HomeMy WebLinkAboutApproved Security Bond Document 1 (2)
Building and Code Regulations Division
Permitting and Zoning
2300 Virginia Ave
Ft. Pierce, Fl 34982
772-462-1553
Cash Security Fund, Irrevocable Letter of Credit or Bond to Secure Cost of
Removing an Antenna, Antenna Array or Tower
Service Provider Information
1. Liberty Mutual Insurance Company
2. Address: 175 Berkeley Street, Boston MA 02116
Phone Number: (425)383‐5998 Fax Number: _______________
3. Location of Tower (Address): 6189 N US Hwy 1, Fort Pierce, FL
4. Parcel Identification Number: 1406-413-0003-000/8
5. Lease Holders Name & Address: T-Mobile, 1300 Concord Terrace,
Suite 200 Sunrise FL 33323
Phone Number: _954 832 6133 Fax Number: ______________
6. ID Number of Bond, Irrevocable Letter of Credit or Check: 674215518
7. Permit Number of Tower, Antenna or Antenna Array: 2105-0581
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Cash, Security Fund, Irrevocable Letter of Credit or Bond to Secure Prior
Service Provider Information (If Replacement Bond):
1. Name: _____________________________________________________
2. Address: ___________________________________________________
____________________________________________________
Phone Number: __________________ Fax Number: _____________
3. Location of Tower (Address): ___________________________________
4. Parcel Identification Number: ___________________________________
5. Lease Holders Name & Address: ________________________________
__________________________________
__________________________________
Phone Number: ___________________ Fax Number: _____________
6. ID Number of Bond, Irrevocable Letter of Credit or Check: ___________
7. Permit Number of Tower, Antenna or Antenna Array: ________________
1/12/2009
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