIe1it 12734 Kenwood Lane, Ste 85 TIT Fort Myers, FL 33907 •credit Phone: 239-277-3202 800-371-3348 Fast, Accurate & Secure. Fax: 239-277-0167 Web: www.meritcreditservices.com Email: meritteam@meritcreditservices.corn FOR: REPORT TYPE: DATE RECEIVED: PREPARED BY: CONTRACTOR LICENSING BUSINESS RESPOSITORIES: I EXPERIAN 8-3-2016 (ES D l y<,(,4 Ao/H/4 APPLICANT C.' Ei) Am Q Y ADDRESS LEWIS CONSTRUCTION ENTERPRISES- OF FL, INC 1914 IMPERIAL GOLF COURSE BLVD FEIN#:20 0154057 NAPLES, FLORIDA,34110 PUBLIC RECORD CERTIFICATION THE REPORTING BUREAU CERTIFIES THAT: PUBLIC RECORDS HAVE BEEN CHECKED ON ALL COUNTY, STATE AND FEDERAL LEVEL,INCLUDING PINELLAS COUNTY FOR JUDGEMENTS,FORECLOSURES,GARNISHMENTS,BANKRUPTCIES,TAX LIENS,AND OTHER LEGAL ACTIONS INVOLVING THE SUBJECT(S) WERE OBTAINED DIRECTLY THROUGH THE REPOSITORIES USED, OR BY DIRECT SEARCHES, OR A PUBLIC RECORDS SEARCH FIRM OTHER THAN THE REPOSITORY, OR BY ALL METHODS WITH THE FOLLOWING RESULTS: PUBLIC RECORDS LEARNED: --0-- BUSINESS HISTORY PRINCIPAL: JACK R.LEWIS TITLE: DIRECTOR IRENE M. LEWIS TITLE: DIRECTOR STATUS DATE FILED INACTICE OCTOBER 18.2001 NO INFORMATION WAS FOUND AFTER CHECKING THE FOLLOWING DATABASES: TRADE PAYMENT DATA UCC FINANCIAL STATEMENTS PUBLIC RECORDS COMPANY BACKGROUND BANKING INFORMATION CORPORATE RECORDS SOURCE OF INFORMATION: EXPERIAN B US I N E S S INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS FLORIDA DEPARTMENT OF STATE/DIVISION OF CORPORATIONS This information is furnished in response to an inquiry for the purpose of licensing or evaluating credit risks. The information furnished must be held in strict confidence and complies with the provisions of Public Law 91-508,the Fair Credit Reporting Act. 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 17 NJ 1/90 08/03/16 08:28CT [SUBJECT] [SSN] [BIRTH DATE] LEWIS, JACK R. `AB- [ALSO KNOWN AS] LEWTT,JACK,R [CURRENT ADDRESS] [DATE RPTD] 1064 GERSHAL AV., ELMER NJ. 08318 4/12 [FORMER ADDRESS] 1914 IMPERIAL GOLF COURSE BV., NAPLES FL. 34110 11/04 1495 RAIL HEAD BV., #4. NAPLES FL. 34110 [CURRENT EMPLOYER AND ADDRESS] [RPTD] LEWIS CONSTRUCTION 2/99 MODEL PROFILE * * * ALERT * * * ***FICO SCORE 4 ALERT: SCORE +704 : 040, 020, 008 *** IN ADDITION TO THE ***FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S CREDIT ***FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. CREDIT SUMMARY * * * TOTAL FILE HISTORY PR=2 COL=2 NEG=0 HSTNEG=0 TRD=2 RVL=2 INST=0 MTG=0 OPN=O INQ=5 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $500 $500 $48 $0 $25 90% TOTALS: $500 $500 $48 $0 $25 PUBLIC RECORDS SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 4841287 1/15R $10.6K I CI DC00043613 CIVIL JUDGMENT MIDLAND FUNDING LLC Z 4841287 3/14R $3958 I CI DC00030514 CIVIL JUDGMENT UNIFUND CCR LLC COLLECTIONS SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 8/12 $10.5K 01 CITIBANK SOUTH O9B 8552821054 7/16A $9056 ACCT INFO DSP BY CSM FIN RECOVERY Y 885M001 I 12/12 $637 MEDICAL O9B 85261720 3/15A $637 PLACED FOR COLLECTIO TRADES SUBNAME -SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CAPITAL ONE B 1DTV001 3/15 $500 MIN25 111111111111 RO1 517805874815 7/16A $500 $0 111 I CREDIT CARD $48 15 0/ 0/ 0 SYNCS/LOW L 235041J 6/00 $3522 111111111111 RO1 798222231009 7/16A $3000 $0 111111111111 I CHARGE ACCOUNT 9/09C $0 CLOSED 48 0/ 0/ 0 INQUIRIES DATE SUBCODE SUBNAME TYPE AMOUNT 8/03/16 ZNP6284423(FLA) MERIT CREDIT 5/18/16 ZSD7183303(CAL) FDNG STE 3/21/16 FC01207005(CAL) CREDCO 12/07/15 RNY6298261(EAS) LOUIS CINQUE 3/18/15 BPC2699824(NTL) CAP ONE CREDIT REPORT SERVICED 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 PC SALEM ZP4841287 (856) 935-7510 92 MARKET ST SALEM NJ. 08079 MIDLAND FUND YC36ET009 (844) 236-1959 2365 NORTHSIDE DRI SAN DIEGO CA. 92108 FIN RECOVERY YC885M001 (800) 220-0260 200 EAST PARK DRIV MOUNT LAUREL NJ. 08054 CAPITAL ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 SYNCS/LOW LH235041J (800) 444-1408 PO BOX 956005 ORLANDO FL. 32896 FDNG STE Z 7183303 (858) 750-1703 12255 EL CAMINO RE SAN DIEGO CA. 92130 • CREDCO F 1207005 (800) 523-0233 PO BOX 509124 SAN DIEGO CA. 92150 LOUIS CINQUE R 6298261 (631) 232-3810 3770 EXPRESSWAY DR LAKE RONKONKOM NY. 11779 CAP ONE B 2699824 (800) 955-7070 PO BOX 30281 SALT LAKE CITY UT. 84130 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. �► 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: UI CONSTRUCTION,LLC FEDERAL ID:47-3346832 CURRENT STATUS:ACTIVE PRINCIPAL(S):JACK R. LEWIS TITLE: MANAGER IRENE M. LEWIS TITLE: MANAGER DATE INCORPORATED: MARCH 05. 2015 Premier Profile-UI CONSTRUCTION,LLC • Os . Subcode:970135 Ordered:08/10/2016 14:07:17 CST Experian Transaction Number:C501414169 Search Inquiry:Iji construction/3475 LAKE SHORE DR APT 111/BONITA SPRING/FL/34134/US/N/A/997587371 • • Model Description:Intelliscore Plus V2 Business Name Bit me- l(lentitier,tiun N,."rebe-'r UI CONSTRUCTION, LLC 997587371 Primary Address: 3475 LAKE SHORE DR APT 111 BONITA SPGS,FL 34134-1369 TOP 0 Risk Dashboard Risk "4 ? >. AA o- Abolts Intelliscore Plus Financial Stability Risk Company DBT Original Filings High Risk Alerts Score unavailable. Score unavailable. Information on file not Information on file not DBT proven to predict serious proven to predict financial Unavailable future risk. stability risk. Credit Limit Recommendation:N/A TOP 1� Business Facts Years on File: 1;(FILE ESTABLISHED 03/2015) State of Incorporation: FL Date of Incorporation: 03/05/2015 Business Type: Profit Contacts: IRENE M LEWIS-MANAGER JACK R LEWIS-MANAGER Top e) Commercial Fraud Shield Evaluation for: LJI CONSTRUCTION, LLC, 3475 LAKE SHORE DR APT 111, BONITA SPGS, FL34134-1369_ Active Business Indicator: Experian shows this business as active BUSINESS ADDRESS IDENTIFIED AS RESIDENTIAL Possible OFAC Match: No No OFAC match found Business Victim Statement: tiNo victim statement on file TOP" Credit Risk Score and Credit Limit Recommendation Credit Risk Score:-intell Pius i,r, • r' Current Intelliscore Plus Score:Score and Risk Class Unavailable(999) This score predicts the likelihood of serious credit Hi h delinquencies for this business within the next 12 Risk k ._ '. { 3 ' Low months.This report does not include data elements t Risk statistically proven to predict serious future delinquency. 0 10 250 75 100 Therefore an Intelliscore Plus score cannot be calculated and the risk class is unavailable. Premier Profile-LJI CONSTRUCTION,LLC 1/3 Credit Risk Score:Financial StaiiiityRTsk `. ..r 4 , } yi r x• Current Financial Stability Risk Score:Score and Risk Class Unavailable (999) This score predicts the likelihood of financial stability risk High 44:" " within the next 12 months.Information on file is not LOW Risk "` s v; proven to predict financial stability risk.Therefore a ` Risk Financial Stability Risk score cannot be created. 0 3 10 30 65 100 Credit Limit Recommendation , 4� z . • Credit Limit Recommendation This recommendation compares this business against similar businesses in the Experian business Not available-This report does not credit database. It is based on trade information,industry,age of business and the Intelliscore include the data elements needed to Plus.The recommendation is a guide.The final decision must be made based on your company's create the credit limit recommendation. business policies. TOP 0 Payment and Legal Filings Summary Payment Performance Trade and Collection Balance lin. Current DBT: Not Available Total trade and collection(0): $0 Bankruptcy: No Predicted DBT: N/A All trades(0): $0 Tax Lien filings: 0 Monthly Average DBT: 0 All collections(0): Judgment filings: 0 ( ) $0 Sum of legal filings: $0 Highest DBT Previous 6 Months: 0 Continuous trade(0): $0 UCC filings: 0 Highest DBT Previous 5 Quarters: 0 6 month average: N/A Cautionary UCC filings: No Payment Trend Indication: Highest credit amount extended: N/A Payment trend indicator not available Most frequent industry purchasing terms: Industry purchasing terms not available Industry Comparison Industry DBT Range Comparison The current DBT of this business is Not Available. DBT for this business: Not Available 0..0 of businesses ns 11%n" DBT Range 0-5 6-15 16+ TOPV' d on•1 B s' acts • rh'.*NiIF#$ `� 4..Y' ;, ra�:•'a`Aw..�`eY• � `r+�eFiM.'�r'."- •`-'= Corporate Registration THE FOLLOWING INFORMATION WAS PROVIDED BY THE STATE OF FLORIDA.THE DATA IS CURRENT AS OF 08/10/2016. State of Origin: FL Date of Incorporation: 03/05/2015 Current Status: Active Business Type: Profit Charter Number: L150000406 Agent: LEWIS JACK R Agent Address: 3475 LAKE SHORE DRIVE BONITA SPRINGS,FL TOP Experian prides Itself on the depth and accuracy of the data maintained on our databases.Reporting your customer's payment behavior to Experian will further strengthen and enhance the power of the information available for making sound credit decisions. Give credit where credit is due. Call 1-800-520-9221, option#4 for more information. End of report 1 of 1 report The information herein is furnished in confidence for your exclusive use for legitimate business purposes and shall not be reproduced.Neither Experian information Solutions,Inc.,nor their sources or distributors warrant such information nor shall they be liable for your use or reliance upon iL Premier Profile-LJI CONSTRUCTION,LLC 2/3 Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS ,asnf r i .z , ' r4.° _),.. Detail by Entity Name Florida Limited Liability Company LJI CONSTRUCTION, LLC Filing Information Document Number L15000040638 FEI/EIN Number 47-3346832 Date Filed 03/05/2015 Effective Date 03/05/2015 State FL Status ACTIVE Principal Address 3025 DRIFTWOOD WAY APT 3202 NAPLES, FL 34109 Changed: 08/02/2016 Mailing Address 3025 DRIFTWOOD WAY APT 3202 NAPLES, FL 34109 Changed: 08/02/2016 Registered Agent Name & Address LEWIS, JACK R 3475 LAKE SHORE DRIVE APT. 111 BONITA SPRINGS, FL 34134 Authorized Person(s) Detail Name &Address Title MGR LEWIS, JACK R 3475 LAKE SHORE DRIVE, APT. 111 BONITA SPRINGS„ FL 34134 Title MGR LEWIS, IRENE M http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/11/2016 Detail by Entity Name Page 2 of 2 3475 LAKE SHORE DRIVE, APT. 111 BONITA SPRINGS, FL 34134 Annual Reports Report Year Filed Date 2016 08/03/2016 Document Images 08/03/2016 -- ANNUAL REPORT View image in PDF format 03/05/2015 -- Florida Limited Liability View image in PDF format Copyright and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 10/11/2016 RESOLUTION OF AUTHORIZATION WHEREAS Ljl go . S7Rtce Tje,c), Lie. proposes to engage / (Name of Business Entity) in contracting as eL,7 0,<)-C770107- /0 /Lc1. in (Type of legal entity: corp.,partnership,etc.) Collier County,Florida,according to Collier� County Ordinance 2006-46,as amended: and WHEREAS -TZ�o,v,S7T2u<<7%.Q,t), .Lcl . proposes to qualify (Name of Business Entity) for a Certificate of Competency with N/A(,(' , LFw/S (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned Xi(1ePS of lkr-T (Officers,Owners,Partners) ("O��T/�GIC�//A . hereby resolve and represent to the Collier County (Name of Business Entity) Contractor's Licensing Board that the qualifying agent, 6,jilet £ ,is active (Name of Individual) / /n • in all matters connected with the contracting business of qZ��JST,� 'Tp,J'and JM/< (Name of Business Entity) We further resolve and represent that - /.&111-C- is / / (Name of Individual) Legally empowered to act for L 7 i C ot�S7��[C�T/o�J�.in all matters connected with its (Name of Business Entity) contracting business,and has the authority to supervise construction undertaken by LArz C"a loSTe e7jo.J, / . . (Name of Business Entity) AgIUL PASSED AND ADOPTED THIS DAY OF (Officers,Partners,Owners-with designation underneath) ",ess (� Witne ,, Witness Corporate Seal(if applicable)or Notary Public Certificate Sworn to and subscribed before me this ,( day of 'c,4 , Vic(( by r w i C • The foregoing instrument as acknowledged before me this v( (€),61C- ,,(Date) bye L �yi who has produced 1.1 � (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL Eric Johnsen o�*"r %416GNATURE OF NOTARY) st1 MY COMMISSION#IT 147441 Expires:August 3,2018 State ofFlorida�'lo�i of StateDe artment p I certify from the records of this office that LJI CONSTRUCTION, LLC is a limited liability company organized under the laws of the State of Florida, filed on March 5, 2015, effective March 5, 2015. The document number of this limited liability company is L15000040638. I further certify that said limited liability company has paid all fees due this office through December 31, 2016, that its most recent annual report was filed on August 3, 2016, and that its status is active. Given under my hand and the Great Seal of the State of Florida at Tallahassee,the Capital,this the Third day of August, 2016 (7,--.,..„, --- ,:i, ,,„,.,.., . , 0, Yy,, , ., Tracking Number:CC4239947981 To authenticate this certificate,visit the following site,enter this number,and then follow the instructions displayed. https://services.sunbiz.org/Filings/CertificateOfStatus/CertificateAuthentication Electronic Articles of Organization L15000040638 FILED 8:00 AM Florida Limited For CompanyMarch. 05 2015 jdharris Shat@ Article I The name of the Limited Liability Company is: LJI CONSTRUCTION, LLC Article II The street address of the principal office of the Limited Liability Company is: 3475 LAKE SHORE DRIVE APT. 111 BONITA SPRINGS, FL. 34134 The mailing address of the Limited Liability Company is: 3475 LAKE SHORE DRIVE APT. 111 BONITA SPRINGS, FL. US 34134 Article III The name and Florida street address of the registered agent is: JACK R LEWIS 3475 LAKE SHORE DRIVE APT. 111 BONITA SPRINGS, FL. 34134 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent. P Registered Agent Signature: JACK R. LEWIS Article IV L15000040638 The name and address of person(s) authorized to manage LLC: FILED 8.00 AM March 05 2015 Title: MGR Sec. Of State JACK R LEWIS jdharris 3475 LAKE SHORE DRIVE, APT. 111 BONITA SPRINGS„ FL. 34134 US Title: MGR IRENE M LEWIS 3475 LAKE SHORE DRIVE, APT. 111 BONITA SPRINGS, FL. 34134 US Article V The effective date for this Limited Liability Company shall be: 03/05/2015 Signature of member or an authorized representative Electronic Signature: IRENE M. LEWIS I am the member or authorized representative submitting these Articles of Organization and affirm that the facts stated herein are tate. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1st and May 1st in the calendar year following formation of the LLC and every year thereafter to maintain"active" status. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: — —-- --- ----- PHONE X °S (A/C.No): E-MAIL ADDRESS: ---- — -- -__. INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: - INSURED INSURER B; 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 ADDLISUBR' POLICY EFF POLICY EXP LTR INSD'WVD' POLICY NUMBER (MM/DD/YYYYI (MM(DDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ CLAIMS-MADE OCCUR DAMAGE TO RENTED :P_REMI P + cra2encR)____$_�_._._ --— ------- _ MED EXP(Any one person) $`:' ---- _--, PERSONAL 8 ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY PRO- ._JEC7 LOC . PRODUCTS-COMPIOP AGO OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _tEa accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED -- — ---- ---- AUTOS —AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE --- - --- HIREDAUTOS _._—,:AUTOS 42eLacciden1)____ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE --- — E $ DED , RETENTION$ __-- WORKERS COMPENSATION PER OTH- 'AND EMPLOYERS'LIABILITY Y1 N' STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE — �OFclCEPlvEMBER EXCLUDED� t N!A E.LEACH ACCIDENT $ _ (Mandatory to NH) EL.DISEASE-EA EMPLOYEE S If yes.describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 191,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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U 1988-2014 ACt3RGCORPORATION. All rights reserved.- ACORD 25(2014!01) The ACORD name and logo are registered marks of ACORD . .,..._. .461, , - : ::,.'i ..,.:?, :„...i.T.07-::.1. • ':,..,/E' "-.. .,7 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: 8/18/2016 EXPIRATION DATE: 8/18/2018 PERSON: LEWIS JACK R FEIN: 473346832 BUSINESS NAME AND ADDRESS: LJI CONSTRUCTION, LLC 1064 GERSHAL AVENUE ELMER NJ 08318 SCOPES OF BUSINESS OR TRADE: CARPENTRY INSTALLATION OF CA Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 IRSD lit'-"INTERNAL �SERVICE CINCINNATI OH 45999-0023 Date of this notice: 03-09-2015 Employer Identification Number: 47-3346832 Form: SS-4 LJI CONSTRUCTION Number of this notice: CP 575 B JACK R LEWIS MBR 3475 LAKE SHORE BLVD APT 111 For assistance BONITA SPRINGS, FL 34134 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 47-3346832. 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 1065 04/15/2016 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. A limited liability company (LLC) may file Form 8832, Entity Classification Election, and elect to be classified as an association taxable as a corporation. If the LLC is eligible to be treated as a corporation that meets certain tests and it will be electing S corporation status, it must timely file Form 2553, Election by a Small Business Corporation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8832. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations&Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: ,,J A G LiE Certificate Category Requested: CA 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 informati n Name: a Title: oze +v i License Number(if applicable): - � C (C,O 38S Name of Business: C� (F' �eJ E.Lc, F?-y. '7 CSO P) T C_ Business Address: PA e_..LJA1 Z'1• Z6t5 �i- �: Ft- 331 CZ Business Phone: •Z3a •7-S1-OS`1 ( The applicant's years of experience from 8/LA i0/20 i40 The applicant's scope of work(specific duties)included: ( A M ,rJ f C-A 4'7 :.( 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 ... ic. . • -,• ,t tots stated in it are true. i Sicature Print Name State of Florida County of The foregoing instrument as acknowledged before me this I9/ '/// by ia � (Date) who has produced �, �(� (name of person acknowledging) (type of identification) as identification and did not take an oath. /.4iNOTARY'S SEAL (SIGNATU':' OF NOTARY) MICHAEL LATIN! NOTARY PUBLIC-STATE OF FLORIDA COMMISSION N FF930141 MY COMMISSION EXPIRES OCT.22,2019 ;VERIFICATION OF CONSTRUCTION EXPERIENCE' GMD Operations&Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: ;_\ K K 150)/S Certificate Category Requested: L'ARA.Ef/Ti_I/ i 1/UrVe7d/c The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate,the applicant must verify their experience within this trade. You are being requested to provide information that will aid the applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described,but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: r. Name: 5+ev cr`l b0-1c44-Cir- Title: 'Pr-a KC -Cir- Title: 'Pra iGk -r-1{- License Number(if applicable): L(4 C_, 0 5).1)1(,, Name of Business: 0 w}.1--tom-r.-- r,8 t r-1 eel-t r.1C� a Lor-I-h cLe Al r�C i J r t C . Business Address: 1 -2.1 J `� /� ei% .1 i 2'2 �3r'ic_k:-e_11 ,, v'r .itciDo, WItoLw1i , FL z33i31 / " fie,s,Fi 34102 Business Phone: 239.-511 - t�( 1 c1 The applicant's years of experience from 1115 to q/ (ln The applicant's scope of work(specific duties)included: At( carpe-r\--1-1- 0.55 U i c 1-e� Sc.c p e� d- w s%r- -. et. m o,v--1.0 >}€ mer- 4 r�ems' 7C7 r- b i I ai- c r' b04-3"") -�=1 e,.t ct. *; C.r d-- �� 'ti C Additional comments: yCICY'1� + ime(Y Falsifying any information provided herein may subject your license to revocation. Under the penalties of perjury I declare that I have read the foregoing pplication and that the facts stated in it are true. n ri./._____ Signature Print Name State of Florida County of Cs i ILCA The foregoing instrument as acknowledged before me this /0/6/2L91 b 1 by S-1�VVI l'-) Co, ('V who has produced `1'"i_--D (DaL' as identification and did not take an oath. \ 1 / NOTARY'S SEAL 11111011111 it ._ (SIG(SIG ,ATURE OF i�OTARY) 3117, 1 MAURICIO RAMIREZ 1 Notary Public-State of Florida 1 4 '� 1L �r Commission#FF 922384 1 ( rc9 My Comm.Expires Sep 29,2019 VERIFICATION OF CONSTRUCTION EXPERIENCE: GMD Operations&Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: —7:4e JC E Certificate Category Requested: The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate,the applicant must verify their experience within this trade. You are being requested to provide information that will aid the applicant in meeting this requirement. You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described,but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name: sf9znS �%yT�1 LEI�""— Title: �r� ('� r License Number(if applicable): Name of Business: 1/i//,9 Business Address: /04 fr ,4 Business Phone: 231 For I --4OO,5 The applicant's years of experience from ' to A es The applicant's scope of work(specific duties)included: t'fyi bto F4.40. r` cj� a* L - /4rh`ran:5 '70.4- c JJ Additional comments: V /c Ie S S/;f,ft r E Or 4-04— eseikitA3014i4.6 Ifs Falsifying any information provided herein may subject your license to revocation. Under the penalties of perjury I declare that I have read the for sing application and that the facts stated in it are true. Signature Tics le-dr Print Name State of Florid County of ( (tv The foregoing instrument as acknowledged before me this f Q 1") /1 6 (Date) by {J J `�cA. 4-f who has produced FL (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S S �ly�l a SEAN GRIMES •�� A_ `t Notary Public,State of Florida (SIGNATURE OF NOTARY) Commission#FF 208574 My comm:expires Mar:11,2019 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF -noel da, COUNTY OF col he" VatI, akt. , L. ,having been first duly sworn, state and affirm: I am a resident of C.C) ter County, F(td,GZ. (State) and have resided here for more than five(5)years. During the last five years I have known ao Ckj i 5 (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character �— • Signature Verac.�pa5 iderO Name (DDi2. IsfandcoatK C ue.rJe Naples -garida Address 239- 287-Z(0t,5 Telephone The foregoing instrument as acknowledged before me this J®. 5 . 1(a by k1 t S (Date) who has produced (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL I / A Oka..411111 4 <'� • ° '~ DIANE L GENTRY (SIGNATURE i NOTARY) P • MY COMMISSION#FF162785 EXPIRES October 5,2018 (407)399-0153 FloridallotaryService.com AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF FI-0434 COUNTY I-C}434 COUNTY OF eJ I, 6-1A-4 lff`/.. iv/ , having been first duly sworn, state and affirm: I am a resident of (i? Lel C `''( County, Fi-l/4,63n (State) and have resided here for more than five(5) years. During the last five years I have known it9f.5 (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. /1-41/X-"/ 214ka--,9-•--/` Signature Name 5 -3o 4-6 5; Z,,,t) /V /LC 5), R`. ,31-fiio Address 39- x-3..7 3 3 Telephone The foregoing instrument as acknowledged before me this �'� '(2c' t Z ``(« by (Pate) �� '� who has produced ,i (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL (S GNATURE OF NOTARY) ,,,u,n�. W. A PIN ih..a..a.dimasatioahosommia.46+-daft. C/' �' ��S�YpV6'4 CATHERINE C M 0 � 4 ;'r° `�. Notar Public•State of Florida i iii Commission#r GG 008378 �, ��-Tel My Comm.Expires Aug 1,2020 4 �'''�.......... Bonded through National Notary Assn COLLIER COUNTY BUSINESS TAX RECEIPT APPLICATION ; `= to lua lr t*, 2800 N.Horseshoe Drive,Naples,FL 34104 l Make Check Payable to: Collier County Tax Collector � ` "°'�'% Phone: 239-252-2477 Fax:239-643-4788 Website:www.colliertax.com CHECKLIST Copy of Articles of Incorporation and/or Fictitious letter Yellow Fire Compliance(list of fire district phone number from the State stating that your business name is on file. enclosed) (850-245-6052 or 6058) www.sunbiz.org Copy of Marco Zoning Certificate.(239-389-5000) Copy of State license from Department of Business and Professional(850-487-1395)or Department of Health. Completed Zoning application with appropriate fee made payable (850-488-0595) to:Board of County Commissioners.(239-252-5603) Copy of City Business Tax Receipt.(239-213-1800) Completed Business Tax Receipt application with appropriate fee made payable to:Collier County Tax Collector.(239-252-2477) Copy of Motor Vehicle Repair Registration Certificate from Department of Agriculture.(800-435-7352) Other: Copy of Health inspection from Department of Hotels and Please contact the Property Appraiser's office at 239-252-8145 Restaurants(850-487-1395)or Department of Agriculture. regarding tangible tax. (800-435-7352) CHECK ONE: Date: Original Application Classification Transfer of License# Code Number -Renewal of License# License Amount 1) CORPORATE NAME - la) DBA NAME - Ib) BUSINESS OWNER OR QUALIFIER'S NAME - 2) PHYSICAL ADDRESS - (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - Yes No 3) BUSINESS MAILING ADDRESS - Street City Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - 5) TELEPHONE -Business: Home: 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - 8) OFFICE WITHIN CITY LIMITS OF NAPLES - Yes No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. — — — *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: 10) NUMBER OF EMPLOYEES-Including number of owners: 11) FILL IN THE APPROPRIATE AREAS - a)Rental units(motellhotel/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**** Cof* er County COLLIER COUNTY GOVERNMENT GROWTH MANAGEMENT DEPARTMENT www.colliergov.net 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. Zoning Certificate# Business Tax License# APPLICANT CONTACT INFORMATION Name of Applicant(s): Telephone: Cell: Fax: E-Mail Address: 1 BUSINESS& USE INFORMATION Business Name (If any): Phone Number: Address: City: State: ZIP: 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 12/8/2015 Page 1 of 2 Cnntiniiprl nn nthpr side la . - y - . , . .or . . . _6., _ .. . , .. -f o- - F4litEr' LiC. ' . 45-4. - AUS • 'IWPIIIIIIIIIII 416/ `ti, 3E A :#,..,:. ,-,7 M .} Got[.i€ r �. -o - ty -10 ..............""'"'"44....,^•^"%...... .......................... 6 ) 1,0,� p GMD Operations & Regulatory Management j Licensing Section �Q 2800 North Horseshoe Drive .-� � /V:� Naples, FL 34104 , _ t C j 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: (.2.1:)' Exact Corporate/Business Name: P,) r� 0 rl (4? Fiction Name/DBA: Qualifier Name: j--.I (^ i (- L ; `t$ ( Lc- Physical Address: 17ocl -oak i)a ,_(,),14, u > R....,Sutak-es 33°( r r (Number&Street) (Cit (State) (Zip Code) Mailing Address: 513-Will& (Number&Street) (City) (State) (Zip Code) Telephone: - ),- c9 -- 1g1 "_ 911 E-mail: C n . (\ i ct 56c3 obct 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 Specialty Trade: P 1 a r,T.. 10/27/2016 Reinstatement Fee=$205.00 CHANGE OF STATUS: 3 back Year Fees=$555.00 ( s 'Reinstatement . ( )5 From One Business to Another New license Fee=$205.00 *DiffemrR fees may apply* TOtall=$9655.00 PrP\(i0L(S C'OCZ/Z /v L_J) ± Pagelof4 1. The names, titles,home address and phone numbers of all Officers/Managing Members of the Firm. �..t c-t� (a0�. \i e,5 Zrj "'`�7 t t '1 t-`1 &o �. C . \A. '3 3112,-2 V)3`I qq[[ t� c� ��, } (Z�Er q� 30 5('i li t.c&�i 1 c. c rta (i-1(i r c 3'-1130 v 2. List all businesses,fuels, 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. (2.,\Va...-ek 3.,,,,,,,p,,,-„, a,-„Dr zo12- - ecc,c,,-1-- , CLAOck-A 4 n i 0 SCS Y -(0,C _Lk„ OOO - ,,,,0„6 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. 1e),1� AFFIDAVIT Under the penalties of perjury I declare that I have read the foregoing application and that the facts stated in it are true. (, ;!'1 ` ---- Authorized Officer of the Firm The foregoing instrument as acknowledged before me this / I / Zc 1 / g g (Date) Lbyt'�,i C /,ti HA,'cx ,, of - �- \ 'E= i ,. -e �r �� (Name of Officer, Title/Agent) (Name of Corporation)' `--) a (- 10 ; t ca Corporation on behalf of the corporation. (State or Place of Corporation) - - He/She has produced t 1 - -Dc—; v( 'S I r C-CIA identification and did not take an oath. (Type of identification) NOTARY'S SEAL --C_ 1 —,— �_ (SIGNATURE OF NOTARY) ,soar►re Cecilia Vargas r° �'1 State of Florida Page 2 of 4 64 Itai My Comm.Expires 10/20/2020 4,0p teucr Commission No.OG 40627 QUALIFIER INFORMATION: Name: Address: 1109 Sc O era' [-6--\A-t-01)1 IJtG � , t� 39 7 2 (Number& Street) (City) (State) (Zip Code) c ++ Date of Birth: (: Telephone: ��) � � ( � �9 1 E 1 i C � SS#: ' C3iihGc., . � -111 -- �`� � E-mail: l n � Vitro,--ed S t� 1'\ Lat- 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. _ WacuAlL ( GVia` ) - Oct asl- I n -z (-2Z9) 33o - 3. Have you ever been convicted of a crime related to Contracting? r'Jo (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. 6. List your business or work experience during the last ten year ,c�` �� Doo- ZcGS Wc�' aCe& 2ct4 Zo(2- �� C � {? tc� �'�rik{3-pct' �`f-- N._0„,( � s N�i1LGt\ fGi ,( � iSGGCv ` �tiY l i1iet� 7rs l yotva (-,- 7. Statement of any formal training you have had in the area for whic1 the application is made. 600 k5 4 -�rt .t,r,1 0- of S ex-A" d,oS tAcii --ANN& Sari'\ \W-V3. 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. A licant (please print) a- ^' , 1f-1 � Name of Company Signature of Applicant State of Florida j-e_c_ County of The foregoing instrument as acknowledged before me this /2c Cc'(Date) � . Tom,,--7 v �!- �� -�� by ; G j �� Vr e �`� who has produced • (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL ' — (SIGNATURE OF NOTARY)/ �,so�gi Cecilia Vargas 'o State of Florida My Comm.Expires 1012012020 4 of 4 .' of r° Commission No.GG 40627 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 ofCompetency: ti Signature of Applicant itt/Cerl Cr Business Name ' G`" jL Date BEFORE ME this day personally appeared C icy L E 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 Ld= - The foregoing instrument as acknowledged before me this // f -Z C' (Date) by 4(C(c" � ; R g who has produced $ � �' vt i s Lc( 2 _ -- (name of person acknowledging)- (type of identification) as identification and did not take an oath. NOTARY'S SEALS t..ar Prie��a Cecilia Vargas (SIGNATURE OF NOTARY) State of Florida j, at My Comm.Expires 10/20/2020 ''�°oF n.sCommission No.GG 40627 RESOLUTION OF AUTHORIZATION WIEREAS �-�v'�-��2 `z�j t�f1h �c t , , � proposes to engage (Name of Business Enti4) in contracting as S -Co V.Co Ce-J1o i'\ in (Type of legal entity: corp.,partnership, etc.) Collier County,Florida, according to Collier County Ordinance 2006-46,as amended: and WHEREAS 14-1V .-t�t 4 eo r v'. .u' a proposes to qualify . (Name of Business Entity) for a Certificate of Competency with l CAS f-- A./0.-e (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned (-IC-L - - 'yll — _ of (O cers,Owners,Partners)Qvetic;CoL t ,ou aCe hereby resolve and represent to the Collier County (Name of Business Entit ) t , Contractor's Licensing Board that the qualifying agent, II CACI- of�(4;, , is active jame of Individual) in all matters connected with the contracting business of 1��`►vk 4 �` '` `�'� Q'',and (Name of Business Lntity) We further resolve and represent that LA CIA.. L f e4 - is _ (Name of Individual) Legally empowered to act for -�� `i r)4. G4r in all matters connected with its (Name of BAsines'Entity) contracting business,and has the authority to supervise construction undertaken by VAVO-C-1. 4 (I2 0tL G r (Name of Business ntityl Q 7� DULY PASSED AND ADOPTED THIS -1 DAY OFA). -r+'` > (Officers,Partners,Owners-,with`d nation underneath) ( duu ,s . , ,,t____= 40REre Cecilia Vargas Witness ;° (6 State of Florida *% t MyDors +.Eire 1 /2n1'020 itna � �`% �� 'FnR °° Commission No.GG 40627 Witness Corporate Seal(if applicable) or Notary Public CertificateSworn to and subscribed before me this 2( day of /I by ',/,'("---(c' /- •(.-_/.. t , v.-&. The foregoing instrument as acknowledged before me this 7? tie-c'``6-'``` -2 /, .:2-C / E (Date) by , C.rc� �'P "� who has produced F(- 6 7 v e T L i Cf,,7 S----c._ (name of person acknowledging) (type of identification) as identification and did not take an oath. r NOTARY'S SEAL i` c.) --=-,� (SIGNATURE OF NOTARY) / „Ivi Pare Cecilia Vargas ° :, .---•\�'e State of Florida s . My Comm.Expires 10/20/2020 1'14'toff Commission No.GG 40627 -fele GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 MEMORANDUM Date: February 17, 2015 To: Applicant's for Certificate of Competency From: Michael Ossorio, Contracting Licensing Supervisor Subject: Collection of social security numbers. Pursuant to Chapter I-19, Florida Statutes and Collier County Contractor Licensing Ordinance 2006-46 Section 2.1.1, all applicants are required to submit their social security number (SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's-test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter I-19, Florida Statutes, and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter I-19, Florida Statutes. Rivera & Company Corp 709 Scott Ave Lehigh Acres, FL 33972 (239)789-5991 cin.rivera@sbcglobal.net Collier County GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 Greetings, I am writing today in hopes that I may have my license reinstated. I presently have my license in Lee County since I returned to Florida in 2012. In 2006, when the crash of the construction industry happened, we sold our house and moved to Joshua, Texas (southwest of Fort Worth) where my parents live. Before we left Florida, all our vendors and subcontractors were paid — although WCI still owes us money on metal frame, drywall and stucco work performed to this day. No bankruptcy was ever filed. We worked in Texas doing roof repairs, several remodels, framing and drywall repairs from leaks. In 2011, my daughter (born and raised in Naples and still living in Naples) was diagnosed with Multiple Sclerosis. She was 25 at the time. We decided to sell our farm and move back to Florida to be close to her. We purchased a house in Cape Coral and remodel the interior and also a shell in Lehigh Acres which we completed and now is our residence. Lee County was kind and reinstated my license with letters of recommendation from costumers and employers in Texas. Rivera & Company is presently working for DR Horton at locations in Moody River, McGregor Reserve and Magnolia Landings. All are located in Fort Myers or North Fort Myers. I also have my license in Cape Coral, North Port and Port Charlotte, as we are doing a Culver's Restaurant and a 7-11 for Creighton Construction. Your time and consideration in my case is greatly appreciated. Sincerely, Licia Rivera Rivera & Company Corp (239)789-5991 State of Florida County of Lee Sworn and subscribed before me on this 21st day of November, 2016 by Licia L Rivera who produced Florida Drivers License. Cecilia Vargas PY Fb@ c`P (,� State of Florida 1 * c� My Comm.Expires 1012012020 Commission No.GG 40627 �; c- -) Signature of Notary • ERIC E C}A LEE R SGOT?AVE Et.33472-4E17 e County Southwest rfforik Li C2012-00173 cln.rivera a(�?sbcglobal.net License Holder LICIA L RIVERA Name: Firm Name: RIVERA&COMPANY CORP Address: 709 SCOTT AVE LEHIGH ACRRES FL 33972 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in a safe place as you will not be receiving any additional copies of your license from this office. Be sure to keep your email address current with us at all times. Below please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if you wish to perform work in Unincorporated Lee County. Renewal will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity to maintain your worker's compensation,general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector while performing work in Unincorporated Lee County. You may email your certificates of insurance to ContractorLicensing@Leegov.com. Our phone number is 239-533-8895. Please send e-mail address and/or telephone changes to ContractorLicensing@Leegov.com IMPORTANT CHANGE PLEASE READ: In an effort to reduce costs and "go green" we will no longer be mailing renewal reminders. If you wish to receive a renewal reminder via email please provide us with your email address along with your case number LIC2012-00173 to ContractorLicensing@Leegov.com. Re: "renewal by email". Cut Here Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239)5338835 Shall maintain required insurances on active Renewal due for active and inactive certificates. certificate each year in September. NAME:LICIA L RIVERA D/B/A RIVERA&COMPANY CORP COMP.NO.shall appear on allLICENSED FOR: Piaster&Stucco Cntr Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone#change. a business name. Shall only contract in D/B/A name as it appears on certificate.Board of Approval COMP.NO.: PLI2 x10173 required on business name changes. OT VAL. 3AFTER: Signature of License Holder fcntrlocren2.rpt a County Sour t � o 6 LIC2012-00173 cln.rivera Asbcglobal.nel License Holder LICIA L RIVERA Name: Firm Name: RIVERA&COMPANY CORP Address: 709 SCOTT AVE LEHIGH ACRRES FL 33972 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in a safe place as you will not be receiving any additional copies of your license from this office. Be sure to keep your email address current with us at all times. Below please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if you wish to perform work in Unincorporated Lee County. Renewal will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity to maintain your worker's compensation,general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector while performing work in Unincorporated Lee County. You may email your certificates of insurance to ContractorLicensing@Leegov.com. Our phone number is 239-533-8895. Please send e-mail address and/or telephone changes to ContractorLicensing@Leegov.com IMPORTANT CHANGE PLEASE READ: In an effort to reduce costs and "go green" we will no longer be mailing renewal reminders. If you wish to receive a renewal reminder via email please provide us with your email address along with your case number LIC2012-00173 to ContractorLicensing@Leegov.com. Re: "renewal by email". Cut Here Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239)533-8895 Shall maintain required insurances on active Renewal due for active and inactive certificates. certificate each year in September. NAME:LICIA L RIVERA D/B/A RIVERA&COMPANY CORP COMP.NO.shall appear on al! LICENSED FOR: Plaster&Stntr Shall inform the Contractor Licensing Office of Stucco C advertisements including vehicles reflecting any Address or telephone#change. a business name. Shall only contract in D/B/A name as it appears on certificate.Board of Approval COMP.NO.: 00173 required on business name changes. NOT •LID AFT R:t1913T 1 Signature of License Holder I 1111 fcntriocren2rpt iLèe C Souttwest (FloridaL1C2012-00173 cln.riveraCa�sbcglobal.net .icense Holder LICIA L RIVERA Jame: :arm Name: RIVERA& COMPANY CORP \ddress: 709 SCOTT AVE • LEHIGH ACRRES FL 33972 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file Ina safe place as you wilT-rio be recerVang-any additional copies of your-iicense from this-office. Be sure to-keep your email address current with us at all times. Below please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if you wish to perform work in Unincorporated Lee County. Renewal will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity to maintain your worker's compensation, general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector while performing work in Unincorporated Lee County. You may email your certificates of insurance to ContractorLicensing@Leegov.com. Our phone number is 239-533-8895. Please send e-mail address and/or telephone changes to ContractorLicensing@Leegov.com IMPORTANT CHANGE PLEASE READ: In an effort to reduce costs and "go green" we will no longer be mailing renewal reminders. If you wish to receive a renewal reminder via email please provide us with your email address along with your case number LIC2012-00173 to ContractorLicensing@Leegov.com. Re: "renewal by email". Cut bete Conditions of Certificate LEE COUNTY Conditions of Certificate CERTIFICATE OF COMPETENCY (239)533-8895 Shall maintain required insurances on active 2enewal due for active and inactive certificates. :ertificate each year in September. NAME:LICIA L RIVERA D/B/A RIVERA&COMPANY CORP ;OMP. NO.shall appear on all LICENSED FOR: Plaster&Stucco Gntr Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone#change. i business name. ihall only contract in D/B/A name as it ippears on certificate.Board of Approval COMP. NO.: PL12-00173 equired on business name changes. NOT VALID AFTER:09/301015 Signature of License Holder I fcntrlocren2.rpt y . w ;, , ti : ': a £ L1C2012-00173 dn_dvera b c am`_F:& License Holder LICIA L RIVERA Name: Firm Name: RIVERA&COMPANY CORP Address: 1118 NE 6TH PLACE CAPE CORAL FL 33909 Thank you for assisting Lee County Contractor Licensing in their effort to"Go Green". Please keep this document/file in a safe place as you will not be receiving any additional copies of your license from this office. Be sure to keep your email address current with us at all times. Below please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if you wish to perform work in Unincoprorated Lee County_ Reriewal Will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.lee-county.com/dcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity to maintain your worker's compensation,general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector white performing work in Unincorporated Lee County. You may email your certificates of insurance to ContractorLicensing@Leegov.coo. Our phone number is 239-533-8895. Please send e-mail address and/or telephone changes to ContractorLicensing@Leegov_com IMPORTANT CHANGE PLEASE READ: In an effort to reduce costs and "go green" we will no longer be mailing renewal reminders. If you wish to receive a renewal reminder via email please provide us with your email address along with your case number LIC2012-00173 to ContractorLicens€ng rl 7r Leegov_com. Re: "renewal by email". Cut Hate_ Conditions of Certificate I FF COUNTY Coni oas of Certificate CERTIFICATE OF COMPETENCY ( )533-3E95 Shall maintain required insurances on active Renewal due for active and inactive certificates_ certificate each year in September. NAME:LICIA L RIVERA 13/13IA RIVERA&COMPANY CORP COMP.NO.shall appear on all LICENSED FOR: Plaster&Stucco GMT Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone#change. a business name. Shall only contract in D/B/A name as it appears on certificate.Board of Approval COMP'NO.: PL12-00173 required on business name changes. NOT yAtitTAFTER:tQJY814r Signature of License Holder fcntrlocren2.rC 4. • fg-1Y ' 'Ill L _. ,i,,,,-.. , ._ LIc2012-00‘:73 cln.rivera@sbcglobal.net License Holder LICIA L RIVERA Name: Firm Name: RIVERA&COMPANY CORP Ad z_- 1118 NE 6TH PLACE:::.; in a sate place as you will not be receiving any additional copies of your t ^se from the office. Be sure to keep yc:r email address current with us at all times. Below please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if you wish to perform work in Unincoprorated Lee County. Renewal will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.lee-county.com/dcd/contractorlicensing.htrn In addition to this Certificate, it is your responsiblity to maintain your worker's compensation,general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector while performing work in Unincorporated Lee County. You may email your certificates of insurance to ContractorLicensing@Leegov.com. Our phone number is 239-533-8895. Please.".c-ld e-mail address aril ar te4e1J one chances to `,3-ad s:.F mrc" .c".; _eegto*-'t._ tIVIPORTANT CHANGE PLEASE READ`. In an effort to reduce costs and'go areeezz` we r:e.s no . te x..a`"g Fernewal rernlrders. >y* oz wish to receive a renewal renlirld r vla en ai p!9B;:PFQV e us ` mixt erns]add'css atrg w your case number LIC2012-00173 to ContractorLicensing cz3Leegov.com. Re: "renewal by e aiir. Conditions of Certificate LEE COMP( Conditions of Ceriifrw CERTIFJCATE OF CO':Pi i tf,ICY (239)533-8895 Shall maintain required insurances on a ve Renewal due for active and inactive certificates certificate each year in September. NAME.LICIA L RIVERA D/B/A RIVERA&COMPANY CORP COMP.NO.shall appear on ail LICENSED FOR: Plaster&Stucco Cntr Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone#change. a business name. Shall only contract in 0/B/A name as it appears on certificate.Board of Approval COMP.NO. PL12-00173 required on business name changes. NOT VAtlD A TER:0' 20j3 Signature of License Holder fcntrlocren2.rpt T EE COUNTY LIC2012-00173 License Holder LICIA L RIVERA Name: Firm Name: RIVERA& COMPANY CORP Address: 1118 NE 6TH PLACE CAPE CORAL FL 33909 Below please find your Lee County Certificate of Competency. This Certificate will need to be renewed yearly if yo,.J wish to perform work in Unincoprorated Lee County. Renewal will begin in the middle of August of each calendar year. If you choose to place your license on inactive status please notify this office as soon as possible. Please keep yourself up to date with our departments information by periodically reviewing our website at www.lee-county.cornidcd/contractorlicensing.htm In addition to this Certificate, it is your responsiblity to maintain your worker's compensation, general liability insurance and obtain a yearly business tax receipt from the Lee County Tax Collector while performing work in Unincorporated Lee County. You may email your certificates of insurance to ContractorLicensing@Leegov.com. Our phone number is 239-533-8895 Please e-mail address and/or telephone changes to ContractorLicensing@Leegov.eorn IMPORTANT CHANGE PLEASE READ: prt- r Vine g +,.ew reminders. In an}. effort toreduce costs and ` green w er be ma°�:. re.. , are . .._ � s. r--c wish to receive a renewra; reminder via eme please 7.--rovldra t s mith your erre e address along your case number LIC2012-00173 to ContractorLicens;ng _eegov. sm. Re: `'renege= by emair. C„Bare Conditions of Certificate LEE COUNTY Conditions of Cete CERTIFICATE OF COMPETENCY (239)533-88895 Shall maintain required insurances on active Renewal due for active and inactive certificates. certificate each year in September. NAME:LICIA L RIVERA D/B/A RIVERA&COMPANY CORP COMP.NO.shall appear on altLICENSED FOR: Plaster&Stucco Cntr Shall inform the Contractor Licensing Office of advertisements including vehicles reflecting any Address or telephone#change_ a business name. Shall only contract in D/B/A name as it O COMP.N L92-DD173 appears on certificate. Board of Approval -. :-- required on business name changes. NOT VALJ1D rAFT,tR W30/2012 Signature of License Holder fcntrlocren2.rpt SUOC1174 Local Business Tax Receipt Tax Col for fete of octeam Dear Business Owner: Your 2016-2017 Lee County Local Business Tax Receipt is attached below for account number 1203579. If there is a change in one of the following,refer to the instructions on the back of this receipt. • Business name • Ownership • Physical location • Business closed This is not a bill. Detach the bottom portion and display in a public location. I hope you have a successful year. Sincerely, 6?4r1:147j— Lee County Tax Collector 2016 - 2017 LEE COUNTY LOCAL BUSINESS TAX RECEIPT Account Number: 1203579 Account Expires: September 30, .2017 May engage in the business of: PLASTERING/STUCCO CONTRACTOR Locations 709 SCOTT AVE. LEHIGH ACRES FL 33972 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY GULAI'ORY .. . RIVERA&COMPANY CORP. RIVERA LICIA L Payment Information: 709 SCOTT AVE LEHIGH ACRES FL 33972. PAID 020101 214-1 07/25/2016 01:06 PM DP500 $50.00 SU000403 Co Lee County Tax Collector Tax Col _ tor 2480 Thompson Street Fort Myers, Florida 33901 �rdte of F1otNa/D www.leetc.com Tel: 239.533.6000 Local Business Tax Account: 1203579 Dear Business Owner: Your 2015-2016 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. C7?4rt 11-‘c3C)— Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records tieeC0t LEE COUNTY LOCAL BUSINESS T RECEIPT 2015 - 2016 Tax Col ctor ACCOUNT NUMBER: 1203579 ACCOUNT EXPIRES SEPTEMBER 30, 2016 -`e of F1°'`$ May engage in the business of: PLASTERING CONTRACTOR . . -.... .. . . ... Location 709 SCOTT AVE LEHIGH ACRES FL 33972 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY RIVERA&COMPANY CORP RIVERA LICIA L THIS IS NOT A BILL-DO NOT PAY 709 SCOTT AVE LEHIGH ACRES FL 33972 PAID 019845-264-1 08/10/2015 12:26 D $5 P500 0.00 ‘,8. 06" Lee County Tax Collector Tax Co for 2480 Thompson Street Fort Myers, Florida 33901 sf%of ©taxa www.leetc.com Tel: 239.533.6000 Local Business Tax Account: 1203579 Dear Business Owner: Your 2014-2015 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records vee�°u� LEE COUNTY LOCAL BUSINESS ESS T ECEIPT Tax Co ketor 2014 - 2015 ACCOUNT NUMBER: 1203579 ACCOUNT EXPIRES SEPTEMBER 30, 2015 4,`e of Ftot�a� May engage in the business of: PLASTERING f STUCCO CONTRACTOR Location 709 SCOTT AVE LEHIGH ACRES FL 33972 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY RIVERA&COMPANY CORP RIVERA LICIA L THIS IS NOT A BILL-DO NOT PAY 709 SCOTT AVE LEHIGH ACRES FL 33972 PAID 367156-533-1 11/04/2014 12:23 WEB $54.50 SU000186 4eeeou,74. Lee County Tax Collector `` 2480 Thompson Street Col Tax ton Fort Myers, Florida 33901 s%of eot'�a� www.leetc.com Tel: (239) 533-6000 Local Business Tax Account: 1203579 Dear Business Owner: Your 2012-2013 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records ,,eeCountk LEE COUNTY LOCAL BUSINESS TAX RECEIPT 2012 _ 2013 Tax Col*tor v ACCOUNT NUMBER: 1203579 ACCOUNT EXPIRES SEPTEMBER 30, 2013 csafe of F1o‘°a May engage in the business of: PLASTERING/STUCCO CONTRACTOR Location 1118 NE 6TH PL CAPE CORAL FL 33909 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY RIVERA&COMPANY CORP RIVERA LICIA L THIS IS NOT A BILL-DO NOT PAY 1118 NE 6TH PL CAPE CORAL FL 33909 PAID 018447-102-1 08/13/2012 12:54 DP500 $50.00 ee`oU^y Lee County Tax Collector Tax Col e+ctor 2480 Thompson Street Fort Myers, Florida 33901 kfd4 of F,ot`aa www.leetc.com Tel: (239) 533-6000 Local Business Tax Account: 1203579 Dear Business Owner: Your 2011-2012 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. ZIG/ itze,24 Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records veeCou„6, LEE COUNTY LOCAL BUSINESS TAX RECEIPT 2011 - 2012 Tax Cot{i'tor ACCOUNT NUMBER: 1203579 ACCOUNT EXPIRES SEPTEMBER 30, 2012 %of F1ot"a May engage in the business of: PLASTERING STUCCO CONTRACTOR Location 1118NE6THPL CAPE CORAL FL 33909 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY RIVERA&COMPANY CORP RIVERA LICIA L THIS IS NOT A BILL-DO NOT PAY 1118 NE 6TH PL CAPE CORAL FL 33909 PAID 310807-1-1 05/09/12 12:24:02 RYF1 $25.00 CITY OF t� Q 9A � 4 <ORW City of Cape Coral 9P 4oe Certificate of Competency 62790 Date Issued: 08/25/2016 PLASTERING(LATH,PLAS,STUCCO) RIVERA LICIA RIVERA&COMPANY CORP Expiration Date: 09/30/2018 Detach and post bottom portion CITY OF CAPE CORAL CERTIFICATE OF COMPETENCY City of Cape Coral-- 1015 Cultural Park Blvd--Cape Coral Florida 33990--(239)574-0430 This Certificate expires September 30,2018 Visit Our Website at www.capecoral.net Certificate #: 62790 Location: 709 SCOTT AVE CITY OF Classification: Business Phone: (239)789-5991 SPECIALTY State License: 0 r Q' PLASTERING (LATH,PLAS,STUCCO) � 4 RIVERA LICIA OR�OP RIVERA&COMPANY CORP Date Issued: 08/25/2016 709 SCOTT AVE Amount: $ 150.00 LEHIGH ACRES.FL 33972 CITY OF g27i.-::---=---,';:--- —' t40, U� <OR\OP CfTY 6F , i'cCity of Cape Coral r,4, Certificate of Competency 9 62790 Date Issued: 06/08/2015 1 PLASTERING (LATH,PLAS,STUCCO) RIVERA LICIA 1 RIVERA&COMPANY CORP Expiration Date: 09/30/2016 I Detach and post bottom portion -- —CITY OF CAPE CORAL CERTIFICATE OF COMPETENCY City of Cape Coral -- 1015 Cultural Park Blvd -- Cape Coral Florida 33990 -- (239) 574-0430 This Certificate expires September 30,2016 Visit Our Website at www.capecoral.net Certificate #: 62790 Location: 709 SCOTT AVE :77,11:7 ,,,.7.:„. Classification: Business Phone: (239) 789-5991 SPECIALTY ti State License: .0 �. i PLASTERING :1 9 (LATH,PLAS,STUCCO) RIVERA LICIA oRtoP RIVERA & COMPANY CORP Date Issued: 06/08/2015 709 SCOTT AVE Amount: $ 112.50 LEHIGH ACRES.FL 33972 j N • 0zr{ CHARLOTTE COUNTY LICENSING CERTIFICATE OF COMPETENCY NOT VALID AFTER 09/34/2017 Lic.Type: L PLASTER STUCCO DBA RIVERA&COMPANY CORP Lic.Nbr AAA-16-00069 LICIA RIVERA 709 SCOTT AVENUE LEHIGH ACRES FL 33972 2016/ 2017 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 31344 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2017 TYPE OF 593 DRYWALL,PLASTERING,ACOUSTICAL,AN(STUCCO QUALIFIER) NEW BUSINESS BUSINESS BUSINESS VARIOUS ADDRESS CHARLOTTE COUNTY,FL 00000 BUSINESS RIVERA&COMPANY CORP NAME AMOUNT 35.00 PENALTY 0.00 OWNER LICIA RIVERA TOTAL 35.00 MAILING 709 SCOTT AVE ADDRESS LEHIGH ACRES,FL 33972 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED Paid 11/09/2016 Receipt * 770-00000494 35.00 2016/ 2017 CHARLOTTE COUNTY LOCAL BUSINESS TAX RECEIPT ACCOUNT 31344 MUST BE DISPLAYED IN A CONSPICUOUS PLACE EXPIRES SEPTEMBER 30,2017 TYPE OF 598 DRYWALL,PLASTERING,ACOUSTICAL,AN(STUCCO QUALIFIER) BUSINESS NEW BUSINESS BUSINESS VARIOUS ADDRESS CHARLOTTE COUNTY,FL 00000 BUSINESS RIVERA&COMPANY CORP NAME AMOUNT 35.00 PENALTY 0.00 OWNER LICIA RIVERA TOTAL 35.00 MAILING 709 SCOTT AVE ADDRESS LEHIGH ACRES,FL 33972 THIS FORM BECOMES A RECEIPT ONLY WHEN VALIDATED Paid 11/09/2016 Receipt * 770-00000494 35.00 Dear Business Owner: Your 2016- 2017 Charlotte County Local Business Tax Receipt is attached above.Please detach the receipt and display it in a place that is visible to the public and available for inspection. The Charlotte County Local Business Tax Receipt is in addition to any other license or certificate that may be required by law and does not signify compliance with zoning,health,or regulatory requirements.The Charlotte County Local Business Tax Receipt is non-regulatory and is not an endorsement of work quality. Your 2016 -2017 Local Business Tax Receipt is valid from September 01, 2016 through September 30,2017 .Annual account notices are mailed in June to the address of record at that time.Any Changes to your Local Business Tax Account due to change of Business Name,Ownership, Physical Address or you are Closing your Business please contact our office at 941-743-1350 . VICKIE L.POTTS Charlotte County Tax Collector CITY OF NORTH PORT BUSINESS TAX RECEIPT Valid Thru September 30, 2017 RIVERA& COMPANY CORP 709 SCOTT AVE LEHIGH ACRES FL 33972 JUAN RIVERA OUT OF AREA NORTH PORT FL 34287 Issue Date: July 28, 2016 This Business Tax Receipt is hereby issued for the occupation of CONTRACTOR- STUCCO & PLASTERING. The Business Tax Receipt Number is 17-00016446 and is valid with the City of North Port at 4970 City Hall Blvd. North Port,FL 34286. COMMENTS: RESTRICTIONS: The person, firm or corporation named above is granted this Business Tax Receipt to the provision of Chapter 34 of the North Port Code of Ordinances. Issuance of this tax receipt is not an endorsement, or certification of compliance with other ordinances or laws. This tax receipt does not assure quality of work or confirm that regulatory or zoning requirements have been met. Holder must comply with all city ordinances and state codes. This Business Tax Receipt must be exhibited conspicuously at your place of business. FICO SCORE 5—EFX—N 779 00030/00008/00024/00005 TIME SINCE MOST RECENT ACCOUNT OPENING IS TOO SHORT TOO MANY INQUIRIES LAST 12 MONTHS NO RECENT REVOLVING BALANCES TOO MANY ACCOUNTS WITH BALANCES *i**************************************.********************-*********tet**x.a* __`TTITY SCAN ALERT: TO PERFORM TELEPHONE VALIDATION DUE TO INSUFFICIENT TELE-H=7 -277.77 SS_. _SF ED-663 S=7:3 ISST=D—'_T ***,..—,,,,*:a.,.*******:E***,.******z.m.** **apt.****i*****w***xxzx. * ADDRESS DISCREPANCY — NO SUBSTANTIAL DIFFERENCE OCCURRED * * 032 EQUIFAX INFORMATION SERVICES LLC, P O BOX 740241, ,ATI ANTA,GA,30374-0241,800/6.85-1111, W.EQU=FAX.COM/FCRA *RIVERA,LICIA,L SINCE 08/18/95 FAD 10/18/16 FN-242 709,SCOTT,AVE,LFHIGH ACRES,FL,33972,TAPE RPTD 10/15,DAT DLR 10/18/2016 1118,NE 6TH,PL,CAPE CORAL,FL,33909,TAPE RPTD 10/11,TAPE DLR 07/16/2016 1513,CADDO PEAK,RD,JOSHUA,TX,76058,CRT RPTD 08/15,TAPE DLR 09/02/2015 FN—RIVERA,LICIA FN—TITUS,LIOLA,L FN—TITUS,LICIA BDS-07/04/1960,SSS• 2411 01 ES—BOOKEEPING,RIVERA CO 02 EF—SECRETARY,LEOS SOD & GARDEN 03 E2—,UNKNOWN *SUM-10/00-10/16,PR/OI—NO,COLL—NO,FB—NO, ACCTS:5,HC$0-31320, 5—ONES. INQUIRY ALERT — SUBJECT SHOWS 3 INQUIRIES SINCE 07/16 FIRM / IDENT CODE CS RPTD LIMIT HICR BAL$ DFD/DLA MR(30-60-90+)MAX/DEL ECOA/ACCOUNT NUMBER OPND P/DUE TERM 24 MONTH HISTORY WFB CD SVC*162BB10365 R1 10/16 1000 --- 0 02 I/ 08/16 --- --- CREDIT CARD SYNCB/JCP *404DC2910 R1 06/16 354 --- 0 08/06 99 I/ 07/04 --- --- CLOSED OR PAID ACCOUNT/ZERO BALANCE ACCOUNT CLOSED BY CREDIT GRANTOR SYNCB/LOWE*404LH44 R1 06/16 100 --- 0 08/06 99 I/ 09/04 --- --- CLOSED OR PAID ACCOUNT/ZERO BALANCE ACCOUNT CLOSED BY CREDIT GRANTOR REVOLVING TOTALS 1000 --- --- CHASE --CHASE AUTO*682BB14257 I1 09/16 --- 31320 23517 09/16 14 J/ 07/15 --- 679 AUTO FIXED RATE SANTANDER *682FA10137 Ii 04/09 --- 19921 0 10/05 49 Cl 10/00 --- 494 CLOSED OR PAID ACCOUNT/ZERO BALANCE INSTALLMENT TOTALS --- --- 23517 --- 679 GRAND TOTALS 1000 --- 23517 --- 679 *INQS-DISCOVER 1550N2941 10/18/16 CHASE MTG 605BB56789 08/11/16 WF:CRD SVC_1640N69- _08'/04/16 .. DIRECTV 90UZ846ff2 12/16/15 JEFF 682AN12052 07/09/15 CHASE AUTO 605BB54772 07/09/15 CHASE AUTO 409BB9923 07/09/15 FLAGSHIPCR 496FA3625 07/09/15 END OF REPORT EQUIFAX AND AFFILIATES - 10/31/16 10/31/2016 RIVERA & COMPANY CORP Account# :9001 AR Req# :06324 Search Name :Business Credit Name :RIVERA&COMPANY CORP Date Sent : 10/31/2016 Date Received : 10/31/2016 DISCLAIMER Information contained herein should not be the sole determination in evaluation of this individual. All other factors,references and current situations should be considered. Human error in compiling this information is possible. The FCRA requires certain actions if you take adverse action based in whole or in part on this report. See your Help File,the FCRA or call for procedures. BUSINESS CREDIT SEARCH Name • RIVERA&COMPANY CORP Completed By Search Date • Reference Number : 0255871508 Equifax No Information-Business Profile NO INFORMATION WAS FOUND FOR: RIVERA &COMPANY CORP AFTER CHECKING THE FOLLOWING DATABASES: -TRADE PAYMENT DATA -UCC FINANCIAL STATEMENTS -PUBLIC RECORDS -COMPANY BACKGROUND INFORMATION -BANKIN/LEASING RELATIONSHIPS -CORPORATE RECORD FILINGS End Equifax "A PUBLIC SEARCH OF FEDERAL,STATE AND COUNTY RECORDS HAVE BEEN CONDUCTED." NO RECORDS FOUND. END-OF-REPORT Foran W-9 Request for Taxpayer Give Form to the (Rev.December 2014) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. c‘i 2 Business name/disregarded entityeJif different from above N j\ki1Ora, CO411'9 a CP rti a 3 Check appropriate box for federal tax classification;check o ly one of the ollowing seven boxes: 4 Exemptions(codes apply only to ° ❑Individual/sole proprietor or ❑ C Corporation Corporation 0 Partnership ❑Trust/estate instructions on page 3): a c single-member LLC Exempt payee code(if any) , ❑limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► `p E Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the fine above for Exemption from FATCA reporting m the tax classification of the single-member owner. code(if any) N/A a '7. ❑Other(see instructions)IP- (Applies to accounts maintained outside the U.S.) w 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) a 6 City,state,and ZIP code II j ...-7,---a/ ,-- _-, u, 2Ark'- ac-tic., L t"*`. Ll e 7 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other – – entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TiN on page 3. or Note.if the account is in more than one name,see the instructions for line 1 and the chart on page 4 for i Employer identification number I guidelines on whose number to enter. – j ` E }F Part II Certification ri f.� �j 6t �Fj Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. I am not subject to backup withholding because:(a)i am exempt from backup withholding,or(b)i have not been notified by the Internal Revenue Service()RS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or-(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abando.• - • red property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other thaoEinterest and divjderi=t --, e not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. ( ` (' `N ,) Sign Signature of '~ _ 4116. eri...- Date Ow 1 - 1t; r10 f r%' Here U.S.person► } General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-1 (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.govlfw9. Use Form W-9 only if you are a U.S_person(including a resident alien),to Purpose of Form provide your correct TiN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(MN),adoption taxpayer identifk etion number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014) !,;%., .--- .5!,T6-9k17:56v517.6•",:rfeflei.".. .,:a.74___.e.:%.,..,:i.v,k.,e.e...NT-,•-"4,.. 1 ....:29 •.,.... . wk.t..-..„.,cm,•••.r.N.41.-1,..typm• - :011 ,0, fp $ i. ? RON ct r ... -€.' r. A$1; NI /04 tr. 'Ct .16 Atilt ::w.----,- . r Ko. %,.........,„ ...._,,.. -as—-.sr- .'at ". --_---t.....,g; Cr!ba 174)n gi i - -'0„ . ----. `i' !- -1 VO ..„, _ e.-; •••' AN 10'€! ,,,,, ,-, -•_ ,.. i• ,i,-.E7-,,-'E''' '.4--"- i__StM PrkP N ;es ilepartatEnt of 21'tatt rie0 .g...(0 _ til_i,•c,t,ni KO 41 ri.>..m., 1 94 ,,%t 04)1,4 icertify from the records of this office that RIVERA & COMPANY CORP is a E,.. ..€.. .. .. ,:z. FAA corporation organized under the laws of the State of Florida, filed on FO:d March 1, 2012, effective February 29, 2012 .,.. klk .., NO The document number of this corporation is P12000020739. k.el .•€.4 K: 14.4 KW2 ..!•-t I further certify that said corporation has paid all fees due this office through E-..... .c, Fe ' December 31, 2015, that its most recent annual report/uniform business report 0 P .C1 tkEkt4 was filed on April 11, 2015 and its status is active. 01 ..0.3 1...,. . i.z..-.c Ay" I further certify that said corporation has not filed Articles of Dissolution. 5® WOM KIM- E.:\• i KA kiON eGre,T ;g- --•3 1-.... .E., RO:g K.ON h.).c.i.5 7,"1"01 0 1:2 _ P1 - ..- VVV BID•el r :A ,49,4 ?Ial ligib.6g, mg )74 _Given under my hand and the W€4 Great,-Seal of the State of Florida kliA ›•€..., : - at Tallahassee, the Capital, this the„ ...... Third day of June, 2015 OA ..;:,0..,:,..:_„, - -,0-. . ,.,. --- s; ., • , Vildtk aft44 1* rol :4-.2,<„, i•--.. ., Arn Petz r c- it*i CA2E022 (1-11) $nrefare irf$fait KOM Oc-4 V0c ..Nqty-01 et. *.€14 --3 11%4- '' Itill.„.„.W,-, 0-,kyr--- -%. — , ,,..0-N,_,,,,t-.. _ ,x04 .0-s ,W-E. ....• ,r_.-.. 4%,1 1..,N 44.1V—Vnt 4 ' ....I--,k‘i--0._,,_. -iip-re.- ,4 1 =,.-\''' ,,, ,,,,"6-P---',..-19 .1:r>..r.,: ik__,%C),,-% ,..., ,e-\` ',.-_,,'-'1' .)A.,-_ ,,,..''Me\-4*,,,*_b•.1:1.b:,,,4! Pi14,-. 0- ,--',,CDk.1„._,'O.— '02.." iml'CO\rC>C:).::••Y4Hb.; ' Nr'etf~Vringi 0.1WflAV .11,1%_7.6tirwitt,.-_40 _-_,i'“0.11,YawiN-?._ tirtyvz.#10_ .ilwrgi,IN,T,61a.s.7441101kAiwn.,--A A-- Electronic Articles of Incorporation F LE80020739 For March 01 2012 Sec. Of State psmith RIVERA&COMPANY CORP 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: RIVERA&COMPANY CORP Article II The principal place of business address: 1118 NE 6TH PL CAPE CORAL, FL. 33909 The mailing address of the corporation is: 1118 NE 6TH PL CAPE CORAL, FL. 33909 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS.CONSTRUCTION BUSINESS Article IV The number of shares the corporation is authorized to issue is: 100 Article V The name and Florida street address of the registered agent is: LICIA L RIVERA 1118 NE 6TH PL CAPE CORAL, FL. 33909 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: LICIA L RIVERA P12000020739 FILED Article VI March 01 2012 Sec. Of State The name and address of the incorporator is: psmith LICIA L RIVERA 1118 NE 6TH PL CAPE CORAL, FL 33909 Electronic Signature of Incorporator: LICIA L RIVERA I am the incorporator submitting these Articles of Incorporation and affunn 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 officers) and/or director(s) of the corporation is/are: Title: PRES • LICIA L RIVERA 1118 NE 6TH PL CAPE CORAL, FL. 33909 US Title: VP JUAN G RIVERA 1118 NE 6TH PL CAPE CORAL, FL. 33909 US Article VIII The effective date for this corporation shall be: 02/29/2012 2016 FLORIDA PROFIT CORPORATION ANNUAL REPORT FILED DOCUMENT#P12000020739 Jan 19, 2016 Entity Name: RIVERA&COMPANY CORP Secretary of State CC8608594864 Current Principal Place of Business: 709 SCOTT AVE LEHIGH ACRES, FL 33972 Current Mailing Address: 709 SCOTT AVE LEHIGH ACRES, FL 33972 US FEI Number: 45-4663143 Certificate of Status Desired: No Name and Address of Current Registered Agent: RIVERA,MIA L 709 SCOTT AVE LEHIGH ACRES,FL 33972 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : Title PRES Title VP Name RIVERA,LICIA L Name RIVERA,JUAN G Address 709 SCOTT AVE Address 709 SCOTT AVE City-State-Zip: LEHIGH ACRES FL 33972 City-State-Zip: LEHIGH ACRES FL 33972 Title D Name TUNALES,RICARDO Address 1105 1/2 FAIRVIEW AVE City-State-Zip: BRIDGEPORT WA 98813-9735 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:LICIA L RIVERA PRESIDENT 01/19/2016 Electronic Signature of Signing Officer/Director Detail Date DIVISION of CORPORATIONS I/ 1J (jJ 3.00 (.4.,k-Aorg p ;1)9 I rj f_.)'" Department of State / Division of Corporations / Search Records / Detail By Document Number/ Detail by Entity Name Florida Profit Corporation RIVERA&COMPANY CORP Filing Information Document Number P12000020739 FEI/EIN Number 45-4663143 Date Filed 03/01/2012 Effective Date 02/29/2012 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 05/27/2015 Event Effective Date NONE Principal Address 709 Scott Ave Lehigh Acres, FL 33972 Changed: 03/10/2014 Mailing Address 709 Scott Ave Lehigh Acres, FL 33972 Changed: 03/10/2014 Registered Agent Name&Address RIVERA, LICIA L 709 Scott Ave Lehigh Acres, FL 33972 Address Changed:03/10/2014 Officer/Director Detail Name&Address Title PRES RIVERA, LICIA L 709 Scott Ave Lehigh Acres, FL 33972 Title VP RIVERA, JUAN G 709 Scott Ave Lehigh Acres, FL 33972 Title D TUNALES, RICARDO 1105 1/2 FAIRVIEW AVE BRIDGEPORT,WA 98813-9735 Annual Reports Report Year Filed Date 2014 03/10/2014 2015 04/11/2015 2016 01/19/2016 Document Images 01/19/2016—ANNUAL REPORT View image in PDF format 05/27/2015—Amendment View image in PDF format 04/11/2015—ANNUAL REPORT View image in PDF format 03/10/2014—ANNUAL REPORT View image in PDF format 04/03/2013—ANNUAL REPORT View image in PDF format 03/01/2012—Domestic Profit View image in PDF format fierce Dzperfment of State,D!-:FIs,-,of Corporetbns ACOREP® CERTIFICATE OF LIABILITY INSURANCE DATE D/YYTY) 11/1/2016 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). COPRODUCER NAMEACT Barbara Wasson Brown&Brown of FL, Inc.-Fort Myers PHONE 239-278-0278 FAX 239-278-5306 6611 Orion Drive#201 (A/C,_No Est). (A/C.Nol: Fort Myers FL 33912 ADE-MAIL bwasson@bbftmyers.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arch Specialty Insurance Co* INSURED RIVER13 INSURER B:Auto-Owners Insurance Co* 18988 Rivera&Company Corp INSURER C: 709 Scott Avenue Lehigh Acres FL 33972 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:364404480 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. ILTRR ADDL TYPE OF INSURANCE INSWVD POLICY NUMBER -fMM/DDY E/YYYY)_(MM/DD/YYYYL LIMITS A x COMMERCIAL GENERAL LIABILITY AGL0028360-01 8/3/2016 8/3/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY _ $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PET LOC PRODUCTS-COMP/OP AGG $2,000,000 _ OTHER: $ B AUTOMOBILE LIABILITY 5046084300 8/24/2016 8/24/2017 (a acccideD)INGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ AUTOS NED SCHEEDULED BODILY INJURY(Per accident) $ HIRED AUTOS OS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (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 Collier County Licensing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 North Horseshoe Dr ACCORDANCE WITH THE POLICY PROVISIONS. Naples FL 34104 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD � 7 ® ACO%ZO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 11/2/2016 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 Jennifer Lynch NAMEComegys Insurance Agency (A/C. ). (727)521-2100 FAX No):(727)528-0626 ADDRESS:Jennifer/@comegys.com One Beach Drive S. E. Ste. 230 INSURER(S)AFFORDING COVERAGE NAIC# Saint Petersburg FL 33701 INsuRERA:Florida Citrus Business Indus INSURED INSURER B: Rivera & Company Corp INSURER C: 709 Scott Ave INSURERD: INSURER E: Lehigh Acres FL 33972 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 WC 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 TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYYLJMM!DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYY ICE OPRIETOR PARTNER EXECUTIVE Y i N N/A E.L.EACH ACCIDENT $ 1,000,000 A (Mandatory In NH) - 10657257 11/25/2015 11/25/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION (239)252-2469 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Licensing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 North Horseshoe Dr ACCORDANCE WITH THE POLICY PROVISIONS. Naples, FL 34104 AUTHORIZED REPRESENTATIVE Mike Hickey/ALANNA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 mum) Application For Re-instatement License 1-1 Go1Lh- r Cou.-t-tty GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 ✓ =DO X =DO NOT DO CHECKLIST ❑ APPLICATION (complete and notarized) 11 VERIFICATION OF 75% PASSING SCORE (must be 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 ❑ CREDIT REPORT (must come from enclosed list of credit bureaus and CANNOT be over 60 days old) o Individual (license holder) o Firm (if more than one year old) ❑ COMPANY NAME (sunbiz.org) o Articles & Certificate of Corporation/Incorporation o Fictitious Name ❑ 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). ❑ CERTIFICATE OF WORKER'S COMPENSATION INSURANCE o Collier County Licensing Department must be listed as a Certificate Holder with the above mailing address. o State Worker's Compensation Construction Exemption: DO NOT mail this form until application for license is approved. 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. STATE REGISTRATION The following trades must register with the State Dept.of Business and Professional Regulation before the competency card is considered active for business(DO NOT mail this application until license is approved). General Contractor Master Plumber Building Contractor Roofing Residential Contractor H.A.R.V-Class A &B Swimming Pool Class-A,B,C Master Electrician Mechanical Contractor Burglar/Fire Alarm NOTE: If you already registered with the DBPR,please submit a copy to Collier County Contractor's Licensing. 1-2 ❑ 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 XTHREE (3) Affidavits for Verification of Construction Experience (Must be signed and notarized by 3 different people) o TWO (2) 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 TRADES o THREE (3)Notarized Original letters on their company letterhead stating years of experience in that trade, types of work done, the persons knowledge of the trade and Integrity & Good Character. ❑ 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. ❑ 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. a/ ❑ COPY OF DRIVER'S LICENSE yt COPY OF CITATION o If submitting application to abate a citation issued within 45 days of the date of the 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 information. 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 creditcheckinc.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 Col[�Lier County GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 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: II ?1t c � t � Bly;�'�S Fiction Name/DBA: AlfiRe.,15 fker2f(lrI t Qualifier Name: 4NPR l t) Al d ih©L--S Physical Address: 33'3 /97 Vo'T f?O ,V f 4 c-6 f2, l l� (Number& Street) (City) (State) (Zip Code) Mailing Address: '''-Pe (Number& Street) (City) (State) (Zip Code) Telephone: ,239-2‘;./. -35v E-mail:yYI1Af?e.,S-44z,eb idi /✓►z4-IG 2/XL, 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: COANGE OF STATUS: (v) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 Ili November 9, 2016 Contractor's Licensing, I'm asking for the renewal of my Tile & Marble license that is currently expired. The reason to ask for this special consideration has-to do with my Medical Conditions. I-was just_operated on for cancer at the Moffitt Cancer in Tampa. I was planing on taking my test to re-qualify me but my medical ---- - conditions will not allow my to sit for any period of time without severe pain. I'm more than willing to pay the cost of updating my license and bringing them current. I have enclosed a copy of my license for you to consider this special request. I have also enclosed a copy of another person that you allowed to update his license. I would appreciate any consideration you could give me considering my present circumstances. Dards, Andrew Nichols 239-200-6652 November 15, 2016 VIA U.S. MAIL Re: License Re-Application re: Andrew Nichols To whom it may concern: Recently, Andrew Nichols provided your offices with an application for reinstatement of his qualifier license. As part of that application, Mr. Nichols was to list the debts he or any of his associated companies refused to pay. Mr. Nichols listed a judgment entered against him on behalf of Northern Leasing Systems, Inc. ("NLSI"). A true and correct copy of the Notice of Entry of that judgment is attached hereto as Exhibit "A". The judgment was entered earlier this year, on or around September 21, 2016. My client is currently working to resolve this dispute with NLSI. We have not had a sufficient opportunity to resolve this judgment yet, but we anticipate a resolution forthcoming. This judgment should not be construed in any way against my client or be taken as a suggestion that he does not pay his obligations in a timely and punctual manner. If you have any questions or concerns, please do not hesitate to contact me at the address or phone number referenced herein. Thank you for your attention to this matter, and for your thoughtful consideration of my client's application. Sincerely, Joseph M. Coleman Joseph M.Coleman,Esq. Associate,Woodward,Pires&Lombardo,P.A. 3200 Tamiami Trail North Suite 200 Naples,Florida 34103 Tel:(239)649-6555 Fax:(239)649-7342 • •• • •• .... • •• Experian •.... • • • Credit Report Prepared For: ANDREW NICHOLS Experian Report As Of: Nov 11,2016 Personal&Confidential ANDREW NICHOLS-Experian •°°• Date of Report:Nov 11,2016 ° •° •Experian • • • Account Summary My Accounts Summary My Overall Credit Usage Open Credit Cards 2 Credit Debt 83% $10,520 Open Retail Cards 1 Total Credit Open Real Estate Loans 0 $11,500 Open Installment Loans 2 Total Open Accounts 6 My Debt Summary Accounts Ever Late 3 Credit and Retail Card Debt $10,520 Collections Accounts 1 Real Estate Debt $0 Average Account Age 8 yrs 9 mos Installment Loans Debt $39,357 Oldest Account 26 yrs 11 mos Collections Debt $246 newest account Q Total Debt $50,123 My Hard Credit Inquiries My Public Records 18 1 Summary Accounts Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian •*o®.° Date of Report:Nov 11,2016 •: •::Experian • Account Summary My Personal Information Name ANDREW NICHOLS Also Known As ANDY NICHOLS ANDREW PINSON Birth Year 1948 Addresses PersonalStatement)s) 264 HENLEY DR No Statement(s)present at this time NAPLES,FL 34104-6525 18665 NW 37TH AVE#APT 274 MIAMI GARDENS,FL 33058-5151 3823 TAMIAMI TRL E NAPLES,FL 34112-6224 Employerts) AIRPORT FLOORING AND CA MARCS FLOORING Summary Accounts Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian .�••e. Date of Report:Nov 11,2016 • ••'Experian • • Open Accounts AMEX Open 349991196747XXXX ACCOUNT DETAILS CREDIT USAGE Account Name AMEX Unknown Credit Usage Credit usage could not be calculated for this account Account# 349991196747XXXX N/A because either the balance and/or credit limit were not reported. Account Status Open Last Updated Oct 25,2016 CONTACT INFORMATION Account Type Credit Card-Revolving Terms PO BOX 297871 Date Opened Oct 1,1991 FORT LAUDERDALE,FL 33329 (800)874-2717 Balance $1,008 PAYMENT HISTORY Credit Limit - Monthly Payment _ 2016 2016 2014 Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr OK OK DE OK OK OK OK OBOE Past Due Amount May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Payment Status Current,was past due 30 days two times OK Ott OK OK 222 OK OK OK 2S Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec Highest Balance $8,616 OK OK O O OK OK OK OK OK OK OK O Terms 1 Month 2013 2012 2011 Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr Responsibility Individual OK OK OK OK OK 30 OK OK DODO May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Comments - OK OK OK Cl OK OK D OK OK OD Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec OK OK OK OK SENDS OK OK OK OK Summary Accounts (Open) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian •••S•• Date of Report:Nov 11,2016 •• '• Experian • • • BMW FINANCIAL SERVICES Open 100205XXXX ACCOUNT DETAILS CONTACT INFORMATION Account Name BMW FINANCIAL SERVICES 5515 PARKCENTER CIR DUBLIN,OH 43017 Account# 100205XXXX (800)578-5000 Account Status Open PAYMENT HISTORY Last Updated Oct 10,2016 2016 2015 Jan Feb Mar Apr Jan Feb Mar Apr OKOK OK Account Type Auto Loan OK D o OK OK May JunJul Aug May Jun Jul Aug Qo O Date Opened Jan 1,2015 OQQ OK OK OK OK OK OK OK OK Balance $22,243 Sep Oct Nov Dec Sep Oct Nov Dec DO0 El OK OK OK Original Balance $33,109 Monthly Payment $565 Past Due Amount - Payment Status Current Highest Balance - Terms 60 Months Responsibility Individual Comments - Su77111a1y Accounts (Open) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian •••• Date of Report:Nov 11,2016 •• Experian • COMENITYCAPITAL/LNDCLB Open 57809799XXXX ACCOUNT DETAILS CREDIT USAGE Account Name COMENITYCAPITAL/LNDCLB High Credit Usage Keeping your account balances as low as possible Account# 57809799XXXX 1 00% can have a positive impact on your credit. Account Status Open Last Updated Oct 24,2016 CONTACT INFORMATION Account Type Revolving Charge Account 3100 EASTON SQUARE PL Date Opened Sep 1,2016 COLUMBUS,OH 43219 BYMAILONLY Balance $7,500 PAYMENT HISTORY Credit Limit $7,500 2Monthly Payment $313 Jan Feb Mar Apr Past Due Amount _ O 0 0 May Jun Jul Aug Payment Status Current 00 0 0 Sep Oct Nov Dec Highest Balance $7,500 000 0 Terms Revolving Responsibility Individual Comments - Summary Accounts(Open) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian *X.* Date of Report:Nov 11,2016 ®"Experian • . • IBERIA BANK 422546900005XXXX Open ACCOUNT DETAILS CREDIT USAGE Account Name IBERIA BANK No Credit Usage You have no account balance.Keeping your account Account# 422546900005X0XX 0% balances as low as possible can have a positive impact on your credit. Account Status Open Last Updated Nov 4,2016 CONTACT INFORMATION Account Type Credit Card-Revolving Terms PO BOX 12440 Date Opened Apr 1,2016 NEW IBERIA,LA 70562 (318)365-2361 Balance $0 PAYMENT HISTORY Credit Limit $1,000 Monthly Payment $15 2016 Jan Feb Mar Apr Past Due Amount - DODO May Jun Jul Aug Payment Status Current OE] OK Cl Sep Oct Nov Dec Highest Balance $1,000 OS OK Terms Revolving Responsibility Individual Comments - Summary Accounts (Open) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian •••• Date of Report:Nov 11,2016 •' Experian • . • KIA MOTORS FINANCE Open 2016100727XXXX ACCOUNT DETAILS CONTACT INFORMATION Account Name KIA MOTORS FINANCE 4000 MACARTHUR BLVD STE NEWPORT BEACH,CA 92660 Account# 2016100727XXXX (866)331-5632 Account Status Open PAYMENT HISTORY Last Updated OCt 31,2016 2016 Jan Feb Mar Apr Account Type Auto Loan OO Q CD Date Opened OCt 1,2016 May Jun Jul Aug DE Balance $17 114 Sep Oct Nov Dec Original Balance $17,114 Monthly Payment $299 Past Due Amount - Payment Status Current Highest Balance - Terms 60 Months Responsibility Joint Account Comments - Summafy Accounts (Open) Collections Inquiries Public Records Credit Score • •• • ANDREW NICHOLS-Experian •••®` Date of Report:Nov 11,2016 m•Experian • • SYNCBICARE CREDIT Open 60191834XXXX ACCOUNT DETAILS CREDIT USAGE Account Name SYNCBICARE CREDIT High Credit Usage Keeping your account balances as low as possible Account a 60191834XX0X 67% can have a positive impact on your credit. Account Status Open Last Updated Nov 10,2016 CONTACT INFORMATION Account Type Revolving Charge Account 950 FORRER BLVD Date Opened Sep 1,2016 KETTERING,OH 45420 Balance (937)534-6950 $2,012 PAYMENT HISTORY Credit Limit $3,000 Monthly Payment $88 2016 Jan Feb Mar Apr Past Due Amount - DODD O May Jun Jul Aug Payment Status Current DODO Sep Oct Nov Dec Highest Balance $2,100 oK oK OK O Terms Revolving Responsibility Individual Comments - Summary Accounts (Open) Collections Inquiries Public Records Credit Score • •• • ANDREW NICHOLS-Experian •••• Date of Report:Nov 11,2016 • Experian : •'e Closed Accounts ALLY FINANCIAL Closed 67391683XXXX ACCOUNT DETAILS CONTACT INFORMATION Account Name ALLY FINANCIAL 200 RENAISSANCE CTR DETROIT,MI 48243 Account# 67391683XXXX PAYMENT HISTORY Account Status Closed 14 Last Updated Feb 29,2016 2016M2016Mb0M pd Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr OK OK O C OK OK OK OK OK OK OK OK Account Type Auto Loan May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Date Opened Jan 1,2011 O O OO OK OK OK OK 0000 Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec Balance - 0000 OK OK OK OK OK OK OK OH b0 Original Balance $20,001 b0b0Mar Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr OK OK OK OK OK OK OK OK OK OK OK OK Monthly Payment - May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Past Due Amount 0000 OK OK OK OK OK OK OK OK Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec Payment Status Paid satisfactorily LI OK OK OK 0001:1 Li OK OK OK Highest Balance - 2010 Jan Feb Mar Apr Terms 60 Months (1a O CI May Jun Jul Au Responsibility Joint Account OO O LJ Sep Oct Nov Dec Comments - ELIE OK Summary Accounts (Closed) Collections Inquiries Public Records Credit Score ANDREWNICHOLS-Experian •e••o°Experian Date of Report:Nov 11,2016 • • • CBNA 80605)000( Closed ACCOUNT DETAILS CREDIT USAGE Account Name CBNA Unknown Credit Usage Credit usage could not be calculated for this account Account# 80605XXXX N/A because either the balance and/or credit limit were not reported. Account Status Closed Last Updated Oct 6,2007 CONTACT INFORMATION Account Type Revolving Charge Account PO BOX 6189 Date Opened Jan 1,1990 SIOUX FALLS,SD 57117 Balance BYMAILONLY PAYMENT HISTORY Credtt Limit $350 2007 2006 2006 Monthly Payment _ Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr OK OK OK O OK OK OK OK OK O OK OK Past Due Amount - May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Payment Status Paid satisfactorily [ ]E) OK OK 0002 0200 Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec Highest Balance $2,233 OK Q O 0 OO OK OK D OK OK OK TermsRevolving 2004 2003 Jan Feb Mar Apr Jan Feb Mar Apr Responsibility Individual o oK O oK 000E May Jun Jul Aug May Jun Jul Aug Comments - OK O OK OK 0000 Sep Oct Nov Dec Sep Oct Nov Dec OK OK OK OK OK O OK OK Summary Accounts (Closed) Collections Inquiries Public Records Credit Score ae ANDREW NICHOLS-Experian •rr• Date of Report:Nov 11,2016 .•a Experian •HYUNDAI CAPITAL AMERIC Closed 2012010204XXXX ACCOUNT DETAILS CONTACT INFORMATION Account Name HYUNDAI CAPITAL AMERIC 4000 MACARTHUR BLVD STE NEWPORT BEACH,CA 92660 Account 2012010204X00( (800)523-7020 Account Status Closed PAYMENT HISTORY Last Updated Feb 5,2015 2016 2014 2013 Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr Account Type Auto Loan DE 0 OK Q OK OK ® OK OK OK Jan 1,2012 May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Date Opened ED 0 0 OK OK OK OK L1K OK OK OK Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec _ Balance C1000 0 0 0 0 0 0 0 2 Original Balance $10,044 2012 2011 Jan Feb Mar Apr Jan Feb Mar Apr Monthly Payment El 00 0000 May Jun Jul Aug May Jun Jul Aug Past Due Amount 0000 0 0 0 0000 OK OK OK OK Payment Status Paid satisfactorily Sep Oct Nov Dec Sep Oct Nov Dec 0000 0000 Highest Balance - Terms 48 Months Responsibility Joint Account Comments - Summary Accounts (Closed) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian .®®:®. Date of Report:Nov 11,2016 ::Experian 6 NORTHERN LEASING SYSTE 189)0= Closed ACCOUNT DETAILS CONTACT INFORMATION Account Name NORTHERN LEASING SYSTE 132 W 31ST ST FL 14 NEW YORK,NY 10001 Account# 189XXXX (212)239-3500 Account Status Closed PAYMENT HISTORY Last Updated Aug 28,2015 2016 Jan Feb Mar Apr Account Type Lease 0000 May Jun Jul Aug Date Opened Aug 1,2012 ❑❑❑ ra Balance $2,340 Sep Oct Nov Dec OE Original Original Balance $6,477 Monthly Payment - Past Due Amount - Payment Status Charge-off Highest Balance - Terms 48 Months Responsibility Individual Comments - Summary Accounts (Closed) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian `e::e` Date of Report:Nov 11,2016 .e`ee®� Experian SYNCB/JCP Closed 60088921XXXX ACCOUNT DETAILS CREDIT USAGE Account Name SYNCB/JCP Unknown Credit Usage Credit usage could not be calculated for this account Account n 60088921XXXX N/A because either the balance and/or credit limit were not reported. Account Status Closed Last Updated Feb 23,2012 CONTACT INFORMATION Account Type Revolving Charge Account PO BOX 965007 Date Opened Dec 1,1989 ORLANDO,FL 32896 (800)542-0800 Balance - PAYMENT HISTORY Credit Limit $0 Monthly Payment _ 2012 2011 2010 Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr OK OK O E OK O OK O OK OK OK OK Past Due Amount May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Payment Status Paid satisfactorily END O 0 OK O OK OK OK OK OK OK Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec Highest Balance $1,244 00❑❑ ODE OK O OK CIO Terms Revolving2009 2006 2007 Jan Feb Mar Apr Jan Feb Mar Apr Jan Feb Mar Apr Responsibility Individual OO O O EDGE O O OK O May Jun Jul Aug May Jun Jul Aug May Jun Jul Aug Comments - OO OK O OO OK O O O CIO Sep Oct Nov Dec Sep Oct Nov Dec Sep Oct Nov Dec OOoKO OOO OK 0 22 2006 2006 Jan Feb Mar Apr Jan Feb Mar Apr OO CI O ODD El May Jun Jul Aug May Jun Jul Aug OO 0O O CDS O Sep Oct Nov Dec Sep Oct Nov Dec OK O OK OK ODD OK Summary Accounts (Closed) Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian •:a®::Experian Date of Report:Nov 11,2016 • • • Collections A STATE COLLECTION SERVI Closed 3409XXXX ACCOUNT DETAILS CONTACT INFORMATION Account Name STATE COLLECTION SERVI 2509 S STOUGHTON RD MADISON,WI 53716 Account# 3409XXXX (608)661-3000 Account Status Closed PAYMENT HISTORY Last Updated Oct 30,2016 2016 2015 Jan Feb Mar AprJan Feb Mar Apr FP Account Type Collection Department/Agency/Attorney o 00 0000 May Jun Jul Aug May Jun Jul Aug Date Opened Nov 1,2014 co FP Do Balance $246 Sep Oct Nov Dec Sep Oct Nov Dec FP FP 0D OEM Original Balance $246 Monthly Payment - Past Due Amount $246 Payment Status Seriously past due date/assigned to attorney,collection agency,or credit grantor's internal collection department Highest Balance - Terms 1 Month Responsibility Individual comments - Summary Accounts Collections Inquiries Public Records Credit Score • . . Report Home My reports My account Products Help Business services Logout For help reading this report,please review our sample report. Search inquiry:Airport Flooring&Cabinets Llc/Naples/FL/(My company) CreditScoresM Report as of:11/17/16 12:43 ET Airport Flooring&Cabinets LLC Address: 353 Airport Pulling Rd N Key Personnel: Officer.Robert C Lenahan Naples,FL 34104-3520 Manager:Melnyk Lyudmyla United States Business Type: Corporation Experian BIN: 413401518 Experian File Established: May 2016 Experian Years on File: Less than 1 Year Agent: Nichols Andrew L Agent Address: 353 Airport RD S Filing Data Provided by: Florida Naples,FL Date of Incorporation: 10/24/2014 UCC Filings: 0 This location does not yet have an estimated Days Beyond Terms(DBT),or a Payment Trend Indicator,This is often the result of too few Payment Tradeiines. XBusinesses Scoring Worse: 27% iBankruptcies: 0 tr Liens: 0 /Judgments Filed: 0 'Collections: 0 Credit Summary Back to top Credit i^d.6,,5 0 Score: 28 I The objective of the Credit Ranking Score is to predict payment behavior. High Risk means that there is a significant probability of delinquent Low , payment.Low Risk means that there is a good probability of on-time Hiatt payment. Risk Risk Key Score Factors: •Risk associated with the company's industry. •Company's business type. Recommended Action:Medium Risk 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. ©2016 Experian Information Solutions Inc. Back to top Contact us Score Planner Legal terms Privacy ©2016 Experian Information Solutions,Inc.All rights reserved. Expenan ano the Expenan marks herein are service marks or regrstered trademarks of Expenan. • • ANDREW NICHOLS-Experian •®moi Date of Report:Nov 11,2016 .: e®:Experian Inquiries Q ALLY FINANCIAL Q CREDCO Inquiry Date Oct 2,2016 Inquiry Date Sep 26,2016 Removal Date Oct 2018 Removal Date Sep 2018 Business Type Auto financing companies Business Type Auto reseller Contact Information PO BOX 12699 Contact Information 10277 SCRIPPS RANCH BLVD GLENDALE,AZ 85318 SAN DIEGO,CA 92131 BYMAILONLY (800)523-0233 Q ALLY FINANCIAL Q R&R/AIRPORT KIA DT Inquiry Date Sep 26,2016 Inquiry Date Sep 26,2016 Removal Date Sep 2018 Removal Date Sep 2018 Business Type Auto financing companies Business Type Automobile dealers,used Contact Information PO BOX 12699 Contact Information 3325 WESTVIEW DR GLENDALE,AZ 85318 NAPLES,FL 34104 BYMAILONLY (239)732-8910 Q PNC BANK Q KIA MOTORS FINANCE Inquiry Date Sep 26,2016 Inquiry Date Sep 26,2016 Removal Date Sep 2018 Removal Date Sep 2018 Business Type All banks-non specific Business Type Auto financing companies Contact Information 2730 LIBERTY AVE Contact Information 4000 MACARTHUR BLVD STE PITTSBURGH,PA 15222 NEWPORT BEACH,CA 92660 BYMAILONLY (866)331-5632 Summary Accounts Collections Inquiries Public Records credit Score • •s ANDREW NICHOLS-Experian • os' Date of Report:Nov 11,2016 .mss;•Experian Q R&R/GALEANA KIA DT Q CBNA Inquiry Date Sep 26,2016 Inquiry Date Aug 2,2016 Removal Date Sep 2018 Removal Date Aug 2018 Business Type Automobile dealers,used Business Type Bank credit cards Contact Information 14483 S TAMIAMI TRL Contact Information PO BOX 6000 FORT MYERS,FL 33912 SIOUX FALLS,SD 57117 (239)437-2805 BYMAILONLY Q CAP ONE NA Q CREDCO/QUICKEN LOANS Inquiry Date Jul 30,2016 Inquiry Date Feb 5,2016 Removal Date Jul 2018 Removal Date Feb 2018 Business Type Bank credit cards Business Type Mortgage reporters Contact Information 4851 COX RD Contact Information PO BOX 509124 RICHMOND,VA 23229 SAN DIEGO,CA 92150 (800)523-0233 Q NORTHERN LEASING SYSTE Q CBNA Inquiry Date Jan 24,2016 Inquiry Date Jan 3,2016 Removal Date Jan 2018 Removal Date Jan 2018 Business Type Equipment leasing Business Typo Bank credit cards Contact Information 132 W 31ST ST FL 14 Contact Information PO BOX 6000 NEW YORK,NY 10001 SIOUX FALLS,SD 57117 (212)239-3500 BYMAILONLY Summary Accounts Collections Inquiries Public Records Credit Score ANDREW NICHOLS-Experian •49•x• Date of Report:Nov 11,2016 • .: ANDREW NICHOLS-Experian •eiee' Date of Report:Nov 11,2016 �: •'s Experian Public Records A JUDGMENT Filing Date Sep 8,2016 Amount $2,339 Reference Number Cv00320316ny Court Col ct of city of ny Plaintiff Northern leasing systems inc Surnrnaiy Accounts Collections Inquiries 9 Public Records Credit Score ANDREW NICHOLS-Experian • ee••+•e C Date of Report:Nov 11,2016 e:• e•• Experian Credit Score RATING:FAIR 6 3 5 '�••Experian 300 850 Your score is below the average score of U.S. FICO Score 8 based on consumers,though many lenders will approve Fair Experian data as of Nov 11,2016 loans with this score. 300 85•:.. What's helping your score? What's hurting your score? No factors helping your Score No factors hurting your Score .. In Inquiries Public Records Credit Score Summary Accounts Collections Tow, r. 4 r , y _� :1' • (Requesters arae) I! I � (Address) 700265500647 (Address) (Clty/ttateJZip/Phone — 10.'23/14--o1007--013 **125, Q PICK-UP WAIT 0 MAIL (Businessntity Name) (Document Number) Certified Copies Certificates of Status Special Instructions to Filing Officer; cis ,irel "ZS 151•-C Q - iq A• Office Use 041y- SR; N ashen OCT 2 7 ME 100 .0N Yda #. r 1 a • ,, pip�p/�p/�� /�,' p�� b� �//�y��p �/ ARTICUISO ORGA rzA71VN FORFLO IDA LAMM 1 �I( 1PAN I ARTICLE t-Mune; The name of the Limited Liability Company is: AIRPQ$LFLOORINt3 CAb1[4JS LLC - (Must end with the words"Limited Liability Company,"L.L.C,"or''LLC.") ARTICLE 11-Address: The mailing address and street address of the principal office of the Limited Liability Company is: pri*elnal Of ie *lights Adjitessa 353 AIRPORT RD S 953 AIRPDF T D NAPLES_FL sd104 _ NAPLES.EL_34104 . _ ARTICLE IU-Registered Agent,Registered Office,&Registered Agent's Signature: (The Limited Liability Company cannot serve as its own Registered Agent.You must designate en Individual or another business entity with an active Florida registration.) The name and the Florida street address of the registered agora are: AN REW L NICHOLS Name 354 AIRPORT RDS Florida street address(P.O.Box NM acceptable) NAPE __ FL r t 04 City Zip Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this Cerr fcate,I hereby accept the appointment as reginaxd agent old agree ro as!a 161E eapaefty, !further agree to comply with the provisions of all statutes relating to the proper and complete performance ofinyduties,and!ant famliar ib and accepi the• • ••• ofnty position ae registered agent asprovided foris Chapter60J • Ragist red Agents Signature( QUIRED) 3:a; (CONTINUED) ;. t,) .. Past 142 7Tcza "1" Zc� tV a cOA 0l1 Nd WY 81 : I1 IIA/910U11/AON NOV/I1/2016/FRI 09:04 AM Anew Insurance Corp. FAX No, 239-793-8524 P. 001/001 Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD(YYYY) 11/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: DENISE THOMAN ANEW INSURANCE CORP ( C.PHONE EA): 239.793„8509 FAX Ne). 3940 RADIO RD SUITE 108 E-MAIL ADDRESS: NAPLES FL 34104 INSURER(s)AFFORDING COVERAGE NAIC S INSURER A: CYPRESS INSURED INSURER B: ALLSTATE AIRPORT FLOORING&CABINETS 264 HENLEY DR INSURER C NAPLES FL 34104 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 ADDL SUER POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE s 300 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 17 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 A FGL500236500 07/22/2016 07/22/2017 PERSONAL&ADV INJURY •$300,000 GENERAL AGGREGATE $300,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $300,000 —IPOLICY _cci LOC ... _. _. .. S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT (Ea accident) ,S ANY AUTO BODILY INJURY(Per person)— $ 100000 AUTOS OWNEDALL AUTOS SCHEDULED BODILY INJURY(Per ecOdent)l-t$300,000 B NON-OWNED 64844791 07/22/2016 07/22/2017 PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ 100,000 E UMBRELLA LIAB OCCURET E EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE E _ DED RETENTIONS s WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY STLIJMIT R E ANY PROPRIETOR/PARTNER/EXECUTIVE YIN UNITS ER OFFICE/MEMBEREXCLUDED7 ( I N!A E.L.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONSkeloer E.L.DISEASE-POLICY LIMIT $ FT:El DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 151,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY LICENSING BOARD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2800 HORSESHOE DR N ACCORDANCE WITH THE POLICY PROVISIONS. NAPLES FL 34104 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION *`CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW NON-CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law, EFFECTIVE DATE: 11/14/2016 EXPIRATION DATE: 11/14/2018 PERSON: NICHOLS ANDREW W FEIN: 472179961 BUSINESS NAME AND ADDRESS: AIRPORT FLOORING& CABINETS LLC 353 AIRPORT RD S NAPLES FL 34104 SCOPES OF BUSINESS OR TRADE: BUILDING MATERIAL DEALER-NEW M Pursuant to Chapter 440.05(14),E.S.,an officer of a corporation who elects exemptfon from this chapter by filing a certificate of election tinder this section may not recover benefits or compensation under thio chapter.Pursuant to Chapter 440.06(12),F.S.,Certificates of election to be exempt...eppty only within the scope of the business or trade(feted an 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 ahall be subject to revocation tf.at any time after the filing of the notice or the Issuance of the oerttncate, the person named on the notice or certificate no longer meets the requirements of this section for iaeuance ora certificate.The department shell revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Mil Xdd Ad 6�:Z0 IOW/9102/WAON PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE ,� IMPORTANT STATE OF FLORIDA Pursuant to Duple/.440.06(14),F.S.,an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES w ; ! who elects exemption from thle chapter by filing a certificate of 0' - ' F election under title section may not recover benefits or DIVISION OF WORKERS'COMPENSATION NON-CONSTRUCTION INDUSTRY EXEMPTION i. compensation under this chapter, O CERTIFICATE OF EtECnoN TO BE EXEMMPT FROM FLORIDA L Pursuant to Chapter 440.05(12),F_S.,Certificates of election to woaxERa'couDENSaTtoN LAW be exempt...Apply only within the scope of the business or trade .APPECTIVE DATE: 11/14/2018 EXPIRATION DATE: 11/:4 1018 listed on the notice of election to be exempt. PERSON: NICMOLS ANDREW W Me: 72499tH Pursuant to Chapter 440.05(13),FS.,Notices of election to be E exempt and oertlriastas of election to be exempt shall be BUSINESS NAME AND AbDRBSS: R Subject to revocation IT,at any time after rte filing of the notice AIRPORT FLOORING&CABINETS LLC E or the Issuance of the oenlAcate,the person named on the notice or certificate no longer meets the requirements of this 353 AIRPORT RDs section for issuance of a certificate.The department shall revoke a certificate at any time for failure otthe person named on me NAPLES FL 34104 certificate to meet the requirements of title section, SCOPES OF BUSINESS OR TRA 'BUILDING MATERIAL !DEALER-NEW M DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1809 ZOO 'd '°N nig iN,a PC:711 U I /0T117i47T LinIT w' T�DQr DEPARTMENT OF THE TREASURY 1 INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 10-28-2014 Employer Identification Number: 47-2179961 Form: S5-4 Number of this notice: CP 575 H AIRPORT FLOORING & CABINETS LLC ANDREW L NICHOLS SOLE HER 353 AIRPORT RD S For assistance you may call Us at: NAPLES, FL 34104 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 SIN 47--2179961. 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 BIN and complete sure 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 teax off stub and return it to us. A limited liability company (LLC) may file Form 8832, Entity classification Election, and elect to be classified as en association taxable as a corporation. If the LLC is eligible to be treated as a Corporation that meets certain tests and it will be electing s corporation status, it must timely file Form 2553, Election by a Small Business Cbsparation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8832. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at w w.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDO 1-800-829-4059) or visit your local IRS office. IMPORT S: * Keep a copy of this notice in your permanent records. This notice is issued only one ties 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 Eli. * Use this Err and your mane exactly ae they appear at the top of this notice on all, your federal tax forms. * Refer to this Eli? on your tax-related correspondence and documents. If you have questions about your BIN, you can call us at the phone rusher 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 coeplete and return the stub. Your name control associated with this BIN is AIRP. You will need to provide this information, along with your KEN, if you file your returns electronically. Thank you for your cooperation. 500 'd AN Xdd NY 91 : 11 Idd/9102/II/AOM • ARTICLE IV- The name and address of each person authorized to manage and control the Limited Liability Company: Name_and_lddress: "AMSR"=Authorized Member "MOR"=Manager AC213 ANDREW L id1CHOl.S — 3S3 AIRPORT S NAPLES.FL.34104 (Use attachment if necessary) ARTICLE V: Effective date,if other than the date of filing: (OPTIONAL) Mae effective date is�� R e&the date must be specific and moot be more Haan ftve business days prior to or 90 dens after the date of filing,) ART ICL E VI:Other prvvisivns,if auq. • jtLaulfgen SIG U '-/ 4,46' Stoat:ire of a member or • authorized representative of a member. (In accordant with section 605.0203(I)(b),Florida Statutes,the execution ofthia document • constitutes an affirmation under the penalties of perjury that the facts stated here' ,true„„,,. I am aware that any false information submitted in document to the Department of re constitutes a third degree felony as provided for in LS 17.155,F.S.) z ANDREW L N1CHOLS A' 7,57c Typed or printed name of sigiwe I Mall Fess; P 3 riri . 5125.00 Piling Fee for Ankles of Organization and Designation of R Elm Registered Agent ' .- N 5 30.00 Certified Copy(optional) r7,1can S SAO Certificate of Status(Optional) Page Z oft • {iflfl T 'air YHa rut 01 . 11 run/(11!17/I I /Annr AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF , i . COUNTY OF CO///6"A I, / h i> i Q fd, having been first duly sworn, state and affirm: I am a resident of CCU /672 County, 6-DX)9i " (State) and have resided here for more than five (5) years. 1 During the last five years I have known ,�jt/LREvt/ AI1-4170/5 (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. 0 . :JA-11-A-/ Signature 2- l cwt- re) -.yI 6 Name /S7 ir-e V a V I ift,<, ,-- FT - V-//6 _..— Address 4 .257—.too-- $77-3 Telephone The foregoing instrument as acknowledged before me this /7// V ate) - by /(4/G4/7/1" i s-f/' who has produced (name of person acknowledging) (type of idents kation as identification and did not take an oath. NOTARY'S SEAL __ t7fe--e-_ (2rei<1. _ GNATURE OF NOTARY) P44.14 MARIA BOTANA ,k► ;:Notary Public-State of Florida .N9 .0-40.-4, ."0,r Commission#EE883801 .7tcFF0' My Commission2Expires March 18, 017 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF COUNTY OF �, (1 I, `4 �'fi l/ �Y .�'C , having been first duly sworn, state and affirm: I -' - am a resident of �c(t r County, 70/t G`ck (State) and have resided here for more than five (5) years. During the last five years I have known No-F c.i) A /c/lCL4applicant). 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. %,tri Signature �r71- Name / 2 p/.//4/7- /7/1,9647-7S; ,.//r/T /7/1,96L S /1-7/ 3 r/o* Address Telephone The fpregoing instrument as acknowledged before me this /v�L./. l0, -2e / • (Date) y who has produced FL— (name L(name of person acknowledging) (type of identification) as identification and did not take an oath. Aor NOTARY'S SEAL ‘"'i Notary Public•State of Florida (SIGN RE I ' N•TA' Commission#FF217244 N: '-'411g"•pPf' My Commission Expires ',OF F�.°. April 5,2019 o Q r O A C O O no 0 Z 0 0 y o 2 m D 1 u, 'o c 9 -1 w D 0 ! 3 3 w Z -I -I Z 0 w I 2 g. y o 0 o U, w v - d Z z ZD ; 7'm c n 7 m X = m m NO mD xi = y 0 r= w En ro al al co ox D o 71 1. _ m 0 0 o r O ! o <. o run) 0 3 0-1Z- o0 } m '< m i'< (' 0 j Xo C f Xtee•N z o m 2 DHD ! c t-,-. m 0n ! O n P; Od cn moa Lo � . 0 m �� 0 "° nk 4 -ne„k la 2. ',,,,,i f x i...,,,y , .m 4i `k-,:' m to =1 Cl) g c 1a �� (1) mCI) Z 0 +„a m .- m N' v D • r D W — y1 z w D D -I m-4 o ' D "o x --o H pD o x 1:1 m O _ 0 ...I A �T- OTI TI <n 071 rW' -IO O z nc O22yl cn p o - - Z ZZ D Z o 0 0 m �tmn 4, cn O C7 C) Z A Ca 1 D D D <OO ' D1 _r m > D 2m CO oo O'o w X P r C co Z ~'k' v z m � ccnn m n W r,)f.si C D0 N � � r c �z 4, m' f51 o Dt J PI a' 'i 03 �m : .1, Fa n ± �.., ca tv _I •A i O N O O) -4 f31 o el. County COLLIER COUNTY GOVERNMENT 2800 NORTH HORSESHOE DRIVE GROWTH MANAGEMENT DIVISION NAPLES, FLORIDA 34104 vwwv.colliergov.net (239)252-2400 FAX(239) 252-6358 LAND USE AND ZONING CERTIFICATE: NON-RESIDENTIAL LDC subsection 10.02.06 B.1.f Chapter 4 K. of the Administrative Code Please fill out this form as completely as possible, if you don't know the answer, indicate "unknown", if the item doesn't apply, indicate "not applicable" or "N/A". Your application can not be processed without all of the necessary information. Zoning approval of this application can be expedited if a site plan of the property to be occupied showing parking and surrounding uses is submitted with the application. Zoning Certificate#: ❑ Relocating Existing Business ❑ New Business Additional development orders may be required by the County for any changes in use and/or interior and exterior remodeling. Please be advised that Impact Fees may be due at time of Building Permit. Please contact Impact Fee Administration at (239) 252-2991 and Public Utilities at (239) 252-6237 to verify if any impact fee will be assessed. (Applicant's initials): APPLICANT CONTACT INFORMATION Name of Applicant(s): 4/Kf2Ci— L,DD,Ql61,i; l 6 FJ/de z-zc. P5.9 MA Address: 313 4Rpo' I ' city: /✓�2e State: -1. ZIP:, 1I Telephone:CZ 4,90,1* ' -bb Cell: Fax: E-Mail Address: A /e5 fi 2A '7*yM1ii- BUSINESS& USE INFORMATION Business Owner or Qualifier's Name: /I/y DQttd. /I/Cha/s Business Name: / WM/6 �j / Business Phone: Business Address: 3,5� 1//e9dYr7r A 4' City: /1./ State:State: ' ZIP: Y�% 471 Property Owner or Leasing Agent Name:„53—,5 ,'Bj� ��`/ z Complex Name(If any): Type of Business: i2CCRAV / we3ii le Type and Name of Business Previously or Presently Occupying Location: Cg ffer(5 If Vacant,Provide Length of Vacancy: Check below if the business is any of the following business types*: ❑ Restaurant/Eating Places(SIC 5812) ❑ Bar/Night Club/Drinking Places(SIC 5813)—will require a distance waiver. ❑ Restaurant/Bar with 150 seats or more *Alcohol Licenses will not be signed off by the Planning and Zoning Department until the Business Tax Receipt has been issued. If the license is for consumption on premises, a floor plan will be required showing the location of all serving areas and seating. 1/14/2014 Page 1 of 2 I, totori ll 04.(. HENLEY DR r c • -6525 SEX:M ' 10141446:111 „ N '4,icPtcres 1!437- 4F'3 REST lr" L�. SAFE tOtIVER MOTQRG44L ' 0134.443*„u!b Ni41W 4441e1110 COMNR.S.S COMM,14 afry 6 • it RESOLUTION OF AUTHORIZATION WHEREAS 4(,,p✓4 /c.)0'i ref-(2, L L proposes to engage // (Name / ��o Business Entity) in contracting as i! ;H, F-�- I t ck , 1L. C EnO`p in (Type of legal entity: corp.,partnership,etc.) Collier County,Florida,according to Collier County Ordinance 2006-46,as amended: and WHEREAS Vii,p,,(4- F-1,0 ii,,y, F t 2(0i.\_o-Cir LL C---- proposes to qualify (Name of Business Entity) for a Certificate of Competency with 44iS(.eji--tD i cc o' S (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED THAT: We the undersigned OC —e r of (Officers,Owners,Partners) A f t rPv! ' (' rtoo r c t '' -C(abi f\-e_ct L1- hereby resolve and represent to the Collier County (Name of Business Entity) ' /p� f�L /1,4active Contractor's Licensing Board that the qualifying agent, 4/N (Name of Individual) L , e ". in all matters connected with the contracting business of . K,T ttf''t/'y CAt 'r-;And ,,/ me of Business Entity) We further resolve and represent that A/�O2`E�) N 0 e-4el`S is (Nam f Individual). Legally empowered to act for 4/kel‘al-/ 7 , "iAgri matters connected with its (Name of Business Entity) contracting business,and has thethority to supervise construction undertaken by (Name of Busineg Entity) DULY PASSED AND ADOPTED THIS /V DAY OF 42 , l / (Officers,P ne ,O ners- ith d i 'nation underneath) , W i ess — ---A7-------- itness Witness Corporate Seal(if applicable)or Notary Public Certificate Sworn to and subscribed before me this/ti day of/1)C,,,.1 , 2e.:.L by f},., , - /��,o,e ( The foregoing instrument as acknowledged before me this j tl t 16./l n ( (Date) by i—'ytA,�� M J`-S who has produced K-A e . (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL / s - -o..i4i*.—`:. - 4 • OWARD L. LEVY (SIGNATU OF ' O A: ' 4 ti f7 Public•State of Florida / 'PP— :?.4:. ''" `' Coammission#FF217244 °;. .":",-•" My Commission Expires -'7.?rdf-tL,',os April 5,2019 F COVER LETTER TO: Reglstrstloa Section Division of Corporations ST!$JECT: A1RRQRT FU2DRIMU CAB1N17Sw Name of Limited Liability Company The enclosed Articles of Organization and fee(s)art submitted for filing. Please return all correspondence concerning this matter to the following: ANDREW L NICHOLS Name of Person .AIRPORT FLOORING&CABtNgT8 LLD Fina/Company s` AIRPORT RD S Address NAPLES.Fi_34104 City/State and Zip Code RQ, R*$M[IF1Slid1 F.tina areqs: to a t -Er future annual report n canon For further information concerning this matter,please cell: .RQrsF-MARY A- CIIT at LIE ).2aOgV Name of Person Area Code Daytime Telephone Number Enclosed is a check for the following amount: 0 5125.00 Filing Fee 0:130.00 Filing Feed; rams 00 Filing Fee& DSI60.0o Piling Fee, Certificate of Status Certified Copy Certificate of Status& (additional copy is enclosed) Certified Copy (additional copy is enclosed) itteehttAddrese mer Addmrss Registration Section Registration Section Division of Corporations Division of Corporations P.O.Box 6327 Clifton Building Tallaheseee,FL 32314 2661 Executive Center Circle Tallahassee,FL 32301 ZOO 'd .01sI IVI vY i.1 : 11 iN4/Q117/l I/AnM 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. //1t2A& A1/140/ Applicant(please print) 4// ,v - fieolz/06 A 4,Aeets- ',L Name of Company i , ignature of Apo'icant State of Florida i County of C ll�/— The foregoing instrument as acknowledged before me this II /t `k- ' (Date) by / e,--2-) it)(' S 0 I C who has produced t< ., >"___ (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY'S SEAL L �� ',:, HOWARD Aill 11�`. ,:::`.'•. "'<i' L. LEVY (SIGNA 7! OF NO 'A NY ,�� _ Notary Public-State of Florida N,-, ` ., Commission#FF217244 =„:Fo `o '.. My Commission Expires April 5.2019 4 of 4 QUALIFIER INFORMATION: ) Name: /9 1\,1�Rek AI I Address: 4'/ ,/ Is-e/ i7/ Mee, f L , 541 L/ (Number&Street) (City) (State) (Zip Code) Telephone:, 5‘/°– Date of Birth: / SS#:—01 E-mail: ix,,*'/Oc%/1/f t2//Agit e Driver's License#: (j / 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. hcie, )4A, ,2?�� 4e/ -/°"/ 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? NZ, 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. A/001)Mt ',, � G i ' ,a,„dr1.9 >ee (Pa) ei -/ fa424-44d& aaVe frie s Aaelhoyatife, n. Juljre. 6. List your business or work experience during the last ten years. fi OA 6'We-fah(/' 7. Statement of any formal training you have had in the area for which the application is made. /9411,4e--- /(1,M1C41041 (2--40,” 0)10,,,fryi 3 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 C- r'ficat- of Co, peter y. //i.... .. 'r Lure of Applicant 4"e' i Bu iness Name 7 //////9oF , Date Ni--.,_,RE ME this day personally appeared ,4N9K e-u-� /�" k 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 (1-,--e_r'' The foregoing instrument as acknowledged before me this ( ( (i y /N=> (Date) by V re i Si.,A S who has produced k-tA C'sv-. (name of person acknowledging) (type of identification) as identification and did not take an oath. NOTARY" SoF 0gi;;`, HOWARD L. LEVY ,y =:.. ,,, .., Notary Public-State of Florida .......mor.::..-•�` ��t- = - Commission#FF217244 (SIGNATU'. OF 1OT� P ) 1,. X01, My Commission Expires April 5.2019 1. The names,titles,home address and phone numbers of all Officers/Managing Members of the Firm. (-a37- $f re) - f`I®1C Abe " f./�N1E�/ 4/fJ(�-a4e^ •r�''�/G"�f (;3'? _a oc�--4k,-5.;?./ / 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. ARife,e7- Fi- v� aM? ` G•r943fCl/'f fLooR f t C e'11-Ley hate 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. /,Icgliefexl 4/5,45-14 G'nAn /imekve (,O07No" gaagd,vice) ahpiaorll,412.p, 1: 74:01.4t04 /5 /441,7,47 upj2..h-ei f' 4 P)5/771./ v4° AFFIDAVIT Under the penalties of perjury I declare that I have 7td the oreg. ng app ation and that the facts stated in it are true. Authorized er ' icer of the Firm The foregoing instrument as acknowledged before me this // y// ' (Date) ( // /S of lei( /f' ��loori , l b 1 ' C `� by flni,ll 1�' o f ,jam u r n,P a PC •• (Name of Officer, Title/Agent) (Name of Corporation) F6.70/07' a Flo ri Corporation on behalf of the corporation. (State or Place of Corporation) KAHe/She has produced GamA ' identification and did not take an oath. (Type of identification) NOTARY'S SEAL .►a4.a�a • 6r TT , • EVY •'"�t-"'! 0 I�� : Notary Public-State of Florida (SIG SUR L OF ) =`' = Commission#FF217244 •%►•••tP�' My Commission Expires Page 2 of4 of ° April 5,2019