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HomeMy WebLinkAboutInfo-AUTHORIZATIONS AND LICENSESLETTER OF AUTHORIZATION Owner: BARRACUDA STATIONS, LLC 1201 OAKFIELD DR. BRANDON, FL 33511 Site Address: 8580 S. US HIGHWAY I PORT SAINT LUCIE, FL 34592 Parcel ID #: 3414-501-1902-400-2 I/WE HEREBY AUTHORIZE ALUMINUM PLUS TO PULL PERMITS, AND PERFORM ANY OTHER WORK THAT IS REQUIRED AT THE ABOVE LOCATION. ONCE PERMITS ARE APPROVED, ALUMINUM PLUS IS AUTHORIZED TO PICK UP ALL NECESSARY PERMITS. William D. McKni ht OWNER/AUTHORIZED AGEVT OWNER (PRINT) SIGNATURE NOTARY ACKNOWLEDGEMENT State of Florida County of Hillsborough THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME BY OF _ PH AL PRESENCE OR ONLINE NOTARIZATION :THI:S16th DY OF JUNE 2020, by WILLIAM DE. IGHT , h� s personally known to me. Af June 16, 2020 7ryt Public Signature) (Date) blic gYPU.I JOANNE C.JfltiNSON °' :commission #GG009678 SEAT, to of Florida %gqf Exphs MY 13, 2020 BondedThruTwyFain insurance8fl03s570S3 Aluminum Plus 750 E International Speedway Boulevard State Certified DeLand, FL 32724 CBC056832 (386) 734-2864 Fax: (386) 736-7096 PERMIT AUTHORIZATION I, R. Scott Pollitt hereby authorize Ileen Loveland to sign for and to obtain a Building and/or a Sign permit and any required licenses in my behalf under my License # CBC056832 for the job described below: DESCRIPTION: Owner: BARRACUDA STATIONS, LLC 1201 OAKFIELD DR. BRANDON, FL 33511 Site Address: 8580 S. US HIGHWAY 1 PORT SAINT LUCIE, FL 34592 Parcel ID #: 3414-501-1902-400-2 (License holder Signature) (Date) NOTARY ACKNOWLEDGEMENT State of Florida County of Volusia THE FgAEGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME BY MEANS OF P YSICAL PRESENCE O ONL EAZATION THIS 1 (,.p DAY OF , 2020,6y r J)(W, who is personally known to Signature) Notary Public State of Florida (Date) SEAL • ;;,Y•► ,, DEBRAl BASS t; MY COMMISSION # GG 949M F�CPIRES.Apri{l,6�{�,2fl24 yrl`ooP' gptldgd ThN Notary Ful! M ulld9fMllliBfB i M, I„- I m m p Z (D n C a -i �, p o c a o m r n ov CL) ° t I" 0 C Z � V'1 O=* 0 to X "- R7 O v m O Z �'` 2 Z 'Y"I 3 m r -n Z r Q n w�Ln w 0% N 4 6 m m (D, ( N oo -p A Vi O Z N m © m z 0 (D --� ° G) Z v o ° —f 00 T? ro i _.. M 0 rrD rt (,n m v C rD v+ O m gi 7[) r -f E I Q 2019/2020 Volusia County Business Tax Receipt Issued pursuant to F.S. 205 and Volusia County Code of Ordinances Chapter 114-1 by: Volusia County Revenue Division -123 W Indiana Ave, Room 103, DeLand, FL 32720 -- (386) 736-5938 Account # 199306080005 Expires: September 30, 2020 Business Location: 750 E INTL SPEEDWAY BLVD Business Name: ALUMINUM PLUS Volusia Name: R SCOTT POLLITT !' olusi . Coun Mailing Address: 750 E INTERNATIONAL SPEEDWAY BLVD FLORIDA DELAND, FL 32724 BUSINESS TYPE REQ DOC # CODE COUNT TAX Retail /Wholesale Sales 482 22 $60.00 Building Contractor Class B CBC056832 301 B 22 $54.00 This receipt indicates payment of a tax, which is levied for the privilege of doing the type(s) of business listed above within Volusia County. This receipt is non -regulatory in nature and is not meant to be a certification of the holder's ability to perform the service for which he is registered. This receipt also does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. The business must meet all County and/or Municipality planning and zoning requirements or this Business Tax Receipt may be revoked and all taxes paid would be forfeited. ■ The information contained on this Business Tax Receipt must be kept up to date. Contact the Volusia County Revenue Division for instructions on making changes to your account. THIS PORTION OF THE BUSINESS TAX RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS Volusia County Business Tax Receipt Revenue Division - 123 W Indiana Ave, Room 103, DeLand, FL 32720 — (386) 736-5938 DATE PAID:. RECEIPT #: TOTAL TAX: PENALTY: TOTAL PAID: 07/08/2019 BT 1-18-0001491 114.00 0.00 114.00 I@pp�I�0 N0 lilk'II0IIIYI Business Name: ALUMINUM PLUS Owner Name: R SCOTT POLLITT Mailing Address:750 E INTERNATIONAL SPEEDWAY BLVD DELAND, FL 32724 Account ## 199306080005 Expires:September 30, 2020 Business Location: 750 E INTL SPEEDWAY BLVD PLEASE DETACH THIS PORTION OF THE BUSINESS TAX RECEIPT FOR YOUR RECORDS AC"J?" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 12116/2019 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ios) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Julie Kuhlman NAME: Brown & Brown of Florida, Inc. PHONE(386) 239-5742 FAx (386) 239-5729 AIC No Ext): A1C, No : _ E-MAIL ) kuhlman bbda tona.com ADDRESS: y P.O. Box 2412 INSURER(S) AFFORDING COVERAGE NAIC # DA AGE R1117171� PREMISES Ea occurrence $ 100,000 Daytona Beach FL 32115-2415 INSURERA : Nationwide Insurance Company ofAmerica 25453 INSURED INSURER B: Allied Insurance Company of America 10127 RSR ENTERPRISES OF VOLUSIA COUNTY INC INSURER C : Bridgefield Employers Insurance Company 10701 DBAALUMINUM PLUS INSURER D: Akied Property & Casualty Insurance Company 42579 750 E INTERNATIONAL SPEEDWAY INSURER E DELAND FL 32724 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 REVIS[ON NIfMRE'R- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AIJUL INSD NUU11 W'VD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDNYYY - - LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE O OCCUR EACH OCCURRENCE $ 1,000,000 DA AGE R1117171� PREMISES Ea occurrence $ 100,000 MFD EXP (Anyone person) $ 5,000 PERSONAL INJURY $ 1,000,000 A GLZ03019114046 12131/2019 12J31120201,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. POLICY � JECT [g LOG GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG '.. $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT - $ 1,000,000 Ea accident ANYAUTO BODILY INJURY (Per person) $ B IX OWNED SCHEDULED AUTOS ONLY AUTOS BAL3019114046 12/3112019 12/31/2020 BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident PIP $ 10,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 D EXCESS LIAB CLafMS-MADE CAP3019114046 12131/2019 12/3112020 AGGREGATE $ 2,000,000 DED I X RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I W ANY PROPRIETORIPARTNERIEXECUTIVE ��� OFFICER/MEMBER EXCLUDED? 1 N I (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 83055037 12131/2019 12131/2020 STA OT �RH E. L. EACH ACCIDENT $ 1,000,000 E - DISEASE - EA EMPLOYEE $ 1,000,000 F DISEASE - POUCY LIMIT $ 9,000,000 INLAND MARINE D CIMP3019114046 12131/2019 12/3112020 LEASED/RENTED 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requimdl SEE 'NOTES FOR POLICY COVERAGE FORMS CERTIFICATE HOLDER CANCELLATION O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of AGO RD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ST LUCIE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 23001IIRGINIA AVE FT PIERCE FL 32982 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of AGO RD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Brown & Brown of Flonda, Inc. NAMED INSURED RSR ENTERPRISES OF VOLUSIA COUNTY INC POLICY NUMBER CARRIER T!!ODE71 EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes ICURRFNT BLANKET POLICY FORMS GENERAL LIABILITY 1) CG7246 1115 -ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT (ADDITIONAL. INSURFD-ONGOINGAND COMPLETED OPERATIONS) 2) OG7323 1216 - CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT (ADDITIONAL INSURED -LESSOR OF EQUIPMENT, MGR OR LESSOR OF PREMISES, STATE OR POLITICAL; WAIVER OF SUBROGATION; PRIMARY & NON-CONTRIBUTORY) AUTO LIABILITY 1)AC0102FL 0308 - BUSINESSAUTO ENDORSEMENT FORM -FLORIDA (ADDITIONAL INSURED) 2)AC0101A 0308 - COMMERCIALAUTO PLUS ENDORSEMENT (WAIVER OF SUBROGATION) UMBRELLA LIABILITY THE UMBRELLA LIABILITY FOLLOWS FORM OVER THE GENERAL LIABILITY, AUTO LIABILITY, AND EMPLOYERS LIABILITY PER FORM UMB0002 0413. ACORD 101 (2008/01) OO 2008 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD A & M Electric 1147 E Heartwood Drive State Certified DeLand, FL 32720 ECO002815 (386) 734-2864 Fax: (386)'736-7096 PERMIT AUTHORIZATION I, John W. Matthews, Jr., hereby authorize Ileen Loveland to sign for and to obtain an Electrical permit and/or any required licenses in my behalf under my License # ECO002815 for the job described below: DESCRIPTION• Owner: BARRACUDA STATIONS, LLC 1201 OAKFIELD DR. BRANDON, FL 33511 Site Address: 8580 S. US HIGHWAY I PORT SAINT LUCIE, FL 34592 Parcel ID #: 3414-541-1902-400-2 4 zz-- I �� x-6� " �/ - ZtLicense Holier Signatu NOTARY ACKNOWLEDGEMENT State of Florida County of Volusia (Date) THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE VIE BY MEANS OF PHYSICAL PRESENCE OR _ ONLINE NOT Z TION THIS 1 s DAY OF �] �T , 20209 by� who is personally known to me. blic Signature) (Date) Notary Public SEAL a CP. DEBRA J. BASS ' MX COMMISSION p GG 949898 `'•TE�1rF F1�N•` EXPIRES: Aprl 6, 2024 Bonded Thru Notary PuW Undw wrIte Jun 10 20 03:40P Florida Drawbridges, Inc. 954-943-3214 PA m 1 Ln en rri rte- m IM 0 < nO CD Z -4 3 (n FD n 0 > > 2: Ln 0 > rt o M 0 z r— > m 5 - M rt z 0 -n LM zi -< CO a F Z -n 0 Oft z] 0 to > M 0 0 0 M m Z m > rm rL C) Ln I > w z C) 0 Z Fj7 F - (D 0 > r- 00 4� m La cn m m 3 M m M LA (D C kn Ln n 0 0 zi 954-943-3214 PA m 1 en rri rte- m IM 0 < nO Z -4 (n FD n 0 > > 2: Ln 0 0 o M 0 z r— > m M > 0 -n CO -n 0 Oft to > M 0 0 M m Z m > Ln I > n F, z C) 0 Z Fj7 0 > r- 4� m cn m m > M m M C > 0 2019/2020 Volusia County Business Tax Receipt Issued pursuant to F.S. 205 and Volusia County Code of Ordinances Chapter 114-1 by: Volusia County Revenue Division -123 W Indiana Ave, Room 103, Deland, FL 32720 — (386) 736-5938 Volusia County FLORIDA BUSINESS TYPE Electrical Contractor Account # 198609030018 Expires: September 30, 2020 Business Location: 1147 HEARTWOOD DR Business Name: A&M ELECTRIC CONTRACTOR LLC Owner Name: JOHN W JR MATTHEWS Mailing Address: 1147 HEARTWOOD DR DELAND, FL 32720 REQ DOC # CODE COUNT TAX EC0002815 301 E 5 $18.00 ■ This receipt indicates payment of a tax, which is levied for the privilege of doing the type(s) of business listed above within Volusia County. This receipt is non -regulatory in nature and is not meant to be a certification of the holder's ability to perform the service for which he is registered. This receipt also does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. ■ The business must meet all County and/or Municipality planning and zoning requirements or this Business Tax Receipt may be revoked and all taxes paid would be forfeited. ■ The information contained on this Business Tax Receipt must be kept up to date. Contact the Volusia County Revenue Division for instructions on making changes to your account. THIS PORTION OF THE BUSINESS TAX RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS Volusia County Business Tax Receipt Revenue Division -123 W Indiana Ave, Room 103, Deland, FL 32720 — (386) 736-5938 DATE PAID: RECEIPT #: TOTAL TAX: 07103/2019 BT 1-18-0001042 18.00 IBIIIAAVIIII�I PENALTY: 0.00 Business Name: A&M ELECTRIC CONTRACTOR LLC TOTAL PAID: 18.00 Owner Name: JOHN W JR MATTHEWS Mailing Address:1147 HEARTWOOD DR ®,p DELAND, FL 32720 o Account # 198609030018 Expires:September 30, 2020 Business Location -1147 HEARTWOOD DR PLEASE DETACH THIS PORTION OF THE BUSINESS TAX RECEIPT FOR YOUR RECORDS A1C"R"� CERTIFICATE OF LIABILITY INSURANCE V FDATE(MM'DD"„Y" 05114/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies} must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thla certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCERONTACT NAMEKaitlyn Sault : Brown & Brown of Florida, Inc. P.O. Box 2412 PHONE (386) 239-7273FAX (388) 239 5729 AIC No Ext): (A1C, Nol: ADD RIE55: ksault@bbdaytona.com INSURER(S) AFFORDING COVERAGE NAIC # Daytona 'Beach FL 32115-2412 INSURERA: Southern -Owners Insurance Company 10190 INSURED INSURER B: Owners Insurance Company 32700 A&M Electric Contractor, LLC INSURER C: Bridgefield Employers Insurance Company 10701 1147 Heartwood Dr INSURER D: INSURER E PRODUCTS -COMPIOPAGG $ 2,000,000 Deland FL 32720 INSURER F: tivYt1'CAIitS CERTIFICATE NUMBER' Zu-41 RFVISIAN NIIMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE AULILSLIBIR INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 72736853 05/26/2020 05126/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT PREMISES (Fa occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE L[MITAPPLIES PER: POLICY L:] PEOT- 7 LOC OTHER_ GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNEDPROPERTYDAMAGE AUTOS ONLY AUTOS ONLY 5073685300 05/2612020 05/2612021 COMBINED SINGLE LIMIT $.. 300,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident $ PIP g 10,000 UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEO I I RETENTION $ 5 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PRCPRIETORIPARTNERIEXEOUTIVEE OFFICER/MEMBER EXCLUDEW {Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 83033987 04101/2020 04/01/2021 X STER ATUTE ORH .L. EACH ACCIDENT 5 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POUCY LIMIT S 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ST LUCIF COUNTY CONTRACTOR LICENSING ACCORDANCE WITH THE POLICY PROVISIONS - 2300 VIRGINIAAVE AUTHORIZED REPRESENTATIVE FT PIERCE FL 32982..F_._, O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD