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CLB Agenda 09/20/2023COLLIER COUNTY Board of County Commissioners Contractor Licensing Board I:�da"I .11 Board of County Commission Chambers Collier County Government Center 3299 Tamiami Trail East, 3rd Floor Naples, FL 34112 September 20, 2023 9:00 AM Todd Allen, Chair Stephen M. Jaron, Vice -Chair Matthew Nolton Robert P. Meister, III Richard E. Joslin, Jr. Kyle E. Lantz Elle Hunt Terry Jerulle NOTICE: All persons wishing to speak on Agenda items must register prior to presentation of the Agenda item to be addressed. All registered speakers will receive up to three (3) minutes unless the time is adjusted by the chairman. Any person who decides to appeal a decision of this Board will need a record of the proceeding pertaining thereto, and therefore may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the appeal is to be based. If you are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, the provision of certain assistance. Please contact the Collier County Facilities Management Division located at 3335 East Tamiami Trail, Suite 1, Naples, Florida, 34112-5356, (239) 252-8380; assisted listening devices for the hearing impaired are available in the Facilities Management Division. 1. ROLL CALL 2. ADDITIONS OR DELETIONS 3. APPROVAL OF AGENDA 4. APPROVAL OF MINUTES 4.A. 4A. APPROVAL OF MINUTES - AUGUST 16, 2023 (26627) 4.B. 4B APPROVAL OF MINUTES - AUGUST 29, 2023 (26629) 5. PUBLIC COMMENTS 6. DISCUSSION 6.A. 6A INTRODUCTION OF ATTORNEY TO CLB, PATRICK NEALE (26635) 7. REPORTS 8. NEW BUSINESS 8.A. 8A. ORDERS OF THE BOARD (6 ITEMS) (26612) 8.B. 8B. HUNTER K. JONES - REVIEW OF EXPERIENCE - RESIDENTIAL CONTRACTOR - SWFL STRUCTURAL INC (26613) 8.C. 8C. DUSTY L. LOEWEN - REVIEW OF EXPERIENCE - RESIDENTIAL CONTRACTOR - SUPREME SERVICES AND MORE LLC (26614) 8.D. 8D. ARMANDO MARTINEZ - REVIEW OF EXPERIENCE - PLUMBING CONTRACTOR - AGM GENERAL CONTRACTORS CORP (26615) 8.E. 8E. LUIS I. ZURITA - REVIEW OF EXPERIENCE - SWIMMING POOL/SPA MAINT. & REPAIR - REFLECTIONS POOL SERVICE & REPAIR OF SWFL, INC (26616) 8.F. 8F. ALAN LORA - REVIEW OF EXPERIENCE - ALUMINUM CONTRACTOR - IZZY SCREEN REPAIR, INC (26617) 8.G. 8G. HILLARY A. GARDELLA - REVIEW OF EXPERIENCE - CARPENTRY CONTRACTOR - FLORIDIAN CARPENTRY INC (26618) 8.11. 8H. BRIAN L. SANTOS - RECORD REVIEW - TREE REMOVAL & TRIMMING CONTR. - DYNAMIC TREE SERVICE, INC (26619) 8.I. 8I. DOMINIC L. SANTOS - REVIEW OF CREDIT - TREE REMOVAL & TRIMMING CONTR. - D SANTOS TREE SERVICE " (26620) 8.J. 8J. CLAUDIA A. SACACIAN - REVIEW OF CREDIT - 3 REINSTATEMENT APPLICATIONS (FLOOR COVERING, TILE & MARBLE, AND CABINET INSTALL) - CLASSIC STONE DESIGNS, INC (26621) 9. OLD BUSINESS 9.A. 9A. RESCIND EMERGENCY CERTIFICATES OF COMPETENCY (26622) 10. PUBLIC HEARINGS 10.A. 10A. 2023-17 -ROGER ROJAS DBA ARTISAN SEAL, INC (CEMIS20230007275) (26623) 11. NEXT MEETING DATE 1LA. 11. NEXT MEETING DATE WEDNESDAY, OCTOBER 18, 2023 (26624) 4.A 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 4.A Doc ID: 26627 Item Summary: 4A. APPROVAL OF MINUTES - AUGUST 16, 2023 Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Sandra Delgado 09/13/2023 11:21 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 11:21 AM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Tim Crotts Review Item Meeting Pending Completed 09/13/2023 2:41 PM Completed 09/13/2023 4:59 PM 09/20/2023 9:00 AM Packet Pg. 4 August 16, 2023 4.A.1 MINUTES OF THE COLLIER COUNTY CONTRACTOR LICENSING BOARD MEETING August 16, 2023 Naples, Florida LET IT BE REMEMBERED that the Collier County Contractor Licensing Board, having conducted business herein, met on this date at 9:00 a.m. in REGULAR SESSION in Administration Building F, Yd. Floor, Collier County Government Center, Naples, Florida. MEMBERS: Todd Allen, Chairman Robert Nester Terry Jerulle Matthew Nolton Kyle Lantz Richard Joslin Elle Hunt ALSO PRESENT: Timothy Crotts, Contracting Licensing Supervisor Kevin Noell, Esq., Contractor Licensing Board Attorney Ronald Tomasko, Esq., Assistant Collier County Attorney Michael Bogert, Collier County Licensing Investigator Timothy Broughton, Collier County Licensing Investigator Sandra Delgado, Operations Supervisor Packet Pg. 5 August 16, 2023 4.A.1 Any person who decides to appeal this decision of the 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 made. 1. Roll Call Kyle Lantz was approved leaving at 11:00 a.m. today. Stephen Jaron, approved absence. 2. Additions or Deletions None. 3. Approval of Agenda ■ Kyle Lantz: Approved agenda and made motion ■ Richard Joslin: Seconded All in favor — aye. (Carried unanimously, 7-0.) 4. Approval of the Minutes ■ Terry Jerulle: Motion to approve ■ Matthew Nolton: Seconded All in favor — aye. (Carried unanimously, 7-0.) 5. Public Comments None. 6. Discussion ■ None. ■ At the request of Timothy Crotts, Staff Comments will be discussed after the public hearings. 7. Reports None. 8. Orders of the Board (A)15 Orders ■ Kyle Lantz: Motion to authorize the Chairman to sign the 15 orders of the Board. ■ Richard Joslin: Seconded. All in favor — aye. (Carried unanimously, 7-0.) (B) ADMIR SHAQIRI — REVIEW OF EXPERIENCE — GENERAL CONTRACTOR - ADMIRAL GENERAL CONTRACTOR LLC ■ Admir Shaqiri: Sworn testimony given. ■ Timothy Crotts: Mr. Shaqiri has submitted an application for the issuance of a registered license as a general contractor, which requires 48 months experience. As part of the review process by staff, Mr. Shaqiri has submitted verification of experiences from the following licensed contractors outlining his experience — PIBGS 2 Packet Pg. 6 August 16, 2023 4.A.1 from Brooklyn, NY, the details of the work experience was that of flooring, cabinets and general maintenance; Colony Manor, out of Brooklyn, NY, details of the work experience was that of kitchen, bathroom, flooring and removal; Jonathan Castillo homeowner Brooklyn, NY, details of the experience was that of fencing a porch awning with columns, wrought iron and floor installation; Rayon Home Builders of Brooklyn, NY, we received no information. A phone call interview was conducted with Mr. Shaqiri regarding his application and experience. Mr. Shaqiri stated that the majority of his experience consisted of interior renovations of single family homes, including the building of driveways, walkways and roofing. Mr. Shaqiri did tell me that he did have some experience in the renovation of hospitals. Mr. Shaqiri did state he does not have any experience in the construction of high-rise structures, multiple dwelling structures exceeding three floors, or any commercial structures associated with shopping plaza structures. Based upon the information received from Mr. Shaqiri, it is the opinion of staff that Mr. Shaqiri does not meet the requirements under Ordinance 2006-46 section 1.6.1.1 as it relates to the trade of general contractor. Mr. Shaqiri is being referred to the Board under Section 2.5.2 referral the application to the contractors licensing board for decision. Mr. Shaqiri is here to answer your questions regarding his experience. The 48 months of experience can come from other locations. ■ Todd Allen: Before I turn this over to let you explain to your experience, what are you hoping to use this license for? ■ Admir Shaqiri: I am starting to buy properties and want to build new houses. I saw the requirements for the general contractor license and thought I'm a good fit. ■ Todd Allen: Do you want to build just residential properties? ■ Admir Shaqiri: Yes. I saw the requirements on the website and it says I would need 48 months of experience in construction. I don't have the high rise building (experience) in New York because it was more interesting for me to work for myself because I had my own company, Daniel Contracting. I was working for myself doing a lot of jobs in construction roofing homes, remodeling in residential and commercial. I used to work for a lot of hospitals and ambulatory centers in New York City doing a lot of interior jobs. ■ Todd Allen: You've never built a commercial building? ■ Admir Shaqiri: No. I used to work for another company which was working with commercial buildings and I was a superintendent. I started as a carpenter in that company and I grew more experienced in different buildings — schools and health departments in New York City. I am certificated from OSHA — 30 hours of commercial buildings. I am from Albania and have a mechanical engineering degree from Tirana University. ■ Richard Joslin: Since you only want to do residential contracting or build residential homes, I would suggest to you that maybe that's the license that you would apply for. ■ Timothy Crofts: Based upon the information we received from the verification of construction experience, we would say no, even through Mr. Shaqiri's own 3 Packet Pg. 7 August 16, 2023 4.A.1 admission, most of his experience has been through remodeling, not building from the ground up. ■ Matthew Nolton: As a general contractor you don't come close to having the experience. You could build a thirty story high rise or a 500,000 square foot commercial building, but you don't have that experience based on your testimony here and based on the information you've provided us. ■ Todd Allen: What I would recommend you do is consider withdrawing this application and have a conversation with Mr. Crotts on whether there is a different license you can apply for. Maybe you can provide him with some additional materials that would qualify you to build residential. It sounds like you have some of that experience, but I can't support giving you a general contractor license that will allow you to go build that thirty story high rise. ■ Terry Jerulle: My advice is to work in Florida for a general contractor doing the type of work you want to do and that will give you the experience to become the contractor you want to be. ■ Elle Hunt: Our building here is different than in New York. Our topography is different, code is different in order to maintain hurricane level resilience for homes. If we were even going to consider a residential contractor license, we'd start talking to you about how to build for hurricane resiliency. And from my understanding you don't have experience even with that. ■ Todd Allen: I want to confirm, Mr. Shaqiri that you're going to withdraw this application today? ■ Admir Shaqiri: Yes, I will. (C) JOSE M. JIMENEZ — REVIEW EXPERIENCE — RESIDENTIAL CONTRACTOR — JJ'S INNOVATION QUALITY LLC ■ Jose Jimenez: Sworn testimony given to Mr. Jimenez and his translator. ■ Timothy Crofts: Mr. Jimenez appeared before the Board on April 19, 2023, and attempted to get his registered building contractor license. After review by the Board, it was determined that Mr. Jimenez did not possess the required experience and was allowed to withdraw his application in lieu of the order being denied. A copy of the minutes from the April 19, 2023, has been included in your packet for review. Currently, Mr. Jimenez has submitted an application for a residential contractor, which also requires 48 months experience. As part of the experience and as part of the review process by staff, Mr. Jimenez submitted three verifications of construction experience and documents. A review of these documents show the following: (1) Blue Diamond Home Builders — employed from September 2018 to present and speaking with Mr. Lopez, the president of the company, Mr. Jimenez worked 20 to 25 hours a week and was a 1099 employee. The verification of experience that was resubmitted with the residential contractor license has only been slightly modified. (2) Pinnacle Contracting and Framing — employed from March 2017 to present. I spoke with Mr. Diaz, the president of this company. Mr. Jimenez was a part-time employee working two to three years ago. Mr. Jimenez's work was 90% residential. However, Mr. Diaz could not remember any of the work that was performed by just Mr. Jimenez. The 4 Packet Pg. 8 August 16, 2023 4.A.1 verification of construction experience that was resubmitted again is only slightly modified. (3) Elite Contractors Incorporated reported Mr. Jimenez to have been an employee from February 2010 to present. The information received showed that he had been an electrical employee. There was no mention of any building construction. Based upon the information we received, it is the staff's opinion that Mr. Jimenez does not meet the minimum requirements that's set forth in the Ordinance 2006-46 as it relates to experience under 1.6.1.3 as a residential contractor. Because Mr. Jimenez does not meet the qualifications for the issuance of the residence contractor, Mr. Jimenez is being referred to the Board under section 2.5.2 referral of the application to the Contractor Licensing Board for decision and Mr. Jimenez is here today to answer your questions. ■ Matthew Nolton: For Pinnacle Contracting, did you say how many hours he worked there a week? ■ Timothy Crotts: He just said that he worked two to three years. He did not have a number of hours that was shown and the president of the company could not remember the scope of work that he actually performed. ■ Matthew Nolton: So we can't equate the hours to a certain amount of years experience. ■ Todd Allen: Mr. Jimenez, now is your opportunity to convince us that you've got the experience to qualify for this license. ■ Jose Jimenez: He says that he worked for almost six years for Blue Diamond. He started with cleaning the lot and reading the blueprint, pouring concrete for the slab, then the concrete walls, installing carpentry, and doors. He started learning from the bottom up and is capable to do the job. After seeing the job and experience, Blue Diamond gave him a supervisory position over the contractors for more than two years. He currently is supervising a few houses. ■ Matthew Nolton: How many hours a week does he work at Blue Diamond? ■ Jose Jimenez: Only 20-25 hours a week for Blue Diamond because he opened his own company to do the same job for whomever else needs him. He is a subcontractor for other companies. He supervises the licensed contractors. He may help but he gets paid as a 1099. Blue Diamond gives him five to six houses during the year. He supervises from the beginning through inspections. ■ Matthew Nolton: It's clear he has a lot of experience from Blue Diamond, but it's from September of 2018 to now, and it's half time. So at most that's 2.5 years. He needs four years. We need to hear how he got the rest of that experience in years. ■ Timothy Crotts: Regarding Pinnacle and Mr. Diaz: It was confirmed that he was a part-time employee for two to three years ago, 90% residential work, but he could not remember the scope of work that Mr. Jimenez performed. ■ Richard Joslin: The problem I have is that the application shows him working from March 2017 to present. ■ Timothy Crofts: I can only go by what I'm told when I make the phone calls to the owners of the companies. Elite Contractors, when we spoke to him, the work was that of electrical. There was no construction. 5 Packet Pg. 9 August 16, 2023 4.A.1 Further discussion with regard to Mr. Jimenez: • W rking for Blue Diamond 8-9 years doing electrical work which doesn't come into play for the general contractor license requirements of 48 months experience. • Did you set trusses, dig the slab, put in grade beams, watch them put on the roof? • Mr. Jimenez's daughter steps up to the microphone to clarify her father working full time since 2018. But the majority of the earlier years were doing electrical. (Sworn testimony given.) • Mr. Jimenez has his own company, JJ's Innovations, and is listed as manager of the company. No license could be found. • Working without a license or as a 1099 subcontractor? ■ Todd Allen: Someone like to make a motion? ■ Richard Joslin: I don't think he qualifies for this license, so I'm going to vote to make a motion to deny. ■ Matthew Nolton: It sounds like he has a lot of experience. The problem we're having is trying to figure out how many years it equates to. ■ Translator for Mr. Jimenez: I have worked for Blue Diamond since they started building homes. Mr. Jimenez has worked on 30-40 houses and he's been doing electrical work, but also started getting involved in the construction. He's been with Blue Diamond for over 18 years. He has 6-7 houses in progress now and is supervising the subcontractors. ■ Todd Allen: Motion to approve his application with a 12 month probationary period. Is there a second? ■ Matthew Nolton: I'll second that motion. Aye — four. Elle Hunt and Richard Joslin and Terry Jerulle — nay. (Disunited vote, 4- 3) (D) JACOB L. WERTHEIMER — REVIEW OF EXPERIENCE - RESIDENTIAL SWIMMING POOL/SPA CONTRACTOR - POOL LEAK RESCUE LLC ■ Jacob Wertheimer: Sworn testimony given. ■ Timothy Crotts: Mr. Wertheimer is here today seeking a residential pool and spa contractor license, which requires 24 months experience. As part of the review process by staff, Mr. Wertheimer has submitted three verifications of experience from licensed contractors, outlining his experience all in the state of Massachusetts. While it appears that Mr. Wertheimer has the required months of experience for the trade, all of Mr. Wertheimer's experience has been in the state of Massachusetts. Based upon the information received from Mr. Wertheimer, it is the opinion of staff that Mr. Wertheimer does not meet the experience required under Ordinance 2006-46 Section 1.6.2.8 as it relates to the trade of residential pool and spa contractor license in regards to the construction knowledge and methods required for construction of pools and spas within the state of Florida. Mr. Wertheimer is being referred to the Board under section 2.5.2 referral the application to the Contractors Licensing Board for decision and he is here today to answer your questions. 11 Packet Pg. 10 August 16, 2023 4.A.1 ■ Richard Joslin: Convince me that you can build a swimming pool. What part of the pool construction did you do? ■ Jacob Wertheimer: Everything from start to finish but none of the tiling just because that was very specific and we did have to subcontract that out. From excavating to tying rebar to pouring shotcrete to doing the finish. ■ Richard Joslin: Did you ever work with pilings? ■ Jacob Wertheimer: No, and I know that's a common piece when it comes to especially right on the water table. You want to make sure you've reinforced that when you're building a pool that's going to be affected by hurricanes. We're actually doing repair, so the name of our company is Pool Leak Rescue. We do pool leak detection and repair. We're not actually going into the building side of it. ■ Richard Joslin: So the bulk of your company is going to be repairing pools and checking for leaks and finding leaks and fixing them. You're not really interested in building pools. ■ Jacob Wertheimer: No, we don't even have the equipment to build pools. So we bought all our equipment based off of finding leaks detection. ■ Richard Joslin: I would have a recommendation for you then. There is another license that you can get that will allow you to do what you want to do, which would still allow you to do a lot of repairs on residential pools and do your leak detection as a main body. A pool leak repair is not really a specific type of license, but the pool and spa repair license would be the one that you would want to have. That way you could go and do the leak repairs. You could fix pools. ■ Todd Allen: One of the concerns we have with your application is that you do have a lot of experience. It just may not be constructing pools in Florida and with our water table issues and the piling issues. But it sounds like you've got more than enough experience to do the pool leak repair. If under the current application, if he were to change it to that, that different license would he need to come back before us? ■ Timothy Crofts: If he wants to withdraw this application, change the application over to the repair side, I believe that he has more than enough experience for the repair site, just not the building of pools. ■ Richard Joslin: On this side of the pool, spot repair, you could go and fix the leak in a commercial pool — a leak is a leak, right? ■ Jacob Wertheimer: Explain to me exactly what (the pool repair) encompasses. ■ Richard Joslin: What you're going to have is what's called a pool and spa repair and service contractor. It doesn't allow you to build, doesn't allow you to put in a shell or build a pool, but it does allow you to go and fix any pool. OK, repair. Basically, from the interior/exterior, it doesn't matter as long as you don't change the structure you're good to go find a leak. If you have to dig up a trench and find a leak in a return line, you can do that. All the things that you're talking about leaking you can do. On the shell, yes, interior finish repairs. Anything of that nature. If it's already built and you wanted to go put in and add a bench inside that pool, you could do that. Yes, because you're not changing the structure. But as far as tearing out a wall on the pool and then adding like a sun shelf or something of that nature, no. And equipment work, yes, and cleaning, maintenance. 7 Packet Pg. 11 August 16, 2023 4.A.1 ■ Todd Allen: For our purposes in the record, you want to withdraw this application and resubmit it? ■ Jacob Wertheimer: Yes. (E) JOSE A. BETANCOURT PAZ —REVIEW OF EXPERIENCE —DRYWALL CONTRACTOR - J.A.B PAINTING INC. ■ Jose Betancourt Paz: Sworn testimony given. ■ Timothy Crotts: Mr. Bentancourt has applied for the license of drywall contractor, which requires 36 months experience. As part of the review process by staff, Mr. Bentancourt has submitted verification experience from the following contractors outlining his experience: Build LLC, which is a state certified general contractor. (1) The dates of work were 2018 to present; scope of the detailed work was that of drywall patching, painting, and minimal trim work. Mr. Bentancourt was listed as a subcontractor not an employee. (2) WKMJ LLC is a state licensed building contractor. Days of work were from 2019 to present. Scope of the work detailed as experience was painting, drywall patching and miscellaneous trim carpentry. Mr. Bentancourt was listed as a subcontractor not an employee. (3) Swyger Construction, which is a state licensed residential contractor. The dates of work were 2016 to present. In a phone interview with this company, Mr. Bentancourt was reported to be a subcontractor, not an employee, but that Mr. Bentancourt had been assisted in the installation of several sheets of drywall when working for this company. Mr. Bentancourt currently holds an active Collier County specialty painting license contractor was issued in 2019. Mr. Bentancourt was required to appear before the Board on June 21, 2023, for a hearing working outside the scope of his painting license. The fines assessed as a result of this hearing have been paid and a copy of the minutes has been included in your packet. Based upon the information we received from Mr. Bentancourt it is the opinion of staff that Mr. Bentancourt does not meet the experience required under Ordinance 2006-46, section 1.6.3.15 as it relates to the trade of drywall contractor. Mr. Bentancourt is being referred to the Board under section 2.5.2, referred to the application to the Contractors Licensing Board for decision. Mr. Bentancourt is here today to answer your questions. • Discussion ensued regarding an unlicensed contractor doing non -licensed work • Not condone the work just realize it existed. • Would we be encouraging it; setting a precedent • Doing unlicensed work to gain the experience • His experience with two companies states he only did drywall patching; the third company stated he only hung a few sheets of drywall • Mr. Bentancourt does not have 36 months of drywall experience ■ Todd Allen: I am going to make a motion to deny the application. ■ Terry Jerulle: Second. All in favor — aye. (Carried unanimously, 7-0.) (F) RAFAEL AGUILAR — REVIEW OF CREDIT — SWIMMING POOL/SPA SERVICING/REPAIR CONTRACTOR (26303) E3 Packet Pg. 12 August 16, 2023 4.A.1 ■ Rafael Aguilar: Sworn testimony given. ■ Timothy Crotts: Mr. Aguilar submitted an application for the issuance of a swimming pool and spa service and repair contractor, which requires a minimum credit score 660. Mr. Aguilar appeared before the Contractors Licensing Board June 21, 2023 for review of experience and credit in his attempt to get a residential pool and spa contractor license. As a result of the review, Mr. Aguilar withdrew his application so he could apply for the license he is applying for now. A copy of those minutes has been included in your packet. As part of the application process under Collier County Ordinance 2006-46 2.3.9, Mr. Aguilar was required to submit a personal and business credit report. The credit report submitted was reviewed and appears not to meet the financial responsibility as set forth in section 2.5.1, subsection D, the applicant or qualifier meets the requirement of financial responsibility as set forth in Rule 61G4-15.006 of the State of Florida. A review of the personal credit report submitted by Mr. Aguilar shows the following concern. Credit report shows a credit score of 536, which is below the minimum of 660 required by rule. During the June 21, 2023 license review, Mr. Aguilar's credit report showed a credit score of 525 and an outstanding balance of $1,352 due to AMEX. Mr. Aguilar has submitted documentation showing that this balance has been paid in full. Based upon the information received, Mr. Aguilar does not meet the minimum requirements set forth in ordinance 2006-46 as it relates to the financial responsibility. Regarding his credit, he is being referred to the Board under section 2.5.2 referral the application to the Contractor Licensing Board for decision. Mr. Aguilar is here to answer your questions. ■ Todd Allen: He showed you the payoff for the Amex and there's no credit report showing that he owes anybody? ■ Timothy Crotts: Correct, it's just the credit score itself is below the minimum required. Recommendation that that the issuance of the swimming pool service and SPA license be granted with a 12 month probationary period, that Mr. Aguilar update his current report after six months showing an improved credit score and no additional credit issues. And Mr. Aguilar submit an updated credit report after 12 months showing a credit score of at least 660 and no additional credit issues. Failure to abide by the Board shall result in Mr. Aguilar having to appear before the Board for additional action that may be required. At any time during this period should Mr. Aguilar be able to show that his credit score has reached a credit score of 660 and there are no other credit issues the probationary period would be removed. ■ Todd Allen: I'll make a motion. ■ Terry Jerulle: I'll second the motion. All in favor — aye. (Carried unanimously, 7-0.) (G) ADELA SANTOS — SECOND ENTITY APPLICATION — TREE REMOVAL & TRIMMING CONTRACTOR — D SANTOS TREE SERVICE " LLC" ■ Adela Santos: Sworn testimony given. ■ Timothy Crotts: Ms. Santos has submitted a second entity application for the trade of tree trimming and removal. Ms. Santos currently holds a valid tree trimming and removal license from Collier County which was issued in 2011. A review of the W Packet Pg. 13 August 16, 2023 4.A.1 current license shows that there have been no complaints against this company. However, Ms. Santos has had issues in not renewing her license by the required date as required by ordinance and has had to pay late fees several times in order to keep this license from going into suspended or cancel status. Since 2011, this has occurred in 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2020, 2021 and 2022. As part of the application, Ms. Santos listed herself as 90% owner with a question mark. In the new company, however, Ms. Santos does not appear as an officer according to the Sunbiz documents included in this packet. Ms. Santos has submitted a second application to submit the qualification for D Santos Tree Service for the aforementioned trade. There is no current license listed for D Santos Tree service at this time. ■ Elle Hunt: Tell us why you want to qualify a company that you have no ownership interest in. ■ Adela Santos: I am trying to help my son so he can get his own company going. Discussion ensured concerning the following: • Ms. Santos thought she could add her son as a second entity keeping her business separate. • The son, Dominic, still needs to have his own license. • Dominic has been in the tree business since approximately the tenth grade or since he was 17 years old. He was given a choice to attend school or a work program. He chose the latter. He worked for A Cut Above on their payroll until he received his diploma — a year and a half or two years. Graduated a year ahead. He then worked for his grandfather, Davie Tree Service. • Dominic is not book smart and he can't take the test for his license. He's work smart. • Ms. Santos has issues with keeping her license renewed by the required date and the staff recommends that the second entity be not approved. • If Dominic had taken the exams and was unable to pass them, that might be something different. • It doesn't sound like Ms. Santos would be the responsible officer in the second entity. • If Ms. Santos' license is cancelled then neither of them can work. • I'm building my own customer base because in Estero, Fort Myers, Cape Coral, we can work without a contractor license. ■ Todd Allen: Do you want to withdraw your application and resubmit it? ■ Ms. Santos: Yes, we would like for me to get on his. ■ Terry Jerulle: I think you should take the test. Can't means won't and to say you can't do something without even trying, it is a failure. ■ Todd Allen: Mr. Crotts, if he can't pass it, he could still come before us on the application? ■ Timothy Crotts: Correct. The Board could waive the testing depending on what it is but he has to at least make an effort. 9. Old Business (A)ROBERTO SUAREZ SANCHEZ - REVIEW OF CREDIT — SWIMMING POOL/SPA SERVICING CONTRACTOR - ALPHA POOL GUYS WEST COAST, LLC 10 Packet Pg. 14 August 16, 2023 4.A.1 ■ Roberto Sanchez: Sworn testimony given to Mr. Sanchez and Attorney Bryan Sherman, Sherman Law Firm. ■ Timothy Crotts: Mr. Sanchez has submitted an application for the issuance of a swimming pool and spa servicing contractor license, which requires a minimum credit score of 660. This credit issue was reviewed by the Board at the July 19 meeting. During this meeting, it was discovered as part of the personal credit report that Mr. Sanchez showed a large number of charge offs, collection accounts in the amount of $503,000 and a credit score of 432, which is below the minimum credit score required by rule 61G4-15.006 in the State of Florida of 660. As a result of review by the Board, Mr. Sanchez was granted a temporary 30 day license until today's date at 5:00 PM. Mr. Sanchez was required to appear with his attorney at this meeting to provide a detailed explanation on how the credit worthiness has been negatively impacted in the past, his involvement in the same, and a detailed explanation including a plan and permanent documentation of this action, the steps that he will be taking to improve his credit score, his credit worthiness and to resolve the current debts that he has. A copy of those minutes of the July 19 meeting has been included in your packet. Mr. Sanchez and his attorney are here today to answer your questions. ■ Attorney Sherman: • I am servicing Mr. Sanchez during this probationary period and attending to his delinquent debts. We are trying to negotiate with creditors as they come forward to pursue action against him. One creditor has taken steps to serve in terms of a court appearance and the other creditor we have a response due next week. We are working to negotiate a payment plan with the creditors as Mr. Sanchez is earning income through the next 12 months. • Two creditors have filed a lawsuit. The largest creditor has to do with two trailers. That is about $220,000. • No police report has been filed. • I understand about the optics and a police report and to defend the case as we move toward a negotiation from a defense standpoint and to try to find leverage. I will continue to discuss this with Mr. Sanchez as we move through the process. • There is a certain fear for his personal well being and that did occur so he is afraid for his own personal safety. • What's the plan for reconciling — a six month, 12 month, two year plan to put him in a better situation? To continue his efforts to earn income so we can negotiate payment plans. With regard to the trailers, I don't know yet where that one is going in terms of the mitigation action. • It is all going to be civil — only monetary and we're going to work through this. • With regard to protecting the consumer, Mr. Sanchez does not take deposits and he will only be cleaning pools, no repair or maintenance. • I believe within the 12 month period we will have a better understanding of what the future holds or where this is moving as far as the monetary obligations. 11 Packet Pg. 15 August 16, 2023 4.A.1 • Clients pay Mr. Sanchez at the end of the month after cleaning the pools. No one pays up front so customers are not at risk. ■ Todd Allen: Back to litigation. Are there two lawsuits he's been served? ■ Attorney Sherman: One of them is a Discover Card. He was not been served with process yet, and from the defense perspective, I don't help prosecute cases for the other side. So you need to wait until you get served. ■ Todd Allen: The reason I'm asking that is because accepting service of the lawsuit speeds the litigation. Just by accepting service, you're not helping them prosecute the case. What you're doing is you're kicking off the litigation so it can get started. From my perspective, if you don't accept litigation, we're going to be back here 12 months from now still having to come up with a plan, where if you start getting involved in this litigation now and deal with it now, at the end of 12 months you may possibly have a resolution within that 12 month period depending on court schedules. ■ Attorney Sherman: I'm sure he'll be served soon. The sooner we get into the litigation, the sooner is the settlement. The sooner he has to bring money. We can deal with two or three at a time, but not four or five or six. As he establishes more and more income he can bring payment plans toward the creditors slowly, as is necessary in order to avoid judgments being entered against him. I understand we'd like to resolve them all as fast as possible. ■ Todd Allen: You have a limited resource to settle a vast majority. A number of these cases, and so you're saying, I can't get involved in a bunch of litigation right now because I don't have the money to settle them all. That's essentially what you're saying. ■ Attorney Sherman: We also don't know which ones will get tired and go away. I'm trying to pay everybody as necessary as they come forward, but at the same time he should defend himself as properly as he can as well. But we have to settle the debts as best we can. Only two have served him. The Discover charge is still out there and they haven't served him. ■ Timothy Crofts: Recommend a 24 month probationary license. At the end of every six months from today's date Mr. Sanchez be required to submit a credit report showing the status of the current charge offs and collections to show that his credit score is improving and to show that he has not had any other further credit issues. Staff would also like in the next 30 days to get a written report from Mr. Sanchez and his attorney on exactly how they plan on moving forward over the next 24 months to resolve these issues. ■ Todd Allen: I agree with that motion; I'm going to add a little bit more to it. At every six months when he submits a credit report I would like for him to submit an update on the course of the litigation that he's actively defending because that'll give us an idea of where those are at. ■ Kevin Noell: Just for clarity, since he's already had one month of probation, the board can put him on probation for 24 months total. So it would be one year and 11 months. ■ Timothy Crofts: That temporary license actually expires today at 5:00 PM, so this will be granting a new license as a probationary status and we would ask for 24 months. 12 Packet Pg. 16 August 16, 2023 4.A.1 ■ Kyle Lantz: He came here originally last month to change his license from one company to another company. And somehow he cancelled his license on the first company unintentionally. I just want to make sure that this license is going to be for the company he wants it to be. ■ Timothy Crotts: Correct. This will be for the application that he had submitted at the last meeting ■ Kevin Noell: Mr. Crotts, does that also involve a new license number then that he's going to be issued. ■ Timothy Crotts: Yes, a new issuance number. ■ Richard Joslin: In the motion itself, it says that if the credit score doesn't change or show some improvement in the credit score, with this amount of money that's going to be disputed, I don't think it's going to do much for the credit score. ■ Timothy Crotts: We're looking to see that the credit score doesn't decrease. And that there are no other credit issues that all of a sudden come forward that we haven't been made aware of. ■ Todd Allen: With the litigation report, we'll have an idea of what's going on with those creditors that are actually chasing him. ■ Todd Allen: Motion made. ■ Richard Joslin: Seconds the motion. All in favor — five. Terry Jerulle — nay. Matthew Nolton — abstain. (Disunited vote, 5-2.) ■ Terry Jerulle: So we're in discussion and I have a problem. I'm not an attorney, but if I'm a creditor and I'm trying to chase somebody for money and if he has a police report that somebody stole something from him it would be easier to solve and I just can't get over the fact that he hasn't filed a police report. I mentioned it last time he was here and his counsel, I also recommended that that he do that. So I'm having a hard time with him not filing a police report. You have to identify that you're not complicit with what happened. It gives us comfort that he's not complicit in this scam. (B) TERESA QUIROZ — PROBATION REVIEW (CREDIT) - ELITE PAINTERS OF SWFL LLC ■ Teresa Quiroz: Sworn testimony given. ■ Timothy Crotts: Ms. Quiroz appeared before the Contractor Licensing Board on September 21, 2022, regarding an application for the issuance of a painting contractor license. Based upon the information received, she did not meet the requirements for financial responsibility under the County Ordinance 2006-46 section 2.5.1 subsection D set forth in Rule 61 G4-15.006 of the State of Florida. A copy of the findings, facts and minutes for the September 21, 2022 meeting are included in your packet. A review of Ms. Quiroz credit review shows that on September 21, 2022, the average credit score was 642. A collection debt in the amount of $2,392 was shown as a charge off by Capital One Bank. On March 3, 2023 credit report, the average credit score was 632. Documentation was provided showing a payment plan which had been 13 Packet Pg. 17 August 16, 2023 4.A.1 entered into in the amount of $50.00 per month to resolve the Credit One Bank account. Payments were on time and up to date. The most recent credit score of July 11, 2023, the average credit score was 644. Documentation was provided showing a payment plan had been entered into in the amount of $20.00 to resolve the Capital One. These payments were on time and up to date. This amount due has been reduced to $1,892.53 as of the June 20, 2023. Staff does have a recommendation. While Ms. Quiroz has substantially progressed in lowering the amount due to Capital One Bank, Ms Quiroz's credit report is still below the 660 required by ordinance. It is recommended that the probationary period be extended for 12 months to August 16, 2024. At any time during this probationary period, Ms. Quiroz can submit documentation showing that her credit score has reached the required 660 and that the amount due to Capital One has been paid in full and there are no other credit issues, the probationary status would be automatically removed by staff. Failure to meet these requirements at the end of August 16, 2024 shall result in Ms. Quiroz being required to appear back before the Board to take further action as deemed necessary. ■ Matthew Nolton: I would adopt the county's recommendation for a motion. ■ Richard Joslin: I'll second. All in favor — aye. (Carried unanimously, 7-0.) (C) SIMON J. AGUIRRE — REVIEW OF EXPERIENCE — RESIDENTIAL CONTRACTOR - RED LEVEL CONSTRUCTION LLC ■ Timothy Crotts: Mr. Aguirre did not show up. The background was that Mr. Aguirre has appeared before the Board several times. One was due to experience and the credit score. While the credit score has been resolved, Mr. Aguirre was required to appear back today to submit to staff additional information regarding his experience. We have had no contact with Mr. Aguirre. Sandra Delgado, operations supervisor, has actually sent communications to him prior to this meeting requesting the different information. We have received nothing. Staff would recommend that the issuance of the residential contractor license be denied based on Mr. Aguirre experience. Notice was properly served. He was present at the last hearing, was sent a copy of the finding of facts and the notification prior stating that the Board hearing he was required to submit additional information with the e-mail communications. ■ Todd Allen: We have a recommendation from the county to deny the application. I'll make that motion. ■ Elle Hunt: Second All in favor — aye. (Carried unanimously, 7-0.) 10:47 AM — ten minute break. Record reflects Mr. Lantz has left; maintained quorum. 10. Public Hearings 14 Packet Pg. 18 August 16, 2023 4.A.1 (A) DANIEL FEIERTAG —CONTESTING CITATIONS 11927 (CEUL20230005328) & 11928 (CEUL20230005446) ■ Timothy Crotts: Mr. Feiertag is not here. We have spoken to Mr. Noell, Attorney for the Board, and Mr. Tomasko, Attorney for contractor licensing. Both agree that Victor Bermudas does have the authority to represent Mr. Feiertag and accept any decisions of the Board. Sworn testimony given to all parties. ■ Todd Allen: I'll make a motion to open the public hearing. ■ Terry Jerulle: Second. All in favor — aye. (Carried unanimously, 6-0.) ■ Timothy Broughton: A copy of the hearing preamble was given to and read by the attorney for the respondent, Mr. Daniel Feiertag . He has signed and dated the copy. would like to enter the preamble and packet for both citations into evidence at this time. ■ Todd Allen: Motion that we accept the county's evidence. ■ Richard Joslin: I'll make a motion. ■ Terry Jerulle: Second All in favor — aye. (Carried unanimously, 6-0.) ■ Todd Allen: If I'm not mistaken, Mr. Crotts, he's not contesting liability on this. So we'll make a motion to accept the admission of guilt. ■ Victor Bermudas: I represent Daniel Feiertag and FBC Home Concept LLC. For the record, Daniel Feiertag is an officer of a holding company that has the ownership of the LLC. Someone else was performing or cited under Feiertag's name. We are not contesting the two citations. ■ Todd Allen: I have a motion to accept the admission of guilt. ■ Richard Joslin: I second. All in favor — aye. (Carried unanimously, 6-0.) ■ Todd Allen: Mr. Crotts, do you have any recommendations on penalties? ■ Timothy Crofts: For a little background, I have spoken to both attorneys for Mr. Feiertag prior to this meeting today. They understand, along with Mr. Feiertag, the importance of having the required license, what happens and the penalties for working in Collier County without a license. Both attorneys have assured me that Mr. Feiertag is going to move forward with getting his license. These are subsequent citations. On Count one, the staff is going to recommend a $2,000 fine. On Count two, staff is also going to recommend a $2000 fine. That is the maximum allowed under the subsequent citations. No investigator cost. ■ Todd Allen: I'll make a motion to close the public hearing. ■ Terry Jerulle: Second. All in favor, aye. (Carried unanimously, 6-0.) ■ Victor Bermudas: Comments: 15 Packet Pg. 19 August 16, 2023 4.A.1 • The nature of these citations is more about the company that sells the material. Essentially the jobs are sent to contractors to do the work. They need to cut it off. • The materials have separate contracts so the customer is contracting directly with the contractors, almost like a concierge service, but essentially is it akin to subcontracting. • What I proposed to Mr. Crotts is twofold: (1) the company that sells the materials can then point the customer to contractors for installation. (2) There are three officers of this holding company and that each get licenses in Collier County but they will still be connecting them with contractors. There's no gray area. • The general manager is no longer with the company and I believe was the cause of many problems. • 1 ask the Board to reduce the fines to $400 each. ■ Todd Allen: Motion to vote. ■ Terry Jerulle: Motion to accept the county's recommendation. ■ Richard Joslin: I'll second the motion. All in favor — aye. (Carried unanimously, 6-0.) ■ Todd Allen: By a vote of six in favor and zero opposed, the respondent is found guilty of the violation set forth in Count one and Count two of the administrative complaint. The Board poses the following sanctions against the respondent for Count one the fine of $2,000 payable within 90 days. For Count two, a fine of $2,000 payable within 90 days. (B) NICHOLAS ANTHONY MAZZOLA DBA ABOVE & BEYOND PAINTING AND DECORATING L.L.C. (CEMIS20230005099) ■ Anthony Mazzola: Sworn testimony given. ■ Todd Allen: I'll make a motion to open the public hearing. ■ Elle Hunt: Second. All in favor — aye. (Carried unanimously, 6-0.) ■ Michael Bogert: A copy of the hearing preamble was given to you and read by the respondent. He has initialed and dated the copy. I would like to enter the preamble and packet for case 2023-15 into evidence at this time. ■ Todd Allen: Motion to approve the County's evidence. ■ Terry Jerulle: Second. All in favor — aye. (Carried unanimously, 6-0.) ■ Michael Bogert: The respondent, Nicholas Anthony Mazzola, a Collier County licensed painting and cabinetry contractor with issuance numbers 201100001275 and 201600000901 respectively, is the qualifier for and the owner of Above and Beyond Painting and Decorating LLC. Mr. Mazzola contracted, received payment and performed three pool gate installations at 5105 Cobble Creek Court without a permit, where one was required during a declared state of emergency related to Hurricane 16 Packet Pg. 20 August 16, 2023 4.A.1 Ian. Mr. Mazzola is in violation of the Collier County Code of Laws and Ordinances, Section 222012, which states in pertinent part that it is misconduct for a holder of a Collier County certificate of competency to contract to do any work outside the scope of his or her competency, as listed on his or her competency card, and as defined in this Ordinance or as restricted by the Contractors Licensing Board. Mr. Mazzola is also in violation of Collier County Code of Laws and Ordinances, Section 222018, which states in pertinent part that it is misconduct by a holder of a Collier County certificate of competency to proceed on any job without obtaining applicable permits or inspections from the city building and zoning division or the County Building Review and Permitting Department. ■ Anthony Mazzola: • Hired by Carlton Lakes HOA to paint the gates around the pool. Then we were asked to replace the three gates as well. • Discussion with Ryan Kipper, brother-in-law and part-time worker for Mazzola, decided to call the county and spoke with two individuals, Alicia Morris being one of them. He did explain we were painting contractors. • Alicia Morris said she didn't think so but spoke with Rob Moore at the county. An email was sent to Mr. Mazzola that you do not need a license to do like -for -like fence gates. • Believe to have been a miscommunication. We were notified that we did wrong. • Mr. Mazzola hired a licensed contractor, Premier Fence and Gate, paid them a deposit to pull the permit. The work will be completed by the end of next week. • We have always called the county to make sure we can do a job. I'm asking that you give a warning. • We didn't believe we were wrong because we had permission via e-mail. ■ Michael Bogert: On May 31, 2023, Collier County Code Enforcement reported an unpermitted pool gate installation at 5105 Cobble Creek Court, done by a county licensed contractor. The contractor's licensing case, CEMIS 20230005099, was opened on June 7 to investigate further. Upon investigation it was discovered on April 27, 2023 Above and Beyond Painting and Decorating LLC submitted an invoice to Edgewater at Carlton Lakes Commons Association to clean and paint all fencing and gates and to remove and replace 3 new pool fence gates with new hardware door openers and springs to auto close the gate. The agreed upon amount was $4,039 for that entire contract. The amount quoted on the contract for the gate removal and new gate installation was $2,189. There was an initial deposit of 2,019.50 it was paid on May 8 to Above and Beyond Painting and Decorating LLC. Previously on May 19 with the code enforcement case that was opened, Fred Clum, the Collier County chief building official, determined a permit was required for the pool gate installation. On June 7, when I opened up my case, I also went out and observed the new pool gate installations at the same address. On the same day I did a review of the county records and revealed that no building permits were applied for or even issued for the new pool gate installation. So I issued a stop work order. On June 28, 2023, during a phone call with the respondent, Mr. Mazzola, did confirm that Above and Beyond 17 Packet Pg. 21 August 16, 2023 4.A.1 Painting and Decorating, LLC had contracted with Edgewater at Carlton Lakes for the $2,189 to remove and install the three pool fence gates. He also did mention about the phone calls to the county and specifically with Alicia Morris. One of the things that I would just like to put into context, I do have Alicia Morris in the audience. You can speak to the context of the e-mail, but just a couple of points of interest. Before we get there is the invoice date is April 27 of this year. The install date was in the beginning of May prior to the complaint coming on May 12. There was that initial deposit on May 8. Code enforcement went out and confirmed the install on the 15th of May. The e-mail and conversations with Alicia Morris did not occur until May 22, so it's after the contract and after the installation. Robert Moore's response as well and Fred Clum, the chief building official, eventually had to put another final determination for the permitting as well. At this time, the county would call Alicia Morris up to talk about the context of the e-mail. ■ Alicia Morris: Sworn testimony given. ■ Alicia Morris: I work for the Collier County contractor licensing front staff. I received a phone call May 22 and the person whom I don't recall his name and unsure he said his name, but he did not state their company name. If they did I would have looked up to see what type of license they had to see if they can actually do the work. I did tell him to let me ask Robert Moore because the person did say that it was for residential. So Robert Moore is a residential reviewer. So that's why I had asked him if they were doing a like -for -like residential gate or fence, and if it needed a permit. Robert Moore wrote back and said no they do not. So I told the person on the phone what Robert Moore said. The person on the phone asked me to put that in writing. He gave me his e-mail. He did not state his company name because if he did, I would have been able to tell him you're a painting contractor, you cannot do a fence. ■ Todd Allen: My concern is that if you're giving somebody incorrect information or incomplete information, you're going to get an incomplete result. ■ Michael Bogert: I will reiterate again they were invoiced April 27. The install was the beginning of May prior to any complaint. And the documented conversations didn't happen until May 22 with that context. One final statement, the install by Above and Beyond, the gates were actually installed incorrectly and not to code. They swung in instead of out. There are some replacement gates as a part of the new contractor's job and permit. So there is financial harm to the HOA in the amount of that $2,189 because they had to get them all replaced again. ■ Timothy Crofts: Staff would like to make a closing argument in regards to count two, the permit issue. We feel that the county has proven beyond a reasonable doubt that the phone call made to Alicia Morris clearly stated that the question asked about the replacement of the gate was for residential only. There was no indication made that this was being done for an HOA or commercial. Ms. Morris deals with details every day with the information she was given, and knew she went to a residential plan reviewer to ask this question. Had it been known it was commercial, she would have gone to the commercial plan reviewers or the chief deputy. Based upon the 18 Packet Pg. 22 August 16, 2023 4.A.1 respondent's information today, this is hearsay on his behalf and we feel that we have proven beyond a reasonable doubt that Count one and Count two do exist. ■ Todd Allen: Motion to close the public hearing. ■ Richard Joslin: Second. All in favor — aye. (Carried unanimously, 6-0.) ■ Todd Allen: Now we have to consider whether or not he's guilty of the two Counts. Does anybody have any thoughts or motions they would like to make? ■ Matthew Nolton: I'll make a motion we find the respondent guilty on both Counts. ■ Richard Joslin: I'll second the motion. ■ Todd Allen: All in favor for guilt on Count one and Count two? All in favor — five. Elle Hunt — nay. (Disunited vote, 5-1.) ■ Timothy Crotts: On Count one, County is going to recommend a $1,000 fine to be paid within 60 days. Failure to pay the full amount of the fine within 60 days shall result in the automatic revocation of the respondent's license. That the respondent's license be placed on a 12 month probation period if no issues occur within the 12 month probation period, the probation shall be automatically removed by staff. On Count two, a $1,000 fine to be paid within 60 days. Failure to pay the full amount within 60 days will result in the automatic revocation of the respondent's license. A 12 month probation to run concurrently with Count one. If no issues occur within the 12 month probationary period, the probation shall be removed by staff and we would like to address the issue of restitution. Restitution is to be paid to the Edgewater at Carlton Lakes Commons Association in the amount of $2,189 to be paid within 30 days. Failure to pay the full amount within the 30 days shall result in the respondent's license being automatically revoked. ■ Terry Jerulle: Not in favor of restitution. ■ HOA Employee, Edgewater at Carlton Lakes Commons. Sworn testimony given. Further discussion ensued: • Hired to paint the fence not to replace the gates. • Above and Beyond offered to replace the gates due to it being easier than painting them. • The verbal original contract was for painting but then the gates were added. • There was a 50% deposit for the license gate company after the fact. The other 50% of the work has yet to be done. • No documentation from the HOA regarding the original agreement. • Mr. Mazzola and the HOA president, Pam, agreed to each pay half for the replacement of the new gates. ■ Terry Jerulle: I'd like to make a motion per Mr. Crotts' recommendation, the $1,000 and 60 days to pay it, along with the 12 month probation for both Counts, with no restitution. (Clarification, if the fine is not paid within 60 days, the license shall be automatically revoked.) ■ Todd Allen: Second. 19 Packet Pg. 23 August 16, 2023 4.A.1 All in favor — four. Elle Hunt and Matthew Nolton — nay. (Disunited vote, 4-2.) ■ Todd Allen: Upon consideration of all the testimony received under oath, evidence received and arguments presented by the parties during the public hearing, the Board issues the following findings and conclusions. Service of the administrative complaint and notice was sufficiently provided and in compliance with the applicable law. The respondent is the holder of the license as set forth in the administrative complaint, the respondent was present at the hearing and not represented by Council. The Board has jurisdiction over the respondent and subject matter raised in the administrative complaint. The respondent has committed the violations as set forth in Count one and Count two of the administrative complaint. Therefore, by a vote of four in favor and two opposed, the respondent is found guilty of the violations set forth in Count one and Count two of the administrative complaint and the Board imposes the following sanctions against the respondent for Count one: A fine of $1,000, payable within 60 days. If the fine is not paid within the 60 days, there will be a revocation of the license and there will be a 12 month probationary period; for Count two there will be a fine of $1,000 paid within 60 days. If it's not paid within the 60 days, there will be a revocation of the license and there will be a 12 month probation period; Count 2 to run concurrent with Count one, and I will note for the record that the penalties and sanctions were voted four in favor, two opposed. And this concludes the order of the Board on this matter. (C) 2023-16 VINORA D. WALLACE DBA WALLACE CUSTOM CABINETRY, LLC (CEMIS20230006190) ■ Vinora Wallace: Sworn testimony given to all parties. ■ Todd Allen: Motion to open the public hearing. ■ Terry Jerulle: Second All in favor — aye. ■ Michael Bogert: A copy of the hearing preamble was given to and read by the respondent. She has initialed and dated the copy. I would like to enter the preamble and packet for case #2023-16 into evidence at this time. ■ Todd Allen: Motion to admit the packet in evidence. ■ Richard Joslin: Motion to admit the evidence. ■ Matthew Nolton: Second All in favor — aye. ■ Michael Bogert: Vinora Wallace, Collier County licensed cabinetry contractor with issuance number 202000000618 is the qualifier for and one of the owners of Wallace Custom Cabinetry LLC. Ms. Wallace contracted, received payment and performed interior renovations that included electrical, plumbing, flooring and tiling at 148 Cypress Way E Unit 5 without a permit, where one was required during a declared state of emergency due to Hurricane Ian. Ms. Wallace is in violation of the Collier County Code of Laws and Ordinances and Section 222012, which states in pertinent part that it is misconduct for a holder of a Collier County certificate of competency to 20 Packet Pg. 24 August 16, 2023 4.A.1 contract to do any work outside the scope of his or her competency, as listed on his or her competency card, and as defined in this ordinance or as restricted by the contractors licensing board. Ms. Wallace is also in violation of Collier County Code of laws and ordinances Section 222118, which states in pertinent part that it is misconduct by a holder of a Collier County certificate of competency to proceed on any job without obtaining applicable permits or inspections from the city building and zoning division or the county building review and permitting. ■ Vinora Wallace: I am guilty and I accept responsibility. ■ Todd Allen: Makes motion to accept Ms. Wallace's finding of guilt as to Count one and Count two. ■ Richard Joslin: Second the motion. All in favor — aye. ■ Todd Allen: Made motion to close the public hearing. ■ Elle Hunt: Second. All in favor — aye. ■ Timothy Crotts: On Count one, staff is going to recommend a $3,000 fine to be paid within 60 days. Failure to pay within 60 days will result in the automatic revocation of the license, that the license be placed on a 12 month probationary period. In regards to Count two, a $1,000 fine to be paid within 60 days. Failure to pay the fine within 60 days would result in the automatic revocation of said license. Twelve months probation to run concurrent with Count one. And Count one is based on the number of trades that were worked outside the scope of their current license. No restitution. ■ Discussion: • No prior violations. • Project is near completion and a general contractor has been hired and permitted to fix minor work and get it inspected. • Pool safety is a life safety issue with more people drowning in Florida. That was a $1,000 fine and this is three. At least there were gates. • Norris Wallace, husband, speaks on Mrs. Wallace behalf. We've learned from our mistake. ■ Todd Allen: I'm going to make a motion. I want to explain why I'm making it first, so I'm going to make a motion that we levy a $1,000 fine for Count one, 60 days to pay. If it's not paid within the 60 days the license will be revoked and there will be a 12 month probation. Count two will be a $1,000 fine payable within 60 days. If it's not paid within the 60 days the license will be revoked and a 12 month probation to run concurrent with Count one. I see this differently as from the last case. The last case, he entered into an agreement to split the costs with the homeowner and in this case, they're telling us they're bearing the burden of fixing their mistake. That's admirable to me, and I don't think we need to make it worse. I think they learned the lesson. So that's why I'm making that motion. ■ Elle Hunt: I'll second. ■ Terry Jerulle: I like the fact that they admit wrongdoing. I like the fact that they've already hired somebody and put in for a permit. 21 Packet Pg. 25 August 16, 2023 4.A.1 All in favor — aye. (Carried unanimously, 6-0. ■ Todd Allen: Upon consideration of all the testimony received under oath, evidence received and arguments presented by the parties during the public hearing, the Board issues the following findings and conclusions. Service of the administrative complaint notice was sufficiently provided and in compliance with the applicable law. The respondent is the holder of the license as set forth in the administrative complaint, the respondent was present at the hearing and not represented by Council. The Board has jurisdiction over the respondent and subject matter raised in the administrative complaint. The respondent committed the violations that set forth in Count one and Count two of the administrative complaint. Therefore, by a vote of 6 in favor and zero opposed, the respondent is found guilty of the violations as set forth in Count one and Count two of the administrative complaint and the Board imposes the following sanctions against the respondent. For Count one, there will be a fine of $1,000 paid within 60 days. If the fine is not paid within the 60 days, the license will be revoked and there will be a 12 month probationary period on the license. For Count 2, there will be a another $1,000 fine with a 60 day probation, 60 days to pay the fine and if the fine is not paid the license will automatically be revoked and there will be a 12 month probationary period to run concurrent with Count one. Discussion: Timothy Crofts: This is Kevin Noell's last meeting as the attorney for the Contractors Licensing Board. Patrick Neal will be taking his place starting with the September 20 meeting. Ronald Tomasco as the assistant county attorney and he will be taking the place of Colleen Kerins. 11. Next Meeting Date September 20, 2023 ■ Todd Allen: Motion to adjourn. All in favor — aye. There being no further business for the good of the County, the meeting was adjourned at 12:07 PM. Collier County Contractor Licensing Board Todd Allen, Chairman These minutes were approved by the Chairman of the Contractor Licensing Board on , (check one) as submitted or as amended 22 Packet Pg. 26 4.B 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 4.13 Doc ID: 26629 Item Summary: 4B APPROVAL OF MINUTES - AUGUST 29, 2023 Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Sandra Delgado 09/13/2023 1:11 PM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 1:11 PM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Tim Crotts Review Item Meeting Pending Completed 09/13/2023 2:41 PM Completed 09/13/2023 5:00 PM 09/20/2023 9:00 AM Packet Pg. 27 August 29, 2023 4.B.1 MINUTES OF THE COLLIER COUNTY CONTRACTOR LICENSING BOARD SPECIAL EMERGENCY MEETING August 29, 2023 LET IT BE REMEMBERED that the Collier County Contractor Licensing Board, having conducted business herein, met on this date at 4 p.m. in SPECIAL SESSION at the Collier County Growth Management Department Building, Conference Room #609/610, 2800 Horseshoe Drive North, Naples, Florida, with the following members present: Chairman: Todd Allen Kyle Lantz Terry Jerulle Matthew Nolton Richard Joslin Robert Meister ALSO PRESENT: Patrick Neale Ronald Tomasko Timothy Crotts Sandra Delgado 1. Roll Call Elle Hunt, excused absence Stephen Jaron, excused absence 2. Additions or Deletions None. 3. Approval of Agenda: ■ Richard Joslin: Motion to approve as changed. ■ Terry Jerulle: Second. All in favor — aye. (Motion passed unanimously, 6-0.) 4. Approval of Minutes None. Packet Pg. 28 August 29, 2023 4.B.1 5. Public Comments None. 6. Discussion None. 7. Reports None. 8. New Business (A) Emergency Certificates of Competency ■ Timothy Crotts: The Board of County Commissioners declared a local state of emergency due to Tropical Storm Hurricane Idalia and its possible effects to Collier County. Under Collier County Ordinance 2006-46 Section 2.11 emergency restricted certificate of competency under Section 2.11.1 declare an emergency contracting trade shortage as designated categories of contractors and and/or subcontractors listed in our ordinance. This declaration shall be for a period not to exceed six months. Under Subsection 2.11.2 authorize the contractors licensing supervisor to prepare and regulate the selection of contractors and/or subcontractors from other jurisdictions whose licensing requirements are substantially comparable to those licensed in Collier County and to issue temporary licenses to those contractors for a period of time not to exceed the declaration of emergency. The contractors selected must be licensed and jurisdictions whose testing and licensing requirements have been predetermined by the Contractor Licensing Board to be substantial and comparable to the Collier County requirements. Recommendation of Staff is to authorize the contractor licensing supervisor the authority to issue emergency certificates of competency for those trades deemed warranted by the contractor licensing supervisor due to the after-effects of Tropical Storm Hurricane Idalia for a period of 60 days not to exceed six months and not to exceed the declaration of the local state of emergency of Collier County, Board of County Commissioners and with the City of Naples. A review of the emergency license warranted by the licensing supervisor will be reviewed at the next scheduled Contractor Licensing Board meeting on September 20, 2023. ■ Todd Allen: Do I have a motion to approve the emergency certificates of competency. ■ Kyle Lantz: So move. ■ Richard Joslin: Second. ■ Timothy Crofts: Before the determination of the licenses that will be selected by the emergency issuances, Staff will work in conjunction with the Collier County City of Naples, City of Marco and the City of Everglades building departments to determine what trades will best assist the homeowners and business owners in repairing the 2 Packet Pg. 29 August 29, 2023 4.B.1 damage to be determined as part of the county's crisis track and other reporting systems of our municipalities. If it is determined that no emergency licenses will need to be issued, then Staff will take no actions and the authorization can be revoked at the next scheduled Contractor Licensing Board meeting on September 20, 2023. Further discussion ensued regarding: • The motion is 60 days set by ordinance. If we do not need to issue any licenses, at the September 20, 2023 meeting we can revoke the motion. • If the County does not renew the state of emergency then this order will be null and void. ■ Todd Allen: Call for a vote. All those in favor — aye. (Carried unanimously, 6-0.) 9. Old Business None. 10. Public Hearings None. 11. Next Meeting Date September 20, 2023 at our regular scheduled time. ■ Todd Allen: Can I have a motion to adjourn. ■ Richard Joslin: Motion to adjourn. ■ Todd Allen: Motion All in favor — aye. (Carried unanimously, 6-0.) There being no further business for the good of the County, the meeting was adjourned at 4:05 PM. Collier County Contractor Licensing Board Todd Allen, Chairman These minutes were approved by the Chairman of the Contractor Licensing Board on , (check one) as submitted or as amended 3 Packet Pg. 30 6.A 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 6.A Doc ID: 26635 Item Summary: 6A INTRODUCTION OF ATTORNEY TO CLB, PATRICK NEALE Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Sandra Delgado 09/13/2023 2:51 PM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 2:51 PM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Tim Crotts Review Item Meeting Pending Completed 09/13/2023 2:51 PM Completed 09/13/2023 5:00 PM 09/20/2023 9:00 AM Packet Pg. 31 8.A 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.A Doc ID: 26612 Item Summary: 8A. ORDERS OF THE BOARD (6 ITEMS) Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:25 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:25 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 1:58 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:00 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 32 8.A.1 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY Hernandez, Edgar Luis Antonio 2831 Holly Ave Naples, FL 34112 .. a - . - 11 Pursuant to Section 489.127, Florida Statutes, Operations and Regulatory Management Department/Licensing Section issued Citation No. 12634 CEUL20230005564 on 06/30/23, to Hernandez, Edgar Luis Antonio, in the amount of $1,000.00, within 10 days of issuance of the Citation, THE PENALTY HAS NOT BEEN PAID. Per Section 489.127(5) (g), Florida Statutes, the violator is hereby ORDERED to pay that penalty in full within 15 days from the date of mailing a copy of the ORDER to the violator's address as noted on the Citation. If the penalty is not paid in full within 15* days, this ORDER may be recorded in the public records of Collier County and thereafter shall constitute a lien against any real or personal property owned by the violator. After 3 months from the filing of any such lien which remains unpaid, the Contractor Licensing Board may authorize the County Attorney to foreclose on the lien. DATE: �C);3 CHAIRMAN TODD ALLEN Print Name Attorney to the CLB PATRICK NEALE Code Enforcement Manager TIMOTHY CROTTS For Contractor Licensing Board * If the 15th day falls on a Saturday Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. Approved as to form and legal sufficiency Packet Pg. 33 8.A.1 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY Hernandez, Edgar Luis Antonio 2831 Holly Ave Naples, FL 34112 CLB Agenda Date: September 20. 2023 Pursuant to Section 489.127, Florida Statutes, Operations and Regulatory Management Department/Licensing Section issued Citation No. 12636 CEUL20230005504 on 06/30/23, to Hernandez, Edgar Luis Antonio, in the amount of $1,000.00, within 10 days of issuance of the Citation, THE PENALTY HAS NOT BEEN PAID. Per Section 489.127(5) (g), Florida Statutes, the violator is hereby ORDERED to pay that penalty in full within 15 days from the date of mailing a copy of the ORDER to the violators address as noted on the Citation. If the penalty is not paid in full within 15* days, this ORDER may be recorded in the public records of Collier County and thereafter shall constitute a lien against any real or personal property owned by the violator. After 3 months from the filing of any such lien which remains unpaid, the Contractor Licensing Board may authorize the County Attorney to foreclose on the lien. DATE: CHAIRMAN TODD ALLEN Print Name Attorney to the CLB PATRICK NEALE Code Enforcement Manager TIMOTHY CROTTS For Contractor Licensing Board * If the 15th day falls on a Saturday, Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. Approved as to form and legal sufficiency Packet Pg. 34 8.A.1 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY Feiertag, Daniel 14361 N. Cleveland Ave North Fort Myers, FL 33903 CLB Agenda Date: September 20, 2023 Pursuant to Section 489.127, Florida Statutes, Operations and Regulatory Management Department/Licensing Section issued Citation No. 12740 CECV20230005463 on 06/21/23, to Feiertag, Daniel, in the amount of $2,000.00, within 10 days of issuance of the Citation, THE PENALTY HAS NOT BEEN PAID. Per Section 489.127(5) (g), Florida Statutes, the violator is hereby ORDERED to pay that penalty in full within 15 days from the date of mailing a copy of the ORDER to the violator's address as noted on the Citation. If the penalty is not paid in full within 15* days, this ORDER may be recorded in the public records of Collier County and thereafter shall constitute a lien against any real or personal property owned by the violator. After 3 months from the filing of any such lien which remains unpaid, the Contractor Licensing Board may authorize the County Attorney to foreclose on the lien. CHAIRMAN TODD ALLEN Print Name Attorney to the CLB PATRICK NEALE DATE: Code Enforcement Manager TIMOTHY CROTTS For Contractor Licensing Board * If the 15th day falls on a Saturdays Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. Approved as to form and legal sufficiency a co Packet Pg. 35 8.A.1 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY Jose Saez 1870 51 st Terr SW FL CLB Agenda Date: September 20, 2023 Pursuant to Section 489.127, Florida Statutes, Operations and Regulatory Management Department/Licensing Section issued Citation No. 12724 CEUL20230006187 on 07/17/23 to Jose Saez in the amount of 1 000.00, within 10 days of issuance of the Citation, THE PENALTY HAS NOT BEEN PAID. Per Section 489.127(5) (g), Florida Statutes, the violator is hereby ORDERED to pay that penalty in full within 15 days from the date of mailing a copy of the ORDER to the violator's address as noted on the Citation. If the penalty is not paid in full within 15* days, this ORDER may be recorded in the public records of Collier County and thereafter shall constitute a lien against any real or personal property owned by the violator. After 3 months from the filing of any such lien which remains unpaid, the Contractor Licensing Board may authorize the County Attorney to foreclose on the lien. CHAIRMAN TQDD ALLEN Print Name Attorney to the CLB PATRICK NEALE " DATE: I Code Enforcement Manager TIMOTHY CROTTS For Contractor Licensing Board * If the 15th day falls on a Saturday, Sunday or holiday, the entire fine must be paid no later than 4,00 P.M. on the County s next business day following that weekend or holiday. Approved as to form and legal sufficiency a co Packet Pg. 36 8.A.1 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY LIOR 1FRAH 5130 SW 40TH AVE FORT LAUDERDALE, FL 33314 CLB Agenda Date: September 20. 2023 Pursuant to Section 489.127, Florida Statutes, Operations and Regulatory Management Department/Licensing Section issued Citation No. 12742 CEUL20230006002 on 07111123, to_LIOR IFRAH, in the amount of $2,000.00, within 10 days of issuance of the Citation, THE PENALTY HAS NOT BEEN PAID. Per Section 489.127(5) (g), Florida Statutes, the violator is hereby ORDERED to pay that penalty in full within 15 days from the date of mailing a copy of the ORDER to the violator's address as noted on the Citation. If the penalty is not paid in full within 15* days, this ORDER may be recorded in the public records of Collier County and thereafter shall constitute a lien against any real or personal property owned by the violator. After 3 months from the filing of any such lien which remains unpaid, the Contractor Licensing Board may authorize the County Attorney to foreclose on the lien. CHAIRMAN TODD ALLEN Print Name Attorney to the CLB PATRICK NEALE DATE: q -,2 b v 3 Code Enforcement Manager TIMOTHY CROTTS For Contractor Licensing Board * If the 15th day falls on a Saturday, Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. Approved as to form and legal sufficiency a co Packet Pg. 37 8.A.1 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY Ifrah, Lior 3331 Farragut St. Apt. F Hollywood, FL 33021 CLB Agenda Date: September 20, 2023 Pursuant to Section 489.127, Florida Statutes, Operations and Regulatory Management Department/Licensing Section issued Citation No. CEFRD20230005664 on 07114/23, to Ifrah Lior, in the amount of 2 000.00, within 10 days of issuance of the Citation, THE PENALTY HAS NOT BEEN PAID. Per Section 489.127(5) (g), Florida Statutes, the violator is hereby ORDERED to pay that penalty in full within 15 days from the date of mailing a copy of the ORDER to the violator's address as noted on the Citation. If the penalty is not paid in full within 15* days, this ORDER may be recorded in the public records of Collier County and thereafter shall constitute a lien against any real or personal property owned by the violator. After 3 months from the fling of any such lien which remains unpaid, the Contractor Licensing Board may authorize the County Attorney to foreclose on the lien. CHAIRMAN TODD ALLEN _ Print Name Attorney to the CLB PATRICK NEALE DATE. Code Enforcement Manager TIMOTHY CROTTS For Contractor Licensing Board * If the 15th day falls on a Saturday, Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. Approved as to form and legal sufficiency Packet Pg. 38 8.B 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.13 Doc ID: 26613 Item Summary: 8B. HUNTER K. JONES — REVIEW OF EXPERIENCE - RESIDENTIAL CONTRACTOR - SWFL STRUCTURAL INC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:27 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:27 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:10 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:00 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 39 Comer County =s 8.B.1 Growth Management 20-11- 2 201 Community Development Department L C-C Z 0 2 3- APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY This application trust 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 E�i'6esidential $230.00 ❑ Air Conditioner $230.00 ❑ Mechanical $230,00 ❑ Swimming Pool $230.00 ❑ Roofing $230,00 ❑ Specialty $205.00 Specialty Trade: I. APPLICANT PERSONAL INFORMATION: Name: First Middle Initial Last Business Name: _ SWVL— SA' cU JnN\ 1 irkc Address: 214 V t6ts., SN-- S w �V tf es (� 3411 la - - Street city State Zip Email: &nkr %LA F1 S+-roc.jg &gl , Coon G ' �082- Telephone: �ZU 13 *SS # (Last 4 digits only): 3 Date of Birth: 0N/ 1 7 Driver's t_icense # (Last4 digits only): 137'0 Pursuant to Collier County Contractor Licensing Ordinance No. 2006A6 Section 2.1.1., all applicants are required to submit their social security number, drivers license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized bylaw. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. m 00 ch r W to Contractor Licensing - FIRM Application Rev. 712022 Page 3 of 14 Operations & Regulatory Management Division, Contractor Licensing w 2800 North Horseshoe Drive • Naples, FL 34104 • (23 252-2431 contractofslicensina o)coliiercoun!yn.flov Packet Pg. 40 8.B.1 m tp c� r t0 to N 1.6.1.3. Residential Cofttmctor requires (arty -eight (48) months experience with a Passing grade on die a ved test and a business and law test and =4ns a contractor whose se-r-ACfs are lirnited to consft ction, re]]xo irks, repair, or improvement of ene-family, two�-farniiy, ()r three.fanjily resi noes not exceeding two stories ill height and accessary use strxtctur in connection therewith_ Packet Pg. 41 8.B.1 C0�7er County Growth Management Community Development Department m 00 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY r t0 N Provide the names and telephone numbers of two persons who will always know your whereabouts. U Z Name:.aileCr% loae Name: J+J%1e Leer a Telephone: 7-3 `�'�al - �SC:c. p �. Zt 4 y Telephone: Z i ' (v `�'�•" � to II. NAME OF APPLICANT'S BUSINESS: Business Name: W FL S+fV CA1 Me- C co Business Address: 3JgT 150-W', NQp<<S & 3,4446 Street City State Zip Telephone:. _ r {o SSZ,-%TS 3 Email: +r rer' S.J FL Stv0C+QC4 l . Ce V-% Federal ID Tax No.: lZ OZ 4 Z79 III. FINANCIAL RESPONSIBILITY YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: Filed for or been discharged in bankruptcy within the past 5 years? Had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? Undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? Been convicted or found guilty of, or entered a plea of polo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years?* _7 Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? J Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment.*If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — FIRM Application Rev. 712022 Page 4 of 14 Operations & Regulatory Management Division, Contractor Licensing e 2800 North Horseshoe Drive . Naples, FL 34104 . (239) 9r contractorslicensinp cDcolliercountyfl.goy Packet Pg. 42 8.B.1 SWFLSTRUCTURAL m 3148 50TH ST SW Naples, FL 34116 00 239-682-7083 r RR282812250 N To Collier County Contractor Licensing, To Whom it May concern, I was fined by Collier County Contractor licensing (2) times. The first time was back in 2021 for not working with a license on a small residential home. But that was abated from $1000.00 to $300.00 after submitting a firm application. The second time was for advertisement and not having a permit for the job. I'm still not convinced that I did unlicensed contracting there so I haven't paid it yet and this was back in May 2023. As I worked for a company (SWFL Plastering Inc) we had a contract with the homeowner to do the work under SWFL Plastering Inc. But then we couldn't get the permit so SWFL Plastering and a friend that is a licensed General Contractor decided to take over the project and so we did a change in contractor, and because we had a complaint from the president of the association. I was fined by the county. So for the advertisement I am licensed in Broward county and I had a company design me a website and because my address is in Collier County (Google) verifies it in Collier County all the way to Broward county and the code enforcement found it and saw it to fine me. 08/08/2023 Packet Pg. 43 View blaster Proiect .................................................... I................ Case Information View All Activities on this Case Add new person or business to Address AA ..................... New Case (current project) New Case (no project) Case Number CEUL20230004520 Status .Citation i Case Type RUnlicensed �] Date & Time Entered 05/17/2023 06:10 Phi Priorityf Normal v l Entered B ,Timothy Broughton *� Inspector (Timothy Broughton v ( Department IContractors Licensing .f Jurisdiction !Collier County Property Valuation $134,188.00 Origin Tield Observation Detailed ' Unlicensed Advertising Jones, Hunter K. - Citation-*11913, $2000.00, 2nd Violation, Owner of Description Hooks Construction LLC i ' Location 7300 Glenmoor lane Unit 203 I Comments 1 I I Alleged Violation Date/Time 105/1612023 01:45 Phi Emergency Order Complaint Date/Time 05/17/2023 06:10PM Specialist Investigation Not Required Site Development Contractor Licensing Attributes State Certified? ❑ Issuance Number I Status Tracking Show More Fields v Commissioner District 4 PUD Name BERKSHIRE LAKES v Case Disposition Unpaid Property Zone JPUD State Registered? ❑ Show More Fields m 00 A Packet Pg. 44 View Master Proiect Case Information View All Activities on this Case Add new person or business to Address 8.B.1 New case (current project) I NeW Case (no project)) Case Number CEUL20230004333 Status (Citation v I Case Type Unlicensed _ d Date & Time Entered 05/12/2023 10:40 Aryl Priority (Normal v Entered By Timothy Broughton v Inspector Timothy Broughton _- vJ Department Contractors Licensing v JurisdictionCollier County v Property Valuation $134,188.00 Origin iComplaint v l Detailed Unlicensed General Contracting - 3ones, Hunter K. - Citation #11941, $2000.00, 2nd Violation, Description Owner of Hooks Construction LLC Location Commeentss 7300 Glenmoor Lane Unit 203 Show More Fields l Alleged Violation Date/Time 05/11/2023 03:50 PM y Commissioner District z 4 Emergency Order I PUD Name BERKSHIRE LAKES Complaint Date/Time 05/12/2023 10:40ANI v Case Disposition Unpaid Specialist Investigation Not Required Property Zone PUD Site Development Contractor Licensing Attributes State Certified? Q State Registered? ❑ Issuance Number 202300001358 Status Tracking Status Type date Entered Eantered Motes 'New 05/12/2023 :Timothy Broughton ... ..... PreliminaryReview .:................. . 05J12/2023 _............. Timo.......:...........,.............................;.................,................,...................................................................,............................:.:.:...:.:.:....,..:.:...: thy Broughton ........... Investi....ation.... ... -..............................05/12/2023............... g .. ... :............................................................... Timot...,....,...............,......................i............................................................................................................................................................... by Broughton _....,..................................................... Pre liminaryReview `•.05/16/2023 ,...,....;.,....,...,....................... ';Timothy Broughton r ..................... ,.................................................... ................................................... ..Citation . .. ................1...05116/2023.............,..............7lirin.........................................,........,.............,...,.............,..........................,...,...........,.......,..................,....................................................... thy Broughton Show More Fields m rb c� W to A Packet Pg. 45 View Master- Proiect ViewAllActivities on this Case Add new person or business to Address 8.B.1 Case Information A INew Case (current project) New Case (no project) Case Number CECV20230004519 Status Closed v m Case Type Code Violation v Date & Time Entered 05/17/2023 05:58 PM rb Priority Normal v Entered By Timothy Broughton v M Inspector ITimothy Broughton Department lContractors Licensing v� 3urisdiction _ Collier County _ Property Valuation $134,188.00 - V Z Origin Complaint J Detailed Commence Interior Renovation (Kitchen + Bathrooms) Prior to an Issued Permit - 3ones, Hunter � V Description K. - Citation #11942, $1000.00, 1st Violation, Owner of Hooks Construction LLC � F- Location Comments 7300 Glenmoor Lane Unit 203 -J LL v Alleged Violation Date/Time 05/16/2023 01:45 PM Emergency Order Complaint Date/Time 05/17/2023 05:58 PM Specialist Investigation Not Required Site Development Contractor Licerisiiig Attributes State Certified? ❑ Issuance Number Status Tracking Status Type New .................................................. Preliminary Review .. I ............................................. Citation ................. Closed Date Entered Show htore Fields Y CommissionerDistrict-# 4 PUD Flame BERKSHIRE LAKES v Case Disposition Paid �. Property Zone PUD �J Entered By Timothy Broughton ..................:............................ Timothy Broughton ................................................... .. Timothy Broughton ....................................... Deidr•a De La Cruz State Registered? ❑ PAID Show More Fields n Packet Pg. 46 View rlaster Protect View All Activities on this Case Add new person or business to Address 8.B.1 Case Information New Case (current project) I I New Case (no project) Case Number ICEUL20220001731 Status Closed • m Case Type I Unlicensed *. Date & Time Entered 02/16/2022 03:43 PM 00 Priority (Normal Entered By (Michael Bogert v I Inspector I—.......__� 'Michael Bogert v Department Contractors Licensing N .. I ... krisdiction _ !Collier County Property Valuation 1$120,468.00 U ? Origin v Complaint y-{ J Detailed ! CITATION 11790, UNLICENSED GENERAL CONTRACTING, $1000.00 - 1ST OFFENSE, issued to H Description ]ONES, HUNTER KULLEN, dba ]ONES GENERAL SERVICES, INC., working at 812 100th Ave N., Naples, FL 34108. Location Comments 812 100TH AVE N F- U) -J LL NAPLES, FL 34108 P# 627815601DB Show More Fields I O Alleged Violation date/Time 02/16/2022 03;45 PM v Emergency Order! A Case Disposition (Paid Property Zone RMF-6 Calttractor Licenshig Attributes State Certified? ❑ Issuance Number Status Tracking Commissioner District * 12 Complaint Date/Time 02/16/2022 03;43PM v Specialist Investigation Not Required Site Development State Registered? ❑ Show More Fields A Packet Pg. 47 8.B.1 Findings of Fact, Conclusions of Law and Decision of the Board 00 Collier County Contractor Licensing Board For Applications Submitted to the Board for Review N Type of Application: Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity X Other (specify) Review of Experience THIS CAUSE came on for public hearing before the Contractor Licensing Board (hereafter Board) on April 20, 2022, for consideration of the application for issuance of a Certificate of Competency for licensure as a General Contractor. The Board having heard testimony under oath, received evidence, and heard arguments relative to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law and Order of the Board as follows: FINDINGS OF FACT 1. That Hunter K. Jones DBA Hooks Construction, LLC (hereinafter "Applicant"), has applied to the Collier County Contractor Licensing Supervisor or his designee for licensure as a General Contractor. 2. That pursuant to Section 22-184(b) of the Code of Laws and Ordinances of Collier County, Florida, applications which do not appear on their face to be sufficient require referral to the Board for a decision regarding approval or denial of said Y o: w application. z x m 00 E r a Packet Pg. 48 8.B.1 3. That the pertinent requirements for licensure as a General Contractor are set forth in Section 22-162 of the Code of Laws and Ordinances of Collier County, as N amended. 4. That the Applicant was present at the public hearing and was not represented by counsel. 5. That the Applicant has not demonstrated through testimony and evidence presented at this hearing that the Applicant has the required experience to be issued a license as a General Contractor. CONCLUSIONS OF LAW 1. All notices required by the Code of Laws and Ordinances of Collier County, Florida, have been properly issued and the Board has jurisdiction over the matter. 2. The Applicant has not met the standards set out in the Code of Laws and Ordinances of Collier County, Florida, to be issued a General Contractor license. ORDER OF THE BOARD 1. Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the applicable authority granted in Chapter 489, Florida Statutes, and Section 22-184(b) of the Code of Laws and Ordinances of Collier County, Florida, by a vote of 6 in favor and 0 opposed, a unanimous vote of the Board present, the Applicant's request for this Board to issue him a General Contractor license is denied due to lack of relevant and sufficient work experience. 2022. ORDERED by the Contractor Licensing Board effective the 20th day of April CONTRACTOR LICENSING BOARD COLLIER COUNTY, FLORIDA 2 Packet Pg. 49 8.B.1 r m 00 � M r By: Kyle Lantz, Chairman N I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Timothy Crotts, Licensing Compliance Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this 29 -� day of 1 2022, Secretary/Contractor's Licensing Board 3 Packet Pg. 50 8.B.1 April 20, 2022 m 00 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING April 20, 2022 Naples, Florida LET IT BE REMEMBERED that the Collier County Contractors Licensing Board. having conducted business herein, met on this date at 9:00 a.m. in REGULAR SESSION in Administrative Building F. Yd Floor, Collier County Government Center, Naples, Florida, with the following members present: Chair: Kyle Lantz Vice Chairman: Terry Jerulle Matthew Nolton Richard E. Joslin (absent) Patrick G. White (excused) Todd Allen (excused) Robert Meister III Elle Hunt Stephen Jaron ALSO PRESENT: Kevin Noell, Esq., Contractor Licensing Board Attorney Timothy Crotts, Contractor Licensing Supervisor Colleen Kerins, Assistant Collier County Attorney M to t0 N Packet Pg. 51 8.B.1 April 20, 2022 m 00 Mr. Crotts said at the last meeting, the issue came tip about somebody having a name of a company that may mislead the public into believing they have a license other than what was to approved. There's nothing in our Ordinance that addresses that, so lie reached out to DBPR to N find out if there was anything in the State Statute under their authority that does. At first glance, z they cannot find anything that would prohibit somebody from naming a company for a license — they don't hold. However, DBPR is doing deeper research and he expects an answer by the next meeting. 8. REPORTS: None 9. NEW BESINESS: A. ORDERS OF THE BOARD Vice Chairman Jerrrlle made a motion to have the Chairman sign the Orders of the Board Board Alember 1Volton seconded the rrrotion. The motion lvas carried unanitrrously, 5-0. The Orders of the Board ivere approved. B. Hunter K. Jones — Review of Experience — General Contractor Registered Hooks Construction LLC Chairman Lantz called Mr. Jones to the podium and he ivas sworn in. Mr. Crotts reported that jUr. Jones has .submitted an application for the trade of General Contractor, a license that requires 48 months of experience. As part of the surf -'reviety process, Mr. Jones submitted required Verffications of Experience. • H2 Technologies, They reported that he teas employed there ftorn 2015 to 2019. This company is a licensed litnited-enemy contractor, iMich means they deal in lots voltage only. Mr. Jones ivas an assistant to the apprentice and assisted in running ]fire through co nrnercial buildings. He ryas not an employee at that tune due to his age. • Elias Bros. Group General Contracth—Jttite 2020 to Februiaiy 2021, eight »uonths. Tl?e director of operations confrrined he worked as an assistant supervisor overseeing eniployees and had some hands-on experience. • Double G Construction -- Janirary 2021 through July 2021, six months. A qualifier of'the company confirmed that Afr. Jones assisted in the performance ofroofrepairs and replacements. • Masse Groi(p Construction --July 2021 to August 2021, one inonth. YVe weren't able to contact anybodyfi•orn this company. • Mcflooring Tile & Marble Desi ns — December 20, 2021, to 11arch 2022, three months. IVe ll,ere unable to contact anybody fi-oin the company to determine the scope of lvork. Based upon the experience allowed and the Verification of Experience, it appears that Mr. Jones does not have the required time or experience.for the license. Therefore, Mr. Jones has been referred to the Board under County Ordinance 2006-46, Section 2.5.2, Referral of the Application to the Contractors ' 1,icensing Board for a Decision. Mr. Jones is here ro ansit,er your questions. Packet Pg. 52 8.B.1 April 20, 2022 m CO [Board Member hleisler joined the meeting at 9: 09 a.m.] to Chairman Lantz asked if he could tell them about his experience. 'It's hard to get four years of �° experience when you're not allowed to legally work in the construction trade until you're 18 and v you're only 21. So, do you want to give us a little information? i Mr. Jones said his parents had their own aluminum company and did pool cages and things like that. He worked with them when he was younger. H2 Technologies was his first job when he turned 18 and he left. He also was working for the owner, not being paid and doing commercial work. Then he started doing cabinets. He did cabinets for a hotel in Puerto Rico, for a general contractor down here. After that, he started doing roofing, learning how the roofing trade works and became a supervisor and started learning how to pay employees and how to run 80-person jobs on huge high-rise buildings. After that, he went to Double G Construction to expand his knowledge and do the same thing he was doing before at Elias Brothers. Then he went to Curran Young for three years in commercial work doing high rises. He just finished building a bank for them on November 28, his last day. Chairman Lantz asked if it was three years or three months. Mr. Jones said it was three months. Since then, for four years and three months, he wasn't the full-time superintendent, but was there to punch out the job. Also in Cape Coral, he did a high-rise building for Curran Young for two months and learned how columns and decks were built when they were going vertical with that building. Since then, he started doing his own thing and was charged with unlicensed contracting. He did some work for someone, remodeled her house and had some altercations with her and she reported him to get him fined. Since then, he's been selling tile for a flooring company, getting jobs for them, residential and commercial. He knows a lot of big general contractors here that build a lot and he's best friends with most of them. Board Member Hunt asked what the problem was that the homeowner had with him. Mr. Jones said it had to do with payments. Board Member Hunt asked if he did an excellent job and she refused to pay. Mr. Jones said he didn't want to speak badly about someone, but said she was not someone they'd want to deal with. Board Member Hunt asked if the homeowner thought he'd done an acceptable job. Mr. Jones said yes, she told him he'd done a really good job. But then she turns around and tells someone something else. He offered to show them texts of her saying she loved the work. She's a two-faced person. Board Member Hunt asked Mr. Crotts if there was anything more about the citation in this package. Packet Pg. 53 8.B.1 April 20, 2022 m CO M Mr. Crotts said it was for unlicensed work as a general contractor for the work that he was doing to at that residence. N Board Member Hunt asked if she'd complained about the quality of the work. Mr. Crotts said they weren't here for that issue today. Mr. Jones did not have a license for the trade he was conducting. Mr. Jones noted that he was reading that under Section 22-183 for Experience Requirements, college could be substituted for a portion of experience. It says education and accredited collegefaccredited school may be presented as a certified portion of experience requirements in this section. Specifically, each full year of school -level work in the trade for which the application is made shall be credited to the applicant at 0.75 years of experience, but such credit shall be no more than one-half the total experience required by this section. He said he graduated from college with degrees in construction, architectural design and construction technology. Chairman Lantz asked if he had a two-year associate degree. Mr. Jones said lie worked oil two two-year degrees at the same time. They all had the same classes. He may have spent another month for the other degree. Board Member Nolton asked if his classes were during the day. Mr. Jones said he worked during the day and went to college from 6-8 or 9 p.m. Chairman Lantz said, so you're asking us to give you a license to build a high-rise? Mr. Jones said that was his goal in two years. Chairman Lantz asked him to explain to the Board how he's qualified to build a high-rise. Mr. Jones said he's seen all the trades since he's been on the jobs, especially for Curran Young as a superintendent. He's seen how all these trades work and he learns and figures out how business works. He used that when he got fined, figuring out how the trades work. He learned how from the ground up, especially roofing. Roofing is one of the most important things on a building because if that's not dried in, then everything is going to get soaked when it rains and then everything is going to leak, so everything needs to be structurally attached together and it needs to be dried in. Vice Chairman Jerulle asked if you're building a high-rise, what type of structural system are you using? Mr. Jones said he'd use block. Vice Chairman Jerulle said block is an exterior facia or wall system. What type of structural floor system are you going to use? Mr. Jones said he could show him steps on building a high-rise. Vice Chairman Jerulle asked what type of structural system. Mr. Jones asked him to elaborate further. Vice Chairman Jerulle said you have a floor and there are a dozen floor systems. Which one would you use? Mr. Jones said he'd use pilings. Vice Chairman Jerulle asked if he'd use pilings for a floor. Pilings are for deep foundations. Packet Pg. 54 8.B.1 April 20, 2022 m CO He's asking about a floor system. Mr. Jones said he'd use reinforced concrete slab, to to N_ Vice Chairman Jerulle asked who determines if pilings are required for a high rise. 0 Mr. Jones said an engineer does. i Vice Chairman Jerulle asked how the engineer determines that, Q Mr. Jones said it depends on how many stories are going up and if the building will sway. Vice Chairman Jerulle asked if there were considerations for the soil conditions. Mr. Jones said, yes there are and sand is not your best friend. Vice Chairman Jerulle asked Board Member Nolton if he agreed with that. Board Member Nolton said just from the questions we've asked so far, there's a lot of experience you don't have to build a four-story building or higher. There's a lot you still have to learn, so lie didn't even have more questions to ask because he hasn't been able to answer the few questions we presented. Vice Chairman Jerulle said these are some basic questions people should know for Will to give you a license to be a general contractor. There may be a license you are qualified for, but he didn't see him being qualified in Collier County as a general contractor to build a high-rise. You just don't have the experience. But he appreciates the initiative. Chairman Lantz said they all appreciate the initiative. You're only 21 years old, you've passed the general contractor test, which isn't easy to do. You've gone to college, you've dabbled in a bunch of different trades. Your average job is three or four months, so you haven't mastered anything. You're just figuring out where to go. You're on the right track but have a little more ways to go. We're not trying to tell you anything negative. Keep going on the path you're going on. Board Member Nolton said you're here to ask us to waive experience and the reason you have to have the experience is so that you don't get in trouble and you don't build something wrong for a client. If you, as a general contractor, are going to build those kinds of buildings, you've got to know there are shallow foundations and deep foundations, there are three or four different types of deep foundations, as Mr. Jerulle asked, and there's this type of slab, there's precast slab, there's cast, there's a column. You should know all that. And it doesn't appear that you have that experience. Board Member Jai -on asked why he didn't stay with Curran Young. Mr. Jones said he was talking to a lot of people and they were giving him jobs. He was looking at how many people were giving him jobs. He decided he didn't want to work for people anymore. He remodeled people's homes and obviously, he got fined for that. Board Member Nolton said he applauded his desire to work on his own, but said he needed more time and experience for this license. Board Member Nolton made a motion to deny the waiver of experience. Vice Chairman Jerulle seconded the motion. The motion carried unanimouslif, 6-0. 6 Packet Pg. 55 8.B.1 April 20, 2022 tri 00 M Vice Chairman Jerulle told Mr. Jones that he has a young son in the business and he will to to give him the same speech he gave him. He advised him to find a general contractor who does N the work he ultimately wants to do. The State requires four years of experience, but in his 0 estimation, you need more than four years, about five to six years, to be successful. You Z don't want to go out and fail. You want to be successful. Find a general contractor and work Q five or six years. Mr. Jones said all right, thank you. C. John J. Price — Priceless Customz Fabrication LLC — Aluminum wl Concrete Contractor Review of Experience D. John J. Price — Priceless Customz Fabrication LLC — Aluminum wl Concrete Contractor Review of Credit Chairman Lantz called Mr. Price to the podium and he was sworn in. Mr. Crofts reported that Mr. Price has submitted am application for the issuance of a Certificate of C'ornpeteney for Alrrmintan with Concrete Contractor, a license that requires 24 months of experience. As part of the process, Mr. Price submitted one 1'erifrcation of Experience and two IRS Wage Reports fi-oru employers. • William Bennett Carpentry —January 2016 to December 2017, 24 months ofexperience. Research shows that this company is a local licensed carpentry contractor. • Gatekeeper o South►t,est Florida Inc. -- no dates shown on the IRS IVage Report. This is not a licensed company in Collier County within Cilyl'iem However, the Collier County Business Tax database shows this cornpany as a welding service cornpany; it is not a licensed contractor. • James A. Barr Enter prises — no elates shotivn on the IRS Wage Report. This is not a licensed companyfor contractor licensing in Collier County. The Collier County Business Tax database .shows this business cis an auto repair or maintenance service. In a phone interview frith Nfi•. Price, he stated that the vast majority of the work he has done has been installing railings on hones, such cis stair railings and balcony railings. We discussed the license being restricted for railings ornlj Mr. Price told nne that he may ►vant to do carports and screen cages Inter and would like the license. Pf'hen asked about his experience building carports or screen cages, A/Ir. Price told me he has helped u th a couple. He has not been able to shots, any experience with the concrete aspect of this license. Mr. Price did submit several photos of types of ►t,o•k he says he has installed, however, this could not be verified. Based upon the information received front Mr. Price, it is staff's opinion that Ili% Price does not meet the experience requirements under Ordinance 2006-46, Section 1.6.3.2, as it relates to the trade of Aluminum with Concrete Contractor. Regarding the credit part of the application review process, Mr. Price's credit score currently is 59L The minimum required under Rule GI G4-15 is 660. As part of the credit review, Mr. Price Packet Pg. 56 8.B.1 April 20, 2022 m 00 Board Member Notion Hoare a motion to adopt Mr. Crotts' recommendation: to prove that Strncoasl Credit Union has beery paid on time, to provide his credit report and � prove that his credit score has increased in six months and in twelve rttotrths. Vice N Chairman Jet -title seconded the motion. The motion carried unanitnotisly, 6-0. v 11. PUBLIC HEARINGS= None 12. NEXT MEETING DATE: WEDNESDAY, May 18, 2022 Commissioners' Chambers, Third Floor, Administrative Building F, Collier Couni}, Government Center, 3299 I. Tamiami Trail, Naples, FL Board Member Hunt made a motion to ar jourrn. Board Member Meister seconded the ►ttotiotr. The motion carried unaninlottsl},, 5-0. There being no further business for the good of the County, the meeting was adjourned at 11:02 a.m. Collier County Contractors' Licensing Board Borrrd Te�rry � et•��E� 'eg-�r�na.� These minutes avere a proved br the Chairman or Vice -Chairman of the Contractors' Licensing Board Ott ,> " 1 F a.- aa.D_ , (check ore) as submitted ✓ or as amended 28 Packet Pg. 57 8.B.1 CountyComer Growth Management Community Development Deparlment APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION OF APPLICATION 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. V�C'r -�YCSN'cs Applicant (please print 5W k.. Name of Company ppticanl State of � ldr�\&(A County of The foregoing instrument was acknowledged before me by means of I21physical presence or ❑ online notarization on this day of o y\. , 20 -2'5, by e V- Sane a Such person(s) Notary Public must check applicable box: ff are personally known to me El has produced a current driver license ❑ has produced (Notary Sea[) KATHfRINE V CARCAMO N Notary Public - State of Flortda g' Commission p HH 298053 orF Off' My Comm, ExplresAug 7, 2026 Bonded through National Notary Assn, as identification. Notary Signature:��+k— L'4�7' M 00 rh r t0 Contractor Licensing — FIRM Application Rev_ 712022 Page 6 of 14 operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (23 contractorslicensiii,g@colliorcounlyfi.00v Packet Pg. 58 Comer County 8.B.1 Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY WORKMEN'S COMPENSATION AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I flail to acquire, or maintain at all times effective Workmen's Compensation Insurance itwill result in the possible revocation of my Certificate of Competency. i'tUlrl�t' �ol1CS Applicant (please print Name of Company 'Staatu of Applicant BEFORE ME this day personally appeared 9-uAk-v,,r V a ^e5 who affirms and Applicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of — pY k6o, Countyof Q Am r The foregoing instrument was acknowledged before me by means of Clphysicat presence or ❑ ontitie notarization on this i�day of 20 � , by u . Such person(s) Notary Public must check applicable box: are personally known to me ❑ has produced a current driver license ❑ has produced (Notary Seal) ar"r� KATHERINE V CARCAMO ,� i Notary CommIssion # Kh 2SM053k - State of da 2626 'toyo°•' My Comm. Expires Aug 7, Bonded through National Notary Assn. as identification. Notary Signature Contractor Licensing — FIRM Application Rev. 712022 Page 7 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensiiig@.colliercountyn.gov Packet Pg. 59 8.B.1 No GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. m 00 M r t0 N Official Examination Score Report 0 Official Score Report: Candidate Information: Name — Hunter K. Jones Candidate #: 31011370J Online Testing Site: Ocala, FL Final Score Result: June 2, 2022 Business Procedures General Unlimited Contractor Score: 78% (12/01/2021) Score: 81% (03/18/2022) These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida. If you have any further questions, please do not hesitate to contact us. Sincerely, President PO Box 831127 Ocala, Florida 34483-1127 -- Voice (352) 369-GITS — Fax (352) 387-2443 800 997 2129 Packet Pg. 60 27911 Crown Lake Blvd Suite #6 Bonita Springs, FL 34135 Phone: 239.777.1028 Fax: 877.275.3593 m 00 www.LicensesEtc.com M r W PERSONAL CREDIT REPORT (Compiled From National Records) N <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> U Z (I) P NP7771028 LICENSES ETC 16 NP 3/18 05/26/23 10:24CT <SUBJECT> <SSN> <BIRTH DATE> JONES, HUNTER K. -8943 04/01 <CURRENT ADDRESS> <DATE RPTD> 3148 50TH ST., NAPLES FL. 34116 3/18 <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> HOOKS CONSTNCTION 12/22 12/22 <FORMER EMPLOYER AND ADDRESS> HENNESSY CONSTRUCTION 5/22 5/22 M O D E L P R O F I L E ***FICO SCORE 8 SCORE +706 : LENGTH OF TIME ACCOUNTS HAVE BEEN ***ESTABLISHED;PROPORTION OF BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK ***REVOLVING OR OTHER REVOLVING ACCOUNTS;PROPORTION OF LOAN BALANCES TO LOAN ***AMOUNTS IS TOO HIGH;TOO MANY INQUIRIES LAST 12 MONTHS*** PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS - NONE FOUND ---------------------------------------------------------------------------- T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT$ VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13--24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 DISCOVERBANK B 9616003 3/20 $7567 MIN150 111111111111 R01 5/23A $6500 $0 111111111111 I CREDIT CARD 3/23C $3706 CLSD BY CRDT GRANTOR 38 0/ 0/ 0 CAPITAL ONE B 1DTV001 3/17 $4013 1EElIlIE1111 R01 5/23A $5200 $0 111E11111111 A PFROM SYNCHRONY 5/23 $0 43 0/ 0/ 0 SUNCST CU Q 298QO07 10/20 $506 MIN10 1111111E11E1 R01 5/23A $500 $0 1EE111111111 I CREDIT CARD $419 31 0/ 0/ 0 GM FINANCIAL F 44WK001 12/22 $60.9K 085M978 11111 101 5/23A $0 I AUTOMOBILE $58.6K 5 0/ 0/ 0 GS BANK USA B 2GSZO01 11/20 $2772 MIN54 111111111111 R01 4/23A $3000 $0 EEEElEEE1EEE I CREDIT CARD $949 29 0/ 0/ 0 TD AUTO FIN F 624C382 5/22 $49.1K 075M 1111111 101 Page 1 of 2 Packet Pg. 61 8.B.1 ._.f v 12/2.2A $0 I AUTOMOBILE 12/22C $U CLOSF;D 7 0/ 0/ 0 CAF F 45WK001 9/21 $26.5K 060M 11111111 I01 5/22.A $0 I AUTOMOBILE 5/2.2C $0 CLO:3CU 8 0/ 0/ 0 SYNCB/W1,MRTD 13 235060N 1/17 $4241 ].11]]111]111 R01 10/19M $52.00 $0 ]111111 A SIjDTO CAPITAL ONE, 10/19C $0 PURCII I3Y OTHER a,ENDER 19 0/ 0/ 0 I N 0 U I IZ I E S DATE SUOCODE SURNAME TYPE; AMOUNT 5/26/23 PNP7771020(FLA) LICENSES ETC 12/17/22 FDT3025036(MC1I) TT) AUTO FIN 12./17/22 ACH2101765(CHI) GR1EC0 (AIFVR 11/02/22 BPC3575459(NFL) CAPITAL ONE 10/03/22 NDY1263431(DAY) SYNC13 5/13/22 FD`1'3025036 (MCII) TD AUTO FIN 5/13/22 13RI1403244 (NEN) CITIZENS ONE; 5/13/22. BCI1780815 (1)AY) i.'L€ Tii THIRD 3/11/22 BW1,2345563(W1L) JPMCI3 CARD END OIL REPORT Page 2 of 2 m 00 c� N Packet Pg. 62 8.B.1 1 SWIFL Structural INC BUSINESS CREDIT REPORT Address: 3148 50th St SW Naples, FL 34116-8120 United States Experian BIN: 539605735 Agent: Jones Hunter K Agent Address: 3148 50TH ST SW Naples, FL 27911 Crown Lake Blvd Suite # 211 Bonita Springs, FL 34135 Phone: 239.777.1028 Fax: 877.275,3593 www.LicensesEtc.com 26/23 11:00 ET Fed Tax ID# 92-3024279 Key Personnel: President: Hunter K Jones Business Type: Corporation Experian File April 2023 Established: Experian Years on Less than 1 Year File: Filing Data Florida Provided by: Date of 03/11 /2023 Incorporation: Public Records PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. Bankruptcies: 0 Liens: 0 ✓Judgments Filed: 0 ✓ Collections: 0 END OF REPORT Page 1 of 1 m 00 c� r t0 N Packet Pg. 63 8.B.1 DIvtsioN or CORPORATIONS I M 00 J r N flit Nljlr'dffl .'ifllw r4 /fw O'l i'. 6'i.. rft •.• Department of Stale I Division of Corporations 1 Search Records I Search by Entity game Detail by Entity Name Florida Profit Corporation SWFL STRUCTURAL INC Filing Information Document Number P23000020970 FEI/EIN Number NONE Date Filed 03/13/2023 Effective Date 03/11/2023 State FL Status ACTIVE Principal Address 3148 50TH ST SW NAPLES, FL 34116 Mailing Address 3148 50TH ST SW NAPLES, FL 34116 Registered gent Name & Address JONES, HUNTER K 3148 50TH ST SW NAPLES, FI, 34116 Off icerlDirector Detail Name & Address Title P JONES, HUNTER K 3148 50TH ST SW NAPLES, FL 34116 Annual Reports No Annual Reports Filed Document Images 0311312QU -- Domestic Profd-- Domestic Profd View image in PDF format Packet Pg. 64 1 8.B.1 Electronic Articles of Incorporation For SWFL STRUCTURAL INC P23000020970FILED m March 13 2023 °° S aec�r Of Slate v 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: SWFL STRUCTURAL INC Article II The principal place of business address: 3148 50TH ST SW NAPLES, FL. US 34116 The mailing address of the corporation is: 3148 50TH ST SW NAPLES, FL. US 34116 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 1000 Article V The name and Florida street address of the registered agent is: HUNTER K JONES 3148 50TH ST SW NAPLES, FL. 34116 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: HUNTER JONES Packet Pg. 65 8.B.1 Article VI The name and address of the incorporator is: HUNTER JOKES 3148 50TH ST SW NAPLES, FL 34116 Electronic Signature of Incorporator: HUNTER JONES P23000020970FILED m March 13 2023 °° Sec. Of State Iyarbrough, N I ain the incorporator submitting these Articles of Incorporation and affinii that the facts stated herein are true. I am aware that false information submitted in a document to the Deparinnent of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand die requirement to file an atuwual report between January 1 st and May 1st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P HUNTER K JONES 3148 50TH ST SW NAPLES, FL. 34116 US Article VIII The ett'ective date for this corporation shall be: 03/11/2023 Packet Pg. 66 8.B.1 AN IRS"PAR"T OF THE TREASURY INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 SWFL STRUCTURAL INC % HUNTER JONES 3148 50TH ST SW NAPI,ES, FL 34116 M Date of this notice: 03-21-2023 00 c� Employer Identi€ication Number: 92-3024279 cfl N Form: SS-4 U z_ Number of this notice: CP 575 A For assistance you may call us at: 1-800--829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you BIN 92-3024279. This BIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. Taxpayers request an BIN for their business. Some taxpayers receive CP575 notices whe another person has stolen their identity and are opening a business using their informatio If you did not apply for this EIN, please contact us at the phone number or address listed on the top of this notice. When filing tax documents, making payments, or replying to any related correspondence it is very important that you use your BIN 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 forms by the dates shown. Form 1120 04/15/2024 If you have questions about the forms or the due dates 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 (corporation, partnership, etc.) 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 2020--1, 2020-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-5, U.S. Income Tax Return for an S Corporation, must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. Packet Pg. 67 8.B.1 (IRS USE ONLY) 575A 03-21-2023 SWFL B 9999999999 SS-4 m 00 If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, r CT-1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), you will receive a (�00 Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS). A Personal U Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Z_ Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Q Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial v Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized a -file Providers, such as Reporting Agents or other payroll service w providers, are available to assist you. visit www.irs.gov/mefbusproviders for a list of companies that offer IRS a -file for business products and services. IMPORTANT REMINDERS: 0 H U * Keep a copy of this notice in your permanent records. This notice is issued only < one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. Z * Use this EIN and your name exactly as they appear at the top of this notice on all J your federal tax forms. Q H * Refer to this EIN on your tax -related correspondence and documents. Z w c * Provide future officers of your organization with a copy of this notice. w Your name control associated with this EIN is SWFL. You will need to provide this information along with your EIN, if you file your returns electronically. w 0 Z Safeguard your EIN by referring to Publication 4557, Safeguarding Taxpayer w Data: A Guide for Your Business. w You can get any of the forms or publications mentioned in this letter by IL visiting our website at www.irs.gov/forms-pubs or by calling 800-'TAX--FORM W (800-829-3676). LL 0 w If you have questions about your EIN, you can contact us at the phone number or address listed at the top of this notice. If you write, please tear off the > stub at the bottom of this notice and include it with your letter. w W Thank you for your cooperation. vI) Packet Pg. 68 (IRS USE ONLY) 575A 8.B.1 03-21-2023 SWFL B 9999999999 SS-4 Keep this part for your records. CR 575 A (Rev. 7-2007) ---------------------------------------------------------------- Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 A 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 03-21-2023 ( ) - EMPLOYER IDENTIFICATION NUMBER: 92-3024279 FORM: SS-4 N0130D INTERNAL REVENUE SERVICE CINCIjNNATI OH 45999e-00[23 I I�II�II NII I�illihl�III F�II IlI 11i11lllfilll l�II III SWFL STRUCTURAL INC % HUNTER JONES 3148 50TH ST SW NAPLES, FL 34116 m 00 c� r W W N Packet Pg. 69 8.B.1 Co Ter CouHty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY STATEMENT OF OWNERSHIP This certifies that I, NI- tr mCane.$ am a member or managing APPLICANT'S NAME (please print) member of �W VRI StV- V C-�JrxX-\ 1hC I own { C)o % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. f {r �Urti t J Applicant (please print) S 4xPL Sf vc -u1'4.1 i h c Name of Company m-ac- --4r Signature of Applicant State of County of 11�, Vie foregoing instrument was acknowledged before me by means ofi2l physical presence or CI online notarization on this _Lq day of {, 20_t3-,by V, So C` Such person(s) Notary Public must check applicable box: L are personally known to ire ❑ has produced a current driver license El has produced as identification. (Notary Seal) ;r'p�e ; KATHERINE V CARCAMO Notary Public State of Florida Notary Signature: commission q HN 298053 My Comm. Expires Aug 7, 2026 Bonded through National Notary Assn. M 00 ch r tO Contractor Licensing — FIRM Application Rev. 712022 Page 9 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (23 Packet Pg. 70 con tractorslicensina(c>7colIiercountytl.gov r m 06 ISMS - MOIOVNINOO IVI1N30IS3N - 33N3IM3dX3 30 M31A3M — S3NOf ,m M31NnH '99 :IuGwg3BPV yl LLL0 Z v w E psi = U �' ❑ w C a ❑ Z U)LLI S i LLI Q w ui ui J O < a m Z) Z Q 1 0 Q J i * u aZce(nZ' w Q RI? au) O OnU Z O E N O� c' a LLJ LLJ � Q Z u r+ CV)J ❑ LL cn U 1- Z coCN Q V Q Oj O v —j CY) 000 o J a LL � a z Z D V) ° a LLI © 00 a � cn o - c ~ W Z U 2 j 4 LJ.I LLiC`j� Z.Z y cya NZ Z Q v Z Q LLI N- o z LL 0 Q� 0 Z Z W F- O UI) Z) V o 00 V U Z p w X> o ~ (/� Z v Q in v W cr Z 0� u 0 N a = l ULU F- o 4.1 p[ w UI)a T) a V) o LLI � Q 1- 7125123, 11:20 AM DBPR - JONES, HUNTER K; Doing Business As: SWFL STRUCTURAL INC, Registered Residential Contrac 8.B.1 THE OFFICIAL SITE OF THE FLORIDA DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION dlDr&bD Ment f ausi�tens fesslonal Regulat! ONLINE SERVICES Apply for a License Verify a Licensee View Food & Lodging Inspections File a Complaint Continuing Education Course Search View Application Status Find Exam Information Unlicensed Activity Search AB&T Delinquent Invoice & Activity List Search LICENSEE DETAILS Licensee Information HOME. CONTACT US MY ACCOUNT 11:19:49 AM 7/25/2023 Name: JONES, HUNTER K (Primary Name) SWFL STRUCTURAL INC (DBA Name) Main Address: 3148 50TH ST SW NAPLES Florida 34116 County: COLLIER License Information License Type: Registered Residential Contractor Rank: Reg Residential License Number: RR282812250 Status: Current,Active Licensure Date: 07/07/2023 Expires: 08/31/2025 Special Qualification Effective Qualifications Construction 07/07/2023 Business Alternate Names View Related License Information View License Complaint 2601 Blair Stone Road, Tallahassee FL 32399 :: Email: Customer Contact Center:: Customer Contact Center: 850,487.1396 The State of Florida is an AA/EEO employer. Copyright 2007-2010 State of Florida. Privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. "Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. Please see our Chapter 455 page to determine if you are affected by this change. ca 00 c� r W W N https:llwww.myfloridaIiconse.com/LicenseDetaiI.asp?SID=&id=4FD1DB39AE37716274D01163013641CA Packet Pg. 72 i' i CLASS C GENERAL BUILDER - RESIDENTIAL 23-CGC-C-23018-R JONES, HUNTER K. - QUALIFYING SWFL STRUCTURAL INC 3148 50TH ST SW NAPLES FL 34116 EXPIRES 08/31/2024 j I i 4 RCERTIFICATE OF COMPETENCY ;` Y Y/'�11 \D Detach and SIGN the reverse side of this ` C_'C JH' Y card IMMEDIATELY upon receipt! You • should carry this card with you at all times. 13ROWARD COUNTY, FLORIDA Contractor must obtain a photo I.D. Certificate of Competency Card CERTIFICATE OF COMPETENCY every two years, CLASS C GENERAL BUILDER - RESIDENTIAL CC# 23-CGC-C-23018-R JONES, HUNTER K -QUALIFYING SWFL STRUCTURAL INC JOKES, HUNTER K. 3148 50TH ST SW 3148 50TH ST SW NAPLES FL 34116 NAPLES FL 34116 EXPIRES 08/31/2024 L_ I 503.207 (Rev. 1112) PC201247906 m 00 c� r W W N Packet Pg. 73 8.B.1 CERTIFICATE OF COMPETENCY BR, WARD HUNTER K JONES ra Class C General Builder - Residential SWFL STRUCTURAL INC CC# 23-CGC-C-23018-R EXPIRES 2024-08-31 m 00 c� r t0 N Packet Pg. 74 m w ISMS - NOIO NINOO IVIlN30IS3N - 30N3R13dX3 30 M31ABN - S3NOf 'N N3lNnH '99 :lu8tu43uPV 0 Q 1.0 1;-4 O O V 1 i 1 LO 6 a r aD a Official Academic Transcript from: FLORIDA SOUTHWESTERN STATE COLLEGE OFFICE OF THE REGISTRAR 8099 COLLEGE PARKWAY FORT MYERS, FL 33919 TELEPHONE: 239-489-9121 Official Academic Transcript of: HUNTERJONES Transcript Created: 23-Aug-2021 Requested by: HUNTERJONES 3148 50TH ST SW NAPLES, FL 34116-8120 E-Mail: hunter onesrc@gmail.com 8.B.1 parchment- m 00 Document Type: THIRD -PARTY SECURE PDF M r t0 Intended Recipient: N HUNTERJONES 3148 50TH ST SW Z Z NAPLES, FL 34116-8120 E-Mail: hunter onesrc@gmail.com Delivered by: Parchment, LLC Under Contract To: FLORIDA SOUTHWESTERN STATE COLLEGE Order Number: 1 HY787663- 1 Telephone: (847) 716-3005 Statement of Authenticity This Official Academic Transcript in Portable Document Format (PDF) was requested by the individual identified above in compliance with the provisions of the Family Educational Rights and Privacy Act of 1974 as Amended and in conformance with the prescribed ordering procedures of Florida SouthWestern State College who has contracted with Parchment, LLC of Scottsdale, AZ for electronic delivery of Official Academic Transcripts in PDF form. You may verify the authenticity of our relationship with Florida Southwestern State College by visiting their website at https:/hvww.fsw.edu/registrar/r4stration/2. Colleges and Universities If you are an accredited post -secondary academic institution, please be advised that you are receiving this transcript as a "Third -Patty" receiver. Since you are not registered to our Parchment Receive service, additional security provisions have been added to this document to prevent content copying or alteration. You also are not permitted to print the document without watermark protections or add notations to the document when saving to your student information system. Should you wish to receive future documents through our electronic networks without these additional security features, please register your institution at https://info.parchment.com/comparq--rcceive.htTnl. Privacy and Other Information This Official Academic Transcript is for delivery to the above -named "Intended Recipient". If you are not the "Intended Recipient", please notify the Office of the Registrar at Florida SouthWestern State College. You are not permitted to copy or alter this document. You may not forward this document or disclose its contents to any person or organization other than the "Intended Recipient" without the express written permission of the student. If this document is copied or printed, the words "PRINTED COPY" will appear in the replicated transcript image. In the interest of security and privacy, we delete this Official Academic Transcript from our server 48 hours after it is initially downloaded excluding weekends and holidays. If a replacement is subsequently needed, the requesting party must order another transcript from Florida SouthWestern State College. If you have any questions about this document please contact Parchment Customer Service at (847) 716-3005. Our operators are available from 7:00 am to 7.00 pm Monday through Friday (Central Time). Packet Pg. 76 Data Issued: 23-AUG-2021 Student Name: Hunter Kullen Jones 3148 50th St SW Naples, FL 34116-8120 United States of America SSN: XXX-XX-8943 Course Level: College Credit Student Type: Continuing High School: Golden Gate High School 24-14AY-2019 Only Admit: Fall 2019 8.B.1 FLORDAA SOUTHWESTERN STATE COLLEGE m 8099 College Parkway, SW 00 Fort Myers, FL 33919 M 1-800-749-2322 www.fsw.edu to co PLACEMENT SCORES page 1 Test Score Test Date PERT Math PERT Writing PERT Reading SUBJ NO. H W M COURSE TITLE CRED GRD PTS R Institution Information continued: Fall 2020 Current Program BCN 1040 INTRO TO SUSTAINAHILIT 3.00 A 12.00 Major : Architctural Design & Construc BCN 1230 MATERIALS/METHODS CONS 3.00 C 6.00 Degrees Awarded Associate in Science 04-AUG-2021 BCN 2710 CONSTRUCTION PROCEDURE 4.00 C 8.00 Primary Degree ETD 1530 DRAFTING AND DESIGN (M 4.00 A 16.00 Major : Architctural Design & Construc ETD 2340 ADV COMPUTER AIDED BRA 3.00 A 12.00 Ehrs: 17.00 GPA-Hrs: 17.00 QPts: 54.00 GPA: 3.17 SUBJ NO, H W 24 COURSE TITLE CRED GRD PTS R Spring 2021 BCT 1773 BLDG CONST ESTIM SCHED 4.00 B 12.00 INSTITUTION CREDIT: ETD 1390 INTRO TO REVIT ARCHITE 4.00 A 16.00 ETD 2930 SPEC TOP CAPSTONE ENGR 1.00 B 3.00 Fall 2019 SPC 1017 FUNDAMENTALS OF SPEECH 3.00 B 9.00 BSC 1085C ANAT 6 PHYS I 4.00 W 0.00 Ehrs: 12.00 GPA-Hrs: 12.00 QPts: 40.00 GPA: 3.33 ENC 1101 W COMPOSITION I 3.00 B 9.00 MAT 1033 INTERMEDIATE ALGEBRA 4.00 D 0.00 E SLS 1515 CORNERSTONE EXPERIENCE 3.00 A 12.00 Summer 2021 Ehrs: 6.00 GPA-Hrs: 6.00 QPts: 21.00 GPA: 3.50 BSC 1051C ENVIRON14ENTAL BIO-SW F 3.00 A 12.00 ECO 2013 PRINCIPLES OF MACROECO 3.00 B 9.00 Spring 2020 HUM 2020 W INTRODUCTION TO HU24ANI 3.00 A 12.00 BCN 1272 BLUEPRINT READING 3.00 A 12.00 144C 1105 COLLEGE ALGEBRA 3.00 C 6.00 EGS 1001 INTRODUCTION TO ENGINE 3.00 B 9.00 MAT 1033 INTERMEDIATE ALGEBRA 4.00 C 8.00 I ENC 1102 W COMP II - Technical 3.00 B 9.00 Ehrs: 16.00 GPA-Hrs: 16.00 QPts: 47.00 GPA: 2.93 ETD 1320 COMPUTER AIDED DRAFTIN 3.00 A 12.00 ***xk******x*******k** TRANSCRIPT TOTALS ********x*xxkx*k*kx**x* Ehrs: 12.00 GPA-Hrs: 12.00 QPts: 42.00 GPA: 3.50 Earned Hrs GPA Hrs Paints GPA Deans List TOTAL INSTITUTION 72.00 72.00 234.00 3.25 Summer 2020 BCT 1760 BUILDING CODES 2.00 B 6.00 TOTAL TRANSFER 0.00 BCT 2730 CONSTRUCTION MANAGEMEN 3.00 A 12.00 ETD 1103 ENGINEERING GRAPHICS 1 4.00 B 12.00 OVERALL 72.00 Ehrs: 9.00 GPA-Hrs: 9.00 QPts: 30.00 GPA: 3.33 r++trrtrrr++rt++++rrrr END OF TRANSCRIPT rtrrrrttt+rrtrrtttxtrtt +++++x+++++rrttrrrrr CONTINUED ON NEXT COLUMN rtktt**t**tx+txx** Issued To: HUNTER JONES 3148 50TH ST SW REFNUM:58446238 NAPLES, FL 34116-8120 t.�V' Brenda L. Knight, MS Ed Registrar This transcripl processed and doliverod by Credentials'® Transcripts Network Packet Pg. 77 8.B.1 KEY TO TRANSCRIPT ACCREDITATION: The College began in the Fall of 1962 and is fully accredited by the Florida State Department of Education and the Southern Association of Colleges and Schools. FiCE-001477 CEEB - 005191 m PREVIOUS COLLEGE NAMES: The College has operated under the following names, effective date in parenthesis: Edison Junior College ao (September 1962 - June 1972), Edison Community College (July 1972 - June 2004), Edison College (July 2004 -August 2008), Edison State College (August 2008 - June 2014), Florida SouthWestem State College (July 2014 STATE OF FLORIDA ARTICULATION AGREEMENT: The Associate of Arts Degree is the degree designed for transfer to upper division universities. It is protected by the Articulation Agreement among all Florida public institutions of higher education. By the terms of the Z agreement, a student who is awarded an Associate in Arts Degree by Florida SouthWestem State College has met the general education — requirements for admission to the upper division public universities of the State of Florida. a FLORIDA STATEWIDE COURSE NUMBERING SYSTEM: The course numbers appearing on this transcript are part of a statewide system :3 of prefixes and numbers developed for use by all public, postsecondary, and participating private institutions in Florida_ One of the major ~ purposes of the system is to make transferring easier by identifying courses which are equivalent, no matter where they are taught in the state. All courses designed as equivalent will carry the same prefix and last three digits. FLORIDA SOUTHWESTERN STATE COLLEGE GRADING SYSTEM: co Grade Interpretation Point Value Grade Interpretation Point Value u_ � A Excellent 4 Points WP Withdrew Passing 0 Points B Good 3 Points WF Withdrew Failing 0 Points W C Average 2 Points W Withdrew Not Computed 0 D Poor 1 Point X Audit Not Computed Q F Fail 0 Points S Satisfactory Not Computed I Incomplete Not Computed NR Grade Not Reported Not Computed M Modularized 0 Points Z FSW UNIT OF CREDIT: Florida SouthWestemn Slate College awards semester credits. One semester credit is normally given for a class that meets 50 minutes per week for approximately 16 weeks. Semester credits are also given in short terms but the classes meet longer and more frequently each week. GOOD STANDING: All students are considered to be in good standing unless a remark to the contrary appears on the transcript. CREDITS TRANSFERRED FROM OTHER COLLEGES TO FSW: Degree seeking students have all credits attempted at other colleges evaluated, and previous attempts are computed in the cumulative grade point average. REPEATED COURSES: All grades remain on the record but only the last grade earned is used in the grade point average computation COURSE TYPE: E -REPEATED -NO CREDIT ALLOWED H - HONORS SCHOLAR PROGRAM I - REPEATED - CREDIT ALLOWED Q - COMPUTER LITERACY W -WRITING INTENSIVE 6,000 WORDS ACADEMIC TERWYEAR: FALL TERM (16 weeks) beginning late August SPRING TERM (16 weeks) beginning early January SUMMER TERM (13 weeks) beginning early May ADDITIONAL TEST: A black and white copy is not an original and should not be accepted as an official institutional document. ALTERATION OR FORGERY OF THIS DOCUMENT IS A CRIMINAL OFFENSE! If you have additional questions about this document, please contact the Office of the Registrar at (239) 489-9121. This transcript cannot be released to a third party without the written consent of the student. This is in accordance with the Family Educational Rights and Privacy Act of 1974. This Academic Transcript from Florida SouthWestem Slate College located in Fort Myers, FL is being provided to you by Credentials Inc. Under provisions of, and subject to, the Family Educational Rights and Privacy Act of 1974. Credentials Inc, of Northfield. IL is acting on behalf of Florida SouthWestem State College in facilitating the deliveryof academic transcripts from Florida SouthWestem State College to other colleges, universities and third parties using the Credentials' TranscriptsNelworkTM, This secure transcript has been delivered electronically by Credentials Inc. in a Portable Document Format (PDF) file. Please be aware that this layout may be slightly different in look than Florida SouthWestem State College's printedrmailed copy, however it will contain the identical academic information. Depending on the school and your capabilities, we also can deliver this File as an XML document or an 1-01 document. Any questions regarding the validity of the information you are receiving should be directed to: Office of The Registrar, Florida Southwestern State College, 6099 College Parkway, Fort Myers, FL 33919, Tel: (239) 489-9121. Packet Pg. 78 8.B.1 Collier County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY m ao VERIFICATION OF CONSTRUCTION EXPERIENCE r Applicant's Name: /�rr Certificate Category Requested: QeSt*am\ o1., 6CA%V_'r-A co"'tV*.'r- 'Cjr U Z The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for J this cortificate, the applicant must verify his/her 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 ~ V 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 rote should be described, but may or may not be considered sufficient to demonstrate required W trade experience. The person verifying trade experience for the above -named applicant must provide the following information: U) Name: VVJA4rCof 0n G.S Title: J ILL Business Name: SL�`iJC'�+r'p- �"� C ' 3� " �� 2." 6:� License No. (if applicable): C�..^t�'X1- CG C- C- a36 V4 - M1' O Phone: L U l' Business Address; 3� 1 go cJ a Leo f� 341 / G Street city State Zip Z The applicant was employed by me from S A3 to OU Applicant's title: l��r J Q T The applicant's scope of work (specific duties) included: f\ty'C1.0 ��" w H Z w Coo niii- C6^CM1rr. Me:} ZNLO C.ak -t lb+v C.GO 0 l Additional comments: LoC)k IP-i +e �irars er m4 11 terst +d 001(,'cr earal's1'- w NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. w Z Under penalty of perjury, I declare that the facts stated here are true. w FR w 1L gnature of person pr a statement �J,O \,6, County X w ILL State of L _ of �r O Tice foregoing instrument was acknowledged before me by means of physical presence or 0 online notarization on this w A�_-day of -7Surxg,, 20 , by JAXi L> w Such person(s) Notary Public must check applicable box: 11 are personally known to me 0 has produced a current driver license w Z O ❑ has produced as identification. Y (Notary Seat) 1 W w �Y.Pu''-.. KATHERINEYCARCAA50 ?I Notary Public - State of Florida ` Commission M HH 298053 H Z sofn4.°' My Comm. Expires Aug 7, 2026 Notary Signature: Bonded through National Notary Assn. m ar 00 Contractor Licensing - FIRM Application Rev. 7/2022 Page 11 of 14 C Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 N j_ contractorslicensingPeol liercountvfl.gov t v tv r Q Packet Pg. 79 8.B.1 4 V SWFL STRUCTURAL m 3148 BOTH ST SW Naples, FL 34116 00 239-682-7083 r RR282812250 N To Collier County Contractor Licensing, To Whom it May concern, I have worked for SWFL Plastering Inc from 10/14/2022-5/27/2023. 1 was hired to estimate, supervise and supply labor for jobs that I worked on. This is my Godfather's brother's company that I am very close with. We did jobs from anywhere to small residential homes to Clubhouses, to large multi family. A reason why I couldn't get his signature was because it would be a conflict of interest because we do the same exact work. Types of Jobs we did: Metal framing Drywall Stucco Concrete Flatwork I do have verification that I worked for SWFL Plastering inc, including shirts, Business cards, Pay stubs, all licensing information, contracts, and even insurance. So, I am writing this letter today to verify my work experience with SWFL Plastering Inc. Supervisor name: Beth Burgess 239-431-7102, Juvenal Martinez 239-825-7925 I am also writing this letter because I (SWFL Structural Inc) am a Registered Residential Contractor in Broward County. I have been working for myself as a Residential contractor since May 2023, doing concrete structural work ,stucco, interior and exterior wood and metal framing, and Drywall. And, so I am writing this part of this letter today to verify myself and have a chance to transfer my license over to Collier County. Thank You! 08/08/2023 Packet Pg. 80 Co*er County 8.B.1 Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: Hunter Tones Certificate Category Requested: —Residential Contrada 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 his/her 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 for the above -named applicant must provide the following information: Name: Donald R. Green Title: Pre ident Business Name: Green Construction & p_royManagement� T.LC Phone: (614) 531-7709, . License No. (if applicable): 2 Business Address: 138o Brenthaven Pl . Columbus_ Ohio_ 43228 Street City State Zip The applicant was employed by me from 1 0 201 to 6 1 2020 Applicant's title: Skilled Worker Foreman The applicant's scope of work (specific duties) included: Hunter Was my right hand man, Metal Framing, Wood framing, Stucco., Drywall hanging and Finishing. Additional comments: Hunter came from Florida, stayed here with his grandmother, Grandfather passed away. NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. Under penalty of perjury, I declare that the facts stated here are true. ` 1 / Signature of person providing the statement Stake of � County of l `� , Time foregoin instr mmmtem t was acknowledged before the by,tne so physical presence or ❑ online notarization on thus day of 20 �, by � ( 4� C�Q_Q"y1 Stmclm orson(s) Notary Public must check applicable box: are personally known to ine ❑ has produced a current driver license ❑ has produced identification. M 00 M r (Notary Seal) c d EILEEN i,00:27,2026 t Notary Public • State da Comml Won # NH 2r `ry? aF j My Comm. Explres FeNotary SignatureBonded through National Nssn. Q Contractor L1oensing — FI M Application Rev. 712022 Page 11 of 14 Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive . Maples, FL 34104 . (239)' contractors licensin col liereountyfl.Qov Packet Pg. 81 8.B.1 Contractor Licensing [� Wr C;0'94 tty 2800 N. Horseshoe Dr, Naples, FL 34104 Growth Phone - 239-252 2431 Fax - 239-252-2469 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: Hunter Jones Cerlificate Category Requested: �eS3�en��^1 ('cy\k•raCVo,r The applicant is seeking a Collier County Certificate of Competency in the trade indicated above As part of the application for this certificate, the applicant must verify Nsiher 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 for the above named applicant must provide the following information Name: Kenneth K Nielsen Title, vie President of Operation Business Name: Hennessy Construction Services Phone: 727-823-3223 ext 147 License No. (if applicable) CGC 1526056 Business Address: 2300 22nd street n St. Petersburg, FL. 33713 Street City State Zip The applicant was employed by me from 05/02/2022 to 10/ 14 /2022 Applicant's title: Field Foreman The applicant's scope of work (specific duties) included: Supervise subcontract work for quality Completeness and timelyness Additional comments: Also verified safety Measures were maintained by all workers NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may Under penalty of perjury, I declare that the facts stated here are true 1\�) State of FUS114 LA County of PNEW- ,t license to revocation providing the statement Th foregoing/ �instrument was acknowledged before me by means of physical presence or 0 online notarization on this I day of 1" UGfU�l , 20 13 , by -f�-Ct�l 1T4 .�L- tJ l_eUSC-. N Succhh`person(s) Notary Public must check applicable box, Bare personally known to me ❑ has produced a current driver license fJ has produced (Nota 9L8XyPC1R0CM Y WACHOWIAK MISSIM 0 GG347813 S: S,Pj"ur Ot, 2!>23 Individual Application New.docx REV 1/22/2021 as identification. Notary Signature: + U Page 8 of 13 Packet Pg. 82 8.B.1 Employer Experience Affidavit !mOrpellonts., a The applicnnt to requesting that you celitfy 08 10 your knowledge of their experience by completing Ihta form ■ 11 is being used to support the applicant's qualilicationa. This verification Is required Io be completed by a current or provlous employer holding a conlreclor's Itcanse, • Rome attach a copy of your (venfior's) contractor's license to this document. This form may be duplicated. Please note: All information reported in the above affidavit will be veriffad A licant Information; first Name- ltunler Trade Applied for. Gone rat Contractor Qualifier Employer Verification; 1 2. 3, 4. Last Name; Jonas Employment Start Date: s722 -z End Dale: N/A cS+ 1 ILa 122. Presently Still Employed: O Yes O No re5cn0e in detail the positions held and type of work performed: Field Foreman, assist in scheduling, quality control and coordinslion of subcontractors in the cons tructlon of a Mulfl-family project consisting of 2 three story block and hollow ooro buildings, 48,500 square feet each. 02 apartmonta and a stand alone clubhouse, 00 2 three story block and hollow core structure. 48,500 square feet each and a stand alone block end wood truss single story ctubhouso ComRanv Information: Business Name: Hennessy Cons trucUon Services Contractor's License Number: CGC 1526050 Street Address: 2300 22nd street north City: Si. PetersburnState:. FL Zip: 33713 Phone Number. 727-421-0101 Email: -MIQlaynahray.coin 1 Certify that the information provided above is true and correct Contractor's First Name: K°f111oti Last Name: Nielsen Signature of Contractor: � 0410' 7127122 Sign before publie notary State of County of The oin tea ent was a knowtedged before me Oils �L day of Ly 20 22. by wh2 Is Personally BnMaja nip. a as identificalion AMY WACHOWIAK MY co hasslo;1 M O(d317d13 Notary's Signature and Seal (9EXPIRES: Sepitinixt 01.2M3 m 00 to CD N Packet Pg. 83 8.B.1 CO _7e r County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicants Name: Rtx,�rer =are S Certificate Category Requested: (2Tnff 0.! Co W-Ay tiGtor 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 his/her 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 for the above -named applicant must provide the following information: Name: ci_+\ QU�4C5 Title: rVN044tr Business Name: `] t..,.a�'1 Q ��S'i�c' i +•q t C Phone: License No. (if applicable): C('�1o41°t1 Business Address: 56 � 3 SWoi •d Street City State Zip The applicantvm&emptoge"y me from 33 1.2 1 to L.� $ 7-7 .Z3 Applicant's title: JVb The applicant's scope of work (specific duties) included: ht�4 , W Doll fr a ^n v^ , S{-U Cco _ f�rh w s kt Additional comments: &_00krW&r"Cr i5 OW r%u's _ &4- „Ir _�V N*cf ' NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation - Under penally of perjury, I declare that the facts stated here are true. State of County of Signature of person providing the statement The foregoing instrument was acknowledged before me by means of ❑ physical presence or ❑ online notarization on this day of , 20 , by Such person(s) Notary Public must check applicable box: ❑ are personally known to nre ❑ has produced a current driver license ❑ has produced (Notary Seal) as identification. Notary Signature: m 00 c� r W Contractor Licensing - FIRM Application Rev. 712022 Page 10 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (23 packet Pg. 84 contractorsliicensina aOcolliercountyfl.gov 8.B.1 SWFL o0 PLASTERING, INC. 00 M March 29, 2023 To Whom It May Concern, Hunter Jones has worked on the following projects for our company doing various duties such as; metal framing, drywall, and stucco work, as well as helped with estimating and supervising at same projects. Landmark Building suites 105 & 107, 300 5th Ave S., Naples, FL 34102 Scope of Work: Metal Framing & Drywall Amavi Hair Salon, 7273 Vanderbilt Beach Rd, Unit 29, Naples, FL Scope of Work: Metal Framing & Drywall Restore Hyper Wellness, 3,0171 Estero Town Commons Unit 303, Estero, FL 33928 Scope of Work: Metal Framing & Drywall Bentley Residence, 820 941h Ave., N., Naples, FL Scope of Work: Metal Framing & Stucco Thank you, Juvenal Martinez President SWFL Plastering, Inc. 5683 Strand Court, Suite 4 Naples, FL 34110 Office: (239) 431-7102 Packet Pg. 85 8.B.1 Preferred Builders of Florida, Inc. m M r March 22, 2023 N Florida DBPR 1 CILB 2601 Z Blair Stone Road a Tallahassee, FL 32399 Attention: Amanda Ackermann, Executive Director Amanda: have worked with Hunter Jones with SWFL Plastering Inc, for a significant amount of time as a State Licensed Building Contractor (CBC047687). Hunter of SWFL Plastering does the drywall, framing, stucco, and concrete slabs for our company. I find him knowledgeable of the entire construction process, and proficient at gathering information for me as questions arise. Hunter demonstrates very good communication skills and timing on projects. Hunter is a well spoken and very knowledgeable individual, he doesn't only know his job he knows every other subs job as well. He is an excellent contractor to do work with and would highly recommend him for advancement to the next level in construction contracting. Thank you. Sincerel Louis George Cell (239) 289-8120 Home (239) 354-6766 Fax(239)354-6799 louis@preferredbuilders.net In an Indiuiduai Capacity: Pursuant to Sedicm l I7.05(I Sxa), Florida Statutes, the following notarial eMificates is suwkient for an acknowle4ment in an indiyidual capecily. STAT11 OF FL 1 COUNTY T8c foregoing inslrumeN was acknowledged bsW me this/? day ofrid! 20;A by (n me of person acknowkdgorg), 20,2i, _ +'z!- e _ i, ......... (Si Marne of Notary-1Y%d, Priw rlo-rG 1N1,l. Personally Known k1 OR Produced Wadficalkm Type of ldcntificalion Produced Packet Pg. 86 8.B.1 March 22, 2023 Broward county contractor licensing board BUILDING CODE DIVISION I CONTRACTOR LICENSING 2307 West Broward Boulevard, Suite 300 Fort Lauderdale, Florida 33312 SUBJECT: LETTER OF RECOMMENDATION — CONTRACTOR'S LICENSE To Whom it May Concern, It is my pleasure to write this letter on behalf of Hunter Jones regarding his determination towards obtaining a contractor's license. We have known Hunter for a while and can vouch for his character as a great potential contractor. I am familiar with Hunter's work ethic and can appreciate the passion he has for construction. He demonstrates his vast knowledge of all phases of the Construction process. He is a team player, well organized and will go to great lengths to ensure the job is completed and done properly. Hunter is very personable and has shown the capacity to lead a team while maintaining professionalism. He is punctual, hard-working, and -dependable while on the job. Overall, Mr. Jones is an integrous, well-spoken, solution oriented individual and it is in my opinion that he would be considered an asset to any project he is involved in. Please feel free to contact me should you have any questions. BaRq< Sincerely, = �4.vo 3 �� '�;• No 5 ?c L#:. �E&1 Andres Boral, PE, MB 'A F1o .1fto Boral Engineering & De41W all}������ Florida Professional Engineer License Number: 80373 23150 Fashion Drive Suite 230, Estero, FL 33928 F. 239-692-0509 G www.boralengineering.com Packet Pg. 87 8.B.1 Modern Roof Solutions LLC CCC 1327283 2129 SW 50« Lan Cape Coral FL (239) 3333-6389 Modernroofsolswflftahoo.com APR IL25, 2023 Whom It May Concern Dear [Recipient], This letter services as a reference for SW FL Structural Contractor. Modern Roof Solutions LLC has used the services of SW FL Structural multiple times in the past. Their services have been contracted from minor drywall repairs to stucco repairs. Examples include drywall ceiling damages to stucco repairs on gable end and stucco stop flashing. SW FL Structural has been a reputable and responsible contractor for all service needs in the field of stucco and drywall repairs. Modern Roof Solutions LLC will continue to use SW FL Structural and recommends their services. Regards, L zaro Pena Modern Roof Solutions LLC CCC 1327283 2129 SW 50'h Lane Cape Coral FL, 33914 (239) 333-6389 Shio(— �:Aai;da -1 tr'i� •:• EILEEN LD37 Notary Public • St Commission p �r My Comm. Expite bonded through Nation dc��O�Rq 1h 5k{ •.� W nS 0,0C_r�Uv11eJi C � �£�oCe `rn, CAR.,/ m rb M to CD N Packet Pg. 88 83.1 Goer County Growth hlanagentenl Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: Hunter Jones Certificate Category Requested: BesidentiaLQQntractor 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 hisiher 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 for the above -named applicant must provide the following information: Name:1QWAc1 _ - Title: IAM Business Name: A rdvi u- ,. 7Ur r&170A) ?C�ONsi -m( mcll jc fir, Phone: 4I0 iA`�� Z License No. (if applicable): G SG I _7 7 Business Address: -g�,3Q r'"4 A W la- � sC} ite-1, � - �5 7 Street city State Zip The applicant was employed by me from 910212021 to Applicants title: Swervisor/Foreman The applicant's'scope of work (specific duties) included: Overseejo_c Structural operations and interior operations. Additional comments: C01T1mP_rrja1 R RgSjdential work NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. Under penalty of perjury, I declare that the facts stated here are true. L� Signature of persn p vid g the statement State of 6 c forego'?a trtsirumctakwas acknowledged before tic by nicans of ❑ physical presence or O online notarization on this clzy of .�,5..._• 20Z� , by Such person(s) Notary Public must check applicable box: :rrc personally known to ine O has produced a current driver license CI has produced (Notary Seal) r M P& •. EILEEN LQOR ii Notary Public • State of Florida ®`` Commission N HH 133 .73 ortti My Comm. Expires Feb 27, 2026 Bonded through Nationat Notary Assn. Contracon as identification. Notary Signat Page 11 of 14 Operations & Ragulatofy Management Division. Contractor Licensing . 2800 North Horseshoe Drive • Naples, FL 34104 + (239) 252-2431 c o n 1*Kc to r s t icou n t yil_gp y hi tps:/lmail.google.comlmai 11u101#inbox?projector=l m 00 c� r W W F4 Packet Pg. 89 „WM-'” wyd De arinxnt Conlraclot Licensligl 2600 N,Ildrseshoo Dr. Naples, FL 34101 230-252-2400 APKICATION FOR COLLIER COUNTY CERTIFICATE OF CQMPErENf-Y VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name A jft�ry— /5�V(1e S CerliftcatoCategoryRequoslod l°nec-a� UlltirA%'+f_j COAAcYate-+CJY- The applicant [s snaking a Callker County Certificate of Competency In the credo Indicated above As part of the application for this certificate, the applicant must verify hisn)er experience within (his trade, You Lira being requested to provide Informollon [hat will did the applicant in meeting this requirement You should verify Ilmo of aclivo oxpodanco working as an apprentice or a skilled worker (o g , as a worker commanding the wage of mechanic or bolter In the trade). Time served solely In n supervisory or administrative role should be described, but may or may not be considered sufficient to damonslrale required trade experience. Tito person verifying trade experience for the above -named applicant must provide the following Information. Name ! G Business Noma POkAh Phone' 2 3 9 — `:0 1 Business Address 3 (po (P SUeet Sri on Tilla: Ot3�+> tic- tao91s=1 2 License No. (if applicablo): S! a,,tli_k Z�W The applicant was employed by me front City Noj?VL VL 340,u4 Slain Zip Applicant's title On s0 a The appllcani's ccopo of work (specific duties) Included ' C U r r� f5icr�mc �,nts r }^�uncr i ['rw' crn Urr�ereul u.7`t'r z'crls Additional comments NOTE TO LICENSED CONTRACTORS. Falsifying onyinlormationprovided horoinmay subiocl your license to revocation Under penatly of pcl)ury, I dcclaro that the fads staled hero are true. /� _ ��y}} Grgnntuio of person Idmp the atalernent Staleol, /lr /II �N j counlyof I tic furet;iring areal wds ackuowlcdged bef we Ile I))yntc;uls of Wphyslcal presence or ❑ online notnriyation ur) diix 'N"tlu 21) �y, by . -- Al" h— Z .y SULll per.-Ain(N) N+rlary pilblic ua)tit tlieck uppIk;ihIc hux: j(K,ue per:a�nally t:nuv,)t In wr 01las prisdijued it laurel driver Ittensc ❑ h.rs priw1m cd _ __—_-- - --_.- _�_ _ as idcrllific;dluu. fNutr)ry titan t ..t �k MAITHEW THOMAS SCHAFER �f } r. r'� 3 NOTARYPUBLIC•MINNESOTA NnLIry 51t;unhin': ' 1�f`' My CommissionU%pir66 k/.0 i, January 31, 2025 J v - x7"1tiTr I"Item..App"llim dtk t Rov ,11"WIM0 Pzjx I I ul I Packet Pg. 90 Employer Experience Affidavit 8.B.1 Instructions; • The applicant is requesting that you certify as to your knowledge of their experience by completing this form. • It Is being used to support the applicant's qualifications. • This verification Is required to be completed by a current or previous employer holding a contractor's license', • Please attach a copy of your (verifier's) contractor's license to this document. • This form maybe duplicated. Please note: All information reported in the above affidavit will be verified Applicant Information: First Name: 14 Last Name: Trade Applied for: Qualifier Employer Verification: 1. Employment Start Date: 17 End Date: 5 2. Presently Still Employed: Q Yes QNO . 0 )ascribe •in detail theC positions held and type of work performed: C-V 04) 4. Types of buildings, strL �� 9,0,�A Business Name: Contractor's License Number. Street Address:. � City: l n State: i)o in �2 zip: Phone Number. �l ^a�.� -a? Email: Gt 0 Cel t!e/���! anlraJi'-c carp I certify that the information provided above is true and correct. 4 C loe-s First Na irsNa f» 9 Last Name: b Slgnature of Gont actor: y Date: �1,- , �I_. c,7, sign before public notary - County of Ca 1 The �1,e�,onlnsttumen twsacknowledged efore me thisdof, _(`� __ . 20by •,: ho Is per>onally known t�me tiel> a rlw Id (,.� r7�e., DOREEN J 2ENESKI a O+lLtl °:* s L�:; Notary ?ublic -State of Florida Cornmisslon # GG 342915 My Comm. Expires Jul 6, 2023 Notary's Signaturo and SealBonded through National Notary Assn. m 00 M Packet Pg. 91 F 8.B.1 CO ier Cou ty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY m 00 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER r STATE OF V z J COUNTY OF H V y"Camn , having been first duly sworn, state and affirm: I am a resident of . AL-?—C __ County, V�br&k (State) and have resided here for more than five (5) years. During the last five (5) years I have known _kjrn�O.f \C- (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. Signature Printed Name Address:9,-?,2 5 c6yuS S-�- Street Kti oRkk-,s L- t?-B city State Zip Telephone: 110. - 2-3 k- 3 6 8 O State of (yL County of �� �' � k t - T e foregomi instnunent was acknowledged before me by means of physical presence or ❑ onluie notarization on this AR_day of�� 20 2-& by �7 roww, \�e) Such person(s) Notary Public must check applicable box: ❑ are personally known to me Its ias produced a current driver license 1 "liasproduced_l. 4(p �ijQ-I identification. (Notary SegzHatAon iLEEN LOOR 7 State of Florida CZe� Public' at 233372016 missioneb 21,Ex icesF gssn.m. P Notary SignaI� ough Nation3V Notary Contractor Licensing — FIRM Application Rev. 7/2022 Page 14 of 14 Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing0collierco unlvtl.aov Packet Pg. 92 _ s Growth Management Community Development Department 8.B.1 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF QC)v,(..G COUNTY OF !' 1, ri� tlill� ), -LT - f D , having been first duly sworn, state and affirm: I am a resident of A111 C'iY County, h IU n,( Ca, (State) and have resided here for more than five (5) years. During the last five (5) years I have known - oyNr e ne-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. State of 1' L- County of U ! , The foregoin instrument was aclarowlei Lkday ofN, 20 -: 2-3, by Signature Printed Flame Address: 111 )IS l A�s sk- Street V--,L- 3 14 (0 City State zip Telephone: 23 CA— me by means of qlpi�ysical presence or ❑ online notarization on this Such person(s) Notary Public must check applicable box: C7 are personally known to the ❑ has produced a current driver license n rt_ ��- o e lias produced lam- , , , " q,6 --7 SZ as identification. (Notary Seal) � �i p�, EILEt N LOOR ', Notary Public - Slate of Florida ■i Will371 sio fires feb327, 2026 d' My Comm, Exp Assn. ..off`"' h National Notary Notary Signature: Bonded tttroug Contractor Licensing — FIRM Application Rev. 712022 Page 14 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorslicensing@colliercountyfl.ctov 00 00 M r W W F4 Packet Pg. 93 ACC)Rf> CERTIFICATE OF LIABILITY INSURANCE DATE F06/15/2023 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 have ADDITIONAL INSURED provisions or be endorsed. m If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on 00 this certificate does not confer rights to the certificate holder in lieu of such endorsement(&). PRODUCER CONTACT NAME r BIBERK N FAX 203-654-3613 PHONE 844 - AIC 4720967 No Ext : (Air -,No): P.O_ Box 113247 _ E-MAIL customerservice@biBERK.com ADDRESS: Stamford, CT 06911 INSURERS AFFORDING COVERAGE NAIC# V Z _ INSURER A: Berkshire Hathaway Direct Insurance Company 10391 INSURED SWFL Structural Inc 3148 50th Street Southwest Naples, FL 34116 INSURER E: 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. NOTW#THSTANDING 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 LTR TYPEOFINSURANCE ADDLSUBR S POLICY NUMBER POLICY EFF MMlDDIYY POLICYEXP MMlOD LIMBS X COMMERCIALGENERALLIABILITY EACHOCCURRENCE 5 1 OOO O00 CLAIMS-MADE1XI OCCUR DAMAGETORENTEO PRET(!S>=S oavrtance S 50 000 MED EXP (Any one person) $ 5,000 A N9BP420881 06/11/2023 06/11/2024 PERSONAL B ADV INJURY $ Included AGGREGATE LIMIT APPLIES PER: GENERALAGGRMATE $ 2,000,000 GEHL POLICY jEC7 LOC PRODUCTS-COMPIOPAGG5 2,000,000 S X OTHER: AUTOMOBILE LIABILITY COMBMEDSINGLEUMIT Ea accident $ BODILY INJURY (Per Person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per aocidert) $ PROPERTY DAMAGE Per acddeni $ --— HIRED NON -OWNED AUTOSONLY AUTOSONLY 5 UMBRELLALIAB HCLAIM&MADE OCCUR I EACHOCCURRENCE $ AGGREGATE 5 EXCESS LIAB DED RETENTION$ S WORMRSCOMPENSATION AND EMPLOYERS LIABILITY .I I N PER OTH- STATUTE ER E-L. EACH ACCIDENT $ ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICERlMEMBEREXCLUDED7 ❑ NIA EL DISEASE -EA EMPLOY $ (Mandatoryin NH) R yes. describe under DESCRIPTION OF OPERATIONS bela E.L. DISEASE -POLICY LIMN $ Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES (ACORD797, Add Hional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION Collier County Contractor licensing Board 2800 Horseshoe Dr N Naples, FL 34104 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 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Packet Pg. 94 Ac � CERTIFICATE OF LIABILITY INSURANCE °AT�'MWDD»"YY' f>✓� F06/15/2023 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 poficy(ies) must have ADDITIONAL INSURED provisions or 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(&), PRODUCER CONTACT NAME biBERK HONE Ext : 844-472-0967 _ plc No : 203-654-3613 P.O. Box , CT 06 E-MAIL customerservice@biBERK.com Stamford, CT 06911 ADDRE55�__ National Liability & Fire Insurance Company 1 20052 INSURED INSURER B_ SWFL Structural inc INSURER C 3148 50th St SW I INSURER D Naples, FL 34116 1 INSURER COVFRAGFS C1=RTIFICAW NIIMRFR: RFVISIOPJ Nl1MRFR- 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 W1ICH 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. [IfSR------- TYPEOFINSVRANCE_._,--�ADUL SUBLi—�V�—POLICY NUMBER MMIDP/YYFF MPDLICYEX LT t INSD MIDD/YYP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 U _ CLAIMS -MADE � OCCUR — E TO RENTED PRIM SES Ea occurrence S _ .. . _ _ 0 IVIED EXP (Any one person) 5 0 PERSONAL & ADV INJURY $ 0 LIMIT APPLIES PER: GENERAL AGGREGATE S 0 GFULAGGREGATE POLICY1-1 JEGT LOC PRODUCTS -COMPIOP AGG S 0 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE U WT Ea accident $ BODILY INJURY (Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accdent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S U MBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE S DED I I RETENTION$ A WORKERSCOMPWSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORlPARTNERlEXECUTIVE YIN OFFICERVEMBERFxCLUDED? NIA N9WC431003 06/13/2023 06113/2024 X 8TA UTE ERN EL EACH ACCIDENT $1 000 000 EL DISEASE -EA EMPLOYEE S1,000,000 (Mandatory In NH) N yes, desoibe under DESCRIPTION OF OPERATIONS below I EL DISEASE -POLICY LIMIT $1 000 000 Professional Liability (Errors & Per Occurrence/ Omissions): Claims -Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161, Additional Remarks Schedule, may be attached it more space is requited) Exclusions: Hunter Jones; GCItIIrIGHlt t1ULUr-K GHIVI,CLLA I IUtV Collier County Contractor licensing Board 2800 Horseshoe Or N Naples, FL 34104 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 83.1 Packet Pg. 95 � 'e m JIMMY PATfaONfS 00 CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES r DIVISION OF WORKERS' COMPENSATION N * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * Z CONSTRUCTION INDUSTRY EXEMPTION Q This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 5/31/2023 EXPIRATION DATE: 5/30/2025 H PERSON: HUNTER K JONES EMAIL: HUNTER@SWFLSTRUCTURAL.COM co J FEIN: 923024279 BUSINESS NAME, AND ADDRESS: W SWFL STRUCTURAL INC 0 3148 50TH ST SW NAPLES, FL 34116 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under [his section may not recover benefits or compensation under this chapter- Pursuant to subsection 440.05(11), F.S., Certificates of election to be exempt Issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), 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 revolve a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 01/2023 E01730120 QUESTIONS? (850) 413-1609 Packet Pg. 96 8.B.1 ant�itM 1Na4di MaFleb—� bMWt08Fk11r1et1Fl�stc�.l.c.... i m 00 M to co N Packet Pg. 97 INSTR 6437774 OR 6275 PG 2887 RECORDED 8/7/2023 3:14 PM PAGES 1 CLERK OF THE CIRCUIT COURT AND COMPTROLLER, COLLIER COUNTY FLORIDA REC $10.00 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY JONES, HUNTER•KU E- 1 3148 50TH ST SW---' 4 NAPLES, FL 34116. CLB Agenda Date: Pursuant to Section 489.127, J Department/Licensing Section issuance of the Citation, THE PENAL Hi (g), Florida Statutes, the violator is heretly ( days from the date of mailing a copy of th. the Citation. If the penalty is not paid in full % in the public records of Collier County anti real or personal property owned by the violz lien which remains unpaid, the Contractor Attorneylto foreclose on the lien. Print Name Attorney to the CLB KEVIN NOELL Operations and Regulatory Management ,tne amount of $2,000.00, within 10 days of ,8. NOT BEEN PAID. Per Section 489.127(5) ERED to pay that penalty in full within 15 3RD�R to the violator's address as noted on dt it'i�•:�' days, this ORDER may be recorded t pre�- �c' shall constitute a lien against any :6 AFter.8,,months from the filing of any such Licerfsii�g:-$ and may authorize the County `. DATE." Code Enforcement Managed '-� TIMOTHY CROTTS j For Contractor Licensing Board * If the 151h day falls on a Saturday, Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. STATE OF FLORIDA il Approved as to form and legal sufficiency COUNTY OF Co The for egQ1ng instrument was acknowledged before me by means ofphysical presen or I J online no riza o hisliq Ytty�� dayo J 20 by t (�1 e�*v AS►6 DOMAI�l.DIItACM Nota blic's Signat r Notary Name �h'esParchI16,2W Per a1 Known OR Produced Identfication Type i Id ntification Produced m 00 c� r t0 N Packet Pg. 98 ,r �r INSTR 6437773 OR 6275 PG 2886 RECORDED 8/7/2023 3:14 PM PAGES 1 wax CLERK OF THE CIRCUIT COURT AND COMPTROLLER, COLLIER COUNTY FLORIDA $ B 1 REC $10.00 CONTRACTORS' LICENSING BOARD COLLIER COUNTY, FLORIDA ORDER TO PAY CIVIL PENALTY JONES, HUNTER(UL ,E.N 3148 50TH ST SW-=- NAPLES, FL 34116,,'', =`s CLB Agenda Date; Pursuant to Section 489.127, DepartmentlLicensing Section issuance of the Citation, THE PENAl.TYHt (g), Florida Statutes, the violator is he�4by'� days From the date of mailing a copy of th the Citation. If the penalty is not paid in 1`61 `1 in the public records of Collier County and real or personal property owned by the viol., lien which remains unpaid, the Contractor Attorney jo fgfeclose on the lien. V i L e- CI-JAIRMAN Print Name Attorney to the CLB KEVIN NOELL Operations and Regulatory Management t+mount_of 12,000.00, within 10 days of 3T BEEN PAID. Per Section 489.127(5) RED to pay that penalty In full within 15 2R to the violator's address as noted on 1' days, this ORDER may be recorded bt shall constitute a lien against any ftep.:�•fnonths from the filing of any such tsing a and may authorize the County �o DATE;; Code Enforcement Managef_-- ', TIMOTHY CROTTS"� For Contractor Licensing Board * If the 15th day falls on a Saturday, Sunday or holiday, the entire fine must be paid no later than 4:00 P.M. on the County s next business day following that weekend or holiday. STATE of rio��t°AApproved as to form and legal sufficiency COUNTYOF_ L24-pL_ The foregoing instrument was acknowledged before me by means f hysical presence or I ]Online otarizatio this day of 20a, by % ,eV�Y►k�, �F �6 IL n�uLLDELACM . e r L a r(� Z * * IontMt#ttTJd,� Notary ttC's Sign t e Notary Name r'ersona nown � OR Produced Identification M� 16,202? Type of a tiricabon Produced Packet Pg. 99 8.B.1 9112123, 11:47 AM Detail by Entity Name DIVISION OF CORPORATIONS Dj,m;rc.%o of i - 5 rill f4lif ul :S'lru;' r111.7orfrlrl s: F b.Ilr?. Department of State / Dly[slon of Corpora@ans 1 Search Records ! Search Emily. Name / search.sunbiz.orglInquirylCorporationSearchlSearchResultDetail7inquirytype=EntiityName&directionType=Initial&searchNameOrder=HO Packet Pg. 100 8.B.1 9112/23, 11:47 AM 1 2022 10/13/2022 2023 02/12/2023 Docu e t ggs 02/12/2023 — ANNUAL REPORT View Image in PDF format 10113/2022 — REiNSTATEMENs View Image In PDF format 12/21/2021 — Florida Limited Llabiltty.. View image in PDF format Detail by Entity Name F1.6da D.rad—t ar St te, biv}x'.on 0 Cnrpxali�n. m 00 oe) W W search.sunbiz.org/inquiry/CorporationSoarchlSoarchRosultDolall?inquirytype=EntityName&directionTypo=lnitial&searchNamoOrder=HO Packet Pg. 101 8.0 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.0 Doc ID: 26614 Item Summary: 8C. DUSTY L. LOEWEN — REVIEW OF EXPERIENCE — RESIDENTIAL CONTRACTOR - SUPREME SERVICES AND MORE LLC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:28 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:28 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:30 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:01 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 102 V229.9 -.-./ / 19, ai4l- Colfler County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY 8.C.1 FIRM APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ General $230.00 ❑ Building $230.00 '16 Residential $230.00 ❑ Mechanical $230.00 ❑ Roofing $230.00 Specialty Trade: I. APPLICANT PERSONAL INFORMATION: Name: b First Middle Initial Business Name: SOD C-UA4— (' 1#`NZS C" Address: _ q S 1P b ia. fit\ P1, Street City Email: �1���'�•1-�V�f9��G�-�il�`'1G1� Telephone: I�Ao-) ` 11`p - 3 0 Date of Birth: ❑ Electrician $230.00 ❑ Plumber $230.00 ❑ Air Conditioner $230.00 ❑ Swimming Pool $230.00 ❑ Specialty $205.00 Last State Zip *SS # (Last 4 digits only): 029 j� Driver's License # (Last 4 digits only): v Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit Choir social security number, driver's license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized by law. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing — FIRM Application Rev. 712022 Page 3 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing colliercountvfl.pnv Packet Pg. 103 8.C.1 1.6.1.3. Residential Cofttmctor requires (arty -eight (48) months experience with a Passing grade on die a ved test and a business and law test and =4ns a contractor whose se-r-ACfs are lirnited to consft ction, re]]xo irks, repair, or improvement of ene-family, two�-farniiy, ()r three.fanjily resi noes not exceeding two stories ill height and accessary use strxtctur in connection therewith_ Packet Pg. 104 8.C.1 11* 3456 81" Ave SE, Naples, FL 34117 239-776-0306 Supremeservicesandmore@comcast.net Supreme Services & More N August 18, 2023 To Whom It May Concern: I, Dusty Loewen, would like to withdraw my application for Building Contractor. After my conversation with Tim Crofts, we both agreed it is best for me to pursue and apply for the Residential Contractor license. I have well over the a years' experience and knowledge needed for this license. I have built single family homes from the ground up, start to finish in California with my State Certified GC license as well as in Florida with Fortress Custom Builders. I would like to be considered for the Residential Contractor's license, Thank y u, Dusty Loewen Packet Pg. 105 COt r Count y Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Provide the names and telephone numbers of two persons who will always know your whereabouts. Name: & OI'l LAXWgn Name: Telephone: �-3 �) _ �� a'�5,� Telephone: J It. NAME OF APPLICANT'S BUSINESS-. Business Name: ' Business Address: 2q�- 6 946 Street Telephone: Email: ,S° W 4L l State Zip Federal ID Tax No.: ��-, — � � D 0 )— ^ Ill. FINANCIAL RESPONSIBILITY 8.C.1 YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: / Filed for or been discharged in bankruptcy within the past b years? / Had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? VUndertaken construction contracts or work that resulted in liens, suits, or judgments being filed? Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Made an assignment of assets in settlement of construction obligations for less than the debts tY/ outstanding? Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of y adjudication, a crime in any jurisdiction within the past 10 years?* Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been subject to" disciplinary action by a state, county, or municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment.*If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — FIRM Application Rev. 712022 Page 4 of 14 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (23 contractorslicensing .colliercauntvfl.ctov Packet Pg. 106 CoLLier Count Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY IV. EXPERIENCE VERIFICATION 8.C.1 EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this, application is being made: List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: List below and attach copies any other certificates of competency/licenses you holdlhave held in Collier County or any other jurisdiction. include the license #, Type, and county you hold it in. AFFIDAVIT Under the penalties of perjury, I declare that I have read the foregoi application and the facts stated in it are true, �v Lo e�� erl Applicant (please print) Signature of Applica t State of V-1 D r %�.a , County of The foregoing instrument was acknowledged before me by weans of R physical presence or ❑ online notarization on this Q-1 day of ,)LLI u , 20.?�., by ,� .i L4'LL�)Q r) -- Such person(s) Notary Public must check applicable box: Aare personally known to me ❑ has produced a current driver license ❑ has produced as identification. (Notary Seal) YPV e°1.....•°t'o JANICE WILLIS * COmMISSIa1 # IiH 411093 Or fLO� Expires July 23, 2027 Notary Signature: t� Contractor Licensing -- FIRM Application Rev. 712022 Page 5 of 14 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North horseshoe Drive • Naples, FL 34104 • (233959-9,01 contractorslicensina dcolliercountyf1.gov Packet Pg. 107 Co�er County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION OF APPLICATION 8.C.1 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 orsuch 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. State of �f 1 j) r cC)0-' County of l 1" The foregoing instrument was acknowlec It day of 20 � > by mw'n Applicant (pleas print t sa Nam, am l r l �OLE 011 Wei. of C mpa Sigrfature of Applicant before me by means of Cyphysical presence or ❑ online notarization on this Such person(s) Notary Public must check applicable box: .'`are personally known to me ❑ has produced a current driver license ❑ has produced_.. as identification. (Notary Seal) g1�'RY PUB�ic JAWCE WILLIS * * Commission # HH 411093 Notary Signature: i Explres July 23, 2027 _ - - - FOFFlO v r W to F4 Contractor Licensing — FIRM Application Rev. 712022 Page 6 of 14 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 * (239) 252-2431 contractorsticensinQCc)colliercountytl.gov Packet Pg. 108 Col Comity Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY WORKMEN'S COMPENSATION AFFIDAVIT 8.C.1 It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. Applicant (plaa ,!y print C W., O-AZ '. Name omp y Sidnatu)xrof Applicant BEFORE ME this day personally appeared � Vs�lp t owy, _ who affirms and Applicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of iAr) �. County of �n�1 The foregoing instrument was acknowledged before me by means of Ophysical presence or ❑ online notarization on this day of , 20 _ , by i�c., s e ( OC n Such person(s) Notary Public must check applicable box: CAre personally known to nee ❑ has produced a current driver license ❑ has produced as identification. (Notary Seal) p�v rua4c JANICE WILLIS �' C0MMj3sion # HH 411093 Notary Signatur S QoQ Explres July 23, 2027 OF Fin v r to to F4 Contractor Licensing — FIRM Application Rev. 712022 Page 7 of 14 Q Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive . Naples, FL 34104 • (239 contractorslicensin colliercoun fl. ov Packet Pg. 109 CREDIT CHECk 8.C.1 CONFIDENTIAL r Individual Credit Report N Name ... :LOEWEN, DUSTY LEE Ordered By:18516 ' Address:3456 8TH AVENUE SOUTHEAST Customer .9999 i NAPLES, FL 341.1.7 Received : 06/28/23 Social#: Applicant: — Completed - 06/28/231 i CREDIT SCORE: ' APPLICANT FICO SCORE: 674 (scores range from 300 to 854) SOURCE(S): EXPERIAN TRANSUNION PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE LOCAL, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS AS OF 06/28/23: CLEAR CREDIT RECORD (Credit: history has been checked for a period of seven years or from open date.! i Creditor Date Date High Unpaid past Historic Status Current MOB Account Number Reported Opened Credit Balance Due 30 60 90 status Rev ECO 1 I AFFIRM INC I AS AGREED 65SWRLKN 11/21 07/21 1955 0 0 00 00 00 101 04 I! DLA=11/21 ALLY F'INCL 673927352434 DLA=01/22 ALLY FINCL 228005044944 DLA=06/23 01/22 10/19 06/23 01/21 CAP ONE AUTO 62063566021871001 11/19 12/17 DLA=11/19 CAPITAL ONE 517805884838 DLA=06/23 CAPITAL ONE 517148803915 DLA=06/23 06/23 09/18 06/23 07/22 AS AGREED 46378 0 0 00 00 00 101 26 1; AS AGREED i 22947 0 0 00 00 00 101 27 C', AS AGREED i 33086 0 0 00 00 00 101 23 I; AS AGREED 760 28 0 00 00 00 R01 48 I! AS AGREED 1412 1412 0 00 00 00 R01 10 I Licensee Applicant: APPLICANT - SEE NAMES ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. Packet Pg. 110 CREDIT CHECK 8.C.1 CONFIDENTIAL r t0 Name: LOEWEN, DUSTY LEE Customer: 9999 Page:2 N CAPITAL ONE AS AGREED 517805801451 06/23 08/15 1324 0 0 00 00 00 R01 48 I w DLA=06/23 O 2 CBNA AS AGREED o 426938083167 06/23 03/19 4816 1005 0 00 00 00 R01 48 I Q DLA=06/23 y w U_ CULS/CINCH AS AGREED > 2997093 05/23 12/21 55058 46368 0 00 00 00 101 17 I Lu DLA=05/23 w M DISCOVERBANK AS AGREED w W 601101442781 06/23 12/21 3327 1313 0 00 00 00 RO1 17 I a- DLA=06/23 Cn FLAGSTARBANK AS AGREED 6460472025287 06/23 03/19 358290 333420 0 00 00 00 M01 48 I Q DLA=06/23 z GM FINANCIAL AS AGREED 111038405733 06/23 08/20 42448 27563 0 00 00 00 101 34 C Q DLA=06/23 z JPMCB CARD AS AGREED w 2 414740033605 06/23 01/22 5031 4968 0 00 00 00 R01 16 I w DLA=06/23 i w LIGHTSTREAM AS AGREED U LS90509528 05/23 03/19 20070 11429 0 00 00 00 I01 48 I w DLA=05/23 w a X SHEFFIELD AS AGREED w 2109180309 05/23 12/21 11216 8843 0 00 00 00 I01 17 I p DLA=05/23 3: w SPRINGOAKCAP COLLECTION w 111265238 06/23 10/21 415 415 415 -- 09B -- I ORIGINAL CREDITOR: STERLING JEWELERS INC z w 3-1 SYNCB/CARECR AS AGREED w 601918369000 06/23 06/20 8110 1419 0 00 00 00 R01 35 I 0 DLA=06/23 SYNCB/CUTEDG AS AGREED 603462OB2643 06/23 11/22 9696 7367 0 00 00 00 R01 07 I o DLA=06/23 U 00 SYNCB/KANESF AS AGREED c 601919280247 04/21 03/19 2000 0 0 00 00 00 R01 25 I t DLA=04/21 r a Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. Packet Pg. 111 CREDIT CHECK 8.C.1 CONFIDENTIAL V r t0 Name: LOEWEN, DUSTY LEE Customer: 9999 Page:3 N TELECOM SELF -RE AS AGREED 20720CSC368543GA9101/23 / 21 21 0 00 00 00 101 49 I w DLA=01/23 TELECOM SELF -RE AS AGREED i C30CB652AB7A4BC686 06/23 / 299 299 0 00 00 00 101 54 I; DLA=06/23 i THD/CBNA AS AGREED ! 603532095203 06/23 05/19 2054 1088 0 00 00 00 RO1 48 I DLA=06/23 TRUIST AS AGREED i 518367000021 06/23 09/18 5158 4077 0 00 00 00 R01 48 I! DLA=06/23 i TSC/CBNA AS AGREED j 498563000080 06/23 05/23 133 0 0 00 00 00 R01 01 I' DLA=06/23 i UTILITY SELF --RE AS AGREED i 6506A1AD9F244EC38E06/23 / 345 345 0 00 00 00 I01 54 I DLA=06/23 i i WELLS FARGO AS AGREED 442644103097 02/16 11/13 0 0 0 00 00 00 R01 26 I DLA=02/16 i Total trade lines on this report: 26 INQUIRIES: 05/04/23 by TRACG/CBNA (EXP) #2947378 01/23/23 by JPMCB CARD (EXP) #2920596 i 01/17/23 by JPMCB CARD (EXP) #2920596 12/31/22 by AMEX (EXP) #2916657 11/14/22 by THD/CBNA (EXP) #3184050 11/10/22 by EXPERIAN BUSINESS CRED (EXP) #4301099 i 10/11/22 by CATERPILLAR FINANCIAL (EXP) #1532230 07/29/22 by CAP1/BASS (EXP) #2897500 01/14/22 by JPMCB CARD (EXP) ##1797500 i 12/28/21 by DISCOVER FINANCIAL SER (EXP) #1224590 ' 1.2/23/21 by NCCINC/COCONUT POINT F (EXP) #2906050 12/23/21 by CAPITAL ONE AUTO FIN (EXP) ##1254780 12/23/21 by ALLY FINANCIAL (EXP) #2100547 12/23/21 by ALLY FINANCIAL (EXP) #2393490 11/24/21 by CATERPILLAR FINANCIAL (EXP) #1532230 11/03/21 by AMERICAN EXPRESS KABBA (EXP) #1126348 i 09/15/21 by EXPERIAN BUSINESS CRED (EXP) #4301099 07/12/21 by AMERICAN EXPRESS KABBA (EXP) #1126348 11/10/22 by SYNCB (TU) #4853553 11/10/22 by SYNCB/CML (TU) #2664951 Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. ( Packet Pg. 112 SM CREDITCHECK CONFIDENTIAL r Name: LOEWEN, DUSTY LEE _. Customer: 9999 Page:4 N INQUIRIES - continued: 10/06/22 by KUBOTA L.O.0 (TU) #1307 07/29/22 by CAP1/BASS (TU) #3847656 12/23/21 by CULS/CINCH (TU) #4005027 12/23/21 by COCONUT POIN (TU) ##6211432 12/23/21 by COAF (TU) ##1246538 09/15/21 by SYNCB/LOWES (TU) #1199407 RESIDENCE HISTORY: 3456 SE 8TH AV, 852 N 96TH AV, 1048 COOPER DR, COMMENTS: NAPLES FL 34117 NAPLES FL 34108 NAPLES FL 34103 ***OFAC NAME SCREEN ALERT - CLEAR*** OFAC (OFFICE OF FOREIGN ASSET CONTROL) IS A FEDERAL AGENCY WHICH MAINTAINS A DATABASE OF TERRORISTS, DRUG TRAFFICKERS AND CRIMINAL ORGANIZATIONS. FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ACCESSED BUREAUS. CHECKS FOR IDENTITY THEFT, FAKE SSN, DECEASED SSN AND OFAC DATABASE PERFORMED CREDITOR PHONE DIRECTORY: CAPITAL ONE PO BOX 31293 CAPITAL ONE PO BOX 31293 CAP ONE AUTO CREDIT BUREAU DISP FLAGSTARBANK 5151 CORPORATE DRI ALLY FINCL P.O. BOX 380901 THD/CBNA PO BOX 6497 JPMCB CARD PO BOX 15369 CBNA PO BOX 6497 TSC/CBNA PO BOX 6497 TRUIST PO BOX 849 CULS/CINCH 10800 ALPHARETTA SHEFFIELD PO BOX 25217 LIGHTSTREAM PO BOX 849 GM FINANCIAL PO BOX 181145 WELLS FARGO I'll BC1DTV001 (800) 955-7070 SALT LAKE CITY UT. 84131 BClDTV234 (800) 955-7070 SALT LAKE CITY UT. 84131 FA1W2K001 (800) 946-0332 PLANO TX. 75025 BM2525001 (800) 968-7700 TROY MI. 48098 FA259237L (888) 925-2559 BLOOMINGTON MN. 55438 BZ26H3005 SIOUX FALLS SD. 57117 BC26QK001 (800) 945-2000 WILMINGTON DE. 19850 BB292FO31 (888) 574-1301 SIOUX FALLS SD. 57117 BC292FO55 (800) 263-0691 SIOUX FALLS SD. 57117 EB295SO59 (866) 635-1330 WILSON NC. 27894 FA2ARF001 (404) 669-5380 ROSWELL GA. 30076 FZ40ZM002 (336) 766-1.388 WINSTON SALEM NC. 27114 131423AO67 (866) 635-1330 WILSON NC. 27894 FZ44WK001 (800) 284-2271 ARLINGTON TX. 76096 BC908N664 (800) 462-4720 Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. Packet Pg. 113 CREDIT CHECK 8.C.1 CONFIDENTIAL r t0 Name: LOEWEN._DUSTY LEE Customer: 9999 Page:5 N CREDITOR PHONE DIRECTORY - continued: PO BOX 14517 DISCOVERBANK PO BOX 30939 SYNCB/CARECR PO BOX 71757 SYNCB/KANESF PO BOX 71757 SYNCB/CUTEDG PO BOX 71757 SPRINGOAKCAP P.O. BOX 1216 COCONUT POIN 22400 S TAMIAMI TR CULS/CINCH 10800 ALPHARETTA H KUBOTA L.O.0 1025 NORTHBROOK PK CREDIT CHECK 3017 EXCHANGE COUR SYNCB/CML PO BOX 71724 SYNCB PO BOX 71724 SYNCB/LOWES PO BOX 71727 CAP1/BASS 15000 CAPITAL ONE LOAF 3905 N DALLAS PARK DES MOINES IA. 50306 BC9616003 (800) 347-268: SALT LAKE CITY UT. 84130 FZ999206T (866) 396-8254 PHILADELPHIA PA. 19176 FZ999209H (866) 396-8254 PHILADELPHIA PA. 19176 FZ9992770 (866) 396-8254 PHILADELPHIA PA. 19176 YC2H4W002 (866) 281-3061 CHESAPEAKE VA. 23327 A 6211432 (239) 498-367_ ESTERO FL. 33928 Q 4005027 (404) 669-538( ROSWELL GA. 30076 T 0001307 (770) 995-8851 SUWANEE GA. 30024 Z 0630273 (877) 616-555F WEST PALM BEAC FL. 33409 B 2664951 (855) 411-472� PHILADELPHIA PA. 19176 F 4853553 (800) 924-292, PHILADELPHIA PA. 19176 L 1199407 (800) 444-140t PHILADELPHIA PA. 19176 B 3847656 (800) 955-707C RICHMOND VA. 23238 F 1246538 (800) 946-033� PLANO TX. 75093 *** END OF REPORT *** 7 his rsonal r is famished si This inforrnatlon is confidential and is not to be d vulged excswt as required by Ihs Fa<r Credit Reportng Acf pe epori rnpty as an aid in detemdNng the credit desireN of the applipM(s). N Fs based utrppoonn Informatiar obtained in mood faith by [hfs agen y from sources deemed rebable. The accuracy of same, hovrever, Is h no way guaranteed By your acceptance and use of drls report, you specifically agree to Iwid Credit . Inc. handers from any lability whatsoever. Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. ( Packet Pg. 114 CREDIT CHECK Commercial Credit Report Company: SUPREME SERVICES & MORE, LLC Address:3456 8TH AVENUE SE NAPLES, FLORIDA 34117 Telephone: (239) 776-0306 F'KINUIPALS: OWNER/AR Address: Social Security Number: Stock Ownership: LOEWEN, DUSTY LEE 3456 8TH AVENUE SE NAPLES, FLORIDA 34117 -0819 100% MANAGER LOEWEN, JOAN C. Address: 3456 8TH AVENUE SE NAPLES, FLORIDA 34117 Social Security Number: N/A Stock Ownership: 0 0 Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: RISK SCORE: 8.C.1 CONFIDENTIAL Date: 06/28/23 Cust. No: 9999 Ordered By: 18516 Page: 1 (X) LLC CIA1. O02 OAA07A0f Ex Brian p Financial Stability Risk Score 1 Low Risk 39 -- - - ♦ 2 Low to Med 13 Medium Risk t , q Med to High 1-p ..._ _ _.-- _. .Excellent 160 5 High_ Risk j - - 39 - CREDIT RISK SCORE The score uses tradeline and collections information, public filings as well as other variables to predict future risk. Higher scores indicate lower risk, FACTORS LOWERING THE SCORE: * number of active commercial accounts * balance to high credit ratio for other commercial accounts * balance to high credit ratio for commercial accounts * risk associated with the business type Reported for: APPLICANT - SEE NAME ABOVE a Reported by: Credit Check, Inc. W 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. (561) 616-5556 Packet Pg. 115 CREDIT CHECK 8.C.1 CONFIDENTIAL Commercial Credit Report Company: SUPREME SERVICES & MORE, LLC Address:3456 8TH AVENUE SE NAPLES, FLORIDA 34117 Date: 06/28/23 Cust. No: 9999 Ordered By: 18516 Page: 2 SUPREME SERVICES & MORE, LLC was FORMED in the county of COLLIER, state of FLORIDA, on 10/10, 2017. The charter number is L17000209169. The registered agent is LOEWEN, DUSTY L. of 3456 8TH AVENUE SE, NAPLES, FLORIDA 34117. Offices are LEASED from N/A at N/A per month. The company employs N/A. NET WORTH: ON FILE WITH STATE The company maintains banking relations with TRUIST The officer handling the account is N/A - NAPLES, FLORIDA PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF LOCAL, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: CLEAR AS OF 06/28/23 - SEVEN YEAR SEARCH. *** Credit Profile *** BUSINESS DATE LAST PAY HIGH CATEGORY RPTD ACTIV TERMS CREDIT BALANCE CUR 30 60 90 91+ COMMENTS ---------- FINCL SVCS ----- 05/23 ----- 12/19 -------- LOC ------ 0 --------- 0 ---- 0% ---- 0% --- 0% --- 0% ------------- 0% INDUS MACH 05/23 00/00 CREDIT 7500 5600 89% 11% 0% 0% 0% ROOF CONTR 06/23 00/00 NET 30 0 0 0% 0% 0% 0% 0% BANK CARD 06/23 00/00 REVOLVE 9900 9900 100% 01 0% 0% 00-. EQUIP LEAS 05/23 00/00 ROI 0 0 0% 0% 01 006 Oo REMARKS: N/A = NOT APPLICABLE/NOT AVAILABLE REPORT WORKED BY KELLY END OF REPORT. This mmnexcial report is furnished simf y as an aid in detem"ng the erodit desirability of the apocant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable, The accuracy of same, trowever, Is In no way guaranteed. By your acceptance and use of this report, you spectficaly agree to hold Credit Check. Inc, hamVess from any lability whatsoever. Packet Pg. 116 6127/23, 5:55 PM Detail by Entity Name 8.C.1 DIvisiou OF CORPORATIONS 1� rj JI`miol'I 6f I�+Jl�:org C 'vPC)t�s��r���� s as «Ij( iril 3011le u1 Hwida It t 141f, Department of State 1 Division of Corporations I Search Records I Search 6v Entity Name I Detail by Entity Name Florida Limited Liability Company SUPREME SERVICES & MORE, LLC EWng Information Document Number L17000209169 FEIIEIN Number 82-3043702 Date Filed 10110/2017 Effective Date 10/10/2017 State FL Status ACTIVE Principal Address 3456 8th Ave SE NAPLES, FL 34117 Changed: 04/09/2019 Mailing Address 3456 8th Ave SE NAPLES, FL 34117 Changed: 04/09/2019 &gl§tered gent Name & Address LOEWEN, DUSTY L 3456 8th Ave SE NAPLES, FL 34117 Address Changed: 04/09/2019 Authorized- Pem=t&} Detail Name & Address Title MGR Loewen, JOAN C 3456 8th Ave SE NAPLES, FL 34117 Title Authorized Representative https:llscarch.sunbiz.org/InquirylCorporationSearchlSearchResultDetail?inquirytype=EntityName&dlrectfonType=Initial&searchNameOrder=SUPREM_._ 112 r W to Packet Pg. 117 6/27/2,1 5:55 PM Loewert, Dusty, Jr. 3456 8th Ave SE NAPLES, FL 34117 Annual RepDrtr Report Year Filed Date 2021 02/12/2021 2022 03/24/2022 2023 01 /19/2023 pocument Images 01/19/2023 --ANNUAL REPORT 03/24/2022 --ANNUAL REPORT OV1212Q21 --ANNUAL REPORT 06112/2020 --ANNUAL REPORT 0410912019 --ANNUAL REPORT 07/10/2018 --AMENDED ANNUAL REPORT 0311�,Q18 -- ANNUAL REPORT 1Q11Ql201I — 51prida Limited Liability Oetail by Entity Name View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View Image In PDF format View image in PDF format Ffor I I a OepartmenI of State, n Vis'cn of [prporatbn5 htt s:llsoaTch.sunbiz.or lin ui lCo orationSearchl8earchResullOctail?in ui Packet Pg. 118 p g g ry rp q rylype=EnlityNameStdirectionTypo=lnitial8tsearchNameO 8.C.1 Electronic Articles of Organization F LED�8 001AM For October 10, 2017 Florida Limited Liability Company Sec. Of State jareyes Article I The name of the Limited Liability Company is: SUPREME SERVICES & MORE, LLC Article II The street address of the principal office of the Limited Liability Company is: 852 96TH AVE N NAPLES, FL. US 34108 The mailing address of the Limited Liability Company is: 852 96TH AVE N NAPLES, FL. US 34108 Article III The name and Florida street address of the registered agent is: DUSTY L LOEWEN 852 96TH AVE N NAPLES, FL. 34108 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I Hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: DUSTY LOEWEN Packet Pg. 119 8.C.1 Article IV The name and address of person(s) authorized to manage LLC Title: MGR JOAN C MERILLAT 852 96TH AVE N NAPLES, FL. 34108 US Article V The effective date for this Limited Liability Company shall be: 10/10/2017 Signature of member or an authorized representative Electronic Signature: JOAN MERILLAT L17000209169 FILED 8:00 AM October 10, 2017 Sec. Of State jareyes I am the member or authorized representative submitting these Articles of Organization and affirm that the facts stated herein are tnie. I am aware that false information submitted in a document to the Department of State constitutes a tliird deg�ce felony as provided for in s.817.155, F.S. I understand the requirement to file an annual repport between January 1 st and May 1 st in the calendar year following formation of the LLC and every year Tereafter to maintain "active" status. Packet Pg. 120 2023 FLORIDA LIMITED LIABILITY COMPANYANNUAL REPORT DOCUMENT# L17000209169 Entity Name: SUPREME SERVICES & MORE, LLC Current Principal Place of Business: 3456 8TH AVE SE NAPLES, FL 34117 Current Mailing Address: 3456 8TH AVE SE NAPLES, FL 34117 US FEI Number: 82-3043702 Name and Address of Current Registered Agent: LOEWEN, DUSTY L 3456 8TH AVE SE NAPLES, FL 34117 US FILED Jan 19, 2023 Secretary of State 5422587446CC r co N Certificate of Status Desired: No The above named entity submits this statament forthe purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail: Title MGR Title AUTHORIZED REPRESENTATIVE Name LOEWEN, JOAN C Name LOEWEN, DUSTY JR. Address 3456 8TH AVE SE Address 3456 8TH AVE SE City -State -Zip: NAPLES FL 34117 City -State -Zip: NAPLES FL 34117 hereby certifythat the Information indkated on this retort orsupplemenfaf report is true and accurate and that my ekc&mk signature shag have the same Legal effect as it made under oath; that ! am a managing member or manager of the Smiled Hab#Ay company or the recehve or trustee ernpo Bred to execute this report as required by Chapter 605, Ffodda Statutes; and that my name appears above, or on an alfachment with all other like empowered. SIGNATURE: JOAN LOEWEN MANAGER 01/19/2023 Electronic Signature of Signing Authorized Person(s) Detail Date Packet Pg. 121 8.C.1 SYa,Y� 1'R DEPARTMENT OF THE TREASURY IRS INTERNAL REVENUE SERVICE CINCINNATI OR 45999-0023 SUPREME SERVICES & MORE LLC DUSTY L LOEWEN SOLE MBR 852 96TH AVE N NAPLES, FL 34108 Date of this notice: 10-11--2017 Employer Identification Number: 82-3043702 Form: SS-4 Number of this notice: CP 575 G For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (ETN)_ We assigned you EIN 82-3043702. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. A limited liability company (LLC) may file Form 8832, Entity Classification Election, and elect to be classified as an association taxable as a corporation. If the LLC is eligible to be treated as a corporation that meets certain tests and it will be electing S corporation status, it must timely file Form 2553, Election by a Small Business Corporation. The LLC will be treated as a corporation as of the effective date of the S corporation election and does not need to file Form 8832. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT RS4IDERS : * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN on your tax -related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Your name control associated with this EIN is SUPR. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. Packet Pg. 122 (IRS USE ONLY) 575G 10-11--2017 SUPR 0 9999999999 SS-4 8.C.1 Keep this part for your records. Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 G (Rev. 7-2007) CP 575 G 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 10-11-2017 ( ) - EMPLOYER IDENTIFICATION NUMBER: 62-3043702 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE C INCINN ATIOH 45999-0023 1tltlltitll1l11tltltl1tl1tlltltll111loll l[tlll1tll51 SUPREME SERVICES & MORE LLC DUSTY L LOEWEN SOLE MBR 852 96TH AVE N NAPLES, FL 34108 v r W to F4 Packet Pg. 123 Cofer Count y Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY STATEMENT OF OWNERSHIP This certifies that i, U V -K-W U 1 am a member or managing member of—�� Xg c R j c A �-'� (FYI �(LIMITED LIABILITY COMPANY NA E) I own ____ ] n % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. c1 ty ml fi t• State of -� � p r� C , Coma of Cb 8.C.1 Applicant (please print) ne•nr�-�, Cher Lc ' a-�I M Q(-�, I L,LC, Namelof Company Signature of Applicant The foregoing instrument was acknowledged before me by :Weans of C�physical presence or ❑ online notarization on this Al day of �, 20 � , by Such person(s) Notary Public must check applicable box: A are personally known to me ❑ has produced a current driver license ❑ has produced (Notary Sea]) �Qat Yp?�6�•n JANICE WILLIS * * Commisslon # Hli 411093 Expires July 23, 2027 as identification. Notary Signatur Q (11 Ck v r to to F4 Contractor Licensing — FIRM Application Rev. 712022 Page 9 of 14 Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive • Naples, FL 34104 • (239 Packet Pg. 124 co ntracto rsl icensin collie rcoun ll. ov Co�e-r C;OL9nt u_� Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's 8.C.1 Certificate Category Requested: , NC The applicant is seeking a Collier County Certi Cate of Competency in the trade indicated above. As part of the application for this certificate, the applicant must verify his/her 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 for the above -named applicant must provide the following information: Name log 9L f e C Business Name: Title: Y & r�Z�-e rr Phone: 2 f % — :�Z 5—' if 6,6 v % License No. (if applicable): ate--, /2z Business Address: � L%1 � V_ f-'!�_ Ut l/ IIV . Street State Zip The applicant was employed by me from ,. �l�`t/! e Z z, Z --- to P C�?7— Applicant's title:S The applicant's scope of//work (specific duties) included: C(l)ea ke ke-i -eo fC54 Additional comments: NOTE TO UCEN5ED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. Under penalty of perjury, I declare that the facts stated here are true. �,µf ,�+ � ,yl . Signature of person providing the statement Stale of ' W �TCounty of �jh foregom . sstrurne t was acknowledged before me by means a � physical presence or ❑ online notarization on this [ 6 day of 1 i 7 , 20 2i 1 , by ITlu- � Such persan(s) Notary Public roust check applicable box: �ac personally known to me ❑ has produced a current driver license ❑ has produced (Notary Sea]) as identification. Notary Signature: NICHOLAS DOMINIC'K 7t1LL4 Notary Public State of Florida . +q= comm+ssion N H1i 155635 '•'. a E= My Comm. Expires Aug 10, 2025 Bonded through National Notary Assn, 0A&, Contractor Licensing — FIRM Application Rev. 7/2022 Page 12 of 14 a Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 e (2 contractorslice nsingCcr}coiliercounbL(1.goy Packet Pg. 125 I 8.C.1 I DUSTY LOEWEN Supremeservicesandmore@comcast.net 3456 8th Ave SE, Naples, FL 34117 239-776-0306 OBJECTIVE To obtain my license and build a successful company and expand in the future. PROFESSIONAL LICENSE Aluminum With Concrete Contractor - Collier County LCC20210002178 November 2021 - Present California State Certified General Contractor CGC 883765 September 2006 - September 2008 EXPERIENCE Supreme Services & More, LLC 13456 8t" Ave SE, Naples, FL 34117 Owner October 2017 -Present Job Responsibilities: new enclosure builds, concrete slab wlfooters for enclosure, aluminum carports, lanai's, aluminum railing, screen repair, pressure clean driveway and walkways, Surette Building Company, UC 13840 5th Ave NW, Naples, FL 34120 Assistant to Superintendent September 2017- Present Job Responsibilities: structural building framing and aluminum of pool enclosures and buildings, concrete footers and slabs, pool decks, deco drain, screening using various screen types Supreme Screen & More, LLC 11048 Cooper Dr, Naples, FL 34103 Owner June 2014 - September 2016 Job Responsibilities: screen repair Loewen Construction, LLC I 32YO(0) Odom Ln, Ft. Bragg, CA 95437 Owner September 2006 -September 2008 Job Responsibilities: did underground electrical, road construction, septic systems, paving, concrete, demo and remodeling, roofing, and construction single family homes Fuchsiarama Nursery, LLC 123201 North Hwy il, Ft. Bragg, CA 95437 Owner March 2002 -June 2010 Job Responsibilities: managed, supervised and worked with a collective of 8 employees. Fuchsias, gift store and landscaping materials Packet Pg. 126 8.C.1 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Iq Official Examination Score Report Official Scone Report: Candidate Information: Name -- Dusty L Loewen Candidate #: 72603300L Online Testing Site: Ocala, FL Final Score Result: July 24, 2023 Building Contractor Score: 92% These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on July 7, 2023. If you have any further questions, please do not hesitate to contact us. Sincerely, Jay E. Bowerrneister President r W CO N PO Box 831127 Ocala, Florida 34483-1127 Voice (352) 369-GITS — Fax (352) 387-2443 800 997 2129 Packet Pg. 127 8.C.1 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. le Official Score Report: Candidate Information: Name — Dusty L. Loewen Candidate #: 72603300L Testiniz Site: Fort Myers, FL Final Score Result: Official Examination Score Report August 8, 2018 Business Procedures Score: 88% These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on August 8, 2018. If you have any further questions, please do not hesitate to contact us. Sincerely, Jay E. Bowermeister President PO Box 83112Y Ocala, Florida 34483-1127 — Voice (352) 369-GITS — Fax (352) 387-2443 800 997 2129 Packet Pg. 128 8.C.1 Surette Building Company 3940 5"' Avemme N.W. Naples, l' lorida 34120 ('ullier Lour ty ('onunultity I)c vOopment Department ('untraclor l.iccnsing 2800 Nord I lorseshoe Drive Naples, H., 34104 To whorl it may concern. 1, 'I homa; Surette, have known atul employed Dust) I me►ven since September 2017. Dusty ha< co111111 red many jotts ol'varies skill levels through the years. These include iillllllinutl lilbl'il'atlilln, cotlerete lorm, so and pour, scrcening pro ects. strpervision and general I; bor projects. 1 find him to be of'lhe highest character. very know-ledgeable io trades lis cd above, punctual and just knows litm to complete a job correctly. I ►would certatnit recommend him for licerisur'e. l'eel free to ctlmact me 1l further nllormatlttll is needed T 1 SP ette State of FLORIDA County of Oo`1 i p-( Sworn to (or affirmed) and subscribed before me by means of $ physical presence or ❑ online notarization, this Al day of 20�3 by who iA is personally known to me or ❑ produced a as identification. W . (1: ..... + JANICEWILLI3 r e CornmkWon#HH411093 public signature 9 0 F F`oa`° Expires July 23, 2027 , II n t " U)! I �; notary public printed name Packet Pg. 129 8.C.1 Building Culvert with catch basins Underground Service Structural Roofing Electrical (in CA) PERMHTS Septic Systems Grading and Excavation Aluminum Structures Concrete Drywall Plumbing Owner builder pert -nit for Collier County -- permitted and built 60x24 concrete stab for outdoor lanai with footer and engineered details Owner Builder permit for Mendocino County — permitted and built two10,000 sq ft. greenhouses "Several permits w/Collier County under my active Aluminum Contractor's License State of FLORIDA r i Ccnint), of , C pwl D f 4V The foregoing instrument was acknowledged before me by means of 0 physical presence or ❑ online notarization, this a5 day of 20_ by , who � is personally known to me or ❑ produced a as identification. JANICEWILL1S ' * COMTnj5slOn # HH 411093 c�tar public signature Explros,fuly 23� z027 Y l p6 �-,, notary public printed name Packet Pg. 130 8.C.1 v r W W N Home. CONTRACTORS STATE LICENSE BOARD J J OContractor's License Detail for License # 883765 DISCLAIMER: A license status check provides Information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. , CSlBcomplalnt disclosure Isrestrkted by law(t1GP 7124.6) If Wsentity is subject to public complaintiWosweckk on lints that will appeartntow for more lnfoamatiorn.0ick here for a definition of disclosable actions. r Gntyconstmction related civilludgments reported to[SLBaredisciowd 1B6P7071.171. t Arbitrations are not listed unless the contractor fails to comply wish the terms. Due to xnrklo3d, there maybe relevant information that Aas notyet been entered into the board's lkense database. Data current as of 9122120218:35:33 AM Business Information LOEWEN CONSTRUCTION 32700 ODOM LANE FORT BRAGG,CA95437 Business Phone Number.(707) 972-0552 Entity Soleovinership Issue Dale 0910812006 Expire Date 09130/2009 License Status This license Is expired and not able to contract at this time. A -GENERAL ENGiNEER1NG Classifications Bonding Informafon Contractor's Bond This license fled a Contractor's Bond tvithAMERICAIJ CONTRACTORS INDEMNITY COMPANY. Bond Number.291552 Bond Amount: W,500 Effective Date: 01101/2007 Cancellation Dale: 07f 12J2D07 Contractor's Bond History Workers' Compensation This license is exempt from having workers compensation insurance; theycertified that they have no employees at this time. Effective Dale-09/06f2Do6 Expire Data; None Back to Top Conditions of Use Privacy Policy Accessibility Accessibi(ity Certification Copyright © 2021 State of California A Packet Pg. 131 8.C.1 Home I Online Services i License Detail I Personnel List I Personnel Detait OContractor's License Personnel Detail Contractor License # 883765 Contractor Name LOEWEN CONSTRUCTION Name DUSTY LEE LOEWEN Title and Class History Title SOLE OWNER Classification A GENERAL ENGINEERING Association Date 09/08/2006 Back to Top Conditions of Use Privacy Policy Accessibility Accessibility Certification Copyright o 2021 State of California v r W W N Packet Pg. 132 8.C.1 v r . t0 CO LOEWEN CONSTRUCTION LICENSE #883765 Packet Pg. 133 8.C.1 CONTRACTORS STATE LICENSE BOARD 1{ 9821 Business Park Drive. Sacramento, CA 86827 STATE OF CALIFORNIA Mailing Address: P.O. Box 28000, Sacramento, CA 95828 Arnold Schwarzenegger, Governor I 000-321-CSLB (2752) www.csfb.ca.gov Application for Original Contractor's License — Examination Waiver (7065) Application Fees Singleelm Islficatlan.............................................5250. The application fee for a single classification ($250) is not refundable once the appllcatio-Aasbeen filed. , Each additional classification ................................. 50. Attach a moneyorderor a personal, business, certified, or Initial license fee ....................... .....$150. "" cashier's check made payable to the Registrar of 7oluntartal originallicense...... $400. l lice' e. Contractors. Oa not send cash. ❑ Voluntary contribution to Construction contribution There Is a $ 10 service charge for each dishonored check Management Education Account .......... ....... $ Please type or print neatly and legibly in black or dark blue ink. FOR CSLB USE ONLY 06 0102457 SECTION 1 — BUSINESS NAME AND ADDRESS Business Name: The legal business name is the name that will appear on the license and Is the actual name under which the contracting business will operate. The full buss ness name must be provided. Name Compatibility: The business name must be compatible wi th the license classification and business entity. For example, it would not be acceptable for ABC123 Tile to apply for a B-General Building Contactor license, but It would be acceptable for ABC 123 Construction to apply for a B license or for ABC123 Tile to apply for a C-54 Ceramic and Mosaic Tile license, In addition, it would not be acceptable for a sole ownership to use the words'partners' or *corporation' in its business name. I. FULL NEW BUSINESS NAME ]. CLASSIFICATION(S)REQUESTED(See page 3 ofthe General _ Information recdanJ 3a. BUSINESS MAILING ADDRESS numberJstreetor P.O. box city state - ZlPcode 3b.BUSINESS STREET ADDRESS numberlstreetonly - NO P.O. boxes city state ZIP code 3 L Fo Q 3c, BUSINESS PH -ONE NUMBER BUSINESS FAX NUMBER BUSINESS E-MAILADDRE55 l e-,L 0AiA -AJe.-- Ir) SECTION' 2 — BUSINESS ENTITY California Corporation !Partnership: Corporations must provides current and active registration number Wow. Please be Sure towritethecorporate �r _ secretary, P P appropriate officer tilles (president, secrets and treasurer) In the space provided for the a personnel In Sections 3 and 4. Partnerships must list their Federal Employer C' Identincation Number (FEIN) below (personal Social Security numbers are not acceptable), (Seepage 2oftheGeneral Information sectlon formore Information.) 4. NEW BUSINESS WILL OPERATE AS A (check onlyone) Sole Ownership ❑Partnership - Federal Employer ID ❑CalifornlaCorporationV SECTION 3 — QUALIFYING INDIVIDUAL FULL LEGAL NAME AND ADDRESS Qualifying Individual (QUahfler): A qualifying Individual Is required for every classification on every license Issued by CSLB. See NOTE below about multiple ual€fiiers.You must providegull legal names ofall Individuals. (SeepageleffheGeneral fnlormatlansection for more lnfomatienJ 5. OUALIFfEWS FULL LEGAL NAME last first middle DATE OF BIRTH NUMBER L me w Q u 0- e. -- o -6E-OV19 6a. QUALM ER'S EXISTING/ PREVIOUS CSLB LICENSENUMBER(S) 1 7. PERCENTAGE OF NEW BUSINESS DRIVER LICENSE NUMBER (If none, enterN/A) y OWNED BYTHE QUALIFIER I 6b. RESIDENCE ADDRESS number/street only -NO P.O. boxes city state 60000MOMFPcocle I a TITLE OR POSITION (check only one) IRESIDENCE PHONE NUMBER Owner ❑Qualifying Partner ❑RME ❑RMO1CorporateOfficer -Titles) 1 ('767) 97a ��SS 1 certify under penairyof perjury under the laws of the State of California that all statements, answers, and representations made in this application, including all supplementary statements attached hereto, are true and accurate, and that I have reviewed the entire contents of this application. (The der7nition of perjury"is telling a lie while and oath.) 16.Date Stgnat a Printed Name L pe uJ -e In (NOTE: If this license will have m ultiplWaliffers for multiple classifications, please make a copy of this blank page and complete items f ond2 in Section I and allol'Section 3 for each additional qualifier.) NIl�iiiPiggiHEii�91111 13A-15 (ray. 0IM81 Application — Page 1 of 3 FOR C819 USE ONLY Packet Pg. 134 8.C.1 v r THIS BOND SHALL BE FILED WITH THE REGISTRAR OF CONTRACTORS SURETY CODE 052 W STATE OF CALIFORNIA CONTRACTORS STATE LICENSE BOARD OOND No. _ 291552 V uceNse NO. 20040128.3^7�/0 - Contractor's Bond J LU IY APR FEE NO. _ / _ (8USINESSANDPADFFSSNJWS Coot SE'CTfON57071.5-7071.JI) -- OCC C ❑ The premium on this band is $ 93.00 forth a term 03/22/06 TO 03/22/07 ZQ to KNOW ALL BY THESE PRESENTS: That LOEWCNCONSTRUCTION e W BUS'NESSNANESHDWNONAPPLICATIONORLICENSE whose address for service is 32700 ODOM LANE FORT BRAGG CA 94537 BTFiEE7 MDAEss CITY STA39 xIPCODE LU as Principal, and AMERICAN CONTRACTORS INDEMNITY COMPANY W NA%IEOFEURETY M a corporation organized under the laws of CALIFORNTA LU and authorized to transact a general surety business in the State of California, as Surety, are held and firmly bound unto the d State of California, for the penal sum of Ten Thousand Dollars ($10,000) for the payment of which wall and truly to be made we Cl) ----- = bind. -ourselves, our -heirs; adminisirators; successors•and•assigns, jolntiy--and=severalty,-firmly,by-thesa.presents:— --°- WHEREAS, The provisions of Sections 7071.0 and 7071.6, Business and Professions Code, require that the Principel file or have on O file with the Registrar a bond issued by an admitted surety in the sum of $10,000 and this bond Is executed and tendered In H accordance therewith. U NOW THEREFORE, The conditions of the foregoing obligation are that If the Principal shall comply with and be subject to the provisions of Diviston 3, Chapter 9 (commencing with Section 700D) of the Business and Professions Code, then this obligation shall F- be null and void, otherwise to remain In full force and effect. Z PROVIDED HOWEVER, This band is issued subject to the following express conditions: OU 1. This bond may be cancelled by the Surety in accordance with the provisions of Sections 996.310 et seq. of the Code of Civil Procedure. J 2. This bond shall be deemed continuous in form and shall remain in full force and effect and shall run concurrently with the 1Ecense period a H for which license Is granted and each and every succeeding license period or periods for which said Principal may be licensed, after Z which liability hereunder shall cease except as to any liability or indebtedness therefore incurred or accrued hereunder. W 3. The limitation of the liability of the Surety and the conditions of the bond are set forth in Sections 7071.5. 7071.6. and 7071.11. Business and Professions Cade and any person claiming against said bond may bring an action In a proper court on this bond for Fn w the amount of the damage he may suffer as the result of such acts or omissions by the Principal, except that such action must be brought within two (2) years after the expiration of the license period during which the act or omission occurred, except provided I further that a claim for fringe benefits shall be brought within six (6) months after the date the fringe benefit delinquencies were u.I discovered, and any civil action thereon shall be filed within two (2) years after the date the fringe benefit contributions were due. V 4. This bond is executed by the Surety to comply with the provisions of Division 3, Chapter 9, (commencing with Section 7000) of the W Business and Professions Code and of Chapter 2, 'Fills 14, Part 2 (commencing with Section 995.010) of the Code of Civil 2 Procedure and said bond shelf be subject to all of the terms and provisions thereof. W 5. This bond to become effective 03/22/06 fl X DA,C w AMERICAN CONTRACTORS 1NDEN&1TY CpMPAiVY— 9841 Airpor! Blvd„ 9th noor, Los Ain eles, CA 90045 LL O N"E OF SURETY ADDRESS FDA SEANCE LU I certify (or declare) under penalty of perjury under the laws of the State of Califorrla that I have executed the foregoing bond under an unrevoked power of attomey. W IY Executed in Santa Rosa, CA on 03/22/06 under the laws of the State of California, Z CITY ANU S1A1E uAIE. W Certificate of Authority # � 5906 Signature ofAttomey-In-Fact /L.�� WO �Vr1a7 J Printed or Typed Name of Attorney4n-Fact M. ARGA B RIGHT ►' Address of Attorney -In -Fact 320 College Ave, #260, Santa Rosa.'tA = ffrf 111111 7II EpEpIII I�1'XX1'IIIII1FF11lII ++IIII1{{yy �I�f �111 �IIIIIISI I IIIIIII I !. -. 1 ; - .. ,: ." ❑ �liu Telephone Number ofAttorney-in-Fact 707-528-4215 l�n IIIIYf - 0 C O M1 - ao T R = i3�it�tro3► • d E 2�06IiIK 9 Pill' 51 U r a Packet Pg. 135 1 Collier County Growth Management r Community Development Department W to N APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY J J W AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER o STATE OF COUNTY OF I, Ihhving been first duly sworn, state and affirm: I am a resident of 0 i -e r Count EUL State and have resided here for more than five (5) years. During the last rive (5) years I have known Walplicant). I have had the opportunity to observe his or her business and personal dealings an find him or her to be a person of honesty, integrity and good character. Signature �r rinted Name +n Address:A � , _ ,,street Cit State Zip Telephone: L State of V[ o (' % 6 e.. County of l bW 2 r The foregoing instrument was acknowledged before me by means of )A physical presence or ❑ online notarization on this �dayof 20�a5,by Such person(s) Notary public must check applicable box: _~} Dare personally known to me ❑ has produced a current driver license ❑ has produced as identification. (Notary Seal) {,�v Huey ,fANiCE WILLIS c* C0mrnisst0n # HH 411093 Qr Expires July 23, 2027 Contractor Licensing -- FIRM Application Rev. 712022 NotarySignature: i Page 13 of 14 Operations & Regulatory Management Division, Contractor Licensing e 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 _contractorslice nsinq(a)colliercorZIA L.gov_ Packet Pg. 136 8.C.1 Cof[ier County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF U� r COUNTY OF CSC LIB having been first duly sworn, state and affirm: am a resident of _Q'0%\ v County, u (State) and have resided here for more than five (5) years. During the last five (5) years I have known"dea�linggs LO ��"� (applicant). I have had the opportunity to observe his or her business and persond find him or her to be a person of hon ty, integrity nd good character. Signature Printed Name Address: i &yt) /4- e. i'-t' /� / ' Street A/�Aa S T- L— Z4411�1 Uty State Zip Telephone: 1,14 ) ~ 7 H T ~ / ° 2 L State ofCountyof l ni13 2 C The foregoing instrument was acknowledged ��before yy me by means ^^ol O physical presence or © online notarization on this al day of 20 � , by 7 i l L! Lca Such person(s) Notary Public must check applicable box: Arare personally known to me ❑ has produced a current driver license ❑ has produced (Notary Seal)�Yp�e(n JANICE WILDS * Commis 0D#HH41`I093 9yFOF FlO4O Expires July23,202➢ Contractor Licensing — FIRM Application Rev. 7/2022 as identification. Notary Signaiur Page 14 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorsl icensinn (a)col liercou ntyfl.gov r to to F4 Packet Pg. 137 8.C.1 Florida wrm ucEm "Of 330-0 A" WIM ESE rr 6EUSE 8TH qE. fL 34117a461R6E UR1Vfit� 3, rya .0i 1011960 is;c. #4 maxi 0g1G12 . 11g67 C p3 szP--STNOMfi MaroA a. s.s OWW20'a �SL-fl Ri11110ii�Q arrGr N imolW �1�Y cOr1sOM�s ro�an7 to 1n7 falrsNYN �lsl M4'i°� � �` r� 21 01CORT57adIom IIIIIf1111[ I -I 111111111111111111111 AEBT,"o CHM A-M ACL Al:y CLASS: May ne *(ryriracwl veh wctr a CYWR � 76.Q01 lai, of IM AV _ Ths trMr o1 FL rslrna Aproperry nglxs IlsrluL login Packet Pg. 1 8771 _ I8.C.1 _ ACORO® DATE (MMIDDIYVYY) CERTIFICATE OF LIABILITY INSURANCE 10-21-2022 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 cro BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED N REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. J If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on J this certificate does not confer rights to the certficate holder in lieu of such endorsements . W PRODUCER CONTACT NAME: w O Liberty Mutual Insurance PHONE 800-962-7132 IFAXNo : $00-W-3666 ADDRESS: BusinessService@LibeliyMutual.com ❑ Z PO Box 188465 INSURERS AFFORDING COVERAGE NAIC iF Q INSURERA: Ohio Security Insurance Company 24082 W Fairfield OH 45018 INSURED INSURER B : 0 INSURERC: Supreme Services & More Lie > INSURER D : 3456 8th Ave Se W INSURER E W INSURER F : Naples FL 34117 M COVERAGES CERTIFICATE NUMBER: 0232103122 REVISION NUMBER: 2016-03 W w 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. lLTR TYPE OF INSURANCE ADDLSUBR POLICYNUMBER MMMIDDYEFF POLICY MMtDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY � OCCUR X X BKS58343064 10-16-2022 10-16-2023 EACH OCCURRENCE S 1,000,000.00 E TO RENTED DAMCLAIMS-MADE PREM PREMISES Ea oxurrence $ 300,000.00 MED EXP (Any one person) $ 15,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L X AGGREGATE I-Odn' APPLIES PER: POLICY [S] PEOT [X] LOG OTHER: GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS-COMPIOPAGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOSONLY AUTOS HIRED NONAWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea ao We., ; BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTYDAtMGE Per acdderd $ _ $ UMBRELLALIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNE1 RIEXECUTiVE ❑ OFFICERIMEMBEREXCLUDED7 (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E,L. EACH ACaDrNT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT ; DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUonal Remarks Schedule, may be attached it more space IS requlred) d Cl) O I— U l— z O U J a F- z W W I W U Z W W d X W LL O W W I z W 3-1 O J J H CERTIFICATE HOLDER CANCELLATION ❑ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier County Contractor Licensing Board THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN 000 2800 N Horseshoe Drive ACCORDANCE WITH THE POLICY PROVISIONS. C d Naples FL 34104 AUTHORVED REPRESENTATIVE E L7 Curtis Luken r ©1986 2015 ACORD CORPORATION. All rights reserves. Q ACORD 2512016103) The ACORD name and logo are registered marks of ACORD Packet Pg. 139 8.C.1 ILO JIMMY PATRONIS J CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES w� 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: 2/19/2023 PERSON: DUSTY L LOEWEN FEIN: 823043702 BUSINESS NAME AND ADDRESS: SUPREME SERVICES & MORE, LLC 3466 8TH AVE SE NAPLES, FL 34117 EXPIRATION DATE: 2/18/2025 EMAIL: SUPREMESERVICESANDMORE@COMCAST.NET This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicanse.com. IMPORTANT: Pursuant to subsection 440.05(13), 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 subsection 440.05(11), F.S., Ceritficates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F,S., notices of election to be exempt and certificates of election to he exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for fallure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 0112023 E01656487 QUESTIONS? (850) 413-1609 Packet Pg. 140771 COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: COLLIER COUNTY TAX COLLECTOR - 2800 N. HORSESHOE DRIVE - NAPLES FLORIDA 34104 - (239) 252-2477 VISIT OUR WESSITE AT: www.colliertaxcdkW.com THIS RECEIPT EXPIRES SEPTEMBER 30, 2023 j DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTI( r LOCATION: 3456 $TH AVE SE ; ` FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. N ZONED: HOME OCCUPATION �� BUSINESS PHONE: 776-0306 STATE OR COUNTY LIC #: LCC2021-2178 1-10 EMPLOYEES CLASSIFICATION: ALUMINUM WITH CONCRETE CLASSIFICATION CODE: 02104101 This document is a business lax only. This is not certification th It does not permit the licensee to violate any existing regulatory nor does it exempt the licensee from any other taxes or permits that may be required by law. SUPREME SERVICES &MORE, LLC LOEWEN, DUSTY. 3456 8TH AVE SE MAPLES, FL 34117 -THIS TAX IS NON -REFUNDABLE - DATE 08/15/20 AMOUNT 18. RECEIPT WWW-23-001065 ;i�OiO �� o ve,"Cloy Packet Pg. 141 6129123, 4:65 PM db3pr [)e� rtment of Business & i�rofessiona! Regulation View User Profile Press "Add Licenses" to add licenses to this registration. Press "Edit" to edit a section. Press "Close My Online Account" to retire this user account. Press "Back" to go to the main menu. View User Profile (viewProflie) Mf to DBPR ONLINE SERVICES N Chain Menu Update Profile I f.ocyoff I contact Us J Logged in as Loewen, Dusty J Personal Information First Name: Dusty Second Name: Last Name: Loewen E-Mail/User ID; SUPRE MESERVICESAN0MORE@COMCAST.NET Edit Close My Online Account Password Password: ******** Edit Secret Question and Answer Secret Question: Edit Add Licenses Back The State of Florlda Is an AA/EEO employer. agyjjght 2007-2013 State of Florida. PrIyacy Statement Under Florida law, email addresses are public records. If you dresponse to rot want your ¢-mall address released In responto a public -records request, do not send electronic mal to this entity. instead, contact the ofrxe by phon or by traditional mal. if you have any questions, please contact 850.4117.1395. -Pursuant to Section 455.275[1), Florida Statutes, effective October 1, 2012, ikensees licensed under Chapter 455, F.S. must provide the Department with an email address if they haye one. The emails prvrided may be used for official communication with the licensee. However email addresses are public record. if you do not wish to supply a personal address, please provide the Department wlth an email address which ran be made avallahle to the pubk. Please see our meter 455 page to determine if you are affected by this change. https:/Avww.myfloridalicense.com/datamarVviewProFiilo.do I Packet Pg. 142 T ci od rin V d V - NOIO NIN00 IVIIN301SBN - 30N3lN3dX3 30 MBIABH - N3M30l 'i Jima 08 :jUGWLj3e;;d U J J W 0 w 06 W J u W Z �W �co 0 � (a I- wW Ao7cm10 W > -i m O W w= �wZIM �o�c`-4 W W `` W N 40 o Z N a;n ao�wt�04 ccooAz�_5-1NQo S t O N I- ui CL > E 'C a fd G1 7 0 :D U¢ �C3�J Nii�[liN GI1 O U O > c V > E. 3 C O 0 o o 0 0 0 o m .O 0 i GN1 � Q C. 4=. Y0) V Uj � U N � _ CL O, OCL O O m4) L 2U) 'L (, +; TD W U) y 3 Q E M N O O N AN r A CC E C L 0 3 m c ro U C W EC > CU c > N O E O X a N (D L N m - to 0 E � E N L U � m' (D o Ea)E L U �� ' 460 0 = .� U a U ^` con, L W W O U p- M L o� V 0 �Z E CO 0 tq 0 C H2 E 8.C.1 Home r CONTRACTORS STATE LICENSE BOARD '= y`p =.., ®Contractor's License Detail for License # 883765 DISCLAIMER: A license status check provides informationtaken from the CSLB Ilcensedatabase. Before relying on this information, you should be aware of the following limitations. CSLS camplain[disclosure is restricted by law (S&P 7124.6)1Rhis entity is subjcd to po blic complaint disclosure clickon link that will appear beima For mare 'information -pick here fora definition of dls[losableactions- t Onlyconstrvction related ciw0.}udgmenls reported to CSLB are disclosed (Bf.P7071.17). I Arbitralions are not fisted unless the conlractor fails to comply with the terms. P Due to workload, there maybe relewant information that has not yet been entered into the board'slicense dalab.s- Data current as of 7/28/2023 9MA9 Ah1 LOEWEN CONSTRUCTION 32700 ODOM LANE FORT BRAG6, CA 95437 Buslne5s Phone Number.(707) 972-0552 Entity Sale Ownership Issue Date 09/08/2006 Expire Date 09J3012006 s_r,^.flSC .cit�iUS This license is expired and not able to contract at this time. A-GE14ERALENGINEERING Cassifi.at ons 8c1TT#€tT� Ilifoiniat€rn Contractor's Bond This license filed a Conlfactoi s Bond with AMERICAN CONTRACTORS INDEMNITY COMIPANY. Bond Number: 291552 Bond Amount: $12,500 Effective Date: 0110112007 Cancellation Date: 07112f 2007 Contractor's Bond History ,016Ef� �Gflij)2rTS8tI0ii This license is exempt from having workers compensation insurance; they certified that theyhave oo employees at this time. Effective Date: 09/06/2006 Expire Date: None Back to Tot, C-otlditions of U5i Privacy Policy Acr_essibitity Accessibility Certification Copyright © 2023 State of California v r W W N Packet Pg. 144 8.C.1 Home j Online Services I License Detail i Personnel List OContractor's License Detail (Personnel List) Contractor License # 883765 Contractor Name LOEWEN CONSTRUCTION Click on the person's name to see a more detailed page of information on that person Licenses CurienliyAsseciated With Name DUSTY LEE LOEWEN Title SOLE OWNER Association Date 09/08/2006 Classification A Licenses No Longer Associated With Back to Top Conditions of Use Privacy Policy Accessibility Accessibility Certification Copyright © 2023 State of California v r W W N Packet Pg. 145 CSLB'S GET LICENSED TO BUILD WORKSHOP -will take place on Friday, August 4th,10 a.m. $•C•� Register on Webex Workshop Presentation Watch Workshop on YouTube .C;U`J f _'7 e it, JUr.Pnse(h(!dv. !iSubscfiT)P AbovtCILB f>ubticMt rztings LnnladLis Select Lang�gB � � � har6.<�€<•tli�t .3;a; r Sc•tt.iny;'> ® v tlf A4MT fir toNfuuee Arr4rrs W , J r� CONTRACTORS # J STATE LICENSE BOARcLU onsumers Licensees applicants Online Services Media Resources W T A GENERAL ENGINEERING COO I-RACTOR --- - - — --�— :- ar- A- General Engineering Contractor Business & Professions Code Division 3, Chapter 9. Contractors, Article 4. Classifications 7056. A general engineering contractor is a contractorwhose principal contracting business is in connection with fixed works requiring specialized engineering knowledge and skill, including the following divisions orsubjects: irrigation, drainage, water power, water supply, flood control, inland waterways, harbors, docks and wharves, shipyards and ports, dams and hydroelectric projects, levees, river control and reclamation works, railroads, highways, streets and roads, tunnels, airports and airways, sewers and sewage disposal plants and systems, waste reduction plants, bridges, overpasses, underpasses and other similar works, pipelines and other systems forthe transmission of petroleum and other liquid or gaseous substances, parks, playgrounds and other recreational works, refineries, chemical plants and similar industrial plants requiring specialized engineering knowledge and skill, powerhouses, power plants and other utility plants and installations, mines and metallurgical plants, land leveling and earthmoving projects, excavating, grading, trenching, paving and surfacing work and cement and concrete works in connection with the above mentioned fixed works. Back to Top Conditions of Use Pi1var.y Policy Accessibility Acressibility Certification Copyright © 2023 State of California Packet Pg. 146 CSLB'S GET LICENSED TO BUILD WORKSHOP- will take place on Friday, August 4th,10 a.m. Rgg'I_SterOn_Webex Workshop Presentation WatchWorkshopouYouTube 8.C.1 .G;>v 'sl Y t`f (`') ill 1 1 J Ucensv Check d Subscnbq About M11 T2,mskAQ Ili;-, Silt:: Putiiic_ i•l2Ft�ngs Contact us Select Language I 1 to N CONTRACTORS —�'j !# STATE LICENSE BOAR"Consumers Licensees Applicants Online Services Media Resources B - General Building Contractor Business & Professions Code Division 3, Chapter 9. Contractors, Article 4. Classifications 7057. (a) Except as provided in this section, a general building contractor is a contractor whose principal contracting business is in connection with any structure built, being built, or to be built, for the support, shelter, and enclosure of persons, animals, chattels, or movable property of any kind, requiring in its construction the use of at least two unrelated building trades orcrafts, orto do orsuperintend the whole or any part thereof. This does not include anyone who merely furnishes materials or supplies under Section 7045 without fabricating them into, or consuming there in the performance of the work of the general building contractor. (b) A general building contractor may take a prime contract or a subcontract for a framing or carpentry project. However, a general building contractor shall not take a prime contract for any project involving trades other than framing or carpentry unless the prime contract requires at least two unrelated building trades or crafts other than framing or carpentry, or unless the general building contractor holds the appropriate license classification orsubcontracts with an appropriately licensed specialty contractor to perform the work. A general building contractorshall not take a subcontract involving trades other than framing or carpentry, unless the subcontract requires at least two unrelated trades or crafts other than framing or carpentry, or unless the general building contractor holds the appropriate license classification. The general building contractor may not count framing or carpentry in calculating the two unrelated trades necessary in order for the general building contractor to be able to take a prime contract or subcontract for a project involving other trades. (c) No general building contractor shall contract for any project that includes the "C-16" Fire Protection classification as provided for in Section 7026.12 or the "C-57" Well Drilling classification as provided for in Section 13750.5 of the Water Code, unless the general building contractor holds the specialty license, or subcontracts with the appropriately licensed specialty contractor. (Amended byStats.1997, ChapterM (SB 857)) Fast Facts: What Jobs a "B" General Contractor Can/Cannot Perform ead, to Top Conditions of list Privmy Policy Ai-ccssihilRy Accessibility certifiration Copyright© 2023 State of California Packet Pg. 147 8.C.1 it K;3r}f"a'Y'1��`u"•�: �Y..Ys�'iCoara ��3r31lL.jc+4�2s To whore it may concern: have worked side by side with Dusty Loewen on many of my construction projects. He has worked and built multiple homes of all types froin start to finish with our company from February 2018 to the present date. Dusty is proficient in a variety of machinery, including but not limited to skid steer, backhoe, font end loader, lifts, forklifts, and many other larger machines. He has the knowledge and experience and has performed all facets of concrete, framing, installation of windows and doors, roof trusses, drywall, interior work, fascia and gutter, stonework, fiat work, all varieties of metal work, including, screen cages and custom ornate metal. He works clean, on time and professionally. I'm a contractor that does not let my workers and subcontractors build my homes alone. Dusty is one that I feel comfortable knowing he Is on my job. He would be a great asset to work on any projects all over Collier County, but the fact that he wants to do work in my neighborhood makes me rest easy, and it should be the same for Collier County. If you need any references on my background, you can speak.to most inspectors right in your building about Fortress. I fully back Dusty Loewen in all his endeavors. CEO Fortress Custom Builders 239-420-SO40 STATE OF Florida County of Collier Sworn to (or affirmed) and subscribed before me by means of S physical presence, this q day of August. 2023 byC" ar- 5 OnCl1. W, arn5, wtio is personally know to me or 0 produced a as identification. o��nvpuen JANICEWILLIS Commission # HH 411093 �rFOF �LQ�•° Expires July 23. 202T �t ary public signature CA Notary public printed name Packet Pg. 148 8.C.1 N J APPLiCAriCtl,; FOR C 01.LlE(: ,t.11=1"x` C" fc t; iC:�.'it 0F CC"-P&=_EtNICY Applicant's Name: Certificate Category Requested: The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As port of the applicaliOrt for this cariifpate, the applicant must verify hisliker experience within this trade. You are being requested to provide information that %01 aid the applicant in meeting this requirement_ You shoukrf 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). T irne served solely in a supervisory or administrative rote should be described, but may or may not ba considered sufficient to demonstrate required trade experience. Tile person verifying trade experience for the above -named applicant must provide the following information: Name: � � � � � � � �t� e (�:�� a' _ 'Fine: Business Name:C,_5-*v Phnne; .'u 1 " } • -- . ? .7 t i_icanse Na. (if applicable):-- s Business Address: 1 �_T L Street 1F)- State zip The applicant was employed by me from' `'- Applicant's title'. � � 6 r' (( The applicant's scope of tvori( (spee.iF'tto duiles) iiiclu� M�.,�� t�' ded;' � y �. e i ;A (a•; lye •A 3 '.j .1' � Additional oS5,, mmentsA> 1 �' Ll C-ai-''��Q yv��ci�� �'t; -� 7 � ' ' C.0 = + Y] � � •11' �rt(li` NOTE TO UCENSED CONTRACTORS. 1=alsilyiny any intommuon provided hor©in may sffbjoct your license fo revocation. Under penalty of perjury, t declare that file facts stated here are true. Signature of person providing lha statement Statcnr ��r, _Countyor__ML#__C_____ The ford ah)g initrtltrlC11t was acknowledged before ine by gleans of 0 physical prcSU[-1cc or ❑ online notarira d" ail this A —day of ��. 20 , by Such person(s) Notary Public lutist chock upplicable box: Ilk are personally known to lute C3 has produced a current driver license © ])as produced...-_ — as ideniiGt anon. (Notary Seal) rosra�B��c JANICEW(LL(S Cammisslon # HH Ai1093 s, 1` July • Ex iresJuy23.2027 Notary �i�nittut � �J.+i.� ��,�ly_..�� .-•-- Ft]Ff40 CantraC10F Licensing - f=1RM Application Rev. W2022 Page io of 14 Ouwaiions & Argulalwy Mannijement ()i°J'.E(u:l. Contractor Liconsing a =0 f ?lil r'!',fsfBilGe FnvE. c Nnplus. FL VH04 n (23g) 252-2431`~ --'- Packet Pg. 149 8.D 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.D Doc ID: 26615 Item Summary: 8D. ARMANDO MARTINEZ — REVIEW OF EXPERIENCE — PLUMBING CONTRACTOR - AGM GENERAL CONTRACTORS CORP Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:30 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:30 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:32 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:01 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 150 8.D.1 ezvo Coxer County Growth Management IL Community Development Department W APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY �(- CERTIFICATE OF COMPETENCY 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ General $230.00 ❑ Building $230.00 ❑ Residential $230.00 ❑ Mechanical $230.00 ❑ Roofing $230.00 ❑ Electrician $230.00 Pr'Plumber $230.00 ❑ Air Conditioner $230.00 ❑ Swimming fool $230.00 ❑ Specialty $205.00 Specialty Trade: M Q tAe '-�1um be-e- I. APPLICANT PERSONAL INFORMATION: Name: Fir5t Middle Initial Last Business Name:._ �—� C'�einP�o �L}� "-pAddress: LA'V k Street U City Email: Qc1m glC'_I e-yal QD� Telephone:_ Date of Birth: )7-A , g -IrL1n 5tate Zip *SS # (Last 4 digits only): : i 2�C, Driver's License # (Last 4 digits only):;} I ! Pursuant to Collier County Contractor Licensing Ordinance No. 2006A6 Section 2,1,1., all applicants are required to submit their social security number, drivers license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise he authorized bylaw, We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing -- FIRM Application Rev. 712022 Page 3 of 14 Operations R Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensingO,coltiercountvFl.gov Packet Pg. 151 8.D.1 1.612,11. Plumbing CoeLactar nNUires twenty-four (24) m93nlha txpericnae as a liCcnseti Joumeyniao or equivalent with a passing grade on :;M1 + . _ � IL3,UovedtCdj and a p'061ng gEade Co a the business bnd law test and mean any pers,)n whose contracting boini ss consisr of the "OnItiM of conwuls ret}ttiriigg Ihe exp0ri010% financial M=na, litnawladge, rand skill to inst&U, maintain, repair, alter, extend,, or when not prohibited by law, tlGsign plumbing. A 12 4'v Vm*Ld*@Wk era deleled, warps_ rJ«A ut edd&d. plumbing oontra,ctor may install, roeinudrL. repair, alto, rattcnd, or, when not prohibited by law, deign tltc following without obWTiing any additional focal regulatory licertso, ocftif1j; c, uT registration; sanitary CIWTulgo or storm drainap fxilitics; vCMting systems; public or private water supply systems; septic tanks; drainage and supply wcliti; swimming pool piping; irrigation systems; or s4laT hearing waW systems and all uppurtcunnr-cFr, apparatus, or equipment usod in Cbnneckm themwA, including boilers and presawn process piping and including the installation Of water, narUral gas and swan and sanitary sewer J ines; and water and sewer plants And substaticros_ TIC scope of earls of the plumbing contractor also include& the design when not paaMNtcd by law, and installation, n ainrgt4ncc, Fcpair. alterationr Of exWnsions of air -piping, vycuum line piping, oxygen line piping, nitrous oxik piping, and all slated metiiccal gas sysrcros; fire line muidpipes and fire spHnJrlers to tha extent authr+ri� by WlicaWe law; ink and chrmical lines; luol oil and gasoline piping, axecpt bulb storage. plants; and pneumatic Lwtwl piping systerns, %U in such a manner as w comply with A plans, 9pccjfw& wn6, codes, laws, and regulations applicable. ThG scope of work of the plumbing contractor shall apply to private pmperty and public property, shai] include any excavation work incidental thcrew. "d shall include the work of t$c specialty pEtimbing cant wr. Such t:ontracwr shall subcontract, with a qualifies{ contractor in the fteJd comcrnc4ail other work incidental to the work but which is specified herein As being the work of it Laic other than that of EL pJ u.mbing cvtttractnT, -Fle.:emcnt of fire Safi rtg and fire stopping materials shall be permitted an wall, soiling and €loan pemetratlpar" created withie the taeope of the wont allowed by this section. � r - � . Packet Pg. 152 8.D.1 C;a7BY County Growth Management Community Development Departmeni APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Provide the names and telephone numbers of two persons who will always know your whereabouts. Name: Lal n, (,� 4 i� - Name:, Telephone: i q Telephone: l L. �. ?J II. NAME OF APPLICANT'S BUSINESS: ((''�� ,,,� �,�n �1y�o Business Name:A EN w 1r� ) i C L1( Business Address: ` r Street U Telephone: L 1.3q Do —1— a-,-Ia I Email: City Federal ID Tax No.: u S k lQ l� y Ill, FINANCIAL RESPONSIBILITY "J.c a Fc- —;SL4r0� State Zip YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: >� Filed for or been discharged in bankruptcy within the past 5 years? Had t/ a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? V, Undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? I/ Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? V Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years?` / V Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment.1f you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — FIRM Application Rev. 712022 Page 4 of 14 Operations & Regulatory Management Division, Contractor Licensing o 2800 North Horseshoe Drive o Naples. FL 34104 •3 (2W 252-2431 -ontractorslicensingO..colliercountvfI gov Packet Pg. 153 8.D.1 Subject: Explanation of Bankruptcy Filing in 2019 Dear Sir/Madam, I hope this letter finds you in good health. I am writing to provide an explanation regarding my bankruptcy filing in 2019. My name is Armando Martinez, and I reside at 410S 29th PI SW, Naples, FIL 34116. In 2019, 1 faced significant financial challenges that arose due to a combination of factors. Primarily, I encountered difficulties in maintaining my financial stability, which eventually led to overwhelming debt. Additionally, during that period, I experienced a deeply personal crisis that further exacerbated my financial situation. Despite my earnest efforts to manage my debts and address the situation, I found myself unable to cope with the mounting financial burdens. As a last resort, I made the difficult decision to declare bankruptcy in order to seek relief and a chance to rebuild my financial well-being. Since that challenging time, I have actively sought personal growth and have worked diligently to overcome the obstacles that led to my bankruptcy filing. With the support of my loved ones and a deep faith in God, I managed to find the strength and resilience to navigate through those difficult times. I have learned valuable lessons from my experiences, and I am determined not to repeat the mistakes of the past. Today, I am grateful for the opportunity to move forward and to have emerged from those adversities with a fresh perspective on financial management and responsibility. I have become more financially literate, and I am committed to making sound financial decisions moving forward. I genuinely believe that the difficulties I faced in 2019 were a turning point in my life, and I view this as a new chance that God has graciously given me. I am eager to make the most of this fresh start and to ensure that my financial matters are handled responsibly and with prudence. humbly request your understanding and consideration of my situation. I assure you that I am now better equipped to manage my finances and fulfill my obligations. Thank you for taking the time to review my letter. Should you require any additional information or documentation, please do not hesitate to contact me. I look forward to putting this challenging chapter behind me and embracing a brighter and more financially stable future. Sincerely, Armando Marti ez Packet Pg. 154 8.D.1 Debtor 1 Armando Martinez First Name Mid6a Name last Name Debtor 2 (Spouse, if filing) First Name Middle Name Last Name United States Bankruptcy Court Middle District of Florida Case number. 2:19-bk-00500-FMD Order of Discharge Social Security number or ITIN XYX—XX-9258 EIN Social Security number or ITIN _ _ —. EIN IT IS ORDERED: A discharge under 11 U.S.C. § 1328(a) is granted to: Armando Martinez Dated: February 25, 2022 Ca Ir--� l E. Delano United States Bankruotcv Judae Explanation of Bankruptcy Discharge in a Chapter 13 Case This order does not close or dismiss the case. Creditors cannot collect discharged debts This order means that no one may make any attempt to collect a discharged debt from the debtors personally. For example, creditors cannot sue, garnish wages, assert a deficiency, or otherwise try to collect from the debtors personally on discharged debts. Creditors cannot contact the debtors by mail, phone, or otherwise in any attempt to collect the debt personally. Creditors who violate this order can be required to pay debtors damages and attorney's fees_ However, a creditor with a lien may enforce a claim against the debtors' property subject to that lien unless the lien was avoided or eliminated. For example, a creditor may have the right to foreclose a home mortgage or repossess an automobile. This order does not prevent debtors from paying any debt voluntarily. 11 U.S.C. § 524(f). Form 318OW 12/18 Most debts are discharged Most debts are covered by the discharge, but not all. Generally, a discharge removes the debtors' personal liability for debts provided for by the chapter 13 plan. In a case involving community property: Special rules protect certain community property owned by the debtor's spouse, even if that spouse did not file a bankruptcy case. Some debts are not discharged Examples of debts that are not discharged are: Chapter 13 Discharge ♦ debts that are domestic support obligations; ♦ debts for most student loans; ♦ debts for certain types of taxes specified in 11 U.S.C. §§ 507(a)(8)( C), 523(a)(1)(B), or 523(a)(1)(C) to the extent not paid in full under the plan; For more information, see page 2 page 1 Packet Pg. 155 8.D.1 Co ier County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY IV. EXPERIENCE VERIFICATION EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: ,Sp���cL�.�n , ,nnsa��n�•�estczn.Cc� �ec�,��'s t S-e.�1�C�ns_t c��4c List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: CURRENT/PREVIOUS LICENSE: List below and attach copies any other certificates of competency/licenses you hold/have held in Collier County or any other jurisdiction. Include the license #, Type, and county you hold it in. 1111 it ' lip Mill! ��..AII _ �/ If +► ' rain. i11 211 1 ' 1x Ir 1W-1 AFFIDAVIT Under the penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. Applicant (please print) --8tgrf5fure of Applicant State of i� i a ck - County of 0-0 V, The foregoing instrument was acknowledged before me by means of i1v physical presence or ❑ online notarization on this (rlayof —k)LSJ 20_23,by AYvyut(I&D mCc(+I e7. Such person(s) Notary Public must check applicable box: -'�are personally known to me ❑ has produced a current driver license ❑ has produced as identification. (Notary SeE—= Publicslate of Florida rcia n GG 9081952023 Notary Signature: Contractor Licensing — FIRM Application Rev. 712022 Page 5 of 14 Operatlons & Regulatory Management Divislon, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing(dcolliercountyfl.gov Packet Pg. 156 8.D.1 COMICr C01411ty Growth Management d Community Development Department W APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION OF APPLICATION 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. - Applicant (please print Afn)!n eyigp-�+y:s Name of Company Sign,WurazL62glica State of ( — County of Cal ll G✓ The foregoing instrument was acknowledged before me by means of L-Physis (day of :S k .iAe , 20 2Z, by A Y +M �,�(, ' - LU it Such person(s) Notary Public must check applicable box: arc personally known to me ❑ has produced a current driver license ❑ has produced (No(ary Seal) y ► Notary Public State of Florida Beattlie A Garcia ' My Commission GG 90Bt95 �� EKpics tOf2f12023 identification. Notary Signature: presence or ❑ online notarization on this Contractor Licensing — FIRM Application Rev. 712022 Page 6 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensinggcolliercountvfl.gov Packet Pg. 157 8.D.1 Clorrxer County Growth Management a Community Development Department w APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY WORKMEN'S COMPENSATION AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. All Klaw JP IM AppliGT nt� a print fk-� Wi 6,014 a yet f C C mY Name of Company Sig ttfre-of-Appii BEFORE ME this day personally appeared. �4_ y monk Ma(- neZ who affirms and Applicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of fi c--y6 6a_ County of CO Ili L� The foregoing instrument was acknowledged bA,(aAca ore nie by means _4day of �, 20 �, by Such person(s) Notary Public must check applicable box: P-gre personally known to me ❑ has produced a current driver license ❑ has produced (Notary Seal) � Y• 1MPublic of Florida Beae A Garcia My Commission GG 908195 urn I xpifoc 10I2V2023 Contractor licensing — FIRM Application Rev. 712022 as identification, Notary Signature: 1 presence or ❑ online notarization on this Page 7 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing aacolliercountyfl.gov Packet Pg. 158 Licensee Ltfonnation 8.D.1 Licensee Number LCC20120002434 Name MARTINEZ, ARMANDO Type ;Contractor Status `(Open Descry on T Pr AJert View Master Project Examination Results View All Activities for this Licensee Add a new eo rson or business to Address Book Go to Alerts Add Exam Result Link ExarrdTest Ty Dale of ExaaVTest city Score received Examrfest result BUSINESS AND LAW : 07/21/2012 BONITA SPRINGS, FL �� 42.0 a ° Fail ... ...... ....... BUSINESS AND LAW .... _ 09/15/201280NITA SPRINGS, FL 55.0l -Fair^ ............ ............... .....:BUSINESS AND LA1"! r. t 10113/2012 ........, ..., BONITA SPRINGS, FL 78 0% Pass { i GENERAL CONSTRUCTION 04l16l2019 ; OCALA. FL �1.0 /a Fail ActiveC 1. Show More Fields Charge Exam Fee 0 Exam Code IF10010 Sponsoring County !COLLIER COUNTY Sponsorship App Date - Sponsorship Expiration Date 12/07/2012 Testing Facility PROMETRIC A Packet Pg. 159 8.D.1 GITS, LLG Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Score Report: Candidate Information: Name — Armando Martinez Candidate #: 00844611M Testing Site: Ocala, FL Final Score Result: Official Examination Score Report September 30, 2019 Master Plumber Scare: 78% These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on September 30, 2019. If you have any further questions, please do not hesitate to contact us. Sincerely, !Bowermeister lay President PO Box 831127 Ocala, Florida 34483-1127 — Voice (352) 369-GITS — Fax (352) 387-2443 800 997 2129 Packet Pg. 160 CREDIT CHECk M 8.D.1 CONFIDENTIAL Individual Credit Report Name...:MARTINEZ, ARMANDO Ordered B 17850 Address:4105 29TH PLACE SOUTHWEST Customer :9999 c NAPLES FL 34116 Received :04 21 23 social#: Applicant: ;-9258 Completed :04 21 23 CREDIT SCORE: APPLICANT FICO SCORE: 797 (scores range from 300 to 850) SOURCE(S): EXPERIAN TRANSUNION PUBLIC RECORDS: PUBLIC RECORDS HAVE BEEN CHECKED AT THE LOCAL, STATE AND FEDERAL LEVELS WITH THE FOLLOWING RESULTS AS OF 04/21/23: CLEAR CREDIT RECORD {Credit history has been checked for a period of seven years or from open date. Creditor Date Date High unpaid Past Historic Status Current MOB ` Account Number Reported Opened credit Balance Due 30 60 90 Status Rev HcO; l ALLY FINCL AS AGREED i 673921636631 01/16 04/15 25865 0 0 00 00 00 I01 08 I� DLA=01/16 i ALLY FINCL AS AGREED 673923592704 12/16 01/16 28642 0 0 00 00 00 I01 11 C; DLA=12/16 ; ALLY FINCL AS AGREED 1 611924759046 03/18 07/16 32417 0 0 00 00 00 101 20 C� DLA=03/18 i i BRCLYSBANKDE AS AGREED 00037558771 04/23 05/22 2000 30 0 00 00 00 R01 11 I: DLA=04/23 CAPITAL ONE AS AGREED 400344959705 01/19 03/15 9023 RUR 00 I� DLA=01/19 CAPITAL ONE AS AGREED 517805962535 11/16 08/11 1762 0 0 00 00 00 R01 48 I DLA=11/16 Licensee Applicant; APPLICANT _ SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . Packet Pg. 161 CREDIT CHEICk M 8.D.1 CONFIDENTIAL Name: MARTINEZ, ARMANDO Customer: 9999 Page:2 ( CAPITAL ONE AS AGREED 517805998770 03/23 03/22 3079 0 0 00 00 00 R01 11 I� DLA=03/23 F C CREDITONEBNK AS AGREED e f 444796265122 03/23 03/22 485 39 0 00 00 00 R01 12 I� DLA=03/23 DISCOVERBANK AS AGREED [ 601149942275 02/19 02/18 7496 R01 00 I: DLA=02/19 L FIRST PREMIER B AS AGREED ; 517800637895 06/13 08/11 871 0 0 00 00 00 R01 23 I DLA=05/13 F JPMCB AUTO AS AGREED ` 528210544073 11/13 11/11 10269 0 0 00 00 00 101 23 IF DLA=11/13 PENNYMAC AS AGREED SSE0018012373355 04/23 05/17 282150 271428 0 00 00 00 M01 48 It DLA=04/23 SUNCST CU AS AGREED 460819002200 04/23 09/22 4998 69 0 00 00 00 R01 06 IL DLA=04/23 L SYNCB/RMSTGO AS AGREED L 601919124015 02/22 06/16 0 RUR 00 I) DLA=02/22 L L TBOM/FORTIVA AS AGREED ` 777676807619 04/23 04/22 1741 0 0 00 00 00 R01 12 I� DLA=04/23 i THD/CBNA AS AGREED i 603532052419 04/22 03/15 3379 RUR 00 IF DLA=04/22 WESTLAKE FIN AS AGREED 6355010 06/14 11/13 7959 0 0 00 00 00 101 06 I[ DLA=06/14 WESTLAKE FIN AS AGREED ` 9693104 05/18 10/15 7991 0 0 00 00 00 101 29 I[ DLA=05/18 C. WFHM AS AGREED 9360423315431 05/17 03/15 137362 0 0 00 00 00 M01 22 I u DLA=05/17 Q Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 .tzr Packet Pg. 162 CREDIT CHECK 8.D.1 CONFIDENTIAL Name: MARTINEZ, ARMANDO Customer: 9999 Page;3 Total trade lines on this report: 19 INQUIRIES: 12/03/22 by 11/15/22 by 09/20/22 by 09/10/22 by 05/02/22 by 04/08/22 by 03/07/22 by 03/06/22 by 07/22/21 by 09/20/22 by 05/16/22 by 03/06/22 by CITIBANK NA., BEST WELLSFARGO CAP ONE NA SUNCOAST CREDIT JPMCB CARD CBNA/THD CREDIT ONE BANK CAP ONE NA SUNCOAST CREDIT CAPITAL ONE BRCLYSBANKDE CAPITAL ONE RESIDENCE HISTORY: BUY (EXP) #2145203 (EXP) #2891530 (EXP) ##2844550 UNION (EXP) 41879040 (EXP) #2920S96 (EXP) #1002549 NA (EXP) #3278143 (EXP) #2844550 UNION (EXP) #1879040 (TU) ##3575459 (TU) #3390354 (TU) ##3575459 4105 SW 29TH PL, NAPLES FL 34116 4591 SW 26TH AV, NAPLES FL 34116 760 NE 14TH ST, NAPLES FL 34120 COMMENTS: ***OFAC NAME SCREEN ALERT - CLEAR*** OFAC (OFFICE OF FOREIGN ASSET CONTROL) IS A FEDERAL AGENCY WHICH MAINTAINS A DATABASE OF TERRORISTS, DRUG TRAFFICKERS AND CRIMINAL ORGANIZATIONS. FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ACCESSED BUREAUS. CHECKS FOR IDENTITY THEFT, FAKE SSN, DECEASED SSN AND OFAC DATABASE PERFORMED CREDITOR PHONE DIRECTORY: CAPITAL ONE PO BOX 31293 WESTLAKE FIN 4751 WILSHIRE BVLD BRCLYSBANKDE P.O. BOX 8803 TBOM/FORTIVA POS 105555 ALLY FINCL P.O. BOX 380901 ALLY FINCL P.O. BOX 380901 THD/CBNA PO BOX 6497 SUNCST CU 6801 HILLS AVE PENNYMAC PO BOX 514387 CREDITONEBNK BC1DTV001 (800) 955-7070 SALT LAKE CITY UT. 84131 FS1.T9Q001 (323) 692-8800 LOS ANGELES CA. 90010 BZIZZB001 (888) 232-0780 WILMINGTON DE. 19899 BZ24FC039 (888) 247-0237 ATLANTA GA. 30348 FA259237L (888) 925-2559 BLOOMINGTON MN. 55438 FA259237N (800) 925-2559 BLOOMINGTON MN. 55438 BZ26H3005 SIOUX FALLS SD. 57117 QC298QO07 (813) 621-7511 TAMPA FL. 33680 FM2CCH001 (866) 545-9070 LOS ANGELES CA. 90051 BC54MR013 (877) 825-3242 Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . Packet Pg. 163 CREDIT CHECk M 8.D.1 CONFIDENTIAL Name: MARTINEZ, ARMANDO Customer: 9999 Page:4 I CREDITOR PHONE DIRECTORY - continued: PO BOX 98872 LAS VEGAS NV. 89193 JPMCB AUTO BB8251008 (800) 336-6675 700 KANSAS LANE MONROE LA. 71203 WFHM BM82TE004 (800) 416-1472 PO BOX 10335 DES MOINES IA. 50306 DISCOVERBANK BC9616003 (800) 347-2683 PO BOX 30939 SALT LAKE CITY UT. 84130 SYNCB/RMSTGO HF9992545 (866) 396-8254� PO BOX 71757 PHILADELPHIA PA. 19176 1 CREDIT CHECK Z 0630273 (877) 616-555Ei 3017 EXCHANGE COUR WEST PALM BEAC FL. 33409 1 BRCLYSBANKDE B 3390354 (866) 370-5931: PO BOX 8803 WILMINGTON DE. 19899 CAPITAL ONE B 3575459 (800) 955-707C 15000 CAPITAL ONE RICHMOND VA. 23238 1 *** END OF REPORT *** This Information Is confidential and is not to be divulged except as required by the Fair Credit Reporting Act. This personal report is fumished simply as an aid in determining the credit desirability of the applicanl(s�. It is based uppon information obtalned m ggood faith by this agency from sources deemed rel€able. The accuracy of same. however, is in no way guaranteed. By your acceptance and use of this report. you speciTically agree to hold Credit Chedr, Inc. harmless from any liability whatsoever. Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc, - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . Packet Pg. 164 CREDIT CHECK Commercial Credit Report Company: AGM GENERAL CONTRACTORS, CORP. * Address:4384 PROGRESS AVENUE NAPLES, FLORIDA 34104 Telephone: (239) 777-2231 r KINUIFHLS: VICE PRESIDENT Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: r_�rrrM Social Security Number: Stock Ownership-, RISK SCORE: MARTINEZ, ARMANDO 4105 29TH PLACE SOUTHWEST NAPLES, FLORIDA 34116 -9258 100% 8.D.1 CONFIDENTIAL Date: 04 /21/23 Cust. No: 9999 Ordered By: 17 8 5 0 Page: 1 (X) Corporation r�\1_ ww I w. 1+w1 11. v%111V 1avi;r asaa:. Experian ' Financial Stability Risk Score92j y a�a�a a 1-Poor E ellant-10D i Low Risk 2 3 Low to Med Medium Risk 4 Med to High 5 Hi h Risk CREDIT RISK SCORE 92 The score uses tradeline and collections information, public filings as well as other variables to predict future risk. Higher scores indicate lower risk, FACTORS LOWERING THE SCORE: * risk associated with the company's industry sector * number of active commercial accounts * risk associated with the business type * balance to high credit ratio for other commercial accounts Reported for: APPLICANT - SEE NAME ABOVE Reported by: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . (561) 616-5556 Packet Pg. 165 CREDIT CHECK Commercial Credit Report Company: AGM GENERAL CONTRACTORS, CORP. * Address:4384 PROGRESS AVENUE NAPLES, FLORIDA 34104 8.D.1 CONFIDENTIAL Date: 04/21/23 Cust. NO: 9999 Ordered By: 17850 Page: 2 AGM GENERAL CONTRACTORS, CORP, was INCORPORATED in the county of COLLIER, state of FLORIDA, on 07/24, 2018. The charter number is P18000063897. The registered agent is OPTIMUM TAX AND ACCOUNTING CONSULTANTS of 4384 PROGRESS AVENUE, NAPLES, FLORIDA 34104. Offices are LEASED from N/A at N/A per month. The company employs N/A. NET WORTH: ON FILE WITH STATE The company maintains banking relations with WELLS FARGO The officer handling the account is N/A - NAPLES, FLORIDA PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF LOCAL, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: CLEAR AS OF 04/21/23 - SEVEN YEAR SEARCH. BUSINESS DATE LAST PAY CATEGORY RPTD ACTIV TERMS BLDG MATRL 04/23 04/23 CREDIT- FINCL SVCS 01/23 01/23 VARIED BANK CARD 04/23 00/00 REVOLVE EQUIP LEAS 03/23 03/23 CONTRCT LEASING 04/23 00/00 CONTRCT PLUMBING 08/22 07/22 NET 10 *** Credit Profile *** HIGH CREDIT BALANCE CUR 2700 1000 100% 105200 24700 100% 8400 6500 100% 20000 19000 100% 5200 2100 100% 4900 0 0% 30 60 90 91+ COMMENTS 00 0 0% o 0% 0% a 001 0% 0% 00-. SATSFTRY 0% 0. 0% 0% 0% 0% 0% 006 0% 0% 006 0% 0% 0% 006 D% REMARKS: N/A = NOT APPLICABLE/NOT AVAILABLE * NAME CHANGE AMENDMENT FILED 04/29/19; OLD NAME WAS: AL'S EXPRESS TRUCKING SERVICE CORP * NAME CHANGE AMENDMENT FILED 07/30/19; OLD NAME WAS: THREE A'S CONSTRUCTION, CORP. REPORT WORKED BY KELLY END OF REPORT. This commercial report is furnished simply as an aid in determining the Credit desirability of the applicant(s), It is based upon information obtained in goad faith by this agency from sources deemed reliahle. The accuracy of same, however, is in no way guaranteed. By your acceptance and use of this report, you specifically agree to hold Credit Check, Inc. harmless from any liability whatsoever. Packet Pg. 166 8.D.1 Division of CORE ORATIONS Department of State 1 Division of Corporations 1 Search Records I a€ n i N_ ame J Detail by Entity Name Florida Profit Corporation AGM GENERAL CONTRACTORS, CORP Fig Information Document Number P18000063897 FEI/EIN Number 83-1615074 Date Filed 07/24/2018 Effective Date 07/23/2018 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 10/22/2020 Principal Address 4384 PROGRESS AVE NAPLES, FL 34104 Changed: 04/27/2019 Mailing Address 4384 PROGRESS AVE NAPLES, FL 34104 Changed: 04/27/2019 Registered Agent Name & Address Optimum Tax and Accounting Consultants 4384 PROGRESS AVE NAPLES, FL 34104 Name Changed: 04/19/2023 Address Changed: 04/27/2019 Off icer/Director Detail Name & Address Title President Packet Pg. 167 1 MARTINEZ, ARMANDO 4105 29TH PL SW NAPLES, FL 34116 Annual Reports Report Year Filed Date 2021 02/09/2021 2022 03/28/2022 2023 04/19/2023 Document Images 04119/2023 —ANNUAL REPORT 03 2812022 —ANNUAL REPORT 02109/2021 --ANNUAL REPORT 10l2212020 -- REINSTATEMENT 07103/2019 — Name Change 04/29/2019 — Amendment and Name Change 04/27/2019 -- ANNUAL REPORT 07/24/2018 -- Domestic Profit View image In PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Florida Department Of States, of Cwpa Qfj,,s Packet Pg. 168 8.D.1 Electronic Articles of Incorporation For AL'S EXPRESS TRUCKING SERVICE CORP P18000063897 FILED July 24, 2018 Sec. 4f State cmwood 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: AL'S EXPRESS TRUCKING SERVICE CORP Article II The principal place of business address: 4591 26TH AVE SW NAPLES, FL. US 34116 The mailing address of the corporation is: 4591 26TH AVE SW NAPLES, FL. US 34116 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: t00 Article V The name and Florida street address of the registered agent is: ODALYS GONZALEZ MUNOZ 4591 26TH AVE SW NAPLES, FL. 34116 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: ODALYS GONZALEZ MUNOZ Packet Pg. 169 8.D.1 P18000063897 FILED Article VI July 24, 2018 See. Of State The name and address of the incorporator is: cmwood ODALYS GONZALEZ MUNOZ 4591 26TH AVE SA NAPLES, FL 34116 Electronic Signature of Incorporator: ODALYS GONZALEZ MUNOZ I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are true, I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1 st and May 1 st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P ODALYS GONZALEZ MUNOZ 4591 26TH AVE SW NAPLES, FL. 34116 US Article VIII The effective date for this corporation shall be: 07/23/2018 Packet Pg. 170 8.D.1 US IRS'DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE OGDEN UT 84201-0023 006839 006939.246672.360759.13363 I MB 0.439 914 'Ill'�II'�"IIII:I:��lillslllll61°II°1'IOI'I'lllnelll���lllllll�e AGM GENERAL CONTRACTORS CORP 4384 PROGRESS AVE NAPLES FL 34104 Date of this notice: 04-06-2020 Employer Identification Number: 80-0974718 Form: 1120 Number of this notice: CP 576 A For assistance you may call us a+ 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER As we were processing your For:n 1120 for tax period 122019, see -found that your form didn't have a valid Employer Identification Number (EIN). Our records show that no EIN assigned to this business. Since an EIN is required by law, we assigned EIN 80-0974718 to this business. Please keep this notice for your 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 shorn above, please make the correction using the attached tear -off stub and return it to us, Every taxpayers must figure taxable income on the basins of an annual accounting Period, called a tax year. For trusts, your tax year generally must be a calendar year, unless you are a charitable trust or are exempt from tax under the law. For Partnerships, your tax year must conform with either the tax year of the majority Partners, the tax year of the principal owners, or a calendar year, in that order, unless you establish a business purpose for using a different tax year. A personal service corporation must use a calendar year as its tax year, unless you establish a business purpose for using a different tax year. For further information, see Publication 538, Accounting Periods and Methods, which is available at most IRS offices or from our Web site at www.irs.gov. Please complete the Form SS-4, Application for Employer Identification Number, so we can complete our record of your account. Be sure to date the form and send it to us with this tear off stub from this notice. You can get Form SS-4, by calling 1-800-TAX-FORM (1-800-829-3676) or by downloading it from the IRS Web site at www.irs.gov. If you already have an EIN for--this-business, please -send a copy of the noYIce­ you received assigning you that EIN, along with the tear off stub from this notice, so we can update our records, Your name control associated with this EIN is AGMG. You will need to provide this information, along with your EIN, if you file your returns electronically. If you have questions about your EIN, you can contact us at the phone number or address lasted at the top of this notice. If you write, please tsar off the stub at the bottom of this notice and include it with your letter, Thank you for your cooperation, Packet Pg. 171 8.D.1 2023 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# P18000063897 Entity Name: AGM GENERAL CONTRACTORS, CORP. Current Principal Place of Business: 4384 PROGRESS AVE NAPLES, FL 34104 Current Mailing Address: 4384 PROGRESS AVE NAPLES, FL 34104 US FEI Number: 83-1615074 Name and Address of Current Registered Agent: OPTIMUM TAX AND ACCOUNTING CONSULTANTS 4384 PROGRESS AVE NAPLES, FL 34104 US FILED Apr 19, 2023 Secretary of State 2816197278CC Certificate of Status Desired: No The above named entity submits this statement for the purpose of chenging its registered once or registered agent or both, in the State of Florida. SIGNATURE: KETIH SIMPSON 04/19/2023 Electronic Signature of Registered Agent Date Officer/Director Detail Title PRESIDENT Name MARTINEZ, ARMANDO Address 4105 29TH PL SW City -State -Zip: NAPLES FL 34116 I hereby ceffily that the Information Indicated on this report orsupplemenfal report is true and accurate and that my electronic signature shall have the same legal effect as H made under oath; that f am an officer ordirectorof1he corporation or the Waiver or trustee empowered to execute This report as required by Chapter 6e7, Flodds Statutes; and that myname appears above, oron on attachment with all otherllhe empowered. SIGNATURE: ARMANDO MARTINEZ PRESIDENT 04/19/2023 Electronic Signature of Signing Officer/Director Detail Date Packet Pg. 172 8.D.1 covr county Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY STATEMENT OF OWNERSHIP This certifies that I, / 1 f ( am a member or managing APPLICANT'S NAME (please print) member LIABILITY COM I own tbO % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the hest of my knowledge. km4oJ0 YV I��KP'L- A Applicant (please print) Name of Company f Signatur of Applicant State of FL. colA 6c%- � County of C D 11 L e /L The foregoing instrument was acknowledged before nie by means of hystcal presence or Ll online notarization on this day of 1L�, 20 23 by i'T Y- nn,[ Z r17) (`fl (I e 7 Such person(s) Notary Public must check applicable box: ate personally known to uie ❑ has produced a current driver license /❑ has produced as identification. (Notary Seal) 1►¢Y ° Notary Public Stale of Florida Notary Sign,hll'C: Bealrie A Garcia N : < My Commission GG 806195 fir+ of f4 4 Expire. 10121,2023 Contractor Licensing — FIRM Application Rev, 712022 Page 9 of 14 Operations & Regulatory Management Division. Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contra ctorslicensin collie rcou ntvfl.gov Packet Pg. 173 8.D.1 C0V-1CY 0014 ity Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name:_ Xrv,*�d 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 his/her 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. Thepersonverifyin trade experience for the above -named applicant must provide the following information: Name: �( Y1 JGfP fr> Title: 04VI i eV, r Business Name: ✓y1C�i /��U'ifb tom') Phone: 931 ��i6 S`3 '�� � License No. (if applicable): Business Address; 7J ! _5,P4W V 6 y x,;&i h, /Y. -o'n's 3 M3 Street f City State Zip The applicant was employed by me from rr 2o5-F to _�? - -?O/ Applicant's title: The applicant's scope of work (specific duties) included: ��l t�CC�J< � �r _Q 4/ !% - Cooper ( Irle g roy'l � P r4 4 .S Additional comments: «n 7� ?b� / oy,- , j Ye 1,001e "4" ,,, � NOTE TO LICENSED CONTRACTORS: Falsifying any Information provided herein maysubject yourlicense to revocation. Under penalty of perjury, I declare that the facts stated here are true. 4 Signature of persori providing,( a statement State of F�-�d� County of ���,tie.tii ll The foregoing instrument was acknowledged before me by means of (physical presence or ❑ online notarization on this day of _Mtn( __, 20 2'2� , by _ 2Q h e f Such person(s) Notary Public must check applicable box: mare personalty known to me ❑ has produced a current driver license ❑ has produced as identification. (Notary Seal) Wary Public State of Florida BeatO A Garcia .0 My Commission GG 908195 mar 114, Exp'rc6 10/21/2023 Notary Signature: Contractor Licensing — FIRM Application Rev. 712022 Page 10 of 14 Operations & Regulatory Management Division, Contractor Licensing o 2800 North Horseshoe Drive s Naples, FL 34104 a (239) 252-2431 ,00yactorslicensino c?colliarcountvf3.QOv Packet Pg. 174 8.D.1 COer county Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF: CONSTRUCTION EXPERIENCE Applicant's Name: Ay-yy oG y-��+O Certificate Category Requested: t LCLS+e__r1l T . The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate, the applicant must verity his/her experience within this trade. You are being requested to provide information that will aid the applicant in meefing 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 for the above -named applicant must provide the following information: Name: � &ay' LOn� Tit[e: Df-C!t;i del t Business�Naame: \) 'C p I -PC?JJ) ?lU � r�� {� /�, Phone: ECG-�Cf� t ~t rUS- License No. (if applicable): C �� —1 z (Ct- U 0 Business Address: e 15 c� L 4 ` l !' f lfl ?vl [ ram} - Street 'City State Zip The applicant was employed by me from O'LOC to LA f y m, L Applicant's title: The applicant's scope of work (specific duties) included: 1cf-Dnws � �'�V, 6ff.,_LV C, t W Qo<. (�Cl i V iM �tr L�j Additionai comments: � i0.�� UILG .1 NOTE TO LICENSEE) CONTRACTORS: Falsifying any information provided herein may subje t your 11 ense to revocation. Under penalty of perjury, I declare that the facts stated here are true, I r !� IfIJ �^ Signature of person .k ing statement State o£ P,lr ,A f•� Countyof �� i p� f The foregoing instrument was acknowledged before me by means of Xphysical presence or f online notarization on this day of c)e ,20ZI,by.�05CC,e- L632Zl _ Such person(s) Notary Public must check applicable box: mare personally known to me Cl has produced a cut -rent driver license ❑ has produced as identification. (Kota +dr ° notary Puhlic State of Flarlda Beane A Garcia My cammission GG 908195 '�crs<e Exptres tol2112023 Notary Signature: •- Contractor Licensing- FIRM Application-Rev.712022 Page 11 of 14 Operations & Regulatory Management Division, Contracior Licensing � 2800 Noith Hoes; shoe Drive Maples, FL 34 Irt, s (239, r52-2 S3 k n Packet Pg. 175 8.D.1 lo Cer County Growth Management Community development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Certificate Category Requested: MP SirZI l V 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 his/her 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 for the above -named applicant must provide the following information: Name: `� C Ql�t�. Title: Business Name; 1^n Phone; License No. (if applicable): I Z S� Business Address: }OQ� l C I�tfl l , FL z Street City State Zip The applicant was employed by me from rQ Q _ to Applicant's title: Zv"),n)22,�f The applicant's scope of work (specific duties) included: L u�5 i f)cj b lC-- 0-� air of Additional comments: iSx0e * iAnr'0-r ` NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation Under penalty of perjury, I declare that the facts stated here are true. Signature of person providing the statement State of L_OC^ C1 C�_ County of � _t,p C The foregoing instrument was acknowledged before me by means of P< physical presence or ❑ online notarization on this 0 day of u(12 , 20 2a , by Such person(s) Notary Public must check applicable box: are personally known to me ❑ has produced a current driver license ❑ has produced identification. (Notary Seal. �y Notary Public State of Florida 6eal;e A Garcia My Commission GG 908195 cats EMpkc$ 10/21/2025 Notary Signature: teLA; Contractor Licensing -- FIRM Application Rev. 712022 Page 12 of 14 Operations & Regulatary Management Division. Contractor Licensing e 2800 North Horseshoe Drive j Maples,. FL 34104 a (239) 252-2431 .ontractorsiiaensino a�calliereauntn'l.00v Packet Pg. 176 8.D.1 Co�er County Growth Management Department Contractor Licensing 2800 N. Horseshoe Dr. Naples, FL 34104 239-252-2400 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF -F'�c��lt� COUNTY OF I, -FT C 01(Yj[zGCt'kNa ing been first duly sworn, state and affirm: I am a resident of Oc)k ie--ye County, .i'L'�•CkQ (State) and have resided here for more than five (5) years. During the last five (5) years I have known i,Ar(A� I�"1 . I (! Z (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a pe_CsoR of honesty, integrity and good character. Signature Printed Name Address: 1316 tckk lwe— dt d20 2 Street City State Zip Telephone:_ �Z�t1 (6 Z- 01922 State of II County of The foregoing instrument was acknowledge before melby means O)d day o r i'f 20,ja , bylfl�'�'j j Such person(s) Notary Public must check applicable box: re personally known to ine ❑ has produced a current driver license ❑ has produced as identification, (Notary Sea]) Es -, PSI 0 Notary Public State of Florida Notary Signature: l3ealpk A GarciaExp'rec 1af2412U23 908195 presence or ❑ online notarization on this Firm_Application.docx Rev 4/06/2020 Pa Packet Pg. 177 8.D.1 COV 7eY C;014 .ty Growth Management Department Contractor Licensing 2800 N. Horseshoe Dr. Naples, FL 34104 239-252-2400 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF - `JtA COUNTY OF Q I, 0-k be-) Raving been first duly sworn, state and affirm: am a resident of Lee- County, t�� .. (State) and have resided here for more than five (5) years. During the last five (5) years I have known A— WtY O-D MQAY1�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 }Pone rity and good character. nature yn-f-h1`a �'c-o�_ -Gyms Printed Name Address:, � r qC Street 3Vn'fj� �`r City State Zip Telephone: State of Countyof MLL, The foregoing instrument was acknowledged before the by meaps o physical presence or ❑ online notarization on this Clay of �, 20, by r S Such person(s) Notary Public must check applica le box: e personally known to me Elhas produced a current driver license (!!!❑ has produced as identification. (Notary Seat) Y ° tlptary Public St to of Florida Notary Signature: Oealk? A Gar0a < My Commission GG MOM Expres 10i2112023 Firm_Application.docx Rev 4/06/2020 Pa Packet Pg. 178 8.D.1 Sheppard's Plumbing LLC I, Dan Sheppard, owner of the company mentioned above. I hereby attest that Armando Martinez who is applying for a master plumber certificate of qualification through the City of Collier County, has been employed from 2008 to 2011 and has full-time experience in the plumbing trade in my company. He is very good at his work and quickly solves problems; he also has experience in many residential buildings and commercial areas as well. He has a good understanding of water distribution and disposal systems, has a good working knowledge of ventilation and heating of appliances, has the ability to handle plumbing tools and equipment, has good communication skills, and is very patient and friendly in nature which is his plus point. I also affirm that I have personally overseen his performance and he is very competent at this trade. I was his employer and if you have any questions, I can certify that all statements contained herein are true, you may reach me at: (239) 896-5366 for anything further. NOTARY PUBLIC'S STAMP AND SEAL: Y ABOVE APPEARD BEFORE ME, A NOTARY PUBLIC, ON THIS -DATE: O(o IZ.3IZ3 459 Seaworthy Rd North Fort Myers, FL 33903-4323 (239) 896-5366 CFC1428286 Packet Pg. 179 8.D.1 Oscars and Paul Plumbing & Mechanical, Inc. oscarsandpaulplumbinci@gmaiI.com PO Box 150211 Cape Coral, FL 33915-0211 CFC1426980 (239) 841-7465 I, OSCAR LOPEZ -President who represents, OSCARS & PAUL PLUMBING & MECHANICAL, INC company engaged in the plumbing trade. I hereby attest that, ARMANDO MARTINEZ who is applying for a master plumber certificate of qualification through the City of Collier County, has more than (3) Three years of full-time, practical, hands-on experience in all aspects of the plumbing trade, including at least two years certified at the journeyman plumber level. The applicant's experience includes all these areas: Installation, maintenance, repair, servicing, and testing of all sanitary plumbing and potable water supply piping, the complete installation of water heaters, etc. I also attest the individual has experience in both residential and commercial plumbing applications and that such experience also includes the installation, maintenance, repair, and testing of backflow prevention devices; tying into and/or installing water and sewer mains; installing, maintaining, and/or repairing septic tanks and related lines; and performing septic system change outs, in addition to the items listed above. affirm that all the applicant's plumbing trades experience has been legally gained in the direct employ of one or more licensed contractors. I also affirm that I have personally overseen this individual performing plumbing trades work during that period and that he is competent at the trade and has demonstrated sufficient mastery of the trade to act in a supervisory capacity. My relationship to the applicant is Employer. am not a past or present employee of the applicant, nor have I ever worked under the applicant's direction. certify that all the statements contained herein are true; and I hereby authorize verification of the information,given iA this reference letter. My daytime telephone number is (239) 841-7465. HEREBY CERTIf Y MAT THE SIGNATORY ABOVE APPEARED BEFORE ME, A NOTARY PUBLIC, ON THIS DATE NOTARY PUBLIC'S SIGNATURE: -DATE: NOTARY PUBLIC'S STAMP AND SEAL: a Bealir Public State of Florida Beane ABarciaMy Commission GG 900195 Exprei 10/21/2023 Packet Pg. 180 8.D.1 J&D PREFERRED FINISHES INC. 9097 Gervais Cir # 1810 Naples, FI 34120 (239) 595-9101 CFC1429307 I, Daniel Guevara -President who representsJ & D PREFFERED FINISH ES_company engaged in the plumbing trade, I attest that, ARMANDO MARTINEZ who is applying for a master plumber certificate of qualification through the City of Collier County, has more than t3) Three years of full-time, practical, hands-on experience in all aspects of the plumbing trade, including at least two years certified at the journeyman plumber level. The applicant's experience includes all these areas: Installation, maintenance, repair, servicing, and testing of all sanitary plumbing and potable water supply piping, the complete installation of water heaters, etc. Residential and Commercial plumbing installations, maintenance, repair, and testing of backflow prevention devices; tying into and/or installing water and sewer mains; installing, maintaining, and/or repairing septic tanks and related lines; and performing septic system change outs, in addition to the items listed above. I am not a past or present employee of the applicant, nor have I ever worked under the applicant's direction. If you have any questions or concerns, you can reach me at my daytime telephone number is (239) 595-9101 REFERENCE'S SIGNATURE DATE I HEREBY CERTIFY THAT THE SIGNATORY ABOVE APPEARED BEFORE ME, A NOTARY PUBLIC, ON THIS DATE % Z NOTARY PUBLIC'S SIGNATURE: TE: Ckb-S NOTARY PUBLIC'S STAMP AND SEAL: �vw ,y+ Hotaly PublicSe�I1� AMy CommfKp►aG 16023 Packet Pg. 181 Huffman Construction Group 201 Airport Road South Naples, FL 34104 rUFFMAN CONSTRUCTION GROUP 239-920-4806 Letter of Reference To: Licensing Board Re: Armando Martinez John Huffman, being first duly sworn, says that he is the Owner of Huffman Consulting and Investment Group, LLC. dba Huffman Construction Group and a Certified General Contractor - CGC1528960. I have had the pleasure of working with Armando Martinez for over 7 years. He is always professional, courteous, knowledgeable and completes his jobs in a timely manner. I have used Armando on over 40 jobs and will continue to use him as a subcontractor in the future. Please call me if you have any questions. By: John T. Huffman Owner of Huffman Construction Group STATE OF FLORIDA/COUNTY OF COLLIER The foregoing instrument sworn to and subscribed before me this 2"d day of May 2023, by John T. Huffman, Owner of Huffman Construction Group who is personally known to me. le'- Witi: =Notaryate of Florida Signature of Notary PublicOV- tkerson n28 irlr nt de Name of Notary PublicT- Packet Pg. 182 8.D.1 #0#65 G Repopel X / 2T =SERV251 INI,= (239) 389.8850 c.,,,,,,, FROM THE DESK OF: CAREY L. SMITH DATE: 4-26-23 TO WHOM IT MAY CORNCERN, IN REGARD TO ARMANDO MARTINEZ, WE'VE HAD THE PLEASURE OF WORKING WITH HIM FOR 6 YEARS. WE'VE WORKED ON MANY KITCHEN REMODEL PROJECTS INCLUDING BATHROOM REMODELS ALSO. HE IS WELL QUALIFIED IN MY OPINION TO PERFORM PLUMBING WORK ON ALL ABOVE ITEMS. THANK YOU FOR CONSIDERING THIS QUALIFICATION FOR HIM. CAREY L. SMITH OWNER OF SMITH HOMES & REMODELING SERVICES, INC, DATE: 4-26-23 Packet Pg. 183 8.D.1 -0� IECQ� SPO Construction Inc PO Box 100897 Cape Coral FL 33910 (239)574-7430 info a-i spohomes.com Leger of Reference To: Licensing Board Re: Armando Martinez STATE OF FL COUNTY OF LEE Shery Ciccone, being first duly sworn, says that she is the Office manager of SPO Construction, Inc., Stephen W. Ondrejka is the qualifier and is a Certified Building Contractor - CBC047788 We have had the pleasure of working with Armando Martinez for over 10 years. He is always professional, courteous, knowledgeable, and completes his jobs in a timely manner. We have completed dozens of projects and continue to im as a subcontractor. Please call me if you have any questions. M 'Sherry Cigope Office Ma a_ er of SPO Construction Inc STATE OF FLORIDA / COUNTY OF LEE The foregoing instrument sworn to and subscribed before me this 21 St day of April 2023, by Sherry Ciccone, Office Manager of SPO Construction Inc. who is personally known to me. Signature of Notary Public Printed name of Notary Public Packet Pg. 184 205 Airport Rd S Naples, FL 34104 Phone: 239-572-2495 Fax: 239-231-3503 ■ ■■ Email: Chris@naplesconstruction.net ■ ■ a W ■■■■ O ■ WEST CONSTRUCTION CONCEPTS Reference Letter To: Licensing Board Re: Armando Martinez 4/25/2023 I Christopher West am the owner of West Construction Concepts LLC and a general contractor license #: CGC-1532731. I have had the pleasure to work with Armando Martinez for the past 9 years as a subcontractor on kitchen and bathroom remodels. He is always professional, courteous, knowledgeable, and caring for his customers. I will always continue to use him as a subcontractor. Thank You, Chris West This article was acknowledged before me on April 25, 2023 by Christopher West, Owner of West Construction Concepts LLC, who is Personally known to me. Signature of Notary Printed name of Notary Packet Pg. 185 W8V-N010VNINOO ON2mn]d-30N3l 3dX]]0 M]m]N-z]mlNVm O(INVWNV,a2 uewLi2q} � . 00 2 --�-- tu /]EL� 2 a � k a 8.01.1 ACORDIF `� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) F05/15/23 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER Bruce Hendry Insurance CONTACT NAME: PANE , , 239-657-3614 arc No : 239.657-fi468 711 W. Main Street ADDRESS: karen@bhins.com INSURERS AFFORDING COVERAGE NAiC N Immokalee, FL 34142 INSURER A: EVANSTON INSURANCE COMPANY L02303.1___ _ INSURED INSURER B: INSURER C: AGM GENERAL CONTRACTORS CORP INSURER D ' INSURER E 4304 PROGRESS AVE 1 INSURER F: NAPLES FL 34104 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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 LTR TYPE OF INSURANCE ADD SUBR NUMBER MMIDOY EFF POLICPOLICY MMIODY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS.MADE OCCUR 3AA670926 0511 OJ23 05110/24 EACH OCCURRENCE $ 1,000,000 OE ToRE PREM SES Ea oNwEDnce $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY S 1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOPAGG $ 2,000,000_ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY I COMBINED SINGLE LIMIT Ea accdent $ BODILY INJURY(Per Person) $ BODILY INJURY (Per accident)$ PROPERTY DAMAGE Per accident $ $ UMBRELLA UAB EXCESS LWB OCCUR CLAIMS-MADF EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N ANYR:E ERPARTNDE07ECUTIVE ❑ {Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I PER O7H- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYfl $ $ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) REMODELING OF HOMES Collier County Contractor Licensing Hoard 2800 N. Horseshoe Dr. Naples, FL 34104 Lal_T�LaL�RS_7!. 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 n 1949.2015 ACORCI'COI2PORATION. All rinhrc racarvad- , ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Packet Pg. 187 8.D.1 Ac RCi CERTIFICATE OF LIABILITY INSURANCE PATE (MMIPPIYYYY) L . 05/15/2023 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 have ADDITIONAL INSURED provisions or 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: (800) 277-1620 X 4800 FAX: (727) 797-0704 E-MAIL ADDRESS: FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue INSURERS(S) AFFORDING COVERAGE NAIC# INSURER A: Frank Winston Crum Insurance Company 11600 Clearwater, FL 33756 INSURED INSURER B: INSURER C: INSURER D: FrankCmm LICIF AGM General Contractors, Corp. 100 South Missouri Avenue NSURER E: INSURER F: Clearwater, FL 33756 COVERAGES CERTIFICATE NUMBER: 1059451 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 LTft TYPEOF INSURANCE ADDL wsRO SURR VNP POLICYNUMBER POLICY EFF (MM/D➢NYYY) POLICY EXP (MMIDDIYYYIf) LIMITS COMMERCIAL GENERAL LIABILITY CLAllAS h"E ❑OCCUR AGGREGATE LIMIT APPLIES PER: POLICY ❑PROJECT [::]LOC OTHER EACH OCCURENCE 3 DAMAGE TO RENTED PREl.IFSES (Ea oCvuenee) $ GEHL NIEO EXP (Any one person) 5 PERSONAL S AOV INJURY 5 GENERALAGGREGATE 5 PRODUCTS-COMPlOP AGO $ 3 AUTOMOBILE LIABILITY ANYAUYo OWNED AUTOS SCHE➢UL Ell ONLY Autos HIRED AUTOS NON.OYJNrn ONLY AUTOS ONLY COMBINED SINGLE UNIT (Ea accident) $ BODILY INJURY (Perpcl ) $ O BDILY INJURY Per aCGdenl ( ) $ PROPERTY OAhVIGE(Per aeddenU 5 S UMBRELLALIAB EXCESSLIAB OCCUR CLAIMS MADE EACH OCCURENCE ; AGGREGATE 5 DEO I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LWBILITY YIN ANY PROPRIETORIPARTNEWEYECUTIVE ❑ OFFICEAMEMBEREXCLUDED? (Mandatory In NH) If yes, descaibe under DESCRIPTION OF OPERATIONSNegrr NIA WC202300000 01/0V2023 01/0112024 X PER STANE OTHER E.L. EACH ACCIDENT 51,DDe,e00 E.L. DISEASE -EA EMPLOYEE $1.000,eoo E.L. DISEASE -POLICY LIMIT 51,DW,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 7a1, Additional Remarks Schedule, may be attached It more space is required) Effective 02103/2020, coverage is for 100%p of the employees of FranWrum leased to AGM General Contractors, Corp. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. 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. Collier County Contractor Licensing Growth Management Community Development AUTHORIZED REPRESENTATIVE Department 2800 North Horseshoe Dr. Naples, FL 34104 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Packet Pg. 188 G WOV - NOIO NINOD ONiewnld - 33N3RI3dX3 =IO M31n3N - Z3NIINVW OONVWNV 'a8 :;uBWL43elIV as N i ru C3 nVZ — � m � Os I D 0 I1 � � 3 W �u Q m Q Q w w _ I z v Q m Q Z} � y Z U LLI Vc< zQ, vM oLua wON ANU ZO in U cu a WZ Zc� W w Z: ce O , U ceO U.— Q O�On O V It U) 72 c co = `o � °" z az � ��� E s O Q z rr 'I .0 u a °ILL, Z (n 2wwU OO m-a c 0 Q v� Z Ooo - z Z Z a w Q W -- � '2 O "� w c� 0- w p r +� a U)Z Z U a w Z Z 2 `' o m 5 Z Z G U .�, X> z w O Z Q w U. V O �_ O OC cn a u-, 7 ? _ Q aCy i W Z Z L v �u O U a L F- V w o y �. tA a o W F- w A, c{ t G od WOV - NOIOVNINOD ON18Wflld - 30N3lN3dX3 =10 M31n3N - Z3NIINVW OONVWNV 'a8 :;u8WL43ePV C0 O V N Q� .a L N w O U CL m z 0 U O v L M O U a c O U a) O U a o � U o V3 ❑ w O w o v c/i (D w O ❑ W rn Z �'° o Z aM J U)M o w cM M Q d cY'M 0o w C7 J LL N N 0 Lo L) r Z Q N ti w o 0 J N p N LU U) w z p O 90a N r N � a Q f..� T- (M N (M M W Q rZ��J(14 CD Q r o (n F- m M c a U) o CD aa)i U 0a F-C1.5 Nis>cncn a O U L- (U O U Lo O L) (D c L CL a) 0 N C O O. (1) L. CY 8.E 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.E Doc ID: 26616 Item Summary: 8E. LUIS 1. ZURITA - REVIEW OF EXPERIENCE - SWIMMING POOL/SPA MAINT. & REPAIR - REFLECTIONS POOL SERVICE & REPAIR OF SWFL, INC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:31 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:31 AM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Review Item Tim Crotts Meeting Pending Completed 09/13/2023 2:34 PM Completed 09/13/2023 5:01 PM 09/20/2023 9:00 AM Packet Pg. 191 8.E.1 ColiTer County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Conditioner $230.00 ❑ Mechanical $230.00 dSwimming Pool $230.00 ❑ Roofing $230.00 ❑ Specialty $205.00 Specialty Trade: i .!J 1664 / Lf I. APPLICANT PERSONAL INFORMATION: Name: First Middle Initial Last Business Name: ` �` ^� ?ap/ Address: -� J— `� -� 2.f�C.<► (iG ! he I)f ff " /V ay? (.to l �L J L Street CityState Zip Email: 1 V(A n ? .) (I' I C, � � ,� 4""aj, • CP 44,1 Telephone: o2 3 9" 2 g r- S t O*SS # (Last 4 digits only): ( 84- `!5^ Date of Birth: 0 e- 0 3 L g 1 1 Driver's license # (Last 4 digits only):,,? U 3 Pursuant to Collier County Contractor Licensing Ordinance No. 200646 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized bylaw. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing — FIRM Application Rev. 712022 Page 3 of 14 10 J LLI 00 C E t v ra Q G�?C Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive e Naples, FL 34104 • (239) 252-2431 contra ctorslicensing (r-)colliercoui1lvfl.cov Packet Pg. 192 8.E.1 1.6.2.9. Swimming PooBpa ervicing/Repair Contractor mquiTes 24 months experience With a passing ode an _ of an awrove d test and a passing grade on a �w& (2) hou� 11_ Words VX40""`A are delttW-, woFds ur�dc are added, business and law test and ulj,-ans a contractor whose y.: pc of WoTk involves, but i8 not limited to, the repair and wvicing of any swimming pool, or hot tub or spa, whether public or private, or otherwise, regardless of use, The scope of work ineludu the repair or replacement of existing equipment, any cleaning or equipment sanitizing which requires at least a partial disassembling, excluding filter changes, and the installation of new pool/spa equipment, interior reftnishit<g, the z reinstallation or aciciitiDn of pool heaters, the repair or replacement of all perimeter piping and filter piping, the repair of equiprneat rooms or dousing for poollspa equipment, and the Cn w substantial or complete draining of a swimming pool, or hot tub or spa, For the purpose of any z w repair or renovation. The scope of such work does not include direct connections to a sanitary w IL sewer system or to potable water lines. The installation, construction, modification, substantial X w w or complete disassembly, ar re lacement of p equipment permanently attached to and associated � w with the pool or spa for the purpos, of water treatment or cleaning of the pool or spa ra quiire's w rr liccnsure; hawever, the usage of such equipment for the purposes of water treatment or Cleaning a shall not require lieensure unless the usage involves construction, modification, substantial or � N complete disassembly, or replacement of such equipment. Water treatment that does not require Co such equipment does not rr-quire a license. In addition, a liczue shall not be requir(,d for the J w 00 cleaning of the good or spa in any way that does not affect the stroutural integrity of the pool or spa ar its associated equipment, E Packet Pg. 193 8.E.1 coiiie`r county Growth Management Community Development Department 06 W APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY V N Provide the names and telephone numbers of two persons who will always know your whereabouts, Name: �.. c1/�7.� Name: ] s-C y� cJ ..� 4, � 3 �2 _ �' Telephone: �� 5j 1 Telephone: `3 % ` II. NAME OF APPLICANT'S BUSINESS: Business Name: /GG� 0/?.r OO� �t-! (��G� 1ee 4 t1' SW �L � Business Address: -7 S q,3 G s14 �✓_ �t �t _ ' ljay , FL 3 r / Street City Telephone: o;2 ,3 Email: L i 0 G !i „ Z t + k 0,10 LJ�-� l - "%,.% Federal ID Tax No.: O Y— 13 E 0 ,9- I III. FINANCIAL RESPONSIBILITY State Zip YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: Filed for or been discharged in bankruptcy within the past 5 years? Zvi Had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? Undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past id years?* Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? NOTE:/If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment,*If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing— RRM Application Rev. 712022 Page 4 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 cuntractorsl icensino(cacolliercountvtt.00v 10 J W 00 C E t v Packet Pg. 194 8.E.1 CACT C014"ty Growth Management Community Development Department 06 1.1 APPLICATION FOR COLLIER COUNTY CERTIFICATE Of COMPETENCY IV. EXPERIENCE VERIFICATION EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being mad : - List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: CURRENT/PREVIOUS LICENSE: List below and attach copies any other certificates of competency/licenses you hold/have held in Collier County or any other jurisdiction. Include the license #, Type, and county you hold it in. IL O z AFFIDAVIT Cnn Under the penalties of perjury, I declare that I have read the foreg ing ap lication a id the fa is st ted in it are w v z true. w v414 Z41r,' � w a.x , W Applicant (please print) Si natur u_ O / State County of of The foregoing instrument before by &physical ❑ this w was acknowledged the menus of presence or online notarization on ZIA day ofiA, 20 � , by (� Z LL4L V-t Such person(s) Notary Public tnust check applicable box: � ❑ are personally known to the `i7has produced a current driver license N Cl) ❑ has produced as identification. J (Notary Sea]) :.R�yv P&% DEBRA P CHARLSON Cr ui 00 r-� _° •`� . Notary Public - state of Florida Commission # HH 276373 C 3— v s�°: My Comm. Expires Jun 20, 2026 (� Bonded through National Notary Assn. Notary Signature: ILU L/ � f � (D---- Q Contractor Licensing — FIRM Application Rev. 7/2022 Page 5 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive e Naples, FL 34104 • (239) 252-2431 contractorsIicens!ng@c;oIliercoun!yfl.goy Packet Pg. 195 8.E.1 Col CY County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION OF APPLICATION 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. ZC0 15 -77 M' " Z C-1 r/ r� C 4pplicant (please print 2e- Name I) el State of T L _ _ _ _ County of The foregoing instrument was acknowledged before me by means of42'physical presence or ❑ online notarization on this day of fin— uT 20 , by Uo s L Lo f A A Such person(s) Notary Public must check applicable box: ❑ are personally known to me ras produced a current driver license ❑ has produced (Notary Seal) as identification. R .DEBRA P CHARLSO�Notary Public - Stale of FloridaCommissionif HH 276373Notary Signature: My Comm, Expires Jun 20, 2026 nded through National Notary Assn. T J Contractor Licensing — FIRM Application Rev, 712022 Page 6 of 14 j rb Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 4.; contractorslicensi nci@co Ili ercou ntyfl.nov E t v Q Packet Pg. 196 8.E.1 covier County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY WORKMEN'S COMPENSATION AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. vJ J ,T11,6ti Zc1 /i 1G Applicant (pie print lit .l O/ i?l GC Name ofCom any Signature BEFORE ME this day personally appeared zv � f 1114 H �i/�i >`G. who affirms and Applicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of FL County of Cc (6,e /- The foregoing instrument was acknowledged before me by means of &rp"hysical presence or ❑ online notarization on this day ofA�t_LA&-1 203,by t-ti\S_� Zto�t�C� Such person(s) Notary Public must check applicable box: ❑ are personally known to me tar produced a current driver license ❑ has produced as identification. (Notary Seal) C. °ve1., DEBRA P CHARLSON z°r. Notary Public • Stale of Florida /1 is Commis€on p HH 276373 Notary Signature: +�'f ''For tti4 My Comm. Explres Jun 20, 2026 Bonded through National Notary Assn. Contractor Licensing — FIRM Application Rev. 712022 Page 7 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 * (239) 252-2431 con Iractorslicensi ng@collie rcoun lyf I.gov T Q Packet Pg. 197 8.E.1 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report Official Score Report: Candidate Information: Name —Luis I. Zurita Candidate #: 2971283OZ Online Testing Site: Ocala, FL Final Score Result: January 30, 2023 Business Procedures Score: 76% These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on January 27, 2023. If you have any further questions, please do not hesitate to contact us. Sincerely, Jay E. Bowermeister President 1! J W 00 C E s .r r� Q PO Box 831127 Ocala, Florida 34483-1127 — Voice (352) 369-GITS — Fax (352) 387-2443 800 997 2129 Packet Pg. 1 8771 8.E.1 GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report August 10, 2023 Official Score Report: Candidate Information: Name Luis I. Zurita Candidate #: 2971283OZ Online Testing Site: Ocala, FL Final Score Result: Pool Maintenance and Repair Contractor Pool Maintenance and Repair Contractor Score: 58% (07/28/2023) Score: 76% (08/07/2023) These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida. If you have any further questions, please do not hesitate to contact us. Sincerely, Jay E. Bowermeister President 10 D J W 00 a+ C E t Q PO Pox 831127 Ocala, Florida 34483-1127 — Voice (352) 369-GITS — Fax (352) 387-2443 800 997 2129 Packet Pg. 199 8.E.1 -low- S'tAwn �r.--�.Ilr r Ulf r, Led• CRS: C- r-edir Re��nr•ti�i,�� .1c�r•>r�ic•c� PERSONAL_ CREDIT REPORT MERGED REPORT COMPILED FROM NATIONAL RECORDS Entry # 13542 Phone: 850-539-8000 Email: un itedcrsappsOwmail.com www.UnitedCRS.com 3590 Frontier Road Tallahassee, FL 32309 August 29, 2023 Personal Information Since 09/07/10 FAD 08/25/23 Name ZURITA, LUIS I Former Name ZURITA, IVAN SSN ; , -8845 DOB: 08/03/1971 Address 7543 BERKSHIRE PINES DR, NAPLES, FL 34104 Address 7745 WOODBROOK CIR APT 3703, NAPLES, FL 34104 Address 1840 FLORIDA CLUB CIR APT 5204, NAPLES, FL 34112 Reported 04/21 - 08/23 08/14 - 08/23 06/14 - 07/14 FICO CLASSIC SCORE - 749 Summary PRIOI 0 Rev 15 # Accts 31 30 0 Hist 30 1 Lowest HC $300 Bankruptcies 0 Inst 15 # Inq 9 60 0 Hlst 60 1 Highest HC $408,500 Collections 0 Open 1 Curr Accts 30 90 0 Hist 90 0 Type High Balance Past Due Payment %Avall Revolving $86,600 $30,214 $0 $752 65% Installment $57,799 $47,143 $0 $979 Real Estate $603,500 $578,630 $0 $4,000 Open/Other $5,103 $3,067 $0 $61 Totals $753,002 $659,054 $0 $5,792 Revolving Accounts W Current Status Hist Status Q Acc Name/Address RPTD High PIVIT Bal PastDue Mths 30 60 90 Rating Date ~ OPND Limit Terms DLA ECOA M BK OF AMER 08/23 $26 $1,281 83 R 1 Cn Customer:801ON00119 08/16 $2,900 CREDIT CARD 08123 Individual AMOUNT IN H/C COLUMN 15 W CREDIT LIMIT 00 BK OF AMER 08/23 $60 $2,535 07 R 1 +-; Customer: 801 ON001 19 01/23 $9,000 CREDIT CARD 06123 Individual E t v Page 1 of 5 a Packet Pg. 200 8.E.1 AMOUNT IN HIC COLUMN IS °Q CREDIT LIMIT Lu CB/BLLSFL 08123 $10 $0 99 U R 1 Customer:372DC00929 10111 $3,000 Est. CHARGE 06/23 Individual w AMOUNT IN HIC COLUMN IS CREDIT LIMIT J CITI 08/23 $105 $3,288 44 R 1 O Customer.,9068B00040 11119 $8,300 a CREDIT CARD 08/23 Individual 07 z AMOUNT IN H/C COLUMN IS O CREDIT LIMIT I— JPMCB CARD 08/23 $102 $2,996 99 R 1 W Customer:458ON13374 08/14 $10,900 J AMOUNT IN HIC COLUMN IS 08/23 Individual ILL. CREDIT LIMIT w FLEXIBLE SPENDING CREDIT CARD SYNCB/CARE 08/23 $10 $0 86 R i Q Customer:404FF21789 06/16 $6500 Est. a CHARGE 07/23 Individual w w' AMOUNT IN HIC COLUMN IS 06 CREDIT LIMIT CBNA 07/23 $3,600 $29 $300 99 R 1 ~ z Customer- 362HT00104 06/11 Q CONSUMER DISPUTES THIS 07/23 Individual g ACCOUNT INFORMATION Q CHARGE d CBNA 07123 $101 $6,704 79 R 1 07 Customer-. 362BC00040 12116 $10,100 J CREDIT CARD 07/23 Individual O AMOUNT IN HIC COLUMN IS d CREDIT LIMIT O CAP ONE 07/23 $189 $6,540 07 R 1 z Customer:850BB01498 11/22 $10,000 AMOUNT IN HIC COLUMN IS 07/23 Individual CREDIT LIMIT ?j BUSINESS ACCOUNT - to PERSONAL GUARANTEE DISCOVER 07/23 $141 $6,570 17 R 1 w V Customer:165BB03747 02/22 $13,500 z CREDIT CARD 07/23 Individual AMOUNT IN HIC COLUMN IS w CREDIT LIMIT d SYNCB/RM2G 05/23 $4,500 $10 $0 99 R 1 x Customer:404FF08646 04111 Est. w u_ PAID ACCOUNTlZERO BALANCE 11/19 Individual O CHARGE ODPT/CBNA 03122 $1,000 $10 $0 79 R 1 w Customer:616FF04908 08/15 Est. > PAID ACCOUNTIZERO BALANCE 12119 Individual w ACCOUNT CLOSED BY CREDIT GRANTOR Q BK OF AMER 11/18 $1,500 $10 $0 98 R 1 Customer:801ON00119 09/10 Est. ACCOUNT CLOSED BY CREDIT 10118 Individual N GRANTOR _ CREDIT CARD SYNCB/RM2G 07117 $1,500 $10 $0 23 R 1 Customer-. 404FF08646 08115 Est, PAID ACCOUNT/ZERO BALANCE Joint w CHARGE 00 53 BANK NA 11/13 $300 $10 $0 55 R 1 c Customer:636ON24228 12108 Est. ACCOUNT CLOSED AT 01111 Individual �a Page 2 of 5 Q Packet Pg. 201 8.E.1 CONSUMER'S REQUEST PAID ACCOUNT/ZERO BALANCE Revolving Totals $752 $30,214 $0 Installment Accounts Current Status Hlst Status Acc Name/Address RPTD High PMT Sal PastDue Mths 30 60 90 Rating Date OPND Limit Terms DLA ECOA WSTLAKESVC 07/23 $8,046 $213 $7,946 Customer: 180 FA07681 05/23 AUTO 07123 Individual SHEFFIELD 07/23 $10,317 $180 $8,601 Customer:062FP00203 03122 RECREATIONAL MERCHANDISE 07/23 Individual SUNCOASTCU 07/23 $39,436 $586 $30,596 Customer, 728FC00168 02122 AUTO 07/23 Individual FIXED RATE SUNCOASTCU 07/22 $12,974 $0 Customer:728FC00168 04120 72M PAID ACCOUNTIZERO 07/22 Individual BALANCE AUTO SUNCOASTCU 02/22 $4,014 $0 Customer:728FC00168 05/21 60M PAID ACCOUNT/ZERO 02/22 Individual BALANCE UNSECURED SUNCOASTCU 02122 $16,734 $0 Customer:728FC0016B 04/20 72M PAID ACCOUNT/ZERO 02/22 Individual BALANCE AUTO KIAMOTORS 05120 $10,354 $0 Customer:180FA06907 04/17 36M PAID ACCOUNTIZERO 03120 Individual BALANCE AFFECTED BY NATURAL DISASTER ALLY 05/20 $17,807 $0 Customer:613FA16693 01/18 72M PAID ACCOUNT/ZERO 05/20 Individual BALANCE AUTO HYUNDA 11/18 $975 $0 Customer:180FA06899 11/14 49M PAID ACCOUNTIZERO 05/18 Individual BALANCE AUTO FMCC 12117 $16,151 $0 Customer:644FA04640 07114 PAID ACCOUNTIZERO 11117 Individual BALANCE AUTO CARMAXFIN 08/14 $20,923 $0 Customer:850FA00369 11112 60M PAID ACCOUNTIZERO 06114 Individual BALANCE Installment Totals $979 $47,143 Page 3 of 5 $0 01 11 lb 11 17 11 27 11 09 11 22 11 37 11 28 11 47 01 01 00 19 13 06/18 12 05118 41 11 21 11 10 J w 00 c m E �a Q Packet Pg. 202 8.E.1 Mortgage Accounts Current Status Hist Status Ace Name/Address RPTD High PMT Sal PastDue Mths 30 60 90 Rating Date OPND Limit Terms DLA ECOA PNMAC 08123 $195,000 $1,198 $190,032 20 11 Customer: 180 F M 22448 10121 REAL ESTATE MORTGAGE 08123 Joint CONVENTIONAL MORTGAGE CALIBER 08123 $408,500 $2,802 $388,598 29 11 Customer:625FZ10323 03121 FREDDIE MAC ACCOUNT 08123 Joint REAL ESTATE MORTGAGE ROUNDPTMTG 11121 $159,600 $0 83 11 Customer: 241 FM02448 07114 24Y FANNIE MAE ACCOUNT 10121 Joint PAID ACCOUNT/ZERO BALANCE ENVOY MTG 11114 $159,600 Customer:605FM39496 08114 ACCOUNT TRANSFERRED OR 09114 Joint SOLD REAL ESTATE MORTGAGE Mortgage Totals $0 02 30Y $4,000 $578,630 $0 11 Open Accounts Current Status Hist Status Ace Name/Address RPTD High PMT Sal PastDue Mths 30 60 90 Rating Date OPND Limit Terms AMEX Customer. 402BB48257 CREDIT CARD Open Totals Date 08/10/2023 09/14/2022 03/24/2022 12/29/2021 01 /26/2023 1 V2512022 03/24/2022 01/29/2022 11/05/2021 DLA ECOA 08123 $5,103 $61 $3,067 99 05111 Est. 08/23 Individual $61 $3,067 $0 Inquiries Customer Name CBNAIBBY ONE CREDIT SHEFFIELDi± CBNAIBBY CPS/MAIL CAPITALONE SUN SPORTS CARMAX CAPITALONE Customer Number 362HT00039 133ZBO2493 062FP00765 362HT00039 180FA02468 484BB05812 425AZ00281 401FA01342 484BB05812 PUBLIC RECORDS PUBLIC RECORDS HAVE BEEN CHECKED AT THE COUNTY, STATE, AND FEDRAL LEVELS Page 4 of 5 01 10 J W 00 a+ c E t v �a Q Packet Pg. 203 8.E.1 RESULTS; NO PUBLIC RECORDS FOUND END OF REPORT It is with understand Ing that the credit scoro allachod to this report can fluctuate daily and can chongo drastically. to soma cases, over 100 points whon making big purchases, etc. C0 J W 00 .r C tv t V R Page 5 of 5 Q Packet Pg. 204 8.E.1 F).F 7j�zq ri•�� .1c i•�icc• ow Phone: 850-539-8000 Email:unitedcrsapps@gmail.com www.UnitedCRS.com 3590 Frontier Road Tallahassee, FL 32309 BUSINESS CREDIT REPORT Entry ## 13542-0000 As of:8130123 REFLECTIONS POOL SERVICE & REPAIR Credit Summary: OF SWFL, INC 7543 BERKSHIRE PINES DR Bankruptcies: NAPLES, FL 34104 Vf Liens: PHONE: (239) 351.8026 `4T�Judgments Filed; Trade Lines Found: 1 V Collections: Credit Standing: Good Standing DBPR PUBLIC RECORD STATEMENT: Business Type: CORP PUBLIC RECORDS HAVE BEEN CHECKED AT LOCAL, STATE AND FEDERAL LEVELS FEIN Number: 88-1310219 RESULTS: NONE FOUND Florida SOS Document #: P22000020999 Key Facts Years in Business: Key Personnel: Florida Registered Agent: 1 Years President: ZURITA, LUIS I ZURITA, LUIS I N 7543 BERKSHIRE PINES DR Cn NAPLES, FL 34104 J W 00 C E t Page 1 of 1 a Packet Pg. 205 8.E.1 DnNstoN OF CORPORATIONS �t rtn ��llzrrrt! Slrrl� r�j!•7rtrffllt ts'��}rsN�� Department of State / Division of Corp r atins 1 Search Records 1 Search by Entity,Name ! O Detail by Entity Name Florida Profit Corporation W -j REFLECTIONS POOL SERVICE & REPAIR OF SWFL, INC w Filing Information Document Number P22000020999 Q a FEIIEIN Number 88-1310219 LU W Date Filed 03107/2022 06 H Effective Date 03/01/2022 Z a State FL Q Status ACTIVE tL Principal Address O 7543 BERKSHIRE PINES DR O a NAPLES, FL 34104 Z Mailing Address 7543 BERKSHIRE PINES DR NAPLES, FL 34104 Registered Agent Name & Address V Z ZURITA, LUIS I w 7543 BERKSHIRE PINES DR w NAPLES, FL 34104 a. x w Officer/Director Detail LL O Name & Address 3: w Title P, D w Q .ZURITA, LUIS I 7543 BERKSHIRE PINES DR N NAPLES, FL 34104 _ to Annual Reports J W Report Year Filed Date 00 2023 04/13/2023 E Document Images Q 04/13/2023 -- ANNUAL REPORT View image in PDF format 03/07/2022 — Domestic Profit View image in PDF format Packet Pg. 206 1 8.E.1 Electronic Articles of Incorporation FILED 2000020999 For March 07 2022 Sec. Of State Iyarbrough REFLECTIONS POOL SERVICE & REPAIR OF SWFL, INC The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: REFLECTIONS POOL SERVICE & REPAIR OF SWFL, INC Article II The principal place of business address: 7543 BERKSHIRE PINES DR NAPLES, FL. US 34104 The mailing address of the corporation is: 7543 BERKSHIRE PINES DR NAPLES, FL. US 34104 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 1,000 Article V N The name and Florida street address of the registered agent is: CO) LUIS I ZURITA � 7543 BERKSHIRE PINES DR ui NAPLES, FL. 34104 00 I certify, that I am familiar with and accept the responsibilities of registered agent. s Registered Agent Signattire: LUIS I ZURITA a Packet Pg. 207 8.E.1 Article VI The name and address of the incorporator is: LUIS I ZURITA 7543 BERKSHIRE PINES DR NAPLES FL 34104 Electronic Signature of Incorporator: LUIS I ZURITA P22000020999 FILED March 07 2022 Sec. Of State {yarbrough I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are hiie. 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 I st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P, D LUIS I ZURITA 7543 BERKSHIRE PINES DR NAPLES, FL. 34104 US Article VIII The effective date for this corporation shall be: 03/01/2022 10 J W C 4) E s .r r� Q Packet Pg. 208 8.E.1 IRS DEPARTMENT OF THE TREASURY 7i rJ INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 REFLECTIONS POOL SERVICE & REPAIR OF SWFL INC 7543 BERKSHIRE PINES DR NAPLES, FL 34104 Date of this notice: 03-21-2022 Employer Identification Number $8-1310219 Form: SS-4 Number of this notice: CP 575 A For assistance you may call us at 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Humber (EIN). We assigned you a EIN 88-1310219. 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 J records, O O IL Taxpayers request an EIN for their business. Some taxpayers receive CP575 notices when 0 another person has stolen their identity and are opening a business using their information. Z If you did not apply for this EIN, please contact us at the phone number or address listed on the top of this notice. When filing tax documents, making payments, or replying to any 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 W your account, or even cause you to be assigned more than one EIN. If the information is Z not correct as shown above, please make the correction using the attached tear -off stub W and return it to us. w IL Based on the information received from you or your representative, you must file W the following forms by the dates shown. LU Form 940 01/31/2023 O Form 944 01/31/2023 W Form 1120 04115/2023 Form 720 04/30/2022 w If you have questions about the forms or the due dates shown, you can call us at Q 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. N We assigned you a tax classification (corporation, partnership, etc.) based on information obtained from you or your representative. It is not a le al determination of your tax classificat thy T�f you want a legal J determination of your te� e°rivate letter ruling Uj from the IRS under the gu�4' lines anKnue r ui*e 2 M 2020-1 I.R.B. I (or 00 superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by fil-ing-Form-8832, End-ity Classification EIection. r_ See Form 8$32 and its instructio 3dd�it 6 Vormation. Q Packet Pg. 209 8.E.1 Co Zr County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY STATEMENT OF OWNERSHIP This certifies that I, Zo f ,Tl/a a member Iown am a member or managing t0 49 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledue. /1 Applicant (please print) State of 7� County of The foregoing instrument was acknowledged before me by means of & p"hysical presence or ❑ online notarization on this Aday of 1 c_ _ _ �, t ti�� 0 1,� , by Lt L\ Z Ll f- L \G; Such person(s) Notary Public must check applicable box: ❑ are personally known to me G as produced a current driver license ❑ has produced (Notary Seal) DEBRA P CHARLSON r° •�.¢ Notary Public • state of Florida Commission k HH 276373 icy Comm. Expires Jun 20, 2026 Bonded through National Notary Assn, Contractor Licensing — FIRM Application Rev. 712022 as identification. Notary Signature: Page 9 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive . Naples, FL 34104 . (239) 252-2431 contractors I icensi ng0co Ili ercoun lyf €.00v T J W 00 a+ C tv E L V Q Packet Pg. 210 Cower C;atmty 8.E.1 Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: zAla Certificate Category Requested: � 1 �� �� PO 42�' ��� 1�-4-14 �, 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 his/her 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 for the above -named applicant must provide the following information: Name: Cr`ti P l z7A� Title: � • 1 - Business Name: D L75 kcG I O( ,C Phone: License No. (if applicable): (� Phi 6 :Z. Business Address:. V:O-&Yl01,114y _fphyt Tv1 uy)-7 6nc-41,pv Ali&�l v,��rIC1) N OL�'S r—L ZYII& Street City �1 State Zip '7 The applicant was employed by me from n2 ~I -CJ to -a 4--R d, Applicant's title: i amain The applicant's scope of work (specific duties) included: . L I /� r t _ .-- I -- Additional comments: NOTE TO LICENSED CONTRACTORS: Falsifying any infomaation provided herein may subject your license to revocation. Under penalty of perjury, I declare that the facts stated here are true. f l r Signature rsah pf peroviding the statement State of � 6ri J Q, County of Th forego instrument s acknowlec U�a4y o 2Qaj, by presence or ❑ online notarization on this Such person(s) Notary Public must check applicable box: are personally known to me ❑ has produced a current driver license ❑ has produced { t�sk.%§,g l) LISA M GALLAGHER Notary Public -State of Florida -* *� Commission it GG 948984 zy My Commission Expires February 20, 202 Contractor Licensing -• FIRM Application Rev. 7/2022 identification. Notary Signa e: f"d, 2 4 — C— - Page 11 of 14 in 10 D J W ib C t is Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive e Naples, FL 34104 • (239) 252-2431 contractorslicensin it(�colliercoun tvFl.gov Packet Pg. 211 8.E.1 Collier County Growth Management Community Development Department °d APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: ZL)/,j 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 his/her experience within this trade. You are being requested to provide information that will aid the applicant in meeting this requirement. You should verify lime 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 for the above -named applicant must provide the following information: Name: B ra yy_ 5, 1 !C. 2 _.S r- Title: Business Name: P 1 Gi, b�e r s Pbo l SCE cy i C e Phone: 9,3 q " oZ 5 3 " L4 ;),O License No. (if applicable): G D S ! 3 `7 I Business Address: 1,9,33q }(` S+ 60 K001P-S FL q ) t 7 Street �} City State Zip The applicant was employed by me from oc' '� g ^� to — a- a� Applicant's title: ouke s_laec t'aL's -� n_n d- s_u p ery I The applicant's scope of work (specific duties) included: k h d t y 1 A d 5 C' rl7 1 C e, main + aid repair aF a mslan+-f`a 1 pob I . Additional comments: NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject yourlicense to revocation. Under penalty of perjury, I declare that the facts stated here are true. State of S County of cl l t e f The foregoing instrument was acknowledged before�me by means cs�adayof?.S+,20,by Such person(s) Notary Public must check applicable box: ignature of on providing lFe statement ❑ are personally known to me r�ias produced a current driver license ❑ has produced as identification. (Notary Seal) 11181 E yann UmlorIC - STATE OF FLORIDAN EXPIRES JULY 31, 2o26 Notary ION N0. HH 295273 Contractor Licensing — FIRM Application Rev. 712022 presence or ❑ online notarization on this Page 12 of 14 10 D J W 00 c as E t �a Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractors] icensing@colliercountvfl.goo Packet Pg. 212 8.E.1 VLASTER'S i POOL SERVItE� INC. �, August 25, 2023 Dear Sir/Madam P.O. Box 990094 Naples, Florida 34116 239-643-6140 Plasters Pool Services, Inc. has been a full -service residential pool service and repair company serving Collier County for over 20 years. I have held a Certified Pool Contractor license since inception. We specialize in weekly pool cleaning and maintenance of residential pools. Luis Zurita worked for us here as a pool service technician from 2008 thru September 2022. He has always been punctual, honest and full of integrity in my day to day experience with him. Sincerelny, Y i Eric Plaster V.P., Plaster's Pool Services, Inc. �]At:ole Gj� \ t=cx)(-0`1 +v1e J S n of a Ares cy)ce c'n of- i -'�It�er � cis a�>(1p beta Shayann Umlor NOTARY PUBLIC - STATE OF FLORIDA MY COMMISSION EXPIRES JULY 31, 2026 ____COMMISSION NO. HH 295273 b`j .)r \ C R1 Cksk � 1�UCn n Gr e_ � a�a� k�_( �" V,\Cwn A0 � 10 J W 00 a+ C E t Q Packet Pg. 213 8.E.1 COter C01414ty Growth Management Community Development Department 06 II APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF G COUNTY OF e0l6 / Gl"' - I, ,N Pl�ti 6(4 Za% 4�/ , having been first duly sworn, state and affirm: am a resident of col' l C� County, Lo aI'fyt (State) and have resided here for more than five (5) years. During the last five (5) years I have known /441 1(1414 2c) nG� (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person Qfhonesty, integrity and good character. a_ Signature 1-tOA)ICA 0AJA� Printed Name Address: 35 _� 2 2-tiP A�JC 5G Street NAPCEs F1, 3gll� City State Zip Telephone: 9-3 9 .. State of T'ovidq County of CQt►t w The foregoing instrument was acknowledged before me by means of 0 physicaI presence or ❑ online notarization on this Lu day of l3aor�{ ,20 Z3 ,by F-ta,�ca SZo�cLs T. Q Such person(s) Notary Public must check applicable box: ~ ❑ are personally known to me L1 has produced a current driver license N Cn I9/has produced VL. cA_ as identification. J (Notary Seal) LLJ 00 +�Y pvs'• SHIRLEY OESIREE ARGUETA � ': Notary Public • State of Florida m Commission k HH 90362 E My Comm. Expires reb E, 2025 Notary Signature: ecy- __.J�c� to Q Contractor Licensing —FIRM Application Rev. 712022 Page 14 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contra ctorslicensing@coltiercounWI.nov Packet Pg. 214 8.E.1 CO*Y COunty Growth Management Community Development Department 06 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF jF6 COUNTY OF 0-O /8 G I, w0lt° K due UG4 , having been first duly sworn, state and affirm: / j I am a resident of /it' G � County, r! 0 ly (State) and have resided here for more than five (5) years. During the last five (5) years I have known &f , va" ZL) I (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a perso nesty, integrity and good character. Signature ('D 40 Lo 4 Printed Name Address:_ ('eooW M&& fib -f 4y Street �6)gLel 4G 3 utr O 'I City State zip Telephone; D 31 W 0 dG t"o 11 r r LL State of 0(f County of : W The foregoing instrument was acknowledged before me by means of ld physical presence or 0 online notarization on this w day of 4•f S 20 , by Such person(s) Notary Public must check applicable box: Q ❑ are personally known to me has produced a current driver license N ❑ has produced as identification. Cn J (Notar W SCHEMALDAJUSTE Notary Pubic •State of Florida 00 + � Commission d HH 178505 E 1= cr t� my Comm. Expires Sep 23, 2025 Notary Signature: t 001 WPM to Q Contractor Licensing — FIRM Application Rev. 7/2022 Page 14 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing(d-)colliercountvfi.aov Packet Pg. 215 8.E.1 ra z FA iLUISIVAN a7643'139ftKSHIRE P.NAFE S, FL 34104 � � � .: 4 :C4 Qaro-►-M 12R;—::SY8f�E' ! uISE OSM62616 .. 55E Mt�Oi�le9la,r REP-��.a 06t01s"!F 48wslz 6' Y m T J W 00 C E s .r r� Q Packet Pg. 216 8.F 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.17 Doc ID: 26617 Item Summary: 8F. ALAN LORA — REVIEW OF EXPERIENCE - ALUMINUM CONTRACTOR - IZZY SCREEN REPAIR, INC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:32 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:32 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:35 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:01 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 217 co -,r CO.14"ty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY 05 q CERTIFICATE OF COMPETENCY < 0 S__ /?q�9— 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ 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: A rAk' A LA G'�v yr 1. APPLICANT PERSONAL INFORMATION: Name: Middle Initial C) C Last Business Name: 7�-2- r ��.1 CU t— 4e- Address: u.✓ L 0 :L aj, Street City Email: OLkCLN 1 V;r� Ct S e t C Luc �r✓(• (�y Telephone:(i ] _. to Date of Birth: U IS � 15 � i cl State *SS # (Last 4 digits only): Zip C1 S Driver's License # (Last 4 digits only): Q Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit their social security number, drivers license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized by law. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes, Contractor Licensing — FIRM Application Rev. 712022 Page 3 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 conlractorslicensing(a7colliercoun".aov 8.F.1 U- 00 r- aD E t U ca r Q Packet Pg. 218 8.F.1 p 1A.3 3. Aluminum Contractor 0 requires twenty-four (24} months experience with s O J �]71CC1° on = a�m-s�`r n. orovW test a.nd a passing grade on awoo- ; business Q and law test and mcana those who are qualified to fabric, instal], maintain, repair, Alton, or J Q extend accessories such as rnctaJ and vinyl siding, awnings, u_ y g gs, security shutters, $+suers, soffits and CO Prefabricated roams, screon enclosures, and ~ PGmetal or vinyl parduts, N LL CO �.i C d E t U R a+ Q Packet Pg. 219 8.F.1 co ier County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Provide the names and telephone numbers of two persons who will always know your whereabouts. Name: :Is t' 'a't �_ LLo !Name: L_Zt'i � c�, 1= o ( C, Telephone:(2---S9) $2—i `5)3\ II. NAME OF APPLICANT'S BUSINESS: Telephone(-2-3 q ) 92.1 — S g aO Business Name: ?D! 17CC2 r Tt, Business Address: Street city Telephone:`? �~ Cis -5 y Email: ie. 2 0 L rl ? q Federal ID Tax No.: - T 1 7 g q III. FINANCIAL RESPONSIBILITY state Zip YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: Filed for or been discharged in bankruptcy within the past 5 years? Had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? xUndertaken construction contracts or work that resulted in liens, suits, or judgments being filed? k Undertaken construction contracts or work that a third party, such as a bonding or surety company, or made financial statements on? I completed I Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years?* Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment."If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — FIRM Application Rev. 712022 Page 4 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensin colliercoun fl. ov Packet Pg. 220 Complaint Status CEUL20230001190 Date: 2/8/2023 I Expand All / Collapse All Note: You can collapse and expand Individual sections by clicking the header of the section you wish to collapse/expand. I Z — Complaint Information J Q Case Number: CE01-20230001190 00 Status: Closed ti Complaint Type: Unlicensed c� Description: Unlicensed Aluminum Contractor - Lora, Alan - Citation #12589, $1000.00, 1st cm Violation, [zzy Screen Repair Inc, Locality of Complaint: 128 Trinidad St. t i Property Owner's Full Name: PIAS, MICHAEL P Z — Locations Locations: Property 52398320000 Address 128 Trinidad Sir, -"a les -- - Fees Paid Fees Contractor's Lic, Citation (1st Offense) outstanding Fees No outstanding fees. Totals: Total Amount Payable Online: $0.00 — - Inspections Amount Paid $1,000.00 $1,000.00 Amount Paid $1,000.00 1 $1,000.Oo There are no inspections for this complaint. Owing Date Paid Description Pald 03/15/2023 Owing Date Paid Description r'0.0[i LL 00 C N E s t� r Q Packet Pg. 221 Complaint Status CECV20230001240 Date: 2/10/2023 I Expand All / Collapse All Note: You can collapse and expand individual sections by clicking the header of the section you wish to collapse/expand. I Z — - Complaint information J Q Case Number: CECV20230001240 co Status: Closed i` Complaint Type: Code Violation Description: Commence Nevr Screen Enclosure Prior to an Issued Permit - Lora, Alan - Citation to #12690, $1000,00, 1st Violation, Izzy Screen Repair Inc. Locality of Complaint: 128 Trinidad St, Property Owner's Full Name: PIAS, MICHAEL P Z — - Locations 0 Locations: Property 52398320000 Address 128 Trinidad ST. Naples — - Fees Paid Fees Amount Paid Owing Date Paid Description Contractor's Lic. Citation (1st $1,000.o0 l,0o0.p0 Paid 03/15/2023 Offense) Outstanding Fees Amount Paid Owing Date Paid Description No outstanding fees. Totals: $1,000.00 $1,000.00 $0.00 Total Amount Payable Online: $0.00 — -Inspections There are no inspections for this complaint. LL 00 C N E s t� r Q Packet Pg. 222 8.F.1 Co Der County Growth Management I Community Development Department Q O APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Z a J IV. EXPERIENCE VERIFICATION Q u: EDUCATION: 00 List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: N Z List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: t1 C r e P w Ife,C� [ Vt L ,ti,�� G— t.[ i�r., ✓t t i,�v� r%Q [., ' r 3 V� CURRENT/PREVIOUS LICENSE: List below and attach copies any other certificates of competency/licenses you hold/have held in Collier County or any other jurisdiction. Include the license #, Type, and county you hold it in. AFFIDAVIT Under the penalties of perjury, I declare that I have read the foregoing application true. A I (A -A Lo ( C Applicant (please print) the facts stated in it are of Applicant State of et( County of CC The Joregoing instrument was acknowledged be ore me by means of ®physical presence or ❑ online notarization on this day of , 20 ` , by 1l10 Z,2ra Such person(s) Notary Public must check applicable box: ���� Q Lg are personally known to me ❑ has produced a current driver license 0 J ❑ has produced as identification. ZQ J (Notary Seal) Q Notary Public State of Florida j Kevin Russatto 00 My commission +: I Exp. 9/ 9�2025 — Notary Signature: E E t Contractor Licensing — FIRM Application Rev. 712022 Page 5 of 14 U r Operations & Regulatory Management Dlvision, Contractor Licensing • 2800 North Horseshoe Drive • Naples. FL 34104 • (239) 252-2431 Q contractorslicensinq(a.colliercount fS f�� Packet Pg. 223 8.F.1 A Co -rer County Growth Management I Community Development Department O J APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY z a J CERTIFICATION OF APPLICATION Q u: 00 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 N 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 Z 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 w 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. w (A L o-A L�Tc,- Applicant (please print ,TLZ4 Name of Company AM — Signature of Appli a State of County of L1� The foregoing instrument was acknowledged before me by means of I"physical presence or El online notarization on this ' � day of --, 20,, , by Such person(s) Notary Public must check applicable box: 12 are personally known to me ❑ has produced a current driver license ❑ has produced (notary Seal) =ALNoE Public State of Florida Kevin Russetto n1y Commission till P 9119/2026 Contractor Licensing - FIRM Application Rev. 7/2022 as identification. Notary Signature: nature: Page 6 of 14 Operations & Regulatory Management Division. Contractor Licensing r 2800 North horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing@cofliercountyfl.gov u_ 00 r- E t U ca r Q Packet Pg. 224 s 8.F.1 C O TeY county Growth Management I Community Development Department O APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Z a J WORKMEN'S COMPENSATION AFFIDAVIT Q 00 It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. N z Applicant (please print a Name of Companv W Signature BEFORE ME this day personally appeared iOAI L,0 ,ra- who affirms and Applicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of County of The foregoing instrument was acknowledged 30�6y of , 20 ,23-, by me by means of physical presence or 0 online notarization on this Such person(s) Notary Public must check applicable box: L°I are personally known to me © has produced a current driver license ❑ has produced (Notary Seal) Notary Publlc State of Florlda Ak Kevin Russetto My Commission It't 801 EXp 9/1912025 as identification. Notary Signature: Contractor Licensing — FIRM Application Rev. 712022 Page 7 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 !North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensin colliercoun ov U- 00 r= aD E t U ra r Q Packet Pg. 225 5/16/23, 10:58 AM Score Report Score Report 8.F.1 Name: Sponsor; tD P- Score: # Unanswered Questions: Module FLBO FLLIC FLTL FLSRR FLLL FLCM FLPM FLE&B FLFM FLRM FLLIEN ALAN LORA Test: Collier County Date: Test It] 76 ReSull: 0 Subject Area Status LOW Business Organization F Licensing F Tax Laws F Safety OSHA P Labor Laws F Contract Management F Project Management P Estimating & Bidding P Financial Management P Risk Management P Lien laws F Prod Business and Law, 2nd edition 05/16/2023 188168520 Pass Cut Score HIGH I a 0 J Z a J a 00 r t0 to tV U- 00 r- E t U ca r a https:llproctorconsole.provexam.com/g/pages/dashboad Packet Pg. 226 3129/23, 11:10 AM Score Report Score Report 8.F.1 Name: Sponsor: ID #: Score: # Unanswered Questions Prov ALAN LORA Test: Aluminum/Screen Enclosure - (FL08304) Collier County Dale: 03/2912023 Test ID: 886774378 84 Result: Pass 0 Module Subject Area Status LOW Cut Score HIGH - -----. . . ...- ------------------ FLPRE Plan Reading & Estimating P - ------------------ FLSAFE Safety P - ---- ------ --- .. FLSENC Screen Enclosures P ... ,_, ................ - _.... FLSCEEN Screen Rooms F FLCAR Carports & Patio Covers P FLMISCALS Miscellaneous Aluminum Structures P U- 00 r- E t U ca r a https:llproctorconsole.provexam.coml#Ipages;lcode=en-US;token=3mcdKRaIpW2n2Olvre5vFHgEroPog4zP41ojbfCBlciUlpyegJrfPFm Packet Pg. 227 6/20/23, 8:22 AM Fifth Third Identity Alert - Credit Gateway 8.F.1 3 Bureau Credit Report with 3 Bureau VantageScores as of 5/31/2023 780Good � �0, . e I Score Factors • Few or no installment accounts with delinquent or derogatory payment status • The balances on your accounts are not too high compared to loan limits • You have few or no accounts that were opened recently • Lack of sufficient relevant first mortgage account information • The date that you opened your oldest account is too recent Show more Summary 780 Good DU Score Factors • Few or no installment accounts with delinquent or derogatory payment status • The balances on your accounts are not too high compared to loan limits • You have few or no accounts that were opened recently • Lack of sufficient relevant first mortgage account information • The date that you opened your oldest account is too recent • You have either very few loans or too many loans with recent delinquencies Show more 780 Good Eq Score Factors • Few or no installment accounts with delinquent or derogatory payment status • The balances on your accounts are not too high compared to loan limits • You have few or no accounts that were opened recently • Lack of sufficient relevant first mortgage account information • The date that you opened your oldest account is too recent • You have either very few loans or too many loans with recent delinquencies Show more Revolving Credit Accounts @ '. StE 4 w a Count 3 3 3 X w u_ Balance $239.00 $230.00 $230.00 O Payments $44.00 $40.00 $40.00 W W Open 2 2 2 a' I Closed 1 1 1 O DeferredlUnknown 0 0 0 Z Q �• Real Estate Credit Accounts !@ `u Eq J Q L� 00 Count 0 0 0 aD Balance $0.00 $0.00 $0.00 t v Payment $0.00 $0.00 $0.00 f6 Q hilps://www.53identityalert.com/secure/CreditGateWay.aspx Packet Pg. 228 6120123, 8:22 AM Fifth Third identity Alert - Credit Gateway Open 0 0 0 Closed 0 0 0 1 Q Deferred/Unknown 0 0 0 OJ Installment Credit Accounts 0 �, to Eq z J • Q Count 1 1 1 00 Balance $0.00 $0.00 $0.00 r— Payment $0.00 $0.00 $0.00 r t0 N Open 0 0 0 0 z_ Closed 1 1 1 7 Deferred/Unknown 0 0 0 d W Open Accounts � 'e u Eq z w U Count 2 2 2 rn Balance $239.00 $230.00 $230.00 N Payment $44.00 $40.00 $40.00 0 Open - - - H Q Closed _ - F- z DeferredlUnknown - - O U Collection Accounts a. ': a to Eq z Count 0 0 0 Q Balance $0.00 $0.00 $0.00 LU U 0 z Payment $0.00 $0.00 $0.00 W W W Open 0 0 0 X W Closed 0 0 0 LL O Deferred/Unknown 0 0 0 W Other Accounts W. !e fu Eq W Q Count 0 0 0 O J Balance $0.00 $0.00 $0.00 z Q Payment $0.00 $0.00 $0.00 Q Open 0 0 0 00 Closed 0 0 0 Deferred/Unknown 0 0 0 U cc r Q https:llwww.53identityatert.comisecure/CreditGateWay.aspx Packet Pg. 229 6120123, 8:22 AM Fifth Third Identity Alert - Credit Gateway I Personal Information O J Z a Personal Information s� !e #u Eq J tp Name Alan Lora Alan Lora Alan Lora r— Dale of Birth 1995 1995 1995 r ttoo N 138 Cyrus St 138 Cyrus St 138 Cyrus St Address Marco Island FL 34145-4644 Marco Island FL 34145 Marco Island FL 34145 U Z Date Address Reported 5/16/2017 3/7/2016 5/30/2023 a a w Previous Addresses 'e to Eq Z w w 138 Cyrus St 138 Cyrus St 138 Cyrus St lY Address 1 Marco Island FL 34145-4644 Marco Island FL 34145 Marco Island FL 34145 U 1272 Kendari Ter N Address 2 N Naples FL 34113-8483 O Employment Details t; e f�u Eq Q Employer 1 Izzy Screen Repair Z O U Z_ Consumer Statement J Q w U No Consumer Statements Available. Z w FR w a X w Credit Inquiries LL. O w w No Credit Inquiries Available. I Q lY O J Revolving Credit Accounts Z Q J Q LL 00 Account 1 •. !e #u Eq E Account JPMCB CARE] JPMCB CARD JPMCB - CARD SERVICE v c� Account Holder 414720XXXXXX 414720XXXXXX 414720XXXXXX r Q htips://www.63!dentilyalert.com/secure/CreditGateWay.aspx Packet Pg. 230 6/20/23, 8:22 AM Fifth Third Identity Alert - Credit Gateway Account Type Revolving Revolving Revolving Account Condition Open Open Open Date Opened 6/24/2020 6/24/2020 6/24/2020 High Balance $3,331.00 $3,331.00 $3,331.00 Monthly Payment $40.00 $40.00 $40.00 Account Balance $230.00 $230.00 $230.00 Last Reported 5/14/2023 5/14/2023 5/14/2023 Amount Past Due $0.00 $0.00 $0.00 Limit $16,300.00 $16,300.00 $16,300.00 Remarks - Responsibility Individual Individual Account Individual Account Past Due - 30 Days 0 0 0 Past Due - 60 Days 0 0 0 Past Due - 90 Days 0 0 0 Experian Transunion Equifax Past 24 months J A S O N D J F M A M J J A S O N D J F M A M J i 8.F.1 I Q O J Z a J Q 00 r` N Current 30 Days Late m 60 Days Late m 90 Days late 120 Days Late 150 Days Im180 Days Late m Payment Plan m R m Collection Late m Negative Nol Available J Foreclosure Forectasure ure Charge Off Q W U Account 2 ■. r; a Eu Eq W Account JPMCB CARD JPMCB CARD JPMCB - CARD SERVICE d X Account Holder 426684XXXXXX 426684XXXXXX w 426684XXXXXX Lt_ O Account Type Revolving Revolving Revolving LJ Account Condition Open Open Open > LU Date Opened 8/23/2019 8/23/2019 8/23/2019 I Q High Balance $1,872.00 $1,872.00 $1,872.00 O J Monthly Payment $4.00 $0.00 $0.00 ZQ Account Balance $9.00 $0.00 J $0.00 Q Last Reported 5/22/2023 5/26/2023 5/26/2023 00 Amount Past Due $0.00 $0.00 $0.00 (D E Limit $3,900.00 $3,900.00 t $3,900.00 U c� r Remarks httpsllwww.53identityalert.com/secure/CreditGateWay.aspx Packet Pg. 231 6/20123, 8:22 AM Fifth Third Identity Alert -Credit Gateway Responsibility Individual Individual Account Individual Account Past Due - 30 Days 0 0 0 Past Due - 60 Days 0 0 0 Past Due - 90 Days 0 0 0 Past 24 months J A S O N D J F M A M J J A S O N D J F M A M J Experian Transunion Equifax mCurrent :;W 1 30 Days late M180 Days Late m Payment Plan Negative m 60 Days Late 90 Days Late 120 Days late iiAii9 150 Days Late Roposession Collection • Y� Not Available Foreclosure Charge Off I•-- 8.F.1 I Q d' O J Z a J Q LL 00 r` r to to N Account 3 0■ !e to Eq W Account FIFTH THIRD BANK NA - FIFTH THIRD BANK, N. N Account Holder 54440OXXXXXXXXXX - 54440OXXXXXX 7 O Account Type Revolving - Revolving F_ U a Account Condition Closed - Closed W Z Date Opened 4/11/2018 - 4/11/2018 O High Balance $2,090,00 - $2,090.00 Z Monthly Payment $0,00 - $0.00 Account Balance $0.00 - $0.00 J Q Last Reported 1/24/2023 - 1/25/2023 W U Z Amount Past Due $0.00 - $0.00 W W Limit $3,500.00 - $3,500.00 d X Remarks - w O Responsibility Individual - Individual Account w Past Due - 30 Days 0 - 0 W Past Due - 60 Days 0 - 0 I Q Past Due - 90 Days 0 - 0 O J Z Past 24 months J Q J A S O N D J F M A M J J A S O N D J F M A M J LL Experian • • • • • • • . • . • • • . • . • • �mmm®mmmmm®mmmmmmm® 00 Transunion (D t 1 Equifax • • • • • • • • • • • • . • • • . • ca Q htips://www.53identityalert.com/socuro/CreditGateWay.aspx Packet Pg. 232 6/20/23, 8:22 AM mCurrent 14s 130 Days Late 0 180 Days Late m Payment Plan Account 4 Account Account Number Account Type Account Condition Date Opened High Balance Monthly Payment Account Balance Last Reported Amount Past Due Limit Remarks Responsibility Past Due - 30 Days Past Due - 60 Days Past Due - 90 Days Fifth Third Identity Alert - Credit Gateway 60 Days Late 90 Days Late + 120 Days Late 150 Days Im Late ®Reposession Collection `S.;E�'f Negative m L ji"fa\ NotAvaliabfe Foreclosure Charge Off - -1 !=-- 'e ,Fq 5/3 BANK NA - - XXXX - Revolving - Closed - - 4/11/2018 - - $2,090.00 $0.00 - $0.00 1 /25/2023 $0.00 $3,500.00 - Inactive Account - - Individual Account - - 0 - 0 - 0 8.F.1 Past 24 months J A S O N D J F M A M J J A S O N D J F M A M J Experian Transunion Equifax m Current 30 Days Late �,P- 60 Days Late I' 1n f 90 Days Late :'l!l1, 120 Days Late Lat i a: Days - Late ®s 1 380 Days Late m Payment Plan m Reposession m Collection Foreclosure j ; (:. Negative Not Available Charge Olf I 0 J z a J Q 00 r` r co co N LL 00 Q Packet Pg. 233 6/20123, 8:22 AM MCurrent I _ h 30 Days Late Im 180 Days Late m Payment Plan Account 4 Account Account Number Account Type Account Condition Date Opened High Balance Monthly Payment Account Balance Last Reported Amount Past Due Limit Remarks Responsibility Past Due - 30 Days Past Due - 60 Days Past Due - 90 Days Fifth Third Identity Alert - Credit Gateway M 60 Days Late . r 90 Days Late M 120 Days Late 150 Days ®Re osessW Foreclosure cotfecuon m Charge Off ktd Negative Lato s'l �j Nat Available .e D Eq • 513 BANK NA - - XXXX - - Revolving - Closed - 4/11/2018 - $2,090.00 - $0.00 - - $0,00 - - 1/25/2023 - - $0.00 $3,500.00 Inactive Account Individual Account 0 - 0 0 8.F.1 Past 24 months J A S O N D J F M A M J J A S O N D J F M A M J Experian Transunion Manama Equifax Current ."ii, 30 Days Late r 180 Days Late m Payment Plan Real Estate Credit Accounts No Account Information Available. �aaammmam®aa m 60 Days Late 90 Days Late 120 Days Late 150 Days Late mReposession m Collection ® Negative Not Available Foreclosure Charge Off LL 00 C tv E t U ca r Q hilps://www.53identityalert.corrVsecure]Cred[tGa[eWay.aspx Packet Pg. 234 6/20/23, 8:22 AM Fifth Third Identity Alert -Credit Gateway High Balance - $2,055.00 Monthly Payment $0.00 Account Balance - $0.00 - Last Reported - 4/2612019 - Amount Past Due $0.00 - Limit $0.00 Remarks - Closed Responsibility - Individual Account Past Due - 30 Days - 0 Past Due - 60 Days - 0 Past Due - 90 Days - 0 Fxnarinn 8.F.1 Past 24 months J A S 0 N D J F M A M J J A S 0 N D J F M A M J I Q O J Z a J Q 00 r` to LL tb C E t V ca r Q Packet Pg. 235 6120/23, 8:22 AM Installment Credit Accounts Fifth Third Identity Alert - Credit Gateway Account 1 !e fu Eq Account IBERIA BANK FSB - - Account Number 690056XXXX - - Account Type Installment - - Account Condition Closed - - Date Opened 5119/2017 - - High Balance $0.00 - - Monthly Payment $0.00 - - Account Balance $0.00 - - Last Reported 5/1/2019 - - Amount Past Due $0,00 - - Limit $0.00 - - Remarks - - Responsibility Individual Past Due - 30 Days 0 Past Due - 60 Days 0 Past Due - 90 Days 0 8.F.1 Past 24 months J A S O N D J F M A M J J A S O N D J F M A M J Experian Transunion Equifax mCurrent �::Sii # 30Oays Late 60 Days Late 90 Days Late �r Payment Plan m Reposasslon Collection 180 Days Late m Foreclosure Charge Off Account 2 •. !e fu Account IBERIABANK Account Number - 69XXXX Account Type - Installment Account Condition - Closed Date Opened - 5/19/2017 120 Days Late r 150 Days r s Late F401 Negative i Not Available Eq I Q O J z a J Q tp r` r t0 to N U- 00 r- (D E t U ca Q https:llwww.53 identi lyalert,comiser-u re/Gred!tGatoWay.aspx Packet Pg. 236 6120123, 8:22 AM Fifth Third Identity Alert - Credit Gateway High Balance - $2,056.00 - Monthly Payment $0.00 Account Balance $0.00 - Last Reported - 4/2612019 - Amount Past Due - $0.00 - Limit - $0.00 - Remarks - Closed Responsibility - Individual Account Past Due - 30 Days - 0 - Past Due - 60 Days - 0 Past Due - 90 Days - 0 - 8.F.1 Past 29 months J A S 0 N D J F M A M J J A S 0 N D J F M A M J Experian Transunion Equifax mCurrent I :.iu i 30 Days Late r 60 Days Late 180 Days Leta m Payment Plan m Reposession Foreclosure � N. . Account 3 e • Account - Account Number - Account Type Account Condition Date Opened - High Balance - Monthly Payment - Account Balance - Last Reported Amount Past Due Limit - Remarks Responsibility Past Due - 30 Days - Past Due - 60 Days - hilps:llwww.53identityalert.com/socufe/CreditGateWay.aspx 90 Days Late I+ 120 Days Late 150 Days Late mCharge rRi-d Negative 11ta� NotAvallable 0 Eq z - 1BERIABANKLU Q - 69XXXX 0 U z - Installment w W - Closed d X w - 5/19/2017 LL O - $2,055.00 w - $0.00 5; LU - $0.00 I Q - 8/112019 0 O J - $0.00 Q J - $0.00 Q ti - Fixed Rate 00 1= - Individual Account aD E t - 0 U ca r Q - 0 Packet Pg. 237 6120123, 8:22 AM Fifth Third Identity Alert - Credit Gateway Past Due - 90 Days - - 0 Past24 months I Q tY J A S O N D J F M A M J J A S O N D J F M A M J O Experian Z a Transunion J Q Equifax ti 00 r` •� Current f :l+l 30 Days Late r r 6o Days Late 90 Days Late r 124 Days Late 150 Days Lateto r to r 190 Days Late Payment Plan y y IReposesslon Collection a 0.19 Negative Foreclosure Charge Off — lal,_ Not Available � N , Open Accounts e _ U lJ 0 C Account 1 !e to Eq n r_ Account JPMCB CARD JPMCB CARD JPMCB - CARD SERVICE 0 Account Holder 414720XXXXXX 414720XXXXXX 414720XXXXXX C F C Account Type Revolving Revolving Revolving p F Account Condition Open Open Open C C Date Opened 6/2412020 6/24/2020 6/24/2020 High Balance $3,331.00 $3,331.00 $3,331.00 Monthly Payment $40.00 $40.00 $40.00 Account Balance $230.00 $230.00 $230.00 u C Last Reported 5/14/2023 5/14/2023 5/14/2023 u 0 Amount Past Due $0.00 $0.00 $0,00 U 0 Limit $16,300.00 $16,300.00 $16,300.00 U u C Remarks e "u Responsibility Individual Individual Account Individual Account u Past Due - 30 Days 0 0 0 Past Due - 60 Days 0 0 < 0 0 C Past Due - 90 Days 0 0 0 e e Past 24 months < u a J A S O N D J F M A M J J A S O N D J F M A M J Experian ®mmmmmmmmmmm®®m • mmm®mm® i Transunion �m�mmmmmmm • mmmm • m®mmmm c c ®m®mmmmmmm • mmmmmmm®®m® < Equifax https:l/www,53identityalert.com/securelCreditGateWay.aspx Packet Pg. 238 6/20123, 8:22 AM Fifth Third Identity Alert - Credit Gateway 8.F.1 MCurrent I <ai J 30 Days Late M180 Days Late m Payment Plan Account 2 Account Account Holder Account Type Account Condition Date Opened High Balance Monthly Payment Account Balance Last Reported Amount Past Due Limit Remarks Responsibility Past Due - 30 Days Past Due - 60 Days Past Due - 90 Days Experian Transunion Equifax 60 Days Late 90 Days Late mReposess}on m Collection Foreclosure Charge Off � 0. .e JPMCB CARD 426684XXXXXX Revolving Open 8/23/2019 $1,872.00 $4.00 $9.00 5/22/2023 $0.00 $3,900.00 Individual 0 0 0 D JPMCB CARD 426684XXXXXX Revolving Open 8/23/2019 $1,872.00 $0.00 $0.00 6/26/2023 $0.00 $3,900,00 Individual Account 0 0 0 120 Days Late 150 Days Late 4s• Negative k1• Not Available Eq JPMCB - CARD SERVICE 426684XXXXXX Revolving Open 8/23/2019 $1,872.00 $0.00 $0.00 5/26/2023 $0.00 $3,900,00 Individual Account 0 0 0 Pasl24 months J A S 0 N D J F M A M J J A S O N D J F M A M J M Current I 'ig)1 30 Days Late Ir 180 Days Late m Payment Plan Collection Accounts No Account Information Available. m 60 Days Late m 90 Days Late mReposessien ® Collection Foreclosure Charge Off 12D Days Late mi 150 Days Late Tit Negative FbAl Not Available I O J z a J Q 00 r` r to to tV U- 00 r= tv E t v cc r Q htlps://www.53identityalert.comtsecure/CreditGateWay.aspx Packet Pg. 239 6/20/23. &22 AM Other Accounts No Account Information Available. Derogatory Information No Derogatory Information Available. Public Records No Public Records Available. Creditor Contact Information No Creditor Contact Information Available. Fifth Third Identity Alert - Credit Gateway 8.F.1 LL 00 LL 00 r- aD E t U cc r Q htips://www.53!dentityalert.com/securelCreditGateWay.aspx Packet Pg. 240 8.F.1 !experlan. Search inquiry. (My company) ProfilePluss" Report as of: 06/20/23 22:12 ET Izzy Screen Repair, Inc Address: 138 Cyrus St Marco Island, FL 34145-4644 United States Phone: 239-3$2-0850 Experian MK: 744080750 Agent: Leticia Lora Agent Address: 138 Cyrus ST Marco Island, FL Key Personnel: SIC Code: NAICS Code: Business Type: Experian File Established: Experian Years on File: Years in Business: Total Employees: Sales: Filing Data Provided by: Date of Incorporation: Experian Business Credit Score President: Israel T Lora Vice President: Leticia Lora 5211-Lumber & Building Materials Dealers 1521-Construction, Single -Family Houses 7699-Repair Shops & Related Services, Nec 444180-Other Building Material Dealers 236118-Residential Remodelers 444190-Other Building Material Dealers Corporation November 2004 19 Years 19 Years 1 $298,000 Florida 11/29/2004 I a 0 J z a J Q LL 00 r- to LL. 00 C aD E t U c� r Q littps:JfsinaIIbusine ss.expeHen. corn/report. aspx?fn=744080...aglefree%20credlt%20repo rt%20for%20bus Ines s&IInk=5558 Packet Pg. 241 I 8.F.1 I Business Credit Score i AL Low Risk The objective of the Experian Business Credit Score is to predict payment behavior. High Risk means that there is a significant probability of delinquent payment. Low Risk means that there is a good probability of on -time payment. Key Score Factors: • Number of recently active commercial accounts. • Ratio of total bal to total high bal across all Comm accts. • Length of time on Experian's file. Business Credit Scores range from a low of 1 to high of 100 with this company receiving a score of 91. Higher scores indicate lower ris{• This score predicts the likelihood of serious credit delinquencies within the next 12 months. This score uses tradeline and collections information, public filings as well as other variables to predict future risk. Experian Financial Stability Risk Rating I Financial Stability Risk Rating Low Risk A Financial Stability Risk Rating of 1 indicates a 0.55% potential risk of severe financial distress within the next 12 months. Key Rating Factors: • Number of active commercial accounts. • Risk associated with the company's industry sector. • Risk associated with the business type. • Employee size of business. I Na I.L O J Z a J Q 6L 00 r to to tV U- 00 r- to E t U M r Q https:/fsmallbusines s.experi an. comlroport.aspx7fn=744080...oglefree%20cred It%20report%20for%20busities s&Pink=5558 Packet Pg. 242 8.F.1 Financial Stability Risk Ratings range from a low of Ito high of 5 with this company receiving a rating of 1. Lower ratings indicate lower risk. Experian categorizes all businesses to fit within one of the five risk segments. This rating predicts the likelihood of payment default and/or bankruptcy within the next 12 months. This rating uses tradeline and collections information, public filings as well as other variablE Q to predict future risk. O J Z a Credit Summary J Q ti 00 This location does not yet have an estimated Days Beyond Terms (per), or a Payment Trend Indicator. This is often the result of too r few Payment Tradelines. ttoo tV Please refer to Exper ian's'www.Bus! nessCreditFacts.com' website for more information on establishing Payment Tradelines. Lowest 6 Month Balance: Highest 6 Month Balance: Current Total Account Balance: Highest Credit Amount Extended: Payment Tradelines (see charts, detail): Business Inquiries: UCC Fi g% veBusinesses Scoring Worse: ,/Bankruptoles: `/Liens: ,/Judgments Filed: ,/Collections: Payment Trend Summary $122 $162 $122 $162 4 0 0 90% 0 0 0 0 LL 00 r- aD E t U c� r Q lit tps:f fsrnallbusiness.experlan.comfroport.aspx7fn=744080...oglefrea%20cred It%20roport%20for%2obusInoss&Ihik=5558 Packet Pg. 243 8.F.1 -0- Industry 4- This Company 100% I 60% 60% 0 J 40% Q 20% J Q 0% 12122 01123 02123 03125 0423 05f23 00 *Percentage of on -time payments by month. r- r tD CO Monthly Payment Trends - Recent Activity N, Date up to 301 )l 1 31-60 DBT 61-90 DBT >90 DBT V Z 12/22 100°% 0°% 0°% 0°% 0°% 7 01/23 100°% 0% 0% 0% 0°% d 02/23 100°% 0%0%0% 0% LLJ w 03/23 100°% 0%0%0%0%w w 04/23 100°% 0°% 0°% 0°% 0°% U 05/23 100°% 0% 0% 0°% 0% 11}0e; 80% 60% 40% 20% 0% 03122 Gc22 09f22 1202 0323 *Percentage of on -time payments by quarter. Quarterly Payment Trends - Recent Activity Date Current up to 30 1 !; • : 31-60 DBT 61-90 DBT >90 DBT 03/22 100°% 0% 0% 0°% 0% 06/22 100°% 0°% 0% 0°% 0°% 09/22 100°% 0% 0°% 0% 00% 12/22 100°% 0°% 0°% 0% 0% 03/23 100°% 0% 0°% 0% 0°% LL 00 1= aD E t U c� r Q https://smaIIhuSincss.experian.com/report.aspx?fn=744080...aylefree%20credit%20report%2Ofor%20business&Ilnk=565R Packet Pg. 244 8.F.1 Trade Payment information Currentt-30 31.6061-90 >90 *Continuous distribution with DBT. Insufficient information to produce Newly Reported Payment Trends chart. ,WI 60% 60% 40% 20% 0% Cmentl-30 31-6061.90 >90 *Combined distribution with pu. Tradeline Experiences (Continuous Trades) Supplier Reported Activity Date Payment Recent High Balance Current Up to 30 31-60 61-90 >90 Comments Category Date Terms Credit MIT DBT DBT DBT Bus Servcs 2/28/23 Varied $162 $122 100% Roof Contr 6/06/23 Net 30 $0 Roof Contr 6/06/23 Net 30 $0 I a O J Z a J It LL 00 r- r t0 CO N Additional Tradeline Experiences (Aged Trades) a J Supplier Reported Activity Date Payment Recent High Balance Current Up to 30 31-60 61-90 >90 Comments a Category Date Terms Credit DBT DBT DBT DBT LL. 00 Prntg&Publ 1/10/23 Varied $202 $0 (r E t U c� Payment Trend Detail Q htt1)s:J/smaIIbusine ss.experian.com1report. aspx?fnu744080... ogiefree%20credit%20report%20for%20bus iness&link=5558 Packet Pg. 245 8.F.1 Date Industry* 3 l Industry* Current Up to 30 DBT 31-60 DBT 61-90 DBT >90 DBT DBT Current I 05/23 4 0 90% 100% 0% 0% 0% 0% 04/23 4 0 90% 100% 0% 0% 0% 0% O J 03/23 4 0 91% 100% 0% 00/0 0% 0% Q J 02/23 4 0 90% 100% 0% 0% 0% 0% Q 01/23 5 0 89% 100% 0% 0% 0% LL: 0% 00 12/22 5 0 89% 100% 0% 0% 0% 0% r to *Industry: Lumber & Building Materials Dealers to * The information herein is furnished In confidence for your exclusive use for legitimate business purposes and shall not be reproduced Cu disclosed, or shared to any third party per the restrictions in the Terms and Conditions that you accepted. Neither Experlan nor its 13 sources or distributors warrant such Information nor shall they be liable for your use or reliance upon it. (R&O.5e1732) u 02023 Experian Information Solutions Inc. n Back to to[ a LL 00 C tV E t V «s r Q lit tps:/fsiriallbusiness.experian.cote/report.aspx?fn=744080... ogletree%20credit%20report%20for%20business&liitk�5rj58 Packet Pg. 246 8.F.1 DMSION or GORF}oRArioNs I Q O �tf J jr onu o''I JJ Z 11j��Jr, or rl(�i� ���� --- rrr: „ryir iu! ';lut[' u] !"l±rillfr :: _•Ix,f!> LL 00 pepanment of Stale / Division of Corporations ] Search Records 1 Search by Entity Name I r to to N Detail by Entity Name Florida Profit Corporation IZZY SCREEN REPAIR, INC Filing Information Document Number P04000162770 FEI/EIN Number 56-2491789 Date Filed 11/29/2004 State FL Status ACTIVE Principal Address 138 CYRUS ST MARCO ISLAND, Ft_ 34145 Changed: 01 /09/2007 Mailing Address P.O. BOX 2561 MARCO ISLAND, FL 34146 Registered Agent Name & Address LETICIA, LORA 138 CYRUS ST MARCO ISLAND, FL 34145 Off icer]Director Detail Name & Address Title P ISRAEL, LORA P.O. BOX 2561 MARCO ISLAND, FL 34146 Title VP I Q U- 00 LETICIA, LORA +% P.O. BOX 2561 E MARCO ISLAND, FL 34146 c� r Q Annual Reports Packet Pg. 247 Report Year Filed Date 2021 01 /22/2021 2022 01 /23/2022 2023 01/27/2023 Document Images Q112712023 -- ANNUAL REPORT View image in PDF format 01/23/2022 -- ANNUAL REPORT View image in PDF format 01/22/2021 --ANNUAL REPORT View image in PDF format 01/24/2020 -- ANNUAL REPORT View image in POF format 0210312019 ANNUAL REPORT View image in PDF format 0111612018 -- ANNUAL REPORT View image in PDF format 02/14/2017 -- ANNUAL REPORT View image in PDF format 64/07/2016 -- ANNUAL REPORT View image in PDF format 01/30/2015 -- ANNUAL REPORT View Image in PDF format I 01 /16/2014 --ANNUAL REPORT View image in PDF format 01123/2013 --ANNUAL REPORT View image in PDF format 01/1112012 -- ANNUAL REPORT View image in PDF format 22118/2011 --ANNUAL REPORT View image in PDF format _ 02/04/2010 -- ANNUAL REPORT View image in PDF format 01123/2009 ANNUAL REPORT View image in POE format 01/14/2008 --ANNUAL REPORT View image in PDF format i 01/09/2007 --ANNUAL REPORT View image in PDF format 01/16/2006 -- ANNUAL REPORT View image in PDF format 07/01/2005 -- ANNUAL REPORT View image in PDF format 11/2912004 -- Domestic Profit View image in PDF format Fr.,::"a ew:ri.reiu �:r st,i[r, [)Ms�.m .-,rco,p-at .,Is tl 00 j.7 C N E t 0 r Q Packet Pg. 248 8.F.1 i a O J Z a rR w a i 00 r- r t0 CO N i (Requestds Name) (Address) (Address) (City/StaterZi p/Phone #i) ❑ PICK-UP Q WAIT 11 MAIL (Business Entity blame) (Document Number) C ied Copies Certificates of Status Office Use Only 800042508768 _ C Ti iv LL ib iv E t U c� r Packet Pg. 249 f� 8.F.1 r . 4 TRANSMMAL LETTER 14 DTmtnmt of State Division of Corporations P. 0. Box 5327 Thffabassee, FL 32314 $UWECF: IZZY SCREEN REPAIR, INC. Bused are an original and one (1) copy of the articles of incorporation and a check for: L7 $70.00 M $78.75 Filing Fee Filing Fee & CeXii ude of Status FROKISRAFL LORA ❑ $78.75 13$87.50 Filing Fee Filing Fee, & Coed Copy Certified Copy & Certificate of ADDITIONAL COPY REQUIRED Mi 138 Cyrus St. A ress Marco Island, Fl 34145 tatE P (239) 389-4987 /(239)-821-5090 i�ytize 1 a ep one nurubcr NOTE: Please provide the original and one ropy of the articles. i Q O J z a J Q LL tp r- r to to LL 00 r- 0 E t u c� r Q Packet Pg. 250 8.F.1 i a O J +I Z J ARTICLES OF INCORPORATION a In compli4ace with Chapter 607 and/or Chapter 621, FS. (Profit) 00 ARTICLE I IVA AW r The name of ttre corporation shall be: co N IZZY SCREEN REPAIR,INC ci Z ARTICLE .It PRINCIPAL O.F�',iC.>1�'�, 'The principal plane of business/mailing address is: I ZZY SGREEN l2EPAI12 P.O. BOX z561. MARCO ISLAND, FL 34146 f. j ;,, ;. w� ARTICLE ID' PURPOSE w w 'the purpose for wHch the corporation is organized -is: SCREED REPAIR ARTICLE W SHARES The number of shares of stock is; 1000 ARTICLE V IN7T7AZ- OFFICERS AND/OR DIRECMRS List name(s), address(es) and specific title(s): ISRAEL LORA- PRESIDENT LETICIA LORA- VICE—PRESIDENT ARTICLE V1 .REGISTERED AGENT The mane and Fiotida sttwt addmss (P.O. Box NOT acceptable) of the registered agent is: LETICIA LORA 138 Cyrus St: Marco Island,F1. 34145 ARTIC,L.E VIZ INCORPORATOR The name and address of the Incorporator is: 1_SRAEL LORA L38 Cyrus St Marco Islatndjl 34145 F,famWg been mmmd as regirteried agent to accept sm*e of process fur the above stated corporation at the place desig axed in this aartificate, I amfarrrXar os*h and accept the appoinlnKnt as regisraed agent and agree to ad in this capacity f,, Q Q i! VA /6,--1 /LETICIA LORA 11-24-2004 SignaturelRegistered Agent Date 00 J���ISRAEL LORA 11-24-2004 E � Signature/lncorporator Date r a Packet Pg. 251 06/23/2023 9:00:35 AM -0400 FRS fitDepartment of the Treasury �b+�, Internal Revenue Service Ogden, UT 84201. IZ7.Y SCREEN REPAIR INC 1SRAEL LORA 138 CYRUS ST MARCO ISLAND FL 34145-4644 384 tttl.L I V LU V01 L3/ LVLO V�I: VVAM PAGE 2 OF 2 in reply refer to: 0245606886 Jun 23, 2023 LTR 147C 56-2491789 Taxpayer Identification Number: 56-2491789 Porm(s): Dear Taxpayer: Thank you for your telephone inquiry of June 23rd, 2023. Your Employer Identification Number (LIN) is 56-2491789. Please keep this letter in your permanent records. Enter your name and your FIN on all business federal tax forms and on related correspondence. If you have any questions regarding this letter, please call our Customer Service Department at 1-800.829-0115 between the hours of 7:00 AM and 10:00 PM. If you prefer, you may write to us at the address shown at the top of the first page of this letter. When you write, please include a telephone number where you may be reached and the best time to call. Sincerely, Mr.Colvard 1003755408 Customer Service Representative 8.F.1 O J z J Q LL 00 I- to tV U- 00 N E s Q Packet Pg. 252 8.F.1 CO 7EY C01.nty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY STATEMENT OF OWNERSHIP o(�-t_ C-e_,(-, l Ow ; This certifies that 1, `Cuv" L. am a me\�ber or managing APPLICANT'S NAME (please print) me ber of E �1 C' pct t CA p. ( C., (LIMITED LIABILITY COMPANY NAME) I own Z4) r( ;) % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. cAN1 Lo rt ` Applicant (please print) 22 —S, F C3 Name of Company Signature of Applicant U Skate ofA�n�County of(061�w The foregoing ins runient was acknowledged before me by means of physical presence or ❑ online notarization on this w IL day of , 20 , by X w w Such person(s) Notary Public must check applicable box: O tJ are personally known to the 1-1 has produced a current driver license w w ❑ has produced as identification. I (Notary Seal)01 O Notary Public State of Florlds J Ath Kevin Russetto Z AM� My Commission Q 1�7111>� HH 1713601 Notary Signature: J Exp. 911912025 Q u_ 00 aD E t Contractor Licensing — FIRM Application Rev. 7l2022 Page 9 of 14 r Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive + Naples, FL 34104 • (239) 252-2431 Q contractorslice nsing(a)colliercountvtt.gov Packet Pg. 253 8.F.1 C o leY County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY RESOLUTION OF AUTHORIZATION Complete this form if multiple people own part of the company the license will be attached to. If there is only 1 owner, then this form is not required for the application. In accordance with Collier County Ordinance 2006w46, as amended, 1_ ': 'j Pii 1n C_ proposes Company Name ' to engage in contracting as [CQ t� c v114 in Collier County where 0_-41, Lo t OfficersIOINnersiPariners Applicant Name proposes to qualify for a Certificate of Competency with company { Company It is hereby agreed upon that we the undersigned C -Si tt¢ v{' Officers/Own rslPartners Company resolve and represent to the Collier County Contractor's Licensing Board that the proposed qualifying agent, \Ow" t— � �C- , is active in all matters connected with the company named Applicant Name _ �( +e4tWe further resolve and represent that Pc l i• r"` is legally Company -L /I(_1 Applicant Name empowered to act on behalf of: z-2-f _��f�c'r� 1 ){_'�)cuj' in all matters connected with its contracting Company business and as the authority to supervise construction undertaken byL C mpa ny _ X,,! Officers/OwnerslPartners��� �L �J I l_ ( '. SL3 it —�� O , rslOwners/PartnersWitness officers/Owners/Partners Witness Officers/Owners/Partners of the above -mentioned company need to sign on the left and a witness to the signature signs on the right. State of ✓ " County of e The foregoing instrument was acknowledged before me by means of physical presence or ❑ online notarization on this day of , 2023, by = 5Yu_P ( LQ6 .P/ f_r7LCad 1 ,66 -- Such erson(s) Notary Public must check applicable box: 2are personally known to me ❑ has produced a current driver license ❑ has produced as identification. Q ri (Notary Seal) 00 EkNolary Public State of Florlde C Kevin Russetto aD y Commisslon Notary Signature:HH76601 xp. 9119/2025 t Contractor Licensing Page 8 of 14 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorslicensing@colliercountytl.gov Packet Pg. 254 8.F.1 CoVi r C01414ty Growth Management Community development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: 4A-A� L oeA. 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 hisiher 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 for the above -named applicant must provide the following information: Name: A I Q.-ic r- zr YTitle: resioll.�7'- Business Name:: �4rrlWei'S GMV,—'WOC-0S 4C Phone: 23 !' `Y2• -77V6 License No. (if applicable): L' �C_ D Business Address: III %3R,lolf fr v{4IrC. Q. C14&4x( 17-C- 3 Yr y I City State Zip The applicant was employed by me from 2-ar t to Applicant's title: __ r The applicant's scope of work (specific duties) included: YP�'• 1,44-4. LN v a.ws C�iGJis �.� Additional commen s: C&�4p"1S 00) Q, _welt If QS _044k*t&, vq. NOTE TO LICENSED CONTRACTORS: Falsifying any informmfion provided erein mays your li ense to re oc ion. Linder penalty of perjury, I declare that the facts stated here are true. YAL- C-4-1.,s•-MR►'fy Cll.t,41 ej0e00W% CXP !44tt, i•�- r rva✓G�. .+(w,e�-�4� ar•�..P 2f�itrS Signature of pars roviding the statement State of ���^�'� _ County of � Lt�.t+t� The foregoing instrument was acknowledged before me by means of I( hysical presence or ❑ online notarization on this 23 day of ' -T - 20?3 , by —� t*0&"ot& MkA&'Such person(s) Notary Public must check applicable box: IQ are personally known to nic ❑ has produced a current driver license ❑ has produced _ as identification. O J (Notary Sc Q �r►�'•• SHANNON MARIE HILL Notary Public • State of F;or!t& J Q N GS 913793 CommsionExpires 00 202 My Comm., Expires Sep 17. 2023 Notary Signature: _ #londed through National Notary Assr. Contractor Licensing - FIRM Application Rev. 712022 y Page 10 of 14 t U Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 262.2431 cantr rsjgQn�lnar lcolliercountvll.aov Q Packet Pg. 255 8.F.1 -p'=�L��ry,:t r.'°•rro-.`fy :.•-rs�-� �-PYh.: Growth fdalvagei;tenr Li Gotnrtlurlity ilevriopnient Ue:pnrtment O API?LICA i IOM FOP COLT. R COUNTY CERTIFICATE OF COMPE TE114CY � �L VERIFICATION OF C NSTRUCTIONI EXPERIENCE00 .�.' Applicant's Nallne: ti Certificate Category Requested: t0 The applicant Is seeking a Collier County Certificate of Gompetency in the trade indicated above. As part of the application for this certifiCate, the applicant must verify tilsltler experience Within this trade. You are being requested (o provide Inforrrlation that wilt aid the applicant in meeting this requirement. You Stioula verifv ilmt3 of active experience working as an apprentice or a stliflaU ,vort,er (e,g„ as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role shafrid be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience for the above -named applicant must provide the following information: Nam a: ��� G'���� _ - Tiut=:—f�/�j2 • . ---- - _ ... Business Name: �_tihup_5t`?13 Ri'.w�t) , V� fGGS� NC Phone:. 2. 39 — .3 89 - 8 850 _ -- t_icense No. f it applicable;:. Business Address:;_' Fka> r^� _- ems WI •_-�� �LCD �S , FL. Strut city Stale- Zip The applicant 4la3 employed by me fromp' - Applicant's title: I --- - -- 7'he a!}pIicarIt's sropo of work (specify, duties) iricluded. — Sc�te� ,� t_p -�- T-, f4 Additional conwnenls: NOTE TO LIGENS517 CONTRACTORS. Falsilyirtrg any infonnation provided herein may subject yourlicen5e to rav,3c&(ion. Under penalty of perjury. I declare that litre facts stated hero are true. 1_ Si ,,ura of parson providing tite statement state of—C_�� (� �- C,.�uitty of -� �l% R� _ The for",oin� zstrumcnt %v js acknow1cdged bobre the by means ol'.�11Y%psic ti prwSe}tCc or CI oldirie notarization on tits 1. � _dsti- of (d.A/ / 20 o� . b} f GFr Ki .`will pci-som&.1 Notary fyubkc must ch(A itppllcable box'. I ittc persuiiall} known to mt CJ has produced a current driver license t, has produced as identification. M p J {t[tnt'�'ti�'a11 Z Q J t+iotery PubAc State Of Fiorlds Q Donne t. Theyer 4 Ex lift "1 04 HH t 19583 /Inn � � tL F_xpkec OUZO/2025 Iv'ukrr}- Sistuatttrc: 00 C Contractor Licensing - FIRM Appiieation Rev 7120-22 page i t of N 1q 1= 00aratiaits & Rc-gkj€atory Management I)WiBiDn. Contractor Ucensi,tp a 2800 Nora[ l-tnrsrahor. Drive o Naples. Ft 1410A a (239) 252.2431 � ran rr,etn cGcan_r, ro1_Ilinrrcurt�y)i_gq� Q Packet Pg. 256 8.F.1 C O Te-F C014Hty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION Of CONSTRUCTION EXPERIENCE Applicant's Name: Certificate Category Requested: lu �y! i �I a �lJ� �T'�lG:;r'� ✓' The applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate, the applicant must verify his/her 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 for the above -named applicant must provide the following information: Name: J ooty),e-j % f lL G Title: —pi" C.J i ✓�G�� -- Business Name: �l� ,s �i �- L� i1�S �� ° h LNG Phone: L � `I - 3 e--1 - 2-71; -- Business Address: `✓ 1 Street The applicant was employed by me from 7_a16 License No. If applicable): 'l Vg"3S`� - Y`L � City State Zip to /� I" -ei c.o? �— Applicant's title: 4 le-) %r! t/ryi V- -5-L -2 xt- 60>?11�4(-,Ker The applicant's scope of work (specific duties) included: _061�r.�- i r1 fy�h C a Additional comments: ' 1?�ee.- , �, NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. Under penalty of perjury, I declare that the facts stated here are true. / 2/ Signatu person providing the statement Slate of ^ Del JC County of 1 % The foregoing instrument was acknowledged before me by means of Ild'physical day of % 20 > , by Such person(s) Notary Public must check applicable box: ❑ are personally known to me fdhas produced a current driver license or ❑ online notarization on this /s I Q d' O J z a J a tp r- to N ❑ has produced as identification. Z Q (N �fd J ANNA S GIONErt Q tlotary Pnhlic Scale of Florida Comalission 8 HH t67G2G yuFs t 2.1, 2025 +' PAY Comm. rK li[ef sep Notary Signature: E t U Contractor Licensing — FIRM Application Rev. 712022 Page 11 of 14 W Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 Q contractorslicensinq@colliercountyft.gov Packet Pg. 257 8.F.1 I Coley county ° -� Z Growth Management Q Community Development Department J Q APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY 00 r- AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER to N STATE OF FL Z COUNTY OF COLLIER a a w 1, 1SAAC JOSE MARTINEZ fY having been first duly sworn, stale and affirm: I am a resident of CITY OF MARCO more than five (5) years, During the last five (5) years I have known County, FL (State) and have resided here for (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 tjonesty, integrity and good character. --�-� Signature State of FL ALAN LORA Countyo£ COLLIER ISAAC JOSE MARTINEZ Printed Name Address; 20 VIA MARCO A-6 Street MARCO ISLAND FL 34145 City State lip Telephone: 239-250-5345 The foregoing instrument was acknowledged before me by mean 0FN Physic1aI presence or ❑ online notarization on this i 22 day of MAY 20 23 , by iSCtt') C„ 3_(�h }`1GLY )6ne? O Such person(s) Notary Public must check applicable box; W tt.f are personally known to me ❑ has produced a current driver license fY I ❑ has Produced as identification. Q (Notary Sea]) O *—IRM ae�s A wndo rod tpttctx Z J Nate o public Notary Si Q State of FlarldaComm# HH36M2 00 Contractor LicenP��A QVJ22 Paco 13 of 14 tv Oporadons d Rogulalory Managamont Divislon, Contractor ticonsing • 2600 North Horsoshoo Drive • Noplos, Ft.341a4 . (239) 252.2431 E GQriltocierautanslnaificnnlnt�Qtlg nov U «s r Q Packet Pg. 258 8.F.1 COT Nr County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF/O�iC[a COUNTY OF I, &M 1TUSSe& , having been first duly sworn, state and affirm: I am a resident of (1)Me r County, f L01r odc (State) and have resided here for more than five (5) years. During the last five (5) years I have known AL LY4 (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. i State of Countyof % Signature Printed Name Address: DQ SQin ftn&1.5 Jkd Street 11labIli_s �l - 3 ity State Zip Telephone:6ZW) 1�-6 3 The foregoing instrument was acknowledged before me by means of 111 physical presence or ❑ online notarization on this ? I I day of T, 20 , by '< o i � j ! e t- ) Such person(s) Notary Public must check applicable box: Ll'are personally known to me ❑ has produced a current driver license ❑ has produced (rotary Sea Notary Public State of Florida Nichoias Long My r4H 17541glon 9113/2026 Notary Signature: Contractor Licensing - FIRM Application Rev. 712022 as identification. Page 13 of 14 I Q d' O J Z a J Q LL tp r, r to to LL tb r- 0 t U W r Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensina (&col I iercou ntvf i.uov Packet Pg. 259 8.F.1 F'l or"eta DWR UCOM �iMYRUSST l4i;AI4C1� i�t..k.MiD, F'1.341Mi �na 98�1511$96 �a�t.� IK 'arc time .�Vep4-htO1E� i,� HQtiE ��e, h!ytl�rlFi� ..wy.,.� h r► \a�r.rq lax n.grr*1 ey [r► LL 00 C E t V r Q Packet Pg. 260 8.G 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.G Doc ID: 26618 Item Summary: 8G. HILLARY A. GARDELLA - REVIEW OF EXPERIENCE — CARPENTRY CONTRACTOR - FLORIDIAN CARPENTRY INC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:33 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:33 AM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Review Item Tim Crotts Meeting Pending Completed 09/13/2023 2:37 PM Completed 09/13/2023 5:02 PM 09/20/2023 9:00 AM Packet Pg. 261 8.G.1 C olflyeY County C9 Growth Management 00 Community Development Department 00 r t0 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY �C����,� ��y� CERTIFICATE OF COMPETENCY �L� -�� }-� � xy�Z�Z`iJ 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ 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 W Specialty $205.00 Specialty Trade: I. APPLICANT PERSONAL INFORMATION: Name: P1. First .P Middle Initial Business Name: N Oh A r`Qy1 Ca io t n+," t n /" Address: Street Email: �H'Taw fgrdtAtA art VA u e City Telephone: Dy1' p.a 1 r q) I I Date of Birth: 1 a 11771► � 1 D lei (TgydcI Last FL 3 State zip *SS # (Last 4 digits only): g 7 7 3 Driver's License # (Last 4 digits only): 5 7 Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's lest scores and information. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized by law. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing— FIRM Application Rev. 7/2022 Page 3 of 14 0 00 r Q Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive • Naples, FL 34104 * (239) 252-2431 contractorslicensinua.colliercountvFl.cov Packet Pg. 262 8.G.1 0 Go 1.6.3.6. Carpentry Contractor requires thirty-six (36) months experience with a passing00 grade on awe (3}y an apmoved test and a passing grade on a two-(2) he business and law FM test and means those who have the knowledge and skill to install any wood and metal products v z including, but not limited to, rough framing, wood structural wood and metal non-structural trusses, sheathing, paneling, trim, metal framing, and cabinetry. Placement of fire safing and fire stopping materials shall be permitted on wall, ceiling and floor penetrations created within the scope of the work allowed by this section. c� a Packet Pg. 263 8.G.1 CO er C01.11ty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Provide the names and telephone numbers of two persons who will always know your whereabouts. Name:A`'Qii d-c(lQ Telephone: 23q� I I — 53 S II. NAME OF APPLICANT'S BUSINESS: Name: _bV-iff9i1 !d p r Telephone: 2525 Business Name: y-i c Alan C,Atrpf nA2, J) In C •it _ Business Address: t4r 9 a �,A+-V , Street P-vtK u e NXoIes City Telephone: 43fl cg-�l 4 733 Email: W lkawo Cnw e 11Vt0& rk t11 • il:v -, Federal ID Tax No.: H 1 — 445 11? 7 III. FINANCIAL RESPONSIBILITY State YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: ` Filed for or been discharged in bankruptcy within the past 5 years? v Had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? v `f Undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of a adjudication, a crime in any jurisdiction within the past 10 years?* Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of .,, construction experience? Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or ` municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment.*If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — FIRM Application Rev. 712022 Page 4 of 14 a 00 0 00 r Q Operations & Regulatory Management Envision, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslice nsing cotliercountyfl.goy Packet Pg. 264 8.G.1 Cower County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY IV. EXPERIENCE VERIFICATION EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: A.Oln e'l 0 ifs List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: OS � 5a ft•. woY{c� CURRENT/PREVIOUS LICENSE: List below and attach copies any other certificates of competencyliicenses you hold/have held in Collier County or any other jurisdiction. Include the license #, Type, and county you hold it in. Gel l cam, 4w A.b hn ► c L Se L C c 20 1 to 00 0 o 4 3 a AFFIDAVIT Under the penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I-i I1awt ()AV-d-e 16 plicant (please print) Signature of Applicant State of r-IOv d el County of Cif 1 y r l The foregoing instrument was acknowledged before nie by means of Si physical presence or ❑ online notarization on this day of 20 ,by •p- LIMN �t1l auA. Wi rlv ftY Gukd{ji�, Such person(s) Notary Public must check applicable box: ® are personally known to me ❑ has produced a current driver license a 00 00 r W W F4 ❑ has produced as identification. J 2 (Notary d �0014 Notary Public State of Flwda Brittany Napior My Commssron GG 875883 a) erti Expires 04/0b12024 E Notary Signature: t v Contractor Licensing — FIRM Application Rev. 7/2022 V Page 5 of 14 r Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 2.52-2431 con traclorslicensing @colIiorcountyfl.ciov Packet Pg. 265 8.G.1 ColfleY County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION OF APPLICATION 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. State of la o A, � A County of C0 1 1I W The foregoing instrument was acknowledged before me 6 day of , 20 by Such person(s) Notary Public must check applicable box: 41(a(�q (0- t[k Applicant (p ease print P("%Are Ca (hC Name of Company Signature of pplicant means of 4iysical presence or ❑ online notarization oti this are personalty known to nie ❑ has produced a current driver license ❑ has produced (Nota►y Seal) •r, .p ry' N wotaFy r'uns1G Slate of Ftnnaa Oriilany Napior My Ccmn1iS5M GG 915083 EKpwe•0410512024 Contractor Licensing -- FIRM Application Rev. 712022 as identification. Notary Signature: ME Page 6 of 14 a 00 0 00 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 con tractorslicens'np(a colliercountvfl.gov Packet Pg. 266 8.G.1 COer County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY WORKMEN'S COMPENSATION AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. �11 la WI N46 A __ Applicant (ple se print Name of Company Signature 9 TAOplicant BEFORE ME this day personally appeared k1114-JAAy AV *1L 1 who affirms and pplicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of 4 County. of I'lie foregoing instrument was acknowledged before me b means of (�h sical presence or ❑ online notarization on this g � � Y P Y ` day of lu 120 , by "11t�y1� � V. GttiCi Such person(s) Notary Public must clieck applicable box: ll are personally known to nie ❑ has produced a current driver license ❑ has produced as identification. (Notary Seal) �.40 Notary Puloha State of Florida Notary Signature: Q4�L Brittany NaptoIr r a* My Commnsron GO 975t383 MMy Coe mssir202a Contractor Licensing — FIRM Application Rev. 7/2022 Page 7 of 14 a 00 0 tb Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive a Naples, FL 34104 . (239) 252-2431 contractors li tens! ng(a,collie rcou ntyfl.gov Packet Pg. 267 8.G.1 GiTS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. C9 00 00 r t0 N Official Score Report: Candidate Information: Name Hillary Gardella Candidate 9: 2190957OG Testing Site: Ft. Myers, FL Final Score Result: Official Examination Score Report January 11, 2016 Business Procedures Score: 84% These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on January 9, 2016. If you have any firrther questions, please do not hesitate to contact us. Sincerely, Jay E. Bowermeister President 0 00 c a� E U �a r PO Box 831127 Ocala, Florida 34483-1127 —Voice (352) 369-GITS — Fax (352) 387-2443 Q 800 997 2129 Packet Pg. 268 8.G.1 GITS, LLC Examination Operations Division Providing the services and products to assist Govemment Agencies to make informed educated decisions. 6 00 Official Examination Score Report Official Score Report: Candidate Information: Name —Hillary Gardella Candidate #: 2190957OG Online Testing Site: Ocala, FL Final Score Result: August 1, 2023 Carpentry Contractor Score: 82% These results represent the grade that has been achieved on the above named examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on July 25, 2023. If you have any further questions, please do not hesitate to contact us. Sincerely, Jay E. Bo �Jw//enneister President 00 r t0 N 0 00 c a� E M U �a r PO Box 831127 Ocala, Florida 34483-1127 — Voice (352) 369-GITS — Fax (352) 387-2443 Q 800 997 2129 Packet Pg. 269 CREDIT CHECK 8.G.1 CONFIDENTIAL a Individual Credit Report °° Go Name...:GARDELLA, HILLARY A. Ordered By:18880 r N Address:4482 KATHY AVENUE Customer :9999 Z NAPLES, FL 34104 Received :08/01/23 w r-- z Social#: Applicant: ;_ -4733 Completed :08/01/23 a o: Q CREDIT SCORE: a APPLICANT FICO SCORE: 812 (scores range from 300 to 850) SOURCE(S): EXPERIAN TRANSUNION U. PUBLIC RECORDS: 0 PUBLIC RECORDS HAVE BEEN CHECKED AT THE LOCAL, STATE AND FEDERAL LEVELS WITH a THE FOLLOWING RESULTS AS OF 08/01/23: CLEAR Z 0 U CREDIT RECORD z w (Credit history has been, checked for a period of seven years or from open date a o: creditor Date Date High unpaid East Historic Status current Hos V Account Number Reported Opened Credit Balance Due 30 60 90 Status Rev ECOI i W CAPITAL ONE AS AGREED V Z 517805851654 07/23 06/17 8949 4330 0 00 00 00 R01 48 I w DLA=07/23 w w a. x CCB/DAVIDS AS AGREED w 578097960246 05/20 01/13 843 0 0 00 00 00 R01 48 I 0 DLA=05/20 ?� w CITI AS AGREED w 542418151851 07/23 05/22 9152 885 0 00 00 00 R01 14 A DLA =07/23 J J W DOVENMUEHLE AS AGREED 0 3101449152857 11/20 07/18 150000 0 0 00 00 00 MO 27 C Q DLA=11/20 Q DPT ED/AIDV AS AGREED E0052012091921121606/23 09/12 2271 1445 0 00 00 00 101 48 I DLA=06/23 J DPT ED/AIDV AS AGREED 000 E0012012012021121606/23 01/12 4500 2519 0 00 00 00 101 48 I c DLA=06/23 M U �a r Q Licensee Applicant: APPLICANT — SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. Packet Pg. 270 CREDIT CHECK 8.G.1 CONFIDENTIAL a Name: GARDELLA, HILLARY A. Customer: 9999 Page:2 00 •• 00 DPT ED/AIDV AS AGREE? r E0042012082621121606/23 08/12 2400 770 0 00 00 00 101 48 1 DLA=06 /23 Z DPT ED/AIDV AS AGREED E0032012052921121602/23 05/12 1000 0 0 00 00 00 101 48 1 w DLA=02/23 a Q DPT ED/AIDV AS AGREED U B0022012012021121606/23 01/12 2000 1037 0 00 00 00 101 48 I a DLA=06/23 0 O FRD MOTOR CR AS AGREED -J 61587356 07/23 10/22 64210 52783 0 00 00 00 101 09 1 DLA=07/23 O H U GATEWAY 1 AS AGREED Q 20160654405969 07/19 06/16 9296 0 0 00 00 00 101 36 C DLA=07/19 Z O U NSTAR/COOPER AS AGREED 675426522 04/23 07/18 150000 0 0 00 00 00 M01 29 C z DLA=04/23 a ROUNDPOINT AS AGREED V 5962012415200 07/23 07/18 150000 120507 0 00 00 00 M01 02 C DLA=07/23 W U Z W_ SUNCOAST CU AS AGREED W 45206 02/14 04/11 8445 0 0 00 00 00 101 34 I a DLA=02/14 X w U. O SUNCOAST CU AS AGREED 4515803 09/22 03/20 31535 0 0 00 00 00 101 30 C w DLA=09/22 w w SYNCB/CARECR AS AGREED Q 601918309129 08/17 01/11 1000 0 0 00 00 00 R01 18 C DLA=08/17 0 SYNCB/CARECR AS AGREED a 601918366753 07/23 09/19 3995 0 0 00 00 00 R01 46 1 d DLA=07/23 Q SYNCB/CARECR AS AGREED 601918232055 07/23 12/19 6228 0 0 00 00 00 R01 43 C = DLA =07/23 00 SYNCB/TJX AS AGREED r aa'i 604585103540 07/23 12/16 1003 96 0 00 00 00 R01 48 I E DLA=07/23 U r Q Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 Q Packet Pg. 271 CREDIT CHECK 8.G.1 CONFIDENTIAL a 00 Name: GARDELLA, HILLARY A. Customer: 9999 Page:3 •• 00 r THD/CBNA AS AGREED 603532118537 07/23 03/17 5175 4810 0 00 00 00 R01 48 A DLA=07/23 v THD/CBNA 603532038770 10/17 08/12 DLA=10/17 TOYOTA MTR 70403662679400001 02/20 12/15 DLA=02/20 AS AGREED 0 0 0 00 00 00 R01 48 I AS AGREED 21096 0 0 00 00 00 101 48 C Total trade lines on this report: 22 i INQUIRIES: 10/12/22 by FORD MOTOR CREDIT CORP (EXP) #1654440 10/12/22 by SUNCOAST CREDIT UNION (EXP) #1879040 07/09/21 by SUNCOAST CREDIT UNION (EXP) #1879040 RESIDENCE HISTORY: 4482 KATHY AV, NAPLES FL 34104 3555 SEAGRAPE AV, NAPLES FL 34104 2536 LONGBOAT DR, NAPLES FL 34104 COMMENTS: ***OFAC NAME SCREEN ALERT - CLEAR*** OFAC (OFFICE OF FOREIGN ASSET CONTROL) IS A FEDERAL AGENCY WHICH MAINTAINS A DATABASE OF TERRORISTS, DRUG TRAFFICKERS AND CRIMINAL ORGANIZATIONS. FRAUD RECORDS HAVE BEEN SYSTEMATICALLY CHECKED BY THE ACCESSED BUREAUS. CHECKS FOR IDENTITY THEFT, FAKE SSN, DECEASED SSN AND OFAC DATABASE PERFORMED. CREDITOR PHONE DIRECTORY: CAPITAL ONE BCIDTV001 (800) 955-7070 PO BOX 31293 SALT LAKE CITY UT. 84131 CCB/DAVIDS CSINZ8180 PO BOX 182120 COLUMBUS OH. 43218 NSTAR/COOPER FMlQC3005 (888) 480-2432 350 HIGHLAND HOUSTON TX. 77067 SYNCB/TJX CG235065M (877) 890--3150 PO BOX 71737 PHILADELPHIA PA. 19176 THD/CBNA BZ26H3005 PO BOX 6497 SIOUX FALLS SD. 57117 DOVENMUEHLE QZ285RO01 (847) 550-7300 1 CORPORATE DR LAKE ZURICH IL. 60047 SUNCOAST CU QU298Q001 (813) 621-7511 PO BOX 11904 TAMPA FL. 33680 GATEWAY I FZ2C5K001 0 00 r Q Licensee Applicant: APPLICANT - SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 . Packet Pg. 272 CREDIT CHECK 8.G.1 CONFIDENTIAL Name: GARDELLA, HILLARY A. Customer: 9999 CREDITOR PHONE DIRECTORY - continued: 3818 E CORONADO ANAHEIM CA. 92807 ROUNDPOINT FF2EED002 446 WRENPLACE ROAD FORT MILL SC. 29715 DPT ED/AIDV BS2JC8001 PO BOX 300001 GREENVILLE TX. 75403 FRD MOTOR CR FA3796761 POB 542000 OMAHA NE. 68154 TOYOTA MTR QA4176124 PO BOX 9786 CEDAR RAPIDS IA. 52409 CITI BC64DB002 PO BOX 6217 SIOUX FALLS SD. 57117 SYNCB/CARECR FZ999206T PO BOX 71757 PHILADELPHIA PA. 19176 CREDIT CHECK Z 0630273 3017 EXCHANGE COUR WEST PALM BEAC FL. 33409 a 00 Page: 4 00 r t0 N (877) 426-8805 (800) 722-1300 (800) 727-7000 (800) 874-8822 (866) 396-8254 ( 877 ) 616--5556 *** END OF REPORT *** This information is confudenliat and is not to be divulged ex t as required ib the Fair Credit Reporting Act. This personal report is furnished simply as an aid in detetmining the credit deskablity of the appfcant(s). It 3s based upon information obtained In good taAh by this agency from sources deemed reliable_ The accuracy of same, however, Is m no way guarani By your acceptance and use of this report, you spediically agree to hold Credit Check, Inc. harmless from any Iiabilily whatsoever. 0 rb r Q Licensee Applicant: APPLICANT — SEE NAME ABOVE Reporting Agency: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409. Packet Pg. 273 CREDIT CHECK 8.G.1 CONFIDENTIAL Commercial Credit Report Company: FLORIDIAN CARPENTRY INC. Address: 4482 KATHY AVENUE NAPLES, FLORIDA 34104 Telephone: (239) 227-4333 PRINCIPALS: VICE PRESIDENT/PRESIDENT GARDELLA, HILLARY A. Address: 4482 KATHY AVENUE NAPLES, FLORIDA 34104 Social Security Number: -4733 Stock Ownership- N/A VICE PRESIDENT GARDELLA, ALEXANDER Address: 4482 KATHY AVENUE NAPLES, FLORIDA 34104 Social Security Number: N/A Stock Ownership: N/A Address: Social Security Number: Stock Ownership: Address: Social Security Number: Stock Ownership: RISK SCORE: a 00 Go r t0 Date: 08/01/23 N Cust. No: 9999 ., Ordered By: 18 8 8 o Page: 1 (X) Corporation EIN: 47-4451856 f A. Experian Financial Stability Risk Score .ipo� 7_2Low ow Risk j to Med _3 Medium Risk g �821 4 Med t_o Fti h --- I-Poor ExcelentlOO S High Risk 82 CREDIT RISK SCORE The score uses tradeline and collections information, public filings as well as other variables to predict future risk. Higher scores indicate lower risk. FACTORS LOWERING THE SCORE: * number of active commercial accounts * risk associated with the company's industry sector * risk associated with the business type * employee size of business Reported for: APPLICANT - SEE NAME ABOVE Reported by: Credit Check, Inc. - 3017 Exchange Court, Suite H, West Palm Beach, FL 33409 0 00 c m E M U �a r Q (561) 616-5556 Packet Pg. 274 CREDIT CHECK Commercial Credit Report Company: FLORIDIAN CARPENTRY INC. AddreSS:4482 KATHY AVENUE NAPLES, FLORIDA 34104 8.G.1 CONFIDENTIAL a 00 Go r t0 Date: 08/01/23 N Cust. No: 9999 t, Ordered By: 18880 Page: 2 FLORIDIAN CARPENTRY INC. was INCORPORATED in the county of COLLIER, state of FLORIDA, on 06/25, 2015. The charter number is P15000055625. The registered agent is GARDELLA, HILLARY of 4482 KATHY AVENUE, NAPLES, FLORIDA 34104. Offices are LEASED from N/A at N/A per month. The company employs N/A. NET WORTH: ON FILE WITH STATE The company maintains banking relations with SUNCOAST FEDERAL CREDIT UNION The officer handling the account is N/A - NAPLES, FLORIDA PUBLIC RECORDS WERE CHECKED FOR COLLIER COUNTY, FLORIDA. A SEARCH OF LOCAL, STATE, AND FEDERAL RECORDS HAS BEEN CONDUCTED WITH THE FOLLOWING RESULTS: CLEAR AS OF 08/01/23 - SEVEN YEAR SEARCH. *** Credit Profile *� BUSINESS DATE LAST PAY HIGH CATEGORY RPTD ACTIV TERMS CREDIT BALANCE CUR 30 60 90 91t COMMENTS BLDG MATRL 07/23 07/23 CREDIT 4000 600 100% 0% 0% 0% 0% FINCL SVCS 12/22 12/22 VARIED 45300 0 0% 0% 0% 0% 0% ACCTCLOSED REMARKS. - N/A = NOT APPLICABLE/NOT AVAILABLE REPORT WORKED BY KELLY END OF REPORT. 0 00 r Q This commercial report is furnished simply as an aid in determining the credR des'uability of the appiicant(s). It is based upon information obtained in good faith by this agency from sources deemed reliable. The accuracy ofsame, however, is in noway guaranteed. By your acceptance and use of this report, you specifically agree to hold Cred,1 Check, rnc. harmless from any kabiiity whatsoever. Packet Pg. 275 8.G.1 DIvISION OF CORP 00 �I 00 1: J�IJff o rg l���� r`rIII :J �`�. '.�.� v till rr1%!!'�r�l :ilr+tr {r� lluri!Ilr ::'t4�:(tr V Z Department of State I Division of Corporations 1 Search Recerds 1 Search by Entily. Name I Detail by Entity Name Florida Profit Corporation FLORIDIAN CARPENTRY INC. Filing Information Document Number P15000055625 FEIIEIN Number 47-4451856 Date Filed 06/25/2015 State FL Status ACTIVE Principal Address 4482 kathy avenue NAPLES, FL 34104 Changed: 06/21 /2019 Mailing Address 4482 kathy ave NAPLES, FL 34104 Changed: 06121 /2019 Registered Agent Name & Address GARDE=LLA, Hillary 4482 kathy AVENUE NAPLES, FL 34104 Name Changed: 02/17/2016 Address Changed: 06/21/2019 Officer/Director Detail Name & Address Title President a GARDELLA, Hillary 00 r 4482 KATHY AVENUE NAPLES, FL 34104 E M U �a r Title vice president I Q Packet Pg. 276 1 Gardella, Alexander 4482 Kathy AVENUE NAPLES, FL 34104 Annual Reports Report Year Filed Date 2021 03/08/2021 2022 04/26/2022 2023 02/2012023 Document Images 02/20/2023 --ANNUAL REPORT 04/26/2022 — ANNUAL REPORT 03/08/2021 —ANNUAL REPORT 03/2312020 -- ANNUAL REPORT 06/21/2019 — ANNUAL REPORT 03/29/2018 -- ANNUAL REPORT 02/09/2017 --ANNUAL REPORT 09/21/2016 —AMENDED ANNUAL REPORT 02/17/2016 --ANNUAL REPORT 06/25/2015 — Domestic Profit View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Florida Uepa,invant w State, ❑lvislon or Cc,. po,aGcn, C9 00 00 r t0 0 00 Q Packet Pg. 277 State of Florida Department of State I certify from the records of this office that FLORIDIAN CARPENTRY INC. is a corporation organized under the laws of the State of Florida, fled on June 25, 2015. The document number of this corporation is P 15000055625. I further certify that said corporation has paid all fees due this office through December 31, 20165 that its most recent annual report/uniform business report was filed on September 21, 2016, and that its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given under my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Twenty-first day of September, 2016 V^ 0 4 k� ju Secretary of State Tracking Number: CC5404314156 To authenticate this certificate,visit the following site,enter this number, and then follow the instructions displayed. https:llset,vices.sunbiz.org/FilingsICertircateOfStatusICertificateAuthentication a 00 00 r t0 W N 0 00 r c m E M U �a r Q Packet Pg. 278 8.G.1 Electronic Articles of Incorporation For FLORIDIAN CARPENTRY INC. P15000055625 FILED June 25 2015 Sec. Of Mate nhaney 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: FLORIDIAN CARPENTRY INC. Article II The principal place of business address: 3555 SEAGRAPE AVENUE NAPLES, FL. 34104 The mailing address of the corporation is: 3555 SEAGRAPE AVENUE NAPLES, FL. 34104 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 100 Article V The name and Florida street address of the registered agent is: ALEX V GARDELLA 3555 SEAGRAPE AVENUE NAPLES, FL. 34104 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent SiViatare: ALEX V. GARDELLA 0 00 00 to to 0 00 d E M a Packet Pg. 279 8.G.1 P15000055625 FILED Article VI June 25 2015 Sec. Of Mate The name and address of the incorporator is: nbaney ALEX V. GARDELLA 3555 SEAGRAPE AVENUE NAPLES, FL 34104 Electronic Signature of Incorporator: ALEX V. GARDELLA I ani the incorporator submitting these Articles of hicorporation and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a thud degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1 st and May 1 st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P ALEX V GARDELLA 3555 SEAGRAPE AVENUE NAPLES, FL. 34104 0 00 00 to to 0 00 d E a Packet Pg. 280 8.G.1 v DEPARTMENT OF THE TREAliur T R INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0( FLORIDIAN CARPh;N'ri CARPENTRY 3555 SEAGRAPE AVE NA2LES, FL WE A5s1k Thank you for appl EIN 47-4451856. This E documents, even if you records. When filing tax dt that you use your EIN may cause a delay in p, cause you leasebmakesthe' please Based on the info the following form(s) if you have cquesti the phone number or wri need help in determinin Accounting Periods and We assigned you a representative. It is binding on the IRS. I request a private lett 2004-1, 2004-1 I.R.B. Certain tax classifica Classif Ca tion Electic If you intend to election to file a Fo: corporation must meet instructions for Form Date of this notice: 07-07-2015 Employer Identification Number: 47-4451856 Form: SS-4 Number of this notice: CP 575 A For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACK THE STUB aT THE END OF THIS NOTICE. � yOU AN EMPLOYER IDENTIFICATION NUMBER ig for an Employer Identification Number ,ta assigned you will identify you, your business accounts, tax reetturns, and ve no employees. Please keep this notice in your permanent imp?x'tant ments, payments, and related exactly asnshownrabove- very vaiation complete name and address, exactly essing, result in incorrect information in your account, or even n is not more than Ethe attached itea offocorrect s IN. If the stub and returnittohusl �rrection using ition received from you or your representative, you must file the date(s) shown. 1120 10/15/2015 s about the form(s) or the due date(s) shown, you can call us at to us at the address shown at the top of this notice. If You your annual accounting period (tax year), see Publication 538, ax classification based on information obtained from you or your of a legal determination of your tax classification, and is not you want a legal determination of your tax classification, you may ruling from the IRS under the guidelines in Revenue Procedure (or superseding Revenue Procedure for the year at issue). Note: on elections can be requested by filing Form 8832, EntitY See Form 8832 and its instructions for additional information. FoR s CORPORATION ELECTION: ect to file your return as a small business corporation, an 1120-S must be made within certain timeframes and the rtain tests. All of this information is included in the 53, Election by a Small ,Business Corporation. a 00 00 0 00 r Q Packet Pg. 281 8.G.1 (IRS USE ONLY) 575A 07-07-2015 FLOR S 9999999999 SS-4 If you are required t CT-1, or 1042), excise ta) Welcome Package shortly, v electronically through the Identification Number (Plt Please activate the PIN or tax professional or repre: Publication 966, Electron. - make a deposit immediatel) Institution to complete a o deposit for employment taxes (Forms 941, 943, 940, 944, 945, es (Form 720), or income taxes (Form 1120), you will receive a fiich includes instructions for making your deposits Electronic Federal Tax Payment System (EFTPS). A Personal for EFTPS will also be sent to you under separate cover. ce you receive it, even if you have requested the services of a entative. For more information about EFTPS, refer to c Choices to Pay All Your Federal Taxes. If you need to , you will need to make arrangements with your Financial mire transfer. The IRS is committed o helping all taxpayers comply with their tax filing obligations. If you need aelp completing your returns or meeting your tax obligations, Authorized e-file Provider , such as Reporting Agents (payroll service providers) are available to assist you. lisit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for ausiness products and services. The list provides addresses, telephone numbers, and lin s to their Web sites. To obtain tax forms a d publications, including those referenced in this notice, visit our Web site at www.rs.gov. If you do not have access to the Internet, call. 1-800--829-3676 (TTY/TDD 1-'00-829-4059) or visit your local IRS office. n4PORTANT REMENDERS; * Keep a copy of thi3 notice in your permanent records. This notice is issued only one time and the MkS will not: be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms. * Refer to this EIN Vn your tax -related correspondence and documents. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice, If you write, please tear off the stub at the bottom of this noti e and send it along with your letter. If you do not need to write us, do not complete nd return the stub. Your name control information, alone} with Thank you for your ated with this EIN is FLOR. You will need to provide this EIN, if you file your returns electronically. a 00 0 00 r c m E M U �a r Q Packet Pg. 282 8.G.1 AV Coer County d 00 Growth Management 00 Community Development Department co APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY RESOLUTION OF AUTHORIZATION Complete this form if multiple people own part of the company the license will be attached to If there is only 1 owner, then this form is not required for the application. In accordance with Collier County Ordinance 2006-46, as amended, F)QyMt'&, . CgYMNItM proposes Company Na e `—i to engage in contracting as C) , rVU --s in Collier County where 4-V1 q Vti_4 &A tro(f.l Officers/ownerslPartners Ap—pl_ic nt Name proposes to qualify for a Certificate of Competency with company.__ rit7yti 4tAV-, 4 F�L1 Company It is hereby agreed upon that we the undersigned of OV A. 0-Vx_ Officers/Owners/Partners Company resolve and represent to the Collier County Contractor's Licensing Board that the proposed qualifying agent, bAuL km 6 1 it (!;41- , is active in all matters connected with the company named App Cant Name 4�j Q -AM-V% � 0.Y>El�l'� . We further resolve and represent that �,�f�t �t� �� is legally Company App' ant Name empowered to act on behalf of 4�j in all matters connected with its contracting Company I �� , , ` ,� q business and as tho u# rity to supervise construction undertaken by fA�4 a Vkq Company A L Office rs/Owners/Partners Witness Officers/Owners/Partners Officers/Own ers/Pa riners Witness Witness Officers/Owners/Partners of the above -mentioned company need to sign on the left and a witness to the signature signs on the right. State of CNtny►-*L%-County of (jAt41_W The foregoing instrument was acknowledged before me by means of physical presence or ❑ online notarization on this day of lA� u� , 20 -A, by A & de Vim— ft ► A4b 1— Suc t person(s) Notary Public must check applicable box: l are personally known to nie ❑ has produced a current driver license p Y I ❑ has proEoj as identification. d ac a of Ronda rxa any Napiar {Notary Som W8n GG 975883 c es 04105r2024 d Notary Signatiue: U �a Contractor Licensing -- FIRM Application Rev. 712022 Page 8 of 14 Q Operations & Regulatory Management Division, Contractor Licensing + 2800 North Horseshoe Drive + Naples, FL 34104 + (239) 252-2431 con tractorslicensing C1 colliercountyit.rtoy Packet Pg. 283 8.G.1 COY County C9 Growth Management 00 Community Development Department ao r t0 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY z RESOLUTION OF AUTHORIZATION L Complete this form if multiple people own part of the company the license will be attached to. If there is only 1 owner, then this form is not required for the application. In accordance with Collier County Ordinance 2006-46, as amended, _ flot l4o!, DAWN rn<- " proposes Compan Name to engage in contracting as TW firS in Collier County where t-hlIIA1iM Officers/Owners/Partners Applicant Name proposes to qualify for a Certificate of Competency with company f-Lm"tA4'-, C06Y'Mfi +J 1r1 f Company It is hereby agreed upon that we the undersigned uw yxers of gryas"W-,- Officers/Owners/Partners Company �J resolve and represent to the Collier County Contractor's Licensing Board that the proposed qualifying agent, 14Q�4�t�` is active in all matters connected with the company named Applicant Name ol�ia'�''l�i . We further resolve and represent that _ �1LNN �C1 � is legally Company ,G� (►� , ,,� A IppA tnaci�NName empowered to act on behalf of . T Li�ytiAlk 1 �ul�ltl `in all matters connected with its contracting Company business and has the authority to supervise construction JJjaJ,-i bk&�_ Officers/Owner artners Officers/Owners/Partners Officers/Owners/Partners Witness Officers/Owners/Partners of the above -mentioned company need to sign on the left and a witness to the signature signs on the right. State of CIOrt� County of AVVY, The foregoing ' istrument was acknowledged eforg me by means of E7'physi. �'- day of � 20 _e , by Such person(s) Notary Public must check applicable box: ❑ are personally known to meLi I as produced a current driver license ❑ has produced as identification. (Notary Sea[) oti�s+Ypo'. ALYSHIAMORSE � � ' c Comtnlssiort � HH 190514 9� \7 Expires October 25,2025 Notary Signature: e0Frto> BWedTWDudp1Not&g8wj es Contractor Licensing — FIRM Application Rev. 7/2022 or 0 online notarization on this Page 8 of 14 (9 00 Q Operations & Regulatory Management Division, Contractor Licensing o 2800 North Horseshoe Drive o Naples, FL 34104 o (239) 252-2431 contractorslicensing d..colliercountvFl.gov Packet Pg. 284 8.G.1 Cottle-r county Growth Management 00 Community Development Department 00 co APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY v STATEMENT OF OWNERSHIP z This certifies that I, am a member or managing APPLICANT'S NAME (please print) member of I own 5o LIABIW COMPANY NAME) % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. Applicant (please print) �e�►�+~did � Cot rn � roc . Name of Company Signature of Applicant State of PI QVjAA County of_ _Cv 11� f* The foregoing instrument was acknowledged before me by means of iphysicall presence or ❑ online notarization on this day of , i K y 20 _, by I JJA &A C)TIl' .f.IL4b• oLjj to f 4e ► r I LL Such person(s) Notary Public must cheek applicable box: 1 are personally known to me ❑ has produced a current driver license © has produced as identification. (Notary Seal) y• J_ ;? �,+qr PO Notary Public State of Florida Notary Signature: > Brittany Napior • My Commission GG 915893 .0i Expues"0512024 — - - � j 00 E t U R Contractor Licensing — FIRM Application Rev. 712022 Page 9 of 14 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive . Naples, FL 34104 • (239) 252-2431 contractors lice nsing@colliercountvn.dov Packet Pg. 285 8.G.1 Comer county Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: W l tdL14 l5 �t"C111 a Certificate Category Requested: �>r fJt'.n.' intj cnk1_T'ZACt0Y- 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 his/her 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 for the above -named applicant must provide the following information: Name: Business Name: L'AJ_h.W G (a i Phone: Z?.? !�2 — Zs�—A 7, IX _ Business Address: 1"914 Street Title: . Z�� License No. (if applicable): City CZ 3'IKI- /G State Zip The applicant was employed by me from of O j % to Applicant's title: The applicant's scope of work (specific duties) included: Additional comments; NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject yourlicense to revocation. Under penally of perjury, I declare that the facts stated here are true. State of P L County of CotI-, The foregoing instrument was acknowledged before me by means of Qrphysi) day of 1414A U Sri , 20 o) by # Slare ch person(s) Notary Public must check applicable box: personally known to rue ❑ has produced a current driver license ❑ has produced (Notary REi tate of Flonaa r n GG 975803 024 OF Contractor Licensing — FIRM Application Rev. 712022 as identification. providing the statement presence or ❑ online notarization on this WE a r" rb r W W F4 0 00 d Notary Signature: E U R r Page 10 of 14 Q Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive e Naples, FL 34104 • (239) 252-2431 coittractorslicensing0colliercountyfl.goy Packet Pg. 286 8.G.1 Comer County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name:+� is 61vz[G7 L0. Ij Certificate Category Requested: V 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 his/her 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 for the above -named applicant must provide the following information: Name: 1.,,Ar $ 12 Title: V Business Name: Qt='I..-Z> f �"s���•l.{� ::Pyo C_ Phone: 'I Z) G - 300 S � Q Business Address: z 33 Street License No. (if applicable): City �34I 1:? State Zip The applicant was employed by me from of 1.7- 6_--t C1 to o z 2 o 3 Applicant's title: ! The applicant's scope of work (specific duties) included: j (2,L—:`/V7_V- Additional comments: NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may suW ur license to revocation Under penalty of perjury, I declare that the facts stated here are true. r f Signatu�f pers-dtt-providing the statement State of ff f WCounty of [�' � l � 1y` The foregoing instrument was acknowledged before tic by nicans of Q physical presence or ❑ online notarization on this qiuday of '� , 20 _a, by x&v C? 7Suel person(s) Notary Public must check applicable box: ] are personally known to nie ❑ has produced a current driver license 0 has produced ( ►y� Notary Public State of Florrtla Brittany Naplor my commission GG 975083 w Expires 04ro512024 identification. a 00 0 rb tv Notary Signature: _ E U ra r Contractor Licensing — FIRM Application Rev. 712022 Page 11 of 14 Q Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive . Naples, FL 34104 • (239) 252-2431 contractorslicensinoocolliorcountvfLgov Packet Pg. 287 8.G.1 Comer County d 00 Growth Management Community Development Department � co APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY N v z VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: H L LCL1A_J tn7 lrr( C I lD, z LU Certificate Category Requested: C.Nrga-ev,•-tl^uiCb-rL-b'-A-C4ey_ Q 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 his/her 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 verifyi trade experience for the above -named applicant must provide the following information: Name: O 5 Title: A /,S 1 5 f L5 j Business Name: L�//'�� ? Phone: � ` -7 7 OLo O License No. (if applies le): Business Address: I � S 11 'DMA 1 A ME A I �ks t rz I _S q 10 3 Street City State Zip The applicant was employed by me from 01 to �O 9,3 Applicant's title: Caykn-etntey- t5 The applicant's scope of work (specific duties) included: IV0'1 ToOR 0 L Additional comments: i'N Lo I v +^ V I''4 J �� pp,arr NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license tolrevocation. Under penalty of perjury, I declare that the facts staled here are true. * ( Signature of person providi a statement State of �l � ��� County of CA t(�'eh� Theforegoing instrument was acknowledged before me by means of ❑ physical presence or Elonline notarization on this aday of � AC-_ 20 , by ��y i�_Ql�' -- S li person(s) Notary Public must check applicable box: iJ'are personally known to me ❑ has produced a current r v p y } driver license ❑ has produced (Notary a 4P Notary y Na State G Ftw1da � Oflttdny NBprOr My Commrsswn GG 915883 Expires 04105)2024 Contractor Licensing — FIRM Application Rev. 712022 as identification. 0 < 00 c d Notary Signature: E U R r Page 12 of 14 Q Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive . Naples, FL 34104 . (239) 2A?-2431 contractorsl_icensing{cDcolliercountvfl..cI Packet Pg. 288 8.G.1 coffier County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF —Ft 6"66'- COUNTY OF C-J9 W 'Q'Y- I am a resident of c©1.1 % -e V more than five (5) years. having been first duly sworn, state and affirm: County, V L- (State) and have resided here for During the last five (5) years I have known lf'K M" 6Y4f- 1 lA (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. 11 �� ' Signature Ah Y, Printed Name Address:_ �30k a ew10.66A4 Street City State Zip Telephone: � 39 " 860 _ L2k()?- State of 1 �- County of (-O 10, f-V, The foregoing instrument was acknowledged before me by means of Volysical presence or ❑ online notarization on this, clay of , 20 , by Suco person(s) Notary Public must check I fare personally known to me ❑ has produced a current driver license ❑ has produced as identification. 00 00 W W F4 (Notary Seal) U 00 10 Notary Put)tic state of Honda ~ gIN Brittany Napior GG a)MY c0rnmj� 24 91503 Notary Signature: t Expire% 64105 of 'if v tts r Contractor Licensing — FIRM Application Rev. 7/2022 Page 13 of 14 Q Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe drives Naples. Ft_ 34104 • (239) 2p- cotttractorslicensing(ab.colliercountyfl.goy Packet Pg. 289 8.G.1 Comer County d 00 Growth Management Community Development Department T" co W APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY N v z AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER z STATE OF 'FL LU a. Q COUNTY OF CO LU LV v z I, L'CA.nold@ , having been first duly sworn, state and affirm: I am a resident of r✓ 'W" Co entry County, 'ltWOA (State) and have resided here for more than five (5) years. During the last five (5) years I have known 4ikloGr . Gavdcl\c\ (applicant). I have had the opportunity to observe his or her business and personal dealings and find him or her to be a person of honesty, integrity and good character. State of T— L_ County of co I 1 `' Ir Signature Printed Name Address: -19'5 1 tAS&Ck a%( Ur\'ktgQ'A- Street City State Zip Telephone: 04�Z �'C� r 1, The foregoing instrument was acknowledged before me by means of ❑ physical presence or ❑ online notarization on this Kday of u 20 d 7�, , by 2 fl SSucmust h.person(s) Notary Public Hst clieck applicable box: -tap J Ly'chare personally known to aie ❑ has produced a current driver license 171 has produced as identification. J J_ (Notary S = Notary PUdtIG $late of Honda d r° 'rj� Brittany Napior eo My GOMM&gs4on GG 975883 Tres p4r05r202a ' Ex C ?o,n G Notary Signature: E U R r Contractor Licensing -- FIRM Application Rev. 712022 Page 14 of 14 Q Operations & Regulatory Management division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, Ft_ 34104 • (239) 2 contractorslicensing(o)colliercouiityfl.cLov Packet Pg. 290 8.G.1 Florida 0+s //-957.0 GARDELLA iLLARY ALEMS 34482 KATHY AVE NAPLES, FL 34104-9000 3 ,ca 1211711990 ,> F OUP 1211712028 ,a: 5-03" 12 RV T NONE I., - .: NONE - - WE s 4.+ss 03117i2020 ., �_,+,,. 'CQ Jfb12fJI317f?B1 Oprra[rn of a motor r�i�,cq crxsea+tes corsant to any aobiW=t required by law. 0 00 0 00 d E L a Packet Pg. 291 Mn - NOIOVNINOO ANIN3dNVO - 33N3R13dX3 30 M31A3M - `d1130MVD 'V J1MVIIIH 'J8 :lU8Wy3e;;'y C.) z Z Z U W a.� T �_M a U a M to Q 00 N 0= � � Z a� Nti _�o1-N W t W Q C) Z pC4 dai�(NjmmCO) 00 z 0_5caAUo U-� it O Vl F- A a L L V G. `= 0 a c m N -p d a) O d 0 0 ._ M 0a �a1:5>nn 0 N Q N 0 w a� fA C d V .i c Gf t 0 0 a c L O y- L5 E fA C V L 0 N fN H m �i L 0 LL 4- 0 L '^M Q Vl O d) ,. O O .� Q) o a N o T C a� O N a)CY)-0 {o co w (3E N c�E a) E o O C U c � o EL m E 0 cU 0c 0 n E > a)O r�U. m .-. a) c Q �: 0) E L ,U O 3 L U O o 0 U a) > w O C a) += Ua m E � i (Y) CY CU O M Lz E T _ U 0 M D D �0 CY a) N 0 N Cb d r+ d Y V m 8.G.1 CABRAL CONSTRUCTION Tim Cabral (239) 649-5001 501 Goodlette-Frank Rd STE D100, Naples, FL 34102 July 30, 2023 Collier Country Licensing Department To whom it may concern, Cabral Construction has worked with Hillary Gardella since 2017. The projects consisted of detailed finish carpentry work that reflected skilled craftsmanship. Floridian Carpentry has been in business since 2016 and always held a reliable and honest reputation. Cabral construction is confident in Hillary Gardella's knowledge in the field and good character. Sincerely yours, Tim Cabral a 00 0 00 r c m E M U �a r Q Packet Pg. 293 8.G.1 0 00 00 r t0 ON Bravo Builders group 786-300-8681 bravo[Wbbg.compaU. 233 $altusrol Dr Naples. FL 34113 Z July 31, 2023 Collier County Licensing Department, Bravo Builders Group has worked with Hillary Gardella completing interior trim carpentry work on projects for five years. Hillary is honest and easy to work with and has the knowledge and experience needed to work in the industry. We continue to choose Floridian Carpentry for projects as they are always quality service and nice to work with. If you have any further questions please contact me. Elias Bravo 0 00 r c m E M U �a r Q Packet Pg. 294 8.G.1 FROM THE DESK OF General Builders August 1, 2023 Mark Owens General Builders 1180 Diana Avenue Naples, FL 34103 239-777-6200 Contractor licensing department: General Builders has conducted work with Floridian Carpentry under the direction of Hillary Gardeila for several years. The first job being September 2017. The work performed over the last 6 years was trim packages and interior finish work. Hillary is knowledgable in the field and of high integrity, we have had a great working relationship with Floridian Carpentry and Hillary Gardella and continue to do so. Sincerely yours, 1 Mark Owens C9 00 00 r t0 N 0 00 r Q Packet Pg. 295 qCo o® CERTIFICATE OF LIABILITY INSURANCE F°ATE`MMr°°"Y Y' ik 0713112023 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER CONTACT 1 Falcone Bill ..Falc _ Arnold and Barton Insurance Group PHONE E)dt (239) 331-8595 FAX. No): (239) 331-8589 70011th Street South E-MAIL gill abna les.Gom ADDRESS: IJ INSURERS] AFFORDING COVERAGE NAIC #_ Naples_ _ FL 34102 INSURERA: NATIONWIDE INSURANCE COMPANY _ INSURED INSURER B : _ Floridian Carpentry, Inc. INSURERC: TECHNOLOGY INSURANCE COMPANY 4482 Kathy Ave INSURER 0: Naples FL 34104 IINSURERF: COVFRAGFS CFRTIFICATF NIIMRFR• RF11mini'd NIIMRFR- 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 LTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER EFF MM1UDDIYYYY MMIDPOLICY Y EXP CDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ $100,000 MED EXP (Any one person) $ $10,000 PERSONAL &ADV INJURY $ $1,000,000 A Y ACP 3201392156 06101/2023 06/01/2024 AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE $ $2,000,000 GFUL X POLICY1:1 PRO- JECT 1-1 LOC PRODUCTS -COMPIOP AGG $ $2,000,000 S OTHER: AUTOMOBILE - _ LIABILITY COMBINED Ea acciden SINGLE LIMIT $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per acddenl) $ HIRED NON-0W4EO AUrOSONLY AUTOS ONLY PROPERTY DAMAGE Pera-Aent $ _ S LIAR X OCCUR EACH OCCURRENCE $ $1,000,000 A 4UMBRELLA XEXCESS LIA13 CLAIMS -MADE Y ACP CU023201392156 0610112023 06f0112024 AGGREGATE S $1,000,000 DED RETENTION S $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN OFFICER@dEhIBER EXCLUDED? (Mandatory in NH) NI'4 TWC4219638 03104/2023 03I04/2024 PER OTH- STATUTE ER S 1,000,000 EL EACH ACCIDENT EL DISEASE- EA EMPLOYEE - $ 1,000,000 IT yes, desaibe under DESCRIPTION OF OPERATIONS below I EL DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Collier County Contractors Licensing Board is named as additional insured per written contract CFRTIFICATF HOI nFR CANCFI I ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Contractors Licensing Board ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE N. Horseshoe Drive Naples Naples FL 34104 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marts of ACORD 8.G.1 a 00 Ib N 0 00 r Q Packet Pg. 296 8.G.1 COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: 152240 COLLIER COUNTY TAX COLLECTOR - 2800 N. HORSESHOE DRIVE - NAPLES FLORIDA 34104 - (239j 252-2477 VISIT OUR WEBSITE AT: www,colliertaxcollecW.com THIS RECEIPT EXPIRES SEPTEMBER 30, 2024 DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION. LOCATION:4482 KATHY AVE M i FAILURE TO 00 SO IS CONTRARY TO LOCAL LAWS. ZONED: HOME OCCUPATION BUSINESS PHONE: 239-777-5386 STATE OR COUNTY LIC #: 2016-0432 orporation 1.10 EMPLOYEES CLASSIFICATION: CABINET & MILLWORK CONTRACTOR;;• CLASSIFICATION CODE: 02107501 This document is a business tax only. This is not certification that licensee is qualif'�d: • ._ It does not permit the licensee to violate any existing regulatory zoning laws of the state, coun�, or cities nor does it exempt the licensee from any othar taxes or permits that may be required by law. FLORIDIAN CARPENTRY INC. GARDELLA, HILLARY 4482 KATHY AVE NAPLES, FL 34104 -THIS TAX IS NON -REFUNDABLE - DATE 07/05/2023 AMOUNT 18,00 RECEIPT WWW-24-00043002 a 00 00 r t0 to 0 00 r Q Packet Pg. 297 8.H 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.1-1 Doc ID: 26619 Item Summary: 8H. BRIAN L. SANTOS - RECORD REVIEW - TREE REMOVAL & TRIMMING CONTR. - DYNAMIC TREE SERVICE, INC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:34 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:34 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:38 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:02 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 298 8.H.1 vv4a.�vr vvrara�� Growth Management Community development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY aUl r.� CERTIFICATE OF COMPETENCY This application most 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ General ❑ Building ❑ Residential ❑ Mechanical ❑ Roofing Specialty Trade: $230.00 ❑ Electrician $230.00 $230.00 ❑ Plumber $230.00 $230.00 ❑ Air Conditioner $230.00 $230.00 ❑ Swimming Pool $230.00 $230.00 © Specialty $205.00 Tree Removal and Trimming I. APPLICANT PERSONAL INFORMATION: Name: Brian First Business Name: L Middle Initial Dynamic Tree Service, Inc Address: 875 39th Ave NW Street Email: Dynamictreeservice@aol.com Telephone: 239-537-2360 Date of Birth: 06/24/1990 Santos Last Naples FL 34120 City State Zip `SS # (Last 4 digits only): 8704 Driver's License # (Last 4 digits only): 2240 Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized by law. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing — FIRM Application Rev. 712022 Page 3 of 14 Packet Pg. 299 8.H.1 x 00 2.6.3A& "free RRmova] and Trimming Contractor requires twelve (1) months as eXPericnCe with a passing gra& on a business and law rest and moans (hose who are m N qu$lified to trite and remove trees and stumps. V All now lira a n Fo rce s cc li are wired obtain ussin r��ic z W Dn an agpirgy-eA dxM ReTIO Aingtree 2'Mrdng and saf n addition tot bust rrd lauw V Packet Pg. 300 8.H.1 Any business organization desiring a Certificate of Competency in Collier County shall submit the following information on forms provided by the Collier County Contractor Licensing = Supervisor. eo rn 2.3.1. Business organization name; V- m W 2.3.2. Business address and telephone number. A business organization must have an N U office in Collier County or have an agent in Collier County for purposes of receiving notices Z pursuant to this Ordinance. ui V 2.3.3. Qualifying agent; W 2.3.4. Proposed contracting business; W 2.3.5. Type of Certificate of Competency for which application is made; W 2.3.6. Names and addresses of all partners, directors and officers; U_ 2.3.7. Where applicable, a copy of a certificate of incorporation or proof of recorded Q >- fictitious name; 9 2.3.8. A list of all contracting businesses owned by the business organization during the last five years; 2.3.9. A credit report from a nationally recognized credit agency if the business organization has been in existence for more than one (1) year. If the business organization has been in existence for less than one (1) year, a credit report on every business organization in which the Applicant/Qualifier was an agent is required. If neither of the above is applicable a personal credit report on the applicant/qualifier is required. 2.3.10. A complete list of all outstanding debts related to the business organization's contracting business which the business organization has not paid or refuses to pay and a statement of the reasons for nonpayment; 2.3.11. The signature of an authorized officer of the business organization; 2.3.12. Qualifier information: a. The name of the qualifying agent and date of birth; b. The name of the business organization to be qualified; C. Type of Certificate of Competency for which application is made; d. The home address of the qualifying agent; e. The names and telephone numbers of two persons who will always know the qualifying agent's whereabouts; f. Scores on any approved examination; including the area of competency tested, the date of testing and the place of testing; g• Affidavits as to the qualifier's honesty, integrity, good business reputation and competence in the trade category for which application for a Collier County/City Certificate of Competency has been made; 27 Words stfus]E-tl3re are deleted; words underlined are added. Packet Pg. 301 8.H.1 h. A statement whether the qualifying agent has ever been convicted of a crime related to contracting and any crime of moral turpitude; i. A complete list of all outstanding debts related to the qualifying agent's contracting business which the qualifying agent has not paid or refuses to pay and a statement of the reasons for nonpayment; j. A statement of the qualifying agent's business and work experience during the previous five years; k. A statement of any formal training possessed by the qualifying agent in the trade category for which application is made for a competency card; 1. Proof that the qualifying agent is legally qualified to act for the business organization in all matters connected with its contracting business and that said qualifying agent has the authority to supervise construction undertaken by such business organization. Proof that a qualifying agent is legally qualified to act for the business organization includes, but is not limited to, authority to sign checks for the business organization, training and supervision of employees, hiring and firing of employees or other actions indicating active involvement in the business organization. made; 2.4. Master or Journeyman Applications. a. The name of the applicant and date of birth; b. Home address and telephone number; C. Business address and telephone number; d. Type of Certificate of Competency for which application is being e. The names and telephone numbers of two persons who will always know the applicant's whereabouts; f. Scores on any approved examination, including the area of competency tested, the date of testing and the place of testing. Prior to taking the tests required by this Ordinance, an applicant must provide verification that he or she has complied with the experience requirements. ten years; g. A statement of the applicant's business or work experience during the past h. A statement of any formal training in the trade categories for which application is made for a competency card. 2.5. Standards for the Issuance or Denial of a Certificate of Competency. 2.5.1. Contractors. The Contractor Licensing Supervisor or his/her designee, shall issue a Certificate of Competency to the applicant if it appears, on the face of the application, as submitted by the applicant, that: 2 00 rn m m N U Z ui U w U) w LU W F- L) Q Z 28 Words stf a are deleted; words underlined are added. Packet Pg. 302 9113123, 8:53 AM Statutes & Constitution :View Statutes : Online Sunshine 2 Select Year: 2023 v FGo 00 rn r t0 t0 N The 2023 Florida Statutes Title XXXII Chapter 489 REGULATION OF PROFESSIONS AND OCCUPATIONS CONTRACTING CHAPTER 489 CONTRACTING PART I CONSTRUCTION CONTRACTING (ss. 489.101-489.147) PART II ELECTRICAL AND ALARM SYSTEM CONTRACTING (ss. 489.501-489.538) PART III SEPTIC TANK CONTRACTING (ss. 489.551-489.558) PART I CONSTRUCTION CONTRACTING View Entire Chapter 489.101 Purpose. 489.103 Exemptions. 489.105 Definitions. 489.107 Construction Industry Licensing Board. 489.108 Rulemaking authority. 489.109 Fees. 489.111 Licensure by examination. 489.113 Qualifications for practice; restrictions. 489.1131 Credit for relevant military training and education. 489.1136 Medical gas certification. 489.114 Evidence of workers' compensation coverage. 489.115 Certification and registration; endorsement; reciprocity; renewals; continuing education. 489.116 Inactive and delinquent status; renewal and cancellation notices. 489.117 Registration; specialty contractors. 489.118 Certification of registered contractors; grandfathering provisions. 489,119 Business organizations; qualifying agents. 489.1195 Responsibilities. 489.121 Emergency registration upon death of contractor. 489.124 Business records requirements; address of record; service. 489,125 Prequalification of certificateholders. 489,126 Moneys received by contractors. 489.127 Prohibitions; penalties. www.leg.state.fl.uslstatuteslindex.cfm?App_mode=Display_Statute&URL=0400-04991048910489.html Packet Pg. 303 9113/23, 8:53 AM Statutes & Constitution :View Statutes : Online Sunshine respect to the regulation of the construction industry. History.—ss. 4, 17, ch. 79-200; ss. 2, 3, ch. 81.318; ss. 5, 20, 21, ch. 88.156; s. 35, ch. 88-205; s. 1, ch. 89-5; s. 62, ch. 89-162; s. 31, ch. 89-374; s. 4, ch. 91-429; s. 58, ch. 92-149; s. 7, ch. 93-166; s. 258, ch. 94.119; s. 4, ch. 97.228; s. 12, ch. 99.254; s. 40, ch. 2000-141; s. 27, ch. 2009-195; s. 405, ch. 2011-142; s. 4, ch. 2021-135. _ 00 489.111 Licensure by examination.— (1) Any person who desires to be certified shall apply to the department in writing. N (2) A person shall be eligible for Licensure by examination if the person: (a) Is 18 years of age; (b) Is of good moral character; and (c) Meets eligibility requirements according to one of the following criteria: 1. Has received a baccalaureate degree from an accredited 4-year college in the appropriate field of engineering, architecture, or building construction and has 1 year of proven experience in the category in which the person seeks to qualify. For the purpose of this part, a minimum of 2,000 person -hours shall be used in determining full-time equivalency. An applicant who is exempt from passing an examination under s. 489.113(1) is eligible for a license under this section. 2. Has a total of at least 4 years of active experience as a worker who has learned the trade by serving an apprenticeship as a skilled worker who is able to command the rate of a mechanic in the particular trade or as a foreman who is in charge of a group of workers and usually is responsible to a superintendent or a contractor or his or her equivalent; provided, however, that at least 1 year of active experience shall be as a foreman. 3. Has a combination of not less than 1 year of experience as a foreman and not less than 3 years of credits for any accredited college -level courses; has a combination of not less than 1 year of experience as a skilled worker, 1 year of experience as a foreman, and not less than 2 years of credits for any accredited college -level courses; or has a combination of not less than 2 years of experience as a skilled worker, 1 year of experience as a foreman, and not less than 1 year of credits for any accredited college -level courses. All junior college or community college - level courses shall be considered accredited college -level courses. 4.a. An active certified residential contractor is eligible to receive a certified building contractor license after passing or having previously passed the building contractors' examination if he or she possesses a minimum of 3 years of proven experience in the classification in which he or she is certified. b. An active certified residential contractor is eligible to receive a certified general contractor license after passing or having previously passed the general contractors' examination if he or she possesses a minimum of 4 years of proven experience in the classification in which he or she is certified. c. An active certified building contractor is eligible to receive a certified general contractor license after passing or having previously passed the general contractors' examination if he or she possesses a minimum of 4 years of proven experience in the classification in which he or she is certified. 5.a. An active certified air-conditioning Class C contractor is eligible to receive a certified air-conditioning Class B contractor license after passing or having previously passed the air-conditioning Class B contractors' examination if he or she possesses a minimum of 3 years of proven experience in the classification in which he or she is certified. b. An active certified air-conditioning Class C contractor is eligible to receive a certified air-conditioning Class A contractor license after passing or having previously passed the air-conditioning Class A contractors' examination if he or she possesses a minimum of 4 years of proven experience in the classification in which he or she is certified. C. An active certified air-conditioning Class B contractor is eligible to receive a certified air-conditioning Class A contractor license after passing or having previously passed the air-conditioning Class A contractors' examination if he or she possesses a minimum of 1 year of proven experience in the classification in which he or she is certified. 6.a. An active certified swimming pool servicing contractor is eligible to receive a certified residential swimming pool contractor license after passing or having previously passed the residential swimming pool www.leg.state.fi.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0489/0489.html Packet Pg. 304 9/13123, 8:53 AM Statutes & Constitution :View Statutes : Online Sunshine contractors' examination if he or she possesses a minimum of 3 years of proven experience in the classification in which he or she is certified. b. An active certified swimming pool servicing contractor is eligible to receive a certified commercial swimming pool contractor license after passing or having previously passed the swimming pool commercial 00 contractors' examination if he or she possesses a minimum of 4 years of proven experience in the classification into r which he or she is certified. W c. An active certified residential swimming pool contractor is eligible to receive a certified commercial N swimming pool contractor license after passing or having previously passed the commercial swimming pool U z contractors' examination if he or she possesses a minimum of 1 year of proven experience in the classification in v which he or she is certified. > d. An applicant is eligible to receive a certified swimming pool/spa servicing contractor license after passing or w having previously passed the swimming pool/spa servicing contractors' examination if he or she has satisfactorily co ul completed 60 hours of instruction in courses related to the scope of work covered by that license and approved by X the Construction Industry Licensing Board by rule and has at least 1 year of proven experience related to the scope U_ of work of such a contractor. a (3)(a) The board may refuse to certify an applicant for failure to satisfy the requirement of good moral >- character only if: 9 There is a substantial connection between the lack of good moral character of the applicant and the professional responsibilities of a certified contractor; and 2. The finding by the board of lack of good moral character is supported by clear and convincing evidence. (b) When an applicant is found to be unqualified for a certificate because of a lack of good moral character, the board shall furnish the applicant a statement containing the findings of the board, a complete record of the evidence upon which the determination was based, and a notice of the rights of the applicant to a rehearing and appeal. (4) The department shall ensure that a sensitivity review committee has been established including representatives of various ethnic/minority groups. No question found by this committee to be discriminatory against any ethnic/minority group shall be included in the examination. History.-ss. 5, 17, ch. 79-200; s. 369, ch. 81.259; ss. 2, 3, ch. 81-318; ss. 6, 20, 21, ch. 88-156; s. 12, ch. 89-162; s. 4, ch. 91-429; s. 480, ch. 97-103; s. 5, ch. 97-228; s. 1, ch. 2001-117; s. 7, ch. 2002.392; s. 64, ch, 2020-160. 489.113 qualifications for practice; restrictions. (1) Any person who desires to engage in contracting on a statewide basis shall, as a prerequisite thereto, establish his or her competency and qualifications to be certified pursuant to this part. To establish competency, a person shalt pass the appropriate examination approved by the board and certified by the department. If an applicant has received a baccalaureate degree in building construction from an accredited 4-year college, or a related degree as approved by the board by rule, and has a grade point average of 3.0 or higher, such applicant is only required to take and pass the business and finance portion of the examination. Any person who desires to engage in contracting on other than a statewide basis shall, as a prerequisite thereto, be registered pursuant to this part, unless exempted by this part. (2) A person must be certified or registered in order to engage in the business of contracting in this state. However, for purposes of complying with the provisions of this chapter, a subcontractor who is not certified or registered may perform construction work under the supervision of a person who is certified or registered, provided that the work is within the scope of the supervising contractor's license, the supervising contractor is responsible for the work, and the subcontractor being supervised is not engaged in construction work that would require a License as a contractor under any of the categories listed in s. 489.105(3)(d)-(o). This subsection does not affect the application of any local construction licensing ordinances. To enforce this subsection: (a) The department shall issue a cease and desist order to prohibit any person from engaging in the business of contracting who does not hold the required certification or registration for the work being performed under this part. For the purpose of enforcing a cease and desist order, the department may file a proceeding in the name of www.leg.state.fl.uslstatutes/index.cfm?App_mode=Display_Statute&URL=0400-0499i0489/0489.html Packet Pg. 305 8.H.1 `lV1LL71E-1r VVvx►LL j Growth Management Community Devolopment Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY Provide the names and telephone numbers of two persons who will always know your whereabouts. Name: Annalye Pacheco Telephone: 305-303-7768 II. NAME OF APPLICANT'S BUSINESS: Business Name: Dynamic Tree Service, Inc Name: Maria Roman Telephone: 239-289-3682 Business Address: 875 39th Ave NW Naples FL 34120 Street City State Zip Telephone: 239-537-2360 Email: Dynarnictreeservice@aol.com Federal ID Tax No.: 92-0551988 Ili. FINANCIAL RESPONSIBILITY YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: x Filed for or been discharged in bankruptcy within the past 5 years? X Had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? X Undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? Undertaken construction contracts or work that a third party, such as a bonding or surety company, x completed or made financial statements on? Made an assignment of assets in settlement of construction obligations for less than the debts X outstanding? Been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of x adjudication, a crime in any jurisdiction within the past 10 years?* Had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? X Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or x municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment.*If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing -- FIRM Application Rev. 712022 Page 4 of 14 o: z 0 U C9 Z Packet Pg. 306 8.H.1 4 I00 w N P uo Osr. �9ae z w U w Cn July 13, 2023 w To Collier County Contractor Licensing Board, U_ Q I Brian L Santos pled no contest in Collier County on 12/15/2014 to a charge of Home z Invasion- Robbery. I was sentenced to 8 years in prison with a credit of time served of 74 c days no probation. Due to good behavior i served 6 years and 10 months. I am truly looking forward to the opportunity this board will provide me in obtaining my own license within the z county. O U 0 Z_ Respectfully, ; Brian L Santos (239) 537-2360 Dynamictreeservice(@aol.com 875 39th Ave NW Naples, FL 34120 Packet Pg. 307 Z ter County Growth Management Communily Dovolopmanl Deparlment APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPEUNCY IV. EXPERIENCE VERIFICATION EDUCATION: List below and provide transcripts for any formal education you have obtained In the area of competency for which this application Is being made: Certificate# GV9233B4-1 Training Best Management Practices Florida Green Industries List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: Tree Trimmin , Stump Grinding, Tree Removal Management CURRENT/PREMUS LICENSE: List below and attach copies any other certificates of competency/licenses you hold/have held in Collier County or any other jurisdiction. Include the license #, Type, and county you hold it in. Lee County State License Number: GV923384-1 for Tree Service AFFIDAVIT Under the penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. C L SO.A Applicant (please print) Signature of Applicant State of r1n o ci g County of f Cr The foregoing instrument was acknowledged befog me by means of C�rplrysieal presence or ❑ online notarization on dais �ay of ��, 20 2 , by _ �C.L� ►~� `- Ct r'�LQ <� Such person(s) Notary Public must check applicable box: Flare personally known to me ❑ has produced a current driver license ❑ has produced a3 identitieation. M 00 r to to CIA (Notary Seat) c� { Hatery Public StA 6 of Fladde ! /nJ E Annslyo Paaheoo f { / ,rf M MV comr..!aNan Hit 2 0*17WP CQnlndor Ltcens1n0—tM Application Rev. 712022 .',+la_ar� Sibr•Atu:e: ,�•i`+ Pspe 8 of 14 Qco "s operations & Regulalory Msnagemont Division, Corilrador Licensing . 2800 Norih Horseshoe ❑rive o Naples, FL 34104 . (239) 5iLttorpl��g_rtg� lM r „ �, Packet Pg. 308 1 CO ?eT C;014 t Contractor sho 8.H.1 y 2800 N. Horseshoes Naples, Fl- 34104 Growth Management department phone - 239-252-2431 Fax - 239-252-2469 = Go APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY co CERTIFICATION OF APPLICATION 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. S f t ,mn L, &^ �-a Applicant (please print tiMI C —fP 5-P PV1( P Nam6 of Company of Sine of l O'�- \ 60A County of CCU l 1(? The foregoing instrument was acknowledged before the by means of bysical presence or ❑ online notarization till this j-&bay of � �`` � 20 Z 5 , by ► �rl A -\ L Such persons) Notary Public must check applicable box: are personally known to me 0 has produced a current driver license ❑ bas produced (Notary Seal) Natsry Publlo Sic. • o! POWs Annglyo Puchboo !IN My Commission HH 3903@7 Expires W2712o27 as identification. Notary Signature: Finn_Applls000n docx Rev 410612020 packet Pg. 309 V 8.H.1 Score Report Name: BRIAN LEE SANTOS Test: Sponsor: Collier County Date: ID #: Test ID: Score: 82 Result: # Unanswered Questions: 0 Module Subject Area Status LOW FLBO Business Organization P FLLIC Licensing P ------------------------------------------------ FLTL Tax Laws P F-L- --- ------------------------------------ Safely OSHA --- P ----------- FLLt. --.__--------------------------------- Labor Laws -- _ P FLCM Contract Management F FLPM Project Management F FLE&B Estimating & Bidding P FLFM Financial Managemenk P FLRM Risk Management P FLLIEN Lien laws P Prov/ Business and Law, 2nd edition 0711012023 868499266 Pass Cut Score HIGH Packet Pg. 310 V 8.H.1 Narne: Sponsor: ID 4: Score: Score Report Prov- BRIAN LEE SANTOS Test: Tree Trimming and Removal Collier County Date: 08/02/2023 Test ID: 000417094 100 Result: PASS # Unanswered Questions: 0 Module . Subject Area Status LOW Cut Score HIGH FLSAFE Safety P FLT&E Tools & Equipment P - FLTPM Tree Pruning and Maintenance P - FLTPT Tree Planting and Transplanting P - - FLTSR ------------------------------- Tree & Stump Removal ----------- - ---------------- - P Packet Pg. 311 27911 Crown Lake Blvd Sui 8•H.1 Bonita Springs, FL 34135 Phone: 239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com PERSONAL CREDIT REPORT (Compiled From National Records) <FOR> <SUB NAME> <MKT SUB> <INFILE> <DATE> <TIME> (I) P NP7771028 LICENSES ETC 16 NP 9/08 07/10/23 13:57CT <SUBJECT> <SSN> <BIRTH DATE> SANTOS, BRIAN LEE -8704 06/90 <CURRENT ADDRESS> <DATE RPTD> 875 39TH AV., NAPLES FL. 34120 5/22 <FORMER ADDRESS> 261 19TH ST., NAPLES FL. 34117 9/08 875 39TH NW AV., NAPLES FL. 34120---------5/23 ---------------------------------------------------------- M 0 D E L P R O F I L E ***FICO SCORE 8 SCORE +733 LENGTH OF TIME ACCOUNTS HAVE BEEN ***ESTABLISHED;PROPORTION OF LOAN BALANCES TO LOAN AMOUNTS IS TOO HIGH;TOO ***MANY INQUIRIES LAST 12 MONTHS;LENGTH OF TIME REVOLVING ACCOUNTS HAVE BEEN ***ESTABLISHED*** PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS -- NONE FOUND --------------..--------_--_--__--------------------------------------------- T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 CAPITAL ONE B 1DTV001 8/22 $185 EEIEIEEIE R01 6/23A $200 $0 I CREDIT CARD 3/23 $0 9 0/ 0/ 0 SYNCB/SAMSDC B 235061D 8/22 $698 1111111111 R01 6/23A $3800 $0 I CREDIT CARD 5/23 $0 10 0/ 0/ 0 JPMCB AUTO B 402DO38 4/23 $57.3K 075M974 1 I01 6/23A $0 C AUTOMOBILE $57.3K 1 0/ 0/ 0 OPENSKY CBNK B 2CKJO02 5/22 $189 MIN38 EEFIlEFEI111 R01 6/23A $200 $0 1 I CREDIT CARD $38 13 0/ 0/ 0 ------------------------------------------------------------------------------ I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 7/10/23 PNP7771028(FLA) LICENSES ETC 4/06/23 BC03201671(DAY) HUNTINGTON 4/06/23 BC11780815(DAY) FIFTH THIRD 4/06/23 FDT3025836(MCH) TD AUTO FIN 4/06/23 ALA9080603(CAL) TAMIAMI HYUN x 00 o� co m N U z L U w Cn w w H U_ Q z C z O U C9 z Packet Pg. 312 10/06/22 BNC6199555 (FLA) BK OF AMER 8/18/22 NNY4215612(EAS) SYNCB/SAMS 7/23/22 BPC3575459(NTL) CAPITAL ONE ------------------------------------------------------------------------------- END OF REPORT x w as to to N Packet Pg. 313 8.H.1 Dynamic Tree Service, INC BUSINESS CREDIT REPORT 27911 Crown Lalce Blvd Suite # 211 Bonita Springs, FL 34135 Phone: 239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com as of: 08/09 Fed Tax ID# 92-0551988 Address: 875 39th Ave NW Key Personnel: President: Brian L Santos Naples, FL 34120-3317 Secretary: Annalye Pacheco United States SIC Code: 0782-Lawn & Garden Services BIN: 525869353 NAICS Code: 561730-Landscaping Services Agent: Santos Brian L Business Type: Corporation Agent Address: 875 39TH Ave NW File Established: June 2022 Naples, FL Years on File: 1 Year Years in Business: More than 1 Year Filing Data Florida Provided by: Date of 05/01/2022 Incorporation: PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. I/ Bankruptcies: 0 v` Liens: 0 Judgments Filed: 0 '/' Collections: 0 END OF REPORT Page 1 of 1 2 00 rn co m N U z W U W Cn W W H U_ a z C I— z O U C9 z Packet Pg. 314 8.H.1 OMSION OF CORP 1 00 t .. �cVr;J0'f ref' (0140 an uj/!�lt,f ';?ra?t. r�J Ilurlt!?t f:el�slJr U Z Department of Slate ! Division of Corponatlons I Search Records ! Search by. EntityName 1 W U Detail by Entity Name LU Florida Profit Corporation LU w DYNAMIC TREE SERVICE, INC H Filing Information U Document Number P22000037040 a z FEI/EIN Number 92-0551988 p Date Filed 05/02/2022 Effective Date 05/01/2022 z O State FL U Status ACTIVE z Principal Address � 875 39TH AVE NW H NAPLES, FL 34120 1 .6 Mailing Address 875 39TH AVE NW NAPLES, FL 34120 Registered Agent Name & Address SANTOS, BRIAN L 875 39TH AVE NW NAPLES, FL 34120 OfficerlDirector Detail Name & Address Title P SANTOS, BRIAN L 875 39TH AVE NW NAPLES, FL 34120 Title S PACHECO, ANNALYE 875 39TH AVE NW NAPLES, FL 34120 Annual Reports Report Year Filed Date Packet Pg. 315 1 2023 02/26/2023 Document Images 2 02f2V2023 -- ANNUAL REPORT Yew image in PDF formal 00 05/0212022 -- Domestic Profit View image in PDF format tD CO N I� Z Z 0 U C9 Z_ H Packet Pg. 6 8.H.1 Electronic Articles of :Incorporation For DYNAMIC TREE SERVICE, INC P22000037040 FILED May 4f State bcoates 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: DYNAMIC TREE SERVICE, INC Article II The principal place of business address: 875 39TH AVE NW NAPLES, FL. 34120 The mailing address of the corporation is: 875 39TH AVE NW NAPLES, FL. 34120 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: Article V The name and Florida street address of the registered agent is: BRIAN L SANTOS 875 39TH AVE NW NAPLES, FL. 34120 I certify that I am familiar with and accept the responsibilities of registered agent Registered Agent Sigxiahare: BRIAN L SAN`I'OS 00 N Packet Pg. 7 8.H.1 Article VI The name and address of the incorporator is: BRIAN L SANTOS 875 39TH AVE NW NAPLES FL 34120 Electronic Signature of Incorporator: BRIAN L SANTOS P22000037040 FILED May 02 2022 Sec. Of State bcoates I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are tare. 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 arumal report between January 1st and May 1st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P BRIAN L SANTOS 875 39TH AVE NW NAPLES, FL. 34120 Title: S ANNALYE PACHECO 875 39TH AVE NW NAPLES, FL. 34120 Article VIII The effective date for this corporation shall be: 05/01/2022 x 00 N Packet Pg. 318 DEPARTMENTRVIURYMIRSiAiREVENUE SERVICE CINCINNATI OH 45999-0023 8.H.1 DYNAMIC TREE SERVICE INC 875 39TH AVE NW NAPLES, FL 34120 Date of this notice: 10-03-2022 Employer Identification Number: 92-0551988 Form: SS-4 Number of this notice: CP 575 A For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN MIPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 92-0551988. This BIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. Taxpayers request an EIN for their business. Some taxpayers receive CP575 notices when another person has stolen their identity and are opening a business using their information. If you did not apply for this EIN, please contact us at the phone number or address listed on the top of this notice. When filing tax documents, making payments, or replying to any 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 forms by,the dates shown. Form 1120 04/15/2023 If you have questions about the forms or the due dates 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 (corporation, partnership, etc.) 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 2020-1, 2020-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: certain tax classification elections can be requested by filing Form 8832, Entity classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S, U.S. Income Tax Return for an S Corporation, must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for form 2553, Election by a Small Business Corporation. 2 w as as W N Packet Pg. 319 Contractor Licen 8.H.1 C:O er CO-tiVlty 2800 N. Horseshoe LT Naples, i=L 34104 Growth Management Department 239-252-2400 x 00 APPLICATION FOR COI.1_11:R COUNTY CERTIFICATE OF COMPETENCY r' eo STATEMENT OF OWNERSHIP This certifies that I, L` � a'n L am a member or managing APPLICANTS NAME (please print) member of 1 ),--I t1 Q yVN i C- t -Tn 1 own � a 0 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant; I certify under penalty of perjury that the information contained Is a true and correct statement to the best of my knowledge. &'Ja1 San'ioS Applicant (please print) G -Tree Sp rr !/Ice Name of Company Signature of Applicant State or �06 6a County or C J Oe ( 7hforegoing instrument was acknowledged before me by ►neans of �pltysical presence or 0 online notarization on this .Z day or v l � .202 _ 3'6 Ck r\ L fSa b -nS Such person(s) Notary Public mus(clieck applicable box: Pare personally known to me ❑ has produced a current driver license © bas produced (NotarySeal) Identification. Notary Signature; Notary p'J "Stalo of Florida Annaiye Paoheco 11U My CommIsilon HH 300307 t:xplres 6127120,27 With Tiny Sci I-Iml—Application.doex Itov 4/0612020 ( Packet Pg. 320 Cto3er C014nt y Growth Management Department Contractor Licen 2800 N. Horseshoe Naples, FL 34104 239-252-2400 'A x co APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY 0 VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name;_�R_ l 0-iiL - � � d Certificate Category Requested: `I r rr- m t na -1 oval 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 hislher experience wilhln this trade. You are being requested to provide Information that will aid the applicant In meeting this requitement. 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 batter in the trado). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade e7m/ . The person agfp�rade experience for the above -named applicant must provide the following In`formalio Name: u 0 t� CL V Title: I ram , (lei Business Name: r �-�� t r �� 1 �- - Phone: ';_�P � -1 5tE5 ✓'� .DLO S License No. (if appil ble): I !f Business Address: \329 street The applicant was employed by me from ZIa-rie Applicant's title: plicant' scope of wor (specific X t_100CCS . Additional comments: city ?_24 1 YY) n--) (.f- V, Statd Zip to jDr- e- C_ n Included: f r \ �� cn in uryl i-D (rtlrl NOTE TO LICENSED CONTRACTORS: Falsifying any informaflo Under penalty of perjury, I declare that the facts stated here are trt State of 1 a t C�Cti County of Cc �Vk <_�- f ry7 the Foregoing instrument was aclalowledged before me by means oC�piiyslcal presence or CI online notarl7,ation on this kLLly of 20 Z.3 , by Swett person(s) Notary Public must check applicable box: Fare personally known to the © has produced a current driver license © bas produced (Notary Seal) s N018ry Public State or Flo, IdA Annelye Pacheco My Commiselon HH 390307 AXPIrSO 5127120 77 tls Identification. ,�S Firm AmAcation.doex Rev 410012020 If Packet Pg. 321 Contractor licensing Ci0 ?er County 2800 N. Horseshoe Dr. Naples, FL 34104 Gmwth Management Department 239-252-2400 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF Etnrk8a COUNTY OF Col 1 Jrl J b Q sworn slate and affirm: I, GAL y i , having been first duly I �Y i C� �' State lama resident of � e r County, (State) and have resided here for more than flve (5) years. During the East five (5) years i have known f t�rl ��` Yl ilicant). I have opportunity to observe his or her business and personal dealings and find him or he L f honesty, inte r€ty and good character. i C�h � f V I ccrf 0- j ':;� t:) tin a- rl I Printed game Addles 1� �� ��es I qty I State Zip Telephone: 2 39 — q5 — U I to S State of FA Oy' ., d O� County of C(-) \ ve f T'he foregoing instrument was acknowledged before me by means of,0phys'tcal presence or ❑ online notarization on this -]+kdayof ul 207-3 ,by M C -S G Such person(s) Notary Public must check applicable box: p4 are personally known to me Cl has produced a current driver license ❑ has produced as identification. (Notary Scal) =W&E of Fledde Notary Signature: tt6co H 390347 021 Flrm_Appllcalion.docx Rev 4/0612020 Page 14 of 1�i x 00 rn to W F4 wY Z O U 0 Z_ H Packet Pg. 322 Co -,c.r Cirowth Maimpoillont I)apnrlmord Contractor Llcan 2800 N. Horseshoe Dr. Naples, FL 34104 230-252-2400 AI'Iai1CA[ION I'OR COLLWR COUNTY CI:1 FIFICATh OF C OMPHINCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF - 01 t► 6A COUNTY OF ( 61r'Cn- i, having been first duly sworn, state and affirm; I am a resident of ( D0 /L-' County,, (State) and have resided here for more than five (5) years, During the last five (5) years I have known "&// 11-1 &NTb,S (applicant), I have had the opportunity to observe his or her business and personal dealings and fired him or her to be a X11.on of honesty, Integrity and good character, Signature Printed Noma Address: Yr7g6 Rn e ,e( Cfr eacic=( streat fVa.pb7i FL city State Zip Telephone(c230 �a/- 2asq -- state of F�o n� - _-- County of 00 LULIL-- `I'lie roregoin insirtunent was acknowledged before me by means of lysical presence or © online notarization on Oils 0 day of � , 20 d-3 , by ZA9& % J�WWdS Sucil person(s) Notary Public nlust check applicable boll: re personally known to me ❑ has produced a current driver license 0 bas produced as Identilicallon. (Notary ,Sell]) Notary Public Slate or Florida Notrlrv_ 5igllaturc: Annj4X elya Rnoitsaa , .. ,; ,� My CommlaaloA kH 9068t1T u E><pire� �rs>'r2ozT = x 00 rn to N z 0 U C9 z FIrm_.Applleagon.docx Ruv 4/06/2020 p packet Pg. 323 8.H.1 Florida DFMR. Nn USA - SANTOS �6RIA.N LEE iW539THAVE NW NAPL.ES, FL 3412 wfl$ 06124119 W vi —.x M -lbEK? 124�2-0,30 16Hf-,T 6--07" 2 RES'' A qa emiD NC O iE SAFE DRIVER 7 •" 4a MS 1111912021 500 x632203021698 . CEP± A�,cD 03102#22 -V►+' s SAWf+r>'m Op fame -ot a moor vahitke constitutes Cottsen[ to any Sabite!+t requsred bry yaw. Created i11 hIfi `I`iny Scanner x CO r CD CD N U Z W _U W U) W W d' H _U Q Z H Z O U 0 z Ix Packet Pg. 324 Department ®f UF1IFAS UNIVERSITY ofFLORIDA. Envi«onmental Protection Florida -Friendly i.an�dscapinq-,P S'pAM �lt� ls.H.� 2600 Blair Stone Road, M.S. 3510 Tallahassee, Florida 32399-2400 GI-BMP Trainee ID: GV923384 Certification date: 2/28/2023 Test Score: 90% e Congratulations on successfully completing the Florida Green Industries Best Management Practices Training Program. Your certificate of completion and wallet card are attached. If there are errors in the certificate, or if we can be of further assistance, please contact the GI-BMP office of the UF/IFAS Florida -Friendly Landscapinel" Program at gi.bmp a ifas.ull.edu or (352) 273-4517. Please note that this training certificate alone does not authorize you to apply fertilizer commercially. You must take additional steps to become licensed for commercial fertilizer application in the state of Florida. The Limited Urban Commercial FertilizerApplieator Certification (state "fertilizer license") is issued by the Florida Department of Agriculture and Consumer Services (FDACS). Apply online: https://aesecomm.freshfiotnflorida.com. The certificate number from this document is required to apply for Fertilizer Applicator Certification. For assistance contact: The Bureau of Licensing and Enforcement, (850) G 17-7997. If your test score is 90% or greater, you may be eligible to become a GI-BMP Instructor: littps://ffl, i f,ts.ufl.edti/professionals/i tistrtictor j)rogram, html State of Florida DEPARTMENT OF ENVIRONMENTAL PROTECTION Brian L Santos Brian L Santos Dynamic Tree Service GV923384-1 GV923384 Certificate it Traince ID I/ GREEN INDUSTRIES BEST MANAGEMENT PRACTICES TRAINING PROGRAM UPWAS Florida -Friendly IJ IVIYEa5rrY of FLORIDA LenC�SCapinCj"r.R,"�w GV923384-1 Certificate of Training P F Of fw„y, Certificate tl Best Management Practitces GV923384 Trainee 1D itFlorida Green Industries ° °ay The undersigned hereby acknowledges that ]�rlan L Santos has successfully completed the Green Industries Best Management Practices Program developed by the Florida Department of Environmental Protection with the University of Florida Institute of Food and Agricultural Sciences. I.",/4L T. Wichman Tom wichman Instructor 0I-13MP Statewide Coordinator 2/29/2023 � Dale of Class Esen Momol, Ph.D. Director Florida -Friendly LandscapfngT111 Program 00 CD to to F1 Packet Pg. 325 ACOR" CERTIFICATE OF LIABILITY INSURANCE `, DATE (MMIDD1YYYY) 07/07/2023 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 have ADDITIONAL INSURED provisions or 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 Patti Muzzoni r0 NAME; 9 uc°N o Exl (239) 353-3500 Fn c No ; (888) 353-9910 G & P Insurance Inc E-MAIL attimDzzoni ro allstate.com ADDRESS: p g @ 4930 Golden Gate Pk Wy INSURERS AFFORDING COVERAGE NAIC p Ste A INSURERA; WESTERN WORLD INSURANCE COMPANY Naples FL 34116 INSURED INSURER B INSURER C : Dynamic Tree .Service Inc. INSURER D: 875 39TH AVE NW INSURER E : NAPLES, FL 34120 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER fdMl �IYYYYF PO fOpY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR NPP1617979 04/11/2023 04/11/2024 EACH OCCURRENCE $ 1,000,000 DA TO RENTED PREMSES Eaoccurrrenoe $ 100,000 MED EXP (Anyone person) $ 5,000 GEN'L X PERSONAL BADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PEA LDC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO S INCLUDED S AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREO NON -OWNED AUTOS ONLY AUTOS ONLY f COaMBaaidenINLDf SINGLE LIMIT E $ BODILY INJURY (Per person) $ BODILY INJURY (Per aecident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y r N ANY PROPRIETOPdPARTNERIEXECUTIVE ❑ OFFICERR.IEMSER EXCLUDED? (Mandatory in NH) If yes, describe under CESCRIPTION OF OPERATIONS below N f A PER O7H- ISTATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYF $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) contractorslicensing@colllercountyfl.gov GEKI-IFiGA It HLJLULK GANGLLLA I IUN Collier County Contractor Licensing Board 2800 Horseshoe Dr N Naples FL 34104 contractorslicensing@colliercountyfl.gov 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 O 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 8.H.1 2 Do CD to w N Packet Pg. 326 oe�"a 8.H.1 00 00 JIMMY PATRONIS 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. rw LU EFFECTIVE DATE: 7/12/2023 EXPIRATION DATE: 7/11/2025 w W PERSON: BRIAN L SANTOS EMAIL: DYNAMICTREESERVICE@AOL.COM ~ U_ FEIN: 920551988 M a BUSINESS NAME AND ADDRESS: C DYNAMIC TREE SERVICE, INC t— z O 875 39TH AVE NW v c� NAPLES, FL 34120 z This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the 06 license of the certificate holder, go to www.myfloridalicense.com. de IMPORTANT: Pursuant to subsection 440.05(13), 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 subsection 440.05(11). F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation it, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any lime for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 01/2023 E01753629 QUESTIONS? (850) 413-1609 Packet Pg. 327 7 2 od - 'NiNOO JNIWWINI T IVAOW3N 33HI - M3lA3N ON003H - SOINVS 'l NVINS H8 :;uGwLl3B;;d JJiLA O GW7 p4 z O z a a a c z �a N p o o � � N O� y � 5 M S •. L�r Z M N O Z° o Q� U rn .� z .� �.r.6a z ❑ wiz Qacn a�z MiNOO JNIWININI 8 IVAOW3N 33Ni - M31n3M ON003N - SOlN`dS 'l NVINEI H8 :;uGw43eUV OD 00 v- N a LU 00 cn uw z �- 55 �f O �M J N LL to N O coca z Zjw LU mm W m0 W LuI�N d �leU� '01U)uj UJ J 0- opt--U rUVSLLI J co s O C.� z M O V aC ltl J J t„ 1 z 0 m � � o O Z Lu65 w U W o o o W Z m 0 d w m g ¢ Mw _ z } z f� 0 u) fl- coo Z T- N N O a Q zoN I- LU 0- =Uo rn U (-4 =, 0 hZ .. O 6 p o= ww zr m rn N O ccq- �16 00 Q0 cJi o 4 p a � to 0 z U) g. wza w 2w m Q� gfol A�I� .'ter c 0 W U LL c O o c y Q � � o U) (D Z a jet w Q Q 0 0 0 N U_ U_ E LL LL U U) v V 0 a) N M Cb a m m a 8.1 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.I Doc ID: 26620 Item Summary: 81. DOMINIC L. SANTOS - REVIEW OF CREDIT - TREE REMOVAL & TRIMMING CONTR. - D SANTOS TREE SERVICE " Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:35 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:35 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:40 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 5:02 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 330 Corer County L/� �] Growth Management 1 cc uo,-3� w5c Community Development Department [�� J /04 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY FIRM APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY 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. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY: ❑ General $230.00 ❑ Electrician ❑ Building $230.00 ❑ Plumber ❑ Residential $230.00 ❑ Air Conditioner ❑ Mechanical $230.00 ❑ Swimming Pool ❑ Roofing $230.00 A Specialty Specialty Trade: I. APPLICANT PERSONAL INFORMATION: Name: Domim G L First Middle Initial Business Name: JoinimTreeJemceL L C Address: 21D { I q -Fh Street Email: Telephone:_z 3 Jr �1 a j� 9 z_7 `t' Date of Birth: r 0 5 1 g q Je I [I State $230.00 $230.00 $230.00 $230.00 $205.00 Snkif0S Last 3 I I Zip *SS # (Last 4 digits only): 5l I f Driver's License ## (Last 4 digits only): 4950 Pursuant to Collier County Contractor Licensing Ordinance No. 2D08-46 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. c) Verification of applicant's identity. Our office will only use the personal information noted above for (hose reasons pursuant to Chapter 110, Florida Statutes, and as may otherwise be authorized by law. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing — FIRM Application Rev. 712022 Page 3 of 14 Operations R Regulatory Management Division, Contractor Licensing s 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensing a.colrierconntyfl.aov Packet Pg. 331 8.1.1 0 N 2.6.3A& "free RRmova] and Trimming Contractor requires twelve (1) months cc co N eXperienCe with a passing gra& on a business and law rest and moans (hose who are U J qu$lified to trite and remove trees and stumps. J ul All now lira a n Fo rce s cc li are wired obtain ussin r��ic V Dn an agpirgy-eA dx in tree nin d saf n addition tot LU bust nd law W w Packet Pg. 332 8.1.1 otper County Growth Management Community Development Department N Co to N APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY U J J Provide the names and telephone numbers of two persons who will always know your whereabouts. w V Name: Tiff�+�Yow Name: delay S0dos LU w Cn Telephone: � p Z 3 1- z y� � "' C3 9] Z. Telephone: 2 3 °� Q p Z I Z 0� 7 w ll. NAME OF APPLICANT'S BUSINESS: � Business Name: S tm Tree Se_r y c-e L. L C ° z r 1 Business Address: _7 t0 t� S 1 . ,i ��i�� D eS �L I F L 3 T 11 �1 Q ro ° Street �y State Zip a; q Telephone: Z 3 -! ` 3U ` Z 7 �' z II-- Email: dsomtosfree.service @ y o oo , c o m o Federal ID Tax No.: I Z` 11 � 3 15 III. FINANCIAL RESPONSIBILITY YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: XFiled for or been discharged in bankruptcy within the past 5 years? XHad a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? XUndertaken construction contracts or work that resulted in liens, suits, or judgments being filed? / Undertaken construction contracts or work that a third party, such as a bonding or surely company, x completed or made financial statements on? an assignment of assets in settlement of construction obligations for less than the debts XMade outstanding? convicted or found guilty of, or entered a plea of nolo contendere to, regardless of XBeen adjudication, a crime in any jurisdiction within the past 10 years?* claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of XHad construction experience? Been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? NOTE. If you have answer YES to any of the questions below, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences of conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment.*If you have had a felony conviction, proof that your civil rights have been restored will be required prior to Iicensure. Contractor Licensing — FIRM Application Rev. 712022 Page 4 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 coiilractorslicensing(a)colliercountvft.pov Packet Pg. 333 6t=UL2U2__�00> �—(oe—,--3 8.1.1 COLLIER COUNTY 12629 GROWTH MANAGEMENT DIVISION CITATION Pursuant to section 489 Florida Statutes, the undersigned hereby cerlifies that upon personal investigation, helshe has reasonable and probable grounds to believe that the person whose name appears below as issued to, did violate subsection 489.127.(1), Florida Statues, and the Collier County Contractor's Licensing Ordinance No. 2006.46 (as may be amended) by committing the violation stated below. t� Monlil Day �'�' IW- 1`iitc A;t 1'Ivi �- Issued To S A N T C) ,S D M L:%1 L C L. Address lcitL C,.-T City N APLVS State— Zip phoe7 oD. � L 1� ` ` ! � � � Date of Birth +� ttc(Z r, Vehicle Make/Type (i(applicable) Year I Color Tag No. Location of Violation Lf-W( T �l CLl oC)tL OPTIONS I have been informed of the violation for which I have been charged and elect the following option (Check one) p d 1) ❑ 1 choose to pay the penalty of 2) ❑ I choose not to pay the penalty, and will request in writing by certified mail or hand delivery an Administrative Hearing before the Contractors Licensing Board. Description of Violation Date Violation Observed a) ❑Falsely hold self or business organization out as a licensee, certificate holder or registrant; h) ❑ Falsely impersonate a certificate holder or registrant; c) ❑Present as his/her own the certificate or registration of another; (1) ❑ Knowingly give false or forged evidence to the hoard or a member thereof; e) ❑Use o attempt to use a certificate or registration which has been suspended o evoked; -t i 1 [' f� J.t-L � P D v I� l f 3 (' f) 'gage to the business or act in the capacity of a contractor or a mItlse self or business organization as available to engage in the business or act ill the capacity of a contractor without being duly registered or certified; g) []Operate a business organimflon engaged in contracting after (60) days; h) ClCornmence or perform work for which a building permit is required pursuant to an adopted state mininuttn building code or without such permit being in effect; i) ❑ Willfully or deliberately disregard or violate any Collier County ordinance relating to uncerlified or unregistered contractors. A person or business organization operating on a' inactive or suspended certificate, or registration, or operating beyond the scope of work or geographical scope of the registration, is not duly certified or registered. PRINT (RECIPIENT'S NAME.) PRINTONVES'T'IGATOItS NAME) Pursuant to 489.127, Florida Statues, willful refusal to sign and accept this citation constitutes a misdemeanor of the second degree, punishable as provided in section 775.082 or 775.083 Florida Statutes. (Sufi REVERSE FOR INSTRUCTIONS) 0 N to to N U J J 0011IER COUNTY CONTRACTORS LICENSI: Packet Pg. 3 47 8.1.1 Collier County Growth Management Division 2800 Horseshoe Drive N. Naples, FL 34104 239-252-2400 Receipt Number: 20231104046 Transaction Number: 2023-059719 Date Paid: 07/07/2023 Amount Due: $1,000.00 Payment Details: Payment Method Amount Paid Check Number ACH $1,000.00 3105490964 Amount Paid: $1,000.00 Change / Overage: $0.00 Contact: Dominic Santos 261 19th st sw Naples, FL 34117 FEE DETAILS: Fee Description Reference Number Original Amount GL Account Fee Paid Contractor's Lic. Citation (1st CEUL20230005663 $1,000.00 $1,000.00 113-138900-321237 Offense) Cashier Name: comanager Batch Number: 12178 Entered By: Greg.StJean 0 N to to N U J J Packet Pg. 335 8.1.1 ClPyew County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY IV. EXPERIENCE VITRIFICATION EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: - N O YI IZ List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: CURRENT/PREVIOUS LICENSE: List below and attach copies any other certificates of competencyAcenses you hold/have held in Collier County or any other jurisdiction. Include the license #, Type, and county you hold it in. AFFIDAVIT Under the penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. D o m l V1 t G Santos DeY6 41 Applicant (please print) Signature of Applicant State of O rl CIA County of a I r The foregoing instrument was a owledged before me by Means of i ph-N ical presence or ❑ online notarization on this day of U� , 20 by �r Such person(s) No� •y Public must check applicable box: ❑ are personally known to nie 0 as produced a current driver Iicense ❑ has produced as identification. (Notary Seal) oirgY"te�, SANDRADELOADO o Cammissbn # HH 101718 NggQ Expires March 8, 2025 FOF FLr4 Bonded 71w Budget Nobry SoNim Notary Signature: Contractor Licensing — FIRM Application Rev. 712022 Page 5 of 14 Operations & Regulatory Management Division, Contractor Licensing e 2800 North Horseshoe Drive • Maples, FL 34104 + (239) 252-2431 contra ctorsliconsinq(�colliorcounivf Lgov 0 N Co CD CV U J J Packet Pg. 336 8.1.1 C _ :Of f ie' ly C"O dlty Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION OF APPLICATION 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. State of S ��n �� County of 1 The foregoing instrument was acknowledged before me t• a�vjay of , 20 Q�, by Such person(s) N ary Public must check applicable box: aom irl i c Sot ntos Applicant (please print _LSo os Tree _Service- LLC Name of Company L"tri 1'C' salm Signature of Applicant of hysical presence or ❑ online notarization on this ❑ are personally known to me U_l�s produced a current driver license ❑ has produced as identification. (Notary Sea]) =0{'6pt"',�c SANDRADELGADG Notary Signature; * * Commission# HH 10 IMO Noz Expires March 8, 2025 I IOF rtOQ' Bo)Mwihru Budget Notary services Contractor Licensing — FIRM Application Rev. 712022 Page 6 of 14 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractors licensincolliercouni Fl. ov CD N CD CD N U J J Packet Pg. 337 8.1.1 �i011jer 00"V1.ty Growth Management Community Development Department N CO CD N APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY U J WORKMEN'S COMPENSATION AFFIDAVIT J It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I tail to acquire, or maintain at all times effective Workmen's Compensation insurance it will result in the possible revocation of my Certificate of Competency. Domi4,lc Applicant (please print b Sofhfos Tue Service LLC Name of Company aln4 at(—, SG4f)JOJ Signature of Applicant BEFORE ME this day personally appeared o iM { M C J a h tQ-S who affirms and Applicant (please print) says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. State of CA Countyof e— C The foregoing instrument was acknowledged before me by means of 9$day of _ LL� , 20, by _ �� A�1.1(� �C Such person(s) I ry public must check applicable box: ❑ are personally known to nze ❑d!ias produced a current driver license ❑ has produced �' L- D (= - as identification. (Notary Seal) presence or ❑ online notarization on this , 0'! rU@SANDRADELGA00 =o '• ° t;omrnlssj0n#tjKi017A8 Notary Signature; . 7S I * * Expires March fS, 2025 Q N�9�Fo{F�°4� 8ondedihNB>x�lNots�YS�mce� Contractor Licensing — FIRM Application Rev. 712022 Page 7 of 14 Operations R Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensinq rpcolliercountyf[.gov Packet Pg. 338 Score Report Page I of Score Report Name: DOMINIC LEE SANTOS Sponsor: Collier County ID #: Score: 84 # Unanswered Questions: 0 Prov- Test: Business and Law, 2nd edition Date: 08/22/2023 Test ID: 886166477 Result: Pass Module Subject Area Status LOW FLBO --------------------------------------------------- Business Organization P ---- FLLIC Licensing F FLTL Tax Laws P ---- --- FLSRR - ---------------------------------- Satety OSHA ---- P FLl_L Labor Laws P FLCM Contract Management F FLPM Project Management F FL1=&13 Estimating Bidding P FLFM Financial Management P ----------- FLRM --------ent ------------------------- Risk Managem P ----- ---- FLLIEN Lien laws P CulScore HIGH ffle:l//C:/Users/12073/AppData/Local/Teml)/arkiv/TFC2F I F0906.1itm Id Packet Pg. 339 Score Report Page I of Score Report Name: DOMINIC LEE SANTOS Test: Sponsor: Collier County Date: ID #: TestID: Score: 88 Result: # Unanswered Questions: 0 Pro✓ Tree Trimming and Removal 08/2412023 9411107073 Pass Module Subject Area Status LOW Cut Score HIGH FLSAFE Safety P FLi-iW -T--oo-l-s- &--E-q-ui-p-m-e-n-( -e----------------- -re- -ru-n-i-niand- -M-Maintenance : : : : ---- � - - - - � : : : -1 ------ ---------------------------------------- ---- --------------- FLiF�, -T- F-Lii�-( Tree- Planting and Transplanting P - — --------------- --------------- FLTSR Tree & Stump Removal P7 CD 04 to w N, 0 -j -j filc:///C:/Uset-s/12073/AppData/Local/Teiiii)/ai-kiv/TFC2F I F5BD9.htrn 8I Packet Pg. 340 1 LicenseExa T5ervicesLLC 8.1.1 4713 Webber St Sarasota, FL 34232 Phone:941-706-2336 Fax:866-473-0571 Email: info(@needfloridalicense.com c N to to U J J CONTRACTOR CREDIT REPORT Below you will find the information that was requested. We have used reasonable care in selecting the private entity that has gathered this information. However the ultimate responsibility for the accuracy and completeness of this information along with the information gathering methodology rests with the parties providing the information and performing those functions, and we cannot accept any liability for errors or omissions in connection therewith. CREDIT REPORT AND PUBLIC RECORDS HAVE BEEN CHECKED AT LOCAL, STATE AND FEDERAL LEVELS FOR JUDGMENTS, LIENS, AND BANKRUPTCIES. DATE OF SEARCH: August 28, 2023 Personal Information Name: SSN: On File Since: Address: Reported On: Scorecards DOMINIC LEE SANTOS -5619 12/23/20 l 3 261 SW 19TH Street NAPLES FL 34117 12/22/2013 Scorecard:FICO Risk Score, Classic 04 Score: 545 (006) Too many consumer finance company accounts (011) Amount owed on revolving accounts is too high (024) No recent revolving balances Reasons: Collections Date of Birth: 11/5/1995 Phone: No alert information is found in the file and/or inquiries do not impact the credit score Member Number Creditor Status Narratives OI GZD005/CREDIT COLL 06 PROGRESSIVE Industry Code Account Number Collection services 78347663 Date Reported Date Verified Date Closed 9/18/2019 8/ 14/2023 Cn O H z Q Cn J U Amount Z Balance o c 00 r c $545 E $545 U Page l of -� Q Packet Pg. 341 8.1.1 4713 Webber St Sarasota, FL 34232 ES Phone:941-706-2336 Fax:866-473-0571 O O Email: infoO)needfloridalicense.com N co co Uc.enseExaiT SeMcesLLC U J J (9B)Collection account - w Placcd for collection v 042DF003/WAKEFIELD Collection services 8/28/2020 $1,293 MEDICAL 1202528882 3/9/2023 $1,489 (9B)Collection account - Placed for collection 042DF003/WAKEFIELD Collection services 8/28/2020 $1,293 MEDICAL 1202528883 3/9/2023 $1,483 (9B)Collection account - Placed for collection 042DF003/WAKEFIELD Collection services 2/28/2020 $1,350 MEDICAL 1200717429 3/9/2023 $1,577 (9B)Collection account - Placed for collection 042DF003/WAKEFIELD Collection services 3/27/2020 $1,259 w MEDICAL 1201052068 3/9/2023 $1,467 1- (9B)Collection account - Placed for collection w o' U w O 042DF003/WAKEFIELD Collection services 7/24/2020 $861 MEDICAL 1202182396 3/9/2023 $990 (9B)Collection account - w Placed for collection CO O z 042DF003/WAKEFIELD Collection services 8/28/2020 $1,350 CO MEDICAL 1202527667 3/9/2023 $1,554 (9B)Collection account - z Placed for collection O c CO Trade Lines c d E Page 2 of 2 a Packet Pg. 342 Firm Name/ID Account Number _KOB/Trad_e Type Status Phone # SANTANDERIF OIR18003 30000203538851000 Finance, / Automobile (09)Cliarged off as bad debt Opened Credit Limit Balance Reported High Credit Past Due Acet. TypeChargeo Orig. Amt. Lst. Paymnt.Closed Ind 4/8/2017 - $0 7/31/2018 $14,868 $0 Installment- - 3/28/2019 Purchased by another lender WESTLAKE FIN/F 01T9Q001 5/10/2019 - 11311960 12/9/2021 $11,000 Finance, / Automobile Installment - (0 ])Paid or baying as agreed 12/9/2021 Closed Inquiries 8.1.1 4713 Webber St Sarasota, FL 34232 Phone:941-706-2336 Fax:866-473-0571 Email: infoCa�i needfloridalicense.com c N CO t,D N U J J McPmnt 30 60 90 MoRep Pattern Date Closed Owner Terms $0 - - - 0 7/31/2018 closed chargoff Individual account72 Months $0 $0 0 0 0 $0 31 1111111111111 - 12/9/2021 l l l l l l l l l l l l l 11111111 closed normallylndividual account66 Months Date Subscriber Name Subscriber #AmountMkt.SubMkt.KOB Phone # 8/25/2023 MICROBILT Z04639463 16 AM Miscellaneous and public record W U U- O w CREDIT REPORT AND PUBLIC RECORDS HAVE BEEN CHECKED AT LOCAL, STATE AND FEDERAL w LEVELS FOR JUDGMENTS, LIENS, AND BANKRUPTCIES WITH THE FOLLOWING RESULTS: an O NO RESULTS FOUND z a Cn J U_ Z_ O C 00 r c m E t U Page 3 of -- Q Packet Pg. 343 8.1.1 `''REDIT •.0 UPREME N U J J Credit Supreme LLC W 8200 Nw 27+h St # 101 v Doral, FI 33122 To Whom It May Concern: I am writing to provide you with an update on the credit repair progress of Dominic Santos, who is actively working on addressing credit issues that may have previously affected his ability to apply for a contractor's license in Collier County. We understand the significance of a solid financial foundation when it comes to professional licensing, and I wanted to assure you that Mr. Santos is taking proactive steps to improve his credit profile. As his credit repair service provider, we are committed to supporting him throughout this process. Our team has been diligently engaging with the credit bureaus and creditors to address and rectify any inaccuracies or negative items on Mr. Santos credit report. While credit repair is an ongoing process that requires time, dedication, and patience, we believe that Mr. Santos commitment to improving his credit demonstrates his responsible approach to financial management. We are actively working to ensure that his credit report accurately reflects his current financial standing. In line with Mr. Santos efforts to rectify his credit issues, we are prepared to provide any necessary documentation or updates that may support his Collier County contractor's license application. We understand the importance of transparency and accountability in the licensing process and are more than willing to cooperate with your requirements. Should you require specific information or documentation that highlights Mr. Santos dedication to credit repair, please do not hesitate to reach out to us directly. We are fully committed to assisting Mr. Santos in his journey towards obtaining his contractor's license and achieving his professional goals. Please feel free to contact me directly at 01-TiceC<?Credi(Supre me,ccill if you have any questions or require further information. Best regards, Dimitri Katsabanis Manager Packet Pg. 344 CUTTERS CHOICE INC. 8.1.1 (KAW) KAWASAKI MOTORS CORP (LH) LABOR (MSC) MISC VENDOR (RBI) RBI CORP (RO) ROTARY CORP (STI) STIHL SOUTHEAST (VER) VERMEER SOUTHEAST Sub Total Mfr : Labor Sales Misc. Sales: Combined Totals: Customer Sales D SANTOS TREE SERVICE LLC For period 111/2023 to 8/25/2023 Sales 270.00 561.60 80,95 814.95 61.00 3925,69 1135.00 6849.19 0.00 0.00 6849.19 Serialized Sales Part Serial Description Sales 0 N to w N U J J 0 w U LL O w w O H Z Q u7 J U_ Z_ O C 00 r c m E t U r Q Packet Pg. 345 713/23, 2:57 PM Detail by Entity Name 8.1.1 DivisioN or Cor ,o, u,i iEv!s 55 �/I';If_��i ref, i1.-A)*�(r' Deparirnent of Slate / Division of Corporations / Search Records 1 Search by Enti Name 1 Detail by Entity Name Florida Limited Liability Company D SANTOS TREE SERVICE " LLC" Fi{ing Information Document Number L22000478987 FEIIEIN Number 92-1143756 Date Filed 11/08/2022 Effective Date 11/15/2022 State FL Status ACTIVE Principal Address 261 19TH ST SW NAPLES, FL 34117 Mailing Address 261 19TH ST SW NAPLES, FL 34117 Registered Agent Name & Address SOLOW, NICOLE 510 15TH ST SW NAPLES, FL 34117 Address Changed: 02/01/2023 Authorized Persons) Detdil Name & Address Title AMSR DOMINIC, SANTOS 261 19TH ST SW NAPLES, FL 34117 Annual Reports Report Year Filed Date 2023 02/01 /2023 C N to CD U J J Document Images Packet Pg. 346 htips:l/search.sunbiz.org/Inquiry/CorporationSearch/SearchResul(Detail?inquirytype=EntityName&directionType=Initial&searchNameO 8.1.1 Electronic Articles of Organization For Florida Limited Liability Company Article I The name of the Limited Liability Company is: D SANTOS TREE SERVICE " LLC" Article II L22000478987 N FILED 8:00 AM N November 08, 2022 v Sec. Of State J amrivers The street address of the principal office of the Limited Liability Company is: 261 19TH ST SW NAPLES, FL. 34117 The mailing address of the Limited Liability Company is: 261 19TH ST SW NAPLES, FL. 34117 Article III The name and Florida street address of the registered agent is: NICOLE SOLOW 510 15TH ST SW NAPLES, FL. 34117-330 Having been named as re istered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: NICOLE SOLOW Packet Pg. 3 7 8.1.1 Article IV The name and address of person(s) authorized to manage LLC Title: AMBR SANTOS DOMINIC 261 19TH ST SW NAPLES, FL. 34117 Article V The effective date for this Limited Liability Company shall be: 11/15/2022 Signature of member or an authorized representative Electronic Signature: DOMINIC SANTOS L22000478987 N FILED 8:00 AM N November 08, 2022 v Sec. Of State arnrivers I am the member or authorized representative submitting these Articles of Or anization and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitites a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an aruival report between January 1 st and May 1 st in the calendar year following formation of the LLC and every year thereafter to maintain "active" status. Packet Pg. 348 X " 17 S NE TREASURY INTERNAL SERVICE PHILADE~LPHIA PA 192555-0025 000911 000911,481162.271386.5769 1UB 0.515 692 lrllllrt,Iwlclrllit�Irlullll'i'�'IlIIII'ltll�l'!I'Ill�ll'I�n�r D SANTOS TREE SERVICE LLC DOMINIC SANTOS SOLE; MDR 261 19TH ST SW NAPLES FL 54117 0 Date of thin; notice: 11-30-2022 04 (D Employer 4%ntification Number: 92-1143756 V Forma SS•-W J J Number of this notice: CP 575 G W For assistance you may call us at 1-OOO-829-033 IF YOU WRITE, ATTACH THE STUD OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thant: you for apEaly:ing for an Grsrployer Identification Number 0-F-IN), We assigned you EIN 92-•1143756. This EIN will identify your entity, accounts, tart returns, and documents, even of ,you have no employees. Please keep this notice in your periltanent records. Taxpayers request on EIN for their business, Some taxpayers; receive CP575 notices when another person has stolen their identity and are opening a business using their information. If you did not apply for this EIN, please visit, www,irs.gov/ einnotrequested. When ,filing tax documents, making payments, or replying to any 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 Oven cause you to be assigned more than one EIN. If the information is not correct as shown above, please snake the correction using the attached -tear-off stub and return it to us. A limited ,liability company (LLC) may file Form aG32, Entity 0assificetion 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 rrru.;t timely rile Form 2553, Election by a Small Business Corporation, The I.LC will bo treated as a corporation as of the effective date of the S corporation election and does not need to file Form (1852, IMPORTANT REMINDERS: N Keen a copy of this notice $n your permanent records. This notice is issued only one time and IRS will not be able -io generate a duplicate cnpy for you. You may give a copy of this document to anyone asking for proof of your EIN. 3� Use this EIN and your name exactly as they appear at the 'top of this notice on all your foderal twx forms. 0 Refer, to this EIN on your tax-rolated correspondence, and documents. :f Provide future officers of your organization uifli a copy of this notice, Your name control associated with tha.:s EIN is DSAN. You wall. need to provide this inforrraation, alone with your rIN, if ,you file your returns electronically. Safeguard your EIN by referring •ko Publication 4557, Safecounrdinr) Taxpayer Data: A Guide for Your Dusiness, You can get any of the form,,- or p61b1a.r.Qtions mentioned :in this latter by visiting our website at at, by calling 000-TAX-FORM (600-029-3676). If you have ques.•tiuns about ,your EIN, ,you can contact us at the phone number or address listed at the top of than notice. If you write, plense tear off the stub at the bottum of this; no+.ice and include :it with your letter. 1f you do not noed to write us, do not complete, and return this stub. Thank ,you for your cooperation, Packet Pg. 3 9771 C;®f fier C;0m.nty Growth Management Community development Department 04 co N APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY U J STATEMENT OF OWNERSHIP J This certifies that I, D o m m i c So it to s am a member or managing APPLICANT'S NAME (please print) member of, b Snim TYe. e. J e rV I c Q L L C (LIMITED LIABILITY COMPANY NAME) I own 10 0 % of the units issued by the Limited Liability Company listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. Dominic Smntas Applicant (please print) D sgvtos Tw Service LLC (� Name of Company Signature of Applicant State of � County of The foregoing instrument was a knowledged before me by means of 13'physical presence o p online notarization on this day of , 20' , by - �1 L Q }� z� Such person(s) No Public must check applicable box: ❑ are personally known tome04fas produced a current driver license ❑ has produced �` \�J� as identification. (Notary Seal) SANDRADELGADO Q1�nva��fn Commission # HH 10171B Notary Signature: * * ExpireMarch 8. 25 q Budget 6o dedS ih ry Contractor Licensing — FIRM Application Rev. 712022 Page 9 of 14 Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive • Naples, FL 34104 e (239) 252-2431 contractorslicensincolliercounlytl.gov Packet Pg. 350 8.1.1 COLLICT County Growth Management c Community Development Department 04 co N APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY v J VERIFICATION OF CONSTRUCTION EXPERIENCE w Applicant's Name: �i� Q jO� > 'f f Certificate Category Requested: � Tree T y 1 I� m I n m ��� m� Y� 1 w Cn w w The applicant is seeking a Dallier County Certificate of Competency in the trade indicated above. As part of the application for this certificate, the applicant must verify his/her experience within this trade. You are being requested to provide information that will aid the applicant in meeting this requirement. You should verity time of active experience working as an apprentice or O a skilled worker (e.g., as a worker commanding the wage of mechanic or better in the trade). Time served solely in a Z 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 for the above -named applicant must provide the following information: co Name: Title: H Business Name: ZJ " f ~� Z i� ` O Phone: ' C7� G �i'`f License No. (if applicable): Z 510 lbl"QkA3 /_z_ 3 Business Address: - Street city State Zip h The applicant was employed by me from ����L " GCS to ati /�1'2 _ t7 Applicant's title: pe_r 6 M_(5y /V/L_) 71uf'3_'m/1i j2 J > _ The applicant's scope of work (specific duties) included: S&Z ,�/1/1J �U% O W w w Additional comments: F_ NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. Under penalty of oeriurv. I declare that the facts stated here are true. State of k, k 1 C t u Countyof C Cj\\ 1 ey' The foregoing JiA trumen t was acknowledged before me by day of lJ 20 a; by v Such person(s) Notary Public must check applicable box: r Signs re of 77 rson providing the statement of 114/3hysical presence or © online notarization on this D are personally known to me as produced a current driver license Vasroduced �� �T�kt as identification. roducedD Ty `` NWFIry Pllt)iiC-State of Fiorid ;'Q, C•ornrnissinn li GG 914242 Ct)-hiissim, Expires sePtemljer 17 2023 Notary Signatur Contractor Licensing - FIRM Application Rev. 712022 page 10 of 14 operations & Regulatory Management Division, Contractor licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensino(a7colliercountyfl.-ov Packet Pg. 351 8.1.1 CD / Cm CD t0 N r W w --- w F- �pf61AIQ �Ci :ec d - - j-0 AL— CO m I'd,' 4 c-)-r u r�l- - CA�Qy 4a �'1r► rV —�?( o+b rp —PU. — r ! f lmn S' I O M iAl %c_.—Pn�G m e,—1 lts v r i- ,-- - -�O r - 41u d r - J- -- U.3 a �= to merJd e nr S_t UA - --.- ! - --T�— ---y 0 b -hp v e � lv A J v �'o 2o�r?, P �e�c SANDRA ELGADO _ ATE OF �LORI �► * * Commission#HH101718 OUNIY OF- E?�r "s �o= Cxpires March 8, 2025 i .`c-VO BondedThruBudgetHoWrySerricee `LJ heforegoin.instrument was acknowledged before ,rneb meansoftiphysic0prosenceorliqnline notartratio�ti►le �^ ayof 2Q,by Nat Public's Igna re Notary Name ersonally Known OR Produced Id¢�((5tifrratkxt {4 - ype of tdentlncation Produced: L JL- Packet Pg. 352 8.1.1 w CO 7PY CaDnvity Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY VERIFICATION OF CONSTRUCTION EXPERIENCE Applicant's Name: 100M/Ii f L Certificato Category Requested: i Qe-e- - A myl E r- � !` e-m o 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 his/her 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 for the above -named applicant must provide the following information: Name: d c! Q s�i k, , / 1 Title:.{"cSd e n Business NN�ame: A r' e-r-- of+ - L . Lr"�' Tree S �r� [G2 !� Phone: Gr- 'T J-! r °20 / License No. (if applicable): Business Address:. 2 tp f . q(� ST SW 1\19 1 eo' i =L 3411 ]. Street City I State Zip The applicant was employed by me from 2 0 s to oL o 1 ! ) Applicant's title: LOIc f r l cu-) W Trc e- -�r i rn rn-e r (�n d � ern ov a--1 The applicant's scope of work (specific duties) included: i e • r �f Ve-mNval rh(� (4r>di W o 1t,'4hrowk will) Additional comments: t4) e. NOTE TO LICENSED CONTRACTORS: Falsifying any information provided herein may subject your license to revocation. Under penalty of perjury, I declare that the facts stated here are true. Signature of person providing the statement State of ii7 rj � County of � h foregoing instrument was acknowledged before me. by means of lYphysical presence or 0 online notarization on this day of , 20 e by Such person(s) NoE Public must check applicable box: ❑ are personally known to me t?'has produced a current driver license ❑ has produced --T- C. V as identification., (Notary Seal) 1 Ypv SANDRADELGADO 20....,e�i�, * Commission # tiH 101718 * Expires March 8, 2025 N9`FOFw,10� $ondedihrugad9elkaRarySe�vlcas Notary Signature: Contractor Licensing — FIRM Application Rev. 712022 Page 12 of 14 0 N to to N U J J Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contraclorslicensinp(a.colliercountyfl.gov Packet Pg. 353 8.1.1 CO 7eY County Growth Management Community neveiopment Department 04 APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY co N U J J AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF O /',�i ,✓( w to w w COUNTY OF F�(,J>✓L�JI Y/'O, CIO O I, 4 having been first duly sworn, state and affirm: Q CIO C 1/ . I am a resident of [i L� �� ! �County, � (State) and have resided here for more than five (5) years. tY Z During the last five I have known � � fi O Z (5) years � ,4,yc�/7 (applicant). I ave had the opportunity Z to observe his or her business and personal dealings and find him or her to be a pe n of honesty, integrity and good character. obi / signature J Print Name' a State of 41 -(L. County of0r Th foregoing .nstrume was acknowle( z day of U +, 24 Z7j , lay Address: 2/ Street City State Zip Telephone: '-7-5 � (0 G / � U me by means of pQ' _hysipal presence or ❑ online notarization on this Such person(s) Notary Public must check applicable box: ❑ are personally known to me ras produced a current driver license ❑ has produced identification. (Notary Seal) � LINDSAY D. ONTIVEROS r' z � Notary Public, Slate of Florida Commission# HH 104303 Notary Signature: My Comm. expires April 3, 2025 Contractor Licensing — HRM Application Rev. 712022 Page 13 of 14 Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive a Naples, FL 34104 a (239) 252-2431 cont ractors lice nsin colliercount fl. ov Packet Pg. 354 8.1.1 comer County Growth Management Community Development Department APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER STATE OF COUNTY OF / having been first duly sworn, state and affirm: am a resident of County, (State) and have resided here for more than five (5) years. During the last five (5) years I have known (applicant). I have had the opportunity to obsery his r her business and personal dealings and tin sir r her to be a person of jt onesty, integrity and good character. Signature Printed Name Address: P, �J/�tf1. Street , A/ ity State Zip Telephone: 2 5/,51 State of t \v1 County of �l) 'O- r The f regoing 'nstrument was AknowledgH before me b means of IlAysical presence or ❑ online notarization on this ay of, 20 L3 , by L Such person(s) Notary Public must check applicable box: ❑ are personally known to vie as produced a current driver license bAilas produced k,�°f( t'r V as identification. .(NotarySeal) -Y - Y� 11 11o!wry Public -State of Florida Commis ;ion't GG 914242 tidy ComMission Fzpires 5eptenlber 17, 2023 , Contractor Licensing — FIRM Application Rev. 712022 Notary Signature: Page 14 of 14 0 N to CD N U J J Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive o Naples, FL 34104 . (239) 252-2431 con iraclorslicensingacolliercountytl.gov Packet Pg. 355 Florida DRYEt uakw . la OUfSi_ 40 5.o Sslasa ISANPOS }MANIC LFE CDNA 426 1lTH 8 SW T FL S4117 N I DOV 1110611995 Mrl IM ttoo to€x. 1VOWQ21 uHr1T 5'-07" v 'I RFIT NONE i, no NONE V 44.s D6lI:b120/�0 J icc IM1}it4Yl00iL . .� W MEP;acE4 1Na1fi0�1 I�pp.a (,) M:.r, .111 hWlCf nlj�cN confmn.r. +O.`Ynl ll fin/ 1Jb1iMy Y�I UF71r...•1 by ARM Li ''W^ V! AOJ'AWSHIJ'MMM W 302" 3MVN YO 1231 WV lO SAVO CC NlUVA 0l1 iNAM3V1.131 W 119SHR a/ OICN ON! y 0 O OUCH 'Al31 Al Z �4 IOOSC a 1NN0 • yr ww 1+•awuu»>an� itul/' ! �:f'1'1] Q 0 O Z MD Aed 1 S6S011 gp I 11111dO1d L 1. 41••MI O pp 8� II •pyq; IC :.i •v T. • 1 •r wi Packet Pg. 356 Fes$_ 0 COD }y JIMMY PATRONIS 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: 3/23/2023 PERSON: DOMINIC L SANTOS FEIN: 921143756 BUSINESS NAME AND ADDRESS: D SANTOS TREE SERVICE " LLC" 261 19TH ST SW NAPLES, FL 34117 EXPIRATION DATE: 3/22/2025 EMAIL: DSANTOSTREESERVICE@YAHOO.COM This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), 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 subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6,01.2, F.A.C. REVISED 0112023 E01692903 QUESTIONS? (850) 413-1609 8.1.1 0 N W W N U J J Packet Pg. 357 8.1.1 61G4-15.006 Financial Responsibility and Financial Stability, Grounds for Denial. N (1) The financial responsibility ground on which the Board shall refuse to qualify an applicant is failure to provide a current N consumer credit report, as defined in Rule 61G4-12.011, F.A.C., which consumer credit report does not disclose any unsatisfied V judgments or liens against the applicant. In addition, there must not be any unsatisfied judgments or liens against the business entity J which the applicant previously qualified as a primary qualifier or which the applicant has applied to qualify. w (2) The financial stability ground on which the Board shall refuse to qualify an applicant is failure to provide proof of either a U financial stability bond or an irrevocable letter of credit from a bank authorized to do business in the State of Florida. The bond or letter of credit must be in a form acceptable to the Board and must remain in effect until the applicant can demonstrate a credit score, y FICO derived, of 660 or higher, and must be payable as provided in Rule 61G4-15.0021, F.A.C., for Financially Responsible w Officers in the amount of: LU ly (a) $20,000 for Division I applicants. (b) $10,000 for Division II applicants. (3) Fifty percent of the financial stability bond or the letter of credit requirement may be met by completion of a 14-hour financial responsibility course approved by the Board. (4) An applicant may meet both the financial responsibility and financial stability requirements by providing proof of a current consumer credit report, as defined in Rule 61G4-12.011, F.A.C, with a credit score, FICO derived, of 660 or higher, which consumer credit report does not disclose any unsatisfied judgments or liens against the applicant. In addition, there must not be any unsatisfied judgments or liens against the business entity which the applicant previously qualified as a primary qualifier or which the applicant has applied to qualify. Specific Authority 489.115(5), (6) FS. Law Implemented 489.115(5), (6) FS. History —New 1-6-80, Amended 5-4-80, Formerly 21E-15.06, 21E- 15.006, Amended 10-31-96, 11-13-97, 2-12-08. 05 J Q O 2 W W W W W H Packet Pg. 358 8.J 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 8.J Doc ID: 26621 Item Summary: 8J. CLAUDIA A. SACACIAN — REVIEW OF CREDIT — 3 REINSTATEMENT APPLICATIONS (FLOOR COVERING, TILE & MARBLE, AND CABINET INSTALL) - CLASSIC STONE DESIGNS, INC Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:37 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:37 AM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Review Item Tim Crotts Meeting Pending Completed 09/13/2023 2:51 PM Completed 09/13/2023 5:02 PM 09/20/2023 9:00 AM Packet Pg. 359 8.J.1 COT County Growth Management 11 JV� 4 Community Development Department C 2-3 5G REINSTATEMENT APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY This application can be used for a business or an individual. This application must be typewritten or legibly printed to be accepted. The application fee must be paid upon approval and is non-refundable. All checks are payable to: Collier County Board of County Commissioners. For additional information, consult Collier County Ordinance No. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY Major Trade: $230.00 plus back fees ❑ Air Conditioning, Class A H Air Conditioning, Class B Air Conditioning, Class C ❑ Building ❑ Electrical Specialty Trade: $205.00 plus back fees [-IFLOORCOVERING CONTRACTOR ❑ General- - ❑ Mechanical ❑ Plumbing ❑ Residential ❑ Roofing I. APPLICANT PERSONAL INFORMATION: Name: CLAUDIA First ❑ Sheet Metal — - -- - - - ❑ Swimming Pool/Spa, Commercial ❑ Swimming Pool/Spa, Residential ❑ Swimming Pool/Spa, Service & Repair Muddle SACACIAN Last Address: 4791 11TH AVE SW NAPLES FL 34116 Street city State Zip Email: OFFICE@ABBOTHILL.COM Telephone: (239) 877-0058 Social Security Number (Last 4 digits only): 0119 Cell Phone: (239) 877-0058 Driver's License Number (Last 4 digits only): 7450 Date of Birth: 7/5/1976 Provide the names and telephone numbers of two people who will always know your whereabouts. Name: PETRU SACACIAN Name: LUANN THOMAS Telephone: (239) 825-6747 Telephone: (239) 465.6700 Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be aulhorized by law. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing - reinstatement Application Rev. 812022 Page 1 of 9 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive a Naples, FL 34104 a (239) 252-2431 contractorsticensiiig@_colliercountyfl.ctov w J m Q 06 w J N Packet Pg. 360 8.J.1 ctoZr co1.Hty Growth Management Community Development Deparirnent APPLICANT BUSINESS INFORMATION: Business Name: (If no business name vrill be used, write "Individual') Fictitious Name/DBA, if applicable CLASSIC STONE DESIGNS INC Business Address 4791 11TH AVE SW NAPLES (Physical): Street City Business Address 4791 11TH AVE SW (Mailing): Street NAPLES city FL 34116 State Zip FL 34116 State Zip Telephone: (239) 825-6747 Federal Tax IDIEIN: (943617523 III. FINANCIAL RESPONSIBILITY: YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: ✓ Have you filed for or been discharged in bankruptcy within the past 5 years? ✓ Have you had a lien Tiled against you by the Internal Revenue Service or Florida Corporate Tax Division? Have you undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? ✓Have you undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? ✓Have you made an assignment of assets of construction obligations for less than the debts outstanding? Have you been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years?* Have you had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Have you been charged with or convicted of acting as a contractor without a license, or if licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? If you have answered YES to any of the above questions, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences, or conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment. *If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — Reinstatement Application Rev. 812022 Page 2 of 9 Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive . Naples, FL 34104 • (239) 252-2431 contractorslicensin colliercounty(Lc�nv LL J m lY Q 06 w J i= G Q J <.i 00 r c m E U to r Q Packet Pg. 361 8.J.1 COtY C014 ty Growth Management Community Development Department IV. EXPERIENCE VERIFICATION: EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: FLOOR COVERING CONTRACTOR FOR THE PAST 21 YRS List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: ON THE JOB TRAINING FOR OTHER COMPANIES FOR AT LEAST 3 YRS PRIOR TO MY CONTRACTOR LICENSE CURRENTIPREVIOUS LICENSE: List below and attach copies any other certificates of competency/licenses you hold/have held in Collier County or any other jurisdiction. Include the license number, type, and county you hold it in. TILE & MARBLE CONTRACTOR BUSINESS TAX LIC# 050633 CABINET & MILLWORK CONTRACTOR BUSINESS TAX LIC # 192533 Contractor Licensing — Reinstatement Application Rev. 812022 Page 3 of 9 Operations & Regulatory Management Division, Contractor Licensing 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 contractorslicensiiigicolliereountyfi.go_v r Q Packet Pg. 362 8.J.1 COT COUnty ui J Growth Management Community Development Department Q WORKMEN'S COMPENSATION AFFIDAVIT 06 w J It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire or always maintain effective Workmen's Compensation Insurance and/or Workmen's Compensation Exemption, it will result in the possible revocation of my Certificate of Competency. Z CLAUDIA SACACIAN Applicant Name (please print) CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. if no business name will be used, write "Individual" c Signature of Applicant State of FLORIDA County of COLLIER V T e foregoing in t mont was acknowledged b Pre me by means of _❑d physical presence or ❑online notarization this V ✓ day of �t7�, by U_iet irlc...]u�Li�AUDIASACACIAN rQ !!!!llSu�cchh�'person(s) Notary Public must check applicable box: Q Q 0 are personally known to me ❑ has produced a current driver's license G C] has produced as identification J V Notay Seal)00 r , Notary Public State of Florida Al uann Thomas ti c MyHN� misslon ll Notary Signature E Exp. i1121z42s t C c on f2 2 Page 4 of 9 v R r Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 Q contractorslicensingPcclliercountyfl.rAov Packet Pg. 363 8.J.1 COZY COUHty I„ J Growth Management Community Development Department Q STATEMENT OF OWNERSHIP 06 w Not required for non -business licenses (individual). J i= This certifies that I, CLAUDIA SACACIAN am a member or managing Applicant Name (please print) member of CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. I own 50 % of the Business listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. State of FLORIDA CLAUDIA SACACIAN Applicant Name (please print) Signature of Applicant County of COLLIER /T e foregoing inst ment was acknowledged a ore a by.means of FZ physical presence or online notarization this day ofCLAUDIA SACACIAN Such person(s) Notary Public must chock applicable box: 0 are personally known to me n has produced as identification Notary Public State of Florida A Luann Thomas dM My Commission HH IIFI Exp. 1/1212026 ❑ has produced a current drivers license ry signature Page 5 of 9 Operations & Regulatory Management Division, Cora r Licensing : 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractors licensin o@colliercountyfl.gov a G Q J <.i 00 c d E t v M r Q Packet Pg. 364 8.J.1 CrO�Y County Growth Management Community Development Department RESOLUTION OF AUTHORIZATION Not required for non -business licenses (individual). In accordance with Collier County Ordinance 2006-46, as amended, CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. intends to engage in contracting as in Collier County where is applying to qualify for a Certificate of Competency. FLOOR COVERING CONTRACTOR Type of license CLAUDIA SACACIAN Applicant Name It is hereby agreed upon that 1/we the undersigned ❑✓ Officer(s) ❑ Owner(s) ❑ Partner(s) of said business resolve and represent to the Collier County Contractor's Licensing Board that the applicant is active in all matters connected with the business. We further resolve and represent that the applicant is legally empowered to act on behalf of the business in all matters connected with its contracting business and has the authority to supervise construction activities undertaken by the business. c G �i Officer 1 Owner I Partner Signature itness Officer wner / Partner Signature Witness Officer / Owner I Partner Signature Stato of FLORIDA Witness County of COLLIER �Th foregoing in tf ment was acknowledged before me r ay of 14,59' , by t Such person(s) Notary Public must check applicable box: 0 are personally known to me [� has produced as identification Notary Public Slate of Florida Luann Thomas Illll HH 178 001ion EXp, 1/12/2026 eans,of 0 physical presence or G4Ge- CLAUDIA SACACIAN ❑ has produced a current driver's license Notary Signature notarization this I - - M-P. Contractor Licensing — Reinstatement Application Rev. 812022 Page 6 of 9 Operations & Regulatory Management Division, Contractor Licensing e 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorslicensinq�colliercountytl.gav w J m Q 06 w J i- a r Q Packet Pg. 365 8.J.1 Growth Management (,'ornMUnity D velopm6mt Depaftwent r�i`1ii T - °tf=l-'F:��i�. Y ND l having been first duly sworn, state and affirm: l any a resident of (County) (State) and l have known CLAUDIA SACACIAN for years. l have had the opportunity to observe hislher business and personal dealings and find him/her to be a person of honesty; integrity, and good character. Signature* iw Z /01 Printed Name 1 Address , State, Zip ..?13 5'112� 31 Telephone Slate of t(.L County of The foregoing in t anent was acknowledged bef a me by bmeans of�(N physical presence or ❑online notarization this f 11 dayof [zS �(���j by Such person(s) Notary Public trust check applicable box: Mare personally known to me has produced a current driver's license ❑ has produced as identification n (Notary Seat) Notary Public State of Florida Luann Thomas M HH 17B401ion Notary Signature 1111 Cxp.111212026 Contractor Licensing — Reinstatement Application Rev. 812022 Page 7 of 0 Operations & Regulatory Management Division, Contactor Licensing a 2800 North Horseslioe Drive • Naples, Fl_ 34104 a (230) 252-2431 ui J m Q 06 w J i= G D Q J c.> 00 c m t v R Q Packet Pg. 366 8.J.1 C© ICr C©unty w Growth Management J m Community Development Department Q CERTIFICATION OF APPLICATION 06 w J The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 200646, as amended, and under penalties of perjury. I declare that I have read the foregoing application information and that the facts stated in it are true. Z The undersigned hereby certifies that he/she 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/she has full authority to supervise O U construction undertaken by himself/herself or such business or organization and that he/she will continue during W this registration to be able to so bind said business organization. The qualified license holder understands that in O all contracting matters, he/she will be held strictly accountable for all activities involving his/her license. 0 Any willful falsification of any information contained herein is grounds for disqualification. z O CLAUDIA SACACIAN Q Applicant Name (please print) V J d CLASSIC STONE DESIGNS fNC d Q Business Name, include DBA, if applicable. If no business name will be used, write "Individual" z w State of FLORIDA County of COLLIER Th foregoing i lrument was acknowledged before me by ears of 0 physical presence or online notarization this day of f �, by�,%r��Cu�ri�-t- CLAUDIA SACACIAN _ Such perso (s} iJo ary Public must check applicable box: 0 are personally known to me has produced as identification (N Notary Public State of Florida Luann Thomas My Commission EIIII HH Exp 1/12/2028 ❑ has produced a current driver's license Contractor Licensing — Reinstatement Application Rev. 812022 Notary Signature Page 9 of 9 operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive . 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C'H as=W cw> t L1 fl +w 4HN q2 s-v r0 ao.: O H.0 G.n e_ 6P: C3 zz Y!-1 4n 0 3� O LYP: ••i T o V •VZ JWF U.-I IL -S F- - q O II LSmT Joao l6N ax.., GHrl Ort Y q oa�.a N x 7 17 J L 4 q P O O O t •rtP VI E La ep In l 41 I I I I 1 T L q T 4- to O IIr•� N T E cw a 7 a• tf � 74 Pi L77 tnS as o- q •,sa ] N•H O O P.H 11 U 4 L4� My C E L.0 7 c ua V. vLt LSL N 0 x tt P �r L xapm O +•Ear{ O u u 0 o L E C O a •Y T�rt O 0 9 0.00 a E F fl o ,Vq 7 Lm p y-PMF Y •.r L R H L1O no 2 QO�q L 4 fl q c OX O Oj 7 v �vRT QOU I i fla O •HHaN N 7VV C cOP4-R L O7 a q LN aiU v Ro o TL ao YI wo.Hu a a r ID U.H F-C HV 9/13/23, 2:49 PM Detail by Entity Name DIVISION OF CORPORATIONS I 02���r� �� r �f�� mt uj/7rlrtl Stw?� U/'It�rri!!u svdbsit? Department of State / Division of Corporations / Search Records / Search by Entity. Name / Detail by Entity Name Florida Profit Corporation CLASSIC STONE DESIGNS, INC. Filing Information Document Number P02000008146 FEI/EIN Number 04-3617523 Date Filed 01/24/2002 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 12/11/2017 Event Effective Date NONE Principal Address 2100 Trade Center Way Suite G Naples, FL 34109 Changed: 04/25/2023 Mailing Address 2100 Trade Center Way Suite G Naples, FL 34109 Changed: 04/25/2023 Registered Agent Name & Address THOMAS, LUANN 2100 Trade Center Way Suite G Naples, FL 34109 Name Changed: 04/29/2017 Address Changed: 04/25/2023 Officer/Director Detail Name & Address 11mraz LLI J m Q W J N Q J U 00 c m E t .r a lJ Packet Pg. 370 search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=C 9/13/23, 2:49 PM Detail by Entity Name SACACIAN, PETRU 2100 Trade Center Way Suite G Naples, FL 34109 Title V SACACIAN, CLAUDIA 2100 Trade Center Way Suite G Naples, FL 34109 Annual Reports Report Year Filed Date 2021 04/06/2021 2022 04/27/2022 2023 04/25/2023 Document Images u.i J m Q LU J N 04/25/2023 --ANNUAL REPORT View image in PDF format 04/27/2022 --ANNUAL REPORT View image in PDF format 04/06/2021 --ANNUAL REPORT View image in PDF format 04/03/2020 --ANNUAL REPORT View image in PDF format 04/30/2019 --ANNUAL REPORT View image in PDF format 02/28/2018 --ANNUAL REPORT View image in PDF format 12/11/2017 --Amendment View image in PDF format 04/29/2017 --ANNUAL REPORT View image in PDF format 04/21/2016 --ANNUAL REPORT View image in PDF format 04/28/2015 --ANNUAL REPORT View image in PDF format 04/21/2014 --ANNUAL REPORT View image in PDF format 03/25/2013 --ANNUAL REPORT View image in PDF format 04/30/2012 --ANNUAL REPORT View image in PDF format 04/30/2011 --ANNUAL REPORT View image in PDF format 05/03/2010 --ANNUAL REPORT View image in PDF format 03/23/2009 --ANNUAL REPORT View image in PDF format 04/17/2008 --ANNUAL REPORT View image in PDF format 08/20/2007 --ANNUAL REPORT View image in PDF format 04/26/2006 -- REINSTATEMENT View image in PDF format 03/26/2004 --ANNUAL REPORT View image in PDF format 05/07/2003 --ANNUAL REPORT View image in PDF format 01/24/2002 -- Domestic Profit View image in PDF format Florida Department of State, Division of Corporations search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=C Packet Pg. 371 8.J.1 2023 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# P02000008146 Entity Name: CLASSIC STONE DESIGNS, INC. Current Principal Place of Business: 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 Current Mailing Address: 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 US FEI Number: 04-3617623 Name and Address of Current Registered Agent: THOMAS, LUANN 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 US FILED Apr 25, 2023 Secretary of State 5841848444CC Certificate of Status Desired: No 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: LUANN THOMAS O4/25/2023 Electronic Signature of Registered Agent Date Officer/Director Detail: Title P Name SACACIAN,PETRU Address 2100 TRADE CENTER WAY SUITE G City -State -Zip: NAPLES FL 34109 Title V Name SACACIAN, CLAUDIA Address 2100 TRADE CENTER WAY SUITE G City -State -Zip: NAPLES FL 34109 I herebycertity that the information trNficatedon this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as it made under oath, that I am an officer or director of the corporation or the receiver or trustee empowered to execute Ibis report as required by Chapter 607, Florida Stalutes, and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: PETRU SACACIAN PRESIDENT 04/25/2023 Electronic Signature of Signing OfficerlDirector Detail Date ui J m fY Q 06 W J N a G Q J <.i 00 c d E t v to r Q Packet Pg. 372 8.J.1 BUSINESS CREDIT REPORT Classic Stone Designs, INC. Address: 5880 Shirley St Ste 201 Naples, FL 34109-2308 United States Phone: 239-825-6747 Website: classicstonedesign.com BIN: 742344892 27911 Crown Lake Blvd Suite # 211 Bonita Springs, FL 34135 w J Phone:239.777.1028 m Fax: 877.275.3593 Q 06 www.LicensesEtc.com w J N as of: 08/08/23 17:22 ET Fed Tax ID# 04-3617523 Key Personnel: i i SIC Code: Agent: Thomas Luann NAILS Code: Agent Address: 5880 Shirley Street Unit 201 Naples, FL j Also is (or has been) operating as: Classic Stone Designs Family Linkage: Ultimate Parent Branches / Alternative Locations Classic Stone Designs, Inc 5880 Shirley 5t Ste 201 Naples, FL Classic Stone Designs, Inc 4791 filth Ave SW Naples, FL United States President: Sacacian Petru Vice President: Sacacian Claudia 1752-Floor Laying & Other Floor Work, Nec 1743-Terrazzo, Tile, Marble & Mosaic Work 8999-Services, Nec 238330-Flooring Contractors 238340-Tile And Terrazzo Contractors 541990-All Other Professional, Scientific, And Technical Services Business Type: Corporation File Established: January2002 Years on File: 21 Years Years in Business: More than 21 Years Total Employees: 3 Sales: $559,000 c D Q J c.> 00 r c m E U M Q Page Packet Pg. 373 8.J.1 Classic Stone Designs, Inc 1549 SE Faculty CT Port ST Lucie, FL United States Classic Stone Designs, Inc 5800 Houchin St Naples, FL United States Classic Stone Designs, Inc 9107 Spanish Moss Way Bonita SPGS, FL United States Classic Stone Designs, Inc 6455 Waverly Green Way Naples, FL United States Piling Data Provided by: Date of Incorporation: Florida 01/2412002 PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS ✓bankruptcies: Y"Llens: VJudgments Filed: V Collections: END OF REPORT ui J m Q 06 w J G D Q J c.> 00 r C d E L V R r Q Page Packet Pg. 374 8.J.1 27911 Crown Lake Blvd Suite #6 Bonita Springs, FL 34135 PERSONAL CREDIT REPORT (Compiled From National Records) <FOR> <SUB NAME> M P NP7771028 LICENSES ETC <SUBJECT> SACACIAN, CLAUDIA ANA <CURRENT ADDRESS> 4791 11TH AV., NAPLES FL. 34116 <FORMER ADDRESS> Phone: 239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com <MKT SUB> <INFILE> <DATE> <TIME> 16 NP Vol 08/09/23 08:55CT <SSN> <BIRTH DATE> 07/76 <DATE RPTD> 1/10 9107 SPANISH MOSS WA., BONITA SPRINGS FL. 34135 12/06 6455 WAVERLY GREEN WA., NAPLES FL. 34110 11/05 <POSITION> <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> CLASSIC STONE DESIGN OWNER <FORMER EMPLOYER AND ADDRESS> NEPTUNE HOTEL 2/18 2/18 7/01 M O D E L P R O F I L E ***FICO SCORE 8 SCORE +596: DEROGATORY PUBLIC RECORD OR COLLECTION ***FILED;TIME SINCE DELINQUENCY IS TOO RECENT OR UNKNOWN;PROPORTION OF ***BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER ***REVOLVING ACCOUNTS;PROPORTION OF LOAN BALANCES TO LOAN AMOUNTS IS TOO ***HIGH*** PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS — NONE FOUND C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND CRED Y 36ET017 I 11/20 $396 SYNCHRONY BANK 09B 7/23A $396 PLACED FOR COLLECTIO JEFFCAPSYS Y 2BJ3001 I 10/22 $511 VERIZON WIRELESS 09B 7/23A $511 PLACED FOR COLLECTIO ---------------------------------------------------------------------------- T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT—MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 SYNCB/AMEG D B 235064W 1/19 $4530 MIN176 1/23 555555432221 R02 7/23A $4110 $329 05 111111111211 I CREDIT CARD 11/22C $3583 CLSD BY CRDT GRANTOR 54 4/ 1/ 7 SUNCOAST CU Q 298QO01 11/22 $2509 036M75 11111111 101 7/23A $0 I UNSECURED $1893 8 0/ 0/ 0 ui J m Q 06 w J N G Q J c.> 00 c m E U R Q Packet Pg. 375 8.J.1 SYNCB/CARECR F 999206T 7/17 $6119 MIN30 11111111111"1 R01 7/23A $1850 $0 IIEIIIIII111 I CHARGE ACCOUNT $387 72 0/ 0/ 0 W J SYNCB/TJX C 235065M 12/17 $3095 MIN74 3/23 144432111111 R01 7/23A $2910 $0 $441 04 111111111111 Q I CHARGE ACCOUNT 2/23C $1930 CLSD BY CRDT GRANTOR 66 1/ 1/ 3 06 W CAPITAL ONE B 1DTV001 10/02 $2598 MIN28 1/23 111112111111 R01 J 7/23A $2200 $0 $23 02 111111111111 ~ I CREDIT CARD $901 82 1/ 0/ 0 O z Fe SYNCB/TJX C 235065M 2/20 $326 EEEEEEEEEEEE R01 W 7/23A $330 $0 EEEEEEEEEEEE O I CHARGE ACCOUNT 4/23C $0 CLSD BY CRDT GRANTOR 41 0/ 0/ 0 O CCB/ULTAMC B 1NZ8325 10/18 $4073 MIN92 1/23 111112111111 R01 OJ 7/23A $3800 $0 02 111111111111 I CREDIT CARD $2491 57 1/ 0/ 0 cn z O CB/VICSCRT C 16US001 3/17 $1916 MIN37 1/23 111112111111 R01 Q 7/23A $1820 $0 $165 02 111111111111 V I CHARGE ACCOUNT $628 76 l/ 0/ 0 J d d CB/EXPRESS C 8349001 2/17 $856 3/22 EEEEEEE11111 R01 7/23A $100 $0 $37 02 111211EEEEEE z w I CHARGE ACCOUNT 5/23 $0 76 1/ 0/ 0 W H CB/ANNTYLR C 1NZ8078 7/17 $2099 MIN37 1/23 111133221111 R01 F- 7/23A $2100 $0 $266 03 111111111111 U) z I CHARGE ACCOUNT $722 71 2/ 2/ 0 ul w BMG MONEY F 2E2E001 6/23 $4776 024M100 101 M 1 6/23A $0 F- I UNSECURED $4786 0 Lu W U BMG MONEY F 2E2E001 12/22 $6000 024M 111X11 I01 11 6/23A $0 O I UNSECURED 6/23C $0 CLOSED 6 0/ 0/ 0 W_ > CB/NY&CO C 1NZ8074 11/09 $502 8/21 EEEEEEEEEEE E R01 w 6/23A $1390 $0 02 EEEEEEEE1211 I I CHARGE ACCOUNT 5/23C $0 DISP INV CMP-CNS DSGR 82 1/ 0/ 0 z Q U BMG MONEY F 2E2E001 8/22 $5000 024M 1111 101 V 12/22A $0 Q I UNSECURED 12/22C $0 CLOSED 4 0/ 0/ 0 Q BMG MONEY F 2E2E001 5/22 $5000 024M 111 101 Q G 8/22A $0 I UNSECURED 8/22C $0 CLOSED 3 0/ 0/ 0 J V ROCKET MTG F 13XJ001 10/18 $90.OK 360M 11111111 M01 0000 8/21A $0 I FRD632447907 8/21C $0 CLOSED 9 0/ 0/ 0 FLAGSTARBANK B 2525001 10/18 $90.OK 360M 111111111 MO1 8/21A $0 Q I FRD632447907 8/21C $0 TRNSFRD: OTHER LENDER 10 0/ O/ 0 Packet Pg. 376 8.J.1 DOVENMUEHLE Q 285RO01 10/18 $90.OK 360M 111111111111 MOl 10/20A $0 1111111111 I FPD632447907 1002 10/20C $0 TRNSFRD: OTHER LENDER 22 0/ 0/ 0 W J m SYNCB/WALMAR D 235057X I1/12 $473 EEEEEEEEEEEE RO1 Q 1/20A $100 $0 EEEEEEEEEEEE I CHARGE ACCOUNT 7/19C $0 INACTIVE ACCOUNT 82 0/ 0/ 0 06 W J_ DISCOVERBANK B 9616003 8/05 $15.9K 111111111111 RO1 ~ 3/19A $18.OK $0 111111111111 Z T CREDIT CARD $0 82 0/ 0/ 0 W TRUISTMRTG B 3122001 5/18 $84.OK 360M 11111 MOl 0 1/19A $0 I FRD558553028 1/19C $0 CLOSED 7 0/ 0/ 0 00 J ENVOY MTG Q 2E2Q001 10/18 $90.OK 360M MOl 11/18A $0 Cn Z I CONY R.E MORTGAGE 11/18C $0 'TRNSFRD OTHER OFFICE 0 0 H a VIVE/FEB F 895P004 7/14 $0 EEEEEEEEEEEE R01 V 10/16A $3000 $0 EEEEEEEEEEEE J d I CREDIT CARD 7/16C $0 CLSD BY CRDT GRANTOR 27 O/ 0/ 0------------------------------------------------------------------------------- d a I N Q U I R I E S Z Lu DATE SUBCODE SUBNAME TYPE AMOUNT 2 8/09/23 PNP7771028(FLA) LICENSES ETC Q --------___----------------------------------------------------------------------- H END OF REPORT r a Packet Pg. 377 ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODIYYYY) 08/1512023 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 have ADDITIONAL. INSURED provisions or be endorsed. It 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 endorsements , PRODUCER CONTACT NAME: BIII Falcone Arnold and Barton Insurance Group PRONE , (239) 331-8595 ac No : (239) 331-8589 EMAIL ADDRESS: abna BillC P les.com 700 11 th Street South INSURERS AFFORDING COVERAGE NAIC p INSURER A: CLEAR BLUE INSURANCE COMPANY Naples FL 34102 INSURED INSURER B : INSURER C : Classic Stone Designs Inc INSURER 0: 5880 Shirley Street Suite 201 INSURER E: INSURER F : Naples FL 34109 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 LTR TYPE OF INSURANCE AbOL SUBR POLICY NUMBER MMIDDIYCY YYFY MMN)DNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s $1,000,000 CLAIMSMADEOCCUR PRIM SIS� aENTED occurrrence $ $300,000 MED EXP (Any one person) $ $10,000 PERSONAL BADVINJURY $ $1,000,000 A Y BGFL0012307103 09J2212022 09/2212023 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGRGATE $ $2.000,000 PRO-JECT ❑ LOC POLICY ❑ PRODUCTS - COMP/OP AGG $ $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT IF.acc"I "I $ DODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accidenl) $ PROPERTYaccidentDAMAGE Per $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION 5 $ WORKERS COMPENSATION �, AND EMPLOYERS'LIABILITY YIN STATUTF ER ANY PROPRIETOR/PARTNFRIFXECUTIVF E.L. EACH ACCIDENT $ OFFICERRAEMBFR EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ it yes. describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space m required) CG 2038 04 13 additional insured when required by the written contract Collier County Licensing Board 2800 Horseshoe Drive N Naples, FL 34104 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 ©1980.2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD 8.J.1 W J fb IY Q 06 W J_ H Q J V 00 r C d E t v M r Q Packet Pg. 378 8.J.1 A� a� CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDfYYYY) 08/08/2023 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 INS D, the po icy(les) must be endorsed. It SUBROGATION IS WAVED, 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 endorsemeni(s). PRODUCER NAME: Amanda Katulich PHONE VAX PGI of West Central Florida, 11C AIC. No, Ext : 941-242-9619 l (AIC. No):_ 941-242:9621 3809 E SR 64 ADDRESS: amanda®pglofWeslcentralflorida.com INSURER(S) AFFORDING COVERAGE NAIC 9 Bradenton FL 34208 INsuRERA: Markellnsurance Company 38910 INSURED INSURER B : _ Classic Slone Designs, Inc. INSURER C : 4791 111h Ave SW INSURER D : INSURER E: Naples FL 34116 INSURER F:' COVFRAGFS 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. 1 _.. .._ -POLIGY EF LTR TYPE OFINSURANCE INSO V"P POLICYNUMBER (M"DIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL OASILITY CLAIMSMADE OCCUR EACH OCCURRENCE SDAfJAb'E S PREMIS as ocwmehte)_ n MED EXP(Anyone person) S PERSONAL B ADV INJURY $ $ $ N'L AGGREGATE LIMIT APPLIES PER: PODGY JET [A LOG OTHER: GENERAL AGGREGATE PRODUCTS-COMPIOPAGG AUTOMOBILELIABWYV ANY AUTO ALL OWNED - SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS (Eaaccidenl) $ BODILY INJURY tPer person) S BODILY INJURY(Perewdent) $ ERIY BW AG (Per accident) $ _ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLWMS4NADE EACHOCCURRENCE AGGREGATE $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIF.TOR1PARTNERIEXFCUnvF YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS balm NIA MWC0156325-04 09l18/2022 09118l2023 x STATUTE ER _ $ 10().0()0 E.L. EACH ACCIDENT E.L. DISEASE -EAEMPLOYE $ 100,000 E.L. DISEASE-POLICYLIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES (ACORD 1DI. Additional Romadcs Schedule, may he 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. Collier County Contractors Licensing Board 28DONHorseshmDrive AUTHORIZEDREPRESENTATIVE /' Naples FL 34104 yjw �� }Y ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD LU J m Q 06 LU J_ N al c D Q J <.i 00 C d E t U R r Q Packet Pg. 379 8.J.1 1.6 ` r'r10 t NJ WE tY JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES 06 DIVISION OF WORKERS' COMPENSATION w J H * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW z_ CONSTRUCTION INDUSTRY EXEMPTION W w This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. O EFFECTIVE DATE: 2/23/2023 EXPIRATION DATE: 2/22/2025 O O PERSON: PETRU SACACIAN EMAIL: LUANN@THOMASPA.COM -j FEIN: 043617523 fn z BUSINESS NAME AND ADDRESS: 0 H CLASSIC STONE DESIGNS, INC. caj 4791 11TI1 AVE SW NAPLES, FL 34116 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), 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 subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01676571 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 01/2023 a r Q Packet Pg. 380 8.J.1 oF� NLd '�CUL IYC` 1.6 JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES 06 UJ DIVISION OF WORKERS' COMPENSATION 1= * * 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: 2/23/2023 EXPIRATION DATE: 2/22/2025 PERSON: CLAUDIA SACACIAN EMAIL: LUANN@THOMASPA.COM FEIN: 043617523 BUSINESS NAME AND ADDRESS: CLASSIC STONE DESIGNS, INC. 4791 11TH AVE SW NAPLES, FL 34116 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), 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 subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.65(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01676443 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 0112023 a r Q Packet Pg. 381 ZZ t CLAUEMAKIA' SACACIM lNA.VIE SW FL U114-OW MSSEx f 17 "GT. 6412 t El I Packet Pg. 382 1 8.J.1 COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: 192633 COLLIER COUNTY TAX COLLECTOR - 28.00 N. HORSESHOE DRIVE - NAPLES FLORIDA 3004.. {239j 252-2471 VISIT OUR WEBSITE AT: www.colliertaxcollector vom THIS RECEIPT EXPIRES SEPTEMBER 30, 2023 LOCATION: 4791 1 iTH AVE: SW OISPLAYAT PLACE OF BUSINESS FOR PU9t [G INSPECTION: ZONED: HOME OCCUPATION I17N q 0 FAILURE TO i O SO IS CONTRARY TO LOCAL LAWS, 'BUSINESS PHONE: $26-6747. � yy� STATE OR COUNTY LIC # 23562 V pryration CLASSIC STONE'DESIGNS, INC. SACACIAN, CLAUDIA 1 4791 11TH AVE SW NAPLES, FL 34116 1.10 EMPLOYEES CLASSIFICATION: CABINET &.MILLWORK CONTRA CLASSIFICATION CODE: 02107601 This document Is a buslneSS lax only, This is not ceracallon that lit uq II does not perMft the licensee to violate any existing regulatory zoning laws nor does it exempt the llcarMe from any other taxes or permits that may be required THIS TAX IS NON-REFUNDABLE DATE 11/2112022 AMOUNT 20.70 RECEIPT WWW-23-00289009 `'�aO�fhas nn law. �tTr�y►+E%!P✓L a COLLIER COUNTY BUSINESS 'FAX BUSINESS TAX MUMMER: 050633 COLLIER COUNTY TAX COLLECTOR - 2800 N. HORSESHOE'DRIVE- NAPLES-FLORIDA 34104.(239) 252-2477 VISIT.OUR;WESSITE AT: www,colllartol.com axeTEMBER THIS RECEIPT EXPIRES SrP30, 2023 LOCATION: 4791 11 TH AVE SIN DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION; 0 FAILURE TO DO SO IS CONTRARY TO LOCAL LAWS. ZONED: HOME OCCUPATION! - 6USINESS PHONE: 825-6747 . ' STATE OR COUNTY t_iC # 23562 orporation ` , CLASSIC STOKE DESIGNS, INC. 4 SACACIAN, CLAUDIA 4791 11TH AVE SW N4PL.ES, FL 34116 r; 1-10 EMPLOYEES. CLASSIFICATION: TILE & MARBLE CONTRACTOR THIS TAX ISNON-REFUNDABLE- CLASSIFICATION CODE: 02161901 DATE 11/21/2022 AMOUNT 20.70 This document is a business tax only. This is not certification that Rcene is nil' RECEIPT W W W 23-00289009 It does not permit the licensee In vitiate any existing reguletary.zoning taws Mh Un o as nor does h exempt the l censee from any other taxes or pemtils that may be required by fmv. 0 W J co 045 W J_ H rb C d E t t� a Packet Pg. 383 8.J.1 COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER: 1s2532 COLLIER COUNTY TAX COLLECTOR - 2800 N. HORSESHOE p IVE NAPLES FLORIOA 34164 • [239) 2524477 VISIT OUR W913SITE AP waww col Ilettexcolector com THIS RECEIPT EXPIRES SEPTEMB'ER 30, 2023 LLI J LOCAT10N:.479.1 11TH AVE SW w DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION. co ZONEb:HOMI OCCUPATION� lA]LURETOb05p1&GONTfiAFiYTOLOCALt/{'NS. co BUSINESS PHONE: 826-6747 STATE OR COUNTY LIC It: 23562 ation CLASSIC STONE DESIGNS, INC. 06 W SACACIAN, CLAODIA J a ' 479111THAVESW. ~ NAPLES, FL 34,116 C9 1-10 EMPLOYEES CLASSIFICATION: PLOOR COVERING CONTRALTO CLASSIFICATION CODE: 02104301 This documunt is a business tax only. This is not celt1killon ih8t It does not permit the licensee to violate any exsting regulatory zoning laws fifth nor does it exempt the licenses frixn MY other taxes.or permits that may be required a -TEAS TAX IS NON-REFUNDABLE- . DATE 11/21/2022 AMOUNT 20.70 RECEIPT WWWV 23-0028.9009 aeesfl✓�> rb C d E t t� r� a Packet Pg. 3 47 8.J.1 () 2,2�_39 C1 er Counq Growth Management Community Development Department REINSTATEMENT APPLICATION FOR COLLIER COUNTY CERTIFICATE OF COMPETENCY This application can be used for a business or an individual. This application must be typewritten or legibly printed to be accepted. The application fee must be paid upon approval and is non-refundable. All checks are payable to: Collier County Board of County Commissioners. For additional information, consult Collier County Ordinance No. 2006-46, as amended. TYPE OF CERTIFICATE OF COMPETENCY Major Trade: $230.00 plus back fees ❑ Air Conditioning, Class A ❑ General ❑Air Conditioning, Class B Mechanical ❑Air Conditioning, Class C Plumbing ❑ Building ❑ Residential ❑ Electrical ❑ Roofing Specialty- Trade: $205.00 plus back fees ❑ TILE & MARBLE CONTRACTOR I. APPLICANT PERSONAL INFORMATION: Name: CLAUDIA First Address: 479111TH AVE SW Street Email: ❑ Sheet Metal ❑ Swimming Pool/Spa, Commercial ❑ Swimming Pool/Spa, Residential ❑ Swimming Pool/Spa, Service & Repair SACACIAN Middle Last OFFICE@ABBOTHILL.COM NAPLES FL 34116 City State Zip Telephone: (239) 877-0058 Social Security Number (Last 4 digits only): Cell Phone: (239) 877-0058 Driver's License Number (Last 4 digits only) Date of Birth: 7/5/1976 Provide the names and telephone numbers of two people who will always know your whereabouts. Name: PETRU SACACIAN Name: LUANN THOMAS Telephone: (239) 825-6747 Telephone: (239) 465-6700 0119 7450 Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth 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. c) Verification of applicant's identity. Our office will only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized by taw. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statutes. Contractor Licensing — Reinstatement Application Rev. 812022 Page 1 of 9 Operations & Regulatory Management Division, Contractor Licensing o 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorsticensi ny@calliercountyfl. gov w J m Q 06 w J N Packet Pg. 385 8.J.1 Comer County Growth Management Community Development Department APPLICANT BUSINESS INFORMATION: Business Name: (If no business name will be used, write "individual") Fictitious Name/DBA, if applicable CLASSIC STONE DESIGNS INC Business Address 4791 11TH AVE SW NAPLES FL 34116 (Physical): Street City Stale Zip Business Address 4791 11TH AVE SW NAPLES FL 34116 (Mailing): Street City State Zip Telephone: (239) 825-6747 Federal Tax VON: 643617523 III. FINANCIAL RESPONSIBILITY: YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: ✓ Have you filed for or been discharged in bankruptcy within the past 5 years? Have you had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? Have you undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? JHave you undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Have you made an assignment of assets of construction obligations for less than the debts outstanding? Have you been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years?* ✓Have you had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Have you been charged with or convicted of acting as a contractor without a license, or if ✓ licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? If you have answered YES to any of the above questions, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences, or conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment. *If you have had a felony conviction, proof that your civil rights have been restored will be required prior to Iicensure. Contractor Licensing — Reinstatement Application Rev. 812022 Page 2 of 9 operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive . Naples, FL 34104 • (239) 252-2431 contractors lice nsingCa colliercountytt.aov ui J m lY Q 06 w J G Q J <.i 00 r c m E U M r Q Packet Pg. 386 8.J.1 COZY County Growth Management Community Development Department IV. EXPERIENCE VERIFICATION: EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: TILE & MARBLE CONTRACTOR FOR THE PAST 21 YRS List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: ON THE JOB TRAINING FOR OTHER COMPANIES FOR AT LEAST 3 YRS PRIOR TO MY CONTRACTOR LICENSE CURRENTIPREVIOUS LICENSE: List below and attach copies any other certificates of competency licenses you holdthave hold in Collier County or any other jurisdiction. Include the license number, type, and county you hold it in. LOOR COVERING CONTRACTOR BUSINESS TAX LIC# 192532 ABINET & MILLWORK CONTRACTOR BUSINESS TAX LIC # 192533 Contractor Licensing -- Reinstatement Application Rev. 812022 Page 3 of 9 Operations & Regulatory Management Division, Contractor Licensing e 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorslicensiii colliercount ov r Q Packet Pg. 387 8.J.1 CO Ner County ui J Growth Management m Community Development Department Q WORKMEN'S COMPENSATION AFFIDAVIT 06 w J It is understood and acknowledged by the Collier County Contractors' licensing Board and myself that if I fail to acquire or always maintain effective Workmen's Compensation Insurance and/or Workmen's Compensation Exemption, it will result in the possible revocation of my Certificate of Competency. Z w O U CLAUDIA SACACIAN O Applicant Name (please print) O J LL CLASSIC STONE DESIGNS INC Cn Business Name, include DBA, if applicable. If no business name will be used, write "Individual" p H Signature of Applicant a State of FLORIDA County of COLLIER V ��' a foregoing in rument was acknowledged fore me by ean� of ✓❑ physical presence or ❑online notarization this Q '4'dayof (,�Sfi �� , by �' �k.�'a._'-{�►'Y CLAUDIASACACIAN Such person s) Notary Public must check appiicabfe box: Q Q 0 are personally known to me ❑ has produced a current drivers license ❑ has produced as identification Q V (Notary Seal) -3 Notary Public State of Florlda r Luann Thomas G [A C My Commisslon Ilfl HH 178401 Notary Signature E EXp, 111212026 Imcmu n a m ication Rev. 8/2022 Page 4 of 9 U r Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe Drive s Naples, FL 34104 a (239) 252-2431 Q contra ctor8licensing(a7colliercountyft.aov Packet Pg. 388 8.J.1 comer County w J Growth Management m Community Development Department Q STATEMENT OF OWNERSHIP 06 w J Not required for non -business licenses (individual). i- This certifies that 1, CLAUDIA SACACIAN am a member or managing Applicant Name (please print) member of CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. I own 50 % of the Business listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. CLAUDIA SACACIAN Applicant Name (please print) 1(J�I�C��(/�Jul - C' Signature of Applicant State of FLORIDA County of COLUE:R V The foregoing in rument was acknowledged b f re me by m ans of 0 physical presence or ❑online notarization this V Such persa s) Notary Public must check applicable box: Q Q ❑✓ are personally known to me ❑ has produced a current driver's license G ❑ has produced as identification J V (No ry Seal) (� ' Notary Public Stale of F1011da 1, I, 00 Luaen Thomas flif MY Commission NN 178401 Exp. 1/12/2026 Notary Signature E t Contractor Licensing — Reinstatement Application Rev. 812022 Page 5 of 9 r Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 • (239) 252-2431 Q contractorslicens€n colliercoun ov Packet Pg. 389 8.J.1 C0111'er County 1. J Growth Management m Community Development Department Q RESOLUTION OF AUTHORIZATION 06 w Not required for non -business licenses (individual). J i- In accordance with Collier County Ordinance 200646, as amended, CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. intends to engage in contracting as TILE & MARBLE CONTRACTOR Type of license in Collier County where CLAUDIA SACACIAN Applicant Name is applying to qualify for a Certificate of Competency. It is hereby agreed upon that Vwe the undersigned E]Officer(s) ❑Owner(s) ❑Partner(s) of said business resolve and represent to the Collier County Contractor's Licensing Board that the applicant is active in all matters connected with the business. We further resolve and represent that the applicant is legally empowered to act on behalf of the business in all matters connected with its contracting business and has the authority to supervise construction activities undertaken by the business. Officer 1 Owner 1 Partner Signature Witness Officer 1 q / Partner Signature Witness Officer 1 Owner 1 Partner Signature Witness w w I State of FLORIDA County of COLLIIER Q The foregoing in rument was acknowledged before me lay m ans of 0 physical presence or o ine notariza Qn this V day of (,C r �?-3 , by ja0e. i a- 0--44-�FQAUDIA SACACIAN Q U co Such perso (s) Notary Public must check applicable box: Q ❑✓ are personally known to me has produced a current driver's license Q G has produced as identification Q J ( try Seal) v Notary Public slate of Florida 00 Luann Thomas fill MYHH t784olion Notary Signature y Exp. 111212026 Contractor Licensing — Reinstatemen App i a n Rev. 8/2022 Page 6 of 9 R r Operations & Regulatory Management Division, Contractor Licensing . 2800 North Horseshoe drive • Naples, FL 34104 . (239) 252-2431 Q contractorslicensin{a(@Colliercountvfl.gov Packet Pg. 390 8.J.1 � o .-"Ie r County Growth Man,gnment < o+rimunity Dovelapment Department AFFIDAVITOF ifNT EGI.41`I Y AND GOOD G#- AkACI Lk' 1 d having been first duly sworn, state and affirm: I any a resident of (County) (State) and I have known CLAUDIA SACACIAN for 3 years. I have had the opportunity to observe his/her business and personal dealings and find him/her to be a person of honesty, integrity; and good character. Signature Printed Name )-% 3��L� Z&tl < Ad less , State, Zip Telephone r , I State of dZ/L County of (rjC/6( The foregoing In-trument was acknowledged befAre me t Ylday of ZO L3 by C�6 Such person(s) Notary Public must check applicable box: ns of E physical presence or ❑online notarization this 1Z1E✓ti W are personally known to me ❑ has produced a current driver's license ❑ has produced as identification (NE)ti Notary Public State of Florida` Luann Thomas My Commisslon II11 HH 178401 Exp. 111212026 Notary Signature Contractor Licensing — Reinstatement ApptiGation Rev. W2022 Page 7 of J Operations & Regulalory 14fanage€lent Division, Contractor Licensing r 2800 North Horseshoe Drive . Naples, FL 34104 a (239) 252-2431 �pr�tt.�€;raraiir,;;r�sii��(ist_ulli€�t�o€li�lyfL€�rav w J m Q 06 w J_ H G Q J <.i 00 c d t v R Q Packet Pg. 391 w Growth lvianag6"€lt co Cammurtiljp0vAfo antDepatfn2enk Q _ T AFI<1© V-110F INTEGRITY AND GOO© CHARACTER _ ca w Liliana M re Rnman 8.J.1 CD P r County ui J Growth Management m Community Development Depari€Went Q CERTIFICATION OF APPLICATION 06 w J The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County i= Ordinance No. 200646, as amended, and under penalties of perjury. I declare that I have read the foregoing d application information and that the facts stated in it are true,UJI Z The undersigned hereby certifies that he/she 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/she has full authority to supervise O U construction undertaken by himself/herself or such business or organization and that he/she will continue during W this registration to be able to so bind said business organization. The qualified license holder understands that in 0 all contracting matters, he/she will be held strictly accountable for all activities involving his/her license. J Any willful falsification of any information contained herein is grounds for disqualification. z O CLAUDIA SACACIAN Q Applicant Name (please print) v J d CLASSIC STONE DESIGNS INC d Q Business Name, include DBA, if applicable. If no business name will be used, write "Individual" z w w Signature of Applicant Q State of FLORIDA County of COLLIER I The foregoing inslr ment was acknowledged fore me y mE(aps of © physical presence or online notarization this Z day of { �0�3 Gl [C�ut+.ELAUDIA SACACIAN Q U Such person(s) Notary Public must check applicable box: V Q ❑✓ are personally known to me has produced a current driver's license has produced as identification Q (Notary Seal) Q J U Notary Public Stele of Florida Notary Signature 00 l.uann 00 �y comm€ssionas +' III! HH 178401 Exp, 1/12/2026 E t Contractor Licensing -- Reinstatement Application Rev. 812022 Page 9 of 9 v €a r Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 Q contractorslice€ising@colliercountytl.g ov Packet Pg. 393 SNOI1Valldd`d 1N3W31`d1SN1321 £-11a321a d0 M31A3M - NVIOVOVS 'v vianvio 're :;uauayaew � � M 7 00 CF) a d cc a 1 w wr Aw ~ x ..�.i-1 au La ¢ r.+ p wn co � dx Yw-5 0 F r - n 6; r �O •H 33 }aL rt LL bN wln W O z 4 v •e �N .r ar H a Ec L: `�N fA }.Na W LiN YN HQO, O L U1 w 0; [ 0 AV GWM TT j O WS Q L< Z T s i ra N vwi LL v°• a u 6 YN L)2 2 T L J4 4� N W Y-i ZZ HrnE C- a.� ~U F I l Ifllll 1 G C 9 s µ ++ y u c CO •n LC m°, Y � �CIRi •-�i SUH V PLI a TTy P '+ O� yv T o •H J o •+'o� E 0 PO. 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O m >0 L °p C L O F 11 G •� Gjti LO OC 6� m^TP 0 L a µ O G•H Lj CNN O T P G q T q.a O•H --Y ' C 7 �O i1 O 0— N 6a: LVD:N 0 3 TO Pi' TO Ow 3 µ T µ^ O°nR a POCO R N C1 i i•~ 0-0 U qC ti;J, O �n LdT 4 tNij OaM LML1 U UN 8.J.1 �`E F I1J J * CAA WE JIMMY PATRONIS � CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES 06 DIVISION OF WORKERS' COMPENSATION � i= ' * 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: 2/23/2023 PERSON: CLAUDIA SACACIAN FEIN: 043617523 BUSINESS NAME AND ADDRESS: CLASSIC STONE DESIGNS, INC. 4791 11TH AVE SW NAPLES, FL 34116 EXPIRATION DATE: 2/22/2025 EMAIL: LUANN@THOMASPA.COM This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440,05(13), 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 subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 01/2023 E01676443 QUESTIONS? (850) 413-1609 a r Q Packet Pg. 395 8.J.1 4!,mj;� ui CODWg NJ W JIMMY PATRONIS < CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES 06 DIVISION OF WORKERS' COMPENSATION � i= CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW z_ CONSTRUCTION INDUSTRY EXEMPTION W w This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. O EFFECTIVE DATE: 2/2312023 EXPIRATION DATE: 2/22/2025 O O PERSON: PETRU SACACIAN EMAIL: LUANN@THOMASPA.COM —J FEIN: 043617523 Cn z BUSINESS NAME AND ADDRESS: 0 H CLASSIC STONE DESIGNS, INC. caj 4791 11TH AVE SW NAPLES, FL 34116 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myforidalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), 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 subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 01/2023 E01676571 QUESTIONS? (850) 413-1609 a G Q J rJ 00 r C d E L V R r Q Packet Pg. 396 8.J.1 2023 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# P02000008146 Entity Name: CLASSIC STONE DESIGNS, INC. Current Principal Place of Business: 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 Current Mailing Address: 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 US FEI Number: 04-3617523 Name and Address of Current Registered Agent: THOMAS, LUANN 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 US FILED Apr 25, 2023 Secretary of State 5841848444CC Certificate of Status Desired: No The above named entilysubmits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: LUANN THOMAS O4/2512023 Electronic Signature of Registered Agent Officer/Director Detail Title P Name SACACIAN, PFTRU Address 2100 TRADE CENTER WAY SUITE G City -State -Zip: NAPLES FL 34109 Title V Name SACACIAN, CLAUDIA Address 2100 TRADE CENTER WAY SUITE G City -State -Zip: NAPLES FL 34109 Date I hereby certify Thal the infomrationlndicaled on this report or supplemental report is true and accurate and that myelecfronic signature shall have the same legal effect as if made under oath, that f am an officer or director of the corporation or the receiver or trustee empowered to execute This report as required by Chapler 50% Florida Mantles, and that my name appears above, or on an attachment with aN other like empowered. SIGNATURE: PETRU SACACIAN PRESIDENT 04/25/2023 Electronic Signature of Signing Off+cerlDirector Detail Date ui J m Q 06 W J N r Q Packet Pg. 397 COLLIER COUNCOLLIER.COUNTY BUSINESS TAX' BUSINESS TAX NUMBER: 192533 TY TAX COLLECTOR . 2800 N. HORSESHOE'DR1VE - NAPLES FLORIDA 34104= (239] 252-2477 VISIT OUR.WEBSITE AT: wm.colllertaxcollei a! Gam THIS RECEIPT EXPIRES SEPTEMBER 30, 2023 LOCATION; 4791.11;TH AVE SW DISPLAY AT PLACE OF BUSINESS FOR PUWC INSPECTION. ZONED! HOME OCCUPATION i FAIWRETODOSOISCONTRAAYTOLWALLAIvs, 'BUSINESS LLI PHONE 825 6747 STATE OR COUNTY L1E 9,23562 m . -Corporation CLASSIC STONE DESIGNS, (NC. SACACIAN, CLAUDIA 06 4791 11 TH AVE SW J NAPLES, FL 34116 1-10 EMPLOYEE5 CO CLASSIFICATION: CABINET & MILLWORK CONTRACT Z CLASSIFICATION CODE: 42107501 - -THIS TAX ISNONREFUNDABLE- DATE 11/21/2022 This document >O is a business tax only. Thls is not certdicallon that 6ce is oa►'t AMOUNT :Zvo . It dons not permit the licensee 16 �`� RECEIPT WWW-23-00289009 U Violate any existing reguintvry zoninglaws a n oT nor does It exemptthe ►icensee imm any other taxes or pertnifs that may ba required by I, es aw,g) . �'t wa�e.Lre:e2 W O J COLLIER COUNTY BUSINESS TAX BUSINESS TAX NUMBER; 050633 COLLIER COUNTY TAX COLLECTOR - 2806.N. HORSESHOE DRIVE,- NAPLES FLORIDA 34104- (239) 252.2477 VISIT OUR WE8SITE AT: www.collfetiaxc0II(x r.Com THIS RECEIPT EXPIRES SEPTEMBER 30, 2023 DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION: LOCATION: 4791 11T4 # AVE 5W FAILURE TO DO SO IS.CONTRARI'_To LOCAL LAWS. .ZONEO: HOME OCCUPATION BUSINESS PHONE: 825-6747 . ` STATE OR COUNTY LIC /: 23562 CLASSIC STONE DESIGNS; INC. orporalion ; ', •" SACACIAN, CLAUDIA 4791,11TH AVE SW NAPLES, FL 34116 1-10 EMPLi3YEES ; f CLASSIFICATION: TILE & MARBLE CONTRACTOR -THIS TAXIS NON•REFUNpA8LE- CtASSIFICATION CODE: 02101901 V'ir DATE 11/21/2022 AMOUNT 2030 t This document Is a business tax only. This is not corti ication that Ticeh a : q41' e . �'' RECEIPT WWW-23-002ggp0g It does not perrn t the licen"see to violate any existing regulatory zoning lays etas c un o7c. ies �4 nor does 1exempt the licensee from any other taxes or permits that may he required bylaw. 00 C d E t tt r� a Packet Pg. 3 8771 8.J.1 COLLIER COUNTY BUSINESS TAX BUSINESSTAX NUMBER: 192532 COLLIER COUNTY TAX COLLECTOR - 2800 N. HORSESHOE DRIVE , NAPLES rLORIOA 34104 • (239) 252.2477 VISIT OUR WESSITE AT: www.collieHaxoollectarcom THIS (RECEIPT EXPIRES SEPTEMBER 30, 2023 LOCATION: 4791 11TFI AVE SW x- y t DISPLAY AT PLACE OF BUSINESS FOR PUBLIC INSPECTION, ZONED: HOME OCCUPATION � � " �' FAILURE TO DO SODS CONTRARY TO LOCAL LAW& BUSINESS PHONE: 825-8747 STATE OR COUNTY LIC tl: 23562 §'3 Orporaffan CLASSIC STONE DESIGNS, INC. c SACACIAN, CLAUDIA VE SW NAPLES, FL 34116 1-10 EMPLOYEES � CLASSIFICATION: FLOOR COVERING CONTRACTOf�, CLASSIFICATION CODE:, 02104301 �4 This document is a business lax only. Thu is not ceitificalon that lica�l It does not Periflit the licensee to violate any existing regulatory zoning law nor does it exempt the licensee from any other taxes or permits that may be required I -THIS TAX IS NWREFUNDASLE- DATE 11121/2022 AMOUNT 20J0 RECEIPT WWW-23-00289009 K4 `14ve.drlvt� F W J m Q' Q 06 W J N r Q Packet Pg. 399 8.J.1 BUSINESS CREDIT REPORT 27911 Crown Lake Blvd Suite #i 211 Bonita Springs, FL 34135 w J Phone:239.777.1028 m Fax: 977.275.3593 Q 06 www.LicensesEtc.com w J N as of: 08/08/23 17:22 ET Classic Stone Designs, INC. Fed Tax ID# 04-3617523 Address: 5880 Shirley St Ste 201 Key Personnel: President: Sacacian Petru Naples, FL 34109-2308 Vice President: Sacacian United States Claudia Phone: 239-825-6747 Website: classicstonedesign.com BIN: 742344892 Agent: Thomas Luann Agent Address: 5880 Shirley Street Unit 201 Naples, FL Also is (or has been) operating as: Classic Stone Designs Family Linkage: Ultimate Parent Classic Stone Designs, Inc 5880 Shirley St Ste 201 Naples, FL Branches / Classic Stone Designs, Inc Alternative 4791 11th Ave SW Locations Naples, FL United States SIC Code: NAICS Code: 1752-Floor Laying & Other Floor Work, Nec 1743-Terrazzo, Tile, Marble & Mosaic Work 8999-Services, Nec 238330-Flooring Contractors 238340-Tile And Terrazzo Contractors 541990-All Other Professiona Scientific, And Technical Services Business Type: Corporation File Established: January 2002 Years on File: 21 Years Years in Business: More than 21 Years Total Employees: 3 Sales: $559,000 G D Q J c.> 00 c m E U �a r Q Pagll -f 13 Packet Pg. 400 8.J.1 Classic Stone Designs, Inc Filing Data 1549 SE Faculty CT € Provided by: Port ST Lucie, FL United States Date of j Incorporation. Classic Stone Designs, Inc 5800 Houchin St Naples, FL United States Classic Stone Designs, Inc 9107 Spanish Moss Way Bonita SPGS, FL United States' Classic Stone Designs, Inc 6455 Waverly Green Way Naples, FL United States Florida 01/24/2002 PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS. Bankruptcies: ►� Liens: Judgments Filed: VC011ections: END OF REPORT ui J m Q 06 w J r Q Pag Packet Pg. 401 8.J.1 27911 Crown Lake Blvd Suite ##6 Bonita Springs, FL 34135 PERSONAL CREDIT REPORT (Compiled From National Records) <FOR> <SUB NAME> (I) P NP7771028 LICENSES ETC <SUBJECT> SACACIAN, CLAUDIA ANA <CURRENT ADDRESS> 4791 11TH AV., NAPLES FL. 34116 <FORMER ADDRESS> Phone: 239.777.1028 Fax: 877.275.3593 www.LicensesEtc.com <MKT SUB> <INFILE> <DATE> <TIME> 16 NP 7/01 08/09/23 08:55CT 9107 SPANISH MOSS WA., BONITA SPRINGS FL. 34135 6455 WAVERLY GREEN WA., NAPLES FL. 34110 <POSITION> <SSN> <BIRTH DATE> 07/76 <DATE RPTD> 1/10 <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> CLASSIC STONE DESIGN OWNER <FORMER EMPLOYER AND ADDRESS> NEPTUNE HOTEL 2/18 2/18 7/01 12/06 11/05 M 0 D E L P R O F I L E ***FICO SCORE 8 SCORE; +596: DEROGATORY PUBLIC RECORD OR COLLECTION ***FILED;TIME SINCE DELINQUENCY IS TOO RECENT OR UNKNQWN;PROPORTION OF ***BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER ***REVOLVING ACCOUNTS;PROPORTION OF LOAN BALANCES TO LOAN AMOUNTS IS TOO ***HIGH*** PUBLIC RECORDS HAVE SEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS — NONE FOUND C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND CRED Y 36ET017 I 11/20 $396 SYNCHRONY BANK 09B 7/23A $396 PLACED FOR COLLECTIO JEFFCAPSYS Y 2BJ3001 I 10/22 $511 VERIZON WIRELESS 09B 7/2.3A $511 PLACED FOR COLLECTIO ------------------------------------------------------------------------------- T R A D E S SURNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT$ VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 SYNCB/AMEG D B 235064W 1/19 $4530 MIN176 1/23 555555432221 R02 W23A $4110 $329 05 1111-11111211 I CREDIT CARD 11/22C $3583 CLSD BY CRDT GRANTOR 54 4/ 1/ 7 SUNCOAST CU Q 298Q001 11/22 $2509 036M75 11111111 101 7/23A $0 I UNSECURED $1893 8 0/ 0/ 0 ui J m Q 06 uj J N G Q J <.i 00 c m E U �a Q Packet Pg. 402 8.J.1 SYNCB/CARECR F 999206T 7/17 $6119 MIN30 111111111111 R01 7/23A $1850 $0 IIEII1111111 I CHARGE ACCOUNT $387 72 0/ 0/ 0 W J SYNCB/TJX C 235065M 12/17 $3095 MIN74 3/23 144432111111 R01 co 7/23A $2910 $0 $441 04 111111111111 I CHARGE ACCOUNT 2/23C $1930 CLSD BY CRDT GRANTOR 66 1/ 1/ 3 06 CAPITAL ONE B 1DTV001 10/02 $2598 MIN28 1/23 111112111111 R01 J H 7/23A $2200 $0 $23 02 111111111111 I CREDIT CARD $901 82 1/ 0/ 0 Z_ FR SYNCB/TJX C 235065M 2/20 $326 EEEEEEEEEEEE R01 Lu > 7/23A $330 $0 EEEEEEEEEEEE O U I CHARGE ACCOUNT 4/23C $0 CLSD BY CRDT GRANTOR 41 0/ 0/ 0 w O CCB/ULTAMC B 1NZ8325 10/18 $4073 MIN92 1/23 111112111111 R01 7/23A $3800 $0 02 111111111111 I CREDIT CARD $2491 57 1/ 0/ 0 z O CB/VICSCRT C 16USOOI 3/17 $1916 MIN37 1/23 111112111111 R01 Q 7/23A $1820 $0 $165 02 111111111111 V I CHARGE ACCOUNT $628 76 1/ 0/ 0 d Q CB/EXPRESS C 8349001 2/17 $856 3/22 EEEEEEE11111 R01 Z 7/23A $100 $0 $37 02 111211EEEEEE w I CHARGE ACCOUNT 5/23 $0 76 1/ 0/ 0 Lu w F- CB/ANNTYLR C 1NZ8078 7/11 $2099 MIN37 1/23 111133221111 R01 F- 7/23A $2100 $0 $266 03 111111111111 z_ I CHARGE ACCOUNT $722 71 2/ 2/ 0 w w M BMG MONEY F 2E2EO01 6/23 $4776 024M100 101 1 6/23A $0 ~ I UNSECURED $4786 0 uj U BMG MONEY F 2E2E001 12/22 $6000 024M 111X11 I01 u- 6/23A $0 W I UNSECURED 6/23C $0 CLOSED 6 0/ 0/ 0 CB/NY&CO C 1NZ8074 11/09 $502 8/21 EEEEEEEEEEEE R01 w w 6/23A $1390 $0 02 EEEFEEEE1211 I CHARGE ACCOUNT 5/23C $0 DISP INV CMP--CNS DSGR B2 1/ 0/ 0 z Q U BMG MONEY F 2E2E001 8/22 $5000 024M 1111 I01 Q U 12/22A $0 Q I UNSECURED 12/22C $0 CLOSED 4 0/ 0/ 0 Q Q BMG MONEY F 2E2E001 5/22 $5000 024M 111 I01 p 8/22A $O Q I UNSECURED 8/22C $0 CLOSED 3 0/ 0/ 0 V ROCKET MTG F 13XJ001 10/18 $90.OK 360M 11111111 MOl 00 8/21A $0 c I FRD632447907 8/21C $0 CLOSED 9 0/ 0/ 0 E u FLAGSTARBANK B 2525001 10/18 $90.OK 360M 111111111 M01° 8/21A $0 r Q T FRD632447907 8/21C $0 TRNSFRD: OTHER LENDER 10 0/ 0/ 0 Packet Pg. 403 8.J.1 DOVENMUEHLE Q 285RO01 10/18 $90.OK 360M 111111111111 MOl 10/20A $0 1111111111 I FRD632447907 1002 10/20C $0 TRNSFRD: OTHER LENDER 22 0/ 0/ 0 m SYNCB/WALMAR D 235057X 11/12 $473 EEEEEEEEEEEE R01 < 1/20A $100 $0 EEEEEEEEEEEE 2 I CHARGE ACCOUNT 7/19C $0 INACTIVE ACCOUNT 82 0/ 0/ 0 W J_ H DISCOVERBANK B 9616003 8/05 $15.9K 111111111111 R01 3/19A $18.OK $0 111111111111 z T CREDIT CARD $0 82 0/ 0/ 0 w TRUISTMRTG B 3122001 5/18 $84.OK 360M 11111 MOl 0 U 1/19A $0 I FRD556553028 1/19C $0 CLOSED 7 0/ O/ 0 0 0 J ENVOY MTG Q 2E2Q00l 10/18 $90.OK 360M MOl LLCn 11/18A $0 zz I CONV R.E MORTGAGE 11/18C $0 TRNSFRD OTHER OFFICE fl H a VIVE/FEB F 895P004 7/14 $0 EEEEEEEEEEEE R01 V J 10/16A $3000 $0 EEEEEEEEEEEE d I CREDIT CARD 7/16C $0 CLSD BY CRDT GRANTOR 27 0/ 0/ 0 a ---------------------------------------------------_------------------------- z I N Q U I R I E S Lu DATE SUBCODE SUBNAME TYPE AMOUNT W 8/09/23 PNP7771028(FLA) LICENSES ETC ~ a ------------------------------W_-_-____---------------------------------------- END OF REPORT z r a Packet Pg. 404 ,d►coRr�® CERTIFICATE OF LIABILITY INSURANCE DAT£(MMIDPIYYYY) 0811512023 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER CONTACT Bill Falcone NAME: PHONE (239) 331-8595 ac No): (239) 331-8589 Arnold and Barton Insurance Group ADDRIESS: Bill@abnaples.com 700 11th Street South INSURER 5 AFFORDING COVERAGE NAIC N INSURERA: CLEAR BLUE INSURANCE COMPANY Naples FL 34102 INSURED INSURER B INSURER C C�assic Stone Designs Inc INSURER D: 5880 Shirley Street Suite 201 INSURER E 1 INSURERF: Naples FL 34109 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 LTR TYPE OF INSURANCE ADDL SUDR POLICY NUMBER POLICY EFF MMIDOIYYYY POLICY EXP MWDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ $1,000,000 OCCUR OE T'CLAIMS-MADE Pi2EMI$ES Ea£occuu Tence $ $300,000 MFD EXP (Any one person) $ $10,000 PLRSONAL & ADV INJURY $ $1,000,000 A Y BGFLOO12307103 09/22/2022 09/22/2023 L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ $2,000,000 GEN' RI- POLICY JECT PRO ❑ LOC. PRODUCTS - COMP/OP AGG $ $2,000,000 $ OTHER, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE PeraWdent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE i DED RETENTION $ $ _j WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ {Mandatory in NH) IF DISEASE - POLICY LIMIT $ II yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additienal Remarks Schedule, may be attached if more space is required) CG 2038 04 13 additional insured when required by the written contract [tl�:illr7Nl_\Ia:LeJS�L�;t Collier County Licensing Board 2800 Horseshoe Drive N Naples, FL 34104 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 01988-2016 ACORD CORPORATION, All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 8.J.1 W J m Q 06 W J_ H al l] Q J <.i 00 r C d E t v R r Q Packet Pg. 405 8.J.1 AC R" CERTIFICATE OF LIABILITY INSURANCE P�'=U,mw.,'U23 DfYYYY) 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 po icy(ies) must be endorsed, If SUBROGATION IS WAVED, 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 Amanda Kalullch _ PGI of West Central Florida,, LPHONE LC AIC, No, Ext): 941-242-9619 _ _ _ _ F C, No_). 941-242-9621 3609 E SR 64 ADDRESS: amandaopglofwestcenlrat0orida.com INSURER(S) AFFORDING COVERAGE NAIC 9 Bradenton FL 34208 iNSURERA: Markel Insurance Company 3R970 INSURED _ _.� INSURER B : Classic Stone Designs, Inc. INSURER C : _ 4791 11 th Ave SW INSURER D : INSURER E:---- Naples FL 34116 INSURERF: rrN1I9=CIArFQ e`GOTICIf ATF MI1MRFC• D=11IQInKI iJI1MRr-P• 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 CONTRACTOR 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. ILSR OF INSURANCE NDDLTYPE INSD YryDOffH POLICY NUMBER (Mwaor YYY) (MwnT)NYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE_ S PREMISES (Ea occt ce) S MEDEXP(Any one, Person) $ PERSONAL R ADV INJURY $ GEN'L AGGREGATE LIMITAPPLJES PER POLICY JEC 11 LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGO S $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS "RED AUTOS AUNON-OWNED (Ea accident) $ BODILY INJURY (Per person) S RODILYINJURY(Peracddnnl) $ (Per accident) S - i UMBRELLA LIAR EXCESS LIAR OCCUR CIAIMS4'IADE EACHOCCURRENCE $ AGGREGATE $ DEO RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIFXF.CLTnVE OFFICERIMEMBER EXCLUDED? ❑Y (Mandatory in NH) If yes, doscrrbe wxler DESCRIPTION OF OPERATIONS below NIA MWC0156325-04 09JI812022 09118l2023 )( STATUTE ER E.L. EACH ACCIDENT S 100,000 E.L. DISEASE -FAEMPLOYE9 $ 100,000 E.L. DISEASE -POLICY LIA4IT 1 $ 500.WO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, maybe 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. Collier County Contractors Ucensing Board 28M N Horseshoe Drive AUTHORIZED REPRESENTATIVE Naples FL 34104 wemww� /t �wmjj 01988-2014 ACORD CORPORATION, All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD W J m Q 06 W J_ l- 1 al c D Q J V 00 C d E t v R r Q Packet Pg. 406 .CLAUMA#�I_ ,SAlCt M IITM AVE S FL 01 _ 76 SEX F -17 ANN a � a 3 0 - a J V C _ d t V R r r El Packet Pg. 407 8.J.1 CONT C014"ty L J Z Growth Management m ZS 3 C a 2 Community Development Department Y&Q REINSTATEMENT APPLICATION FOR COLLIER COUNTY w CERTIFICATE OF COMPETENCY ~ c� This application can be used for a business or an individual. This application must be typewritten or legibly printed Z to be accepted. The application fee must be paid upon approval and is non-refundable. All checks are payable to: > Collier County Board of County Commissioners. For additional information, consult Collier County Ordinance No. p 2006-46, as amended. v IY TYPE OF CERTIFICATE OF COMPETENCY o Major Trade: $230.00 plus back fees ❑ Air Conditioning, Class A ❑ General ❑ Sheet Metal ❑ Air Conditioning, Class B Mechanical ❑ Swimming Pool/Spa, Commercial ❑ Air Conditioning, Class C Plumbing ❑ Swimming Pool/Spa, Residential ❑ Building ❑ Residential ❑ Swimming PoollSpa, Service & Repair ❑ Electrical ❑ Roofing __Specialty Trade: $205.00 plus back fees -7N[oil :k1iU4Z�6_107:1-1101Z1701NI,]F_1%0[i]►E Name: CLAUDIA SACACIAN First Middle Last Address: 4791 11TH AVE SW NAPLES FL 34116 Street City State ,Zip Email: OFFICE@ABBOTHILL.COM Telephone: (239) 877-0058 Social Security Number (Last 4 digits only): 0119 Cell Phone: (239) 877-0058 Driver's License Number (Last 4 digits only): 7450 Date of Birth: 7/5/1976 Provide the names and telephone numbers of two people who will always know your whereabouts. Name: PETRU SACACIAN Name: LUANN THOMAS Telephone: (239) 825-6747 Telephone: (239) 465-6700 Pursuant to Collier County Contractor Licensing Ordinance No. 2006-46 Section 2.1.1., all applicants are required to submit their social security number, driver's license, and date of birth for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's lest scores and information. c) Verification of applicant's identity. Our office w€II only use the personal information noted above for those reasons pursuant to Chapter 119, Florida Statutes, and as may otherwise be authorized bylaw. We are fully committed to safeguarding and protecting your personal information and once collected, will be maintained as confidential and exempt under Ghapter 119, Florida Statutes. Contractor Licensing — Reinstatement Application Rev. 812022 Page 1 of 9 operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive o Naples, FL 34104 . (239) 252-2431 contracterslicerisingC&colliereoiirttyn.gov Packet Pg. 408 8.J.1 Comer County Growth Management Community Development Department APPLICANT BUSINESS INFORMATION: Business Name: (If no business name will be used, write "Individual`) Fictitious Name/DBA, if applicable Business Address (Physical): 479111TH AVE SW Street CLASSIC STONE DESIGNS INC Business Address 4791 11TH AVE SW (Mailing): Street Telephone: (239) 877-0058 Federal Tax IDIEIN Ill. FINANCIAL RESPONSIBILITY: NAPLES FL 34116 City State Zip NAPLES FL 34116 city State Zip t>43617523 YES NO ALL APPLICANTS MUST ANSWER THE QUESTIONS BELOW: ✓ Have you filed for or been discharged in bankruptcy within the past 5 years? ✓ Have you had a lien filed against you by the Internal Revenue Service or Florida Corporate Tax Division? Have you undertaken construction contracts or work that resulted in liens, suits, or judgments being filed? ✓Have you undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial statements on? Have you made an assignment of assets of construction obligations for less than the debts outstanding? Have you been convicted or found guilty of, or entered a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction within the past 10 years?* ✓Have you had claims or lawsuits filed for unpaid or past due accounts by your creditors as a result of construction experience? Have you been charged with or convicted of acting as a contractor without a license, or if ✓ licensed as a contractor in this or any other state, been "subject to" disciplinary action by a state, county, or municipality? If you have answered YES to any of the above questions, you must attach a written explanation including the nature of the charges, dates, and outcomes, sentences, or conditions imposed. You must also attach proof of payment, satisfaction of lien or judgement, bankruptcy discharge, or agreements for payment. *If you have had a felony conviction, proof that your civil rights have been restored will be required prior to licensure. Contractor Licensing — Reinstatement Application Rev. 812022 Page 2 of 9 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive . maples, FL 34104 • (239) 252-2431 contractorslicensing@cotliercountyfl.gov ui J m Q 06 w J i= G Q J <.i 00 r c m E U R r Q Packet Pg. 409 8.J.1 Comer County Growth Management Community Development Department IV. EXPERIENCE VERIFICATION: EDUCATION: List below and provide transcripts for any formal education you have obtained in the area of competency for which this application is being made: CABINET & MILLWORK CONTRACTOR FOR THE PAST 21 YRS List below non formal education (on the job training) you have obtained in the area of competency for which this application is being made: ON THE JOB TRAINING FOR OTHER COMPANIES FOR AT LEAST 3 YR PRIOR TO MY CONTRACTOR LICENSE CURRENT/PREVIOUS LICENSE: List below and attach copies any other certificates of compete ncyllicenses you hold/have held in Collier County or any other jurisdiction. Include the license number, type, and county you hold it in. TILE & MARBLE CONTRACTOR BUSINESS TAX LIC#050633 FLOOR COVERING CONTRACTOR BUSINESS TAX LIC# 192532 Contractor Licensing — Reinstatement Application Rev. 812022 Page 3 of 9 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorslicensiiig @tolliercountyfl.uov w J m lY Q 06 w J H r Q Packet Pg. 410 8.J.1 COT County L Growth Management J m Community Development Department Q WORKMEN'S COMPENSATION AFFIDAVIT 06 w J It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to � acquire or always maintain effective Workmen's Compensation [nsurance and/or Workmen's Compensation Exemption, it will result in the possible revocation of my Certificate of Competency. Z w O U CLAUDIA SACACIAN Applicant Name (please print) p J LL CLASSIC STONE DESIGNS INC vn Business Name, include DBA, if applicable. If no business name will be used, write "Individual" p C��;C..�.Gt� C.U.i • C� 1Qi Signature of Applicant a State of FLORIDA County of COLLIER Tp foregoing in rument was acknowledged before me by ans of ❑✓ physical presence or ❑online notarization this / �j![tay of r} byojt CLAUDIA SACACIAN Such person(s) Notary Public must check applicable box: ❑✓ are personally known to me ❑ has produced as identification Notary Public State of Florlds Luann Thomas II11 MYCommission EKp, 1/1212026 Contractor Licensing — eins ateme p c on ❑ has produced a current driver's license Notary Signature Page 4 of 9 Operations & Regulatory Management Division, Contractor Licensing a 2800 North Horseshoe Drive a Naples, FL 34104 a (239) 252-2431 contractorslicensin�()colliercountytl.Qov Q Packet Pg. 411 8.J.1 CO NeT C014"ty ui J Growth Management m Community Development Department Q STATEMENT OF OWNERSHIP 06 w J Not required for non -business licenses (individual). i- This certifies that I, CLAUDIA SACACIAN am a member or managing Applicant Name (please print) member of CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. I own 50 % of the Business listed above. Affidavit of Applicant: I certify under penalty of perjury that the information contained is a true and correct statement to the best of my knowledge. CLAUDIA SACACIAN Applicant Name (please print) Lt�� . C . Signature of Applicant State of FLORIDA County of COLLIER The foregoing in rument was acknowledged b r me by m ans of Q physical presence or [online notarization this / day of ,by al; e_c.�cr,,41-AUDIASACACIAN Such person(s) Notary Public must check applicable box: 0 are personally known to me I-1 has produced as identification Ct ❑ has produced a current driver's license ge 5 of 9 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive • Naples, FL 34104 . (239) 252-2431 contractorslicensing cr co ieiercountyii.croy G Q J <.i 00 r C d E L V ra r Q Packet Pg. 412 8.J.1 C, OT MY C014"ty Growth Management Community Development Department RESOLUTION OF AUTHORIZATION Not required for non -business licenses (individual). In accordance with Collier County Ordinance 2006-46, as amended, CLASSIC STONE DESIGNS INC Business Name, include DBA, if applicable. Cabl,n 4- I m i 1IW orvc- intends to engage in contracting as FLOOR-t OVE-RUNG-CQUIRACTOR Type of license in Collier County where CLAUDIA SACACIAN Applicant Name is applying to qualify for a Certificate of Competency. It is hereby agreed upon that I/we the undersigned ✓❑ Officer(s) ❑ Owner(s) ❑ Partner(s) of said business resolve and represent to the Collier County Contractor's Licensing Board that the applicant is active in all matters connected with the business. We further resolve and represent that the applicant is legally empowered to act on behalf of the business in all matters connected with its contracting business and has the authority to supervise construction activities undertaken by the business. < -C.�7ke A�k� Officer 1 Owner 1 Partner Signature Witness c O Owner / Partner Signature Witness Officer 1 Owner 1 Partner Signature State of FLORIDA County of The foregoing in rument was acknowledged before me by f�Fay of Wd4ofl Va3, by � j Such person(s) Notary Public must check applicable box: ❑✓ are personally known to me ❑ has produced as identification (Notary Seal) Witness COLLIER pans of.0 physical presence or ,Q,ea-ef o—CLAUDIA SACACIAN ❑ has produced a current driver's license Ye notarization this �0,t4, _J u-4 r`e-4 cz--� Notary Public State of uann Thomas My commission Notary Signature A. 01 1112/2026 on rac or l ns g - eF a e en. Florida,]i (ion Rev. 8/2022 Page 6 of 9 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive . Naples, FL 34104 • (239) 252-2431 contractorslicensing0colliercountyfl.gov ui J m Q 06 w J H G Q J rJ 00 c m E t v R Q Packet Pg. 413 8.J.1 Cofter County Growth Management Cvn-wunity Development Department ,. b '3 [DAVITOF IN i 1 # ai'V" Y ANO "HAi AC, I lit 1 having been first duly sworn, state and affirm: I am a resident of (County) (State) and 1 have known CLAUDIA SACACIAN for 13 years. 1 have had the opportunity to observe his/her business and personal dealings and find hire/her to be a person of honesty, integrity; and good character. Signature Printed Name Z< - Address , State, zip -q-- Telephone LI J m Q 06 w J_ H State of �i� A County of �d`Y� P/( z a U The foregoing in trument was acknowledged before me by means of ® physical presence or ❑online notarization this V 0-7 aay or + a�3, by Such person(s) Notary Public must check applicable box: Q are personally known to me ❑ has produced a current driver's license p has produced as identification Q J <.i (Notary Leal) 00 Notary Public State of Florida A Luann Thomas CIIIIIIS M commission d n! jj my 178401 Notary Signature E Exp. 111212026 r: V M Contractor Licensing — Reinstatement Application Rev. 812022 Page 7 of J Q Operations & Regulatory Management Division. Contractor Licensing a 2800 North Horseshoe Drive • Naples, FL 34104 a (239) 252-2431 corjtL� � Urslicensin t�r,�[lie€cr���liyil.,r�<3y Packet Pg. 414 8.J.1 COLper COyi.'Vlty Ui J Growth Management m Community Development Department Q CERTIFICATION OF APPLICATION 06 w J The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County i= Ordinance No. 2006-46, as amended, and under penalties of perjury. I declare that I have read the foregoing 0 application information and that the facts stated in it are true. Z The undersigned hereby certifies that he/she is legally qualified to act on behalf of the business organization sought o to be licensed in all matters connected with its contracting business and that he/she has full authority to supervise v construction undertaken by himself/herself or such business or organization and that he/she will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in 0 all contracting matters, he/she will be held strictly accountable for all activities involving his/her license. J Any willful falsification of any information contained herein is grounds for disqualification. rn z 0 CLAUDIA SACACIAN Q Applicant Name (please print) v J d CLASSIC STONE DESIGNS INC d Q Business Name, include DBA, if applicable. If no business name will be used, write "Individual" Z LU A C.- 2 W (- Signature of Applicant Q State of FLORIDA County of COLLIER T e foregoing in ment was acknowledged before me by eans of 0 physical presence or online notarization this /_ :�dayof �- a��! ,by r�g i�iSiCa�,�a.rr--CLAUDIASACACIAN /////Such person() Notary Public must check applicable box: ❑✓ are personally known to me ❑ has produced as identification (Notary Seal) Notary Public State:0FIO]rldsA Luann Thoma dM spy Commission I Hri 178401 Exp, 1/12/202 ❑ has produced a current drivers license Contractor Licensing —Reinstatement Application Rev. 812022 Notary Signature Page 9 of 9 Operations & Regulatory Management Division, Contractor Licensing • 2800 North Horseshoe Drive a Naples. FL 34104 • (239) 252-2431 contractorsticerisin coliiercouiiov G Q J V 00 C d E t v R r Q Packet Pg. 416 SNOIIVOI'ldd`d 1N3W31`d1SN13H £ -1MNO =10 M3lA3N - NVIOVOVS 'v vianvio 'ra :;uewLioeuv ti a Y V R d 1 f M � ! 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ZLL 7 rya Y m£� L_00 C a•N0 Tm C E C 7 c " 2 L F O C a N O V4-. z \ •n•N•rL i+, V O3 L oYD -ni~ x ca �'O�N •r{ J O •rt T 0tOOx zz O L q 4- ] E y o .rt p G v >K •� O O L N Me L or .1 L O N O L L5 M 4 EraD HT3 O(0 U@ 0b/ sN y15 0 0 OXO4- .i uj W1.0. 0 OAT v 4-ry LO u OO: T*L arm Xg00 ar Yv j H N ,rCt Wn a L u fs4 41 110 ..4.1Z-E0 ao•rt y XY@'O Kr[ 0-00C++ N 0-N L00 fU m OA �pJ ir?N Z IL LL O z W O C O0 O L 3L 0 a O 3 @ C tl 00Da M O N •r O q• rl LL s 7� O: Yt> -c 0E-@ ,¢•rti' f3LR L 3 3T,r m T7 NY HL.-'0 >L D OY3 41 O nR aOQR O 3: a T O a `U. 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"OH O L OP 3N •H,n O N 3 W w W L V av N 0 O -0 q 0., O .0 U Uc] YOL C t r O x� OWIL O 4••r1 tl E Ca N 0 O.0 D T7�+ a 1 004•a F!� FN CL URUm MC 6O4-Ln '101 1G L- 00 .0 MaoN as N OC L OO ,M Lr•+0 a CSL O•+TU H >. a 0 N O C O N CY D 17 N ao+m Can+ ,7=N LN>K JC W T m•n •i- 3 C - 7b RO V rtL 41 YH J0 O 3i O Nr+ ZNH~H TU Ta TL O..Oq LU U�LL Y- Oa 7 q 6 NO L 0 Y.aY A T4.0 OaU'rw ,L ai HG H] 6 G LN ,aU L 00 E vV O +• G O 0 0 C 4I1111 I T L m T a,.Pt Ln V UAY 8.J.1 &PIC lL J �epn WIRP JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES 06 UJI DIVISION OF WORKERS' COMPENSATION 1= * * 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; 2/23/2023 PERSON: PETRU SACACIAN F EI N : 043617523 BUSINESS NAME AND ADDRESS: CLASSIC STONE DESIGNS, INC. 4791 11TH AVE SW NAPLES, FL 34116 EXPIRATION DATE: 2/2212025 EMAIL: LUANN@THOMASPA.COM This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exemption from this chapter by fling a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(11). F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time alter the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the cerlificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.012, F.A.C. REVISED 01/2023 E01676571 QUESTIONS? (850) 413-1609 a r Q Packet Pg. 418 8.J.1 = T LU J JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES 06 DIVISION OF WORKERS' COMPENSATION LU i= * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW* c� CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 2/23/2023 EXPIRATION DATE: 2/22/2025 PERSON: CLAUDIA SACACIAN EMAIL.: LUANN@THOMASPA.COM FEIN: 043617523 BUSINESS NAME AND ADDRESS: CLASSIC STONE DESIGNS, INC. 4791 11TH AVE SW NAPLES, FL 34116 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.rnyfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), F.S., an officer of a corporation who elects exomption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), 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 cortificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT E01676443 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 01/2023 a r Q Packet Pg. 419 8.J.1 2023 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# P02000008146 Entity Name: CLASSIC STONE DESIGNS, INC. Current Principal Place of Business: 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 Current Mailing Address: 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 US FEI Number: 04-3617523 Name and Address of Current Registered Agent: THOMAS, LUANN 2100 TRADE CENTER WAY SUITE G NAPLES, FL 34109 US FILED Apr 25, 2023 Secretary of State 5841848444CC Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing ifs registered office or registered agent, or both, in the State of Florida. SIGNATURE: LUANN THOMAS 04/25/2023 Electronic Signature of Registered Agent Off icerlDirector Detail Title P Name SACACIAN, PETRU Address 2100 TRADE CENTER WAY SUITE G City -State -Zip: NAPLES FL 34109 Title V Name SACACIAN, CLAUDIA Address 2100 TRADE CENTER WAY SUITE G City -Stale -Zip: NAPLES FL 34109 Date I hereby certify that the information indicated on this report or supplemental report is true and accurate and That my electronic signalure shalt have the same legal effect as if made under oath; that f am an officer or director of the corporation or the feoeiver orirustea empowered to execute this report as required by Chapter 601, Florida Statutes; and That my name appears above, or on an attachment viilh aff other like empowered. SIGNATURE: PETRU SACACIAN PRESIDENT 04/25/2023 Electronic Signature of Signing OfficerlDirector Detail Date ui J m tr Q 06 W J N G Q J <.i 00 r c d E t U R r Q Packet Pg. 420 F;rMUK U.S� t BUSIN S�STA?(NI3ft18ER: 192533 GOLI fER G'oUN f1f TAXCOLLCTUR80b N k01$SNOE t]RIYE - NA Pi FLpRiDA3410d - {239} 22.2477 VaSiTOURWEBSIrE11T,www.colliertaxsolt cam Z.TR[S RECEIPT EKf�Ii S SEPTEMBER 36,°2023 L06ATION:4791 11TH AVE SW � 171SPLAY AT PLACE OF OUS!NESS FOR PUBLIC INSPECTION, W zONEO: HOME tjCCUT'ATION " ' FAILURE TO DO SO 13 CONTRARY TO LOCAL LA%y& co 6USINM PHONE $25-6747 f STA.TC OR WUNTY.t IC {; 23562 - aiparaboq . tx CLASStC STONE bESIGNS, INC. c ... .... ._.3 _ li C Ca sACACIAN, CLAUDIA W r 4791 11 TH AVE'.SW J T T 1r NAPLES, FL 344116 1 1Q EINPL pYiES CLASSIFICATION -.CABINET' � MILLWORK CONTRA Z -THIS TAX IS NON-REFUNDABLE- CLf1SSEFIGATEOI`iCOD>;;:fl2107501 . `'� ,- W ` DATE 11/21/2022 This document is a blrsiness tax only. Th!s Is riot ce t fica(foq that liegrl Is G �' l :T ' AMOUNT 20,70 O 11 does not peril it the licensee to violate any existing regulatory zonnt lai4s RECEIPT VtfWVV-23-00289003 U � n I.w gar does it exempt the Licensee iraUt any altief taxes or perm!fsiltat [flay tie repaired by taw. O O LL 7h�s dot umen! is a httslness lax only, Ths is cerj�ii1 tat iicansls�lie )t does ript[1B ,I the 1!ceosee to violate any existirs� t�itt�lory zoning laws d�tlt a hor des it 044ipt!!ie licetts6e from any oilier lazes or pivmits lha! may hg required hy,h Packet Pg. 4 1771 COLLIER COUNTY BUSINESS TAX BUSIN> SSTAXNUMUER: 192532 COLLIER COUNTY TAX COLLECTOR • 2800 N. HORSESHOE DRIVE, VISIT NAPLES FLORIDA 34104- (239) 252-24N. OUR tiNEBSITEAT;wtiyw.cnllier€azpectorcvnl THIS RECEirr EXPIRES SEPTEMBI JR 34, 2©23 J LOCATM 4791 11T3-{ AVr SW DISPLAY AT PLACE OF BUSINCSS FOR PUBLIC INSPEC7fUN- bNED;.HOMEQCCUPATIONFAILURE Tal}OS4ISCON7f;jy[iyTOLOCAL LA4ElS: co a BUSINESS PHCNE, 825.6747 STATE 0.R COUNTY LIG #; 23562 -- CLASSIC STONE DESIGNS, INC; orporati�n � ca L 1 SACACIAN, CLAUDIA 4791 11T-f AVE SW Lu J P NAPLI 5, FL 3411fi C� _ Z_ GLASfIFICATIUN: FLUOR G()VERING CONTRACTO W CtASSIFICATIthN 'CODE: U210430i -THIS TAX N NO"EFUNDABLE- t DATE 1112112D22 O U This tioctjmenl is a beslness fax Only, This is not cerhfi�boR iw fA�AbUNT 20,10� � RCt LIPT W WM23-00289009 ft does not permit Ilea k6osee la viola e �1>� d' O a exlstltl ,�,` . r1Y 9►9IY�onl49�1Vs M° ,ies nor does it exempt the Ilcerisae from an //JJ �4St5erl8z �) O J � { t1? 6e n quived by la%y. Il rA O . H a U a. Q z d a 0 a J U 00 r c d E t u R r r Q 8.J.1 BUSINESS CREDIT REPORT 27911 Crown Lake Blvd Suite # 211 Bonita Springs, FL 34135 ui J Phone:239.777.1029 m Fax: 877.275.3593 06 www.LicensesEtc.com w J N as of: 08/08/23 17:22 ET Classic Stone Designs, INC. Fed Tax ID# 04-3617523 Address: 5880 Shirley St Ste 201 Key Personnel: President: Sacacian Petru Naples, FL 34109-2308 Vice President: Sacacian United States Claudia Phone: 239-825-5747 SIC Code: 1752-Floor Laying & Other i Floor Work, Nec Website: classicstonedesign.com 1743-Terrazzo, Tile, Marble & Mosaic Work BIN: 742344892 i 8999-Services, Nec Agent: Thomas Luann NAILS Code: 238330-Flooring Contractors Agent Address: 5880 Shirley Street Unit 201 1 238340-Tile And Terrazzo Naples, FL Contractors 541990-All Other Professional, Also is (or has been) operating as: Scientific, And i Technical Services Classic Stone Designs Family Linkage: Ultimate Parent Classic Stone Designs, Inc 5880 Shirley St Ste 201 Naples, FL Branches / Classic Stone Designs, Inc Alternative 4791 11th Ave SW Locations Naples, FL United States Business Type: Corporation File Established: Januaiy 2002 Years on File: 21 Years Years in Business: More than 21 Years Total Employees: 3 Sales: $559,000 G D Q J c.> 00 c m E U M Q Pag Packet Pg. 423 8.J.1 Classic Stone Designs, Inc 1549 SE Faculty CT Port ST Lucie, FL United States Classic Stone Designs, Inc 4 5800 Houchin St Naples, FL United States Classic Stone Designs, Inc 9107 Spanish Moss Way Bonita SPGS, FL United States Classic Stone Designs, Inc 6455 Waverly Green Way Naples, FL United States Filing Data Provided by: Date of Incorporation: Florida 01/24/2002 PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS Y Bankruptcies: v"'Liens: Vludgments Filed: V"Collections: END OF REPORT r Q Page Packet Pg. 424 8.J.1 27911 Crown Lake Blvd Suite #6 Bonita Springs, FL 34135 PERSONAL. CREDIT REPCiRT (Compiled From National Records) <FOR> <SUB NAME> (I) P NP7771028 LICENSES ETC <SUBJECT> SACACIAN, CLAUDIA ANA <CURRENT ADDRESS> 4791 11TH AV., NAPLES FL. 34116 <FORMER ADDRESS> Phone: 239-777.1028 Fax: 877.275.3593 www.LicensesEtc.com <MKT SUB> <INFILE> <DATE> <TIME> 16 NP 7/01 08/09/23 08:55CT 9107 SPANISH MOSS WA., BONITA SPRINGS FL. 34135 6455 WAVERLY GREEN WA., NAPLES FL. 34110 <POSITION> <SSN> <BIRTH DATE> 07/76 <DATE RPTD> 1/10 <CURRENT EMPLOYER AND ADDRESS> <VERF> <RPTD> CLASSIC STONE DESIGN OWNER <FORMER EMPLOYER AND ADDRESS> NEPTUNE HOTEL 2/18 2/18 7/01 12/06 11/05 M 0 D E L P R O F I L E ***FICO SCORE 8 SCORE +596: DEROGATORY PUBLIC RECORD OR COLLECTION ***FILED;TIME SINCE DELINQUENCY IS TOO RECENT OR UNKNOWN;PROPORTION OF ***BALANCES TO CREDIT LIMITS IS TOO HIGH ON BANK REVOLVING OR OTHER ***REVOLVING ACCOUNTS;PROPORTION OF LOAN BALANCES TO LOAN AMOUNTS IS T00 ***HIGH*** PUBLIC RECORDS HAVE BEEN SEARCHED AT THE COUNTY, STATE AND FEDERAL LEVELS - NONE FOUND C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND CRED Y 36ET017 I 11/20 $396 SYNCHRONY BANK 09B 7/23A $396 PLACED FOR COLLECTIO JEFFCAPSYS Y 28,73001 I 10/22 $511 VERIZON WIRELESS 09B 7/23A $511 PLACED FOR COLLECTIO ----------------------------------_-----------------------__----------------- T R A D E S SUBNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNT# VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 13-24 ECOA COLLATRL/LOANTYPE CLSD/PD BALANCE REMARKS MO 30/60/90 SYNCB/AMEG D B 235064W 1/19 $4530 MIN176 1/23 555555432221 R02 7/23A $4110 $329 05 111111111211 I CREDIT CARD 11/22C $3583 CLSD BY CRDT GRANTOR 54 4/ 1/ 7 SUNCOAST CU Q 298Q001 11/22 $2509 036M75 11111111 I01 7/23A $0 I UNSECURED $1893 8 0/ 0/ 0 ui J m Q 06 w J N G Q J c.> 00 c m E U R r Q Packet Pg. 425 8.J.1 SYNCB/CARECR. F 999206T 7/17 $6119 MIN30 111111111111 R01 7/23A $1850 $0 lIE111111111 I CHARGE ACCOUNT $387 72 0/ 0/ 0 ui J SYNCB/TJX C 235065M 12/17 $3095 MIN74 3/23 144432111111 R01 m 7/23A $2910 $0 $441 04 111111111111 I CHARGE ACCOUNT 2/23C $1930 CLSD BY CRDT GRANTOR 66 1/ 1/ 3 06 CAPITAL ONE 2 1DTV001 10/02 $2598 MIN28 1/23 111112111111 R01 J W23A $2200 $0 $23 02 111111111111 ~ I CREDIT CARD $901 82 1/ 0/ 0 Z FR SYNCB/TJX C 235065M 2/20 $326 EEEEEEEEEEEE R01 Lu > 7/23A $330 $0 EEEEEEEEEEEE O U I CHARGE ACCOUNT 4/23C $0 CLSD BY CRDT GRANTOR 41 0/ 0/ 0 O CCB/ULTAMC B 1NZ8325 10/18 $4073 MIN92 1/23 111112111111 R01 7/23A $3800 $0 02 111111111111 I CREDIT CARD $2491 57 1/ 0/ 0 Z O CB/VICSCRT C 16USOO1 3/17 $1916 MIN37 1/23 111112111111 R01 Q 7/23A $1820 $0 $165 02 111111111111 V I CHARGE ACCOUNT $628 76 1/ 0/ 0 d Q CB/EXPRESS C 8349001 2/17 $856 3/22 EEEEEEE11111 RO1 Z 7/23A $100 $0 $37 02 111211EEEEEE w I CHARGE ACCOUNT 5/23 $0 76 1/ 0/ 0 Lu w CB/ANNTYLR C 1NZ8078 7/17 $2099 MIN37 1/23 111133221111 RO1 F- 7/23A $2100 $0 $266 03 111111111111 Z_ I CHARGE ACCOUNT $722 71 2/ 2/ 0 w w M BMG MONEY F 2E2E001 6/23 $4776 024MI00 I01 6/23A $0 ~ I UNSECURED $4786 0 Lu U BMG MONEY F 2E2E001 12/22 $6000 024M 111X11 I01 LL 6/23A $0 W I UNSECURED 6/23C $0 CLOSED 6 O/ 0/ 0 CB/NY&CO C 1NZ8074 11/09 $502 8/21 EEEEEEEEEEEE R01 Lu w 6/23A $1390 $0 02 EEEEEEEE1211 I CHARGE ACCOUNT 5/23C $0 DISP INV CMP-CNS DSGR 82 1/ 0/ 0 Z Q U BMG MONEY F 2E2EO01 8/22 $5000 024M 1111 I01 Q U 12/22A $0 Q I UNSECURED 12/22C $0 CLOSED 4 O/ 0/ 0 Q Q BMG MONEY F 2E2E001 5/22 $5000 024M 111 I01 p 8/22A $0 Q I UNSECURED 8/22C $0 CLOSED 3 0/ 0/ 0 V ROCKET MTG F 13XJ001 10/18 $90.OK 360M 11111111 M01 00 8/21A $0 c I FRD632447907 8/21C $0 CLOSED 9 0/ 0/ 0 E u FLAGSTARBANK B 2525001 10/18 $90.OK 360M 111111111 MOl r 8/21A $0 Q I FRD632447907 8/21C $0 TRNSFRD: OTHER LENDER 10 0/ 0/ 0 Packet Pg. 426 8.J.1 DOVENMUEHLE Q 285RO01 10/18 $90.OK 360M 111111111111 MOl 10/20A $0 1111111111 I FRD632447907 1002 10/20C $0 TRNSFRD: OTHER LENDER 22 0/ 0/ 0 J OG SYNCB/WALMAR D 235057X 11/12 $473 EEEEEEEEEEEE RO1 1/20A $100 $0 EEEEEEEEEEEE 06 I CHARGE ACCOUNT 7/19C $0 INACTIVE ACCOUNT 82 0/ 0/ 0 W J_ DISCOVERBANK B 9616003 8/05 $15.9K 111111111111 RO1 ~ 3/19A $18.OK $0 111111111111 O z T CREDIT CARD $0 82 0/ 0/ 0 W TRUISTMRTG B 3122001 5/18 $84.OK 360M 11111 MOl O U 1/19A $0 w I FRD558553028 1/19C $0 CLOSED 7 O/ 0/ 0 O O J ENVOY MTG Q 2E2Q001 10/18 $90.OK 360M M01 11/18A $0 z I CONY R.E MORTGAGE ll/18C $0 TRNSFRD OTHER OFFICE 0 O H a VIVE/FEB F 895P004 7/14 $0 EEEEEEEEEEEE R01 V 10/16A $3000 $0 EEEEEEEEEEEE d I CREDIT CARD 7/16C $0 CLSD BY CRDT GRANTOR 27 0/ O/ 0 a ---------------------------------------------------------------------------- H Z I N Q U I R I E S W DATE SUBCODE SUBNAME TYPE AMOUNT Lu W 8/09/23 PNP7771028(FLA) LICENSES ETC ----------------------------------------------------------------------------- N END OF REPORT Z r a Packet Pg. 427 ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDrYYYYt 1 08/1512023 THIS CERTIFICATE tS 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(tes) must have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER CONTACT NAME: Bill Falcone PHONE (239) 331.8595 FAX, No : (239) 331-8589 Arnold and Barton Insurance Group 700 11 th Street South EMAIL Bill abna lea tom ADDRESS: p INSURERS AFFORDING COVERAGE NAIL q INSURERA: CLEAR BLUE INSURANCE COMPANY Naples FL 34102 _ _ INSURED INSURER B : INSURER C Classic Stone Designs Inc INSURER D: 5880 Shirley Street Suite 201 INSURER E : 1 INSURER F Naples FL 34109 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 LTR OF INSURANCE ADDLTYPE Uqn sun POLICY NUMBER MMIDDNY POLICY EFF YY POLICY EXP MWDONYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ $1,000,000 CLAIMS-MADE1-1 OCCUR RNTE '= SESOEaEoccur ante $ $300,000 MED EXP (Any one person( s $10,000 PERSONAL SADVINJURY $ $1,000,000 A Y BGFLOO12307103 09/2212022 09/2212023 AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ $2,000,000 GEN'L POLICY 7 PRO - POLICY ❑ LOG PRODUCTS - COMP/OPAGG s $2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea dCCident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accdent $ HIRED NOWOWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATIONTH AND EMPLOYERS' LIABILITY YIN STATVTE ER ANY PROPRI£TOR/PARTNERIEXECUT kVE E.L. EACH ACCIDENT $ OF FICEWMEMBER EXCLUDE07 ❑ NIA E.L. DISEASE - EA EMPLOYE S (Mandatory in NH) Ir yes_ descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CG 2038 04 13 additional insured when required by the written contract CtRTIPICA Collier County Licensing Board 2800 Horseshoe Drive N Naples, FL 34104 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 ©1988-2016 ACORD CORPORATION. All rights reserved ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 8.J.1 W J m Q 06 W J_ H Q J V 00 C 0) E t v R r Q Packet Pg. 428 8.J.1 A� h® CERTIFICATE OF LIABILITY INSURANCE DATEIMMfDDNYYY) 08/08/2023 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 po icy(ies) must be endorsed. It 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 NAME, Amanda Kaftllch PGI of West Central Florida, IF C (NCNNp, ExI): 941-2M12-9619 W. No): 941-242-9621 36D9FS964 pgnER s amanda*pgiofwestcentralflorida.com INSUREfl(S) AFFORDING COVERAGE NAIC p Rradcnlon rL 3420B INSURERA: Markel Imurance Company 38970 INSURED INSURER 8: Classic Stone Resigns, Inc. INSURER C : 4791 11 th Ave SW INSURERD:Y-._ INSURER E: Naples FL 34116 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMFNT, TERM OR CONDITION OF ANY CONTRACTOR 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. LTR TYPE OF INSURANCE — ADUL SDB - - ....._ INSD WVD POLICY NUMBER (MMlDDIYYYY) (MiNDD1YYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADEOCCUR FACHOCCURRENCE $ PR€MISES(.ocarmence) $ GEN'L MEDEXP(Anyoae,person) $ PERSONAL 8 AUV INJURY $ AGGREGATE LIMIT APPLIES PER: POLICY JET- D LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - GOMHOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 19RED AUTOS AUTOSWNED (Ea accident) _ Mf I BODILY INJURY(Por person) BODILY INJURY JPeraccident) S 3 $ (Perao6dent) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 3 LIED RETENTION $ 3 A WORKERS COMPENSATION AND EMPLOYERS' Y1N LIABILITY ANY PROPRIETORIPARTNF.R/FXF.CUTIVE OFFICEWM€MBER EXCLUDED'? ❑Y (Mandatory in NH) If yes, describe wider DESCRIPTION OFOPERATIONS below NIA MWC015632504 09/18/2ll22 09/18/1.023 Or X STATUTE ER E.L. EACH ACCIDENT $ 100 00,0 E.L. DISEASE - EA EMPLOYE -- $ 100,000 "�- $ 500,000 EL.DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schoduto, maybe attached if more spaco is required) !•=OTICICAT= N[n 1'1pR CANL:FI I ATILIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Collier County Contractors Licensing Board 2800 N Horseshoe Drive. AUTHORIZED REPRESENTATIVE Naples FL 34104 wllxlm 1 11 44-c Y/ ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD W J m Q 06 W J_ N r Q Packet Pg. 429 -: 00 _. .. J_ H z - LU OR - O .: v E � z 40 Q U J a a Q z w 2 w z w Ix M I H W 8.J.1 C z 61G4-15.006 Financial Responsibility and Financial Stability, Grounds for Denial. Q (1) The financial responsibility ground on which the Board shall refuse to qualify an applicant is failure to provide a current L consumer credit report, as defined in Rule 61G4-12.011, F.A.C., which consumer credit report does not disclose any unsatisfied judgments or liens against the applicant. In addition, there must not be any unsatisfied judgments or liens against the business entity which the applicant previously qualified as a primary qualifier or which the applicant has applied to qualify. 2 (2) The financial stability ground on which the Board shall refuse to qualify an applicant is failure to provide proof of either a w financial stability bond or an irrevocable letter of credit from a bank authorized to do business in the State of Florida. The bond or J H letter of credit must be in a form acceptable to the Board and must remain in effect until the applicant can demonstrate a credit score, FICO derived, of 660 or higher, and must be payable as provided in Rule 61G4-15.0021, F.A.C., for Financially Responsible Z Officers in the amount of: (a) $20,000 for Division I applicants. (b) $10,000 for Division II applicants. (3) Fifty percent of the financial stability bond or the letter of credit requirement may be met by completion of a 14-hour financial responsibility course approved by the Board. (4) An applicant may meet both the financial responsibility and financial stability requirements by providing proof of a current consumer credit report, as defined in Rule 61G4-12.011, F.A.C, with a credit score, FICO derived, of 660 or higher, which consumer credit report does not disclose any unsatisfied judgments or liens against the applicant. In addition, there must not be any unsatisfied judgments or liens against the business entity which the applicant previously qualified as a primary qualifier or which the applicant has applied to qualify. Specific Authority 489.115(5), (6) FS. Law Implemented 489.115(5), (6) FS. History —New 1-6-80, Amended 5-4-80, Formerly 21E-15.06, 21E- 15.006, Amended 10-31-96, 11-13-97, 2-12-08. 00 c d E t R Q Packet Pg. 431 9.A 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: 9.A Doc ID: 26622 Item Summary: 9A. RESCIND EMERGENCY CERTIFICATES OF COMPETENCY Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:38 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:38 AM Approved By: Review: Contractor Licensing Contractor Licensing Contractor Licensing Sandra Delgado Review item Tim Crotts Tim Crotts Review Item Meeting Pending Completed 09/13/2023 2:42 PM Completed 09/13/2023 5:03 PM 09/20/2023 9:00 AM Packet Pg. 432 9.A.1 2.11. Emergency Restricted Certificates of Competency. In the event of a declaration of a state of emergency in Collier County by the Collier County Board of County Commissioners or in the City by the City Council, in which substantial damage has occurred to buildings and structures so as to cause a shortage of available persons and firms/entities in the contracting trades for which there are Collier CountylCity Certificates of Competency, the Contractors' Licensing Board is hereby authorized to; 2.11.1. Declare an emergency contracting trade shortage of designated categories of contractors and/or sub -contractors, listed in this Ordinance. This declaration shall be for a period Of time not to exceed six (6) months. 2.11.2, Authorize the Contractor Licensing Supervisor to prepare and regulate the selection of contractors and/or sub -contractors from other jurisdictions whose licensing requirements are substantially comparable to those licensed in Collier County and issue temILOIRLY lic0scs to those ontractors for-Lperiod of time not to exceed the declaration of emer enc . The contractors selected must be licensed in jurisdictions whose testing and licensing requirements have been predetermined by the Contractors' Licensing Board to be substantially comparable to the Collier County requirements. c m E z U a r r Q Packet Pg. 433 10.A 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: IO.A Doc ID: 26623 Item Summary: 10A. 2023-17 - ROGER ROJAS DBA ARTISAN SEAL, INC (CEMIS20230007275) Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:39 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:39 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:45 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 4:59 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 434 10.A.1 BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, Petitioner, V. Case No: 2023-17 Licensee No: LCC20170000816 ROGER ROJAS DIBIA ARTISAN SEAL, INC. Respondent, 1 ADMINISTRATIVE COMPLAINT Collier County (County) files the Administrative Complaint against ROGER ROJAS (Respondent), a Collier County licensed contractor with license # 201700000406, and states the following facts and allegations in support of the cited violations below: The Respondent is currently licensed as a TILE & MARBLE contractor, by Collier County Contractors' Licensing. 2. The Respondent, ROGER ROJAS, is the Collier County license holder of record for the company ARTISAN SEAL, INC. (20170000815) 3. Under the provisions of Chapter 489 Florida Statutes §489.105(12) F.S. and the Collier County Code of Laws and Ordinances Sec. 22-202, the Collier County Contractors' Licensing Board (Board), is authorized to impose penalties against Collier County Certificate of Competency holders who violate the Collier County Code of Laws and Ordinances. 4. Under the provisions of the Collier County Code of Laws and Ordinances Sec 22- 202, the following actions of the Respondent constitute misconduct and grounds for discipline. 5. On August 16, 2023, Collier County Building Inspector Karl Pabst reported unpermitted interior renovations at 7260 Coventry Ct. #426 done by a county licensed contractor. A Contractors' Licensing case # CEMIS20230007275 was opened to investigate further. 6. Upon investigation, it was discovered on August 15, 2023, KITCHEN AND BATH STUDIO DESIGN CORP. (an unlicensed contractor), entered into a written contract with property owner(s) Jody and Lynn Bunting to dismantle and install kitchen cabinets and bathroom vanities at 7260 Coventry Ct. #426 for $19,000.00. Packet Pg. 435 10.A.1 7. On August 16, 2023, ARTISAN SEAL, INC. entered into a verbal contract with unlicensed contractor KITCHEN AND BATH STUDIO DESIGN CORP. to dismantle kitchen cabinets and bathroom vanities at 7260 Coventry Ct. #426 for $1,000.00. 8. On August 16, 2023, Mike Rivera, Collier County Licensing Investigator, observed interior renovations in the kitchen and bathrooms that included cabinetry demolition and plumbing at 7260 Coventry Ct. #426. 9. On August 16, 2023, a review of County records revealed no building permits were issued for the interior renovations and a stop work order was issued. 10.On August 17, 2023, Collier County Site Plans Reviewer II Lisa Blacklidge determined a permit was required for the demo and installation of kitchen cabinets and bathroom vanities. 11.On August 22, 2023, an in -person meeting was held with Mr. Rojas regarding the interior renovations performed by his company, ARTISAN SEAL, INC. During the conversation, Mr. Rojas confirmed that ARTISAN SEAL, INC. had verbally contracted with KITCHEN AND BATH STUDIO DESIGN CORP. for $1,000.00 to dismantle kitchen cabinets and bathroom vanities. Mr. Rojas stated he was unaware of the need for a permit regarding the cabinetry and vanity demo and installation and was unaware his license did not allow for dismantling the cabinetry and vanities. 12. Based on the investigation, and pursuant to Collier County Code of Laws and Ordinances Section 22-202(a)(2) and (b), the Contractors' Licensing Supervisor determined sufficient cause exists to warrant the filing of formal charges. 13.On August 22, 2023, a Notice of Hearing to appear before the Collier County Contractors' Licensing Board on September 20, 2023, at 9:00 am, was issued in person to and signed by the Respondent. 14. The County now brings the following count(s) in this Administrative Complaint against the Respondent: COUNT I A. ROGER ROJAS is the holder of a Collier County license for TILE & MARBLE contractor. ROGER ROJAS'S license does not allow for the dismantling of cabinetry or plumbing that was done in the scope of services he had provided. B. ROGER ROJAS is in violation of Collier County Code of Laws and Ordinances Section 22-201(2), which states, in pertinent part, that it is misconduct by a holder of a Collier County Certificate of Competency to contract to do any work Packet Pg. 436 10.A.1 outside of the scope of his/her competency as listed on his/her competency card and as defined in this ordinance or as restricted by the Contractors' Licensing Board. COUNT II A. Upon review of County permitting records, a building permit was never applied for or issued prior to commencing work, and a permit was required to perform the subject work. B. ROGER ROJAS is in violation of Collier County Code of Laws and Ordinances Section 22-201(18), which states, in pertinent part, that it is misconduct by a holder of a Collier County Certificate of Competency, to proceed on any job without obtaining applicable permits or inspections from the City building and zoning division or the County building review and permitting department. WHEREFORE, the Petitioner asserts the above facts and charges are grounds for disciplinary action under Collier County Code of Laws and Ordinances Sec. 22-201 and, WHEREFORE, in consideration of the foregoing, the Petitioner respectfully requests the Collier County Contractors' Licensing Board to find the Respondent guilty of the violation(s) charged. Dated: �z Z_ Signed: Timothy Crotts Collier County Contractors' Licensing Supervisor r Q Packet Pg. 437 10.A.1 Contractors' Licensing Board 2800 North Horseshoe Dr. Naples, FL 34104 Complaint Case Number: 2023-17 Complainant: Any person who believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90-105, as amended, may submit a sworn complaint to the Conti -actor Licensing supervisor, or his/her designee. The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor. The complaining party shall state with particularity which section(s) of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Please print or type and return signed copies of the complaint. Date: September 11, 2023 Against: Contractor's Name: Roger Rojas Phone: (239) 745,0972 Business Name: Artisan Seal, Inc. License Held: Tile and Marble Collier County Issuance #: 201700000406 Contractor's Business Address: 2310 NE 33`d Ter., Cape Coral, FL 34909 Filed By: Name: Collier County Contractor Licensing Officer/ Michael P. Bogert Address: 2800 N. Horseshoe Dr., Naples, FL 34104 Business Phone: 239-252-2450 Address where work is done: 7260 Coventry Ct. #426 City: Naples County: Collier ti r M N O N a 0 c as E s a Packet Pg. 4 8771 10.A.1 Date of contract: August 16, 2023 Date job started: August 16, 2023 a m 0 Date job completed or new home occupied: NIA a O Were there plans and specifications? No w O Is there a written contract? No If yes, amount of Contract: 0 Has the Contractor been paid in full? NIA 1f not, what amount? NIA M N 0 Was a Building Permit obtained? No N d 0 Was a Building Permit required? Yes M N to Building Permit number if known: NIA Have you communicated by letter with the licensee? Yes Date: August 22, 2023 Do you have a reply? Yes Please attach to this form all copies of the purchase agreement, building contract, home improvement contract, copies of receipts and/or cancelled checks available and any additional evidence to substantiate your allegations. List any subsections of Collier County Ordinance number 22-201, which, in your opinion, have been violated by the contractor, which is the subject of this complaint, (list subsection number): a. Collier County Ordinance 22-201(2) Contracting to do any work outside of the scope of his/her competency as listed on his/her competency card and as defined in this Ordinance or as restricted by the Contractors' Licensing Board. b. Collier County Ordinance 22-201(18) Proceeding on any job without obtaining applicable permits or inspections from the City building and zoning division or the county building review and permitting department. Please state the facts which you believe substantiate your charge of misconduct against the subject contractor. List facts separately for each subsection number above: a. Collier County Ordinance 22-201(2) Contracting to do any work outside of the scope of his/her competency as listed on his/her competency card and as defined in this Ordinance or as restricted by the Contractors' Licensing Board. 1. The Respondent is the holder of a Collier County license for a tile and marble contractor. The Respondent's license does not allow for the demo and or installation of cabinetry or plumbing that was done in the scope of services he had provided. Packet Pg. 4 9771 10.A.1 b. Collier County Ordinance 22-201(18) Proceeding on any job without obtaining applicable permits or inspections from the City building and zoning division or the county building review and permitting department. Upon review of County permitting records, a building permit was never issued prior to commencing work, and a permit was required to perform the subject work. ichael . Bogert Code Enforcement Investigator- Licensing State ofCounty of 6,,? C-e-' C/?-- The foregoing instrument was acknowledged before me by means ofA*hysical presence or ❑ online notarization on this / Z day of S �r �� , 20 Z-2 , by Such person(s) Notary Public must check applicable box: �re personally known to me ❑ has produced a current driver license ❑ has produced (Notary Seal) MICHAEL L. GOVERNALE r * Commisslon # HH 255243 E7 Expires April 20, 2026 Notary Signature: as identification. Packet Pg. 440 10.A.1 CO�e-� C�DYiLYLty Growth Management Division Planning & Regulation Operations Department Licensing Section Received by: 02, QQ Date: 2 z Date: August 22, 2023 Roger Rojas 2310 NE 33RD TER Cape Coral, FL 34909 RE: Case # CEMIS20230007275 -- 7260 Coventry Ct 9426 Dear Roger, Rojas A complaint has been filed against you by the above referenced entity. A hearing of this complaint will be held by the Contractors' Licensing Board on Wednesday, September 20, 2023 at 9:00 AM in the Board of County Commissioner's Room, Third Floor, Administration Building (W. Harmon Turner Bldg.), at 3301 East Tamiami Trail, Naples, Florida 34112. Your presence before the Collier County Contractors' Licensing Board is required at this time. The packet concerning your case marked composite exhibit "A" will be delivered to the members of the Contractors' Licensing Board one week prior to the hearing. If you wish to receive a copy of this packet, please notify the Contractor Licensing Customer Service Office. If you wish to prepare a defense packet and have it delivered in conjunction with composite exhibit "A", you must make fifteen copies and have therm in our office by 8:00 AM on Wednesday, one week prior to the hearing. In your packet, you may give a summary of events. At this meeting, you may present evidence and be represented by an attorney of your choice. In the event the Contractors' Licensing Board finds you in violation of Sec. 22-201 of the Collier County, FL Code of Ordinances: Sec. 22-201— MISCONDUCT — Collier County/city certificate of competency. Sec. 22-201(2) Contracting to do any work outside of the scope of his/her competency as listed on his/her competency card and as defined in this Ordinance or as restricted by the Contractors' Licensing Board. Growth Management Division*Planning & Regulation*2800 North Horseshoe Drive*Naples, Florida 34104*239-252-2400*www.colliergov,rtet Packet Pg. 4 1771 C'Alc.t-gonsri t Report Title. Code Case Details 10.A.1 Date: 9/11/2023 9:16:17 PM Case Number: CEMIS20230007275 Case Number: CEMIS20230007275 Status: Refer to CLB Case Type: Misconduct Date & Time Entered: 8/16/2023 10:09:14 AM Priority: Normal Entered By: day_n Inspector: Mike.Rivera Case Disposition: I Hearing Jurisdiction: Collier County Origin: Building Department Detail Description: A building inspector, there for a different reason, said he saw carpets being ripped up and cabinets being taken down. There is no permit pulled. The workers didnt speak english Location Comments: 7260 Coventry Ct #426 NAPLES, FL 34104 P1N#28279251523 Address 17260 Coventry CT 426, (Unit) , Naples Property 28279251523 v V 11.F1 W-LILY iJ NIFu 1114.1 ✓ V1 . "%m%41 IN IILI.7FAI IVF 6l1. L]V1'A I IIYV, JVJI^r" %X "11`1111 a m 0 m a O o: w a O ti M N 0 N d 0 M N W to N r Q Business Management & Budget Office Packet Pg. 442 Code Case Details Execution Date 9/11 /2023 9:1 10.A.1 Desc Assigned Required Completed Outcome Comments CE Staff Review day_n 8/16/2023 8/16/2023 Complete Complainant: Karl Pabst (Bldg Insp.) - 280( Horseshoe Dr (239-877-2502) Verify Complainant TimothyCrotts 8/16/2023 8/17/2023 Verified CE Staff Review day_n 8/16/2023 8/16/2023 Complete e-mailed cunt. lic. Ind Preliminary Investigation Mike.Rivera 8/17/2023 8/17/2023 Needs Email received from supervisor Crotts Investigatio regarding a complaint for carpets being npl n up and cabinets being taken down. There no permit pulled Attach Picture(s) Mike.Rivera 8/1712023 8/17/2023 Complete Cont. Investigation Mike.Rivera 8/17/2023 8/17/2023 Complete SITE VISIT ON 08/16/2023 1 met Mr. Roger Rojas, the owner and Qualifier of the company Artisan Seal, INC during my visit to 7260 Coventry CT #426, and I explained my complaint over the demolition of cabinets without a permit. I w granted entry to the premises by Mr. Rogei Roja to examine the work being done, and informed me that his business had been verbally subcontracted by Kitchen and Batt Studio Design to remove the cabinets from the kitchen and two bathrooms for a fee of $1,000.00. During my tour of the property, noticed that the cabinets were being demolished and that the water lines in the kitchen and bathroom had no caps. a m 0 Q O w a O ti A N 0 N d 0 M N to to tV Business Management & Budget Office Packet Pg. 443 Code Case Details Execution Date 9/11/2023 9:1 10.A.1 Desc Assigned Required Completed Outcome Comments CE Phone Call Mike.Rivera 8/1712023 8/17/2023 Complete 239.745.0972 (Mr. Roger Rojas) I called Mr. Roge and told him that Architectural Reviewer Lisa Blacklidge had seen interior property images, including the work done by his business, and had determined that a permit is necessary for tl demolition of the cabinets and other interio structures. Following certification of the business ARTISAN SEAL, INC. and Mr. Roger's qualification through DBPR and Cityview, I was only able to determine that license Mr. Roger holds in Collier County v the number LCC20170000815 is only for T & Marble and does not cover cabinet installation or demolition. As a result, I will issue a stop -work order until the permit is granted, and I will also send him a Notice c Hiring for Contracting Outside the Scope o His License for Tile & Marble. In order to le more about the case, Mr. Roger Rojas and arranged to meet in the Growth Manageme Department on August 18, 2023, at 11:30 z CE Phone Call Mike.Rivera 8/17/2023 8/18/2023 Complete 239.745.0972 (Mr. Roger Rojas) I received A call by Mr. Rojas who would n be able to attend the meeting on 08/18/20,' for personal reasons but would be available meet on 08/22/2023 at 10:30am. Cont. Investigation Mike.Rivera 8/22/2023 8/22/2023 Complete Meeting on 08/22/2023 10:30am The owner and qualifier of the company Artesanal Seal, INC, Mr. Roger Rojas, whc signed the notice of Hiring and was provid( a copy, was handed the Notice of Hearing my meeting with Mr. Rojas and Mr. Ernest( Gonzalez, the owner of the company Kitch and Bath Studio Design. During this discussion, Mr. Ernesto Gonzalez stated W he had paid Roger Rojas $1000.00 for the demolition. Mr. Roger Rojas confirmed that this was the case and acknowledged that t was not licensed to install or remove the cabinets. Cont. Investigation Mike.Rivora 8/30/2023 8/30/2023 Complete 8/30/2023 Because no permit had been issued and ti- work was done outside the permitted scop+ work for the license of Tile and Marble Contractor, Mr. Fred Clum, the chief buildir official for Collier County, examined photos the exposed demolition of kitchen and bathroom cabinets on August 30, 2023, an found that it was consistent with a "willful' violation of the building code. a m 0 U) Q O w a O ti M N 0 N d 0 M N to to N ti A N O N Q 0 c m E t U r Q Business Manage€nent & Budget Office Packet Pg. 444 Code Case Details Execution Date 9/11/2023 9:1 10.A.1 Desc Assigned Required Completed Outcome Comments Investigation Mike.Rivera 9/5/2023 9/11/2023 Refer to Address: 7260 Coventry CT 426 CLB Property Owner: BUNTING, JOSEPH=& LYNN Complainant: Karl Pabst (Bldg Insp.) - 280 Horseshoe Dr (239-877-2502) Complaint: Carpels being ripped up and cabinets being taken down. There is no permit pulled Contractor:ARTISAN SEAL, INC Li censeM LCC20170000815 Permit#;None Status: As of: Schedule for CLB MichaelBogert 9/11/2023 9/11/2023 Complete scheduled for 9-20-2023 Generate CLB Notice of Hearing MichaelBogert 9/11/2023 9/11/2023 Complete notice of hearing issued and signed 8-22- 2023 Enter Hearing Results MichaelBogert 9/11/2023 Pending CLB Case # 2023-17 September 20, 2023 22-201(2) Out of Scope; 22-201(18) Commencing Work without a Permit Artisan Seal Inc. Roger Rojas Violation Description Status Entered Corrected Amount Comments 4.1 Misconduct-County/City Certificate of Competency Open 9/11/2023 $0 Title Reason Result Compliance Fine/Day Condition a m 0 Q O w O O ti M N 0 N d 0 M N to to r1 Business Management & Budget Office Packet Pg. 445 10.A.1 CoHq'erl° County Property A,p a'Hser Property Summary AddSite Zone Parcel No 28279251523 I -Site ress , *7260 COVENTRY CT Site City NAPLES * 34104 Q Disclaimer Note - M _ 0 Name / Address 1 - - - — - - CO) BUNTING, JOSEPH=& LYNN Q 600 GRANDVIEW AVE w O ti City PITTSBURGH State PA Zip 15211 N N Map No. Strap No. - Section Township TRange Acres *Estimated c 51305 - 241900 4265B05 5 50 26 i 0 N Legal COUNTRY MANOR CONDO FOUR UNIT 426 I Elk Millage Area Q 180 Sub./Condo 241900 - COUNTRY MANOR CONDO 4 Use Code U 4 - CONDOMINIUM -- Latest Sales History (Not all Sales are listed due to Confidentiality) Date - Book -Page Amount - 05/22/23 6251-1455 _ $ 305,000 02/11/22 6090-1617 T -- - $ 215,000 02/16/22 6090-1612 $ 0 04/29/11 4677-657� $ 141,000 _ --- $ 0 02/09/10 01/04/06 02/25/95 4553-1068 3959-2910 2033-868 $ 0 02/24/95 2033-867 ---- $ 0� $ 89,900 05/01/89 1437-2100 Millage Rates O *Calculations School I Other Total 4.292 6.4876 10.7796 2023 Preliminary Tax Roll (Subject to Change) Land Value $ 0 {+} Improved Value $ 248,470 (_} Market Value $ 248,470 {_) Assessed Value - - - $ 248,470 {_) School Taxable Value $ 248,470 {_} Taxable Value $ 248,470 If all Values shown above equal 0 this parcel was created after the Final Tax Roll y+ a Packet Pg. 446 9112/23, 12:12 PM Property Review - C4yView Portal 10.A.1 Property Review Parcel Number: 28279251523 Q m Property Details o In Parcel Number: 28279251523 Q Parent Parcel Number: 28530280408 0 Status: Active Legal Description. COUNTRY MANOR CONDO FOUR UNIT 426 W Acres: 0.00 0 Block: FLN: 28279251523 ti Improvement Value: $248,470.00 M Land Value: $0.00 C Map Number: 5B05 N Range: 26 Q O Section: 5 T Taxes: $2,678.40 M N Township: 50 Use Code: 4 N Addresses Street # IPre-Direction Street fVarrte Direction Ultit # Status 17260 Coventry CT 426 Active 7260 Coventry CT 426 Historic Contacts Type Description Property Owner BUNTING, JOSEPH & LYNN, Address:600 GRANDVIEW AVE Historic Owner Historic Owner ZIZZI, ROBERT P, Address:533 COUNTRYSIDE DR ANNE LAURAINE DALE LIV TRUST, Address:7023 IRIS COURT Historic Owner ANNE LAURAINE DALE LIV TRUST, Address:7023 IRIS CT Historic Owner ANNE LAURAINE DALE LIV TRUST, Add ress.7023 1RIS CT Historic Owner WOOD, DONALD M & KART J, Address:8198 E LtPP1NCOTT BLVD Code Enforcement Complaints Reference # Type Status Date Entered CEUL20230007342 Unlicensed Closed 08/17/2023 Description: Citation#12821,Unlicensed General Contracting, 1st offense - $1,000.00, Issued to;GONZALEZ, ERNESTO HERNANDEZ (D/B/A)KITC HEN AND BATH STUDIO DESIGN CORP, Working at; 7260 Coventry Ct#426 CEMIS20230007275 Permit Applications Pernilt # — -- PRSD20230623746 Misconduct Refer to CLB 08/16/2023 Description: A building inspector, there for a different reason, said he saw carpets being ripped up and cabinets being taken down. There is no permit pulled. The workers didnt speak english Type Worts Class titatus Date Issued Shutters/Doors/Windows Alteration/Remodel Finaled 07/07/2023 Permits: Description: Enclose lanai with impact glass, remove interior living room sliding glass doors to create A/C space. Existing electric --No new duct work. 7260 Coventry CT Unit 426, Naples htips:llovporial, toll iercountyfl.gov/C ityV iew Web/Property/PropertyReview?searchKey-code&searchValue-P R028279251523 a Packet Pg. 447 9112/23, 12:12 PM Property Review - CityView Portal 10.A.1 Powered by CityView htt salcv orlal,colliercount I. ov/Cit ViewWeb/PrO eri /Pro ert Review?searchKe code&searchValue=PRO28279251523 Packet Pg. 448 P P Y< 9 Y P Y P Y Y= KITCHEN . ' !D DEMN ItI1 $1-:7 It?I II AVV. CAPF. (.'OH 11_, t`L '13990 ki(cIle 11Ito trikiailitstudic,tivelfjfW,cum - 706.66/.5323 CONTRACT Submitted to: Jody & Lynn Hunting CUSTOMER TEL# 412-298-1403 Address: 7260 Coventry Ct. Naples, FI Estimator: Ernesto Gonzalez Type of Contract: Kitchen, (2) Bathrooms cabinets & Quartz DATE: 8/1512023 KBS, hereby proposes to furnish all materials, and necessary equipment to complete the work pertaining to the following areas. Please he aware that oniy_what is written and agreed in this Contract is what will be done. If client request changes or extras. it will incur extra charges. _12-Months warranty on countertop seams, we are not responsible for any stains or discoloration on the cabinets or in natural stone that may occur after installation with improper care by the home owner. 12-Months warranty on Cabinets hardware and hinges 1. Cabinets are solid wood drawers & doors, Soft Closed 2. Plywood 314" prefinished 3. Cabinets s ie: Shaker 4. Cabinets color: White S. Cabinets size: 36" 6. Crown Molding: Yes 7. BACK SPLASH: Full back splash 8. Bathrooms: Two Bathrooms 9. Three Rectangular sinks 10. Stainless Steel Sink for kitchen 11. Quartz Name: Bright Statuario Polido 12. Handles you choose size: 7" 13. Assembly and Installation of Cabinets 14, Fabrication and Installation of,Quartz 15. NO Plumbing NO ELECTRICAL WORK TOTAL $19,000.00 First down payment Cap time of contract .................................. $12,000.00 2n do Sign by Customer: Sign by Contractor: tt @ �time/�ofdelivery of Cab .......................... $ 5,000.00 9 time of CoMpletion................................. $ 2,000.00 a a m 0 U) a O w O O ti A N O N Q O c14 N W N Packet Pg. 449 Detail by Entity Name Page 1 10.A.1 Florida Dapa(tlnenl of State .org Cfj- p pr),p rrji'r: DIVISION of CORPORATIONS Dopartment of Slate / Division of Corporations ! Search Records 1 Seardi by Entity Name 1 U ti Detail by Entity Name M Florida Profit Corporation N ARTISAN SEAL, INC Q Filing Information Document Number P11000056799 M N FEI/EIN Number 45-2663479 CO w N Date Filed 06/2012011 Effective Date 06/18/2011 ti N State FL 0 Status ACTIVE o M Last Event AMENDMENT N 0 N Event Date Filed 09/07/2021 to Event Effective Date NONE LU w U Principal Address U 2310 NE 33RD TERRACE Z CAPE CORAL, FL 33909 J Q Mailing Address w Cn 2310 NE 33RD TERRACE Q CAPE CORAL, FL 33909 N Renistered Agent Narne & Address ~ Q' Q ROJAS, ROGER a 2310 NE 33RD TERRACE m 0 CAPE CORAL, FL 33909 Cl) Q Officer/Director Detail O Name & Address w w w Title P O O w ROJAS, ROGER ti 2310 NE 33RD TERRACE M CAPE CORAL, FL 33909 N 0 N Title VP o MASEDA, JACQUELINE a) m 2310 NE 33RD TERRACE E t CAPE CORAL, FL 33909 U R r r Q Title C littp:Hsearcii.sunbiz.org/Inquiry/CorporatianSearel-tlSearchResultDetail?inquirytype=Entity... I Packet Pg. 2 Detail by Entity Name Page 2 10.A.1 HERCIA RIVERO, JESUS ENMANUEL 2310 NE 33RD TERRACE CAPE CORAL, FL 33909 Annual Report Year Filed Date 2021 04/02/2021 2022 04/11/2022 2023 03/17/2023 Document lmaaes 03/17/2023 -- ANNUAL REPORT View image in PDF formal 04111/2022 -- ANNUAL REPORT View image in PDF format 09107/2021 -- Amendment View image in PDF formal 04/0212021 — ANNUAL RFPOR View image in PDF formal 03/23/2020 -- ANNUAL REPORT View image in PDF Format 01/2812019 --ANNUAL REPORT View image in PDF format 01/1812018 --ANNUAL REPORT View image in PDF format 05/0412017 -- Amendment View image im PDF Formal 03/0312017 — ANNUAL REPORT View image in PDF formal I 08/0812016 -- Amendment Vievr image in PDF farm[ 03/2812016 -- ANNUAL REPORT View image in PDF format 0310412015 —ANNUAL REPORT View image in PDF format 02/27/2014 — ANNUAL REPORT View image in PDF formal 04/01/2013 -- ANNUAL REPORT Vievr image in PDF formal 02/22/2012 -- ANNUAL REPORT View image im PDF famnal 06/2012011 -- Domestic Pforit View image in PDF farnmat Florida Deraftment of Slake. Vvlpon Gr Coipala9— http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity.,, I Packet Pg. 451 10.A.1 e Cor'4 Tax Collector Noolle Branning ARTISAN SEAL INC ROJAS, ROGER 2310 NE 33RD TER CAPE CORAL, FL 33909 Dear Business Owner: Local Business Tax Receipt Your 2023 - 2024 Lee County Local Business Tax Receipt is attached below for account number 1 receipt: number: 1023664 1 1105114 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, aA� Lee County Tax Collector ----Ar ------------------ -- ---------------------------- - 2023-2024 LEE COUNTY LOCAL BUSYNESS TAX RECEIPT Account Number: 1023664 Receipt Number: 1105114 State License Number: LIC2016-00570 Location: 2310 NE 33RD TER CAPE CORAL, FL 33909 ARTISAN SEAL INC ROJAS, ROGER 2310 NE 33RD TER CAPE CORAL, FL 33909 Account Expires: September 30, 2024 May engage in the business of \MISCELLANEOUS DMAINTEiNANCE OR REPAIR THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY Payment Information: PAID 1NT-00-01410577 08/14/2023 $ s0.0o a Packet Pg. 452 10.A.1 CHANGES TO YOUR LOCAL BUSINESS TAX ACCOUNT Change of Business Name and/or Ownership: Q • Submit a new Local Business Tax Application op • Submit other required documents, if applicable (e.g. Fictitious Name Registration, State or County License, etc.) • Submit a Bill of Sale (if changing ownership) W Q • A 10% transfer fee applies to ownership changes • The Lee County Property Appraiser's office should be notified of any change in the business name and/or W ownership W a Change of Location: O • Submit a new Local Business Tax Application • Obtain zoning approval, or provide a copy of a city local business tax receipt, if relocating from: • Commercial to Commercial M • Commercial to Residential N c • Residential to Commercial NQ • A 10% transfer fee applies to location changes o • The Lee County Property Appraiser's office should be notified of any change in business location lh N Tangible Taxes: o to Tangible Personal Property Tax Returns must be filed with the Property Appraiser's office by April 1st of each year. Contact the Property Appraiser's office 239.533.6140, G Closing Your Business: If you are closing or no longer in business, the owner/qualifier must do the following: • Sign, date and submit the Out of Business Affidavit below • File a Tangible Disposition Letter form with the Property Appraiser, www.leepa.org or call 239.533.6140 to avoid receiving future tangible tax notices If you plan to liquidate your merchandise, contact our office at 239.533.6000 for instructions on obtaining a Going Out of Business Permit. Information/Questions: call 239.533.6000 or visit our official website at www.leetc.com. --------------------- .. --- ---------------- Out of Business Affidavit Tangible Personal Property Account Number for the business: The business named on the reverse side of this notice ceased operations and disposed of the assets by: ❑ Retention for personal use ❑ Scrapped, junked, or likewise disposed of, etc. ❑ Date Sold: Purchase Price: Complete the buyer information below: Name: Address: All of the tangible assets were were not ❑ sold to the purchaser. Owner/Qualifier Name Street or PO Box Number (your current mailing address) City/State/Zip Phone Number Phone Number: Date Closed Signature of OwnedQualitier Return this Out of Business Affidavit to: Lee County Tax Collector, PO Box 1549, Fort Myers, FL 33902-1549 Account No: 1023664 Receipt No: 1105114 Packet Pg. 453 10.A.1 04 -ntE Y� JIMMY PATRONIS 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: 6/24/2022 PERSON: ROGER ROJAS FEIN: 452663479 BUSINESS NAME AND ADDRESS: ARTISAN SEAL, INC 2310 NE 33RD TERRACE CAPE CORAL, FL 33909 SCOPE OF BUSINESS OR TRADE: Ceramic Tile, Indoor Stone, Carpentry Installation Of Marble, or Mosaic Work Cabinet Work or Interior Trim EXPIRATION DATE: 6/23/2024 EMAIL: ARTISANSEAL@HOTMAIL.COM IMPORTANT: Pursuant to subsection 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 subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01553194 QUESTIONS? (850) 413-1609 Packet Pg. 454 10.A.1 Collier County Board of County Commissioners Certificate of Competency Collier County * City of Marco * City of Naples * City of Everglades Issued Date: 11/01/2022 Company: ARTISAN SEAL, INC Address: 2310 NE 33RD TER CAPE CORAL, FL 33909 Telephone: (239) 745-0972 Qualifier: ROJAS, ROGER License #: LCC20170000816 Issuance #: 201700000406 Classification: TILE & MARBLE CONTR. Valid Thru: 09/30/2023 State License #: State Valid Thru: It Is the Qualifier's responsibility to keep current all records with Collier County. This shall include insurance certificates and/or contact information. Always verify licenses online at https:llcvportal.colliercountyfl.gov/CityV!ewWeb/ Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. This Collier County Certificate of Competency's status and expiration date may change on July 1, 2023, due to the Slate of Florida House Bill No.735. Please visit our website at lie u fl. vl v ntl r w h-m n ivisi sl r i la o - management/contraclor-licensing for more information as it becomes available. Packet Pg. 455 Collier County * City of Marco * City of Naples City of Everglades * Contractor Licensing 1O.A.1 TILE & MARBLE CONTR. Cert Nbr: Exp: Issuance Nbr: LCC20170000BIG 09/30/2023 201700000406 State Nbr: State Exp: ARTISAN SEAL, INC R0JAS, ROGER 2310 NE 33RD TER CAPE CORAL, FL 33909 This Collier County Certificate of Competency's status and expiration date may change on July 1, 2023 duc to the State of Florida House dill No.735. Please visit our website at for more information as it becomes available. Signed: Packet Pg. 456 'VU CZ99Z) (5;LZLOOOEZOZSIYY30) ONI '-lV3S NVSIIMV vea svrou M300M - LVEZU'VOL 4uetutioul1v ci J— Ck\-- fk--, an moomp 0 'VU : EZ99Z) (5;LZLOOOEZOZSIW30) ONI `-ld3S NVSIIMV vea sv ou M300M - L6-£ZOZ 'VOA 4uau tioul1d 00 W) 0 r � (..f 'VOL : £Z99Z) (5;LZLOOO£ZOZSIW33) ONI ` V3S Nvsi-L v vacs svrom M300N - LL-£ZOZ 'VO4 :;uawLI3L' V T (A aD r r rr (-ja 1 r- k r� �C 5 -. 5, 1'• s `'.'k ,.�+�u`!�1:�iyf��*-`�;, !! �. t� �'�s ;fir - } - \ `� i f 1 it k: ♦5 ' P, ' VOL £Z99Z) (SLZLOOO£ZOZSIW33) ONI `-lV3S NVSI-LNV VETO svrom N300N - L4-£ZOZ 'vO4 :;ugwLl3ellV ru al ii_ 'r � "Jl�.i�,� r •�• fir`. •�t, _ r 'VOL : £Z99Z) (SLZLOOO£ZOZSIW33) ONI ` V3S NVSI-LNV VETO svrom N300N - L4-£ZOZ 'vO4 :;ugwLl3ellV "1 c a ry I Y r , , J1r I M I N CO w N ti N O s N Q c m 1 u' Packet Pg. 462 10.A.1 � � 0 r Q Packet Pg. 463 10.A.1 J J `r] 't)y I I v � J J JI ,I, jj IVI i 1' � r J ) v a m 0 m a 0 W 0 0 M N O N M N O N Collier County, FL Code of Ordinances Page I of I 10.A.1 Sec. 22-201. - Misconduct —Collier County/city certificate of competency. The following actions by a holder of a Collier County/City Certificate of Competency shall constitute misconduct and grounds for discipline pursuant to section 22-202: (1) Knowingly combining or conspiring with an unlicensed contractor by allowing one's Certificate of Competency to be used by an unlicensed contractor with intent to evade the provisions of this Ordinance. When a licensed contractor acts as the qualifying agent for any firm without first making application under this Ordinance to represent said firm, such act shall constitute prima facie evidence of intent to evade the provisions of this Ordinance. When a certificate holder allows his certificate to be used by one or more companies without having any active participation in the operations, management, and control of such companies, such act constitutes prima facie evidence of an intent to evade the provisions of this Ordinance. Active participation requires job site supervision, knowledge of and participation in the business operations of the company(s), including all contractual matters. a. If any individual qualifying any business organization ceases to be affiliated with such business organization, he shall so inform the Board. In addition if such individual is the only certified individual affiliated with the business organization, the business organization shall notify the Board of the individual's termination and shall have no more than sixty (60) days from the date of termination of the individual's affiliation with the business organization in which to affiliate with another person certified under the provisions of this article. In any event, the business organization shall not enter into any new contracts and may not engage in any new contracting until such time as a qualifying agent is employed. (2) Contracting to do any work outside of the scope of his/her competency as listed on his/her competency card and as defined in this Ordinance or as restricted by the Contractors' Licensing Board. (3) Abandoning a construction project in which he/she is engaged or under contract as a contractor. A project may be presumed abandoned if the contractor terminates the project without just cause, or fails to notify the aboutblank III Packet Pg. 465 Collier County, FL Code of Ordinances Page 4 of 1 10.A.1 by the Contractors' Licensing Board, or its designee. (13) Failing to maintain a current mailing address. (14) Failing to appear in person or through a duly authorized representative at any scheduled hearing on a complaint filed against the contractor. (15) Being convicted or found guilty, regardless of adjudication, of a crime in Collier County which directly relates to the practice of contracting or the ability to practice contracting. (16) Allowing another to take a qualifying examination on the applicant's behalf (17) Engaging in contracting business in Collier County or the City when prohibited from doing so by the Contractors' Licensing Board of Collier County. (18) Proceeding on any job without obtaining applicable permits or inspections from the City building and zoning division or the county building review and permitting department. (19) Failing in any material respect to comply with the provisions of this Ordinance as a contractor or as a qualifying agent for a business entity engaging in contracting. (20) Signing a statement with respect to a project or contract falsely indicating that the work is bonded; falsely indicating that payment has been made for subcontracted work, labor, or materials which results in a financial loss to the owner, purchaser, or contractor; or falsely indicating that Workers' Compensation and public liability insurance are provided. (21) Failure of a qualifying agent for a firm/legal business entity to comply with the requirements set forth in F.S. §§ 489.119 and 489.1195. (22) Falsifying or misrepresenting any material fact to another person with the intent or for the purpose of engaging in the contracting business, providing materials or services, or soliciting business for an employer, as a contractor, or as an employee, regardless of any financial consideration. (23) Failing or refusing to provide proof of public liability and property damage insurance coverage and workers compensation insurance coverage. (24) Misconduct in the practice of contracting (see section 22-201.1below). abOLItNank l I Packet Pg. 466 10.A.1 Section 105 Permits (A] 105.1 Required Any ovineror owner's authorized agent who intends to construct, enlarge, alter, repair, move, demolish or change the occupancy of a building or structure, or to erect, install, enlarge, alter, repair, remove, convertor replace any impact -resistant coverings, electrical, gas, mechanical or plumbing system, the installation of which is regulated by this code, or to cause any such work to be performed, shall first make application to the building officialand obtain the required permit [Al 105.1.1 Annual facility permit In lieu of an individual permit for each aiteration to on existing electrical, gas, mechanical, plumbing or interior nonstructural office system(s), the building official is authorized to issue an annual permit for any occupancy to facilitate routine or emergency service, repair, refurbishing, minor renovations of service systems or manufacturing equipment installations/relocations. The building official shall be notified of major changes and shall retain the right to make inspections at the facility site as deemed necessary. An annual facility permit shall be assessed with an annual fee and shall be valid for one year from date of issuance. A separate permit shall be obtained for each facility and for each construction trade, as applicable. The permit application shall contain a general description of the parameters of work Intended to be performed during the year. (A] 105.1.2 Annual permit records The person to whom an annual permitis issued shall keep a detailed record of alterations made under such annual permit The building official shall have access to such records at all times or such records shall be fled with the building offrcialas designated. 105.1.3 food permit In accordance with Section 500.12, Florida Statutes, a food permit from the Department of Agriculture and Consumer Services is required of any person who operates a food establishment or retail store. 105.1.4 Public swimming pool The local enforcing agency may not issue a building permit to construct, develop, or modify a public swimming pool without proof of application, whether complete or incomplete, for an operating permit pursuant to Section 514.031, Florida Statutes. A certificate of completion or occupancy may not be issued until such operating permit is issued. The local enforcing agency shall conduct their review of the building permit application upon filing and in accordance with Chapter 553, Florida Statutes The local enforcing agency may confer with the Department of Health, if necessary, but may not delay the building permit application review while awaiting comment from the Department of Health. (A)105.2 Work exempt from permit Exemptions from permitrequirements of this code shall not be deemed to grant authorization for any work to be done In any manner in violation of the provisions of this code. Aermitsshall not be required for the following: Gas: Portable heating appliance. Replacement of any minor part that does not alter approval of equipment or make such equipment unsafe. Mechanical. Portable heating appliance. Portable ventilation equipment. Portable cooling unit. Steam, hot or chilled water piping within any heating or cooling equipment regulated by this code. Replacement of any part that does not alter its approval or make it unsafe. Portable evaporative cooler. Self-contained refrigeration system containing 10 pounds (4.54 kg) or less of refrigerant and actuated by motors of 1 horsepower (0.75 kW) or less. The installation, replacement, removal or metering of any load management control device. Plumbing: Iof 7 Exported from Q UpCode Packet Pg. 467 Collier County, FL Code of Ordinances Page 1 of i 10.A.1 Chapter 22 - BUILDINGS AND BUILDING REGULATIONS Footnotes: --- (1) --- Cross reference— Housing finance authority, § 2-866 et seq.; affordable housing commission, § 2-966 et seq.; development services advisory committee, § 2-1031 et seq.; community development, ch. 42; environment, ch. 54; fire safety standards, § 58-26 et seq,; floods, ch. 62; impact fees, ch. 74, manufactured homes and trailers, ch. 86; planning, ch. 106; construction in public rights -of -way, § 110-26 et seq. Special act reference— Special acts pertaining to buildings and building regulations, ch. 214. State Law reference— Authority to adopt building regulations, F.S. § 125.01(1)(i); construction industry, F. S. ch. 553; building construction standards, F. S. ch. 553. ARTICLE I. - IN GENERAL Secs. 22-1-22-25. - Reserved. ARTICLE II. - FLORIDA BUILDING CODE Footnotes: --- (2) --- Editor's note— Ord. No. 2012-14, §§ 1, 2, Mar. 27, 2012, provided for the adoption of the 2010 Florida Building Code to read as herein set out. Section 3 of said ordinance provided for the repeal of former article Il, §§ 22-26, 22-22, pertaining to the 2007 Florida Building Code, as enacted by: Ord. No. 2009-59, §§ 1, 4, adopted Nov. 10, 2009. See the Code Comparative Table for a detailed analysis. Cross reference— Fire safety standards, § 58-26 et seq. Land development code reference— Building board of adjustment and appeals, div. 5.4. Sec. 22-26. -Adoption of and additions to the Florida Building Code, (a) Adoption. There is hereby adopted by reference, the Florida Building Code, Sixth Edition (2017), and any amendments thereto, to be enforced by Collier County in the unincorporated portions of the County. (b) Additions. The following exemptions are added to Section 105.2 of the Florida Building Code: 105.2.4. Exemptions for minor repairs residential. The following permit exemptions have been established for Collier County based on Section 102.2.5 (3) of the Florida Building Code and Section 553.80(3)(c), Florida Statutes. ti A N O N Q 0 c m E U r r Q about:blank III Packet Pg. 468 Collier County, FL Code of Ordinances Page 44 of 1 10.A.1 accessories such as metal and vinyl siding, awnings, security shutters, gutters, soffits and prefabricated rooms, screen enclosures, and portable metal or vinyl partitions. (4) Alarm system contractor requires 24 months experience with a passing grade on an approved test and a passing grade on a business and law test and means a person whose business includes the execution of contracts requiring the ability, experience, science, knowledge, and skill to lay out, fabricate, install, maintain, alter, repair, monitor, inspect, replace, or service alarm systems for compensation. a. Alarm system contractor/ means an alarm system contractor whose business includes all types of alarm systems for all purposes. b. Alarm system contractorllmeans an alarm system contractor whose business includes all types of alarm systems other than fire, for all purposes. c. Alarm system means any electrical device, signaling device, or combination of electrical devices used to signal or detect a burglary, fire, robbery, or medical emergency. d. Burglar alarm contractor means an alarm system contractor whose business is limited to the installation of burglar alarms in single-family homes and two-family homes, mobile homes, and small commercial buildings having a square footage of not more than 5,000 square feet. (5) Cahinetinstallation contractor requires 24 months experience with passing grade on a business and law test and means any person who is qualified to manufacture, assemble, install, dismantle, maintain, adjust, alter, extend, and design cabinets and millwork. The scope of permitted work shall include, but not be limited to, kitchen cabinets, bathroom vanities, accessory cabinets, counter tops, office furniture, and millwork items which have been manufactured for installation on job site locations. (6) Carpentry contractor requires 36 months experience with a passing grade on an approved test and a passing grade on a business and law test and means those who have the knowledge and skill to install any wood and metal products including, but not limited to, rough framing, wood structural, wood and metal nonstructural trusses, sheathing, paneling, trim, metal framing and cabinetry. aboutNank III Packet Pg. 469 Collier County, FL Code of Ordinances Page 52 of 1 10.A.1 including such minor field fabrication as may be necessary, of any profile, perimeter or cross-section, that are or may be used as structural members for buildings and structures, and the erection of communication towers, including riveting, welding and rigging, only in connection therewith, (44) Structure moving contractor means persons who are required to be general, building or residential contractors, and who are qualified to lift and secure structures and transport said structures from one site to another, whether or not such transport is across public roads, including the proper placement of structures at a new location. (45) Tile and marble installation contractor requires 24 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means those persons who are qualified to set tile, marble and stone. (46) Tile, marble and terrazzo installation contractor req u ires 24 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means those persons who are qualified to mix, prepare, and finish terrazzo, prepare the base, and set tile, marble and stone. (47) Underground utility and excavation contractor requires 48 months experience, a passing grade on an approved test and a passing grade on a business and law test, and means contractors whose services are limited to the construction, installation, repair, on public or private property, whether accomplished through open excavation or other means, including, but not limited to, directional drilling, auger boring, jacking and boring, trenchless technologies, wet and dry taps, routing, and slip lining of main sanitary sewer collection systems, main water distribution systems, and storm sewer collection systems, and the continuation of utility lines from the main systems to a point of termination up to and including the meter location for the individual occupancy, sewer collection systems at property line on residential or single -occupancy commercial properties, or on multi -occupancy properties at manhole or "wye" lateral extended to an invert elevation as engineered to accommodate future building sewers, water distribution systems, or storm sewer collection systems at storm sewer structures. These contractors may install empty underground conduits in rights -of -way, easements, platted rights -of -way in new site development, and sleeves for parking lot crossings no smaller than two inches in diameter, provided the conduit system is designed by a licensed professional engineer or by an authorized employee of a municipality, county, or public utility, and about:blank I I Packet Pg. 470 11.A 09/20/2023 COLLIER COUNTY Contractor Licensing Board Item Number: I LA Doc ID: 26624 Item Summary: 11. NEXT MEETING DATE WEDNESDAY, OCTOBER 18, 2023 Meeting Date: 09/20/2023 Prepared by: Title: — Contractor Licensing Name: Alyshia Morse 09/13/2023 9:40 AM Submitted by: Title: — Contractor Licensing Name: Tim Crotts 09/13/2023 9:40 AM Approved By: Review: Contractor Licensing Sandra Delgado Review item Completed 09/13/2023 2:40 PM Contractor Licensing Tim Crotts Review Item Completed 09/13/2023 4:59 PM Contractor Licensing Tim Crotts Meeting Pending 09/20/2023 9:00 AM Packet Pg. 471