HomeMy WebLinkAboutAlternative Service Agreement_SES Tier II AntennaA Universal
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Geotechnical Engineering I Construdlon Materials Testing and Inspection
Building Code Compliance i Environmental. Health & Safety 1 Facilities Consulting
LOCATIONS
Atlanta, GA
Hagerstown. MD
Pensacola. FL
Buford, GA
hvine. CA
Port St L.M. FL
Chantilly. VA
Jacksonville. FL
Reno, NV
Charlotte, NC
Kennesaw, GA
Rockledge, FL
Clewiston, FL
las Vegas. NV
Sarasota. FL
Daytona, FL
Miami, FL
St Petersburg, FL
Delray Beach. FL
Ocala, Al
Tampa. FL
Douglaselle, GA
Odando. FL
Tifton, GA
Fort Myers. FL
Palm Coast, FL
West Palm Beach, FL
Fort%ere=. FL
Panama City, FL
Galnesmlle. FL
Pelham. AL
Alternative Service Agreement
Project: SES / United teleports Tier II Antenna Installation
Private Provider Firm: GFA International
Private Provider Name: Thomas Montano
Address: 607 Commodity Cove. Port St. Lucie FL 34986
Phone: (772) 924-3575 Fax: (772) 924-3580
Names, License/Certificate Numbers, and License description of provider and duly authorized agents who will be
providing services for this project.
Name:
License/Certificate No.:
License/Certificate Type:
Don Determan
BN# 4688
Inspector — Building (1 and 2 family), Plumbing
Josean Duprey
BN# 7330 PX# 4208
Plan Review — Building, Inspector - Building
Richard Jefferson
BN# 1164 PX#513
Plan Review —AII Trades, Inspector —AII Trades
As the private inspection services provider for this project, I have read and agree to be bound to the provisions of State
Statute 553.791. 1 further agree and understand that only the above listed personnel may perform inspections on this
project and that if for any reason the inspection personnel should change, or if any person listed above should discontinue
to quality as a duly authorized agent, you will be notified in writing immediately.
Representative Name:
State of Florida, County of Palm Beach,
Sworn to (or affirmed) and subscribed before me this j (o day of oiDb'er
who is personally known to me.
'o �,wy rk ft U,brct�
Printed name of Notary
Notary Public Stamp:
Signature of Notary
2020, by-rhO S (Yk/nfi�./1Q