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CLB Agenda 02/20/2013 CONTRACTORS LICENSING BOARD Agenda February 20 , 2013 44601 Co e County COLLIER COUNTY CONTRACTORS' LICENSING BOARD AGENDA FEBRUARY 20, 2013 9:00 A.M. COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING BOARD OF COUNTY COMMISSIONERS CHAMBERS ANY PERSON WHO DECIDES TO APPEAL A DECISION OF THIS BOARD WILL NEED A RECORD OF THE PROCEEDINGS PERTAINING THERETO, AND THEREFORE MAY NEED TO ENSURE THAT A VERBATIM RECORD OF THE PROCEEDINGS IS MADE, WHICH RECORD INCLUDES THAT TESTIMONY AND EVIDENCE UPON WHICH THE APPEAL IS TO BE BASED. I. ROLL CALL II. ADDITIONS OR DELETIONS: III. APPROVAL OF AGENDA: IV. APPROVAL OF MINUTES: DATE:January 17,2013 V. DISCUSSION: VI. NEW BUSINESS: (A) Robert Rosiles.- Qualifying Second Entity (B) Douglas J.Heidenreich—Waiver of Examination(s) (C) Roger R.Drouin—Waiver of Examination(s) (D) MMC LLC,dba Marco Marine Construction(Eric Karlson) Review question 3,page 2 on application VII. OLD BUSINESS: (A) Orders of the Board (B) Darleen Rowe/Dazzling Floors,Inc.—Review six month credit report VIII. PUBLIC HEARINGS: (A) 2013-01 BCC vs Brenton L.Mongan DBA Naples Property Pros (B) 2013-03 BCC vs Alberto L.Diaz DBA A&M Professional Homes Service,LLC IX. REPORTS: X. NEXT MEETING DATE: WEDNESDAY,MARCH 20,2013 COLLIER COUNTY GOVERNMENT CENTER ADMINISTRATIVE BUILDING THIRD FLOOR IN COMMISSIONERS CHAMBERS 3299 E.TAMIAMI TRAIL NAPLES,FL 34112 January 16,2013 MINUTES OF THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD MEETING January 16, 2013 Naples, Florida LET IT BE REMEMBERED that the Collier County Contractors' Licensing Board, having conducted business herein, met on this date at 9:00 AM in REGULAR SESSION in Administrative Building "F," 3rd Floor, Collier County Government Complex, Naples, Florida, with the following Members present: Chairman: Richard Joslin Vice Chair: Patrick White Members: Michael Boyd Ronald Donino Terry Jerulle Kyle Lantz Robert Meister Jon Walker Excused: Thomas Lykos ALSO PRESENT: Michael Ossorio — Supervisor, Contractors' Licensing Office Jeff Wright, Esq. —Assistant County Attorney James F. Morey, Esq. —Attorney for the Contractors' Licensing Board Karen Clements—Licensing Compliance Officer 1 January 16,2013 Any person who decides to appeal a decision of this Board will need a record of the proceedings and may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the Appeal is to be based. I. ROLL CALL: Chairman Richard Joslin called the meeting to order at 9:01 AM and read the procedures to be followed to appeal a decision. Roll call was taken and a quorum was established. Eight voting members were present. Michael Ossorio, Supervisor—Contractors' Licensing Office,noted Board Member Thomas Lykos had been excused. II. AGENDA—ADDITIONS OR DELETIONS: Deletion: • Under Item VI, "New Business:" (A) Jerome J. Jeker—Contesting Citation (The request to withdraw was made by Mr. Jeker.) Continuation: • Under Item VIII, "Public Hearings:" (A) Case#2013-01: BCC vs. Brenton L. Mongan, d/b/a"Naples Property Pros"was continued to the February meeting. III. APPROVAL OF AGENDA: Vice Chairman Patrick White moved to approve the Agenda as amended. Second by Robert Meister. Carried unanimously, 8—0. IV. APPROVAL OF MINUTES—December 19,2012: Kyle Lantz moved to approve the Minutes as presented. Second by Jon Walker. Carried unanimously, 6—0. (Note: Michael Boyd and Robert Meister could not vote to approve the Minutes because they did not attend the December meeting.) V. DISCUSSION: (None) VI. NEW BUSINESS: (Note: Regarding cases heard under Section VI, the individuals who testified were first sworn in by the Attorney for the Board.) 2 January 16,2013 B. Dagoberto Barcelo—Credit Report Review Applicant: Dagoberto Barcelo d/b/a"Barcelo's Custom Cabinets and Millwork, Inc." Mr. Barcelo explained the reasons for his personal credit problems: • Due to the economic downturn, he had been laid off as a cabinet maker by his former employer • He was unable to find employment and lost his house due to foreclosure • He resorted to using his credit cards to meet his expenses (food, rent, etc.) • He decided to open his own company as a custom cabinet maker in order to improve his situation Chairman Joslin noted Mr. Barcelo is a woodworker who made cabinets and has applied for a license to install his work product. He commended Mr. Barcelo on his test results; the score for the Business Procedures exam was 90%. Michael Ossorio confirmed Mr. Barcelo had taken the examination at GITS, LLC, which is a Board-approved testing facility in Ocala. Chairman Joslin stated Mr. Barcelo presented serious credit issues. The Applicant stated his priorities were to make money since he cares for his 73 year old mother. Mr. Barcelo further stated he had been advised to open his own business since he has the skill and experience in the trade. He guaranteed that if his license application is approved, he will pay all of his obligations and noted he is attempting to establish a payment plan. Vice Chairman White noted the Applicant had received a citation for installing cabinets without a license and requested an explanation. Mr. Barcelo stated he had been working for a General Contractor on Marco Island who was to have included his name on the payroll. The General Contractor failed to do so. When the citation was issued, the Applicant immediately paid the fine. Mr. White stated if the Applicant became a Contractor, it would eliminate this type of problem. He asked the Applicant if he would make every effort to pay off his debts if a license was granted. Mr. Barcelo stated every penny of profit would be put back into the company to allow it to grow. He explained his biggest problem was with the Bank of America and he was obtaining information concerning a new government program that may apply to his situation and arranging a payment schedule for his credit card bills. Chairman Joslin requested recommendations from Staff. Michael Ossorio suggested approving the application for a license while imposing a one-year probationary period. The Applicant will be required to return to present his business and personal credit reports for the Board to review. Jon Walker asked if the Applicant if he understood he would be required to prove to the Board that he had made some progress paying down his debts. Mr. Barcelo responded, "Yes." 3 January 16,2013 Jon Walker moved to approve granting a license to the Applicant with a one-year probationary period. Vice Chairman White offered a second and added the requirement that the Applicant was to return at the end of the one-year probationary period to provide updated personal and business credit reports. Mr. Walker amended his original Motion to include the suggested addition. Second by Vice Chairman White. Carried unanimously, 8—0. Chairman Joslin instructed Mr. Barcelo to contact Contractors' Licensing Office Supervisor Michael Ossorio to complete the required paperwork. VII. OLD BUSINESS: A. Orders of the Board Vice Chairman Patrick White moved to approve authorizing the Chairman to sign the Orders of the Board. Second by Terry Jerulle. Carried unanimously, 8—0. VIII. PUBLIC HEARINGS: A. Case#2013-02: BCC vs. Robert E. Elwell,Jr. Respondent, Robert E. Elwell,Jr., was not present or represented by Counsel. Chairman Joslin outlined the manner in which the Public Hearing will be conducted: • Hearings will be conducted pursuant to the procedures contained in Collier County Ordinance#90-105, as amended, and Florida Statutes, Title XXXII, "Regulation of Professions and Occupations, " Chapter 489. • The Hearings are quasi-judicial in nature. • Formal "Rules of Evidence" shall not apply. • Fundamental fairness and due process shall be observed and govern the proceedings. • Irrelevant, immaterial, or cumulative evidence shall be excluded. • All other evidence of the type commonly relied upon by reasonably prudent persons shall be admissible, whether or not such evidence would be admissible in a trial in the Courts of the State of Florida. • Hearsay evidence may be used for the purpose of supplementing or explaining any evidence but shall not be deemed sufficient by itself to support a Finding, unless such hearsay would be admissible over objection in a civil action in Court. • The "Rules of Privilege" shall be effective to the same extent that such Rules are now, or hereafter may be,recognized in civil actions. • Any member of the Contractors' Licensing Board may question any witness before the Board. 4 January 16,2013 • Each party to the proceedings shall have the right to call and examine witnesses,to introduce Exhibits, to cross-examine witnesses,to impeach any witness regardless of which party called the witness to testify, and to rebut any evidence presented against the party. • The Chairperson or, in his/her absence, the Vice Chair, shall have all powers necessary to conduct the proceedings at the Hearing in a full, fair, and impartial manner, and to preserve order and decorum. • The general process of the Hearing is for the County to present an Opening Statement to set forth the charges and, in general terms, how the County intends to prove the charges. • The Respondent will present his/her Opening Statement setting forth, in general terms, defenses to the charges. • The County will present its Case in Chief by calling witnesses and presenting evidence. • The Respondent may cross-examine the witnesses. • After the County has closed its Case in Chief the Respondent may present his/her defense as described previously, i.e.,to call and examine witnesses,to introduce Exhibits, to cross-examine witnesses, to impeach any witness regardless of which party called the witness to testify, and to rebut any evidence presented against the party. • After the Respondent has presented his/her case,the County will present a rebuttal to the Respondent's presentation. • When the Rebuttal is concluded, each party is permitted to present a Closing Statement. • The County is allowed a second opportunity to rebut the Respondent's Closing Statement. • The Board will close the Public Hearing and begin deliberations. • Prior to beginning deliberations, the Board's Attorney will give a"charge"to the Board, similar to the charge given to a jury, setting out the parameters on which the decision will be based. • During deliberations, the Board can request additional information and clarification from the parties. • The Board will decide two different issues: o Whether the Respondent is guilty of the offense as charged in the Administrative Complaint. A vote will be taken on the matter. o If the Respondent is found guilty,the Board must decide the sanctions to be imposed. • The Board's Attorney will advise the Board concerning the sanctions and the factors to be considered. • The Board will discuss the sanctions and vote. • After the matters are decided, the Chair/Vice Chair will read a Summary of the Order to be issued by the Board. The Summary is a basic outline of the Order and may not reflect the same language contained in the Final Order. • The Final Order will include complete details as required under State laws and procedures. 5 January 16,2013 Vice Chairman White moved to approve entering Case No. 2013-02, Collier County Board of County Commissioners vs. Robert E. Elwell, Jr., d/b/a "Service Star Cooling& Heating,Inc.," consisting of the Administrative Complaint and Exhibits into evidence. Second by Kyle Lantz. Carried unanimously, 8—0. Chairman Joslin entered the information packet into evidence as County's Exhibit "A." Karen Clements, Licensing Compliance Officer,presented the County's Opening Statement: • The Respondent is Robert E. Elwell, Jr., d/b/a"Service Star Cooling & Heating, Inc." • The Respondent is licensed by the State of Florida as a Certified Class A Air-Conditioning Contractor, License No. CAC-0568252 • May 1, 2012: Received a complaint from Kobie Kooling concerning discovery of the installation of an a/c unit at 6216 Bellerive Avenue, Bldg. 17, Apt. # 1702, for which a permit had not been pulled. • May 3, 2012: A site inspection was conducted. The homeowner, Mrs. Martens, stated she had been solicited by Service Star to install a new a/c unit since they were in the area and could give her a"good price"to do the job. • May 14, 2012: A Permit was issued • May 17, 2012: Called the Respondent; reminded him the Permit was to be picked up and an inspection scheduled upon completion. • May 23, 2012: Inspection was schedule for May 25th • May 25, 2012: Inspection failed—installation did not comply with Code requirements. • September 20, 2012: Contacted"Michael"at Service Star. A second inspection was to be scheduled. • September 24, 2012: Calls were placed to Service Star and to Robert Elwell. Messages were left. • September 26, 2012: Received call from Robert Elwell who stated inspection would be called in on September 27, 2012. • October 1, 2012: Final inspection was scheduled. • October 2, 2012: Contractor's license with State had not been renewed—he must re-register with Collier County; Inspection results will be entered into Collier's system at that point • October 10, 2012: Mr. Elwell stated he would no longer qualify Service Star Cooling and Heating after Permit has been completed • October 12, 2012: Robert Elwell called-- Service Star had retained a new qualifier. • October 23, 2012: Spoke with"David" at Service Star"Enterprises"—new company name—who stated the company will not stand behind previous work. Contacted Mr. Elwell who stated he was retaining an attorney. Ms. Clements advised Mr. Elwell to hire a company to finish the work. 6 • January 16,2013 • October 26, 2012: Left several messages for Mr. Elwell. Did not receive a response. • October 29, 2012: Received a phone message from Peter Mackey, counsel for Robert Elwell. • November 1, 2013: Spoke with Mr. Mackey who stated the owner of Service Star had been arrested several times for involvement in"Ponzi" schemes (investment swindles). He further stated options were under consideration to rectify the situation with the homeowner, Mr. Martens. • November 27, 2012: A Non-compliance Letter was sent and the hearing was scheduled for January 16, 2013. Ms. Clements noted the County received a fax dated January 15, 2013 (at 5:34 PM) from the Mackey Law Group, P.A. She read the contents of the letter into the record: "As you know from our previous letter of December 19, 2012, we represent Robert E. Elwell, Jr. We are cognizant of the January 16, 2013, 9:00 a.m. Contractors'Licensing Board hearing. Mr. Elwell is not able to be at the hearing due to health reasons. As we previously referenced, he has heart problems. It is our understanding that the decision to be made tomorrow is whether to revoke Mr. Elwell's permitting privileges with Collier County. Based on our letter of December 19, 2012, Mr. Elwell's health and Mr. Elwell's finances, we are informing you that he has not objection to the revocation of his permitting privileges for Collier County. Mr. Elwell appreciates any consideration that you can provide to him as a result of his unfortunate association with Salvatore Tavoclacci. Please call me if you need any assistance whatsoever and/or if you would like to speak with Mr. Elwell. Sincerely, MACKEY LAW GROUP, P.A. (signed) Peter J Mackey" (Note: A copy of the letter was distributed to the Board members.) Ms. Clement stated she requested direction from Thomas L. DeGram, Collier County Chief Building Official, who stated he considered the situation to be a "willful Code violation." Ms. Clements verified that Mr. Elwell had been properly notified of the Hearing via certified letter delivered to his attorney, Peter Mackey, on December 8, 2012. 7 January 16,2013 Chairman Richard Joslin moved to enter the letter from Peter Mackey,Esq., dated January 15, 2013 into evidence as County's Exhibit `B." Second by Vice Chairman Patrick White. Carried unanimously, 8—0. Terry Jerulle asked if Mr. Mackey's letter of December 19, 2012 had been included in the information packet previously presented to the Board members. Vice Chairman White noted Attorney Mackey's letter of January 15, 2013 referenced the Respondent's Collier County Certificate of Competency(Number 201100001915) while the Administrative Complaint referenced the State License (CAC-058252.) He asked for clarification that the Board would decide whether or not to revoke the Respondent's permit pulling privileges in Collier County under the State License. Michael Ossorio confirmed. Mr. White asked how the Respondent's Collier County Certificate of Competency would be effected. Mr. Ossorio responded the CAC would become inactive. Mr. White clarified the permit pulling privileges would be revoked and the Certificate of Competency would be inactive. Karen Clements produced a copy of Attorney Mackey's December 19th letter. (Note: Vice Chairman White reviewed the letter.) Chairman Joslin asked if the job had ever been completed. Ms. Clements replied it had not passed inspection and a Certificate of Completion has not been issued. Michael Ossorio referred the Members to Exhibit E-13, "Inspection History." Vice Chairman White referred to Mr. Mackey's letter and stated, "in essence," the situation appeared to be a pattern of practice throughout the state with respect to Salvatore Tavolacci,the owner of Service Star. He noted there may be other victims throughout the State. He further stated the letter noted Mr. Elwell was not in a position to do anything to correct the situation due to his health issues and finances. Michael Ossorio stated the charge was "willful Building Code violation." • The Chief Building Official reviewed the Building Permit. • The Respondent chose to qualify a company even though he had no ownership in it. • The Respondent chose to pull and sign for Building Permits in Collier County. • A deposit was taken from a Collier County homeowner. • The installation was inspected twice and failed twice. • The Respondent is responsible to rectify the situation—to complete the job, have the work inspected and pass inspection for the consumer. 8 January 16,2013 Mr. Ossorio stated the company and the qualifier are responsible to make amends to the homeowner. He further stated the local Licensing Board is the first line of defense for consumers. He continued that if the Board finds there has been a violation, a letter will be sent to the State's Construction Industry Licensing Board. All consumers who have been harmed by this contractor would be notified and sent a State complaint form. Chairman Joslin asked if Service Star had been re-qualified in Collier County under a new qualifier. Mr. Ossorio stated the new company name is Service Star Enterprise with the same business address and telephone number. He reminded the Board that Mr. Elwell had previously been before the Board for prior willful Code violations. The previous order of the Board required Mr. Elwell to personally pull building permits and could not rely on the company to do so. Michael Ossorio stated County would rest its case under Count I which charged a violation of Ordinance 90-105, as amended, Section 22-201.1(2), "Willfully violating the applicable building codes of law of the State, City or Collier. " Vice Chairman White asked if the new company was operating in Collier County. Mr. Ossorio confirmed that Service Star Enterprises (formerly Service Star Cooling and IIeating, Inc.)was currently conducting business in Collier County under a different qualifier. Vice Chairman White moved to approve closing the Public Hearing. Second by Terry Jerulle. Carried unanimously, 8—0. Attorney Morey outlined the Charge to the Board: • The Board shall ascertain in its deliberations that fundamental fairness and due process were accorded to the Respondent • Pursuant to Section 22-203(g) (5) of the Codified Ordinance,the formal Rules of Evidence set out in Florida Statutes shall not apply. • The Board shall consider solely the evidence presented at the Hearing in its deliberation of this matter. • The Board shall exclude from its deliberations irrelevant, immaterial and cumulative testimony. • The Board shall admit and consider all other evidence of a type commonly relied upon by reasonably prudent persons in the conduct of their affairs, whether or not the evidence so admitted would be admissible in a Court of Law or Equity. • Hearsay evidence may be used to explain or supplement any other evidence but hearsay by itself is not be sufficient to support a Finding, unless such hearsay would be admissible over objection in a civil action in Court. • The Standard of Proof in actions where a Respondent may lose his privileges to practice his profession is that the evidence presented by the Complainant must prove the Complainant's case in a clear and convincing manner. 9 January 16, 2013 • The Burden of Proof on the Complainant is a larger burden than the "Preponderance of Evidence" Standard set in civil cases. • The Standard of Evidence is to be weighed solely as to the charges set out in the Complaint. • The only charges the Board may decide upon are the only ones to which the Respondent has had an opportunity to prepare a defense. • The damages awarded by the Board must be directly related to the charges. • The decision made by the Board shall be stated orally at the Hearing and is effective upon being read, unless the Board orders otherwise. • The Respondent, if found guilty, has certain appeal rights to the Contractors' Licensing Board,the Courts, and the State Construction Industry Licensing Board("CILB"),pursuant to Florida Statutes and the Florida Administrative Code. • The Board shall vote upon the evidence presented in all areas and if the Respondent is found in violation, shall adopt the Administrative Complaint. • The Board shall also make Findings of Fact and Conclusions of Law in support of the charges set out in the Complaint. Chairman Joslin asked if it was possible to track the State's actions regarding the Contractor. Michael Ossorio responded the State will notify Collier County of the progress of its independent investigation. He noted the investigation process may take months or years before it is concluded. Vice Chairman White asked the Board to could make a recommendation to the State's Construction Industry Licensing Board ("CILB") for further action in addition to the requested penalty. He asked the County for its recommendation. Recommendations: • Indefinite suspension or revocation of the Qualifier's Building Permit pulling privileges under State License#CAC-058252 for the City of Naples, Marco Island, and unincorporated Collier County; • Payment of$1,000 to Collier County for investigative costs incurred; • The State conduct a full investigation into the matter, and • Revocation of the Qualifier's State license Attorney Morey reminded the Board that if a decision was made that a violation occurred,there is to be a finding of guilty of willful violation Vice Chairman White moved to approve finding the Respondent,Robert E. Elwell, Jr.,guilty of the violation as charged and that the evidence presented demonstrated that he willfully violated the Building Codes. Second by Terry Jerulle. Carried unanimously, 8—0. Attorney Morey advised the Board that that when imposing disciplinary sanctions on a State-certified Contractor who has been found to be guilty of misconduct,the Contractors' Licensing Board shall consider the following: 10 January 16,2013 (1) The evidence presented at the Hearing; (2) The gravity of the violation; (3) The impact of the violation on public Health/Safety or Welfare; (4) Any actions taken by the Respondent to correct the violation; (5) Any previous violations committed by the Respondent, and (6) Any other evidence presented at the Hearing by the parties relevant as to the sanction which is appropriate for the case given the nature of the violation or the violator. Mr. Morey verified the Board is allowed to recover administrative costs but cannot impose a fine on a State-certified Contractor. Terry Jerulle asked if a public notice(reprimand) could be published. Michael Ossorio confirmed the Board could only recommend to the State that the State publically reprimand the Respondent; the County did not have the authority to publish a press release. Vice Chairman White moved to accept Staff's recommendations and to approve imposing the following Sanctions: • Denial of all further Building Permit privileges for the Respondent in Collier County, the City of Naples,Marco Island, and Everglades City; • Requesting that the CILB order the Respondent to pay$1,000 to Collier County for administrative/investigative costs incurred; • Recommending to the CILB to revoke the Respondent's state license; • Recommending to the CILB to order a public reprimand of Mr. Elwell. Second by Terry Jerulle. Kyle Lantz suggested adding a recommendation to the State to impose a fine of $5,000 in addition to the other Sanctions. Vice Chairman White amended the Motion to include recommending that the CILB impose a fine of$5,000 on the Respondent. Second by Terry Jerulle. Carried unanimously, 8—0. Chairman Joslin stated: • This cause came on for public hearing before the Contractors' Licensing Board on January 16, 2013 for consideration of the Administrative Complaint filed against Robert E. Elwell, Jr., d/b/a"Service Star Cooling & Heating, Inc.,"the holder of record of State License#CAC-058252. • Service of the Complaint was made in accordance with Collier County Ordinance 90-105, as amended. • The Respondent was not present, and was not represented by Counsel. • The Board, at this Hearing, having heard testimony under oath, received evidence and heard arguments respective to all appropriate matters,therefore issues its Findings of Facts and Conclusions of Law as follows. 11 January 16,2013 Findings of Fact: • Robert E. Elwell, Jr., d/b/a"Service Star Cooling & Heating, Inc.," is the holder of record of State License#CAC-058252. • The Board of County Commissioners, Collier County, Florida, Contractors' Licensing Board is the Petitioner(Complainant) in this matter. • The Board has jurisdiction of the person of the Respondent. • Respondent, Robert E. Elwell, Jr., was not present and was not represented by Counsel at the Public Hearing held on January 16, 2013. • All notices required by Collier County Ordinance 90-105, as amended, have been properly issued and were personally delivered via certified mail. • The Respondent acted in a manner that is in violation of Collier County Ordinance and is the one who committed the act. • The allegations set forth in Administrative Complaint as Count I, under Section 22-201.1(2), "Willfully violating the applicable Building Codes or laws of the State, City, or Collier County, " have been found to be supported by the evidence presented at the Hearing. Conclusions of Law: • The Conclusions of Law alleged and set forth in the Administrative Complaint as to Count I have been approved, adopted and incorporated herein,to wit: o The Respondent violated Section 22-201.1(2) of Collier County Ordinance 90-105, as amended, in the performance of his contracting business in Collier County by acting in violation of the Section set out in the Administrative Complaint with particularity. Order of the Board: • Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and in Collier County Ordinance 90-105, as amended, by a vote of 8 in favor, none in opposition, a majority vote of the Board members present,the Respondent has been found in violation as set out above. • Further, it is hereby ordered by a vote of 8 in favor, none in opposition, a majority vote of the Board members present,that the following Disciplinary Sanctions and related Order are hereby imposed upon the holder of State License#CAC-058252: o Robert E. Elwell, Jr., d/b/a"Service Star Heating and Cooling, Inc." is required to $1,000 to Collier County for administrative costs incurred; o Deny all further building permit pulling privileges indefinitely in Collier County, the City of Naples, Marco Island; o Request that the State Construction Industry Licensing Board revoke his License; o Request that the State of Florida Construction Industry Licensing Board impose a maximum fine $5,000in penalties, and o Request that the CILB issue a public reprimand. 12 January 16,2013 Chairman Joslin noted the case was closed. IX. REPORTS: • Michael Ossorio stated a Resolution was passed by the State Legislature which authorized the Department of Business and Professional Regulations to allow "grandfathering"of any State-registered Contractors who wished to apply for State certification. He explained the process and noted it could be done administratively —an appearance before the State Licensing Board was no longer required. X. MEMBER COMMENTS: (None) XI. NEXT MEETING DATE: Wednesday, February 20, 2013 Board of County Commissioners' Chambers, 3`d Floor—Administrative Building"F," Government Complex, 3301 E. Tamiami Trail,Naples, FL 34112 There being no further business for the good of the County,the meeting was adjourned by the order of the Vice Chairman at 10:15 AM. COLLIER COUNTY CONTRACTORS LICENSING BOARD Richard Joslin, Chairman The Minutes were approved by the Board/Chairman on , 2013, "as submitted" ( 1 OR "as amended" ( 1. 13 Robert Rosiles 23434 Olde Meadowbrook Cir. Naples Florida 34134 (239)384-0951 Date January 24,2013 Re: Qualifying entity. To whom it may concern. I Robert Rosiles, Owner of R. G. S. Electric Inc. would like to thank the Board members present at this time for reviewing and considering my application for the second entity. I Robert Rosiles, do attest that I am aware of what entity is presently qualifying and to what entity I am requesting to qualify. Rich Miller and I have worked side by side in the electrical field over 25yrs together. My qualification are many starting with graduate of IEC of south west Florida,working around town for local Electrical Contractors holding positions from labor to upper management. I would appreciate this opportunity. Thanks again. Robert Rosiles Date „7:_;.;1,4//:" Prints iiiiiho Sign Qom;o.,MtSSioN o�� S 5 ta7,2071A: -go. * ' P. �ZO #DD 878347 • wwp��. cpyy�,�,d ;Q r. Sworn and subscribed befor me: us �t day of \.:,j A�, , _ ,20013 lie,,4,,..STAS.....� et �i�ei�d�aeo Notarized l ;X,r �• " , • Collier County / City of Naples / City of Marco Island Second Entity Qualification Guidelines '10414€c A 5t i C e k E aCP E € �e� C c rc EF Lc,f r F f r,fr [R r e n ' rt €��v^ �c e��,r�.�� fk��'�eFf _ F € fit prn C fri r,o-e Q y�k C� €E 1. A notarized statement signed by an authorized agent of the entity presently qualified as well as a notarized statement signed by an authorized agent of the proposed entity attesting to the fact that each is aware of what entity the licensee is presently qualifying and what entity the licensee is requesting to qualify. l0O bM �2. A credit reportt not more than mold for the present and the proposed entity. If the proposed entity is newly formed(less than one year old), then a rc edit report shall also be required of its qualifier. Proof that the licensee has been active in construction for the previous twelve months with the present entity. Applicant shall submit a list of up to three of the latest jobs completed including the date of completion, address, description of work, and the name of owner. (Use questionnaire) 4: If the proposed entity has previously been qualified (within the previous 12 months), a statement as to why the previous qualifier is no longer willing to qualify the entity. (Use questionnaire) 5. If the proposed entity has previously been qualified (within the previous 12 months), a list of the three jobs completed by the proposed entity within the last twelve months of qualification. Include the dates of completion, address, description of work, name of previous qualifier, and name of owner. (Use questionnaire) (. A statement that there are no outstanding liens or judgments against the present entity or against the proposed entity, or against any consumer/consumers that are a result of construction performed by either the present entity or the proposed entity. If liens or judgments are present, an explanatory statement is required. (Use questionnaire) 7. Bank statements for the previous three months on both the present and the proposed entity (if applicable). 8. Verification of bank balance for each entity, for the same date, not to exceed three months prior to the scheduled hearing. y. Statements indicating the manner of remuneration of the licensee for the present as well as the proposed entities. (Use questionnaire) 10. Statement showing the licensee's ownership in the present entity as well as ownership in the proposed entity. (Use questionnaire) Second Entity Qualification Guidelines continued 11. Application fee of . Make check payable to the Collier County Board of County Commissioners. This fee is nonrefundable regardless of the outcome of the request for additional entity. If approved, the additional fee for the license will be according to the schedule adopted by the Board of County Commissioners. 12. A statement of need, from the licensee, for maintaining the present entity qualification while requesting to qualify an additional entity. (Use questionnaire) -'13. A list of principal suppliers for the present and proposed entity. (Use questionnaire) 14. A list of persons authorized (currently as well as the previous six months) to pull permits for the licensee. (Use questionnaire) 15. A list of all officers in the present as well as in the proposed entity. (Use questionnaire) 16. A properly completed Application to Qualify a Second Entity. It should be noted that the qualifier must be responsible for and capable of supervising, directing, managing, and controlling both the contracting activities of the entity he/she now qualifies as well as the proposed entity. Managing of contracting activities includes the proper collection and disbursement of funds and the proper payment of subcontractors and suppliers. In addition, he/she must be responsible for and capable of the supervision, direction, management, and control of all entities for which he/she pulls permits. Geographical location of all entities involved must be so situated as to permit the aforementioned supervision, direction, management and control. The Board will consider the ownership, interest, status as a corporate officer or partner, check writing authority, and other factors as evidence of control of the entities. At the sole discretion and option of the Board, the Board may deem it a requirement that the qualifier be able to sign on checks relating to construction payables. ALL APPLICANTS MUST APPEAR BEFORE THE CONTRACTOR LICENSING BOARD FOR FINAL APROVAL ''L C FCC g ice EW 6c��.'S L6y. F'e E::' t4!.�y,.Y� E E `t 4 t BdiS ER pC Ck FF F \. P ;.r y 'r� .� •-4"SF £ '� E 6 F"g`c' Fvref C . l ¢.�.F ' t 1 E �,.t t o € k. c_,F p i . 1 ( {� g . d E s '�c c c s �u°�r �.p c r' p a 'F ¢ @ c g L 6 f 6�E' � ty :: g, &v� €`T k[.�'�, C. R nE9 E F e t [ J v F,E d "# F.k tit ma irtkt BUILDING REVIEW AND PERMITTING CONTRACTOR LICENSING SECTION COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO ISLAND Contractors Licensing Board ATTACH(TAPE ON ALL SIDES)A Community Development&Environmental Services Division RECENT PHOTO OF QUALIFIER. 2800 North Horseshoe Drive PHOTO MUST BE FULL-FACED, Naples,Florida 34104 VIEW APPROX.2"x 2",A CLEAR Telephone: (941)403-2431 AND RECOGNIZABLE LIKENESS. Facsimile: (941)403-2345 APPLICATION TO QUALIFY SECOND ENTITY THIS FORM MUST BE COMPLETED IF YOU WISH TIO INITIATE OR CHANGE THE STATUS OF AN EXISTING LICENSE. READ ALL INSTRUCTIONS AND MAKE SURE YOU HAVE SIGNED WHERE INDICATED. TYPE OR PRINT IN INK. MAKE CHECKS PAYABLE TO THE COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS. ALL CHECKS MUST CLEARLY STATE APPLICANT'S NAME AND ADRESS. PLEASE ALLOW 2-3 WEEKS FOR PROCESSING. FEES 105.°° 1. Applicant's Name(Licensee) 7:z--v.::A .+ tre- LICENSE# l C` h--1 UNDER THE FEDERAL PRIVACY ACT, DISCLOSURE OF SOCIAL SECURITY NUMBERS IS VOLUNTARY UNLESS SPECIFICALLY REQUIRED BY FEDERAL STATUTE. IN THIS INSTANCE, SOCIAL SECURITY NUMBERS ARE MANDATORY PURSUANT TO TITLE 42 UNITED STATES CODE, SECTIONS 653 AND 654; AND SECTIONS 455.203(9), 409.2577, AND 409.2598, FLORIDA STATUTES. SOCIAL SECURITY NUMBERS ARE USED TO ALLOW EFFICIENT SCREENING OF APPLICANTS AND LICENSEES BY A TITLE IV-D CHILD SUPPORT AGENCY TO ASSURE COMPLIANCE WITH CHILD SUPPORT OBLIGATIONS. SOCIAL SECURITY NUMBERS MUST ALSO BE RECORDED ON ALL PROFESSIONAL AND OCCUPATIONAL LICENSE APPLICATIONS AND WILL BE USED FOR LICENSE IDENTIFICATION PURSUANT TO THE PERSONAL RESPONSIBILITY AND WORK OPPORTUNITY RECONCILIATION ACT OF 1996(WELFARE REFORM ACT), 104 PUB.L. 193,SEC.317. �. 'i Place of Birth: (City) C,i`X--- °"t` (State) "t (Nation) (I. - Social Security Number Date of Birth SEX: Male Female ; RACE: ?` (1)White (2)African-American;_ 3 Hispanic_ (4)Asian (5)Indian;(6)Other 2. Name of Business To Be Qualified: (: - t. l i : . TM L< ,i_ r Li Mailing Address: -)-C:TY L °� m�i�t�' � J l," t(k0S �-?3 ,,Y�� k i., Street or P.O.Box City State Zip Street Address: Street City jj State Zip Business Phone Number:( i) �L s' � 1 ° Federal ID Number: `i"6 APPLICATION TO QUALIFY SECOND ENTITY 3. Applicant's (Licensee) Name: 1 t°. cb`' ;/yy Last First Middle Applicant's (Licensee) Official Mailing Address of Record: Street City County State Zip Street Address (if Post Office Box is listed above): Street City County State Zip c Home Phone --71, �x s >4- Office Phone ) k 4. VERIFICATION OF GENERAL LIABILITY INSURANCE and WORKERS' COMPENSATION (or exemption from Workers Law)INSURANCE (ATTACH A CERTIFICATE OF INSURANCE OR EXEMPTION. I HEREBY AFFIRM THAT I HAVE OBTAINED GENERAL LIABILITY AND PROPERTY DAMAGE INSURANCE IN THE AMOUNTS SET FORTH BELOW and workers' compensation insurance (unless exemption has been filed with and approved by the Bureau of Workers' Compensation compliance), for the safety and welfare of the public. I further affirm that I have met all continuing education requirements. I understand that it is my responsibility to maintain all documentation supporting this affirmation of eligibility. I affirm that these statements are true and correct and I recognize that providing false information may result in a FINE,SUSPENSION or REVOCATION of my contractor's license. APPLICANT'S SIGNATURE PRINT OR TYPE NAME DATE ' tyb` \F r of f t � P [t E t' t 6 n :, [ l P [ r 3t14.4 C. C� cf F t da „ ' s+ ilru ntii p 1 c1P. � a u r i [ r ,v:. t d f ��:�(�ws{r }C � /P .{a..✓�'€�Yl b € yfE l q �,.� �rfl . �f�-. 314°. t 1 �R 8�t' � r�' P k.l � i?�•, TO FILE A NOTICE OF ELECTION TO BE EXEMPT from the provisions of the FLORIDA WORKERS' COMPENSATION LAW, contact your nearest Florida Department of Labor and Employment Security, Bureau of Workers' Compensation Compliance office to obtain form# BCM-250-T. 3 APPLICATION TO QUALIFY SECOND ENTITY S. QUESTIONNAIRE—QUALIFYING A SECOND ENTITY THIS FORM MUST BE COMPLETED BY THE APPLICANT REQUESTING TO QUALIFY A SECOND ENTITY OR REQUESTING A CHANGE TO AN EXISTING SECOND ENTITY QUALIFICATION. THE APPLICANT AND PRESIDENTS (OR PARTNERS/OWNERS) OF ALL COMPANIES INVOLVED MUST SIGN WHERE INDICATED. PLEASE USE THIS SHEET. ONLY USE ADDITIONAL SHEETS IF NECESSARY. A. Explain why you wish to maintain your present license(s) while qualifying this additional,business. B. Has the proposed entity been previously qualified? If so, explain why the previous qualifier is no longer willing to continue to qualify this entity. C. If the proposed entity has been qualified within the last 12 months, list the last three jobs completed by the proposed entity. Include dates of completion, address, description of work, name of previous qualifier and name of owner. D. List the last three jobs completed by you under your existing license. Include date of completion, . address, description of work, name of previ us qualifier and name of owner. ., , i t ! a _ ��; ,,'� '�t„.7�`. 5s„ � �. „�'' '14?lt;... j .,"•''a.t,,,$.vl, L-e."'vlgtR.,: \ i ^yJ d90 /LA_ � f. 1, Jb� v aS ( l ✓ ' .� - ', t� 3t� ';..\ ) r�1ui. F'± i '6 � . Lek ` fi'J\ '°�`�',r-.:.� +�'s � ,�v1.� i∎-rc.Y°civ t� i r { Aft Y `.` 4 t 4 yt;�.l: E. ` Do the business(s) you presently qualify and/or wish to qualify have any outstanding ing liens against them or against the property of cpnsumers as a result of construction work or a contract they had with your firm? YES NO X If yes, identify business and provide explanation. F. List principal suppliers for the past six months for the business you presently qualify. Vt.; G. List principal suppliers for the past six months for the business you are applying to qualify. 4 APPLICATION TO QUALIFY SECOND ENTITY H. List persons authorized(currently and in the past 6 weeks) to pull permits on your license(s). i' ,ktt I. How are you being paid by the business(s) you presently qualify (examples: salary, % of profits, etc.)? . gip\ J. How will you be paid by the business you are applying to qualify? K. What percentage of ownership do you have in the present business(s) you are qualifying and what percentage of ownership will you have in the business you are attempting to qualify? C is+ �, t: rti i • £ J L. Do you(applicant) have check writing authority for the present and proposed entity? YES NO If yes, provide a letter from the bank. M. List officers (or partners, owners) of business you are applying to qualify and give title/position held. N. List officers (or partners, owners)of business you presently qualify and give title/position held. \,U\ 0. Do the business(s) you presently qualify and wish to qualify have any other licenses presently qualifying those businesses? YES NO . If yes, list licensee's name, license number and address. P. Submit notarized statements signed by an authorized agent of the entity(s) you presently qualify and from an authorized agent of the proposed entity attesting to the fact that each is aware of what entity you presently qualify, and what entity you are requesting to qualify. 5 APPLICATION TO QUALIFY SECOND ENTITY 6. FINANCIAL RESPONSIBILITY. All applicants/licensees must answer the questions below. If you answer"yes" to any of the questions, a written explanation is required. Additional documentation is also required,as indicated. If you are applying to qualify a corporations partnership or other legal business entity, ALL OFFICERS OF THAT ENTITY MUST ALSO EXPLAIN IF ANY OF THE BELOW WOULD PERTAIN TO THEM. This would include the president, vice president, secretary, and/or partners or owner of the proprietorship. HAVE YOU,the business organization, or any of the above mentioned individuals in any capacity ever: YES NO A. Undertaken construction contracts or work that a third party, such as a bonding or surety company, completed or made financial settlements? B. Had claims or lawsuits filed or unpaid or past due accounts by your creditors as a result of construction.operations? C. Undertaken construction contracts or work which resulted in liens, suits or judgments being filed? D. Had a lien filed against you by the U. S.Internal Revenue Service or Florida Corporate Tax Division? If "yes", you must attach a copy of the Notice of Lien, and any payment agreement, satisfaction, Release of Lien or other proof of payment. T _ E. Made an assignment of assets in settlement of construction obligations for less than the debts outstanding? '- F. 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" any disciplinary action by a state, county, or municipality? If "yes", you must attach a copy of any state, county, municipal or out-of-state disciplinary order or judgment. _`` G. Filed for or been discharged in bankruptcy within the past five years? If"yes", you must attach a copy of the Discharge Order, Order Confirming Plan,or if a Corporate Chapter 7 case, a copy of the Notice of Commencement. H. 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? NOTE: IF YOU, THE APPLICANT/LICENSEE, HAVE HAD A FELONY CONVICTION, PROOF THAT YOUR CIVIL RIGHTS HAVE BEEN RESTORED WILL BE REQUIRED PRIOR TO LICENSURE. NOTE: The Board requires any applicant/licensee who answers "yes"to any question contained in the Financial Responsibility Section of the Application to supply a complete explanation of the response, and include a statement detailing the steps taken by the licensee to prevent a recurrence of the circumstances leading to the conviction, discipline,judgment, bankruptcy, or other event leading to the response. You must include nny proof of pnymont,anliafneliun of lions,judgments and bankruptcy discharge papers in your submittal,if applicable. Applicants may be required to appear before the Application Review Committee to answer questions regarding such responses. 7. CREDIT REPORT (Reports that do not include the following information will not be acceptable) Reports for the present and proposed entities must be submitted (not more than six months old) from a nationally recognized credit- reporting agency and must be submitted before an additional license can be issued. If you are applying to qualify as an individual, the credit report must be on you. If you are applying to qualify a business organization,the credit report must be on the business organization. If your business is newly established,you will ALSO need to submit credit reports on the following: the newly formed business and the majority owners holding 25%or more interest PLUS letters from three construction related suppliers indicating that an account either exists or has been opened for the entity you are applying to qualify. A credit report is also required for the entity that you are presently qualifying. 6 • APPLICATION TO QUALIFY SECOND ENTITY Make sure you give written authorization to the credit agency so they can accurately check your credit references. Federal,State,County (including all counties within the State of Florida)public records pertaining to judgments,bankruptcies,and tax liens must be searched and results noted on the credit report. The credit report must include a public records check of the.home counties and all other counties where 25% or more of the contractor's work has been done over the last three years. (If public records reflect unsatisfied obligations, attach written explanation and legal documentation.) The credit report must reflect officers, partners, and proprietors and FEIN and Social Security numbers. Attach a credit report(s) from a nationally recognized credit-reporting agency to this application. If you are unable to receive the credit report, you may have a credit agency send the credit report directly to: Florida Construction Industry Licensing Board, 7960 Arlington Expressway,Suite 300,Jacksonville,Florida 32211-7467,and complete this statement: I have requested a credit report(s)on i "t i� t Lr ( ' - Date (PROPOSED ENTITY AND PRESENT ENTITY) to be sent directly from (NAME OF CREDIT REPORTING AGENCY) 8. CORPORATIONS — ATTACH A COPY of the current Annual Report Form filed with the Florida Secretary of State or, if your corporation is newly established, attach a copy of the Florida Certificate of Incorporation for the proposed and present entities, if applicable. All foreign (out of state) corporations must register with the Florida Secretary of State (850)488-9000. 9. FICTITIOUS NAME — ATTACH A COPY of the recorded Fictitious Name Registration from the Division of Corporations; also submit a copy of the filed application or newspaper article for the proposed and present entities, if applicable. (This does not apply to corporations using their registered name.) 10. ORGANIZATIONAL RELATIONSHIPS7 Do you qualify any business other than the business you are applying to qualify? YES NO (If "yes", what percentage of the business do you own(if any)? %). Contact Board office for guidelines to qualify more than one business. Company Name: Company Address: Your License Number: 11. PROOF OF CONTINUING EDUCATION IS REQUIRED when reactivating or reinstating a license. When reactivating or reinstating your license, you must attach a copy of your Certificate of Completion from a Board approved sponsor. You must provide proof of your continuing education hours, equal to those required of an active licensee, during the period of time your license was delinquent or inactive (beginning December of 1993). 7 AFFIDAVIT , t, certify that the foregoing is true and correct to the best of my knowledge. 4 itt- AUTHORIZED OFFICER FOR THE FIRM STATE OF FLORIDA COUNTY OF f t , The foregoing instrument was acknowledged before me this (DATE) t 4 1 by of I (NAME OF OFFICER,TITLE/AGENT) (NAME OF CORPORATION) a corporation, on behalf of the corporation. He/She has (STATE OR PLACE OF CORPORATION) produced as identification and did not take an oath. (TYPE OF IDENTIFICATION) SIGNATURE OF NOTARY (PRINT NAME OF NOTARY) NOTARY PUBLIC ,,Ortve,:•,, HIM SANGHVI ten-. Notary Public-State of Florida My Comm C Expires Sep 21,2014 .0 Commission#EE 28343 8 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance 90-105, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. 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 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 all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. to- ,,t.,`.'.4 APPLICANT(PLEASE PRINT) NAME OF COMPANY SIGNATURE OF APPLICANT STATE OF FLORIDA COUNTY OF , - The foregoing instrument was acknowledged before me this S .e_' . - , ° '". - by (DATE) I who has produced =:7--,(', y.1',-.( ' �, (NAME OF PERSON ACKNOWLEDGING) f `` e. (TYPE OF IDENTIFICATION) as identification and who did not take an oath. A SIGNATURE OF NOTARY t •`'�!VW*% NINA SANGHVI (PRINT NAME 2 a...'" 6tar P NOTARY PU' = f �:� ` '-Y y Public-State of Florida u. Q My Comm.Expires Sep 21.2014 1?FO�,op�� Commission#EE 28343 9 RESOLUTION OF AUTHORIZATON WHEREAS S , AL- proposes to . it,`n (Name of Business Entity) engage in contracting as L�.N ( t>^ in (Type of legal entity:corp.,partnership,etc. Collier County,Florida,according to Collier County Ordinance 99-45;and WHEREAS?e-At 64 e .a SC') n proposes to (Name of Business Entity) qualify for a Certificate of Competency with ` , (Name of Individual) NOW,THEREFORE,BE IT HEREBY RESOLVED LVED THAT: We the undersigned j L 1&dA 2 - C "er of (Officers,Owners,Partners) P - (c0-6\e 4 yr 5 L' Pi 5" hereby resolve and represent to the Collier County (Name of Business Entity) t�� Contractors'Licensing Board that the qualifying agent, ,is active (N of In '' idual) in all matters connected with the contracting business of ASS GieC L _j ry_ ,and (N e of Business,Entity) We further resolve and represent that e U ✓'C ,`-e,5 i t e 5 is (Names of Individual) legally empowered to act for to\C SI-e(1M(... in all matters connected with its (Name of Business Entity) coiacting business, and has the authority to supervise construction undertaken by Usl S ( -ecrvtc . (Name of Business Entity) °(' DULY PASSED AND ADOPTED THIS Z 1 day of v , ck 13 (Officers,Partners,Owners—with Designation underneath) Witness l,(-v' - Witness Witness Corporate Seal(if Applicable) Or Notary Public Certificate ; 5 � i 'b -Sworn to and subscribed before me this y of,A.LI,°%. ,a ,/-�1p ' d '- `� `®._ ) ''' cut L- f.+ Y S `..._ .,t- ,),i. ,,,,`-i """' Notary Public Name Printed„ .i Notary Public Signature Commission Number L-`'/ i .- e., 7 . My Commission expires: �j 1 '7'//` 3 �, \`' 111utq,u , r,1�� V:•;y,?lRES c _Z.g o.. • ^c 1,•w • t... Ail COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples,Florida 34104 • 239-403-2400 • FAX 239-403-2334 MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio, Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy-creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statues. Pelican Electric of SW Floirda Inc. 1341 Frank Whiteman Blvd. Naples Florida 34103 (239)248-7566 Date January 24,2013 Re: Qualifying second entity. To whom it may concern. I Richard Miller, Owner of Pelican Electric would like to apply for a second entity. My business has grown and I need skilled help in order to take care of more customers in the Collier County area. I Richard Miller do attest that I am aware of what entity I am presently qualifying and to what entity I am requesting to qualify. Thank you for your time and consideration on this matter. Date Jam' Print Sign r-1 Sworn and subscribed before me day of �i 1 ,20013 Notarized B , ' J Y \AONIEl"TE P •• C � MMISSIpN•.��if�ii Zo •• N• 4 ti #b � 8347 41'1' tST gRATE��4\S Raa 4 Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 7/82 01/22/13 14:31CT [SUBJECT] [SSN BIRTH DATE] MILLER, RICHARD T. [CURRENT ADDRESS] [DATE RPTD] 9/94 1341 FRANK WHITEMAN BV., NAPLES FL. 34103 [FORMER ADDRESS] 7/94 1911 ADDISON WY. , LOS ANGELES CA. 90041 2800 PINE ST. , #11. NAPLES FL. 34112 [POSITION] :=RENT EMPLOYER AND ADDRESS] [RPTD] PELICAN ELECTRIC OF SWFLA PRESIDENT NAPLES FL. 11/04 [FORMER EMPLOYER AND ADDRESS] MACHINE OPER DOLLY MADISON CAKES 4/88 LOS ANGELES CA. MODEL P R O F I L E ***FICO CLASSIC 04 SCORE +808 : 004, 014, 012 *** CREDIT S U M M A R Y * * * T O T A L F I L E H I S TOR Y PR=0 COL=O NEG=0 HSTNEG=0 TRD=7 RVL=6 INST=0 MTG=1 OPN=0 INQ=2 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $4303 $8000 $766 $0 $15 90% TOTALS: $4303 $8000 $766 $0 $15 TRADES 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 GECRB/EGIA F 999204R 5/08 $0 111111111111 RO1 1/13A $5000 $0 111111111111 I CHARGE ACCOUNT 3/09C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 EXPO/CENA B 26H3004 7/08 $750 111111111111 RO1 1/13A $2501 $0 111111111111 I CHARGE ACCOUNT 9/11C $0 INACTIVE ACCOUNT 48 0/ 0/ 0 CAP ONE B 1DTV001 3/03 $4303 MIN15 111111111111 RO1 1/13A $8000 $0 111111111111 I BUSINESS CREDIT C $766 48 0/ 0/ 0 SEARS/CBNA B 6256458 3/05 $34 111111111111 RO1 12/12A $8440 $0 111111111111 I CREDIT CARD 2/09C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CHASE B 26QK001 7/01 $1438 111111111111 RO1 2/09A $5000 $0 111111111111 I CREDIT CARD 11/08C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 6331059 6/00 $981 RO1 9779 1/09A $5000 $0 I CREDIT CARD 1/09C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 111111111111 MO1 CHASE B 1ULY004 11/94 $50.4K 360M474 11111111 2/04A $0 46 0/ 0/ 0 I CONVENTIONAL REAL 2/04C $0 CLOSED I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 1/22/13 ZNP6284423 (FLA) MERIT CREDIT 6/15/11 BCI0002250(DAY) FIFTH THIRD CREDIT R E P O R T S E R V I C E D B Y TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com amscr frd rRR . .ImpoRmAplim 342 ' 241. FZ9992C4R (866) 396-8254 C/O PO BOX 965036 ORLANDO 32896 BZ26HF FL. EXPO/CBNA PO BOX 6497 SIOUX FALLS SD. 57117 (800) 955-7070 CAP ONE BC1DTV001 POB 30281 SALT LAKE CITY UT. 84130 SEARS/CBNA BC6256458 PO BOX 6282 SIOUX FALLS SD. 57117 (800) 945-2006 CHASE BC26QK001 P.O. BOX 15298 WILMINGTON DE. 19850 BK OF AMER PO BOX 982235 EL PASO TX. 79998 (800) 848-9136 CHASE PO BOX 24696 COLUMBUS OH. 43224 FIFTH THIRD B 0002250 (513) 579-5353 38 FOUNTAIN SQ CINCINNATI OH. 45263 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECT.= AND VERIFIED AT THE COUNTY. STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UUNIONCLLC COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. =PERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 01/22/2013 14:32:46 -AN1 REPORT 404 PELICAN ELECTRIC OF SOUTHWEST FLORIDA, INC BIN: 738246796 1341 FRANK WEITEMAN BLVD FILE ESTABLISHED: SEP. 2002 NAPLES FL 34103-3878 PROMS: 239-649-8309 EXECUTIVE SUMMARY THE PRIMARY BUSINESS FOR PELICAN ELECTRIC OF SOUTHWEST FLORIDA, INC IS Electric Contractors (SIC 17310100) WITH A SECONDARY BUSINESS CATEGORY OF Electrical Contractors (SIC 17310000). MAYS BEYOWD TERMS (DST) FOR PELICAN ELECTRIC OF SOUTHWEST FL, INC AS OF 01/22/13 : 0 ** THIS BUSINESS IS PAYING, ON AVERAGE, PREDICTION FOR 03-20-13 : 1 0 DAY(S) LATER THAN INVOICE DUE DATE.** DST NORMS ELECTRICAL WORK: 13 ALL INDUSTRIES: 10 NET 30,THE MOST FREQUENT PURCHASING TERMS IN THE ELECTRICAL WORK INDUSTRY A CREDIT AND REVOLVE DBT RANGES BASED ON CURRENT PAYMENT BEHAVIOR: THIS BUSINESS'S RANGE === 80% OF U.S. BUSINESSES HAVE A DDT OF 0 - 15, 11% OF U.S. BUSINESSES HAVE A DBT OF 16 - 50, 5% OF U.S. BUSINESSES HAVE A DBT OF 51 - 90, 4% OF U.S. BUSINESSES HAVE A DBT OF OVER 90. HISTORICAL PAYMENT GUIDE 6 MONTH ACCOUNT BALANCE RANGE : $1900-$4300 (CURRENT TOTAL: $2900) HIGHEST CREDIT AMOUNT EXTENDED: $4300 (MEDIAN: $2200) INDUSTRY PAYMENT COMPARISON : HAS PAID SOONER THAN 50% OF RELATED FIRMS PAYMENT TREND INDICATION : STABLE SIGNIFICANT DEROGATORY DATA: NONE REPORTED COPYRIGHT 2013 =PARIAH INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **CONTINUAD** 7r^*" m qtr,,. -- EXPERIAN BUSINESS REPORT PAGE 2 01/22/2013 PELICAN ELECTRIC OF SOUTHWEST FLORIDA, INC BIN: 738246796 TRADE PAYMENT INFORMATION TRADE PAYMENT EXPERIENCES (TRADE LINES WITH AN (*) AFTER DATE REPORTED ARE NEWLY REPORTED) RECENT ACCOUNT STATUS HIGH -DAYS PAST DUE- BUSINESS DATE LAST PAYMENT CREDIT BALANCE 1- 31- 61- CATEGORY REPTD SALE TERMS $ $ CUR 30 60 90 91+ COMMENTS BLDG MATRL 01-13 CREDIT 0 BLDG NAM 12-12 12-12 CREDIT 4300 2900 100% PAYMENT TOTALS CONTINUOUSLY REPORTED( 2): 4300 2900 100% DST: 0 ADDITIONAL PAYMENT EXPERIENCES CRED CARD 01-13 12-12 REVOLVE 4300 800 100% ELEC SUPLR 01-12 NET 30 100 100 100% PAYMENT TRENDS (EASED ON CONTINUOUSLY REPORTED TRADE LINES) -DAYS PAST DUE- BUSINESS BALANCE 1- 31- 61- DBT $ CUR 30 60 90 91+ AS OF 01/22/13: 0 2900 100% 01-01-13: 0 2900 100% 12-01-12: 0 2100 100% 11-01-12: 0 2800 100% 10-01-12: 0 1900 100% 09-01-12: 0 4300 100% 08-01-12: 0 2500 100% COPYRIGHT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **CONTINUED** 14/1W REPORT .--------- BIN: 738246796 MOB 3 01/2212013 PELICAN ELECTRIC OF SOUTHWEST FLORIDA, INC PAINENT HISTORY--QUARTERLY AVERAGES -DAYS PAST DUE- BALANCE 1- 31- 61- DBT $ CUR 30 60 90 91+ 4TH-Q-12 (OCT-DEC): 0 2600 100% 3RD-Q-12 (JUL-SEP): 0 2900 100% 2ND-Q-12 (APR-JUN): 0 2400 100% 1ST-Q-12 (JAN-MAR): 0 700 100% 4TH-Q-11 (OCT-DEC): 0 1400 100% THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. MILLER LOCATED AT 1341 CURRENT STATUS : ACTIVE BUSINESS. AGENT IS RICHARD T ML_ FRANK WEITZMAN BLVD, NAPLES, FL. FEDERAL ID : 46-0492293 SIC: 1731 PRIMARY PRODUCT/SERVICE: ELECTRICAL WORK CONTRACTORS SIC: 1731 ADDL PRODUCT/SERVICES : ELECTRICAL ADDL PRODUCT/SERVICES : ELECTRICAL WORK CONTRACTORS SIC: 1731 NO. OF EMPLOYEES : 4 ESTIMATED SALES : $564,000 TITLE: PRESIDENT PRINCIPAL(S) : RICHARD MILLER INQUIRIES BUSINESS 2013 2012 CATEGORY JAN DEC NOV OCT SEP AUG JUL JUN MAY ELEC DISTR 1 TOTALS 1 THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SMALL NOT BE REPRODUCED. NEITHER EXPERIAN INFORMATION SOLUTIONS, INC., NOR ITS SOURCES OR DISTRIBUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE SOLUTIONS,FO OR RIGHTS RELIANCE SPON xT COPYRIGHT 2013 EXPERIAN INFORMATION **END REPORT** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY TEE BUSINESS OWNER/PROPRIETOR. PUBLIC THIS REPORT NAVE BEEN CHECKED AND VERIFIED AT THE COUNTY INCLUDINGPINELLAS),, STATE AND LEVELS. PUBLIC RECORDS LEARNED: _0_ SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1- 800-371-3348 OR 239-277-3202. COLLIER COUNTY CERTIFICATE OF COMPETENCY CERTIFICATION INFORMATION C18855 Certification Information Collier County Board of County Commissioners Date: January 22, 2013 DBA: Pelican Electric Of Southwest FL, Inc. ADDRESS: 1341 FRANK WHITEMAN BLVD. NAPLES, FL 34103- PHONE: 2396498309 CELL: 2392487566 FAX: LICENSEE NBR: C18855 QUALIFIER: RICHARD T. MILLER TYPE: ELECTRICAL CONTR.-REGISTERED CLASS CODE: 2000 STATE NBR: ER13012470 ISSUANCE NBR: 18855 STATE EXPIRATION: INSURANCE: ORIG ISSD: COUNTY EXPIRATION: August 31, 2014 General Liability October 15, 1998 September 30, 2013 June 14, 2013 Worker's Comp Exemption August 28, 2014 NOTE: It is the Qualifier's responsibility to keep all business, licensing and requirements current and to provide up to date copies for Collier county files. This includes all insurance certificates and any change of address information. Collier County * City of Marco * City of Naples Contractor Licensing ELECTRICAL CONTR.-REGISTERED Cert Nbr: County Exp: Status: C18855 September 30, 2013 Active State Nbr: State Exp: ER13012470 August 31, 2014 Pelican Electric Of Southwest FL, Inc. RICHARD T. MILLER 1341 FRANK WHITEMAN BLVD. NAPLES, FL 34103- Signed: Ti]P DEPARTMENT OF THE TREASURY 11\.)INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 01-14-2013 Employer Identification Number: 46-1758674 Form: SS-4 Number of this notice: CP 575 A R G S ELCTRIC INC 23434 OLDE MEADOWBROOK CIR BONITA SPGS, FL 34134 For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 46-1758674. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1120 03/15/2014 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year) , see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue) . Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. IMPORTANT INFORMATION FOR S CORPORATION ELECTION: If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S must be made within certain timeframes and the corporation must meet certain tests. All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation. (IRS USE ONLY) 575A 01-14-2013 RGSE E 9999999999 SS-4 B J If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042) , excise taxes (Form 720) , or income taxes (Form 1120) , you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS) . A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover. Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer. The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized a-file Providers, such as Reporting Agents (payroll service providers) are available to assist you. visit the IRS Web site at www.irs.gov for a list of companies that offer IRS e-file for business products and services. The list provides addresses, telephone numbers, and links to their Web sites. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. IMPORTANT RENDERS: * 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 RGSE. You will need to provide this information, along with your EIN, if you file your returns electronically. Thank you for your cooperation. (IRS USE ONLY) 575A 01-14-2013 RGSE B 9999999999 SS-4 Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please CP 575 A correct any errors in your name or address. 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 01-14-2013 ( ) - EMPLOYER IDENTIFICATION NUMBER: 46-1758674 FORM: SS-4 NOBOD INTERNAL REVENUE SERVICE R G S ELCTRIC INC CINCINNATI OH 45999-0023 23434 OLDE MEADOWBROOK CIR IdAhldoh.hlulA.M.An.d.1.11,1dul BONITA SPGS, FL 34134 141/ :- .. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION kEt- "'` ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MILLER, RICHARD T PELICAN ELECTRIC OF SOUTHWEST FLORIDA INC 1341 FRANK WHITEMAN BLVD NAPLES FL 34103 r r -STATE OF FLORIDA AC# 6 3 9 5 5 ? Congratulations! With this license you become one of the nearly one million - ' DEPARTMENT OF .BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers,from PROFESSIONAL REGULATION boxers to barbeque restaurants,and they keep Florida's economy strong. ER13 012 47 0 05/24/12 110 3 9 8 758 Every day we work to improve the way we do business in order to serve you better For information about our services,please log onto www.myfloridalicense.com. REG ELECTRICAL CONTRACTOR There you can find more information about our divisions and the regulations that MILLER, RICHARD T impact you,subscribe to department newsletters and learn more about the PELICAN ELECTRIC OF SOUTHWEST FL Department's initiatives. (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR Our mission at the Department is:License Efficiently,Regulate Fairly.We TO CONTRACTING-IN ANY AREA) constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida,and congratulations on your new license! HAS atjo data: AUG under 20 provisions 24 Ch.489 itre ration date: AIIG 31, :2014 L/2052401231 DETACH HERE THIS DOCUMENT HAS A COLORED BACKGROUND•MICROPRINTING•LINEMARK"'PATENTED PAPER AC# 6139557 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#L12052401231 DATE BATCH NUMBER LICENSE NBR 05/24/2012 110398758 ER13012470 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS Expiration date: AUG 31, 2014 (INDIVIDUAL MUST MEET'ALL LOCAL LICENSING REQUIREMENTS 'PRIOR. TO CONTRACTING IN ANY AREA) MILLER, RICHARD T PELICAN ELECTRIC 'FOSOUTHWEST FLORIDA..., INC ' 1341 FRANK WHITEMAN BLVD NAPLES FL 34103 RICK SCOTT KEN LAWSON SECRETARY GOVERNOR DISPLAY AS REQUIRED BY LAW First Citizens Bank January 23, 2013 Re: RGS Electric Inc To Whom It May Concern: This letter is to confirm that RGS Electric, Inc. established a deposit relationship with First Citizens Bank in January 2013. If you have any questions please feel free to contact me at(239) 390-5282. Thank you. Sincerely, # I 4 Cindy J. Cedeno Assistant Vice President Service Manager Bonita Springs Bonita Springs,FL 34135 Statement Period Date:9/1/2012-9/28/2012 • ----. Account Type:Business 53 Checking FIFTH THIRD BANK (SOUTH FLORIDA) P.O.BOX 630900 CINCINNATI OH 45263-0900 M Banldng Center:Goodlette Road �� PELICAN ELECTRIC OF SW Banking Center Phone:239-403-6553 11.11.1" FLORIDA 0 Commerdai Client Services: 1-800-589-5355 'um° 600 GOODLETTE RD N www.53.com SUITE 104 821 "1.111 NAPLES FL 34102-5662 mow lilt.li,yd iialitisi.lll4rl ti111111111h11ililllhlliIJIHlul ».: .. .,,.a:, .�,....r ..�,�.,V, •�(.. ... �t' :: ':.•` :.:•8:.r:i�.•^.tv:,, •:�Y••.3i 4'E'SC` C•-?+��:''cs;•:<?.` -....•....`'2•:S}:.Z... , ...�":�....v.. .."�f�`.`e`YY�`"�C'a..�.)•..2i.....;..:.,.s.•_; _ y� .- .. ..:'.7:�:S.i�:n..n,v... >•`;,':j?:`�•.'::'`,•,t'�,'.••:•"`v, �, '��E ti$. . ..,.',•A.,....... ..:,�'r.'.........,.,,. ,'v,.`s.:•..;.;.p.,•..;,r.:, •..:.. - ... .- .-ar.... .. .!�. .:'C.�..rsir:: a:o:•x,,:. :. :.a:r.•::aii.,.`�. i .--....:-'- n' .LY•.�: .\an,t?.....\... -SY:..,.i{.::y:.•.-i .:..:. :. ... .- ....... ....:"A\i,•,i::t>:,i#.......+).1,�:7,:Y:T.'\Yii::M?.{,Y,� h:1Yti�J.0 4';>ti }: 09/01 Beginning Balance $38,570.56 Number of Days in Period 28 11 Checks $(9,050.72) 1 Withdrawals/Debits $(253.03) _ 3 Deposits/Credits $14,455.90 _ _- _ —09/28 Ending Balance $43,722.71 Checks 11 checks totaling$9,050.72 Indicates gap in check sequence i= Electronic Image s=Substitute Check Number Date Paid Amount Number Date Paid Amount Number Date Paid Amount 29971 09/10 823.47 30011 09/12 35.82 30051 09/27 394.91 29981 09/10 4,165.06 30021 09/19 50.00 30061 09/27 68.74. 2999 i 09/10 1,160.95 3003 i 09/19 264.50 30071 09/26 130.96 30001 09/12 1,904.08 3004 i 09/19 52.23 Withdrawals/ Debits 1 item totaling$253.03 -Date Amount Description 09/17 253.03 . IRS USATAXPYMT 270266173453559 PELICAN ELECTRIC OF SO 091712 Deposits/ Credits 3 items totaling$14,455.90 Date Amount Description 09/04 15.30 DEPOSIT 09/04 4,131.32 DEPOSIT 09/25 10,309.28 DEPOSIT Daily Balance Summary Date – Amount Date - Amount Date - Amount 09/04 42,717.18 09/17 34,374.77 09/26 44,186.36 09/10 36,567.70 09/19 34,008.04 09/27 43,722.71 09/12 34,627.80 09/25 44,317.32 THE U.S.DEPARTMENT OF THE TREASURY REQUIRES EVERYONE GETTING PAPER FEDERAL BENEFIT CHECKS TO SWITCH TO DIRECT DEPOSIT BY MARCH 1,2013.DONT WAIT UNTIL ITS TOO LATE.GO ONLINE AT WWW.GODIRECT.ORG OR CALL(800)333-1795 TO SWITCH TODAY. Statement Period Date: 10/1/2012-10/31/2012 ��"�� Account Type:Business 53 Checking \ • FIFTH THIRD BANK (SOUTH FLORIDA) P.O.BOX 630900 CINCINNATI OH 45263-0900 Banking Center:Good lette Road PELICAN ELECTRIC OF SW Banldng Center Phone:239-403-6553 FLORIDA 0 Commercial Client Services: 1-800-589-5355 600 GOODLETTE RD N www.53.com minim SUITE 104 717 111.111' NAPLES FL 34102-5662 ames 11.11I11'II'1'1111'1111'I19 11'II'ill'1'1111911i"lil'tt'Ilittil 22w.: :?tr:w5�` `:¢:is; 2'>3i?i":,:if-:>:°::?22 i3 .. .c..:. 10/01 Beginning Balance $43,722.71 Number of Days in Period 31 15 Checks $(18,235.12) 2 Withdrawals/Debits $(259.03) _ 2 Deposits/Credits $10,450.43 - 10/31 Ending Balance $35,678.99 Checks 15 checks totaling$18,235.12 *Indicates gap in check sequence i= Electronic Image s=Substitute Check Number Date Paid Amount Number Date Paid Amount Number Date Paid Amount 30081 10/04 1,639.17 30131 10/15 823.47 30181 10/25 62.37 30091 10/03 41.51 30141 10/12 30.20 30191 10/24 131.07 30101 10/11 2,410.98 30151 10/18 264.50 30201 10/25 764.84 30111 10/12 406.46 3016 i 10/17 47.83 30211 10/31 41.51 30121 10/12 1,206.21 3017 i 10/22 365.00 30221 10/29 10,000.00 Withdrawals/ Debits 2 items totaling$259.03 Date Amount Description 10/15 253.03 IRS USATAXPYMT 270268960939759 PELICAN ELECTRIC OF SO 101512 10/31 6.00 IRS USATAXPYMT 270270581452675 PELICAN ELECTRIC OF SO 103112 Deposits/ Credits 2 items totaling$10,450.43 Date Amount Description 10/16 4,545.28 DEPOSIT 10/29 5,905.15 DEPOSIT Daily Balance Summary Date Amount Date Amount Date Amount 10/03 43,681.20 10/16 41,456.96 10/24 40,648.56 10/04 42,042.03 10/17 41,409.13 10/25 39,821.35 10/11 39,631.05 10/18 41,144.63 10/29 35,726.50 10/12 37,988.18 10/22 40,779.63 10/31 35,678.99 10/15 36,911.68 IN NOVEMBER 2012, YOUR SAVINGS STATEMENTS CAN BE MADE AVAILABLE ONLINE IN FIFTH THIRD DIRECT BY CONTACTING YOUR RELATIONSHIP TEAM. A NEW FEE WILL BE ASSESSED FOR PAPER CHECKING AND SAVINGS STATEMENTS. TO STOP RECEIVING PAPER STATEMENTS,GO TO"ELIMINATE PAPER"IN FIFTH THIRD DIRECT. ONLY CHECKING,SAVINGS AND BILLING STATEMENTS WILL BE PROVIDED IN ELECTRONIC FORM. ADVICE AND TAX DOCUMENTS WILL STILL BE SENT IN PAPER FORM,FREE FROM CHARGE. FOR MORE INFORMATION PLEASE CONTACT YOUR RELATIONSHIP MANAGER,TREASURY MANAGEMENT OFFICER OR CALL US TOLL FREE AT 1-866-475-0729. Statement Period Date: 11/1/2012-11/30/2012 �•.....� Account Type:Business 53 Checkin FIFTH THIRD BANK O FLORIDA) P.O.P. BOX 630400 CINONNATI OH 45263-0%0 ,t e Banking Center:Goodlette Road �� PELICAN ELECTRIC OF SW Banking Center Phone:239-403-6553 Nom FLORIDA 0 Commerdal Client Services: 1-800-589-5355 600 GOODLETTE RD N www.53.com im'— SUITE 104 709 maimi NAPLES FL 34102-5662 MIMI MINIM 1111111'1IIIIIIIdIIIIII"I"IIId"IIIIIIIIIIIIIII19IIIIIII11p .....::..:.:::::. 11/01 Beginning Balance $35,678.99 Number of Days in Period 30 13 Checks $(7,577.44) 1 Withdrawals/Debits $(253.03) 1 Deposits/Credits $6,178.97 11/30 Ending Balance $34,027.49 Checks 13 checks totaling$7,577.44 *Indicates gap in check sequence i= Electronic Image s=Substitute Check Number Date Paid Amount Number Date Paid Amount Number Date Paid Amount 30231 11/09 2,425.20 3028 i 11/16 391.40 30331 11/21 50.38 30241 11/07 540.62 30291 11/16 264.50 30341 11/28 47.13 30251 11/13 823.47 3030 i 11/19 30.00 30351 11/23 50.00 30261 11/08 2,214.05 30321 11/23 559.45 30361 11/30 131.08 30271 11/09 50.16 Withdrawals I Debits 1 item totaling$253.03 Date Amount Description 11/15 253.03 IRS USATAXPYMT 270272075954519 PELICAN ELECTRIC OF SO 111512 Deposits/ Credits 1 item totaling$6,178.97 Date Amount Description 11/28 6,178.97 DEPOSIT Daily Balance Summary Date Amount Date Amount Date Amount 11/07 35,138.37 11/15 25, 72:46 11/23 28,026.73 11/08 32,924.32 11/16 28,716.56 11/28 34,158.57 11/09 30,448.96 11/19 28,686.56 11/30 34,027.49 11/13 29,625.49 11/21 28,636.18 IN ORDER TO CONTINUE TO STRATEGICALLY INVEST IN SOLUTIONS THAT WILL HELP YOU MANAGE YOUR BUSINESS MOST ht-ttCTIVELY AND STANDARDIZE OUR PRICING,EFFECTIVE JANUARY 1,2013,WE WILL ASSESS AN OVERDRAFT TRANSFER FEE.THE FEE VARIES FROM$10 TO$20 BASED ON NUMBER OF TRANSFERS AND WILL BE ASSESSED WHEN FUNDS ARE TRANSFERRED FROM YOUR BUSINESS SAVINGS ACCOUNT OR CREDIT CARD TO YOUR CHECKING ACCOUNT.IF YOU HAVE QUESTIONS REGARDING THESE CHANGES,PLEASE CONTACT YOUR RELATIONSHIP MANAGER,TREASURY MANAGEMENT OFFICER,OR CALL US TOLL FREE AT 1-877-534-2264. 2:3 PM PELICAN ELECTRIC OF SW FLA INC 11120, , Balance Sheet Accrual Basis As of October 31,2012 Oct 31,12 ASSETS Current Assets Checking/Savings 10000 Checking 35,678.99 Total Checking/Savings 35,678.99 Total Current Assets 35,678.99 i-Hxea Assets 15200.Buildings and Improvements 1,060.00 15300•Leasehold Improvements 31,008.82 15600•Equipment 6,262.06 15800•Transportation Equipment 37,637.00 16000 Accumulated Depreciation -53,783.00 Total Fixed Assets 22,184.88 TOTAL ASSETS 57,863.87 LIABILITIES&EQUITY Liabilities Current Liabilities Other Current Liabilities 22000•Payroll Taxes Payable 237.73 Total Other Current Liabilities 237.73 Total Current Liabilities 237.73 Long Term Liabilities 27000•NIP Shareholders 2,322.54 Total Long Term Liabilities 2,322.54 Total Liabilities 2,560.27 Equity 31000•Capital Stock 1.000.00 32000.Retained Earnings 67,485.83 33000•Shareholder Distributions 33001 •Est Tax Payments -8,208.00 33002•Shareholder Medical -2,657.75 33000•Shareholder Distributions-Other -10,030.00 Total 33000•Shareholder Distributions -20,895.75 Net Income 7,713.52 Total Equity 55,303.60 TOTAL LIABILITIES&EQUITY 57,863.87 Pace 1 12:28 PM PELICAN ELECTRIC OF SW FLA INC 12/17/12 Balance Sheet ActwairVasis As of November 30,2012 Nov 30,12 ASSETS Current Assets Checking/Savings 10000•Checking 33,857.13 Total Checking/Savings 33,857.13 Total Current Assets 33,857.13 Fixed Assets 15200•Buildings and Improvements 1,060.00 15300•Leasehold improvements 31,008.82 15600 Equipment 6,262.06 15800•Transportation Equipment 37,637.00 16000•Accumulated Depreciation -54,683.00 Total Fixed Assets 21,284.88 TOTAL ASSETS 55,142.01 LIABILITIES&EQUITY Liabilities Current Liabilities Other Current Liabilities 22000•Payroll Taxes Payable 237.73 Total Other Current Liabilities 237.73 Total Current Liabilities 237.73 Long Term Liabilities 27000•N/P Shareholders 2,322.54 Total Long Term Liabilities 2,322.54 Total Liabilities 2,560.27 Equity 31000-Capital Stock 1,000.00 32000•Retained Earnings 67,485.83 33000•Shareholder Distributions 33001 •Est Tax Payments -8,208.00 33002•Shareholder Medical -2,922.25 33000•Shareholder Distributions-Other -10,060.00 Total 33000•Shareholder Distributions -21,190.25 Net Income 5,286.16 Total Equity 52,581.74 TOTAL LIABILITIES&EQUITY 55,142.01 1:23 PM PELICAN ELECTRIC OF SW FLA INC 01/18I13r•---= Balance Sheet Accrual Basis As of December 31,2012 Dec 31,12 ASSETS Current Assets Checking/Savings 10000-Checking 31,877.67 Total Checking/Savings 31,877.67 Total Current Assets 31,877.67 Fixed Assets 15200•Buildings and Improvements 1,060.00 15300•Leasehold Improvements 31,008.82 15600-Equipment 6,262.06 15800-Transportation Equipment 37,637.00 16000•Accumulated Depreciation -54,983.00 Total Fixed Assets 20,984.88 TOTAL ASSETS 52,862.55 LIABILITIES&EQUITY Liabilities Current Liabilities Other Current Liabilities 22000•Payroll Taxes Payable 237.73 Total Other Current Liabilities 237.73 Total Current Liabilities 237.73 Long Term Liabilities 27000•NIP Shareholders 2,322.54 Total Long Term Liabilities 2,322.54 Total Liabilities 2,560.27 Equity 31000•Capital Stock 1,000.00 32000•Retained Earnings 67,485.83 33000-Shareholder Distributions 33001 •Est Tax Payments -8,208.00 33002•Shareholder Medical -3,186.75 33000•Shareholder Distributions-Other -12,060.00 Total 33000•Shareholder Distributions -23,454.75 Net Income 5,271.20 Total Equity 50,302.26 TOTAL LIABILITIES&EQUITY 52,862.55 Done I www.sunbiz.org - Department of State Page 1 of 2 FLORIDA DEPARTMENT OF STATE : rAT° DIVISION N O ° CORPORA'I"1 N Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search Events No Name History Submit Detail by Entity Name Florida Profit Corporation PELICAN ELECTRIC OF SOUTHWEST FLORIDA, INC. This detail screen does not contain information about the 2013 Annual Report. Click here to determine if a 2013 Annual Report has been filed. Filing Information Document Number P02000066142 FEI/EIN Number 460492293 Date Filed 06/14/2002 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 12/09/2002 Event Effective Date NONE Principal Address 1341 FRANK WHITEMAN BLVD NAPLES FL 34103 Changed 01/31/2003 Mailing Address 1341 FRANK WHITEMAN BLVD NAPLES FL 34103 Changed 01/31/2003 Registered Agent Name & Address MILLER, RICHARD T 1341 FRANK WHITEMAN BLVD NAPLES FL 34103 US Officer/Director Detail Name&Address Title P MILLER, RICHARD 1341 FRANK WHITEMAN BLVD NAPLES FL 34103 Annual Reports Report Year Filed Date http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&ing_doc_number=P020000661... 1/22/2013 www.sunbiz.org -Department of State Page 2 of 2 2010 01/12/2010 2011 03/27/2011 2012 01/05/2012 Document Images 01/05/2012--ANNUAL REPORT I View image in PDF format 03/27/2011 --ANNUAL REPORT I View image in PDF format 01/12/2010--ANNUAL REPORT I View image in PDF format 05/03/2009--ANNUAL REPORT I View image in PDF format 01/19/2008--ANNUAL REPORT I View image in PDF format 02/03/2007--ANNUAL REPORT I View image in PDF format 01/29/2006--ANNUAL REPORT I View image in PDF format 01/16/2005--ANNUAL REPORT View image in PDF format 01/30/2004--ANNUAL REPORT I View image in PDF format 01/31/2003--ANNUAL REPORT I View image in PDF format 12/09/2002--Amendment View image in PDF format 06/14/2002--Domestic Profit I View image in PDF format Note:This is not official record.See documents if question or conflict. Previous on List Next on List Return To List Entity Name Search Events No Name History I Submit 1 Home ! Contact us Document Searches i E-Fi!na Services i Forms 1 Help i Copyright Le)and Privacy Policies State of Florida,Department of State http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&ingdoc_number=P020000661... 1/22/2013 2012 FOR PROFIT CORPORATION ANNUAL REPORT Jan FILED 012 DOCUMENT# P02000066142 Secretary of State Entity Name: PELICAN ELECTRIC OF SOUTHWEST FLORIDA, INC. Current Principal Place of Business: New Principal Place of Business: 1341 FRANK WHITEMAN BLVD NAPLES, FL 34103 Current Mailing Address: New Mailing Address: 1341 FRANK WHITEMAN BLVD NAPLES, FL 34103 FEI Number:46-0492293 FEI Number Applied For( ) FEI Number Not Applicable( ) Certificate of Status Desired( ) Name and Address of Current Registered Agent: Name and Address of New Registered Agent: MILLER, RICHARD T 1341 FRANK WHITEMAN BLVD NAPLES, FL 34103 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date OFFICERS AND DIRECTORS: Title: P Name: MILLER,RICHARD Address: 1341 FRANK WHITEMAN BLVD City-St-Zip: NAPLES,FL 34103 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: RICHARD MILLER PRES 01/05/2012 Electronic Signature of Signing Officer or Director Date www.sunbiz.org - Department of State Page 1 of 2 FLORIDA DEPARTMENT O DIVISION OF CORPORATIONs Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search No Events No Name History I Submit Detail by Entity Name Florida Profit Corporation R.G. S. ELECTRIC INC. This detail screen does not contain information about the 2013 Annual Report. Click here to determine if a 2013 Annual Report has been filed. Filing Information Document Number P13000004582 FEI/EIN Number NONE Date Filed 01/14/2013 State FL Status ACTIVE Effective Date 01/11/2013 Principal Address 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS FL 34134 Mailing Address 23434 OLD MEADOWBROOK CIRCLE BONITA SPRINGS FL 34134 Registered Agent Name & Address ROSILES, ROBERT 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS FL 34134 US Officer/Director Detail Name&Address Title P ROSILES, ROBERT 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS FL 34134 Annual Reports No Annual Reports Filed Document Images 01/14/2013 Domestic Profit I View image in PDF format Note:This is not official record.See documents if question or conflict. http://www.sunbiz.org/scripts/cordet.exe?action—DETFIL&ing_doc_number=P130000045... 1/22/2013 www.sunbiz.org - Department of State Page 2 of 2 Previous on List Next on List Return To List Entity Name Search No Events No Name History I Submit l Home 1 Contact us i Document Searches E-Filinq Services 1 Forms i Help Copyright©'and Privacy Policies State of Florida,Department of State http://www.sunbiz org/scripts/cordet.exe?action=DETFIL&inci_doc_number=P 13 0000045... 1/22/2013 Electronic Articles of Incorporation F 3000004582 For January 14 2013 Sec. Of State jshivers R. G. S. ELECTRIC 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: R. G. S. ELECTRIC INC. Article II The principal place of business address: 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS, FL. 34134 The mailing address of the corporation is: 23434 OLD MEADOWBROOK CIRCLE BONITA SPRINGS, FL. 34134 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: ROBERT ROSILES 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS, FL. 34134 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: ROBERT ROSILES P13000004582 FILED January 14 2013 Article VI Sec. Of State The name and address of the incorporator is: jshivers ROBERT ROSILES 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS, FLORIDA 34134 Electronic Signature of Incorporator: ROBERT ROSILES I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1st and May 1st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officer(s) and/or director(s) of the corporation is/are: Title: P ROBERT ROSILES 23434 OLDE MEADOWBROOK CIRCLE BONITA SPRINGS, FL. 34134 Article VIII The effective date for this corporation shall be: 01/11/2013 v /e44(AV. 1$ A . 7 j/ 17/411311/7t We t5,-(/(„tte,/, erie,ipcield.-274410,1 - # )01/-41%owl ezied-e-/i22.7 ,-kazo,mw, dA4 ,(44v • / , 4tWW/i/e/7/ 40'r 1:4) "if4j2ife7 "te72 d/AVel'4644/1€1., 1421cqed5 f/V ' f Xli /7rT/ g"lea/4 / 4 CDES Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: Exact Corporate/Business Name: t'�f.a ;(t- J e /LP,(fr (.re_ (- 1_ .,( Fiction Name/DBA: 1)1:5 01(1 1 . J ;I( y c,c Qualifier Name: (sU1tit' J' t-1r2B(1r rt Physical Address:f f n! 1?{; .51. l t..),2,-,1" pr, , (Number & Street) ` 1 ` (City) (State) (Zip Code) Mailing Address tn t. ' t7-7 }) (Number & Street) (City) (State) (Zip.Code) / E-Mail. '1C,ItIty,; y:?r,,. �, i�(.4J:r ' a>i,'r 'TYPE OF LICENSE: L3 General $230.00 L3 Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 CI Air Cond. $230.00 ❑ Mechanical $230.00 ❑ S imming Pool $230.00 ❑ Roofing $230.00 IL/Specialty $205.00 Specialty trade: C. A sz_.(\s\c& CHANGE OF STATUS: ( Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. oi2. 54, 5 A/e1""(;367 8 ,ST45) e4,-(jh i e-i, s, 0fr7/ 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years (ex. Held a license for or been a partner). Attach extra pages if needed. D o u2Cus 7 tfe I. n✓ ; t k L.C-6- 3. List all debts you or any company(s)associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. flog& AFFIDAVIT I,b .. , a S. , -i cJ- ,r e.'I-14 certify that the foregoing is true and correct to the best of my knowledge. DbilyiliS T. He 1.616iVe;Lin Authorized Officer of the Firm STATE OF FLORIDA COUNTY OFQ The foregoing instrument as acknowledged before me this ICti-li. , -e ,91-1 ao ( _ (( '' I (Dote) By �bW�,(CtS i 1-4-Li(1ey) re /0 of 0 ;, (Name of officer, title/agent) ` f 1r C�e r7,e C� t1 �..� (Name of Corporation) a 1 k, Y i d Ci Corporation on behalf of the corporation. (State or Place of Corporation) j/She has produced lr r (l a br,",,,fr-k5 L ,_z 4 <fdentification and did not take an oath. 1 (Type of identification) ■ NOTARY'S SEAL I JESSICA L.PARKE Notary Public-State of Florida '4 �∎ `--- i ----) ny Comm.Expires Dec 15,2013 fr (SIGNATUR +F NOTARY) Crimmission # CD 930269 ^sracd Tt)rougn National Notary Assn. QUALIFIER INFORMATION: Name: )ot(J kf� . Hp, Address: 4M/2 1:-.1 `"fit' /, ,^/, /tn( f (Number& Street) (Cit}^ (State) (Zip Code) Telephone:, -. /5(,i/ Date of Birth S.S. #: 000-00- , - / !' E-Mail:fin >�;f'o/l t`'Y;f 'lc Sj a r z�'' ?,i 17 Driver's License JJ 1. Type of Certificate of Competency for which application is made. a I- r '11, r 2. The names and telephone numbers of two persons who will know your whereabouts. 1. 1", �Y�, t r-� t, _, huh Y, Jw✓ (-7 y l� I 'if �7 fr ,� f �i �P) / f 3. Have you ever been convicted of a crime related to Contracting? (if yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? 8. List all debts you or any company(s)associated with you refused or failed to pay and reasons why. 9. List your business or work experience during the past ten years. 10. Statement of any formal training you have had in the area for which the application is made. AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. 00Gq/U5 Jr F(eideNr6ick APPLICANT(PLEASE PRINT) Dou9/q3 -: klel�./enr�i r.h f Lc • NAA OF COMPANY iiitlia A ., SI;rATURE OF APPLICANT STATE OF FLORIDA COUNTY OF L The foregoing instrument as acknowledged before me this J . i '_ G I - (Date) By . �<L (AST \ _lc,�l f'c_t L� who has produced --.L-- - (Names of parson acknowledging) r ' � )i ) L �' �,� (Type of identification) as identification and did not take an oath. NOTARY'S SEAL , JESSICA L.PARKE ■ 1'�'' ] L_lUf,C _ 1•- /, Notary Public-State of Florida ` )(SIGNATURaOF N TAY) v E ,'•. My Comm.Expires Dec 15,2013 ' ' ` t� Commission # DD 930269 Pr ded through National Notary Assn. Pane 4 of 4 • • AFFIDAVIT It is understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective - Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. % y .� SIGNA a E OF APPLICANT boa Sde)denVe)(1I BUSINESS NAME • ,V/2--0 AT BEFORE ME this day personallyappearedVo /05 f e d en✓e 1 C h who affirms and says that he has less than one employee and does not require Workmen's Compensation and understands that at any time he employs one or • more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF t:Niue" The foregoing instrument was acknowledged before me this *\ Q(-4. 1v) (Date) by;1-• le," .�tet&'n�� Who hasprodu (ham f person acknowledgiry g) � pe of Iddntlflcation) as Identification and who did not take an oath. - • JOANN GREENBERG • * ?_I 0, MY COMMISSION#EE 066562 • EXPIRES:April 8,2015 NOTARY SEAL ` FF°"tee BondedrnN sadoet Notary SerwttA ' .•NATURE OF NOTARY • NOTARY PUBLIC • 1 COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION 2800 N.Horseshoe Dr. • Naples.Florida 34104 • 239-403-2400 • FAX 239-403-2334 .1":111:1 MEMORANDUM DATE: November 29,2007 TO: Applicant's FROM: Michael Ossorio,Contractor Licensing Supervisor. CC: Robert Dunn, Collier County Building Director. Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary, County Attorneys Office. All Contractor Licensing personnel. SUBJECT: Collection of social security numbers. Pursuant.to Chapter 119, Florida Statues and Collier County Contractor Licensing Ordinance 2006-46 Sec. 2.1.1, all applicants are required to submit their social security number(SSN) for the following purposes: a) Assess applicant's ability to satisfy creditors by reviewing their credit history. b) Verification of applicant's test scores and information. Our office will only use your SSN noted above for those reasons pursuant to Chapter 119, Florida Statues and as may otherwise be authorized by law. We are fully committed to safe-guarding and protecting your SSN and once collected, will be maintained as confidential and exempt under Chapter 119, Florida Statues. AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, P 0E74 !EiC1/, am a resident of LE E County, FL-00-164 (State) and have resided here for more than five (5) years. During the last five years I have known Dou Jai 3, H e I'de h r e (✓k applicant). I have had the opportunity to observe his or her business and faersonal dealings and find him or her to be a person of honesty, integrity and good character. z ' a( (Sign ature ,e/-L ' �C/1.�G (Name) /4A/13/1- /1 ' ' 7 // �1 (Address) /763 (/(/Me- /4 h< C /(--) CiVE ( kAL FL 339e r� Telephone) =�t / ` 333`/ 1h STATE OF FLORIDA' COUNTY OF The foregoing instrument was acknowledged before me this / by t /� (Date) 6l�1i0Pr_-70 who has produced / ---k`x)A1, % (name of person acknowledging) (Type of identification) as identification and who did not take an oath. SfGNA URE OF NO TARY NOTARY'S SEAL (PRINT NAME 0 NOTAR NOTARY PUBLIC Notary Punic state or Florida Samuel?Davis ors wy Commission 7147151 arM &spires 02/18/2016 9 Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 6/82 01/04/13 12: 18CT [SUBJECT] [SSN] [BIRTH DATE] HEIDENREICH, DOUGLAS J. [CURRENT ADDRESS] DATE RPTD] 4012 W. 5TH ST. , LEHIGH ACRES FL. 33971 1/07 [FORMER ADDRESS] 4012 5TH WEST ST. , LEHIGH ACRES FL. 33971 12/94 2541 WELCH ST. , FORT MYERS FL. 33901 [POSITION] [Q.URRENT EMPLOYER AND ADDRESS] [RPTD] HOME PRODUCTS CABINET CO INSTALLER 3/85 S P E C I A L M E S S A G E S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS (ES) *** M O D E L P R O F I L E ***FICO CLASSIC 04 SCORE +800 : 004, 014, 011, 012 *** C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=0 COL=0 NEG=0 HSTNEG=0 TRD=7 RVL=6 INST=0 MTG=1 OPN=0 INQ=1 HIGH CRED CRED. LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $9936 $38.2K $2743 $0 $40 93% TOTALS: $9936 $38.2K $2743 $0 $40 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 SUNCST FCU Q 298Q007 2/07 $3395 111111111111 ROl 1/13A $20.0K $0 111111111111 C CREDIT CARD $68 48 0/ 0/ 0 GECRB/WALMAR D 235057X 1/04 $546 111111111111 RO1 12/12A $1250 $0 111111111111 C CHARGE ACCOUNT 8/11C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 AMEX B 21WB001 10/03 $3038 11111111X111 RO1 12/12A $8200 $0 111111111111 A CREDIT CARD $2470 36 0/ 0/ 0 DISCOVER FIN B 9616003 11/99 $3503 MIN40 111111111111 RO1 12/12A $10.0K $0 111111111111 I CREDIT CARD $205 48 0/ 0/ 0 AMEX B 21WB001 10/03 $0 111111111111 RO1 11/11A $5000 $0 111111111111 T CREDIT CARD 11/11C $0 ACCT CLSD BY CONSUMER 48 0/ 0/ 0 HSBC BANK B 2DQ1002 4/96 $4917 111111111111 ROl 4/08A $10. 0K $0 111111111111 A CREDIT CARD 4/08C $0 CLOSED 48 0/ 0/ 0 BK OF AMER B 6331062 11/98 $51.0K 180M697 X111X1111111 MOl 6/03A $0 111111111111 C CONVENTIONAL REAL 6/03C $0 CLOSED 38 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 1/04/13 ZNP6284423(FLA) MERIT CREDIT C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http: //www.transunion.com CREDITOR CONTACT INFORMATION SUNCST FCU QC298Q007 (813) 621-7511 6301 HILLS AVE TAMPA FL. 33680 GECRB/WALMAR DC235057X (877) 294-7880 PO BOX 965024 EL PASO TX. 79998 AMEX BC21WB001 (800) 874-2717 P.O. BOX 981537 EL PASO TX. 79998 DISCOVER FIN BC9616003 POB 15316 WILMINGTON DE. 19850 HSBC BANK BC2DQ1002 (800) 695-6950 PO BOX 5253 CAROL STREAM IL. 60197 BK OF AMER BM6331062 (800) 669-6607 4161 PIEDMONT PKWY GREENSBORO NC. 27410 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. . . A TT Merit Credit INC Fast,Accurate&Secure. 12734 Kenwood Lane#85 Fort Myers, FL 33907 (Mailing address only) I DATE RECEIVED REPORT TYPE January 4,2013 BUSINESS F CONTRACTORS/BUSINESS LICENSING O REPOSITORIES: PREPARED BY: R EXPERIAN ANP APPLICANT I ADDRESS ■ '` NAME: DOUGLAS J.HEIDENREICH LLC 4012 5TH ST WEST LEHIGH ACRES,FL 33971 SSN/FEIN: 52-2414554 r , PUBLIC RECORD CERTIFICATION THE REPORTING BUREAU CERTIFIES THAT: PUBLIC RECORDS HAVE BEEN CHECKED ON ALL COUNTY,STATE AND FEDERAL LEVEL, INCLUDING PINELLAS COUNTY FOR JUDGEMENTS, FORECLOSURES, GARNISHMENTS, BANKRUPTCIES, TAX LIENS, AND OTHER LEGAL ACTIONS INVOLVING THE SUBJECT(S) WERE OBTAINED DIRECTLY THROUGH THE REPOSITORIES USED, OR BY DIRECT SEARCHES,OR A PUBLIC RECORDS SEARCH FIRM OTHER THAN THE REPOSITORY,OR BY ALL METHODS WITH THE FOLLOWING RESULTS: PUBLIC RECORDS LEARNED: -- 0-- BUSINESS HISTORY`` PRINCIPAL: DOUGLAS HEIDENREICH TITLE: OWNER/MANAGER DATE FILED: 12/17/2012 STATUS: ACTIVE BUSINESS NO INFORMATION WAS FOUND AFTER CHECKING THE FOLLOWING DATABASES: TRADE PAYMENT DATA UCC FINANCIAL STATEMENTS PUBLIC RECORDS COMPANY BACKGROUND BANKING INFORMATION CORPORATE RECORDS SOURCE OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS FLORIDA DEPARTMENT OF STATE/DIVISION OF CORPORATIONS MERIT CREDIT: Telephone 239-277-3202 or 1-800-371-3348 Toll Free FAX 239-277-3258 or 1-800-595-8941 Toll Free This information is furnished in response to an inquiry for the purpose of licensing or evaluating credit risks. The information furnished must be held in strict confidence and complies with the provisions of Public Law 91-508,the Fair Credit Reporting Act. www.sunbiz.org - Department of State Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CoRPoR.11`10\5 Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search No Events No Name History I Submit Detail by Entity Name Florida Limited Liability Company DOUGLAS J. HEIDENREICH LLC This detail screen does not contain information about the 2013 Annual Report. Click here to determine if a 2013 Annual Report has been filed. Filing Information Document Number L12000157521 FEI/EIN Number NONE Date Filed 12/17/2012 State FL Status ACTIVE Effective Date 01/01/2013 Principal Address 4012 5TH ST WEST LEHIGH ACRES FL 33971 US Mailing Address 4012 5TH ST WEST LEHIGH ACRES FL 33971 US Registered Agent Name & Address HEIDENREICH,DOUGLAS J 4012 5TH ST WEST LEHIGH ACRES FL 33971 US Manager/Member Detail Name&Address Title MGR HEIDENREICH, DOUGLAS J 4012 5TH ST WEST LEHIGH ACRES FL 33971 US Annual Reports No Annual Reports Filed Document Images 12/17/2012--Florida Limited Liability I View image in PDF format Note:This is not official record.See documents if question or conflict. http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&inci_doc_number=L 120001575... 1/24/2013 www.sunbiz.org - Department of State Page 1 of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search Events No Name History I Submit Detail by Entity Name Florida Limited Liability Company DOUGLAS J.HEIDENREICH LLC Filing Information Document Number L03000045212 FEI/EIN Number 522414554 Date Filed 11/12/2003 State FL Status INACTIVE Effective Date 11/10/2003 Last Event LC VOLUNTARY DISSOLUTION Event Date Filed 09/12/2011 Event Effective Date NONE Principal Address 4012 5TH STREET WEST LEHIGH ACRES FL 33971 Mailing Address 4012 5TH STREET WEST LEHIGH ACRES FL 33971 Registered Agent Name &Address HEIDENREICH,DOUGLAS J 4012 5TH STREET WEST LEHIGH ACRES FL 33971 US Manager/Member Detail Name&Address Title MGR HEIDENREICH, DOUGLAS J 4012 5TH STREET WEST LEHIGH ACRES FL 33971 Annual Reports Report Year Filed Date 2009 01/06/2009 2010 04/09/2010 2011 03/16/2011 Document Images 09/12/2011 --LC Voluntary Dissolution I View image in PDF format 03/16/2011 --ANNUAL REPORT I View image in PDF format 04/09/2010--ANNUAL REPORT I View image in PDF format 01/06/2009--ANNUAL REPORT I View image in PDF format http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&ing_doc_number=L030000452... 1/24/2013 www.suiwiz.oig - Department or Jta e Page 2 of 2 04/16/2008--ANNUAL REPORT View image in PDF format 02/07/2007--ANNUAL REPORT View image in PDF format 01/27/2006--ANNUAL REPORT View image in PDF format 03/07/2005--ANNUAL REPORT View image in PDF format 01/06/2004--ANNUAL REPORT View image in PDF format 11/12/2003--Florida Limited Liabilites I View image in PDF format Note:This is not official record.See documents if question or conflict. Previous on List Next on List Return To List Entity Name Search Events No Name History I Submit Home I Contact us I Document Searches I E-Filing Services I Forms j Help I Copyright©and Privacy Policies State of Florida,Department of State http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&inq doc_number=L030000452... 1/24/2013 ,4 0-%• o 09eN s yi�lie s -e%s e1i-%•,%* %. t%. % e%.Yv(On�yVOvOvOv4OvOvOvOnty/OvYOnOUovO no nOvOvOOvOvOnoOvnoJOO4OvnO C znnnnnnnOnnnnnnnnnn nnnOC.). a Y 40) 0 e _ � f_ .. C . )O.. . Cif j„.„.....) ua 401 400, v __ 4 , 0 0 HOC , % c� 4.)•€. t r �O� N 000 wE cAUS �� tJ � 4()) Department of Otate gO) .0 HOC �0C . 0 ysY C I certify i from the records of this office that DOUGLAS J. HEIDENREICH LLC, is a 0 - 4OC limited •liability company organized under the laws of the State of Florida, filed on OC December 17, 2012, effective January 1, 2013. -'C Pd 40) =C The document number of this company is L12000157521. .101 • • I further certify that said company has paid all fees due this office through 40) II December 31, 2012, and its status is active. X01 10 0 40) 401 . .0 40C Given under my hand and the =r .0F Great Seal of the State of Florida 0 0 at Tallahassee, the Capital, this the ,- to f = _S Fifteenth day of January, 2013 4 j . soff:-< i:- - .... HOC �f r.� Z , ''' 4.4. `.:off.. f 0 'C.F.Il'Ir.-2,--- --4----;'4,' VriAk 0 •-nor T • rn PPf 40f 40) CR2E022 (1 ,Enrrf2Iry of o�fafr O, -c M-yv✓yvt-yvtaVtslvlr�lvr-9v c�YvleYvWv�YvYyvlaly✓aVta�vY�1vY-�1vlt�ve-yv✓�vrYvYevY-9v✓avtyvtavetyv✓�vY-9v✓ O, 5nicr.nnn ( nn ( nnn�nnn (�n�nnnn 4 ? nno�0000� Effective Date j i 1 /0 ARTICLES OF ORGANIZATION FOR FLORIDA LIMi'ED LIABILITY COMPANY ARTICLE I-Name: The name of the Limited Liability Company is: Dos .3. He ;deny nve i t,h 1-1-4�J (Must end with the words"Limited Liability Company,"LLC.,"or"LLC.") ARTICLE II-Address: The mailing address and street address of the principal office of the Limited Liability Company is: Princinal Office Address: Mailina Address: 14012 S-fh St. U1es- Lf o(2 5 h St, W-6st L hijh �t.re4 h; h J}cres Y+ 13871 v-1 �3397I ARTICLE III-Registered Agent,Registered Office,& Registered Agent's Signature: (The Limited Liability Company cannot serve as its own Registered Agent.You must designate an individual or another business entity with an active Florida registration.) The name and the Florida street address of the registered agent are: Dou3 l a_5 Yw e i Lh Name '1olz 5fhStt+Jest Florida street address(P.O.Box�IQT acceptable) C t ! C F_ City,State,and Zip Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate,I hereby accept the appointment as registered agent and agree to act in this capacity. 1 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 as provided for in Chapter 608, F.S.. Re ist�ered�Agent's Signature(REQUIRED) C7 r4! (CONTINUED) ;'� r� y. Pagelof2 fir. N ri; ARTICLE IV-Manager(s)or Managing Member(s): The name and address of each Manager or Managing Member is as follows: Title: Name and Address: "MGR"=Manager "MGRM"=Managing Member Y ) G R 1 pu Ias S. jeidenreiuln ip 0. 54- Sf, sT s AN • (Use attachment if necessary) ARTICLE V: Effective date,if other than the date of filing:S an tAtify 1, . 013 .(OPTIONAL) (If an effective date is listed, the date must be specific and cannot be more than five business days prior to or 90 days after the date of filing.) REQUIRED SIGNATURE: Signal of mber or an authorized representative of a member. (In accordance with section 608.408(3),Florida Statutes,the execution of this document constitutes an affirmation under the penalties of perjury that the facts stated herein are true. I am aware that any 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.) To11a5 S. tie;den i�h Typed or printed name of signs _,.-••-. Finite Fees. --' N S125.00 Filing Fee for Articles of Organization and Designation rft c�; of Registered Agent , S 30.00 Certified Copy(Optional) S 5.00 Certificate of Status(Optional) f' c: ;r Tn ,c,C. y n Page 2of2 = `., fn L I. a ouo / 57.5,21 :::t: m s Nae) 1111111111 111 70 0242284737 (Address) ' (City/State/Zip/Phone# 12/1?/12--01009--027 **125.00 0 PICK-UP WAIT 0 MAIL Bffacttve Date II / j (Business Entity Name) • • (Document Number) Certified Copies Certificates of Status Special Instructions to Filing Officer. N r • • Y1 • Ss 7.ici PO•• Tj.� inn Office Use Only DEC 18 len T HAypTON X DEPARTMENT OF THE TREASURY DATE OF THIS NOTICE: 11-24-2003 INTERNAL REVENUE SERVICE NUMBER OF THIS IlOTICE: CP 575 E HOLTSVILLE NY 00501-0023 EMPLOYER IDENTIFICATION NUMBER: 52-2414554 FORM: SS-4 NOBOD 0000007122 FOR ASSISTANCE CALL US AT: 1-800-829-0115 OR WRITE TO THE ADDRESS SHOWN AT THE TOP LEFT. IF YOU WRITE, ATTACH THE DOUGLAS J HEIDENREICH LLC STUB OF THIS NOTICE. HEIDENREICH DOUGLAS J SOLE MEMBER 4012 5TH ST W LEHIGH ACRES FL 33971 WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER (EIN) Thank you for your Form SS-4, Application for Employer Identification Number (EIN) . We assigned you EIN 52-2414554. This EIN will identify your business account, tax returns, and documents even if you have no employees. Please keep this notice in your permanent records. Use your complete name and EIN shown above on all federal tax forms, payments and related correspondence. If you use any variation of your name or EIN, it may cause a delay in processing and may result in incorrect information in your account. It also could cause you to he assigned more than one EIN. If you want to apply to receive a ruling or a determination letter recognizing your organization as fax exempt, and have not already done so, you should file Form 1023/1024, Application for Recognition of Exemption, with the IRS Ohio Key District Office. Publication 557, Tax Exempt Status for Your Organization, is available at most IRS offices and has details on how you can apply . ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/10/2013 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MAHER INSURANCE INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2038 HENLEY PLACE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. FT MYERS FL 33902 (239)337-1322 (239)337-3159 INSURERS AFFORDING COVERAGE NAIC INSURED INSURER A: AMERICAN VEHICLE 10790 DOUGLAS J HEIDENREICH LLC INSURER B: INSURER C _ 4012 5TH STREET,WEST INSURER0 LEHIGH f■CRES,FL 33971 INSURERS: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HER ADD' POL�C�/EFFECTIVE POLICY EXPIRATION UNITS LTR • TYPE OEINSIMANCE POLICY NUMBER DASIc tMM�DlYY1 . DATE.MBIDDIVY/ • GENERAL ABILITY EACH OCCURRENCE $1,000,000 LIABILITY GENERAL LIABLITY PREMISES J ooclraneel $100,000 SAM CLAIMS MADE OCCUR DAM GE.(Arty oreperson) $5,000 GL-0000014957-00 1/9/2013 1/9/2014 PERSONAL a ADV INJURY $1,000,000 at 12:01 AM GENERAL AGGREGATE _ $2,000,000 GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPAP AGG $2.000.000 ✓ POUCYn JECT El Loc , AUTOMOBILE UA[IUTY COMBINED SINGLE LIMIT $ ■ ANY AUTO (Ea I ALL OWNED AUTOS BODILY INJURY S (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per occident) PROPERTY DAMAGE $ (Per accident) r GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN FA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S I OCCUR I I CLAIMS MADE AGGREGATE $ $ ■ DEDUCTIBLE S RETENTION S ++ S WORKERS COMPENSATION AND t TORY LIMITS i Nit EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S ANY PROPRIETORPARTNERIEXECUTIVE OFFICERAIEMBER EXCLUDED? EL.DISEASE-EA EMPLOYEE S Prat-desuihe under SPEGAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS . INSTALLS KITCHEN CABINETS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION COLLIER COUNTY CONTRACTORS LICENSING/MGMT/LI DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 2800 N. HORSESHOE DRIVE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 30 SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR NAPLES FL,34104 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1 ACORD 25(2001108) ©ACORD CORPORATION 1988 Page 1 of 1 1 /1 100% x Image JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 1/10/2013 EXPIRATION DATE: 1/10/2015 PERSON: HEIDENREICH DOUGLAS J FEIN: 522414554 BUSINESS NAME AND ADDRESS: DOUGLAS J HEIDENREICH LLC 4012 5TH ST WEST LEHIGH ACRES FL 33971 SCOPES OF BUSINESS OR TRADE: CABINET INSTALLER/BUILDER Pursuant to Chapter 44005(14),F.S.,an officer of a corporation who elects exemption from this chapter by Bing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Cerbficates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. OFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 ��eC°uhy Lee County Tax Collector Tax Collector 2480 Thompson Street Fort Myers, Florida 33901 s'f>�e O f��o•6° www.leetc.com Tel: (239) 533-6000 Local Business Tax Account: 9200615 Dear Business Owner: Your 2012-2013 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery of your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector Detach and display bottom portion and keep upper portion for your records veeCotN, LEE COUNTY LOCAL BUSINESS TAX RECEIPT =T� 2012 - 2013 Tax Cod for — - - ACCOUNT NUMBER: 9200615 ACCOUNT EXPIRES SEPTEMBER 30, 2013 s'7re of fk0(` May engage in the business of: CABINET/MILLWORK CONTRACTOR Location 4012 5TH ST W LEHIGH ACRES FL 33971 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY DOUGLAS J HEIDENREICH LLC DOUGLAS J HEIDENREICH LLC THIS IS NOT A BILL-DO NOT PAY 4012 5TH ST W LEHIGH ACRES FL 33971 PAID 323591-2-1 01/23/2013 11:08 AXC1 857.50 uunLy aA i:otietwr s urrice Page 1 of 1 Home•FAQ•En Espanol•Contact Us•Printable Version !Search... Information Property Taxes Vehicles/Vessels Driver License Hunting&Fishing Local Business Taxes Pay Online `'!► ► Checkout ? Nolo ` Page 1 of 1 Show me 120 IL10 Bi 1 match per page Account Name/ Business Address Outstanding Description Balance 9200615 DOUGLAS J HEIDENREICH LLC CABINET/MILLWORK CONTRACTOR DOUGLAS J HEIDENREICH LLC Details 4012 5TH ST W LEHIGH ACRES FL33971 -WOW Page 1 of 1 Show me L. 1 tUrjo match per page Copyright©2009,Lee County Tax Collector's Office.All rights reserved.-View Site Policies-View Payment Policies http://www.leetc.com/search_results.asp 1/24/2013 > � r � 3ia;. t C A7x '^ A 1 Vhf ,,, -,_, '- '- . ".'-:a° N'',. ,' '",''' '7---ktiqg -f 1 iis; Nieriiiiial sr Siswell( ~mom wait w. • % Roger Drouin Collier County Contractor Licensing Board 02/1/13 2800 N.Horseshoe Dr. Naples,Fl. 34104 To Whom it may concern My name is Roger Drouin and I am writing this letter to explain my background in concrete and masonry and why I want to get my licences reinstated so I can qualify my own company. I started Drouin Concrete and Masonry in 1996 and ran a very successful operation till 2008 with 20-50 employees throughout those years, I was divorced in 2005 and unfortunately that was a very brutal and tiring ordeal that still continues to this day. After giving up millions of dollars in the divorce and then with the crash of the economy, I lost another million or so in real estate and bad investments. I could no longer afford to operate my company so I went to work for Commercial Concrete till 2010 when I decided to start another company Novelte Construction Design, I have owned and operated the company from the start and currently still do. I had a qualifier that has recently stopped qualifying my company so at this time I am asking the Board to consider reinstating my previous licenses .(Concrete-form and place and Masonry)so that I may qualify my own company. I am a single parent who has 2 teenage children that live with me a majority of the time,and this is my only source of primary income Novelte Construction Design has been a very successful Concrete and Masonry contractor since the start and has 12 full time employees and gross 1-2 million in sales annually. We have no debt at all and pay all our suppliers and subs on time are current with all our bills. I also am 50%owner of Dock Masters in Naples, Fl. My partner and I bought the business in 2011 from its previous owner from the brink of bankruptcy and have now grown the company more then 200% with more than 6 employees full time. We continue to grow by investing all the monies, including our salarys to the expansion and growth of the company. I run the estimating, scheduling of jobs and employees and also the office for this company as well as for Novelte Construction Design. Her is a list of my suppliers and some of my Contractors that I do business with on a daily basis.. Drake Ready Mix 239-590-9199 VanEmmirik Homes 239-280-6730 Southern Supply 239-597-2176 Gary Lau Builders 239-218-5691 Coastal build. Supply 239-340-6868 Sullivain Construction 239-450-4670 Ready Build.Prod. 239214-5310 D.Roth Construction 239-289-2891 Fortress Block 941-505-7070 J.Christopher Homes 239-877-8467 Thank You for you time in the matter e-r +tom v-pinty GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive Naples, FL 34104 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: o l ,, Exact Corporate/Business Name: nlO\JJ4f Cootho(}rlo `� �1CSl LIL Fiction Name/DBA: Qualifier Name: KGCq 2 VLb'l 0 Physical Address: 2O n TQ.. ( o_ �c) . 14 5 FL 34 l oS (Number 86 Street) 1 (Ci ) (State) (Zip Code) Mailing Address: P(G• kiC[ t,e S FL- 3q10( (Number 86 Street) (City) (State) (Zip Code) Telephone: 2-3(t • (o 2. 0'?0 t E-Mail: li/1 foe 1(1tjyei aws Tfucito . co rift TYPE OF LICENSE: ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 ❑ Specialty $205.00 �n Specialty trade: ezucsife, -fr 'r .ue,o ny CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 1. The names, titles, home address and phone numbers of all Officers/Managing Members of the Firm. .Zoete rz CeoAi 5e Lo,se q S 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years (ex. Held a license for or been a partner). Attach extra pages if needed. rtsuti. e -r Y1G5own.y G odd_ (lit 4 S .0A4)) c s O\I EC.1 C0165-1-+))E900 t�W 3. List all debts you or any company(s)associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. AFFIDAVIT I, Z eit_ UlIA certify that the foregoing is true and correct to the best of my knowledge. Authorized Officer of the Firm STATE OF FLORID I COUNTY OF v�! t. The foregoing instrument as acknowledged before me this I I I V (Date) By TA x ,itn i1� l� 11 of OY �. 1 u 1 ��1°d a� i/1 �--Z-L J (Name of officer, title/agent) (Name of Corporation) a r I i i do Corporation on behalf of the corporation. (State or Place of Corporation) 6H4/She has produced identification and did not take an oath. (Type of identification) NOTARY'S SEAL , , , K. LECUYER NOTARY PUBLIC Ow OF FLORIDA Canm#EE831464 (SIGN PURE OF NOTARY) Expires 11/17/2016 Page 2 of 4 QUALIFIER INFORMATION: Name: �(Z tXbO1i N Address: C7:1 ZD Ofthk-lkov5e_ Lae ).4145 T L 34 105 (Number& Street) (City) (State (Zip Code) Telephone: 739- L 2` C5-20` Date of Birth: (079-7761 61 S.S.#: 000-00- E-Mail: i Yl'CO 1 n et°6 axisfroc4to (OIL Driver's License: ) (' 1. Type of Certificate of Competency for which application is made. Cb Jc — z iuto I ct5640 2. The names and telephone numbers of two persons who will know your whereabouts. Faye_ 0t iio /39• Coq 4'j tai / ZM ° 7W4- 2-0 51-eut. CcomlystA net, 32, ?W Q 3. Have you ever been convicted of a crime related to Contracting? N (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy? iJ 0 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. 9. List your business or work experience during the past ten years. N\alt]+e coos+ - 3 Y rs boc k m4d-eas oc ' � cideA . t3res 10. Statement of any formal training you have had in the area for which the application is made. Page 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. 12■142_ 'b Ut APPLICAtT(PLEASE PRINT) NI ove� CaL6 C J LL NAME OF COMPANY 11111k 4 SIGNATURE OF APPLICANT STATE OF FLORI • COUNTY OF t; ' The foregoing instrument as acknowledged before me this a+ I I I (Date) rJ By R � ,fl who has produced 'Y' k (Na 0e of person acknowledging) (Type of i entification) as identification and did not take an oath. NOTA' LECUYER NOTARY PUBLIC r'_STATE OF FLORIDA r Comm#EE831464 Expires 11/17/2016 (SIGE OF NOTARY) Page 4 of 4 AFFIDAVIT IT IS understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. SIGNATURE OF APPLICANT koVe1,f COAVOCitei 131S .. LL BUSINESS NAME itr5IT5 2-0 3 rb DATE BEFORE ME this day personally appeared '9 who affirms and says that he has less than one employee and does not requir- Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this uZ 1 j 1 j (Date) i by �C t. \) CO 1� r\ ,who has produced r)f � �� k " ► �� (iihme of person acknowledging) . (Type of identifica Pion) as identification and who did not take an oath. K. LECUYER ' NOTARY PUBLIC ,CC C.� i�� `,.� ' STATE OF FLORIDA SIGNATU OF NOTARY -•�:y' Comm#EEE31484 Expires 11/17/2016 L t N NOTARY'S SEAL (PRINT OF NOTARY PUBLIC) NOTARY PUBLIC 4 'VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: P■DCterZ- Certificate Category Requested: Cozad - * x d- .W{.(:L°..-- soPa y The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement.You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name,Title and license number of the person signing below and verifying Applicants relevantexperience: Name: S 2V Go'\ ,ocirw00 r►.4 Title: License Number(if applicable): Z.CZ- 20i Z oboo 3'72 C Name of Business: \J A f L•S �o�► aJOKr EL C t P V vt-6tC'S Lite S d � 7 Business Address: G 9 �G4.c,/ld� Business Phone: Ll3 4/-- 6/7 The Applicant's years of experience from to The applicant's scope of work(specific duties)included: Zy .6e.e- A007 sue-/�s �NJ ce, /r ors e_. . ,s`--t Y«s /- 44, gee..1 at• assv.i 0 Additional Comments: Falsifying any information provided herein may subject your license to revocation. Signs /� Print Name: ✓ Y� (,4 b✓.+t State of Florida County of Collier r �^ r The foregoing strument was acknowledged efore me on this 1 day of by ,' 'v&_ (x i cv b r►G� (who is personally known to meeor produced as identification and who did not take an oath. K. LECUYER 1)iii r NOTARY PUBLIC -�-y 1F STATE OF FLORIDA Signature of Noy • . Comm#EE831484 Expires 11/17/2015 6 VERIFICATION OF CONSTRUCTION EXPERIENCE • GMD Operations & Regulatory Management Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: RCC1 e 0- . (_ * o(, 1 Certificate Category Requested: C f)W;iLaf °— ti.f Wi t i(-F'r- (]DSO_ 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 their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement.You should verify time of active experience working as an apprentice or a skilled worker(e.g. as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name,Title and license number of the person signing below and verifying Applicants relevant experience: Name: - iffbeikt , t:s91 ICVOCA Title: C owl's J( License Number(if applicable): C OO57(p fr Name of Business: <31t Sc)1L iCW1 Vi,S LC Business Address: 441 ti au VootS \ P(l R. 3q1.05- Business Phone: DR)33t-LIV34 The Applicant's years of experience from to The applicant's scope of work (specific duties)included: V I (i o d0 r a l c\-10 S � for ,retie 610(4 1-1(61a J( mu,(t e a A0cm,` Q� S-�rvG-vi\a( Woll' 4e keavvP( 00(kt I 47 keetw15 (cL (4€ i tvinre 11-Nao gpott'F. cuIci II I jc+s , Additional Comments: (�OS do,4 U Jok o n 11'e i�Uo(vec He W< Coe do w1 Seuer0.( i pcowk i karoe C o S+cvvt �a vl F°J'U✓l e_ Falsifying any information provided herein ma'y subject your license to revocation. ItiJh 4 - . Signature Print Name: ..105.61P(A, F SU Re UC State of Florida County of Collier The foregoing instrument was acknowledged efore me on this I day" I---do by" - 3i.i1\\v im.,.,, (who is personally known to me r produced as identification and who did not take an oath. K. LECUVER g • .Q..,e,..A.AA4 Q,.....\ . NOTARY PUBLIC Signature of Notary ll '' STATE OF FLORIDA . , Comm#EE831464 Expires 11/17/2018 7 VERIFICATION OF CONSTRUCTION EXPERIENCE GMD Operations & Regulatory Management'Department Licensing Section 2800 N.Horseshoe Drive Naples,FL 34104 Applicant's Name: {_C 'P_ L, 1 CA aA ii Certificate Category Requested: �C e1 C t\li A Oki C>� The Applicant is seeking a Collier County Certificate of Competency in the trade indicated above. As part of the application for this certificate the Applicant must verify their experience within this trade. You are being requested to provide information that will aid the Applicant in meeting this requirement.You should verify time of active experience working as an apprentice or a skilled worker(e.g.as a worker commanding the wage of mechanic or better in the trade). Time served solely in a supervisory or administrative role should be described, but may or may not be considered sufficient to demonstrate required trade experience. The person verifying trade experience must provide the following information: Name,Title and license number of the person signing below and\erifying Applicants relevant experience: Name: IL�GIC y (IL( Title: 1 LA..t License Number(if applicable): C C.)C 2_11{ Name of Business: tL Gib y lit=' - . t ,u i ? Business Address: Cj <)t)F_LU I f>is. i Vi 1 Business Phone: 7 �(- Z( "1,;��( The Applicant's years of experience from 2O'C' to ( v:re 1 The applicant's scope of work(specific duties)included: f`O L)k fl<ti c, e Ire t �t CI (,.S 41411 -( Additional Comments: ��( �'. "` l�L N C'u LA v Lt ` " (i Q_ >' S 4i ,ve- Falsifying any information provided herein may subject your license to re cation. Si ature r I Print Name: State of Florida County of Collier - The foregoing in t-ument was acknowledged efore me on this I day of 1-Q.I.J by f�k.'\ (ho is personally known to m or produced as identifidsftion and who did not take an oath. K. LECUYER 11 • _NOTARY ATE OF FLORIDA Signature of Not -•.�t.:.,� Comm#EE831484•• Expires 11/17/2016 8 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, ' . , am a resident of re(,1(et/. County, EtOr lk- (State) and have resided here for more than five (5) years. During the last five years I have known ` - Oc'OV i�l.. 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) \,dA!//Md (Name) -o42 P(" (Address) -bcka (k.h `ter 9 U\kp1 2 '1_ 34/0- Telephone) (434) L 3 3 -4-(1070 STATE OF FLORIDA COUNTY OF c QQ /\ The foregoing instrument was acknowledged before me this f( ' by e ItixfiLN S who has produced \/A 12J2-mot � KlV 4 \ (name of person acknowledging) (Type of identifittation) as identification and who did not take an oath. K. LECUYER )° ` ' NOTARY PUBLIC -go I STATE OF FLORIDA SIGNATURE F NOTARY Comm#EE831484 Expires 11/17/2018 K . I-1-G Li 1-J @/ NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC 9 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, y'L` LAt/( , am a resident of L County, (State) and have resided here for more than five (5)years. } `i During the last five years I have known U �" J Vtk- (Applicant). I have had the opportunity to observe his or her business and ersonal dealings and find him or hereto be a person of honesty, integrity and good character. ) (Signature) (Name) ? C ,. (Address) C 'Cc-4I4 U(;.e-A., \ fu\A\ Telephone)J(\ _S 6 ci STATE OF FLORIDA COUNTY OF(c, ' The foregoing instrument was acknowledged before me this .)I / /13 by r ate)/ who has produced 71) krwrv, (namg of person acknowledging) (Type of ide tification) as identification and who did not take an oath. K. LECUYER f • ---Y1 � ` ,• NOTARY PUBLIC _STATE OF FLORIDA SIGNATURE-4-01F NOTARY -0",_;'-i; Commit EE831464 Expires 11/17/2016 G 1,1 u — NOTARY'S SEAL (PRINT NAME OF NOTARY) NOTARY PUBLIC 10 • STATEMENT OF OWNERSHIP This certifies that I, . :1)COU(J) am a member or (AppLICATS NAME) le Managing member of Nove,M (200S- ii)c6k.) lbestAk) (LIMITED LIABILITY COMPANY NAME) I own 100 % of the units issued by the Limited Liability Company listed above.. • Affidavit of Applicant:.I certify that the information contained is a true and correct statement to the best of my knowledge. 1Z9eiz_c_.-1CDDLO (PRINT NAME) "N. 11111' yak* (APPLIC.A‘ S SIGNATURE) • • • DATE) • • • I , I I COLLIER COUNTY GOVERNMENT COMMUNITY DEVELOPMENT AND ENVIRONMENTAL SERVICES DIVISION • 2800 N.Horseshoe Dr. • Naples,Florida 34104 • 239-403-2400 • FAX 239-403-2334 MEMORANDUM • LTE: November 29,2007 • 0.: Applicant's OM: Michael Ossorio, Contractor Licensing Supervisor. Robert Dunn,Collier County Building Director. • Alamar Finnegan, Collier County Permitting Supervisor. Robert Zachary,County Attorneys Office. All Contractor Licensing personnel. • 3JECT: Collection of social security numbers. • ;want to Chapter 119, Florida Statues and Collier Comity'Contractor Licensing Ordinance 2006-40 Sec. , all applicants are required to submit their social security number(SSN)for the following purposes: Assess applicant's ability to satisfy creditors by reviewing their credit history. Verification of applicant's test scores and information. • office will only use your SSN noted above for those reasons pursuant to Chapter 119,Florida Statues .s may otherwise be authorized by law. re fully committed to safe-guarding arid protecting your SSN and once collected, will be maintained as dential.and exempt under Chapter 119,-Florida Statues. • • • www.sunbiz.org - Department of State rage i of f 1'LORiDA DEPAR-61ENT OF STA'L'E DIn u\ 0! C I1RPOR_1110\S . Home Contact Us E-Filing Services Document Searches Forms Help Entity Name Search No Name History Submit,I Detail by Entity Name Florida Limited Liability Company NOVELTE CONSTRUCTION AND DESIGN LLC This detail screen does not contain information about the 2013 Annual Report. Click here to determine if a 2013 Annual Report has been filed. Filing Information Document Number L10000029583 FEI/EIN Number 272242869 Date Filed 03/17/2010 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 10/04/2012 Event Effective Date NONE Principal Address 6089 TAYLOR RD. NAPLES FL 34109 US Changed 10/25/2012 Mailing Address P 0 BOX 8357 NAPLES FL 34101 US Changed 10/25/2012 Registered Agent Name&Address RICE,ROGER B ESQ 9010 STRADA STELL CT. #207 NAPLES FL 34109 US Name Changed:10/25/2012 Address Changed:10/25/2012 Manager/Member Detail Name&Address Title MGRM DROUIN,ROGER 6089 TAYLOR RD. NAPLES FL 34109 US Annual Reports Report Year Filed Date 2012 02/21/2012 2012 08/27/2012 2012 10/25/2012 Document Images ANNUAL[:[ : i-I I View image in PDF format I _Lc:H.rr,anU r„nt View image in PDF format I _?' L)I_ ANNUAL REP OR i View image in PDF format I = NNNUAI_RENOki I View image in PDF format I I ANNUAL RE i I View image in PDF format i 7a L,rmt,iJ View image in PDF format I Note:This is not official record.See documents if question or conflict. LoL JI Entity Name Search No Name History I Submit http://www.sunbiz.org/scripts/cordet.exe?action=DETFIL&ingdoc_number=L 1000002958... 2/1/2013 EXPERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 02/01/2013 11:12:02 -AN3 REPORT 404 NOVELTE CONSTRUCTION AND DESIGN LLC BIN: 965250039 6089 TAYLOR RD STE B DATE INCORPORATED: OCT. 2012 NAPLES FL 34109-1834 COMPANY BACKGROUND INFORMATION THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. CURRENT STATUS : ACTIVE BUSINESS. AGENT IS RICE ROGER BESQ LOCATED AT 9010 STRADA STELL CT, NAPLES, FL. FEDERAL ID : 272242869 PRINCIPAL(S) : ROGER DROUIN TITLE: MANAGER THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INFORMATION SOLUTIONS, INC. , NOR ITS SOURCES OR DISTRIBUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE LIABLE FOR YOUR USE OR RELIANCE UPON IT. COPYRIGHT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **END REPORT** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 0 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR 239-277-3202. koc 4' '?01ti ' akocf F�e Sx? - ,/, ar tom :s p t-. ®- r' �• .0 J w ' J, � _ �z �q' 4f • • Date CERTIFICATE OF LIABILITY INSURANCE 2/1/2013 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no rights 2739 U.S. Highway 19 N. upon the Certificate Holder. This Certificate does not amend,extend or alter Holiday, FL 34691 the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC# Insured: South East Personnel Leasing, Inc. & SubsldiarleC Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages The policies of insurance listed below have been issued to the insured-named above for the policy penod indicated.Notwithstanding any requrement,term or condition of any contract or other document with respect to which this certificate maybe issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms,exclusions,and conditions of such policies.Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Date Limits LTR INSRD Type of Insurance Policy Number Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each occurrence $ Commercial General Liability Damage to rented premises(EA Claims Made ❑ Occur occurrence) $ Med Exp $ Personal Adv Injury $ General aggregate limit applies per: — — General Aggregate $ D Policy ❑Project ❑ LOC Products-Comp/Op Agg $ AUTOMOBILE LIABILITY Combined Single Limit (EA Accident) $ Any Auto Bodily Njuy All Owned Autos (Per Person) $ Scheduled Autos - Hired Autos Bodily Iryuy - Non-Owned Autos - (Per Accident) $ Property Damage I (Per Accident) $ EXCESS/UMBRELLA LIABILITY Each Occurrence Occur 0 Claims Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2013 01/01/2014 x I WC Statu- I I OTH- Employers'Liability tory Limits ER Any proprietor/partner/executive officer/member E.L.Each Accident $1,000,000 excluded? NO E.L.Disease-Ea Employee $1,000000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits $1,000,000 Other Lion Insurance Company is A.M.Best Company rated A-(Excellent). AMB#12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 80-65-357 Coverage only applies to active employee(s)of South East Employee Leasing Serviced,Inc.that are leased to the following"Client Company": Novelte Construction and Design,LLC Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s) ,while working in Florida. Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or by calling(727)938-5562. Project Name: ISSUE 02-01-13(JG) Begin Date: 10/31/2011 CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY LICENSING BOARD Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 2800 N HORSESHOE DR NAPLES, FL 34104 �....4,....r ::...�:.. :. :. :.. �:;'�.r .:�::.': :�.;:::::.. ."::: �:: ' • .:� ::':::.;:: : DATE( / /YY)•:::: :�tTI � T�.:: �`.•�.,.1�4 : : ::.:::::.:::. . :: :: :::: ::::::.:::::::.:: :02 01/13• PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WEEMS INSURANCE OF NAPLES INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2661 STH AIRPORT ROAD, B105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE NAPLES FL 34112- COMPANY (239) 775-8705 ( ) - A REPUBLIC-VANGUARD INSURANCE CO INSURED COMPANY NOVELTE CONSTRUCTION & DESIGN LLC B PO BOX 8357 COMPANY C NAPLES FL 34101- COMPANY (239) 1692-0701 D 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. CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) A GENERAL LIABILITY GENERAL AGGREGATE $ 2 , 000, 000 X COMMERCIAL GENERAL LIABILITY PGL S001261-12 04/08/12 0 4/0 8/13 PRODUCTS-COMP/OP AGG $ 2, 000, 000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 1, 000, 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1, 000, 000 FIRE DAMAGE(Any one fire) $ 100, 000 MED EXP(Any one person) $ 5, 000 AUTOMOBILE LIABILITY / COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM / / / / AGGREGATE $ OTHER THAN UMBRELLA FORM $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY / / / / EL EACH ACCIDENT $ THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS ...................................................................:............................................ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, COLLIER COUNTY CONTRACTORS LICENSING BO BUT (LURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 2800 N HORSESHOE BLVD OF Y KIND UPO1 THE ¢OMPANY, ITS AGENTS OR REPRESENTATIVES. NAPLES FL 34104 AUTHO ED REPRESENTS, E Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 10/91 02/01/13 13:27CT • [SUBJECT] [SSN] [BIRTH DATE] DROUIN, ROGER R. [CURRENT ADDRESS] [DATE RPTD] 3910 DOMESTIC AV. , #C. NAPLES FL. 34104 11/05 [FORMER ADDRESS] 740 NW. 3RD ST., NAPLES FL. 34120 12/05 830 3RD ST., NAPLES FL. 34109 [CURRENT EMPLOYER AND ADDRESS] [RPTD] K1 5/05 [FORMER EMPLOYER AND ADDRESS] DROVIN CONC 5/05 S P E C I A L M E S S A G E S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES) *** M O D E L P R O F I L E ***FICO CLASSIC 04: NOT SCORED: INSUFFICIENT CREDIT *** C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=3 COL=1 NEG=4 HSTNEG=1-4 TRD=20 RVL=6 INST=7 MTG=6 OPN=1 INQ=1 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $211K $210K $ $ 100% CLOSED W/BAL: $17.9K $17.3K $589 TOTALS: $211K $210K $17.9K $17.3K $589 P U B L I C R E C O R D S SOURCE DATE LIAB ECOA COURT ASSETS DOCKET# TYPE PLAINTIFF/ATTORNEY Z 5064186 11/09R $29.9K I CI 98007CA CIVIL JUDGMENT ASSET ACCEPTANCE LLC Z 5064168 5/08R $47.6K I CI 79877 CIVIL JUDGMENT RINKER MATERIALS CORPO Z 5064186 4/08R $39.3K I CI 74044CA CIVIL JUDGMENT FIFTH THIRD BANK C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS AR RESOURCES Y 27GG001 I 11/07 $275 MEDICAL 09B 1666541 1/13A $275 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 SANTANDER F 1R18003 5/05 $55.7K 180M589 I09 4/12A $17.3K I RECREATIONAL MERC 4/12F $17.9K UNPAID BLNC CHRGD OFF UNIT COMM B 25E3018 11/06 $9596 42M254 I09 1/10A $0 C SECURED 1/10F $0 TRNSFRD OTHER OFFICE GECRB/FUNANC F 235060T 5/05 $55.7K 180M I09 8/07A $0 I SLDTO CHARGEDOFF 8/07F $0 PURCH BY OTHER LENDER CENTURY BANK B 424R008 3/05 $1.5M 360M13437 2/07 543211111111 M05 3/07A $0 $65.5 05 111111111111 I BALLOON DUE 04012 3/07C $0 BALLOON PAYMENT 24 1/ 1/ 2 CBT DIV SCBT B 2D14001 3/05 $29.3K 24M260 111111111111 MO1 6/11A $0 111111 C CONVENTIONAL REAL 6/11C $0 24 0/ 0/ 0 UNIT COMM B 25E3018 3/02 $32.3K 60M28219 111111111111 I01 11/06A $0 111111111111 C BALLOON DUE 03152 11/06C $0 BALLOON PAYMENT 46 0/ 0/ 0 REGIONS BANK B 634A011 10/01 $39.3K 5M317 111111111111 MO1 7/06A $0 111111111111 C SECURED 7/06C $0 CLOSED 48 0/ 0/ 0 UNIT COMM B 25E3018 3/02 $32.3K 60M28219 111111111111 I01 7/06A $0 111111111111 C BALLOON DUE 03152 7/06C $0 BALLOON PAYMENT 46 0/ 0/ 0 AMEX B 21WB001 1/99 $6275 1XX11X111111 001 7/06A $0 111111111111 I CREDIT CARD 1/06C $0 CLOSD BY CRDT GRANTOR 48 0/ 0/ 0 CHASE B 26QK001 4/97 $41.2K 111111 RO1 1/06A $40.OK T CREDIT CARD 6 0/ 0/ 0 BEALLS/GNB D 2894002 9/99 $250 111111111111 RO1 225 12/05A $300 $0 111111111111 I SLDTO WFNNB 11/05C $0 PURCH BY OTHER LENDER 48 0/ 0/ 0 UNIT COMM B 25E3018 7/02 $38.2K 35M35676 101 7/05A $0 C BALLOON DUE 06182 7/05C $0 BALLOON PAYMENT AMER HONDA Q 3946010 9/04 $7875 60M163 I01 4/05A $0 I AUTOMOBILE 4/05C $0 CLOSED 6 0/ 0/ 0 EMIGRANT BK B 525T003 4/04 $700K 360M 1111111111 MO1 3/05A $0 I CONVENTIONAL REAL 3/05C $0 CLOSED 10 0/ 0/ 0 5TH 3RD BK B 9302020 5/04 $0 1 C01 85655 3/05A $150K $0 I HOME EQUITY LOAN 3/05C $0 ACCT CLSD BY CONSUMER 1 0/ 0/ 0 1ST NATBK FL B 1Y4F001 5/04 $149K 111111 RO1 7915 1/05A $150K I HOME EQUITY LOAN 6 0/ 0/ 0 1ST NATBK FL B 1Y4F001 12/02 $147K 111111111111 RO1 7908 7/04A $150K $0 111111 C HOME EQUITY LOAN 6/04C $0 CLOSED 18 0/ 0/ 0 BK OF AMER B 6331059 6/98 $20.6K 111111111111 RO1 0491 6/04A $20.0K 111111111111 T CREDIT CARD ACCT CLSD BY CONSUMER 48 0/ 0/ 0 CHASE B 1ULY006 12/02 $80.0K 180M1030 111111111111 M01 6/04A $0 111 P FRD693059257 6/04C $0 CLOSED 15 0/ 0/ 0 FIRSTHORIZON F 418E003 12/02 $360K 180M3796 XXXXXXXX1111 MO1 5/04M $0 1111 P CONVENTIONAL REAL 5/04C $0 CLOSED 16 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 2/01/13 ZNP6284423(FLA) MERIT CREDIT C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION COLLIER CIR ZP5064186 (941) 774-8800 3301 TAMIAMI TRL E NAPLES FL. 34101 HILLSBOROUGH ZP5064168 (813) 276-8100 419 PIERCE ST #114 TAMPA FL. 33602 AR RESOURCES YC27GG001 POB 1056 BLUE BELL PA. 19422 SANTANDER FA1R18003 (866) 923-9282 PO BOX 961245 FORT WORTH TX. 76161 UNIT COMM BZ25E3018 (706) 864-8223 POB 1060 DAHLONEGA GA. 30533 GECRB/FUNANC FZ235060T (866) 220-9432 C/O PO BOX 6153 RAPID CITY SD. 57709 CENTURY BANK BB424R008 (941) 366-1050 1680 FRUITVILLE RD SARASOTA FL. 34230 CBT DIV SCBT BY2D14001 (803) 531-0567 400 NORTH MAIN CORNELIA GA. 30531 REGIONS BANK BO634A011 (770) 503-2000 P 0 DRAWER 937 GAINESVILLE GA. 30503 AMEX BC21WB001 (800) 874-2717 P.O. BOX 981537 EL PASO TX. 79998 CHASE BC26QK001 (800) 945-2006 P.O. BOX 15298 WILMINGTON DE. 19850 BEALLS/GNB DZ2894002 (813) 747-2355 P 0 BOX 25207 BRADENTON FL. 34206 AMER HONDA QA3946010 (404) 475-2121 1030 CAMBRIDGE SQU ALPHARETTA GA. 30201 EMIGRANT BK BS525T003 5 E 42ND ST NEW YORK NY. 10017 5TH 3RD BK BI9302020 (800) 972-3030 5050 KINGSLEY DR CINCINATTI OH. 45263 1ST NATBK FL BZ1Y4F001 1150 CLEVELAND STR CLEARWATER FL. 33755 BK OF AMER BC6331059 PO BOX 982235 EL PASO TX. 79998 CHASE BM1ULY006 (800) 848-9136 PO BOX 24696 COLUMBUS OH. 43224 FIRSTHORIZON FM418E003 (866) 285-2171 1555 LYNNFIELD BLD MEMPHIS TN. 38119 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 3 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. o e-r o-vi.nty GMD Operations & Regulatory Management Licensing Section 2800 North Horseshoe Drive 01%095 Naples, FL 34104 APPLICATION FOR COLLIER COUNTY/CITY OF NAPLES/CITY OF MARCO FIRM INSTRUCTIONS: This application must be typewritten or legibly printed. The application fee must accompany this application. The fee is not refundable after the application has been accepted and entered on the records. All checks should be made payable to the Board of Collier County Commissioners. For further information, consult Collier County Ordinance No. 90-105, as amended. NAME OF COMPANY: Is 1,,,J Exact Corporate/Business Name: T flC o. Gcco _ u...c, Fiction Name/DBA: � ) l4Ct'A Qualifier Name: Fri L '' K4-r1.50 --‘ Physical Address: I )S� Yo W ft 3yrys (Number 8s Street) City) (State) (Zip Code PO( ) Y) ( / ) ( P ) Mailing Address: X j).'1) ill,c(dAdci, F . tiivt(40 (Number 86 Street) (City) (State) (Zip Code)) r e CC Imo` Telephone: 2s.'3,(i-0l5�� E Mail: 1 it. i/. . (fIQ t' • TYPE OF LICENSE: 1CoAr) ❑ General $230.00 ❑ Electrician $230.00 ❑ Building $230.00 ❑ Plumber $230.00 ❑ Residential $230.00 ❑ Air Cond. $230.00 ❑ Mechanical $230.00 ❑ Swimming Pool $230.00 ❑ Roofing $230.00 X Specialty $205.00 Specialty trade: IC\CA'Y CHANGE OF STATUS: ( ) Reinstatement ( ) From One Business to Another ( ) Dormant License to Active Page 1 of 4 1. The names, titles, home address :nd phone numbers of all Officers/Managing Mem ers of the Firm. IPA/. 1! G ORM1112 • • 100, iyipill ()Woo MPHIL /Ueplec, (1/01 2. List all businesses, firms, entities or contracting businesses you have been associated with during the last ten years (ex. Held a license for or been a partner). Attach extra pages if n d. r (`l \ . o ( 3. List all debts you or any company(s) associated with you refused to pay and the reasons for the refusal to pay. Attach extra pages if needed. No " �-- t,J\I tiOrk (OCRAI- 2 c� AFFIDAVIT 401 r I, that the foregoing is true and correct to the best of my wledge. Authorize Officer o t Firm STATE OF FLORID 1/ COUNTY OF 6 ( e The foregoing instrument as acknowledged before me this (Date) By o of )1,-y1/4_/\()A (Name f icer, title/agent)e nt) c'. ame cy of Corporation) a t3Y• Corporation on behalf of the corporation. ( tate or Place of Corporation) He/She has produced !-w`'''J identification and did not take an oath. (Type of identification) NOTARY'S SEAL r- w-. (SIGNATUR OF NOTARY) • `'YpUe DONNA MARIE SENICA► • '4' : MY COMMISSION##DD005161 Page 2 0' • • ',_ g --7,4'0-5,:a. " EXPIRES July 07,2013 8&753-• Flondallolary5orVI d,WIli QUALIFIER INFORMATION: Name: t/'/G /4,#' / tea/^ is an Address: 300 /et,o ke r y c r /4eli-ce .�S• F L 3 Li/ LAS (Number& Street (City) (State) (Zip Code) Telephone: 2?S ( '2 - 2 0 6'6' Date of Birth: 0 3/ ,/3 / Z S.S. #: 000-oo- E-Mail: e 1Ccj r I S in 2 241 cyrri Cos 7e 7' Driver's License- 1. Type of Certificate of Competency for which application is made. /2)4 r r,?� Co., ,5 )i 2. The names and telephone numbers of two persons who will know your whereabouts. 3-4 / 79, et c 239 - 6 - 01 a j � 3. Have you ever been convicted of a crime related to Contracting? 1/0 (If yes attach extra sheet with explanation) 7. Have you or any firms you have been associated with ever filed bankruptcy?_ c 8. List all debts you or any company(s) associated with you refused or failed to pay and reasons why. /1/0 0. List your business or work experience during the past ten years. Pc Lh Thomas- 9/"e /. i -/r, e 1. 6U/s lorlc ,/ 5 c 10. Statement of any formal training you have had in the area for which the application is made. !V o..1 Page 3 of 4 AFFIDAVIT The undersigned hereby makes application for Certificate of Competency under the provisions of Collier County Ordinance No. 2006-46, as amended, and vouches for the truth and accuracy of all statements and answers herein contained. The undersigned hereby certifies that he is legally qualified to act on behalf of the business organization sought to be licensed in all matters connected with its contracting business and that he has full authority to supervise construction undertaken by himself or such business or organization and that he will continue during this registration to be able to so bind said business organization. The qualified license holder understands that in all contracting matters, he will be held strictly accountable for any and all activities involving his license. Any willful falsification of any information contained herein is grounds for disqualification. „ APPLICANT IPLEASE PRINT) �� y L L yh t��/Cj c�4 V��,r c. 1 s ,( CG 1741 r c o M c.! ..1e- C o /1 571f v a 1 / u.-. NAME OF COMPANY SIGNATURE OF APPLICANT STATE OF FLORIDA C/ COUNTY OF / (op, ee` The foregoing instrument as acknowledged before me this 2 1 L( (Z U r 3 (Date) By Fr' c. K4 I S o who has produced ,JP t v tr s L . c e (Name of person acknowledging) (Type of identification) as identification and did not take an oath. DAVID L.TAmER JR I. Alt s °� PJe-state of Florida-; a s ,77� : 1 .ExplrasDct16,2016 •.,,,o��;,°�,;•�� cmmlasion#�EE 21145 Ildod Noun National Notary Assn. SIG ATURE OF NOTARY) Page 4 of 4 AFFIDAVIT IT IS understood and acknowledged by the Collier County Contractors' Licensing Board and myself that if I fail to acquire, or maintain at all times effective Workmen's Compensation Insurance it will result in the possible revocation of my Certificate of Competency. z---77 / SIGNATURE OF APPLICANT " 6.1 c. of ',nlc./-c u I S (a-+.4 L—L/ C (Jo4- tilA.Y CU (fru r,^e. C.....,.511-V Cti c,.. BUSINESS NAME ,2 ( q ( aa ( 3 DATE BEFORE ME this day personally appeared ,' � ' ��r S �' who affirms and says that he has less than one employee and does not require Workmen's Compensation understands that at any time he employees one or more persons he must obtain said Workmen's Compensation Insurance. STATE OF FLORIDA COUNTY OF 2IL/ [ LO13 The foregoing instrument was acknowledged before me this (Date) Er, c <°-4- lso p Of' c �.Y S L , ‹ P��.4 by who has produced (name of person acknowledging) (Type of identification) as identification and who did not take an oath. /1r •Ately `• DAVID L.TABER ra SIGNATURE OF NOTARY �� s Notary Public-State of Florida .14 i:, ;My comet. Oct is.2016 (,)aii .J L .7 — T r $4,-.---- : Commission*EE 211445 • ' .Y N�imeRm. 45 (PRINT NAME OF NOTARY PUBLIC) NOTARY PUBLIC 4 • • • • am a m ember or • STATEMENT OF OWNERSHIP This certifies that 1, C'tie / Keck-4,7 (APPLICANT'S NAME) • • Managing member of /fl/7)C crf i7)are0 Ji I n d 1 G (LIMITED LIABILITY COMPANY NAtetE) • • . • I own a % of the units issued by-the Limited Liability Company listed above. Affidavit of Applicant:.I certify that the information contained is a true and correct statement to the best of my knowledge. ) j<Ar is (PRINT NAME) • (APPLI •NT'S SIGNATURE) • (DATE) • • •• • • • E ; AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER I, 6 � ec5 , '. . resident of County, /1--41,/ C (State) and have resided here for more than five (5) years. During the last five years I have known Ch 1 G /L,r is Q — / applicant). have •ad the opportunity to observe his or her business and personal dealings and find him o• er to be a •erso► of honesty, integrity and good character. i (Signature) �/ (Name411; *PO (Address) //11 61PCc( — Telephone) ? �i 7 7 r ,v Cl STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this !Ui.ia ZO by n (I.te) L LJ_ Al r. who has produced r L - (name of person acknowledging) (Type of identification) //' as identification and who did not take an oath. � di// A-(o Qv�Rp''�� SIG ,i`. A F NO ARY q4' �pTAgy � l� , My Comm.Expires _64 1, �(4 NOT k 'Vi* = (''RINT NAME OF NOTAR• No.EE 106072 = NOTARY PUBLIC pUBL\G 4 if/insure mmO\'' 9 AFFIDAVIT OF INTEGRITY AND GOOD CHARACTER 1)2U` n La--PO/ , am a resident of Co I �� County, FL- (State) and have resided here for more than five (5) years. During the last five years I have known brie- RA," )( (Applicant).�n 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) _ ../11A11041.PP' (Name) keu; A ore 1l1l (Address) J/�s 3 71-1, A15,p?e.S- FL Telephone) �� _ a - Se0 oa STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this 7-1 C 20 ( J by pautl who has produced FLOC C (name of person acknowledging) (Type of identification) as identification and who did not take an oath. >>>>U1141110i771/flpyl// �i � �O C�l�/ f, S�II�I � Ul�E O,NOTARY �� ,,OT49r Q17 My Comm.Expires m 664. - "JAL:0 0 ThairaVi A PRINT NAME OF NOTARY) = No.EE 106072 NOTARY PUBLIC PUBt‘C OF Fk-°‘ O' 10 Ye, Rage 2 of 3 201 2-02-04 17 15 38 (GMT) 12392380270 From: Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME] [MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 NP 9/87 02/04/13 11: 13CT [SUBJECT] [SSN] [BIRTH DATE] KARLSON, EPIC N. 411111111111■ [CURRENT ADDRESS] [DATE RPTD] 300 ROOKERY CT. , MARCO ISLAND EL. 34145 6/08 [FORMER ADDRESS] 362 WATERLEAF CT., MARCO ISLAND EL. 34145 10/06 1260 N. COLLIER BV. , MARCO ISLAND FL. 34145 M O D E L PROFILE **FICO CLASSIC 04: NOT SCORED: INSUFFICIENT CREDIT k" CREDIT SUMMARY * k TOTAL FILE HISTORY PR=1 COL=3 NEG=2 HSTNEG=1-4 TRD=3 RVL=3 INST=0 MTG=0 OPN-0 INQ=1 HIGH CRED CRIED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE CLOSED W/BAL: $967 $473 TOTALS: $967 $473 PUBLIC RECORDS SOURCE DATE LIAR ECOA COURT ASSETS DOCKETS TYPE PLAINTIFF/ATTORNEY Z 5064136 8/06R $9982 I RD 3893736 FEDERAL TAX LIEN B4096 P2075 COLLECTIONS SURNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNTS VERIFIED BALANCE REMARKS PORTFOLIO RC Y 1KSE003 I 2/11. $3492 ESBC BANK NEVADA N 09B 5408010023323588 1./13A $3492 PLACED FOR COLLECTED CREDIT COLL Y 1GZ0002 I 10/12 $393 MEDICAL 09B 36225096 1/13A $393 PLACED FOR. COLLECTIO C SYSTEM Y 29.34002 I 4/10 $393 MEDICAL 092 83320249 7/10A $1213 PLACED FOR COLLECTIO TRADES SURNAME SUBCODE OPENED HIGHCRED TERMS MAXDELQ PAYPAT 1-12 MOP ACCOUNTS VERFIED CREDLIM PASTDUE AMT-MOP PAYPAT 1.3-24 ECOA COLLATRL/LOANTYPE CLSD/PD.BALANCE REMARKS MO 30/60/90 HSBC BANK B 2DQ1002 12/04 $3491 909 2/11A $3100 $0 I CREDIT CARD 12/09F $0 PURCH BY OTHER LENDER CIT1 SHELL B 282E024 6/91 $923 R09 3/10A $730 $473 I CREDIT CARD 1/10F $967 UNPAID 3LNC CHRGD OFF CAP ONE B 1DTV001 11/01 45,85 7/07 111111111111 R01 1/11A 2600 $0 05 111111111111 I CREDIT CARD 8/07C $0 rLOSD BY CRDT GRANTOR 48 1/ 1/ 2 INQUIRTES DATE SUBrODE SUBN?i4E TYPE AMOUNT 2/04/13 ZNP6284423 (FLA) MERIT CREDIT CREDIT REPORT SERVICED BY : TRANSUNION N 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnlon at: httb://www.tranamnion.com CREDITOR CONTACT INFORMATION COLLIER CIR Z(25064186 (941) 774-6800 3301 TAMIAMI TEL E NAPLES FL. 34101 PORTFOLIO RC YClKSE003 (800) 772-].413 287 INDEPENDENCE VIRGINIA BEACH VA. 23462 CREDIT COLL YClOZD[302 (603) 570-4294 PO BOX 9'136 NEEDHAM MA. 02494 I C SYSTEM YC2834002 (828) 735-0516 20 BOX 64378 SAINT PAUL MN. 55164 HSBC BANK BC2DQ1002 (800) 695-6950 PO BOX 5253 CAROL STREAM IL. 60197 CITI SHELL BC282E024 (800) 950-5114 PO BOX 6497 SIOUX FALLS SD. 57117 CAP ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THR ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT NAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 1 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS TF YOU RAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202 . To: Pages-1 of.1 2013-02-O,1 20:5'1:39(GMT) 12392360270 From Ashley Paulus 11� Merit Credit INC Fast,Accurate&Secure. 12734 Kenwood Lane #85 Fort Myers, FL 33907 (Mailing address only) tteP DATE RECEIVED REPORT TYPE APO CONTRACTORS/BUSINESS LICENSING Februar y 4,2013 BUSINESS �! REPOSITORIES: PREPARED BY: EXPERIAN ANP –— " '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' NAME: MMC OF MARCO ISLAND LLC 1757-A SAN MARCO ISLAND DBA: MARCO MARINE CONSTRUCTION MARCO ISLAND, FL 34145 SSN/FEIN: .1648 T-rS .`.. 1VB CR1COR)£ERTI1 ATIOt" ? 1 THE REPORTING BUREAU CERTIFIES THAT: PUBLIC RECORDS HAVE BEEN CHECKED ON ALL COUNTY,STATE AND FEDERAL LEVEL, INCLUDING PINELLAS COUNTY FOR JUDGEMENTS, FORECLOSURES, GARNISHMENTS, BANKRUPTCIES, TAX LIENS, AND OTHER LEGAL ACTIONS INVOLVING THE SUBJECT(S) WERE OBTAINED DIRECTLY THROUGH THE REPOSITORIES USED, OR BY DIRECT SEARCHES,OR A PUBLIC RECORDS SEARCH FIRM OTHER THAN THE REPOSITORY,OR BY ALL METHODS WITH THE FOLLOWING RESULTS: PUBLIC RECORDS LEARNED: —0 $U N z ; 1 I �II�TORY r PRINCIPAL: MMC OF MARCO ISLAND LLC DONALD P RICCI JR TITLE: MANAGER JAMES SCHUCK TITLE: MANAGER DATE FILED: 02/03/2010 STATUS: ACTIVE BUSINESS NO INFORMATION WAS FOUND AFTER CHECKING THE FOLLOWING DATABASES: TRADE PAYMENT DATA UCC FINANCIAL STATEMENTS PUBLIC RECORDS COMPANY BACKGROUND BANKING INFORMATION CORPORATE RECORDS SOURCE OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS FLORIDA DEPARTMENT OF STATE/DIVISION OF CORPORATIONS MERIT CREDIT: Telephone 239-277-3202 or 1-800-371-3348 Toll Free FAX 239-277-3258 or 1-800-595-8941 Toll Free This information is furnished in response to an inquiry for the purpose of licensing or evaluating credit risks. The information furnished must be held in strict confidence and complies with the provisions of Public Lass 91-508,the Fair Credit Reporting Act. EXPERIAN BUSINESS REPORT PAGE 2 02/01/2013 MMC OF MARCO ISLAND, LLC BIN: 943533917 PUBLIC RECORD INFORMATION PUBLIC RECORD REPORT STAT-TX-REL 01-06-12 $249, 4645086, COLLIER COUNTY CIRC COMPANY BACKGROUND INFORMATION THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. HISTORY : BUSINESS INCORPORATED ON NOVEMBER 23, 2009 AS A FOR-PROFIT CORPORATION. CHARTER NUMBER IS L090001125. FEDERAL ID IS 271821648. CURRENT STATUS : ACTIVE BUSINESS. AGENT IS RICCI DONALD PJR LOCATED AT 1757 A SAN MARCO RD, MARCO ISLAND, FL. PRINCIPAL(S) : JAMES SCHUCK TITLE: MANAGER DONALD RICCI TITLE: MANAGER INQUIRIES BUSINESS 2013 2012 CATEGORY JAN DEC NOV OCT SEP AUG JUL JUN MAY --- --- --- --- --- --- --- --- GENERAL 1 --- --- --- --- --- --- --- --- TOTALS 1 THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INFORMATION SOLUTIONS, INC. , NOR ITS SOURCES OR DISTRIBUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE LIABLE FOR YOUR USE OR RELIANCE UPON IT. COPYRIGHT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **END REPORT** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 1 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR 239-277-3202. EXPERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 02/01/2013 12:22:38 -AOX REPORT 404 MMC OF MARCO ISLAND, LLC BIN: 943533917 1757 SAN MARCO RD UNIT A DATE INCORPORATED: NOV. 2009 MARCO ISLAND FL 34145-5151 PHONE: 239-289-6832 SIGNIFICANT DEROGATORY DATA STATE TAX LIEN - RELEASED 01-06-12 $249 TRADE PAYMENT INFORMATION TRADE PAYMENT EXPERIENCES (TRADE LINES WITH AN {*} AFTER DATE REPORTED ARE NEWLY REPORTED) RECENT ACCOUNT STATUS HIGH -DAYS PAST DUE- BUSINESS DATE LAST PAYMENT CREDIT BALANCE 1- 31- 61- CATEGORY REPTD SALE TERMS $ $ CUR 30 60 90 91+ COMMENTS FINCL SVCS 12-12 11-12 CONTRCT 60800 35700 100% PAYMENT TOTALS CONTINUOUSLY REPORTED( 1) : 60800 35700 100% DBT: 0 ADDITIONAL PAYMENT EXPERIENCES CRED CARD 01-13 CONTRCT 400 100 100% COPYRIGHT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **CONTINUED** ■ GITS, LLC Examination Operations Division Providing the services and products to assist Government Agencies to make informed educated decisions. Official Examination Score Report January 23, 2013 Official Score Report: Candidate Information: Name—Eric Karlson'. : r: Candidate#: 14620930K Testing Site: Ocala, FL Final Score Result: Mariner Contractor Score: 76% Business Procedures Score: 66% 1st attempt . . . Score: 76% 2nd attempt These results represent the grade that has been achieved on the Business Procedures and Mariner Contractor examination(s) administered by Gainesville Independent Testing Service for Collier County, Florida on January 22,2013 , If you have any further questions, please do not hesitate to contact us Sincerely, n ., / °A - 1 / Jay E. Bowermeister // fr President PO Box 831127 Ocala,Florida 34483-1127—Voice(352)369-GITS –Fax(352)387-2443 800 997 2129 Feb. 1. 2013 2: 05PM Lutgert Insurance No. 7120 P. 1 Ac CERTIFICATE OF LIABILITY INSURANCE MIDDrYYYY) 2/1/2111/211 3 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 pollcy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTAet NAME: Lutgert Insurance-Marco (No.Ne):239 394 7237 740 N. Collier Blvd.. Ste Ste 1036NO F«D.2 39 394 7575 MAIL Marco Island FL 34145 ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC INSURER A;Northern Assurance Co of Amer 38369 INSURED MARC003 INsuRERe:American EconomV Insurance 19690 Marco Marine Construction INSURER c:American Interstate Ins.C� 23140 MMC of Marco Island LLC d/b/a INSUHER0: PO Box 1247 Marco Island FL 34146 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER;1410841855 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. ADOL :• POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMM/OD/YYYY),(MM/DD/YYYY) LIMITS A GENERAL LIABILITY 65JH24120 10/20/2012 10/28/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREEM SES(Fe occurrence) 450.000 CLAIMS-MADE X OCCUR MED EXP(My one person) 56,000 PERSONAL&ADM INJURY $Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGG 11,000,000 —1 POLICY n PRO• J�LOC pal $1,000,000 JECT B AUTOMOBILE LIABILITY 02CE22807710 1216/2012 12)5/2013 CEe BINED SINGLE LIMIT 31,000,000 X ANY AUTO BODILY INJURY(Per person) $ _y ALL OWNED SCHEDULED BODILY INJURY(Per acclden0 S AUTOS X HIRED AUTOS X AUT SWNED PROPERTY/DAMAGE $ $ • UMBRELLA LIAR OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED J RETENTION$ _ i $ — H. C WORKERS COMPENSATION AVWCFL2151232012 10/11/2012 10/11/2013 X I VICSTATU51 JOFR AND EMPLOYERS'LIABILITY ANY PROPRIETORrPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $1,000,000 NIA OFFICER/MEMBER EXCLUDED? n (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddIllanal Remarks Schedule,If more apace Is required) Marine contractor. P81,USLI and Jones Act Included. CERTIFICATE HOLDER CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Collier County Contractor Licensing Dept ACCORDANCE WITH THE POLICY PROVISIONS. 2800 N Horseshoe Drive FX 252-2469 AUTHORIZED REPRESENTATIVE Naples FL 34104 // Q h- ?c/a. ©1988.2010 ACORD CORPORATION, All rights reserved, ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD Electronic Articles of Organization F 81LED :0 AM For November 23, 2009 Florida Limited Liability Company Sec. Of State nculligan Article I The name of the Limited Liability Company is: MMC OF MARCO ISLAND, LLC • Article II The street address of the principal office of the Limited Liability Company is: 1757-A SAN MARCO RD MARCO ISLAND, FL. 34145 The mailing address of the Limited Liability Company is: 1757-A SAN MARCO RD MARCO ISLAND, FL. 34145 Article III The purpose for which this Limited Liability Company is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The name and Florida street address of the registered agent is: DONALD P RICCI JR 1757-A SAN MARCO RD MARCO ISLAND, FL. 34145 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 perfoimance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: DONALD P RICCI JR • Article V L09000112546 The name and address of managing members/managers are: November ber 23,g g g November 23, 2009 Title: MGRM Sec. Of State DONALD P RICCI JR nculligan 1757-A SAN MARCO RD MARCO ISLAND, FL. 34 145 Title: MGRM JAMES G SCHUCK 1757-A SAN MARCO RD MARCO ISLAND, FL. 34145 Signature of member or an authorized representative of a member Signature: FRED W MUNDIE JR EIN Individual Request - Online Application Page 1 of 1 S ", J AI I :gov 4 EIN Assistant Your Progress: 1.Identity . 2.Authenticate 3.Addresses 4.Details 5. EIN Confirmation Congratulations! Your EIN has been successfully assigned. Help Topics 0 What if I do not have EIN Assigned: 27-1821648 access to a printer at this time? Legal Name: MMC OF MARCO ISLAND LLC 0 Can I access this letter at a later date? IMPORTANT: Save and/or print this page and the confirmation letter below for your permanent records. The confirmation letter below is your official IRS notice and contains important information regarding your EIN. CLICK HERE for Your EIN Confirmation Letter letter Help with saving and printing your Once you have saved or printed your letter,click"Continue"to get additional QCI i MuSik nformation about using your new EIN. https://sal.www4.irs.gov/modiein/individual/confirmationjsp 2/3/2010 1 COLLIER COUNTY BUSINESS TAX RECEIPT oFTH>sF APPLICATION =`7 -=`` 9 f .- q —ft y 2800 N.Horseshoe Drive,Naples,FL 34104 j I ao; Make Check Payable to Collier County Tax Collector `\: _.,9,%`•F Phone: 239-252-2477 Fax: 239-643-4788 Website:www.colliertax.com goo wETR CHECKLIST Copy of Articles of Incorporation and/or Fictitious letter Yellow Fire Compliance(list of fire district phone number from the State stating that your business name is on file. enclosed) (850-245-6052 or 6058) www.sunbiz.org Copy of Marco Zoning Certificate.(239-389-5000) Copy of State license from Department of Business and Professional(850-487-1395)or Department of Health. Completed Zoning application with appropriate fee made payable (850-488-0595) to:Board of County Commissioners.(239-252-5603) Copy of City Business Tax Receipt.(239-213-1800) Completed Business Tax Receipt application with appropriate fee made payable to:Collier County Tax Collector.(239-252-2477) Copy of Motor Vehicle Repair Registration Certificate from Department of Agriculture.(800-435-7352) Other: Copy of Health inspection from Department of Hotels and Please contact the Property Appraiser's office at 239-252-8145 Restaurants(850-487-1395)or Department of Agriculture. regarding tangible tax. (800-435-7352) CHECK ONE: Date: JJ'-(/ 2o( 3 X Original Application Classification Transfer of License # Code Number - - Renewal of License# License Amount 1) CORPORATE NAME - u1 ms ma _,n, , _ A - , ,-4-� la) DBA NAME - • 11 '1► ! ♦ all_4 ner arISOh lb) BUSINESS OWNER OR QUALIFIER'S NAME - '_ i I� t —r'c // 2) PHYSICAL ADDRESS - - : . it . Makin WAS ■ - - (No P.O.Box allowed) 2a) IS RESIDENCE USED AS AN OFFICE - Yes 3) BUSINESS MAILING ADDRESS - ex 1 -1r) *441 fi31,1 .. tilt/(0 Street City H A Zip 4) OWNER OR QUALIFIER'S RESIDENTIAL ADDRESS - P71 61- 1 pv 5) TELEPHONE -Business: — i cf' ofj(( Home: *— ,may fl, 6) LEGAL FORM OF BUSINESS: Sole Proprietorship Partnership Corporation LLC LLP 7) OPENING DATE OF BUSINESS OR DATE ASSUMED - a;, a(.b� 8) OFFICE WITHIN CITY LIMITS OF NAPLES- Yes cf No If Yes,City License No. 9) SOCIAL SECURITY NO. or FEDERAL EMPLOYER IDENTIFICATION NO. - - ?,--) - iss- !(0 *see back of application for explanation 9a) TYPE OF BUSINESS CONDUCTED: 11\G64) Cons J410,40 10) NUMBER OF EMPLOYEES -Including number of owners: 10 11) FILL IN THE APPROPRIATE AREAS - a)Rental units(motel/hotel/apts.)Number of units: b)Seating Capacity(rest./cafes,etc)Number of seats: / c)Number of coin-operated machines owned by business or individual: /0/ 12) STATE LICENSE OR CERTIFICATION NUMBER- Must have photo copy of state license if state licensed and certified UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE TO THE BEST OF MY KNOWLEDGE. xxxAPPLICANT'S SIGNATURE: 4----""�� /1--------- DATE: 2/1(720 t 3 . (Owner and/or representative of business)TITLE: N°"-e-- ****THIS LICENSE IS NON-REFUNDABLE FOR BUSINESS STATED ABOVE**** SECTION A, B,AND C FOR OFFICE USE ONLY THIS.SECTION TO BE FILLED OUT BY CONTRACTORS/BCC LICENSING BOARD SECTION A Classification of Contractor: County Certification Number: Department Supervisor Date: THIS SECTION TO BE COMPLETED BY PLANNING SERVICES SECTION B Business is an in-home occupation and the applicant has agreed to adhere to the requirements as set forth in the Collier County Zoning Ordinance. PROPERTY Business DOES COMPLY with the Collier County Zoning Ordinance. ZONED Signed: Title: Date: Comments: THIS SECTION TO BE COMPLETED BY THE HEALTH DEPARTMENT SECTION C Business DOES COMPLY with the local and/or State requirements. Signed: Title: Date: * In accordance with Florida Statute 205.0535(5),we require you to provide us with either a Federal Employer Identification Number(FEIN) or a Social Security number. Co a Coma-my Growth Management Division Planning & Regulation Operations Department Licensing Section January 30, 2013 Darleen Rowe 7935 Airport Pulling Rd 4-111 Naples, FL 34109 RE: Review six month credit report Dear Ms. Darleen Rowe, You have been added to the agenda for the Contractor Licensing Board meeting on Wednesday, February 20, 2013. The meeting is held at 9:00am at the W. Harmon Turner Building(Bldg. F,Admin. Bldg.), 3299 Tamiami Trl. E., Naples, FL in the Cornrnissioner's Meeting Room on the 3rd floor. If you have any questions or concerns, please call (239)252-2909. Sincerely, .`ij Jennifer Blanco Customer Service Specialist Licensing/Operations Growth Management Division*Planning&Regulation*2800 North Horseshoe Drive*Naples,Florida 34104*239-252.2400*www.colliergov.net A Findings of Fact, Conclusions of Law and Decision of the Board Collier County Contractors' Licensing Board For Applications Submitted to the Board for Review Type of Application: X Credit Report Review Waiver of Testing Requirements Reinstatement of License Request to Qualify Second Entity Other (specify) THIS CAUSE came on for public hearing before the Contractors' Licensing Board (hereafter Board) on August 15, 2012, for consideration of the application submitted to the Board for review. The type of application is set out above. The Board having heard testimony under oath, received evidence, and heard arguments relative to all appropriate matters, thereupon issues its Findings of Fact, Conclusions of Law and Order of the Board as follows: FINDINGS OF FACT 1. That Darleen Rowe d/b/a Dazzling Floors, Inc. (the "Applicant") has submitted an application to the Collier County Contractor Licensing Supervisor or his designee for a Certificate of Competency as a Floor Covering Installation Contractor and based on the credit reports supplied by the Applicant the Licensing Superviser determined a review of the credit by the Board is necessary. 2. That pursuant to Section 22-184(b) of the Collier County Contractors' Licensing Ordinance (Ordinance 90-105, as amended) applications which do not appear on their face to be sufficient require referral to the Board for a decision regarding approval or denial of said application. 1 293902.1 1/25/2012 3. That the Board has jurisdiction over this matter and that Darlene Rowe d/b/a Dazzling Floors, Inc. was present at the public hearing on August 15, 2012, and was not represented by counsel. 4. All notices required by Collier County Ordinance No. 90-105, as amended, have been properly issued. 5. The facts in this case are found to be: a. Applicant has adequately demonstrated through testimony and evidence presented at this hearing that her licensure will not result in risk of economic loss resulting from the Applicant's ability to pay lawful contractual obligations, subject to her satisfaction of the terms set out herein. b. Credit report does not meet the standards of Florida Rule 61G4-15.006 for Financial Responsibility. c. It is appropriate for the Applicant to be issued a probationary license and subject to further credit review. CONCLUSIONS OF LAW 1. Based upon the foregoing facts, the Board concludes that the applicant has met the standard set out in Ordinance 90-105, as amended, subject to the restrictions and stipulations set out herein. ORDER OF THE BOARD 1. Based upon the foregoing Findings of Fact and Conclusions of Law, and pursuant to the authority granted in Chapter 489, Florida Statutes, and Collier County Ordinance No. 90-105, as amended, by a vote of 7 in favor and 0 opposed, a 2 293902.1 1/25/2012 unanimous vote of the Board present, the Applicant's credit report is approved so that a license may be granted subject to the following conditions: a. One year probationary license shall be issued; b. Applicant is to provide updated business and personal credit reports to the Contractor Licensing Supervisor six (6) months from the date of the hearing held August 15, 2012 and one (1) year from the date of the hearing held on August 15, 2012 and shall appear before the Board for a review of the credit reports at the next regularly scheduled Board meeting after submitting the reports. ORDERED by the Contractors Licensing Board effective the 15th day of August, 2012. CONTRACTOR'S LICENSING BOARD COLLIER COU .TY, FLORIDA By: Lee Horn, Chairman I HEREBY CERTIFY that a true and correct copy of the above and foregoing Findings of Fact, Conclusions of Law, and Order of the Board has been furnished the Applicant, and Michael Ossorio, Licensing Supervisor, 2800 North Horseshoe Drive, Naples, FL 34103 on this,/ .th day of August, 2012. ecretary/Contractor's Licensing Board 3 293902.1 1/25/2012 EXPERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 06/11/2012 14:03:30 -AN3 REPORT 404 DAZZLING FLOORS INC BIN: 739397657 337 TEQUESTA DR DESTIN FL 32541-3747 PHONE: 850-650-8007 COMPANY DESCRIPTION THE PRIMARY BUSINESS FOR DAZZLING FLOORS INC IS Legislative Bodies (SIC 91210000) WITH A SECONDARY BUSINESS CATEGORY OF Floor Laying & Other Floor Work, Nec (SIC 17520000) . THE BUSINESS WAS INCORPORATED ON JANUARY 14, 2002 IN FLORIDA SIGNIFICANT DEROGATORY DATA JUDGMENT FILED 05-09-06 $11,269 ACCOUNT PLACED FOR COLLECTION WITH STERLING AND KING (TELEPHONE NUMBER 407-339-9033) IN 10/09 DUE TO UNPAID BALANCE OF $12,051. LAST REPORTED IN 6/12, ACCOUNT REMAINS OPEN WITH THE AGENCY. PUBLIC RECORD INFORMATION PUBLIC RECORD REPORT JUDG-FILED Ob-09-06 $11,269, 05C01222, OKALOOSA COUNTY CIR PLAINTIFF: DESTIN FLOORING INC COPYRIGHT 2012 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **CONTINUED** Created with Print2PDF. To remove this line, buy a license at: http://www.software602.cam/ r EXPERIAN BUSINESS REPORT PAGE 2 06/11/2012 DAZZLING FLOORS INC BIN: 739397657 COMPANY BACKGROUND INFORMATION THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. HISTORY : BUSINESS INCORPORATED ON JANUARY 14, 2002 AS A FOR-PROFIT CORPORATION. FEDERAL TAX ID IS 412025049. CHARTER NUMBER IS P020000047. CURRENT STATUS : ACTIVE BUSINESS. AGENT IS DARLEEN ROWE LOCATED AT 337 TEQUESTA DRIVE, DESTIN, FL. PRIMARY PRODUCT/SERVICE: FLOOR LAYING AND FLOOR WORK, NEC SIC: 1752 ADDL PRODUCT/SERVICES : FLOOR COVERING STORES SIC: 5713 PRINCIPAL(S) : DARLEEN ROWE TITLE: DIRECTOR THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INTOMATION SOLUTIONS, INC., NOR ITS SOTTROZA OR nTRTRTRUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE LIABLE FOR YQT,TR TJ$R OR RELIANCE UPON IT. COPYRIGHT 2012 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **END REPORT** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS), STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 1 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR 239-277-3202. Created with Print2PDF. To remove this line, buy a license at: http:/lwww.software602.corn/ Prepared By: Merit Credit (239) 277-3202 (800) 371-3348 TRANSUNION CREDIT REPORT [FOR] [SUB NAME) (MKT SUB] [INFILE] [DATE] [TIME] (I) Z NP6284423 MERIT CREDIT 15 MO 12/84 06/11/12 13:59CT [SUBJECT] ISSN? [BIRTH DATE] ROWE, DARLEEN MACKLIN [ALSO KNOWN AS] MACKLIN,DARLEEN,MACKLIN MACKLIN,DARLENE (CURRENT ADDRESS] [DATE RPTD] 5835 PO BOX 5835, DESTIN FL. 32540 4/08 [FORMER ADDRESS] 337 TEQUESTA DR., DESTIN FL. 32541 11/06 1632 TOWN PARK DR., PORT ORANGE FL. 32129 [CURRENT EMPLOYER AND ADDRESS] [RPTD] DAZZLING FLOORS 5/04 [FORMER EMPLOYER AND ADDRESS] LAW OFFICE OF GAIONO DUNA 12/96 S P E C I A L M E S S A G E S ***ADDRESS ALERT: CURRENT INPUT ADDRESS DOES NOT MATCH FILE ADDRESS(ES)*** M O D E L P R O F I L E * * * A L E R T * * * ***FICO CLASSIC 04 ALERT: SCORE +474 : 038, 013, 018, 016 *** IN ADDITION ***TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S T O R Y PR=0 COL=13 NEG=11 HSTNEG=4-21 TRD=20 RVL=8 INST=5 MTG=4 0PN=3 INQ=5 IIIGII CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE INSTALLMENT: $32.2K $ $2955 $0 $578 OPEN: $2886 $ $3951 $3951 $ 0% CLOSED W/BAL: $512K $15.4K $2387 TOTALS: $35.1K $ $518K $19.3K $2965 C O L L E C T I O N S SUBNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS ASSET ACCEPT Y 1FJ3001 I 8/11 $6027 01 BANK OF AMERICA 09B 6/12A $6303 PLACED FOR COLLECTIO ASSET ACCEPT Y 1FJ3001 I 6/11 $7843 01 GE CAPITAL CARE 09B 6/12A $8305 PLACED FOR COLLECTIO NCA Y 9883003 I 6/11 $6835 01 CHASE 09B 6/12A $6835 PLACED FOR COLLECTIO RJM ACQ LLC Y 1M7S003 I 12/11 $376 08 BANK OF AMERICA 09B 5/12A $376 PLACED FOR COLLECTIO Created with Print2PDF. To remove this line, buy a license at: http://www.software602.com/ r MIDLAND FUND Y 36ET009 I 6/11 $3916 CHASE BANK USA N A 09B 5/12A $5195 PLACED FOR COLLECTIO CSI Y 2667001 I 7/11 $4118 MEDICAL 09B 5/12A $4118 PLACED FOR COLLECTIO CSI Y 2667001 I 9/11 $1494 MEDICAL 09B 2475309 5/12A $1494 PLACED FOR COLLECTIO CSI Y 2667001 I 2/12 $381 MEDICAL 09B 2571112 5/12A $389 PLACED FOR COLLECTIO CSI Y 2667001 I 8/11 $201 MEDICAL 09B 2464110 5/12A $201 PLACED FOR COLLECTIO CSI Y 2667001 I 9/11 $230 MEDICAL 09B 2486228 5/12A $230 PLACED FOR COLLECTIO CB SERVICES Y 51CQ005 I 1/10 $93 10 SOUTH WALTON UT 09B 1649572 3/10A $93 PLACED FOR COLLECTIO NCO FIN/33 Y 1EDM015 I 2/08 $13.2K MEDICAL 09B 16206693 5/08A $13.2K PLACED FOR COLLECTIO CER STS REC Y 548N004 I 12/06 $702 MEDICAL 09B 4051214 3/07A $702 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 B 1597029 2/07 $6027 R09 319 8/11A $5000 $0 I CREDIT CARD 2/09F $0 PURCH BY OTHER LENDER CHASE B 26QK001 9/06 $4524 R09 1/11A $3500 $0 I CREDIT CARD 6/09F $0 PURCH BY OTHER LENDER CHASE B 26QK001 11/06 $3915 R09 6/09A $3000 $0 I CREDIT CARD 6/09F $0 PURCH BY OTHER LENDER BK OF AMER B 6331059 9/05 $5672 R09 5/09A $4500 $1450 I CREDIT CARD 2/09F $5672 CLOSD BY CRDT GRANTOR GECRB/CARECR F 9992742 4/07 $7843 R09 4/09A $7000 $0 I CHARGE ACCOUNT 10/08F $0 PURCH BY OTHER LENDER CAP ONE B 1DTV001 6/07 $1758 R09 3/09A $1000 $0 I SLDTO SHERMAN ORI 2/09F $0 PURCH BY OTHER LENDER HSBC/MS F 235197C 4/06 $148K 12M M09 Created with Print2PDF. To remove this line, buy a license at: http://www.software602.com/ 14284574 2/09A $0 I CONVENTIONAL REAL 2/09F $0 FORECLOSURE,CLTRL SLD CVF CAC F 2DL3001 8/11 $519 09B 98030 5/12A $507 I 12 WFNNB $507 PLACED FOR COLLECTION LVNV FUNDING F 21T9002 3/09 $1790 09B 5/12A $2880 I 12 CAPITAL ONE $2880 PLACED FOR COLLECTION CVF CAC F 2DL3001 8/11 $577 098 5/12A $564 I 12 WFNNB NEWPORT $564 PLACED FOR COLLECTION AMRCN HM MTG F 1946001 1/06 $474K 480M2387 3/08 44432111111X M04 6/08A $13.9K $7456 04 1X11X11X1111 I CONVENTIONAL REAL 4/08C $506K FORECLOSURE INITIATED 25 1/ 1/ 3 CAPITAL 1 FA F 1W2K001 10/06 $32.2K 72M578 111111111111 I01 5/12A $0 111111121111 I AUTOMOBILE $2955 48 1/ 0/ 0 NEWPORT NEWS C 11428090 9/06 $508 4/09 555432112111 ROl 7/09A $450 $0 05 111111111111 I CHARGE ACCOUNT 7/09C $0 PURCH BY OTHER LENDER 34 2/ 1/ 4 WJ NNU/JST10E C 122P002 11/06 $45/ 4/09 555432113211 RO1 98030 7/09A $250 $0 $78 05 111111111111 I CHARGE ACCOUNT 7/09C $0 PURCH BY OTHER LENDER 33 2/ 2/ 4 BK OF AMER B 6331205 12/05 $37.7K 60M792 1111111111 I01 10/06A $0 I AUTOMOBILE 10/06C $0 CLOSED 10 0/ 0/ 0 HSBC AUTO F 1B6A001 5/04 $25.1K 60M595 111111111111 I01 2/06A $0 1111111 T AUTOMOBILE 2/06C $0 CLOSED 1') 0/ 0/ 0 B HILL AUTO A 1UAZ001 7/04 $7835 175M259 111111111111 I01 K506 2/06A $0 111111 I AUTOMOBILE 2/06C $0 CLOSED 18 0/ 0/ 0 ROMEO F 1B6F123 9/03 $206K 360M1538 111111111111 MO1 1/06A 111111111 I SECURED 1/06C $0 CLOSED 21 0/ 0/ 0 NEW CNTY MTG F 1YP6002 9/03 $206K 360M1335 1111 MO1 982487 12/03A $0 I CONVENTIONAL REAL 12/03C $0 TRNSFRD: OTHER LENDER 4 0/ 0/ 0 VANGUARD BK B 439Y001 8/02 $5067 12M433 X1111XX11X11 101 8/03A $0 I SECURED 8/03C $0 CLOSED 12 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SURNAME TYPE AMOUNT Created with Print2PDF. To remove this line, Ouy a license at: http://www.software602.com/ r 6/11/12 ZNP6284423(FLA) MERIT CREDIT 10/06/11 YDT4587653(MCH) ASSET ACCEPT 7/22/11 YDT4587653(MCH) ASSET ACCEPT 9/07/10 YPE5556540(IND) FIRSTSOURCE 9/02/10 RNR2691233(FLA) CRYSTAL WATE C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE, P.O.BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION ASSET ACCEPT YC1FJ3001 (800) 614-4730 POB 1630 WARREN MI. 48090 NCA YC9883003 (866) 964-5259 P.O. BOX 550 HUTCHINSON KS. 67504 RJM ACQ LLC YC1M7S003 (800) 268-0623 575 UNDERHILL BLVD SYOSSET NY. 11791 MIDLAND FUND YC36ET009 (800) 825-8131 8875 AERO DR SAN DIEGO CA. 92123 CSI YC2667001 (850) 434-0883 POB 1431 PENSACOLA FL. 32596 CB SERVICES YC51CQ005 (850) 862-2154 P.O. BOX 4127 FORT WALTON BE FL. 32549 NCO FIN/33 YC1EDM015 (800) 786-9330 POB 15609 WILMINGTON DE. 19850 l ER JTJ RLC; Y 540N004 (620) 663-8811 1314 N MAIN HUTCHINSON KS. 67501 BK OF AMER BC1597029 (800) 421-2110 PO BOX 982238 EL PASO TX. 79998 CHASE BC26QK001 (800) 945-2006 P.O. BOX 15298 WILMINGTON DE. 19850 DK OF AMER DC6331059 (800) 421-2100 PO BOX 982238 EL PASO TX. 79998 GECRB/CARECR F29992742 (866) 396-8254 C/O PO BOX 965036 ORLANDO FL. 32896 CAP ONE BC1DTV001 (800) 955-7070 POB 30281 SALT LAKE CITY UT. 84130 HSAC/MS FM235197C (800) 365-0175 PO BOX 3425 BUFFALO NY. 14240 CVF CAC FY2DL3001 (866) 297-1485 PO BOX 10525 GREENVILLE SC. 29603 LVNV FUNDING FY21T9002 (866) 464-1183 P.O. BOX 10584 GREENVILLE SC. 29603 AMRCN HM MTG FM1946001 (410) 872-2000 PO BOX 631730 IRVING TX. 75063 CAPITAL 1 FA FA1W2K001 (800) 946-0332 ATTN- CREDIT BUREA PLANO TX. 75093 NEWPORT NEWS CW1NZ8090 PO BOX 182789 COLUMBUS OH. 43218 WFNNB/JSTICE CS122P002 PO BOX 182789 COLUMBUS OH. 43218 BK OF AMER BI6331205 (800) 215-6195 9000 SOUTHSIDE BLV JACKSONVILLE FL. 32256 HSBC AUTO FA1B6A001 (214) 237-3430 Created with Print2PDF. To remove this line, buy a license at: http://www.software602.com/ PO BOX 961245 FORT WORTH TX. 76161 B HILL AUTO AZ1UAZ001 (850) 763-9005 3302 W. 23RD ST PANAMA CITY FL. 32405 HOMEQ FM1B6F123 (877) 867-7378 P.O. BOX 13716 SACRAMENTO CA. 95853 NEW CNTY MTG FM1YP6002 210 COMMERCE IRVINE CA. 92602 VANGUARD BK BZ439Y001 (904) 678-4141 23 JOHNSON PARKWAY VALPARAISO FL. 32580 ASSET ACCEPT Y 4587653 28405 VAN DYKE WARREN MI. 48090 FIRSTSOURCE Y 5556540 (716) 564-4400 205 BRYANT WOODS S AMHERST NY. 14228 CRYSTAL WATE R 2691233 (850) 654-4659 137 MARIGOT BAY CI MIRAMAR BEACH FL. 32550 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: CREDIT DATA SERVICES, INC/EXPERIAN IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Created with Print2PDF. To remove this line, buy a license at: http://www.software602.com/ To: Pe9e 1 of 7 2013-01-29 20:29:00(GMT) 129929.30270 From: Ashiley Peulus EXPERIAN BUSINESS REPORT PAGE RPT DATE TIME PORT TYPE 1 01/29/2013 14:24:02 -AN2 REPORT 404 DAZZLING FLOORS, INC BIN: 739397657 7935 AIRPORT RD #4-111 NAPLES, FL 34109 COMPANY DESCRIPTION THE PRIMARY BUSINESS FOR DAZZLING FLOORS, INC IS Floor Coverings-Retail (SIC 57130800) WITH A SECONDARY BUSINESS CATEGORY OF Floor Covering Stores (SIC 57130000) . THE BUSINESS WAS INCORPORATED ON JANUARY 14, 2002 IN FLORIDA. SIGNIFICANT DEROGATORY DATA JUDGMENT FILED 05-09-06 $11,269 ACCOUNT PLACED FOR COLLECTION WITH STERLING AND KING (TELEPHONE NUMBER 407-339-9033) IN 10/09 DUE TO UNPAID BALANCE OF $12,051. LAST REPORTED IN 12/12, ACCOUNT REMAINS OPEN WITH THE AGENCY. PUBLIC RECORD INFORMATION PUBLIC RECORD REPORT JUDG-FILED 05-09-06 $11,269, 05CC1222, OKALOOSA COUNTY CIR PLAINTIFF: DESTIN FLOORING INC COPYRIGHT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **CONTINUED** e.//////7 E!pt fric)(1/ To: Pepe 2 of 7 2010-01-20 20:20:00(GMT) 12392000270 From: Ashley Peulus I EXPERIAN BUSINESS REPORT PAGE 2 01/29/2013 DAZZLING FLOORS, INC BIN: 739397657 COMPANY BACKGROUND INFORMATION THE FOLLOWING WAS PROVIDED BY THE STATE OF FLORIDA. HISTORY : BUSINESS INCORPORATED ON JANUARY 14, 2002 AS A FOR-PROFIT CORPORATION. FEDERAL TAX ID IS 412025049. CHARTER NUMBER IS PO20000047. CURRENT STATUS : ACTIVE BUSINESS. AGENT IS DARLEEN ROWE LOCATED AT 7935 AIRPORT PULLING RD, NAPLES, FL. PRIMARY PRODUCT/SERVICE: FLOOR COVERING STORES SIC: 5713 ADDL PRODUCT/SERVICES : FLOOR COVERING STORES SIC: 5713 NO. OF EMPLOYEES : 2 ESTIMATED SALES : $566,000 PRINCIPAL(S) : DARLEEN ROWE TITLE: PRESIDENT MICHAEL ROWE TITLE: OFFICER JOEL ROWE TITLE: OFFICER INQUIRIES BUSINESS 2013 2012 CATEGORY JAN DEC NOV OCT SEP AUG JUL JUN MAY BUREAU 1 TOTALS 1 THE INFORMATION HEREIN IS FURNISHED IN CONFIDENCE FOR YOUR EXCLUSIVE USE FOR LEGITIMATE BUSINESS PURPOSES AND SHALL NOT BE REPRODUCED. NEITHER EXPERIAN INFORMATION SOLUTIONS, INC., NOR ITS SOURCES OR DISTRIBUTORS WARRANT SUCH INFORMATION NOR SHALL THEY BE LIABLE FOR YOUR USE OR RELIANCE UPON IT. COPYRIGHT 2013 EXPERIAN INFORMATION SOLUTIONS, INC. ALL RIGHTS RESERVED. **END REPORT** MERIT CREDIT HAS RETRIEVED THE ABOVE BUSINESS REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY (INCLUDING PINELLAS) , STATE AND FEDERAL LEVELS. PUBLIC RECORDS LEARNED: 1 SOURCES OF INFORMATION: EXPERIAN BUSINESS INFORMATION SERVICES IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR 239-277-3202. To: Page 3 of 7 2013-01-29 20:29:00( MT) 12392360270 From:Ash Imy Pe I, Prepared By: Merit Credit ��.../// (239) 277-3202 \ (800) 371-3348 Q, TRANSUNION CREDIT REPORT 9 OP [FOR] [SUB NAME] [M' T S =] [FILE . RATE] [TIME] (I) Z NP6284423 MERIT CREDIT 16 P 124 b 29/13 14 :19CT [SUBJECT] 'r '` [BIRTH TE] ROWE, DARLEEN MACKLIN [ALSO KNOWN AS] MACKLIN,DARLEEN,MACKLIN MACKLIN,DARLENE [CURRENT ADDRESS] [DATE RPTD] 3327 SANDPIPER WY., NAPLES FL. 34109 8/12 [FORMER ADDRESS] 5835 PO BOX 5835, DESTIN FL. 32540 4/08 337 TEQUESTA DR., DESTIN FL. 32541 [CURRENT EMPLOYER AND ADDRESS] [RPTD] DAZZLING FLOORS 5/04 [FORMER EMPLOYER AND ADDRESS] LAW OFFICE OF GAIONO DUNA 12/96 M O D E L P R O F I L E * * * ALERT * * * ***FICO CLASSIC 04 ALERT: SCORE +499 : 038, 013, 018, 010 *** IN ADDITION ***TO THE FACTORS LISTED ABOVE, THE NUMBER OF INQUIRIES ON THE CONSUMER'S ***CREDIT FILE HAS ADVERSELY AFFECTED THE CREDIT SCORE. C R E D I T S U M M A R Y * * * T O T A L F I L E H I S TOR Y PR=0 COL=12 NEG=10 HSTNEG=4-21 TRD=20 RVL=9 INST=6 MTG=4 OPN=1 INQ=6 HIGH CRED CRED LIM BALANCE PAST DUE MNTHLY PAY AVAILABLE REVOLVING: $297 $300 $274 $0 $25 9% INSTALLMENT: $12.0K $ $11.1K $0 $436 OPEN: $1790 $ $3117 $3117 $ 0% CLOSED W/BAL: $512K $15.4K $2387 TOTALS: $14.1K $300 $526K $18.5K $2848 C O L L E C T I O N S SURNAME SUBCODE ECOA OPENED CLOSED $PLACED CREDITOR MOP ACCOUNT# VERIFIED BALANCE REMARKS MIDLAND FUND Y 36ET009 I 6/11 1/13F $3916 CHASE BANK USA N A 09B 8540000195 1/13A $5484 ACCT INFO DSP BY CSM ASSET ACCEPT Y 1FJ3001 I 6/11 $7843 01 GE CAPITAL CARE 098 112715922 1/13A $8576 PLACED FOR COLLECTIO RJM ACQ LLC Y 1M7S003 I 12/11 $376 08 BANK OF AMERICA 09B 898R001516255 12/12A $376 PLACED FOR COLLECTIO CSI Y 2667001. I 7/11 $4118 MEDICAL, 098 2447590 11/12A $4118 PLACED FOR COLLECTIO CSI Y 2667001 I 8/11 $201. 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I01 8/03A $0 I SECURED 8/03C $0 CLOSED 12 0/ 0/ 0 I N Q U I R I E S DATE SUBCODE SUBNAME TYPE AMOUNT 1/29/13 ZNP6284423(FLA) MERIT CREDIT 10/02/12 YPE58556 (IND) CSI 7/10/12 ZC08256078 (CAL) CREDCO IMS 6/11/12 ZNP6284423(FLA) MERIT CREDIT 10/06/11 YDT4587653(MCH) ASSET ACCEPT to: Pege 6 of 7 2013-01-29 20:29:00(GMT) 12392360270 From: Ashley Pe ulus 7/22/11 YDT4587653(MCH) ASSET ACCEPT C R E D I T R E P O R T S E R V I C E D BY : TRANSUNION 800-888-4213 2 BALDWIN PLACE P.O. BOX 1000,CHESTER, PA. 19022 Consumer disclosures can be obtained online through TransUnion at: http://www.transunion.com CREDITOR CONTACT INFORMATION MIDLAND FUND YC36ET009 (800) 825-8131 8875 AERO DR SAN DIEGO CA. 92123 ASSET ACCEPT YC1FJ3001 (800) 614-4730 POB 1630 WARREN MI. 48090 RJM ACQ LLC YC1M7S003 (800) 268-0623 575 UNDERHILL BLVD SYOSSET NY. 11791 CSI YC2667001 (850) 434-0883 POB 1431 PENSACOLA FL. 32596 CB SERVICES YC51CQ005 (850) 862-2154 P.O. 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BOX 13716 SACRAMENTO CA. 95853 NEW CNTY MTG FM1YP6002 210 COMMERCE IRVINE CA. 92602 VANGUARD BK B2439Y001 (904) 678-4.141 23 JOHNSON PARKWAY VALPARAISO FL. 32580 CSI Y 5855636 180 E BURGESS ROAD PENSACOLA FL. 32503 CREDCO IMS Z 8256078 (800) 637-2422 12395 FIRST AMERIC POWAY CA. 92064 ASSET ACCEPT Y 4587653 28405 VAN DYKE WARREN MI. 48090 END OF TRANSUNION REPORT MERIT CREDIT HAS RETRIEVED THE ABOVE PERSONAL CREDIT REPORT FOR LICENSING PURPOSES AS REQUESTED BY THE BUSINESS OWNER/PROPRIETOR. PUBLIC RECORDS FOR THIS REPORT HAVE BEEN CHECKED AND VERIFIED AT THE COUNTY, STATE AND FEDERAL LEVELS. PUBLIC RECORDS HAVE ALSO BEEN VERIFIED FOR PINELLAS COUNTY. PUBLIC RECORDS LEARNED 0 SOURCES OF INFORMATION: TRANS UNION LLC IRS LIEN SECTION COUNTY COURTHOUSE RECORDS IF YOU HAVE ANY QUESTIONS REGARDING THIS REPORT, PLEASE CONTACT MERIT CREDIT AT: 1-800-371-3348 OR (239) 277-3202. Collier County Growth Management Division/ Planning and Regulation Operations Department/ Licensing Section CERTIFIED MAIL# HAND DELIVERED ; /// /3 Mr. Brenton L.Mongan D/B/A—Naples Property Pros/CBC1250145 630 111th Ave N. Naples,FL. 34108 Date:January 10th,2013 RE: Complaint filed against you by Collier County Contractors' Licensing regarding a violation of Ordinance 90-105, as amended, Section 22-201.1(2)on(date of violation) 1/7/2011. Dear: Mr.Mongan A complaint has been filed against you by the above referenced individual. A hearing of this complaint will be held by the Contractors' Licensing Board on February 20th,2013 at 9:00 AM in the Board of County Commissioner's Room, Third Floor, Administration Building(W. Harmon Turner Bldg.), at 3301 East Tamiami Trail,Naples, Florida. Your presence before the Contractors' Licensing Board is required at this time. The packet you will receive marked composite exhibit"A"will be delivered to the members of the Contractors' Licensing Board one week prior to the hearing. If you wish to prepare a defense packet and have it delivered in conjunction with composite exhibit"A",you must make fifteen copies and have them in our office by 8:00 AM on Wednesday, one week prior to the hearing. In your packet,you may give a summary of events. At this meeting,you may present evidence and be represented by an attorney of your choice. In the event the Contractors' Licensing Board finds you in violation of Section number(s)22-201.1(2)of Ordinance#90-105,as amended,the range of disciplinary sanctions which may be imposed are from an oral reprimand to a suspension or revocation of your Collier County Certificate#34641 and/or suspension or revocation of your permit privileges against your state license#CBC1250145 . Sincerely ob Gang h Licensing ompliance Officer Collier County Contractors' Licensing BEFORE THE COLLIER COUNTY CONTRACTORS' LICENSING BOARD BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, CONTRACTORS' LICENSING BOARD Petitioner, V. Case Number: 2013-01 License Number: CBC1250145/C.C.#34641 Brenton L. Mongan D/B/A—Naples Property Pros Respondent. ADMINISTRATIVE COMPLAINT Collier County(County)files the Administrative Complaint against Brenton L. Mongan ( Respondent), a State of Florida licensed Building Contractor( license#CBC1250145/Collier County Certificate#34641), and states the following facts and allegations in support of the cited violations below: 1. The Respondent is currently licensed by The State of Florida as a Certified Building Contractor with license number#CBC1250145. 2. Under the provisions of Florida Statute 489.113(4)(b)the Collier County Contractors' Licensing Board is authorized to impose penalties against State Certified Contractors for willfully violating Building Codes. 3. Under the provisions of Collier County Ordinance 90-105,as amended,Section 22-201.1,the following actions by a holder of a Certified Building Contractor's License shall constitute misconduct and grounds for discipline pursuant to Section 22-202. a. In October, 2011 a complaint was filed against Brenton L. Mongan, qualifier of Naples Property Pros,for performing work without a required building permit at the jobsite located at 690 Club Marco Circle Bldg. 19, unit#201 Marco Island, FL. 34145. b. Mr. Mongan was advised of the violation, and obtained an affidavit from an engineering firm to submit to City of Marco Island Building Services to obtain required permitting. c. The engineer's affidavit was rejected by City of Marco Island Building Services as insufficient to obtain required permitting. d. Mr. Mongan received correspondence from the City of Marco Island Building Official outlining the discrepancies and corrective measures needed to submit for permit by affidavit. e. Mr. Mongan's inability or unwillingness to facilitate the directives of the City of Marco Island Building Official now result in a willful building code violation. f. Thereafter, pursuant to Collier County Ordinance 90-105, as amended,Section 22-202(b) and Section 22-202(c),the case was investigated and found sufficient cause to file formal charges. 4. Collier County brings the following charge in this formal complaint against the Respondent. COUNT I 5. Collier County Ordinance 90-105, as amended,Section 22.201.1(2) state"Willfully violating the applicable building codes or laws of the State, City or Collier County". WHEREFORE, the Petitioner asserts the above facts and charges are grounds for disciplinary action under Section 22-201.1 of Collier County Ordinance 90-105,as amended, and WHEREFORE, in consideration of the foregoing,the Petitioner respectfully requests the Collier County Contractors' Licensing Board to find the Respondent guilty of the violations charged. J� .. Dared: �,Y ,1 t� Signed: --�/ Collier County Contractors' Licensing Supervisor or Designee SUMMARY In October, 2011, I, Rob Ganguli, Collier County Contractors' Licensing Compliance Officer, received a complaint from a former employee of the Certified Building Contractor, Build Naples L.L.C./Naples Property Pros/CBC1250145 who advised me of condominium jobsite in Marco Island, FL. located at 690 Club Marco Circle Bldg. 19 unit#201 where an interior remodel had been performed without a building permit in issuance. The City of Marco Island Building Services verified that no permits existed for this location in their database. Contact was made with the qualifier of Naples Property Pros, Brenton L. Mongan. Mr. Mongan confirmed that he had contracted with the property owners, Steve and Maria Mazza for kitchen and bathroom remodels at this location. Mr, Mongan was advised of the permitting requirement for this type of work and informed me of his intentions to abate this violation. Mr. Mongan further advised of his intention to seek out the services of an engineering firm to submit for a "permit by affidavit" for the completed project. In November, 2011, Mr. Mongan contacted me to advise he had acquired an engineering affidavit to submit to the City of Marco Island to apply for the required permitting for this jobsite. During periodic checks of the status of this application, Mr. Mongan continued to advise me of several months of disagreement between himself and the City of Marco Island Building Services regarding their policy of acceptance for "permits by affidavit." In May, 2012, I arranged a meeting between myself, Marco Island Permitting Supervisor Lisa Lee Loewer and Mr. Mongan. At this meeting Ms. Loewer provided explicit instructions on what corrections would be necessary to facilitate the issuance of this permit. The directives provided in this meeting were also emphasized in a formal letter sent to Mr. Mongan by the Marco Island Building Official, Robert Mahar. Despite these directives, Mr. Mongan advised me that he was still in disagreement with Marco Island's policies. After consulting with Contractors' Licensing Supervisor, Michael Ossorio on alternative resolutions, it was concluded that an option to appear before a Board of Adjustments and Appeals hearing may be the best venue for Mr. Mongan's concerns to be heard. In June, 2012, Mr. Mongan advised me that he had formally requested an appearance in front of the Board of Adjustments and Appeals with the City of Marco Island Building Services and was awaiting a response. In August, 2012, I received e-mail correspondence from Mr. Mongan outlining some medical issues he was suffering from. In this correspondence, Mr. Mongan also advised me of his willingness to face legal actions to resolve this matter instead of requesting a B.O.A.A. hearing In December, 2012, after his discharge from the hospital, a final meeting was held with Mr. Mongan to discuss his intentions. At this meeting Mr. Mongan advised that he was no longer financially solvent enough to request a B.O.A.A. hearing, or to re-hire an engineer to amend his "permit by affidavit" application. At this time Mr. Mongan was advised that he would be scheduled for an appearance in front of the Contractors' Licensing Board for having committed a willful building code violation. The kitchen and bathroom remodel performed at the condominium located at 690 Club Marco Circle Bldg. 19, unit#201 without a building permit in issuance is a violation of Florida Building Code section 105.1. Mr. Mongan's refusal or inability to follow the directives on obtaining the required permitting from the City of Marco Island Building Official, Robert Mahar, construes a violation of Collier County Ordinance section 22-201.1(2) for "Willfully violating the applicable building codes or laws of the State, City, or Collier County." C.L.B. Case #2013-01 Brenton L. Mongan D/B/A— Naples Property Pros Table of Contents E1/E3 — Formal Complaint. E4 — State D.B.P.R . Licensing Detail Report. E5 — Collier County Certificate Detail Report. E6— Notice of Hearing Sent Certified Mail E7— Postal Service Delivery Confirmation Status E8— Preliminary Complaint Form. E9/E11 - Contract E12/E13 — Marco Island Design Professional Pre-Permit Affidavit Criteria. E14— Marco Island Design Professional Completion Affidavit. E15/E16— Letter from Marco Island Building Official Outlining Discrepancies. E17/E18— E-mail Correspondence with Marco Island regarding B.O.A.A. Request. E19/E20— E —mail Correspondence from Respondent Outlining Difficulties. E21 — Letter from Marco Island Building Official Outlining Permit by Affidavit Policies and Willful Building Code Violation Observation E22 — Florida Building Code section 105.1 Pertaining to Permit Requirements. E23 — Collier County Ordinance 22-201.1(2) Outlining Misconduct by State Certified Contractors. • Contractors' Licensing Board 2800 North Horseshoe Dr. Naples, Fl. 34104 Complaint Number-2013-01 Complainant:Any person who believes that a Contractor holding a State Certification or Certificate of competency has violated Collier County Ordinance 90-105, as amended, may submit a sworn complaint to the Contractor Licensing supervisor,or his/her designee.The complaint shall be in substantially the form prescribed by the Contractor Licensing Supervisor.The complainant shall pay a fee of$50.00 to defray the costs of administering the complaint, at the time of filing the complaint.The complaining party shall state with particularity which section(s)of this Ordinance he or she believes has been violated by the contractor and the essential facts in support thereof. Complaint: Please print or type and return signed copies of the complaint. Date: December 27th, 2012 Against: Contractor's Name: Brenton L. Mongan Phone: (239)287-2085 Business Name: Build Naples L.L.C. D/B/A-Naples Property Pros License Number if known:#CBC1250145 Collier County Competency riurnber:4434641 Contractor's Business Address: 630 111 Ave. N. Naples, FL.34108 Filed By: Name: Collier County Contractors' Licensing Address: 2800 N. Horseshoe Dr. Naples, FL. 34104 Business Phone: (239) 252-2914 Address where work done: 690 Club Marco Circle Bldg. 19, unit#201 City: Marco Island, FL. County: Collier Date of contract:January 7th, 2011 Date job started:On or about May 11th, 2011 Date job completed or new home occupied: On or about May 18th,2011 Were there plans and specifications?Yes Is there a written contract?Yes. If yes,amount of Contract:$24,262.91 Has Contractor been paid in full? Not Applicable. If not,what amount? Not Applicable Was a Building Permit obtained? No Building Permit number if known:#11-836 Applied for After the Fact Have you communicated by letter with the licensee?Yes Date: 12/27/12. Do you have a reply? No Please attach to this form all copies of the purchase agreement, building contract, home improvement. contract, copies of receipts and/or cancelled checks available and any additional evidence to substantiate your allegations. List any subsections of Section 4 of Collier County Ordinance number 90- 105, as amended, which, in your opinion, have been violated by the contractor which is the subject of this complaint, (list subsection number): Collier County Ordinance#90-105, as amended, section22-201.1(2) Willfully violating the applicable building codes or laws of the State,City, or Collier County. Please state the facts which you believe substantiate your charge of misconduct against the subject contractor. List facts separately for each subsection number above: Failure to obtain the corrective measures for"permit by affidavit" as directed by the City of Marco Island Building Official. ( Complainant's signature) State of: �—� F b County of: 0_0 Lt_t�(Z Sworn to (or affirmed) . s ascribed before me this 27th day of December, 2012, by , f (signature of person making statement). (signature of Notary Public) Print,type or stamp co missioned name of Notary Public: X6.ren r/e/n er7 fS Personally known ✓ or produced identification KAREN E =•►; Baded Thu Nsotairy Pubtandemiten DBPR- MONGAN, BRENTON LEE; Doing Business As: NAPLES PROPERTY PROS,... Page 1 of 1 • 2:19:08 PM 12/27/2012 Licensee Details Licensee Information Name: MONGAN, BRENTON LEE (Primary Name) NAPLES PROPERTY PROS (DBA Name) Main Address: 630 111TH AVE N NAPLES Florida 34108 County: COLLIER License Mailing: LicenseLocation: License Information License Type: Certified Building Contractor Rank: Cert Building License Number: CBC1250145 Status: Delinquent,Active Licensure Date: 05/18/2002 Expires: 09/14/2012 Special Qualifications Qualification Effective Construction Business 07/21/2009 View Related License Information View License Complaint 1940 race II)M0111E1e,Rlr Fl 37399 Fi!idil Customer Cuntect Center::Curtunldr Contact Canter:850,187.1395 The State of Florida is an AA/EEO employer.Copyright 2007-2010 State of Florida.Privacy Statement Under Florida law,email addresses are public records.If you do not want your email address released in response to a public-records request,do not send electronic mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.*Pursuant to Section 455.275(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emails provided may he 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. httnc•//www mvflnricialicence cnm/T.icencpfetail 0cn7STT)=Rrirl=1FR55TlFiAFFTlA?(91 17/77/')(117 Certificate Detail Report :DPR2305 - Certificate Detail Report CERT NBR QUALIFIER NAME DBA STATUS 34641 BRENTON L. MONGAN NAPLES PROPERTY PROS INACTIVE DETAIL CLASS CODE CLASS DESC STATE NBR 1110 BUILDING CONTR.-CERTIFIED CBC 1250145 ORIG ISSD DATE STATE EXP DATE 10/28/2009 8/31/2012 RENEWAL DATE COUNTY COMP CARD COUNTY EXP DATE EXPIRE DATE 8/31/2012 OTH OL NBR COUNTY OL EXEMPT N OB 67596 CNCL DATE COUNTY OL NBR COUNTY OL EXP DATE OTH OL EXP DATE 091109 9/30/2012 REINSTATE DATE DBA PHONE FAX (239)287-2805 (866)929-0535 MAILING ADDRESS PHYSICAL ADDRESS 715 PARKVIEW LANE 715 PARKVIEW LANE NAPLES FL 34103- NAPLES FL 34103- LIABILITY INSURANCE COMPANY EXP DATE THE CONTRACTORS CHOICE AGENCY 8/19/2012 PHONE EFFECTIVE DATE (800) 918-3584 8/19/2010 POLICY NUMBER CNCL DATE GLF000012868-02 INSURANCE LIMITS 1. 000, 000 WORKERS COMPENSATION INSURANCE WC EXEMPT Y COMPANY EXP DATE AP INTEGO INSURANCE GROUP LLC 8/11/2012 PHONE EFFECTIVE DATE (888)289-2988 8/11/2011 oilier County Board of County Commissioners Printed on 12/27/20 9:27:34AM D-Plus for Windows 95/NT Page 1 Collier County Growth Management Division / Planning and Regulation Operations Department/ Licensing Section Certified Mail#7007 2560 0001 1485 5186 Hand Delivered Mr.Brenton L.Mongan D/B/A-Naples Property Pros/CBC1250145 630 111t Ave N. Naples,Fl. 34108 Date: December 27th, 2012 RE: Complaint filed against you by Collier County Contractors' Licensing regarding a violation of Ordinance 90-105,as amended, Section 22-201.1(2) in. Dear: Mr.Mongan, A complaint has been filed against you by the above referenced individual. A hearing of this complaint will be held by the Contractors' Licensing Board on January 16th,2013 at 9:00 AM in the Board of County Commissioner's Room,Third Floor,Administration Building(W. Harmon Turner Bldg.), at 3301 East Tamiami Trail,Naples,Florida. Your presence before the Contractors' Licensing Board is required at this time. The packet you will receive marked composite exhibit"A"will be delivered to the members of the Contractors' Licensing Board one week prior to the hearing.If you wish to prepare a defense packet and have it delivered in conjunction with composite exhibit"A",you must make fifteen copies and have their in our office by 8:00 AM on Wednesday,one week prior to the hearing. In your packet,you may give a summary of events. At this meeting,you may present evidence and be represented by an attorney of your choice. In the event the Contractors' Licensing Board finds you in violation of Section number(s)22-201.1(2)of Ordinance#90-105,as amended, the range of disciplinary sanctions which may be imposed are from an oral reprimand to a suspension or revocation of your Collier County Certificate#34641 and/or suspension or revocation of your permit privileges against your state license#CBC1250145 . cre R,b Licensi Compliance Officer Collier C unty Contractors' Licensing USPS.com® - Track& Confiiin Page 1 of 1 English Customer Service LISPS Mobile Register I Sign In e:USPS,COM' Search USPS cem or Track Packages Quick Tools Ship a Package Send Mail Manage Your Mail Shop Business Solutions Track & Confirm GET EMAIL UPDATES PRINT DETAILS YOUR LABEL NUMBER SERVICE STATUS OF YOUR ITEM DATE&TIME LOCATION FEATURES 70072560000114855186 Notice Left December 28,2012,2:50 pm NAPLES,FL 34108 •Certified Mail' www.usps.conVredelivery or calling 800-ASK- USPS,or may pick up the item at the Post Office indicated on the notice.If this item is unclaimed after 15 days then it will be returned to the sender.Information,if available,is updated periodically throughout the day.Please again later."> • Depart USPS Sort December 28,2012 FORT MYERS,FL 33913 '.. Facility Processed through December 27,2012,10:49 pm FORT MYERS,FL 33913 USPS Sort Facility • Cheek on Another Item What's your label(or receipt)number? • Find • LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy; Government Services+ About USPS Home; Business Customer Gateway Terms of Use Buy Stamps&Shop> Newsroom: Postal Inspectors F01A r Prat a Label with Postage; Mail Service Updates; Inspector General' No FEAR Act EEO Oats Cuuiomor Curvieu r r nrma&Publieeticns. Paslel Explorer Site tririe'r> Careei s; C'opyrightrt 2013 USPS.Al:Rights Reserved. httos://tools.uses.com/2o/TrackConfirmAction.action 1/R/7(111 COLLIER COUNTY BUILDING REVIEW & PERMITTING 6.16**6, CONTRACTOR'S LICENSING 2800 N. Horseshoe Drive • Naples, Florida 34104 • (239) 252-2432 • Fax (239) 252-2469 PRELIMINARY COMPLAINT FORM Your Name--: C\,,A El"\ Date: 3 . S+ �J Address: � � �' N City: /'�»�}�I�' State: �C.- Zip: ‘39 J a Home Phone: Business Phone:,-,23-3 L/45 THIS COMPLAINT IS AGAINST: Company Com an Name: f 1 G\-Q-A-S M O e_ License# 4(041 / (.113e. t2.5-o r S- Contractor or Peron in Charge: (If Known) A Address: 1q 60 I J p Phone: Date of Contract: THE.SPECIFIC COMPLAINT IS: (Attach additional sheets as necessary) 6 II) �t�..r 9n (job JO „try) q -Q6 N � -? y6 Attach Copies of All Appropriate Documents: Contracts, Checks, Liens, Permits, Etc. Contractor Licensing Officers: Michael Ossorio (Supervisor)- (239)252-5706 Ian Jackson- (239) 252-2451 Allen Kennette- (239) 252-2468 Robin Ganguli- (239) 252-2914 Karen Clements- (239) 252-2450 Signature: o T l T i e r C o H ri t y tot g° n � r - • Estimate . : seer aatw . agar.Oast aarsr. Date Estimate# am err` ..s _.. _ VP72O11 KM0914O037 U wow. itc ts—More.ctt-pm Ca±inets_Vanities.Granite.Qusutz.Plooring More Maria&Steve Maraca 2614 Tsmiami Trail N.#454 6910 Club Marco#201 Naples,FL.34103 Marto Island,FL . Pa:239---213-2221: Fax:866-929-0535 Same IJmail:AacountinggT ittchena-More.coJp Project I Kitchen&Bath 2011 Terms Rep Custom Contikt I Customer Phone 5096Arz]ar/40°/abeiirezy/5%8t S% AAU • Maria 8t Set ..( 84775IO35O• tip40ht - Price . I.)Provide:aod install Kitchen cabinets"Elite" Series all wood construction with soft close drawer glides. Includes.36"Wall cabinets,(2)decorative wall panels,(4)Roll Out Trays, Crown Molding,Light Rail,fillers and toe kick. Per owner approved design. . . 2.)Provide and install Vanity cabinets""Elite" Series all Wood coon with soil close drawer glides.Guest bath VSB-36-34,MasterBath-VSB3--34(2),VDB-I2-34(2).Includes Biers&tae kick. . . .. 3.)Kitchen-Provide&Install Level I Granite Countertops-4"backsplash-Standard . . Edge-Undermoimt Sink(to be selected)-Per Occtier Approved Drawings 4.)Master&Guest Bath-Provide&Install Level I Granite Countertops-4"backsptash-Standard • Edge-(3)White Ceramic Undermount Sink Cutout $.)provide and install all wood shelving in master closet per owner approved drawing. . 6.)Eiectrical-Remove existing kitchen"Dome Lighting"over cabinets. Install (5)mini recess . fixtures.for general illumination. Install(5)undercounter task lighting fixtures. Add fan light • . to existing ceiling fan per owner if needed. . . 7,)Plu tubing✓Disconnect and reconnect kitchen and vats sinks as needed. Replace shut off . valves and exposed plumbing parts as needed. Aeoonneet icennaker line in kitchen. • Note: Proposal includes removal and disposal of existing cabinets and construction debris. Note: Proposal does not include any faai sets for kitchen or vanities. Owner will select and . contractor will supply at owner's expense. Note:Proposal' des all municipal and building fees for Collier County and City of Marco . • Island. . TOTAL.. _. i — 24,26291 Atcepta 7,` tma . . By: 'INA . _—_. Date: t, 4 1( Acpeptmee f• .-',1m moons art:aeiyea so change*thane notice.Order changes and emeetiations may remit in a clone that reflect any menials, • . Platt,ar-aaadatb:_.that tee ., . e to-the order_wvivIGAChmrMkaC.Oarc1 I.0 darcaars all new mamas to lin fire from defnets in material and wottmanship lithe . time of deivey et p t&up.'rids.c ttuea the only War mty and no other waaanty or conrk+aa,statutory or atttatvise shall be implicit Vetted tepees oas Wray.. not be relied upon.Delivery dates prat kkd are approximate and not gtesrunteed Delvuy of products is included to customs-within ten miles. 1WJW.i{itahcc 4ore can TIC renerves'!be right at ent tame atter receipt of yaw mdse*accept or;lease yota order for tar raison.We may require addnianat . vetifcadon or information Wore ally order: £00/I11Od its)V-Ot 1LO7. LE Al :xe 1 3/5/2011 httgs'/enail.landl.com/ajac/mai1?actio... Steve. I sent this last night around 7:00PM, I did not want to bother you on Friday evening. I am not sure you received it. When I came in this morning at 8:00am In had an error message saying it was not delivered, so I am resencling. Steve, First let me thank you for the opportunity to earn your business! I have been a local contractor here for almost 21 years now. I have intentionally kept my business at a level, even during the boom, that allowed me to personally price and supervise each job. I have two employees, Brian who manages the office and Tim who manages field .• operations and design. I also use two independent sales reps that bring me, business. My Jobs, just like when I built homes, are done by long term trusted subcontractors Who are legal U.S. citizens, carry•all insurances and,. . most importantly are the type of people you and I can trust in your home. I. provide quality products that I would have in my own home and I have never sold my jobs, bUilding.homes or remodeling, on price! I sell based on relationships of trust, built with my clients by delivering what I say, when I say! And standing behind it. . My profit margins are modest and fair and I am happy to share them with : you. I have a margin of 20% built into your job with a 5% slippage contingency. When all is said and done and I have paid all of the . . . municipality fees (which are high in our area), subcontractors and my overhead.I usually net around 4-6%. I am happy to proceed with your job s ; on a cost plus basis where I would obtain three bids on every trade and add 15% if you are more comfortable that way. It takes the risks out of it for me and may result in a lower price for you. In conclusion after considering your proposal. today I am prepared to offer. the following final bid of$ 24,878.34 (attached). I do not add fluff to my • proposals and so you know how I arrive at this number, I am willing to . • • reduce my margin by 5% and remove the 5% slippage, removal of the girls bedroom closet and reduction of the molding which I had duplicated in . error. As I mentioned on the phone, it is very important that I understand.: what I am providing you and that you Understand what you are purchasing; With regards to the add-ons per our last meeting. They represent some ' . substantial cost increases not included in the initial estimate for me Le: _ • E00/7oi1 1¢8Y'Ot ZIOZ LE 30(1 !XE- •— a 3/5/2011 httpsI/emaillandLcom/ajax/mail?actio... - Addition of towercabinet in master bath. - Demolition and refinish of soffits, medicine cabinets, mirrors and replacement.of electrical fixtures in both baths. • - Increase upper cabinets to 42" - Addition of cabinet and installation for the drop in range Also, with regards to your suggestions for the revised terms for payment My terms are 50%execution of order/40% Delivery of materials/5% Substantial completion/5% Punch Out, for the following reasons, in the first week in which you execute the agreement to proceed I will submit and pay in advance,for your kitchen cabinets . . (which represents a major portion of the entire job cost), submit for the building permit on Marco (in your case will be around $ 1000.44), purchase your granite, and provide each subcontractor a 80% deposit on their portion of the job. When this is done I will have exhausted the entire deposit. Thus the payment of 40% upon delivery of the materials. The remaining payment of.10%, which contains the profit.. : .;. portion if I have been successful and accurate in my bidding, is paid: only when you are happy with the job! In conclusion I will thank you again for the opportunity to earn your . business and should we.not,have done what was necessary to do so, :l wish you the best in your endeavor. If you have any questions or would like to discuss this further please give me a.call. I am available 5:30AaM-10:00PM.Mon-Sat. and after church on Sunday (1:00PM) on my cell 239.287.280$. • Sincerely, . Brenton L. Mongan The Best for Legs, Affordable Kitchens, baths & More! V .: 'tea Fnu/Ennd meR7 ni 7.LfT. LE oan DESIGN PROFFESIONAL INSPECTED PERMIT INSPECTOR'S PRE-PERMIT AFFIDAVIT 2007 FLORIDA BUILDING CODE Kam ^' Job Information Permit#: //-253(a -'25J(a Job Site Address: (AO el V Al2& Q(I J(„ tin i'r- ?Pt Legal Address of Site: Property Owner: Mkza.A aentk Owner's Mailing Address: Contractor(Company Name): W tz1 t Ptb en) S Contact Information Design Professional Name/License#: SEA C. KCtSii)6k,r" 5L2 $ FLA, jam, Design Professional Company Name: '.C.. I<Dslosia c7%vec injr riv Address: ._._ 1S6 4„ 1 Fo'cLA or, ; +s T Pi K ets Q+ Ch 1Fe-- Phone/Fax/E-mail: ,M-I 2-1 71 Name of Inspector if different from Design Professional named above: Job Description Description of wor that will be inspected: N� CAai txs &i l-arff / Rx S wor ) Pre-permit Acknowledgement A copy of all inspection reports will he submitted, at regular intervals, to the Building Services Division for review. If the individual reports are not signed and sealed then the engineer will provide a sealed cover letter itemizing the attached reports. A final certification letter will be submitted for review by the Building Services Division before completion of the permit. The letter will meet the following criteria: The final certification letter shall state that the Design Professional has made all inspections personally, or a duly appointed representative that is employed by the design professional, has performed the inspections on their behalf. The letter shall bear the Design Professional's signature, date, seal and statement that all phases of the construction have been inspected under his/her supervision and the construction is consistent with the plans and specifications outlined on his/her sealed construction documents. The City's"Engineer's Completion”form may be submitted in lieu of the final certification letter. It shall include the Engineer's signature and seal. t 3/2011 en Regulations and Information 1. The City of Marco Island Building Services Division is regulated by the 2007 Florida Building Code. For more information about the code or to purchase the code visit http://www.floridabuilding.orq 2. The City of Marco Island Building Services Division is further regulated by City of Marco Island Ordinance, Chapter 6, Article IV, Sec. 6-111. 3. Florida Statute 471.045 Professional engineers performing building code inspector duties.— Notwithstanding any other provision of law, a person who is currently licensed under this chapter to practice as a professional engineer may provide building code inspection services described in s. 468.603(6) and (7)to a local government or state agency upon its request, without being certified by the Florida Building Code Administrators and Inspectors Board under part XII of chapter 468. When performing these building code inspection services, the professional engineer is subject to the disciplinary guidelines of this chapter and s. 468.621(1)(c)-(h).Any complaint processing, investigation, and discipline that arise'out of a professional engineer's performing building code inspection services shall be conducted by the Board of Professional engineers rather than the Florida Building Code Administrators and Inspectors Board. A professional engineer may not perform plans review as an employee of a local government upon any job that the professional engineer or the professional engineer's company designed. 4. Florida Statute 481.222 Architects performing building code inspection services.—Notwithstanding any other provision of law, a person who is currently licensed to practice as an architect under this part may provide building code inspection services described in s.468.603(6)and (7)to a local government or state agency upon its request, without being certified by the Florida Building Code Administrators and Inspectors Board under part XII of chapter 468. With respect to the performance of such building code inspection services, the architect Is subject to the disciplinary guidelines of this part and s. 468.621(1)(c)-(h).Any complaint processing, investigation, and discipline that arise out of an architect's performance of building code inspection services shall be conducted by the Board of Architecture and Interior Design rather than the Florida Building Code Administrators and Inspectors Board. An architect may not perform plans review as an employee of a local government upon any job that the architect or the architect's company designed. Design Professional's Certification I certify that all the foregoing information is accurate and that all work must be done in compliance with all applicable laws. Print Name of Design Professional/ License# S. re of Design Professional //-11/7/ Date (Seal) 2 3/2011 �� 13 DESIGN PROFESSIONAL INSPECTED PERMIT � s� ` � COMPLETION AFFIDAVIT is 4 2007 FLORIDA BUILDING CODE t. Job Information Permit#: Job Site Address: CAO 10b (YIGtrC'V brie, t)nIT ?.171 Legal Address of Site: Property Owner: M 672A gC Owner's Mailing Address: (auto 0.106 ()Vireo Orj(t-, AlamoLVQ4S,g. onfrZol Contractor(Company Name): 1Mple5 ?ipptrt ems Contact Information Design Professional Name/License#: Tetstph e,, goSs#NSc *52289 Design Professional Company Name: 3• C. 1;0.5;4).5k; Areil4.46) Address: 135 (7=)tftIlet Di, kar ffeI45 Be4cit / gt. Phone/Fax/E-mail: -2,11— t '- 21 Party paying for the Inspections: Job Description Description of work that was inspected, include any deviations from approved plans: A)2.w e b 4)“:3 / e rt,as , A ) xw1-5 (eilyite ) Design Professional Certification I certify that all necessary inspections have been performed. The construction is consistent with the plans and specifications outlined on the sealed construction documents. 30Se h Ka Nste,' .r- //-fir/ Print Name of Design Professional/ License# Si. . - of Design Professional /// sue// Date (Seal) 3/2011 F—l� t� $ k> ciiy o 1 a i c Y : ii A _cW 4,,' 4 /.27/12 Cdr Di Q a eve June 27,2012 Mr. Brenton L. Mongen License Holder CBC1250145 Naples Property Pros 715 Parkview LN Naples FL 34103-3738 Dear Mr. Mongan: This letter is in regards to building permit#11-836(690 Club Marco Cir Bldg 19-201)by Naples Property Pros. The permit in question has not been issued because you have not provided sub-contractor forms for electric and plumbing. FS 489.113 (3) A contractor shall subcontract all electrical, mechanical, plumbing, roofing, sheet metal, swimming pool, and air-conditioning work, unless such contractor holds a state certificate or registration in the respective trade category. The Building Official will not allow the permit to be issued without the required sub-contractor forms. If you do not submit the sub forms for electric and plumbing, a complaint will be filed with the Construction Industry Licensing Board. Once the City has received the sub-forms and approved the permit for issuance, we need to finish dealing with the special inspector issue. The engineer of record provided a form stating that he performed the required inspections, but failed to clarify exactly what he actually inspected. If he is not certified to perform the electric and plumbing inspections, per chapter 471 F.S. he should not be certifying these types of inspections. The City will provide the necessary electric and plumbing inspections once the permit is issued. 50 !:aid Eagle Drive, Masco Island,Florida 34145 (239) 389-5000 FAX (239) 389-4359 www.cityofmarcoisland.com --i S Additionally,,the Building Official is not required to accept the engineers'inspection and has declined the engineers' inspection form because it does not clearly identify all the work being inspected,or indicate what inspections were performed. Since the work is already performed we will also need,prior to permit issuance,the inspection reports showing what was inspected, date of inspection,name of inspector,design professionals seal, signature and date. I look forward to working with you regarding this matter. Please contact me at 239-389-5058 if you have any questions about this letter. • Sincerely, eZ____ Robert Mahar Chief Building Ofial t E-16 I am not aware of this but Bob is not in. At the moment, he is in a meeting at the County, about pools. Will ask him when he returns. ONO Ms. Lisa Lee Loewer City of Marco Island, Building Services 50 Bald Eagle Drive Marco Island FL Phone: 239-389-3956 From: GanguliRobin [mailto:RobinGanguli@lcolliergov.net] �.. �. Sent: Tuesday, June 19, 2012 7:01 AM To: Lee Loewer Subject: RE : B.O.A.A. Hearing Good Morning Lee. I spoke to Brenton Mongan/Naples Property Pros regarding his permitting issues at 690 Club Marco Circle, Bldg 19, unit 201 that we all met in an attempt to resolve. He has informed me that he has sent the City of Marco Island Building Services a certified letter requested a hearing at the next B.O.A.A. meeting to contest Marco Island's policy of not accepting his permit by affidavit submittal. I le told me he addressed this letter directly to Bob. I am trying to verify that this has actually occurred,and if so,when and where will the next B.O.A.A. meeting take place where this case will be heard. Please advise me on anything you may know regarding this matter. Thanks Lee. Rob tinder Flu'ida Law.e-mail addiesses are public records.If you do riot ward your e-mail address released In response to a public records request,do not send electronic mail to this entity.Instead.contact this office by telephone or in writing. Florida has a very broad public records law. As a result, any written communication created or received by City of Marco Island employees is subject to disclosure to the public and the media, upon request, unless otherwise exempt. Under Florida law, e-mail 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 this office by phone or in writing. 4 GanguliRobin From: Lee Loewer[LLoewer @cityofmarcoisland.com] Sent: Friday, June 22, 2012 11:29 AM To: GanguliRobin Subject: FW: RE : B.O.A.A. Hearing Hello Rob, Thank you for your inquiry regarding permit#11-836 (690 Club Marco Cir Bldg 19-201) by Brenton Mongan, Naples Property Pros This permit has not been issued because the contractor has not provided his sub-contractor forms for electric and plumbing. Florida Statute 489.113 (3) states A contractor shall subcontract all electrical, mechanical, plumbing, roofing, sheet metal, swimming pool, and air-conditioning work, unless such contractor holds a state certificate or registration in the respective trade category, We will not allow the permit to be issued without the sub-contractor forms. If the general contractor does not submit the sub forms for electric and plumbing, a complaint will be filed with the Construction Industry Licensing Board. Once we have received the sub-forms, we need to finish dealing with the special inspector issue. The engineer of record provided a form stating that he performed the required inspections, but failed to clarify exactly what he actually inspected. If he is not certified to perform the electric and plumbing inspections, per chapter 471 F.S. he should not be certifying these type of inspections. The City will be allowed access to perform the electric and plumbing inspections once the permit is issued. The Building Official is not required to accept the engineers inspection and has declined the engineers inspection form because it does not clearly identify all the work being inspected,or indicate what inspections were to be performed. Since we know that the work was already performed we will need the inspection reports showing what was inspected, date of inspection, name of inspector, design professionals seal, signature and date. If Mr, Morgan wishes to have his case heard by a Board of Adjustments and Appeals, he will need to use our hoard, which is our City Council. He should contact our Community Affairs Director, Bryan Milk 239-389-5012,to see about scheduling his request. We will generate a separate letter to Mr. Mongan, reiterating this information. Thanks, Lee Ms. Lisa Lee Loewer City of Marco Island, Building Services 50 Bald Eagle Drive Marco Island FL Phone: 239-389-3956 From: GanguliRobin [mailto:RobinGangulk colliergov.net] Sent: Tuesday, June 19, 2012 2:56 PM To: Lee Loewer Subject: RE: RE : B.O.A.A. Hearing 1 1 —J2 GanguliRobin From: GanguliRobin Sent: Tuesday, August 14, 2012 8:01 AM To: OssorioMichael Subject: FW: RE : B.O.A.A. Hearing From: Brenton Mongan [mailto:Brenton @BuildNaples.com] Sent: Thursday, August 09, 2012 11:13 AM To: GanguliRobin Cc: BLM:CC Subject: RE: RE : B.O.A.A. Hearing I apologize for the delay in getting back to you. I have just returned from a trip to Virginia and came down with a Bronchial and Sinus infection that has had me in bed for four days straight. I finally got antibiotics and hope to be getting better in the next couple of days. I cannot remember the last time I was this ill. Just so you arc aware, shortly after our last meeting together I had an allergic reaction to my arthritis medication. It caused me to be ill for a week and I have subsequently been going through some tests to see what the problem with the medication was and what else could be done for my condition. Not to bore you with details but, I suffer from Osteoarthritis and have "bone on Bone" condition in both hips. I have dealt with the condition for over eight years. I was to have my left hip replaced in 2007 however, I was laid off from DeAngelis Diamond Construction three weeks before my surgery and was unable to have the surgery as a result. Now, not being able to take the medication has left me barely able to walk and has caused me quite a bit of discomfort. It has affected my work and personal life immensely. When I was laid off at DeAngelis Diamond I was unable to obtain health care because of my being a 10 year cancer patient and no companies would accept me. I was fortunate that I was able to turn to the Veterans for care. As you know it is not the best but, has truly been a life saver for me. With no other option for keeping me walking and out of a wheelchair, my primary care doctor here at the Naples VA clinic referred me to the VA hospital in Bay Pines Florida. I started going there for appointments in June and continued weekly until July 23rd. On July 23rd I was approved 1w double hip replacement surgery by the VA. With regards to the letter from Marco Island, I am as confused as ever. The letter itself seems to be contradictory and there is apparently no procedure for a "Permit for Affidavit". What is described in the letter is not a "Permit for Affidavit" and I am prepared to tell the Board the same. A "Permit for Affidavit" does not require a plumber or electrician be on the permit. This is the purpose of a PBA, the engineer does the inspections! No electrician or plumber will go on the permit! It is ridiculous when the other municipalities have the policies and I have complied with them successfully. I now have to be the Ginny Pig for Marco Island. It is ridiculous. I am seeking the advice of my attorney and will be considering legal action against the Engineer. It seems only prudent to bring them in on this since they do this frequently for all other municipalities. I will called to the hearing as well. It is ridiculous that after what I have paid to correct this matter that Marco Island cannot get what they need from them. If I had been able to get a clear explanation of this from the beginning, I could have pursued it then with the engineer. This has been a ridiculous process and I will be happy to tell the board or anyone in attendance that this is exactly i • how this has been handled. As a result I have and will make no money in this job. The owner will use this excuse not to pay me the balance of$ 5300 and I will have paid for his new kitchen. All because we took a kitchen sink out for 2 days and put it back. The job has now been done for a year and no warranty issues have arisen! I have done everything as requested to correct this matter and spent good money after bad trying to correct it! With regards to a hearing, I am no longer requesting a hearing and will peruse my remedies through legal actions. Should a hearing be requested by someone else then so be it. With regards to a possible October as you mentioned in your voicemail. I was informed on my return home that I have been scheduled for double hip replacement surgery at Bay Pines Hospital on September 24th. This surgery is not optional for me. I will have the surgery there in Bay Pines Hospital and then be moved to the on campus therapy unit. I am told I will be released to come home around October 12th. I will then continue therapy here in Naples and will hopefully be released to work and to drive towards the beginning of November. If a hearing is scheduled and I am called in October I will have to inform the board of my unavailability due to medical reasons at that time. Thanks for all of your help. Semper Fi 1 � asp a City of Naar cX11! SLa31�i. December 28, 2012 Collier County Contractor Licensing Board 2800 North Horseshoe Dr Naples, FL 34104 To Whom It May Concern, Please accept this letter in lieu of an affidavit,that Mr. Brenton L. Mongen, License number CBC1250145, DBA Naples Property Pros, 715 Parkview Lane, Naples, FL 34103-3738, did on or about November 18, 2011, make application for a Multi-Family remodel at 690 Club Marco Circle, Building 19, Unit#201, permit application #11-836. The permit has not been issued and Is on hold. The Marco Island Building Department requested that the Contractor provide the sub- contractor information that is required under FS 489.113(3). The sub-contractors listed on the permit application are expected to take whatever steps are necessary to determine that the installation is done correctly and perform any tests available to determine compliance and safety. The Marco Island Building Department will not set a precedence by arbitrarily legitimizing non permitted work by use of an affidavit. There are procedures in place that address non- permitted work. The Code Enforcement Board for the City will make the determination that all reasonable avenues have been exhausted to determine who actually did the work, what licenses they possess and what money trail exists, if any. If the Marco Island Code Enforcement Board rules the original contractor cannot be determined and the Building Department needs a permit to legitimize the work that has been completed, at that point, a permit by affidavit endorsement will be considered on an individual basis. Section 105.14—2010 Florida Building Code—Building and 2007 FBC—Building states the conditions that apply on permits issued on basis of an affidavit. This application does not meet these conditions and the Marco Island Building Official believes this Contractor has willfully committed a building code violation. Sincerel Robert Mahar Building Official City of Marco Island 50 Bald Eagle Drive, Marco bland, Florida 34.145 (239) 389°5000 FAX(239) 389-4559 www.cityofnaarcoisland.counn SECTION 105 PERMITS Page 1 of 7 105 SECTION 105 PERMITS 105.1 Required. Any owner or 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, convert or replace any electrical, gas, mechanical or plumbing system, the installation of which is regulated by this code, or to cause any such work to be done, shall first make application to the building official and obtain the required permit. 105.1.1 Annual facility permit. In lieu of an individual permit for each alteration to an existing electrical, gas, mechanical, plumbing or interior nonstructural office system(s), the building official is authorized to issue an annual permit for any occupancy to facilitate routine or emergency service, repair, refurbishing, minor renovations of service systems or manufacturing equipment installations/relocations. The building official shall be notified of major changes and shall retain the right to make inspections at the facility site as deemed necessary. An annual facility permit shall be assessed with an annual fee and shall be valid for one year from date of issuance.A separate permit shall be obtained for each facility and for each construction trade, as applicable. The permit application shall contain a general description of the parameters of work intended to be performed during the year. 105.1.2 Annual permit records. The person to whom.an annual permit is issued shall keep a detailed record of alterations made under such annual permit. The building official shall have access to such records at all times or such records shall be filed with the building official as designated. 105.1.3 Food permit. As per Section 500.12, Florida Statutes, a food permit from the Department of Agriculture and Consumer Services is required of any person who operates a food establishment or retail store. 105.2 Work exempt from permit. Exemptions from permit requirements of this code shall not be deemed to grant authorization for any work to be done in any manner in violation of the provisions of this code. Permits shall not be required for the following: Gas: 1. Portable heating appliance. 2. Replacement of any minor part that does not alter approval of equipment or make. such equipment unsafe. Mechanical: 1. Portable heating appliance. 2. Portable ventilation equipment. http://ecodes.iccsafe.org/icce/gateway.dlbpFlorida%20CustomBuild2004 FL/3/8?f=templat... 9/5/2008 ARTICLE V. BUILDING TRADES* Page 30 of 36 Sec. 22-201.1 Misconduct--State certified contractors. The following actions by state certified contractors shall constitute misconduct and grounds for discipline pursuant to section 22-202 of this article. (1) Failing or refusing to provide proof of public liability and property damage insurance coverage and workers compensation insurance coverage as required by .Florida Statutes. (2) Willfully violating the applicable building codes or laws of the state, city or Collier County. (3) If the CLB finds through its public hearing process that the contractor was found by another county or municipality within the past 12 months, to have committed fraud or a willful building code violation and the.CLB finds that such fraud or other willful violation would have been fraud or a willful violation if committed in Collier County or within the respective city. (4) Fraud. (Ord. No. 94-34, §4; Ord. No. 99-45, §4.2-4.2.3, 6-8-99; Ord. No. 06-46, § 1(4.1.8.2)) Sec. 22-202. Disciplinary proceedings, including minor violations. (a) There are three categories of violations: (i) violations of subsection 489.127(1), F.S.; (II) violations of subsection 489.132(1), F.S.; and (iii) other violations within the jurisdiction of the contractor's licensing board. (1) Subsection 489.127(1), F.S., is incorporated herein. (Lack of required license, certificate, or registration). The following are designated to enforce subsection 487.127 (1), 'F.S.: Collier County Building Official, all license compliance officers, the 'chief building inspector, chief electrical inspector, chief plumbing/mechanical inspector, and/or other inspectors authorized from time-to-time by the building official: Procedures specified in this section shall apply except to the extent, if any, that Section 489.127 or Section 489.132, may require different procedure(s). The penalties for each uncontested violation of subsection 489.127(1) and/or 489.132(1), F.S., are $300.00 for the first uncontested violation and $500.00 for each subsequent uncontested violation by the same individual or entity. Penalties for contested violations of subsection 489.127(1), F.S., are as now or hereafter specified in Section 469.127, F.S. Penalties for contested violations of subsection 489.132(1), F.S., are as now or hereafter specified in Section 489.132, F.S. The citation form attached hereto as Exhibit "A" is approved, which form may be amended from time-to-time by resolution of the board of county commissioners. (2) Minor violations: The contractor licensing supervisor or designee shall issue a "notice of noncompliance" as the county's first response to a minor violation of any provision of any regulatory law, including this section, when(i),it is reasonable for staff to assume that the violator, at the time of violation, was not aware of the provision that was violated or it can be assumed that it was not clear to the violator how tocemply with the violated provision; and (ii) that violation has not then resulted in economic harm or physical harm to any person; and (iii) the violation has neither adversely affected the public health, safety, or welfare, rior created any significant threat of any such adverse affect. The notice of noncompliance should identify the specific provision that was violated, should provide information on how to comply with that provision and should specify .a reasonably time for full compliance. The notice of noncompliance shall not be accompanied with any immediate threat of any monetary fine or any other disciplinary penalty, but may specify that failure of the violator to correct the violation within the time specified in the notice for compliance may result in disciplinary proceedings. Each