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Backup Documents 06/26/2012 Item #16B 316B 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE (Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on the item.) ROUTING SLIP Complete routing lines #1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the exception of the Chairman's signature, draw a line through routing lines #1 through #4, complete the checklist, and forward to Ian Mitchell (line #5). Route to Addressee(s) (List in routing order) Office Initials Date l.Steven Williams County Attorney's Office Agenda Item Number 16133 2. Original document has been signed /initialed for legal sufficiency. (All documents to be —Applicable) 3. signed by the Chairman, with the exception of most letters, must be reviewed and signed by Number of Original 4. Ian Mitchell, Executive Manager Board of County Commissioners Documents Attached 5. Trish Morgan Clerk's Minutes and Records ?M b (2-1 6 ((2 :401\ PRIMARY CONTACT INFORMATION A'� (The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive summary. Primary contact information is needed in the event one of the addressees above, including Ian Mitchell, need to contact staff for additional or missing information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the item.) Name of Primary Staff Contact Brad Muckel Phone Number 239.867.4121 Agenda Date Item was 6/26/12 Agenda Item Number 16133 Approved by the BCC Original document has been signed /initialed for legal sufficiency. (All documents to be —Applicable) Type of Document signed by the Chairman, with the exception of most letters, must be reviewed and signed by Number of Original Attached the Office of the County Attorney. This includes signature pages from ordinances, Documents Attached INSTRUCTIONS & CHECKLIST I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04 Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is Yes N/A (Not appropriate. (Initial) 1. Original document has been signed /initialed for legal sufficiency. (All documents to be —Applicable) signed by the Chairman, with the exception of most letters, must be reviewed and signed by the Office of the County Attorney. This includes signature pages from ordinances, 4� resolutions, etc. signed by the County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and possibly State Officials.) 2. All handwritten strike - through and revisions have been initialed by the County Attorney's S,il Office and all other parties except the BCC Chairman and the Clerk to the Board 3. The Chairman's signature line date has been entered as the date of BCC approval of the document or the final negotiated contract date whichever is applicable. 4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's 'Vil signature and initials are required. 5. In most cases (some contracts are an exception), the original document and this routing slip should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval. u ✓°I Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 6. Return 1 fully executed copy to Call Brad at the Immokalee CRA for pick-up 867 -4121 I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04 168 3 MEMORANDUM Date: July 9, 2012 To: Bradley Muckel, Project Manager Immokalee CRA From: Martha Vergara, Deputy Clerk Minutes & Records Department Re: Commercial Faeade Improvements Program Recipient Agreement Recipient: Chez Nuos Dadou Restaurant Attached, please find one (1) scanned copy of the original documents for this agreement including the backup referenced above (Agenda Item #16113), approved by the Board of County Commissioners on Tuesday, June 26, 2012. The Minutes and Record's Department has held the original documents for the Official Record of the Board of County Commissioners. If you have any questions, please call me at 252 -7240. Thank you 16B 3 Exhibit B COMMERCIAL FACADE IMPROVEMENT PROGRAM RECIPIENT AGREEMENT �-A THIS AGREEMENT ENTERED this X26 day of Tu vc o 1 a by and between the Collier County Community Redevelopment Agency (CRA) (Immokalee) (hereinafter referred to as "CRA ") and Chez Nuos Dadou Restaurant (company) (hereinafter referred to as "GRANTEE "). WITNESSETH: WHEREAS, in Collier County Ordinance No. 2002 -38, as amended July 22, 2008, by Ordinance 2008 -40, the Board of County Commissioners delegated authority to the CRA to award and administer CRA programs and awards including contracts with business GRANTEES within the boundaries of the Immokalee CRA for CRA grants; and WHEREAS, the CRA Commercial Facade Improvement Program (hereinafter referred to as the Facade Program) allows for the use of CRA funds, in conjunction with private investments, for certain improvements to commercial structures located within the boundaries of the Immokalee CRA; and WHEREAS, the intent of the Facade Program is to increase commercial occupancy rates and property values within the CRA while revitalizing the overall appearance of the Immokalee Area; and WHEREAS, GRANTEE has applied for a fagade grant in the amount of $16,366.67 dollars; and WHEREAS, the CRA has determined that GRANTEE meets the eligibility requirements and was approved for a Facade Program award in the amount of $16,366.67 dollars on C-.16'° / ( "CRA Approval "). NOW, THEREFORE, in consideration of the mutual covenants contained herein and other valuable consideration, the parties agree as follows: 1. GRANTEE acknowledges to the CRA that GRANTEE has received a copy of the Facade Program, that GRANTEE has read the Facade Program Policies and Procedures document, and that GRANTEE has had ample opportunity to discuss the Facade Program with GRANTEE'S counsel or advisor. GRANTEE further acknowledges to the CRA that GRANTEE understands and agrees to abide by all of the terms and conditions of the Facade Program. GRANTEE agrees to the terms and conditions of the Facade Program attached hereto as Exhibit A and incorporated herein by reference. 2. GRANTEE is the record owner of property described as: Legal: Carson S. Block 2, Lot 3, Less N. 20 feet or 1493 Page 865. Folio Number: 25580640004. Address: 211 West Main Street, Immokalee, Florida 34142. 3. GRANTEE has agreed to make certain improvements to the property pursuant to the Fagade Program application submitted to the CRA dated April 24, 2012 attached hereto as Exhibit A and incorporated herein by reference. 4. CRA has approved an award to GRANTEE in the amount of $16,366.67 to be administered pursuant to the terms of this Agreement based on an estimated cost of $24,550.00. 5. Unless prior disclosure is included in the grant application, no GRANTEE, or any immediate relative of GRANTEE, shall serve as a contractor or subcontractor for the construction of the improvements and no GRANTEE or any immediate relative of GRANTEE, shall receive compensation for labor for the construction of the improvements. An immediate relative of GRANTEE shall include mother, father, brother, sister, aunt, uncle and cousin or family member by marriage to include mother -in -law, father -in -law, brother -in -law and sister -in- law. GRANTEE has verified that all contractors who have provided bids for the approved work are actively licensed by Collier County and GRANTEE agrees that all labor will be performed only by the lowest bidding contractor. 6. GRANTEE agrees to obtain all necessary permits and submit any required plans to the Collier County Community Development and Environmental Services Division. Upon completion of the work, GRANTEE shall submit a closeout package to the CRA which will include all applicable (electrical, structural, fire, plumbing, etc.) final inspection verification from Collier County Building Inspection Division. The CRA, through its staff, shall confirm that the improvements were constructed pursuant to the terms of this agreement approved by the CRA and shall create a final report to include digital color photographs of the project before and after completion. 7. Within forty -five (45) days after confirmation that the improvements were constructed pursuant to the terms of the approved application, GRANTEE shall be issued a check in the amount of the award. However, if GRANTEE fails to make the improvements pursuant to the terms of this agreement, including construction start within 90 days of execution of the grant agreement and completion within 12 months of the execution of the grant agreement, the award shall be deemed revoked and GRANTEE shall be entitled to no funding. 8. This Agreement shall be governed and construed pursuant to the laws of the State of Florida. 9. This Agreement, along with its incorporated attachments, contains the entire agreement of the parties and their representatives and agents, and incorporates all prior understandings, whether oral or written. No change, modification or amendment, or any representation, promise or condition, or any waiver, to this Agreement shall be binding unless in writing and signed by a duly authorized officer of the party to be charged. 10. This Agreement is personal to GRANTEE, and may not be assigned or transferred by GRANTEE or to GRANTEE'S respective heirs, personal representatives, successors or assigns without the prior written consent of the CRA. -2- 168 31 IN WITNESS WHEREOF, the parties have executed this Agreement on the date and year first written above. 1 tness Signature Printed/Typed Name GRANTEE(s): By: Printed/Typed Name, Title and Company ( d) � iBy: Witness gnature / Printed /Typ d Name Printed/Typed Name ATTEST: DWIGHT; E. EMCK Clerk test i3.atd � Z 1,:• ,on .. Approved as to form and legal sufficiency: 4=-=Q- LA-- Steven Williams, County Attorney's Office COLLIER COUNTY COMMUNITY REDEVELOPMENT AGENCY By: Comm/ sioner Donna Fiala, Chair This Agreement is to be signed and witnessed AFTER CRA staff has found the application to be complete. -3- EXHIBIT IMMQKALEE Collier veenAC ` A etpmt Agency Date of Application: April 24. 2012 Immokalee CRA I Commercial Fagade Improvement Grant Application Commercial FaVade Grant Application Applicant Information Grantee Name (company): Chez Nous Dadou Restaurant Grantee /Site Address: 211 West Main Street, Immokalee, FL 34142 Daytime Phone: (239) 657 -1207 Alternate Phone: (239) 324 -2488 E -Mail Address: NUSERVICES @yahoo.com Do you own or lease the property? Own Occupational License No. 101102 Authorized Representative Signature: A ; nC Proiect In ormation Describe the existing conditions of the site (attach additional sheets if necessary). The front concrete structure and glass storefront were severely damaged by a vehicle accident (see photo). Outline the proposed improvements in detail (attach additional sheets if necessary). The applicant proposes to replace the front of the building in its entirety. Improvements include new concrete blocks, stucco, windows, doors (re -use existing), paint and decorative trim /sunburst. List Approved Contractors and Amounts. Jackie Williams Contracting: $24,550.00 REQUIRED ATTACHMENTS FROM APPLICANT: 1) One estimate each from TWO contractors for each project. These contractors MUST be listed in the online database htti):Happs2.collier2ov.net/webapps/vision/ConCert/default.asvx 2) Business Owners: copy of occupational CRA STAFF: 1) Attach two color photos of each project to be performed. 2) Attach Property Appraiser 1D. Estimated cost of improvements: $24,550.00 Maximum grant award: $16,366.67 A. EXHIBIT B 16B 3 COMMERCIAL FACADE IMPROVEMENT PROGRAM RECIPIENT AGREEMENT THIS AGREEMENT ENTERED this 22 "d day of May, 2012 by and between the Collier County Community Redevelopment Agency (CRA) ( Immokalee) (hereinafter referred to as "CRA ") and Chez Nuos Dadou Restaurant (company) (hereinafter referred to as "GRANTEE "). WITNESSETH: WHEREAS, in Collier County Ordinance No. 2002 -38, as amended July 22, 2008, by Ordinance 2008 -40, the Board of County Commissioners delegated authority to the CRA to award and administer CRA programs and awards including contracts with business GRANTEES within the boundaries of the Immokalee CRA for CRA grants; and WHEREAS, the CRA Commercial Facade Improvement Program (hereinafter referred to as the Fagade Program) allows for the use of CRA funds, in conjunction with private investments, for certain improvements to commercial structures located within the boundaries of the Immokalee CRA; and WHEREAS, the intent of the Facade Program is to increase commercial occupancy rates and property values within the CRA while revitalizing the overall appearance of the Immokalee Area; and WHEREAS, GRANTEE has applied for a fagade grant in the amount of $16,366.6 7 dollars; and WHEREAS, the CRA has determined that GRANTEE meets the eligibility requirements and was approved for a Fagade Program award in the amount of $16,366.67 dollars on May 22. 2012 ( "CRA Approval'). NOW, THEREFORE, in consideration of the mutual covenants contained herein and other valuable consideration, the parties agree as follows: 1. GRANTEE acknowledges to the CRA that GRANTEE has received a copy of the Fagade Program, that GRANTEE has read the Fagade Program Policies and Procedures document, and that GRANTEE has had ample opportunity to discuss the Fagade Program with GRANTEE'S counsel or advisor. GRANTEE further acknowledges to the CRA that GRANTEE understands and agrees to abide by all of the terms and conditions of the Fagade Program. GRANTEE agrees to the terms and conditions of the Fagade Program attached hereto as Exhibit A and incorporated herein by reference. 2. GRANTEE is the record owner of property described as: Legal: Carson S, Block 2, Lot 3, Less N. 20 feet or 1493 Page 865. Folio Number: 25580640004. Address: 211 West Main Street, Immokalee, Florida 34142. 3. GRANTEE has agreed to make certain improvements to the property pursuant to the Fagade Program application submitted to the CRA dated April 24. 2012 attached hereto as Exhibit A and incorporated herein by reference. 4. CRA has approved an award to GRANTEE in the amount of $16.366.67 to be administered pursuant to the terms of this Agreement based on an estimated cost of 24 550.00. 5. Unless prior disclosure is included in the grant application, no GRANTEE, or any immediate relative of GRANTEE, shall serve as a contractor or subcontractor for the construction of the improvements and no GRANTEE or any immediate relative of GRANTEE, shall receive compensation for labor for the construction of the improvements. An immediate relative of GRANTEE shall include mother, father, brother, sister, aunt, uncle and cousin or family member by marriage to include mother -in -law, father -in -law, brother -in -law and sister -in- law. GRANTEE has verified that all contractors who have provided bids for the approved work are actively licensed by Collier County and GRANTEE agrees that all labor will be performed only by the lowest bidding contractor. 6. GRANTEE agrees to obtain all necessary permits and submit any required plans to the Collier County Community Development and Environmental Services Division. Upon completion of the work, GRANTEE shall submit a closeout package to the CRA which will include all applicable (electrical, structural, fire, plumbing, etc.) final inspection verification from Collier County Building Inspection Division. The CRA, through its staff, shall confirm that the improvements were constructed pursuant to the terms of this agreement approved by the CRA and shall create a final report to include digital color photographs of the project before and after completion. 7. Within forty -five (45) days after confirmation that the improvements were constructed pursuant to the terms of the approved application, GRANTEE shall be issued a check in the amount of the award. However, if GRANTEE fails to make the improvements Pursuant to the terms of this agreement, including construction start within. 90 days of execution of the grant agreement and completion within 12 months of the execution of the grant agreement, the award shall be deemed revoked and GRANTEE shall be entitled to no funding. 8. This Agreement shall be governed and construed pursuant to the laws of the State of Florida. 9. This Agreement, along with its incorporated attachments, contains the entire agreement of the parties and their representatives and agents, and incorporates all prior understandings, whether oral or written. No change, modification or amendment, or any representation, promise or condition, or any waiver, to this Agreement shall be binding unless in writing and signed by a duly authorized officer of the party to be charged. 10. This Agreement is personal to GRANTEE, and may not be assigned or transferred by GRANTEE or to GRANTEE'S respective heirs, personal representatives, successors or assigns without the prior written consent of the CRA. -2- 169 3 1 IN WITNESS WHEREOF, the parties have executed this Agreement on the date and year first written above. Wftness Signature Printed/Typed Name (2) /7-- -, Witiiess"§ignature Priilted�yp d Name ATTEST: DWIGHT E. BROCK, Clerk , Deputy Clerk GRANTEE(s): 13y . Printed/Typed Name, Title and Company I. z9girliz-vic Prhited/1'yped Name COLLIER COUNTY COMMUNITY REDEVELOPMENT AGENCY 0 Commissioner Donna Fiala, Chair EXHIBIT C r, Mto)OMMI-1 IMMOKALEE CRAColter County Community Redevetopment Agency Ili mokaloo CRA I COMMe-FeW Fa add Ir< iproverr ana Grant Appflca-ition Applicant Commitment of Resources I /we, commercial property located at owner(s) / tenant(s) of the have the funding and all Other capability necessary to begin the site improvements listed above and have the ability to complete all improvements within one year of the approval of the improvement grant by the Collier County Community Redevelopment Agency. I / we further affirm that payment for all work on approved improvements will come from accounts in my / our names) or the name(s) of entities registered in the State of Florida which I / we have incorporated or otherwise registered with the state (verification is required). Payment for improvements by from persons or entities not a party to this Grant Application is grounds for disqualification. Signature of Tenant (if leased) Signature of Tenant (if leased) (if jointly leased) Signature of Owner Signa�Own'er (if jointly owned) Date Date Date Date Wells Fargo StoreVision Platf Checking /Savings Ac Tax Responsible Customer Additional Customers Ledger Balance Available Balance Date Description 01/17/12 Deposit i Page 1 of 2 :count History Select action ... - NU WAY OMNI SERVICES Sole Owner MICHEL A LAFLEUR Signer $44,475.74 $63,075.74 Image Check Available Number No (pending) No No No No No No Amount Balance +18600.00 1566.49 44475.74 2006.87 46042.23 1702.51 48049.10 2957.30 49751.61 5500.89 52708.91 445.19 58209.80 Yes +14150.00 58654.99 Yes 453115115 +32101.66 44504.99 Yes 1510 214.86 12403.33 No No No Q•7 1685.20 12618.19 499.79 14303.39 57.82 14803.18 935.09 14861.00 3117.31 15796.09 https:Hal -site 1. salesandservice. wellsfargo .com /svp /accountHistorylnit.do 1/17/2012 Unitransfer 1338 Cash 01/13/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/12/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/11/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/10/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/10/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/09/12 C &d Nu -way Omni Services 1650827358 0 01/09/12 Deposit 01/09/12 Deposit Made In A Branch /store 01/06/12 Check Unitransfer 1338 Cash 01/06/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/05/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/04/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/04/12 C &d Nu -way Omni Services 1650827358 0 Unitransfer 1338 Cash 01/04/12 C &d Nu -way Omni Services 1650827358 0 Image Check Available Number No (pending) No No No No No No Amount Balance +18600.00 1566.49 44475.74 2006.87 46042.23 1702.51 48049.10 2957.30 49751.61 5500.89 52708.91 445.19 58209.80 Yes +14150.00 58654.99 Yes 453115115 +32101.66 44504.99 Yes 1510 214.86 12403.33 No No No Q•7 1685.20 12618.19 499.79 14303.39 57.82 14803.18 935.09 14861.00 3117.31 15796.09 https:Hal -site 1. salesandservice. wellsfargo .com /svp /accountHistorylnit.do 1/17/2012 Wells Fargo StoreVision Platf' ' i Page 2 of 2 Unitransfer 1338 Cash 16B 01/04/12 C &d Nu -way Omni No 7337.70 18913.40 Services 1650827358 0 Unitransfer 1338 Cash 01/03/12 C &d Nu -way Omni No 1617.47 26251.10 Services 1650827358 0 01/03/12 Check Yes 1509 3112.90 27868.57 01/03/12 Deposit Yes +18860.00 30981.47 https:Hal -site 1. salesandservice.wellsfargo .com/svp /accountHistorylnit.do 1/17/2012 Return to: (enclose self - addressed st, J envelope) Now Thomas K. Boardman BOARDMAN & THOMPSON, P.A. Addrsur 1400 -A 15th Street Nbrth P.O. Drawer 5250 Immokalee, Florida 33934 This Instrument Prepared by: Thomas K. Boardman BOARDMAN & THOMPSON, P.A. Adores: 1400 -A 15th Street North P.O. Drawer 5250 Immokalee, Florida 33934 !\ Property Appraisers Parcel Identificatlon (Folio) Number(s): 25 5S ilow IT-- SPACE ABOVE THIS LINE FOR PROCESSING DATA M N nl _ o 0 G' CD CV U U LL1 to C� m WARRANTY 088a /TATUTORY F. S. 689.07 n 0 i 4 9 3 OR BOOT( EXHIBIT D RAMCO FORM 5 n00865 1 6 8 PAGE SPACE ABOVE THIS LINE FOR RECORDING DATA This Indenture, Made this I � W day of December , A. D. 19 89 .Between KENNETH J. BLOCKER, a /k /a KENNY BLOCKER and BARBARA J. BLOCKER, husband and wife, of the County of Collier in the State of Florida part ies of the first part, and HULDA GEORGES, of the County of Collier in the State of Florida whose post office address is 109 West Main Street, Immokalee, Florida 33934 part y of the second 101tUSS9th, That the said t t part, for and in consideration of the sum of TEN ($10.00) DOLLARS AND LNyl ATIONS -------------------- Dallarr, to them in hand paid 6 td part y of the cd+rrl art, the receipt whereof is hereby acknowl- edged, ha ve granted, barggfrte� to the said part f the second part. her heirs and assigns forever, the fol'(ywirl� ed an a e, and ein�in the County of Collier State of Florida , A -w /h __ 'l-� sftti°� e, I Lot 3, less the Nor h 20 e t a so Ts!Subdivision, according It the plat the Pa g 4 is Records of Collier County, Florida. ti Subject to easeme estrictions a Ws ions of record, as well as to taxes for th 'tur nt year and to y rtion of the special assessment lien impoi hi,e Immok e� er and Sewer District for the year 1990 and sub seque�as 1. Dopm, tary Stamp Tax Received $ C4"sr. "C" ;I1;iiilF'bIP_ �_.= ar�onsl Prcperty Tax COL==am� � BY DIG And the said parties of the first part do hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. In Witness UhereofA The said part ies of the first part have hereunto set their hand s and seal s the day and year first above written. :Signed s !ti- ed and delivered in the presence of: _ n :... ......... � A. :,� ............................. � KA.............................. K H J. BL CKER _.......: ...i :.l .............. ............................... *BiARY ..... ...... .......................R J . BLOCKER n oncut COUNTY. ORtf)as l ( raves STATE OF FLORIDA, t �LLtE�cOGNE$ COUNTY OF COLLIER j �AMESC I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, personally appeared ' KENNETH J. BLOCKER and BARBARA J. BLOCKER, �• I to me known to be the persons described in and who executed:'thc Yoregoing instrument and they acknowledged before me that they executed the same. WITNESS my hand and official seal in the County arsd State last aforesaid' this i `) day of f; December A. D. 1989. € NOTARY PUBLIC. STATE OF FLORIDA AT LARGE ^�.....�.R. 1..-.' ...�....�?::.�:'........•. My Commission .................... .. !a.,:.:... ..:.... ... Expires: MY COMMISSION EXPIRES AUGUST 281 1992 N Y PUBLIC BONDED THRU HUCKLEBERRY 8 ASSOCIATES EXHIBIT E 16B 3 2011 Collier C untv Notice of Ad Valorem Taxes and Non -Ad Valorem Assessment If Paid By Nov 30, 2011 Dec 31, 2011 Jan 31, 2012 Feb 29, 2012 Mar 31, 2012 Please Pa 1,217.88 1 230.57 1,243.26 1,255.94 1 268.63 Parcel Number Legal Description Mill Code Escrow Code 25580640004 CARSONS BLK 2 LOT 3 LESS N 20FT OR 1493 PG 865 5 GEORGES, HULDA 211 W MAIN ST Pay in U.S. Funds Drawn on a U.S. Bank To: IMMOKALEE FL 34142 -3928 Collier County Tax Collector 3291 E. Tamiami Tr. Naples, FL 34112 -5758 Visit our website www.colliertax.com Market Value Authority Type Mill Rate Assessed Value Exempt Amt Taxable Value Tax Amount 86,862 County 3.7626 86.862 86.862 326.83 School -State 3.2790 86,862 284.82 Exemption Amount School -Local 2.2480 86,862 195.27 Dependent 1.7992 86,862 156.28 Water Mgmnt .3418 86,862 29.68 Independent 3.0934 86,862 268.70 Voter Apr Dt .0812 86,862 7.05 Millage' Total 14.6052 Total Ad Valorem 1,268.63 Non -Ad Valorem District Type of Assessment Amount Non -Ad Valorem Total .00 See reverse side for important information Combined Ad Valorem and Non -Ad Valorem Total 1,268.63 Pleas( Retain this portior for yor record 05/23/2012 10:06 3058919654 September 3Q, 2011 JA Hume OT Assured MICHAEL & ULDA LAFLEUR 909 JEFFERSON AVENUE DALESIW-.AGCY PAGE 01/03 CERTIFICATE / POLICY NUTABEFt 1 IMMOKALEE, FL 34142 DALES INSURANCE t ,GENCY 12780 W, DIXIE HWY., 2ND FLOOR EXHIBIT F THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SLIRPLUS LINES LAW. PERSONS INSURED BY SURPLU;� LINES CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA INSURANCE: GUARANTY ACT TO THE EXTENT OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF ANY INSOLVENT UNLICENSED INSURER_ N. MIAMI, FL 33181 ' PRODUCER: Dales Docteur CITY: N.11A arni Effective From 1 ,41 drn Both Days et St�ndam (ime ! Sa ember 11, 2(111 TO _ Septemt er 11, 2012 whaEPPanyourinslruclian, NASe:nl' SUFES AMOUNT ORP?RC :e �i NT eff0tted the tn9urencewfth= OW-GA US INSURANCE, INC, 100`'o - p 0 i SECTIMi I - PROPERTY AMOUNT C- WERAGE RATE; PREMIUM $250,000 PROPERTY AVERAGE - SEE FORM CPDSW [10 /001 $3,375 4 SURPLUS LINES INSURERS' POLICY RA "rES ANI3 FORMS AF -E NOT APPROVED BY ANY FLORIDA REGULATCIIRY AGENCY, THIS IS A u CO- INSURAr, CE - CONTRACT. 80 % CO -INSU RANCE CLAUSE APPLIES. 3% DEDUCTIBLE APPLIES TO THE PERILS OF WINOSTO 1M AND HAIL DEDUCTIBLE APPLIES TO ALL OTHER PERILS INSURED AGAINST —... TOTAL BASE $3,376 Form(s) and EndOMement(s) made a parr of this PelicY at time of issue See OUS500 (10/07) Schedult: of Forms and Endorsements 51 Countersigned: TAPCO Urtdenerrlters, Inc. Vlrginla C. Phillips, Surplus Lim :I Agent, Lie# A2Q6695 13577 Feathersound Drive, PO k:! OX 17069, Clearwater, FL MORTGAGEE / LOSS PAYEE FLORIDA COMMUNITY BANE{ 1400 NORTH 15TH STREET IMMOKALEt_, FL 34142 In witness wheroof this Dwomwe hat boon signed at F:.IRLINGTON, NO thK So day of Septombor , 2011 I3GANT FL 01-18100 (09/07) AGENT TERRORISM PREMIUM FOUCYFEE INSPECTION TAX 17_arn� P31.80 sERVk:F ra C SICA ASSESSMENT FEF R4:F FEE W.82 Ei>APA FEE 4d tt►l TOTAL —�— , Inc. 0 • Ils..d 05/29/2 -012 10:06 3058919654 DALESINSAGCY PAGE 02/03 SCIIl, )rJLE OP FORMS AND ENDORSEMENTS TOTP , OR CONSTRUCTIVE I,OSS CAUSE OUS149 10 -07 OUS214 10 -07 6 OUS2S5 07 -09 SCHEDUL E OF FORMS AND ENDORSEMENTS SEVEi�AL LIABILITY NOTICE IL, 00 17 11 -98 POLICY NUMBER: OUS009025686 Endorsement No. /Edition Date /Fon n Description NAMED INSURED MICHAEL & UTXA. LA LEUR OUS100 09 -07 OUS500 10-07 COME" )N POL;*CY DEC OUS101. 10 -07 SCIIl, )rJLE OP FORMS AND ENDORSEMENTS TOTP , OR CONSTRUCTIVE I,OSS CAUSE OUS149 10 -07 OUS214 10 -07 MTN :;ARNED PREM ENDT OUS2S5 07 -09 TERRrJRISM COVG NOT PURcHASpTJ GENE,-AL CLAUSES ENDT OUS267 10-07 OCiS269 10 -07 SEVEi�AL LIABILITY NOTICE IL, 00 17 11 -98 APP.L.CABLE LAW (U -S.A_) CLAUSE COMAS;'V POLICY CONDITIONS IL0255 (09 -09) CP DS 00 10 FL Ci 'ANGES CANCEL /NC)NRENEWAL -00 OUS253 10-07 COMMI;RC'IAL PROPERTY BUSINESS POLICY TOTAI. MOLD, MILDEW OR OTTHER, FUNGI FOCI, OUS254 10 -07 CP A92E,I TOS ENDT 00 10 0402 CP 00 90 07 -88 IDUIL,:ING AND PERSONAL PROPERTY OVtRAGF,; FORM CP 03 21 06 -95 CP COMM;:RCIAr, PROPERTY CONDITIONS WINDi:TORM t)R, HAIL PERCENTAGE DEDUCTIBLE 10 30 04 -02 CP 10 33 06 C "AUS::S OF LOSS SPECIAL FORM -95 TAPCO FLOOD 01 -07 THEF'i EXCL FLOO]', TNSUrzANCE NOTICE OUS500 (10 -07) ADINTLONAL F08MS AGENT 05/29/2012 10 :06 9959919654 DALESINSAGCY PAGE > •. ' COMMEF , "IAL PROPERTY COVE:, ' OE: PART DECLARATIONS POLICY NUMBER: OUS(11,09025886 EFFECTIVE DATE: September 11, 2011 NAMED INSURED: MICK'ZL BSc ULDA LAFLEUR Dt;SCRIPTIQEV OF ORE ISES C!.VERAGE PROVIDED PREM. NO. 01 BLDG. NCI, Q1 LOCATION ADDRESS: 211 WES;I MAIN STREET, IMMOKALEE, FL 34142 CONSTRUCTION; ONE ST0 iY JOISTED MASONRY BUILDING OCCUPANCY: GIFT $HC' - Li1Q PROTECTION CLASS: r; COVERAGE: BUILDING COVERE=D CAUSES OF LOSS: SPECIE'l L COVERAGE EXCLUDING THEFT LIMIT OF INSURANCE: $250,000 RATES: 1.35 PREMIUM: $3,375 MP: COVERAGE: COVERED CAUSES OF LOSS: LIMIT OF INSURANCE: RATES: PREMIUM: $ MP; COVERAGE_: COVERED CAUSES OF LOSS: LIMIT OF INSURANCE;: RATES: PREMIUM= $ MP: REM. NO. BLDG. NO. • —� LOCATION ADDRESS: CONSTRUCTION: OCCUPANCY. PROTECTION CLASS: COVERAGE: COVERED CAUSES OF LOSS: LIMIT OF INSURANCE: RATES: PREMIUM: $ COVERAGE: MP: COVERED CAUSES OF LOSS: LIMIT OF INSURANCE: RATES: PREMIUM: $ MP: COVERAGE: COVERED CAUSES OF LOSS: LIMIT OP INSURANCE: RATES: PREMIUM: $ ME's: PREM. NCI. BLDG, NO. LOCATION ADDRESS: CONSTRUCTION: OCCUPANCY: PROTECTION CLASS: COVERAGE=: COVERED CAUSES OF LOSS: LIMIT OF INSURANCE: RATES: PREMIUM: $ COVERAGE: MP: COVERED CAUSES OF LOSS: LIMIT OF INSURANCE: HATES: PREMIUM: $ COVERAGE: MP.- COVERED CAUSES OF LOSS: LIMIT OF INSURANCE: IATES: PREMIUM: $ MP: AGENT OP DS oc (10/00) 03/03 Contractor Certification Detail, - ge Page 1 of 1 Contractor Details Class Code: 1110 Class Description: BUILDING CONTR.-CERTIFIED Certification Number: 15700 Original Issue Date: 4/25/1990 Certification Status: ACTIVE Expiration Date: 8/31/2012 County Comp Card: State Number: CBC 046132 State Expiration Date: 8/31/2012 Doing Business As: WILLIAMS, JACKIE Mailing Address: 611 LAKE SHORE DRIVE IMMOKALEE, FL 34142 - Phone: (239)657 -3293 Fax: Back Copyright ©2003 -2007 Collier County Government, 3301 E. Tamiami Trail, Naples, FL 34112 ( Phone 239 - 774 -8999 Site Map I Privacy Policy and Disclaimer I Website developed by Vision Internet http: / /apps2.colliergov. net / webapps /vision/ConCert/Detail.aspx ?cert=15700 6/21/2012 JACKIE WILLIAMS 611 Lake Shore Drive IMMOKALEE, FLORIDA 34142 (941) 657 -3293 TO Hilda Georges 211 W. Main Street Immokalee FL 34142 EXHIBIT G Page No. of ­Yy (6 Authorized PHONE DATE 4/18/2012 JOB NAME / LOCATION Ammendment to Proposal #515 Change store front from plan dated 12/5/11, by Morrison Engineering to plan showing raised stucco and stepped top finish to blocks. Cost of extra stucco $ 2,500.00 Engineering and color render 700.00 Total Changes $ 3,200.00 Original Proposal $ 21,350.00 New Total $ 24,550.00 WE PROPOSE hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: dollars ($ ). Payment to be made as follows: All material guaranteed to be as specified. All work be completed in a professional manner according to standard practices. Any alteration or deviation from above specifica- o Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Nbte: This proposal may be Our workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Pay nt will be made as outlined above. Signature Date of Acceptance: Main Level DESCRIPTION LAFLEUR_EXTRAS Main Level QNTY REMOVE REPLACE TOTAL Dumpster load - Approx. 20 yards, 4 tons of 1.00 EA 420.00 0.00 420.00 debris Taxes, insurance, permits & fees (Bid item) 1.00 EA 0.00 400.00 400.00 Total: Main Level 820.00 Exterior Repairs DESCRIPTION QNTY REMOVE REPLACE TOTAL Ornamental iron - security grill - Detach & 169 3 0.00 Gulf Coast Restoration and Construction r 17061 Alico Commerce Ct #101 Illill Ft. Myers, FL 33967 239- 267 -9400 Ornamental iron - security door - Detach & 239 - 267 -3084 fax 0.00 Tax ID 41- 2103493 Main Level DESCRIPTION LAFLEUR_EXTRAS Main Level QNTY REMOVE REPLACE TOTAL Dumpster load - Approx. 20 yards, 4 tons of 1.00 EA 420.00 0.00 420.00 debris Taxes, insurance, permits & fees (Bid item) 1.00 EA 0.00 400.00 400.00 Total: Main Level 820.00 Exterior Repairs DESCRIPTION QNTY REMOVE REPLACE TOTAL Ornamental iron - security grill - Detach & 2.00 EA 0.00 1,357.98 2,715.96 reset Ornamental iron - security door - Detach & 2.00 EA 0.00 77.49 154.98 reset (Install) Storefront - aluminum anodized 2.00 EA 0.00 1,975.16 3,950.32 frame - Remove & Replace R &R Storefront door - alum. anodized 2.00 EA 34.34 1,120.85 2,310.38 frame, YxT - Single pane Masonry block 1.00 EA 0.00 283.80 283.80 Mason - Labor 1.00 EA 0.00 575.68 575.68 R &R Precast sill 22.00 LF 5.73 34.95 894.96 Framing repair - Parapet construction 1.00 EA 0.00 6,800.00 6,800.00 For all metal framing, plywood, cement board, stucco, etc. Awning - Vinyl 1.00 EA 0.00 3,759.00 3,759.00 Roofing repair 1.00 EA 0.00 2,500.00 2,500.00 Painting - 1.00 EA 0.00 2,246.40 2,246.40 Electrical repair 1.00 EA 0.00 1,450.00 1,450.00 Totals: Exterior Repairs 27,641.48 Interior Repairs DESCRIPTION QNTY REMOVE REPLACE TOTAL LAFLEUR_EXTRAS 10/26/2011 Page:2 JACKIE WILLIAMS 611 Lake Shore Drive IMMOKALEE, FL 34142 (239) 657 -3293 FAX (239) 657 -3531 TO: Hulda Georges 211 W. Main St. Immokalee FL 34142 Labor and material to reapir damaged store front: !i PROP SAL PHONE DATE 112/19Z2011 JOB NAME / LOCATION 211 Main Street JOB NUMBER JOB PHONE Build flase wall to secure building during construction, remove borken glass, concrete damaged by car and haul to dump. Replace front wall as shown on drawing by Scot Morrison. Includes all new concrete blocks and framing for glass front, existing doors to b used, and replacement glass to be tempered. WE PROPOSE hereby to furnish material and labor —complete in accordance with the above specifications, for the sum of: Twenty One Thousand Three Hundred Fifty and 00/100 Dollars dollars ($ 21,350.00 ). Payment to be made as follows: 50% at start of job. 50% at completion of job. All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices- Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado, and other necessary insurance. Our N e: This proposal may be workers are fully covered by worker's Compensation insurance. withdrawn by us if not accepted within 30 days ACCEPTANCE OF PROPOSAL —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: Signature PRODUCT 13128T FOLD AT (q TO FIT COMPANION 771 DU -O-VUE ENVELOPE. PRINTED IN U.S.A. B • Gulf Coast Restoration and Construction 17061 ico Commerce Ct #101 Ft. Myers, FL 33967 239-267-9400 239 - 267 -3084 fax Tax ID 41- 2103493 Client: Michel LaFleur Property: 211 W. Main Street Immokalee, FL 34142 Operator Info: Operator: REY Estimator: Rey Soto Type of Estimate: Reconstruction Service Date Entered: 8/24/2011 Price List: FLNA7X JULI I Labor Efficiency: Restoration /Service/Remodel Estimate: LAFLEUR EXTRAS File Number: EXTRAS Extras Date Assigned: 16B 39 Home: (239) 657 -6046 f , � Gulf Coast Restoration and Construction 16B 3 17061 Alico Commerce Ct #101 Ft. Myers, FL 33967 239- 267 -9400 239 - 267 -3084 fax Tax ID 41- 2103493 CONTINUED - Interior Repairs DESCRIPTION QNTY REMOVE REPLACE TOTAL Drywall repair - Minimum charge 1.00 EA 0.00 475.00 475.00 Painting - Minimum charge 1.00 EA 0.00 195.00 195.00 Finish carpentry - Minimum charge 1.00 EA 0.00 255.00 255.00 Mask or cover per square foot 200.00 SF 0.38 0.00 76.00 Cleaning - Minimum charge 1.00 EA 0.00 150.00 150.00 Totals: Interior Repairs 1,151.00 Total: Main Level 29,612.48 Line Item Totals: LAFLEUR_EXTRAS 29,612.48 LAFLEUR_EXTRAS 10/26/2011 Page:3 168 3 Gulf Coast Restoration and Construction ' 17061 Alico Commerce Ct #101 Ft. Myers, FL 33967 239- 267 -9400 239 - 267 -3084 fax Tax ID 41- 2103493 Summary Line Item Total 29,612.48 Material Sales Tax @ 6.000% x 2,576.84 154.61 29,767.09 Overhead @ 10.0% x 29,767.09 2,976.71 Profit @ 10.0% x 29,767.09 2,976.71 Replacement Cost Value $35,720.51 Net Claim $35,720.51 Rey Soto LAFLEUR_EXTRAS 10/26/2011 Page:4 EXHIBIT H C) 5 _ Q � z ;o Q z C7 a > o r4 0 O Ord F, Q ��r� C R a W O w U o `n U �1 Q Q�u a M V O O I r z ma v s� °t __ �o d' �N N cn � _ O u �o 1, o O M cn �- 0 Cal rx h--1 $t a C-0 O _ H O o w a C) Q Co p Q�H cn w PW, C) O � HW SIN 00 z 0 168 3, o � e N � � Z COO U� L7 a €� wY b 0 z 93 G�o o ct o S Si W H 4to g J o a^ n h tiz° ICI g{ €a o� G 4 3� N 'u d� �wF•�� 0 4R Irl Z2 °o `ta j �a eLL B ^g� ° o4y~a aa f �8 go of uw o�aa d ia� O w a 353 a a ooaa o r� ° N goo z� ^.".�` 0000 o'° -'d� o o8 - ON� 30 _ZO Zr�iun ^ ^!� c LLu.V�, .fir yVw� j O uF - c a �3z= LLpp Z�Zn °� °a yy orsu o a?e:. rvJOOUµ y:. 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