Backup Documents 04/25/2017 Item #16A 6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP L A
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO (}
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routinglines N I through#2,complete the checklist,and forward to the Count Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office 114(A`C/)
4. BCC Office Board of County 'F-6
Commissioners V1\14/ 15131A\—\
5. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff John Houldsworth / Phone Number x-5757
Contact/ Department
Agenda Date Item was April 25,2017 Agenda Item Number 16-A6
Approved by the BCC
Type of Document PLAT—Willoughby Preserve Number of Original One
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column, whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? n/a
2. Does the document need to be sent to another agency for additional signatures? If yes, JH
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JH
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's n/a
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JH
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on April 25,2017 and all changes made
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
m . �
9. Initials of attorney verifying that the attached document is the version approved by the of
BCC,all changes directed by the BCC have been made,and the document is ready for th
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 A 6
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. lithe document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office
4. BCC Office Board of County �
Commissioners \f / 7 `6\3`\\--\
5. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff John Houldsworth Phone Number x-5757
Contact/ Department
Agenda Date Item was April 25,2017 Agenda Item Number 16-A6
Approved by the BCC
Type of Document Construction, Maintenance and Escrow Number of Original One
Attached Agreement—Willoughby Preserve Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? n/a
2. Does the document need to be sent to another agency for additional signatures? If yes, JH
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. N /A-
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JH
signed by the Chairman,with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's n/a
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JH
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on April 25,2017 and all changes made I
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. Y-
9. Initials of attorney verifying that the attached document is the version approved by the �)
BCC,all changes directed by the BCC have been made,and the document is ready for th,
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16A6
CONSTRUCTION, MAINTENANCE AND ESCROW AGREEMENT FOR SUBDIVISION
IMPROVEMENTS
THIS AGREEMENT entered into this 15. Day of August 2017 by Blaczko LLC(hereinafter"Developer"),THE BOARD OF
COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIA(hereinafter"The Board")and CHERYL R. KRAUS, P.A., 1072
Goodlette Road, Naples,Florida 34102 (hereinafter"Escrow Company").
RECITALS
A. Developer has,simultaneously with the delivery of this Agreement applied for the approval by the Board of a
certain plat of subdivision to be known as Willoughby Preserve.
B. The subdivision will include certain improvements which are required by Collier County ordinances as set
forth in a site construction cost estimate("Estimate") prepared by Hagan Engineering, a copy of which is
attached hereto and incorporated herein as Exhibit 1. For purposes of this Agreement,the "Required
Improvements"are limited to those described in the Estimate.
C. Section 10.02.05 C and 10.02.04 of the Collier County Land Development Code requires the Developer to
provide appropriate guarantees for the construction and maintenance of the Required Improvements.
D. Developer has paid the required amount into an escrow account with Escrow Company pursuant to that
letter dated August, 15. 2017,attached hereto to fund the cost of the Required Improvements.
E. Developer and the Board have acknowledged that the amount Developer is required to guarantee pursuant
to this Agreement is$142,023.82,and this amount represents 110%of the Developer's engineer's estimate
of the construction costs for the Required Improvements.
Now THEREFORE,in consideration of the foregoing premises and mutual covenants hereinafter set forth, Developer,
the Board and the Escrow Company do hereby covenant and agree as follows:
1. Developer will cause the water,sewer, roads,drainage and like facilities,the Required Improvements,to be
constructed pursuant to specifications that have been approved by the County Manager or his designee
within six months from the date of approval of said subdivision plat.
2. Developer hereby authorizes Escrow Company to hold$142,023.82 in escrow, pursuant to the terms of this
Agreement.
3. Escrow Company agrees to hold in escrow$142,023.82,to be disbursed only pursuant to this Agreement.
4. The escrowed funds shall be released to the Developer only upon written approval of the County Manager
or his designee who shall approve the release of the funds on deposit not more than once a month to the
Developer, in amounts due for work done to date based on the percentage completion of the work
multiplied by the respective work costs less ten percent(10%);and further, that upon completion of the
work,the County Manager or his designee shall approve the release of any remainder of escrowed funds
except to the extent of$31,761.02 which shall remain in escrow as a Developer guaranty of maintenance of
the Required Improvements for a minimum period of one (1)year pursuant to Paragraph 10 of the
Agreement.
However, in the event that the Developer shall fail to comply with the requirements of this Agreement,then the
Escrow Company agrees to pay to the County immediately upon demand the balance of the funds held in escrow
by the Escrow Company,as of the date of the demand, provided that upon payment of such balance to the
County, the County will have executed and delivered to the Escrow Company in exchange for such funds a
statement to be signed by the County Manager or his designee to the effect that:
I6A6
(a) Developer for more than sixty(60)days after written notification of such failure has failed to comply
with the requirements of this agreement;
(b) The County,or his authorized agent,will complete the work called for under the terms of the above-
mentioned contract or will complete such portion of such work as the County, in its sole discretion shall
deem necessary in the public interest to the extent of the funds then held in escrow;
(c) The escrow funds drawn down by the County shall be used for construction of the Required
Improvements, engineering, legal and contingent cost and expenses, and to offset any damages either
direct or consequential,which the County may sustain on account of the failure of the Developer to carry
out and execute the above-mentioned development work;and
(d) The County will promptly repay to the Escrow Company any portion of the funds drawn down and not
expended in completion of the said development work.
5. Written notice to the Escrow Company by the County specifying what amounts are to be paid to the
Developer shall constitute authorization by the County to the Escrow Company for release of only those
specified funds to the Developer. Payment by the Escrow Company to the Developer of the amounts
specified in a letter of authorization by the County to the Escrow Company shall constitute a release by the
County and Developer of the Escrow Company for the specified funds disbursed in accordance with the
letter of authorization from the County.
6. The Required Improvements shall not be considered for preliminary approval until a statement of substantial
completion by Developer's engineer along with the final project records have been furnished to be reviewed
and approved by the County Manager or his designee for compliance with the Collier County Subdivision
Regulations.
7. The County Manager or his designee shall,within sixty(60)days of receipt of the statement of substantial
completion either:a) notify the developer in writing of his preliminary approval of the improvements;or
b) notify the Developer in writing of his refusal to approve the improvements,therewith specifying those
conditions which the Developer must fulfill in order to obtain the Director's approval of the Required
Improvements. However,in no event shall the County Manager or his designee refuse preliminary approval
of the improvements if they are in fact constructed and submitted for approval in accordance with the
requirements of this Agreement.
8. Should the funds held in escrow be insufficient to complete the Required Improvements,the Board,after
duly considering the public interest, may at its option complete the Required Improvements and resort to
any and all legal remedies against the Developer.
9. Nothing in the Agreement shall make the Escrow Company liable for any funds other than those placed in
deposit by the Developer in accordance with the foregoing provisions; provided that the Escrow Company
does not release any monies to the Developer or any other person except as stated in this Escrow agreement
to include closing the account,or disbursing any funds from the account without first requesting and
receiving written approval from the County.
10. The Developer shall maintain all Required Improvements for one year after preliminary approval by the
County Manager or his designee.After the one year maintenance period by the Developer and upon
submission of a written request for inspection,the County Manager or his designee shall inspect the
Required Improvements and, if found to be still in compliance with the Code as reflected by final approval by
the Board,the Escrow Company's responsibility to the Board under this agreement is terminated.The
Developer's responsibility for maintenance of the Required Improvements shall continue unless or until the
Board accepts maintenance responsibility for and by the County.
11. All of the terms, covenants and conditions herein contained are and shall be binding upon the respective
successors and assigns of the Developer and the Escrow Company.
IN WITNESS WHEREOF,the Board. Developer and Escrow Company have caused this Agreement to be
executed by their duly authorized representatives this 31. day of July, 2017.
16A6
For the Developer:
SIGNED in THE PRESENCE OF: Name of Entity: Blaczko LLC
, ---- ------ ''"J By: VC..?
Printed Name: ,,�� Michael Kolb, Manager
0'<ebPcc c, S/Gt10/0
Print Name/Title
C.)
(President, VP, or CEO)
(Provide Proper Evidence of Authority)
Printed e:
��e i 5 / 1
For the Escrow Company:
SIGNED in THE PRESENCE OF: Cheryl R. Kraus P.A.
mac ‘ By: .-
Printed Name: 14--t>171 L VZ t‘__(2 L A 10,127e3
,2-26 -ecc n. 5/moi
Print Name/Title
..._, "6,,....
-, (President,VP, or CEO)
ge
(Provide Proper Evidence of Authority)
tinted Na
tPob eitr 'kY ci/Y) /jil
ATTEST:
DWIGHT E. BROOK, CLERK BOARD OF COUNTY COMMISSIONERS OF COLLIER
Ct ORIDA
/
'-\n 40, I. /
By: YL( L • ifiatarleputy Clerk By: ..or A. C airman
"es • i ' • ." . PE NY TAYLOR'CHAIRMA1J .
App$94 '.' i. and — -
leg lity:
Scott A. Stone, Assistant County Attorney
16A6
�oaro9� CHERYL R. KRAUS,P.A.
Board Certified Real Estate Attorney
17 a 1072 Goodlette Road North
moy ��do Certified County and Circuit Court Mediator Naples,Florida 34102
R/3cex'�` Also Admitted in Michigan Fax 239.261.6747
REAL ESTATE Cheryl@cherylkraus.com 239.261.7716
August 15, 2017
Collier County Board of County Commissioners
3301 Tamiami Trail East
Naples, Florida 34112
Re: Escrow Receipt
Ladies and Gentlemen:
This firm is in receipt of $142,023.82 from Blaczko, LLC, a Florida limited liability
company, pursuant to the Construction, Maintenance and Escrow Agreement for Subdivision
Improvements dated August 15, 2017 by and between Blaczko LLC, the Board of County
Commissioners of Collier County, Florida and Cheryl R. Kraus, P.a. as related to certain real
property located in Collier, County, Florida, more particularly described as follows:
The North Half of the Northwest Quarter of the Southwest Quarter of the Southwest
Quarter of Section 24,Township 48 South, Range 25 East,Collier County, Florida.
Parcel Identification Number: 00162040005.
Said funds, received on August 15, 2017 will be held in accordance with the terms of the escrow
agreement.
Sincerely,
CHERYL R. KRAUS, P.A.
Nay Knaus
Cheryl R. Kraus
Attorney at Law
cc: Blaczko, LLC
Details I Page 1 of 1
lTint [. Tax Bills J Change of Address
16 A 6
Property Summary Property Detail [ sketches him Notices
Parcel No. 00162040005 Site Adr. ,'s
Name/Address BLACZKO LLC
20191 E COUNTRY CLUB DR# 301
City AVENTURA State FL Zip 33180
Map No. Strap No. Section Township Range Acres *Estimated
3A24 000100 054 3A24 24 48 25 5
Legal 24 48 25 N1/2 OF NW1/4 OF SW1/4 OF SW1/4 5 AC
Millage Area 0 18 Millage Rates 0 *Calculations
Sub./Condo 100 - ACREAGE HEADER School Other Total v
II.....f...J.. A n 1/A/'AAIT fICCIMCIUTu Al C I C O0A AA(ICAA
http://www.collierappraiser.com/main_search/recorddetail.html?sid=693391909&Map=No&FolioNum--001... 8/29/2017
E_, k :1, i'-i- i_. 1 6 A
6
LIMAH AG A N Engineer's Opinion of Probable Cost
[.NG,NEEnrNG
Willoughby Preserve PPLA
72016-170 Date:07/18/2017
SANITARY SEWER
Description ,-uantity Unit Unit Cost Total Quantity remaining Cost
8"PVC Gravity Sewer 705 IF $2300 $16,215.00 _ 98 52,254.00
Sanitary Manhole S EA 54500.00 522,500.00 0 50.00
Sewer services 15 EA $1,000.00 $15,000.00 0 50.00
Tie into exsiting Sanitary sewer 1 EA $1,500.00 51.500.00 0 50.00
s„b total SSS 219 00
POTABLE WATER
Description Quantity Unit Unit Cost Total Quantity remaining Cost
8"PVC Water Main DR14 30 LF $27.00 5810.00 0 50.00
8"PVC Water Main DRIB 670 LF 530.00 $20,100.00 0 50.00
8"WATER GATE VALVE 2 EA $1,900.00 53,800.00 0.5 5950.00 75%
Automatic Flushing Device 1 EA $1,500.00 51,500.00 1 51,500.00
TEMPORARY BACTERIAL SAMPLE POINT 1 EA $750.00 5750.00 1 5750.00
PERMANENT BACTERIAL SAMPLE POINT 1 EA 5750.00 5750.00 1 5750.00
2"WATER MAIN SERVICE W/METER(SINGLE) 1 EA 5750.00 $750.00 0.25 5117.50 75%
1"WATER MAIN SERVICE W/METER(SINGLE) 4 EA $650.00 52,600.00 1 5650.00 75%
1"WATER MAIN SERVICE W/METER(DOUBLE) 5 EA 5700.00 53,50000 1.25 $875.00 75%
8"WATER MAIN BLOW-OFF 1 EA $750.00 5750.00 0 50.00
Fire Hydrant Assembly WI GATE VALVE 2 EA $3,800.00 57.600.00 0 $0.00
Connect to existing 6'Water Main 1 EA 53500.00 53,500.00 1 53,500.00
Sub-total $46,410.00
DRAINAGE SYSTEM
Description Quantity Unit Unit Cost Total Quantity remaining Cost
VALLEY GUTTER INLET 2 EA $3,200.00 $6,400.00 2 56,400.00
TYPE'C'INLET 6 EA $2,500.00 $15,000.00 1.5 53,750.00
(UNCTION BOX 1 EA $2,300.00 $2,300.00 025 5575.00 75%
CONTROL STRUCTURE 1 EA $5,000.00 $5,000.00 0.25 51,250.00 75%
24"END WALL 1 EA 53.000.00 53.000.00 0.25 5750.00 75%
RCP 15" 12 LF 536.00 5792.00 5.5 5198.00 75%
RCP 18" 199 LF $37.00 $10,693.00 77.75 52,876.75 7S%
HOPE 8" 370 LF 537.00 513.690.00 92.5 53,422.50 75%
HDPE 10" 357 IF $52.00 518,564.00 89.25 54,641.00 75%
HOPE 12" - 330 LF 530.00 ( $9,900.00 82.5 52,475.00 75%
HOPE 24" 137 LF 552.00 57,124.00 34.25 51,781.00 75%
Sub-total $92,463.00
PAVING AND GRADING
Description Quantity Unit Unit Cost Tata/ Quantity remaining Cost
12"Stabilized Subgrade(LaR 40) 2000 SY 51.50 53,000.00 2000 53,000.00
Limerock Base 8"(LBR 100 2000 SY $6.35 $12,700.00 2000 512,700.00
3/4"Type S-10 ACSC(1st Lift) 1674 5Y $1.65 $2,762.10 1674 52,762.10
3/4"Type S-111ACSC(2nd Oh) 1674 SY $1.65 52,762.10 1674 52,762.10
VALLEY GUTTER CURB 1544 LF $12.00 $18,528.00 1544 518,528.00
5'WIDE CONCRETE SIDEWALK 498 SY 511.00 55,482.89 498 55,478.00
Limerosk Base 4"(LBR 40) 498 SY 53.20 $1,593.60 498 51,593.60
RETAINIAG WALL 4.5'HIGH 330 LF $40.00 513,200.00 0 50.00
RETAINIAG WALL 2.5'HIGH 131 IF $30.00 53,930.00 0 50.00
RIP RAP 0 CY $4000 50.00 0 50.00
Signing&Marking 1 LS $2,000.00 $2,000.00 0 50.00
Sod(disturbed areas) 1100 SY 5300 53,300.00 0 50.00
Subtotal $69,158.69
LANDSCAPE,IRRIGATION AND LIGHTING
Description Quantity Unit Unit Cost Total Quantity remaining Cost
Landscape Improvements 1 IS $2500.00 52,500.00 1 52,500.00
Irrigation Improvements 1 L5 $1,500.00 51,500.00 1 51,500.00 •
Lighting Improvements 1 LS 51,500.00 51.500.00 1 51,500.00
Sub-total 55.500.00
I.11 OSION COTROt
Description Quantity Unit Unit Cost Total Quantity remaining Cost
SILT FENCING 2,011.0 LF 51.00 52,011.00 150825 $1,508.25 75%
TURBIDITY BARRIER 20.0 LF $7.50 $150.00 1s 5112.50 75%
BALED HAY(LINEAR FEET OF COVERAGE) 230.0 IF 51.00 5230.00 57.5 557.50 75%
Sub-total $2,391.00
CLEARING&EXCAVATION
Ckrscoption Quantity Unit Unit Cost Tota/ Quantity remaining Cost
Clearing&Grubbing__-s 5.02 AC 52,000.00 510,040.00 0 $0.00
Total Fiii R1 toted' 11,9740 CY
O.+Aea Excavated Fdh 821.0 CY 53.50 52.873 50 0 $0.00
PeIcit import VA"'. 2,230.6 CY $15.00 533,459.00 1115 516,725.00
Sub.total $46,372.50
•9arrd on,amted toynl,apnrc,rl,,-ermn- -
"9elucsdte7.' 'tow end,e,m4er he:,m 1,7,niy
I1,,andluta) 5317,610.19 I (Remaining Total Cost 5110,262.80)
-titt-n4e. „ 1110%for Bond 5142,023.821
029474
Date: D (t/ i
Bank of America 1 6,A 6 001054
Blaczko LLC 63-27/631
158 Oakwood Ct r- Fzsens•ce
NAectioneinforhL;usinesckFraud
Prots
Naples, FL 34110 8/14/2017
PAY TO
. Cheryl Kraus Trust Account $ **142,023.82
One Hundred Forty-Two Thousand Twenty-Three and 82/100**`***********************`***********************`******* DOLLARS
Cheryl Kraus Trust Account
C/'
MEMO -_._.___._ _____..__ MP
AUTHORIZED SIGNATURE
Escrow Agreement Payment to County
000 L0540 1:063 LOU 2771:89808 L646 27 Lig'
Blaczko LLC 001054
Cheryl Kraus Trust Account 8/14/2017
Date Type Reference Original Amt. Balance Due Discount Payment
8/14/2017 Bill 142,023.82 142,023.82 142,023.82
Check Amount 142,023.82
BOA Escrow Agreement Payment to County 142,023.82
1 6 A 6
STATEMENT OF AUTHORITY
Pursuant to section 605.0302(1), Florida Statutes,this limited liability company submits the following
statement of authority:
FIRST: The name of the limited liability company is: BLACZKO, LLC
SECOND: The Florida Document Number of the limited liability company is: L16000108232
THIRD: The street address of the limited liability company's principal office is:
3838 Tamiami Trail #200,Naples,Florida 34103
The mailing address of the limited liability company's principal office is:
3838 Tamiami Trail#200, Naples, Florida 34103
FOURTH: This statement of authority grants or sets limitations of authority on all persons having the
status or position of a person in a company, whether as a member, transferee, manager, officer or
otherwise or to a specific person on the following:
1. May execute an instrument transferring real property held in the name of the company, including
a. Granted to: Uscher Blaczko and/or Michael Kolb
b. Exception: Michael Kolb does not have authority to execute contracts for the sale
of real property. He does, however, have the authority to sign any and all
documentation required to consummate the sale of the real property pursuant to the
terms of any sales contract for real property which has been executed by Uscher
Blaczko.
2. May enter into other transactions on behalf of, or otherwise act for or bind, the company.
a. Granted to: Uscher Blaczko and/or Michael Kolb
,A; sse b. Exception: See 1 b. above. `
/ Vs?... -i
Uscher B I aclilko
State of Horida
County of Collier
The foregoing instrument was acknowledged before me this 20`h day of April,2017,by Uscher Blaczko,
who personally appeared and produced a passport as identification and who did not take an oath and
acknowledged to me that he executed the same as his free act and deed.
1r _
(Signature of Notary)
SEAL Rebecca Slapp
�-� My Commission Expires: /fir'-, / a 0,. Ld/ 9
REBECCA s.APP
le �h MY WAMISSION$FF fl4329
EX?!AES:April 29,2019
?„ ;�. Ba+a lNeu'WryPuDieurmwrxf
16A 6
I
(Requestors Name) 1111 -IN 11:
(Address)
800298059368
(Address)
(City/State/Zip/Phone#)
•
El PICK-UP WAIT MAIL
04/21/17-01015.-020 *430.00
(Business Entity Name)
(Document Number)
—
Certified Copies Certificates of Status
N : rt
r'1
—0 ::.1
Special Instructions to Filing Officer. N c
O
Office Use Only
6 A 6
. . ___. . .
• •
•
•
COVER LETTER
TO: Registration Section
Division of Corporations
Blaczko, LLC
SUBJECT:
Name of Limited Liability Company
Dear Sir or Madam:
the enclosed Statement of Authority and fee(s)arc submitted for tiling.
Please return all correspondence concerning this matter to the following:
Cheryl R. Kraus
Name of Person
Cheryl R. Kraus, P.A.
Firm/Company
1072 Goodlette Road
Address
• Naples, FL 34102
City/State and Zip Code
(Do not change)
E-mail address:(to be used for future annual report notification)
For further information concerning this matter,please call:
Cheryl Krausat( 239 ) 261-7716
Name of Person Area Code Daytime Telephone Number
STREET/COURIER ADDRESS: MAILING ADDRESS:
Registration Section Registration Section
Division of Corporations Division of Corporations
Clifton Building P.O.Box 6327
2661 Executive Center Circle Tallahassee.Florida 32314
Tallahassee,Florida 32301
CR2E138(2/14)
•
16A 6
STATEMENT OF AUTHORITY
Pursuant to section 605.0302(1), Florida Statutes,this limited liability company submits the following
statement of authority:
FIRST: The name of the limited liability company is: BLACZKO, LLC
SECOND: The Florida Document Number of the limited liability company is: 116000108232
THIRD: The street address of the limited liability company's principal office is:
3838 Tamiami Trail#200,Naples, Florida 34103
The mailing address of the limited liability company's principal office is:
3838 Tamiami Trail#200, Naples, Florida 34103
FOURTH: This statement of authority grants or sets limitations of authority on all persons having the
status or position of a person in a company, whether as a member, transferee, manager, officer or
otherwise or to a specific person on the following:
1. May execute an instrument transferring real property held in the name of the company, including
a. Granted to: Uscher Blaczko and/or Michael Kolb
b. Exception: Michael Kolb does not have authority to execute contracts for the sale
of real property. He does, however, have the authority to sign any and all
documentation required to consummate the sale of the real property pursuant to the
terms of any sales contract for real property which has been executed by Uscher
Blaczko. •
—a.
2. May enter into other transactions on behalf of, or otherwise act for or bind, the compart1
a. Granted to: Uscher Blaczko and/or Michael Kolb ry _:}T1
rn
%V. reser. , b. Exception: See 1 b. above. / = ,,
t'`-rars" Uscher Blaczko
State of Florida
County of Collier
The foregoing instrument was acknowledged before me this 20th day of April,2017,by Uscher Blaczko,
who personally appeared and produced a passport as identification and who did not take an oath and
acknowledged to me that he executed the same as his free act and deed.
(Signature of Notary)
SEAL Rebecca Slapp
•ate 1I I'..me My Commission Expires: /tom-i / 6. Zci 9
fM'?i RFHECCA SIMP
i. M'a0/GUMS 1 FF 224329
EXPIRES:Ape 28,2019
tit; twy. Bads TM.Mpary Regie lid.rwsns
J l l'