HomeMy WebLinkAboutVenture Three Form 101VENTURE THREE
FORM 101
Revised 1 Mar 2020
VENTURE HARBOUR INC.
VENTURE OUT AT INDIAN RIVER INC.
VENTURE OUT AT ST. LUCIE INC.
NOTICE
This form must be attached and made part of all drawings or plans regarding the installation, construction,
remodeling, setting or resetting of any permanent structure, concrete work, or any other type of work that
may be effected by the rules, regulations and bylaws of any of the above associations.
This form shall also serve as notice to the owner or owners of Lot # , that the owner or owners
or their agents of Lot # shall solely or jointly be responsible for the proper setting and
compliance of all rules, regulations and bylaws of any of the above associations, and the Codes, Laws,
Rules and Regulations pertaining to said work as set forth by St. Lucie County. This form does not
absolve the OWNER(s) of the need to obtain any necessary St Lucie County permits, PRIOR to
start of work.
The owner (s) or their agents, by signing this form, shall Bold harmless any of the above associations, its
officers, directors and committee personnel as pertains to its and their duties and responsibilities as -the
administration of said work- The OWNER (s) or their agents are also responsible to ensure their
contractor(s) abides by the rules set forth in Appendix A of this form.
Said work is approved as per the dimensions shown on attached plan or drawing,
of Work (attach drawings) : uQ
e--ld. Fxi57'.-is "�dMP 0-v �1-7- 3 o4w�1
Date Submitted to Association:
Association Building Committee:
By: Print & Sign !.. om, � SS
By: Print & Sign,�b
By: Print &
Owner, Owners, or Agent for Lot # k�
By: Print &
By: Print &
By: Print &
Association
Date: J !zd 2d
Date: 0000
Date:
Phone:
Date:
Date: ; o
Date:
V3 Form 101 Mar 2020 Page 1
VENTURE THREE
FORM 101
Revised 1 Mar 2020
Contractor/Builder agrees to this Indemnification Agreement, and also agrees to irrevocably
indemnify, save harmless and pay to any adjacent Owner in any of the above associations against
any loss, cost, damage or liability arising directly or indirectly out of work or construction
by the Contractor for the owners of the above lot.
OWNERS, who act as their own "General Contractor", shall have any sub -contractors sign
this agreement PRIOR to commencement of work.
PARTIES TO THIS AGREEMENT:
OWNER:
Printed Name:
Signature: �L� r� ,I r�/Qd��Date:
GENERAL CONTRACTOR— FL Contractor License # C 4K 1,
Does Contractor have a "Certificate of Liability Insurance" on Tile in the V3 Office? Y ❑ N ❑
Company Name: _Tiy N u i kf er-,/ LL!'
Agent Printed Name:
Agent Signature:
Contractor License #
Date: �640
Does Contractor have a "Certificate of Liability Insurance" on file in the V3 Office? Y ❑ N ❑
Company Name:
Agent Printed Name:
Agent Signature:
SUB -CONTRACTOR — FL Contractor License #
Date:
Does Contractor have a "Certificate of Liability Insurance" on file in the V3 Office? Y ❑ N ❑
Company Name:
Agent Printed Name:
Agent Signature: Date:
V3 Form 101_Mar 2020 Page 4