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HomeMy WebLinkAboutENGINEERINGEngineering Services, LLC Notice to Building Official of Use of Private Provider Project Name/Address: I i I N Keiiri :)ood V.(/I �prJrp l ier6 11 34 s- I Parcel Tax ID: 1 -() IQd�J(L3�'000-9 Permit No: 2�t)'�k q Ia Services to be Provided: X Inspections _Plan Review NOTE: If the notice applies to Plan Review services the Building Official may require, at his or her discretion, the private provider also provide required building Inspections pursuant to Section 553.791(2), Florida Statutes. 66io the fee owner, affirm I have entered into ontract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: SkyeTec Engineering Services, LLC Private Provider: Keith A. Bowman, P.E. - Address: 9570 Regency Square Blvd., Ste. 410, Jacksonville, FL 32225 Telephone: 866-404-4130 Fax: 904-482-4299 _ Email Address: kbowman@skyeteceng.com Florida License, Registration or Certificate #: PE 80568 I have elected to use one or more private providers to provide building code plans review and/or inspection services on the building that is the subject of the enclosed permit application, as authorized bys. 553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. Instead, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold harmless the local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code Inspection services with respect to the building that is the subject of the enclosed permit application. I understand the Building Official retains authority to review plans, make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. I make any changesto the listed providers or the services to be provided by those private providers, I shall, within 1 business day after any change, update this notice to reflect such changes. The building plans review and/or inspection services provided bythe private provider is limited to building code compliance and does not include review for fire code, landuse, environmental or other codes. 9570 Regency Square Blvd, Jacksonville, FL 32225 866-759-3832 www.skyetecengineering.com l S"kyeTec Engineering Services, LLC The following attachments are provided as required: 1. qualification statements and/or resumes oftheprivate providerandall dulyauthorizedrepresentatives. 2. Proof of insurance for professional and comprehensive liability in the amount of$1 million per occurrence relating to all services performed as a private provider, including tail coverage for a minimumof 5 years subsequent to the performance of building code inspection services. Individual (Sign areas' i Print 6r Name: « ram_ � f Address: Ble ,�zi�wct•.+� 1 Y� Fr�tt r �L Phone:icLE/-�� Please use appropriate notary block STATE OF FL COUNTY Oy Individual Before me, this 145' day of appeared who executed the foregoing Instrument, and acknowledged before me that same was executed for the purposes therein expressed. Corporation Before me, this day of z0_ appeared of part..r hi. Partnership Before me, this day of z0_, appeared partner/agent on behalf of A partnership, who executed the corporation, foregoing Instrument and on behalf of the state corporation, acknowledged before me that who executed the foregoing instrum- same was executed for the purposes ent and acknowledged before me that therein expressed. same was executedforthe purposes therein expressed. Personally known or produced identifiatio4L. Type of identifiatlon produced l Slgna urf of Notary— � `` Print Name [ NOTARY STAMP] u[ APRB. MCCLINTaX 9570 Regency Square Blvd, Notary Public Jacksonville, FL 32225 o state of Florida 866-759-3832 www.skyetecengineering.com Comm# HH205833 t Expires 12/8/2o2s 2021.2022 LOCAL BUSINESS TAX RECEIPT JIM OVERTON, DUVAL COUNTY TAX COLLECTOR 231 E. Forsyth Street, Suite 130, Jacksonville, FL 32202.3370 Phone: (904) 255.5700, option 3 Fax: (904) 255-8403 https:lltaxcollector.coj.neV Note —A penalty is imposed for failure to keep this receipt exhibited conspicuously at your place of business. This. business tax receipt is furnished pursuant to Municipal Ordinance Code, Chapters 770-772, for the period October 01, 2021 through September 30, 2022. SKYETEC ENGINEERING SERVICES, LLC 9570 REGENCY SQUARE BLVD SUITE 405 JACKSONVILLE, FL 32225 ACCOUNT NUMBER: 297430 BUSINESS NAME: SKYETEC ENGINEERING SERVICES, LLC PHYSICAL ADDRESS: 9570 REGENCY SQUARE BLVD SUITE 405 JACKSONVILLE, FL 32225 CLASSIFICATION CODE: 323079 PUBLIC SERVICE OR REPAIR, NOT SPEC COUNTY TAX: 33.75 MUNICIPAL TAX: 76.25 STATE LICENSE NO: COUNTY LATE PENALTY: 0.00 MUNICIPAL LATE PENALTY: 0.00 TOTAL TAX: 110.00 VALID UNTIL September 30, 2022 ""ATTENTION' THIS RECEIPT IS FOR BUSINESS TAX RECEIPT ONLY. CERTAIN BUSINESSES MAY REQUIRE ADDITIONAL STATE LICENSING. This is a business tax receipt only. It does not permit the receipt holder to violate any existing regulatory or zoning laws of the County or City. It does not exempt the receipt holder from any other license or permit required by law. This is not a certification of the receipt holder's qualifications. t1 JIM OVERTON, TAX COLLECTOR THIS BECOMES A RECEIPTAFTER VALIDATION. Paid 2C21-5503328 117/19/2021$110.00 apnpSeleiGwsq MeliCyB .Fnrt.SRrtVry STATE OF FLORIDA dbpr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR THE STANDARD INSPECTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES BLD4 MECH. ELEC FRANKIIN, KEITH DEWAYNE LICENSE NUMBER: BN7563 EXPIRATION DATE NOVEMBER 30, 2021 Nways veriy lcercesomi�e al MVFloridaticeraecom [oil ❑ tb no•akcrdls aovmmrin orry icrtn. O Thisisyaur luss"m It is unla fu, anyone other flan the Ixensee to use this aocumere. R,.a.. „rJ.tl. ,_ Affm STATEOFFLORIDA Wdbpr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION T Fi1ANDAUD I NSPECIORNERF)N SC WIFDUNM LYE PRONSIONS OF DIA M 468, PLORDABTAIUTES PLL ,&W, MF HEINEY, RUSSELL E L NSE WMB Mn9 FXRMTNJNOATE: NOVEM6D130 ml NgaV—IN 4a-.,l a1 . .. Rill. ` - W�Jtahe,Ma Mmmnl lJanV[o<m OAISSYOMYn•,«IIFJk.MWfq yryinM OlNr min Me Ynnaanaa.ra'tM _P[.m�ei: amM1N4fitens •M®uwnwe+n STATE OF FLORIDA dbpr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR THE SIANOAaD PLANS DW 4EN HEREIN ISC£AMRM UNSP TNf P0.0VIRONBOf GiAYEE0. 46& FLIXUOA SIATVTEB BIDG HEINEY. RUSSELL E LCENSE NU MPXUl E RATON DATE NWEM= Y1.2p11 D,.mtaLnM.da.,n.nl mamla,m. �1, TMnwJ.liarnu.IlnwiaWu�lw+l,aoJadM1nlMntM1+li«,p«au JHMNOJ[nmant Florida DFIIKI ul Al Jil vo ... aNONf X' STATE OF FLORIDA dbpr 41 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR TFE STANDARD !NSPEGTORNEREIN ISGERTIPI£D UNDER TI-E PROVISIONS OF CI4AFT£R.1163, FLORIDA STATUTES &2 STUTO,RALPH �icEiu_ ENula�ex Br+rso2 E%PIRATION DATE: NOVEM80 3a 2021 a may. v-mry irnnv. m+bn� m MytMrWl i.r�cerm Do not vltvr ;his Aacamen: i\ arry'enn 11L-Isv rIlcen,e It Is onLTOW far DIV=ethe-Mas M I1ct9tsoo to osethl; QociMeM Florida DWM UCExS 4330-720-8 1-0- ;rUTD H ,#ONE •.<we NONE' 05202019 „n A Ibn OeSnNr.farernw .>i...i nr.-ate„ se.er>v STATE OF FLORIDA dbpr DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR THE STANDARD INSPECTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES ELEC, 1&2. BLDS. PLUM, MECI4 NAVARRO,10HNNY LICENSE NUMBER: BNa477 EXPIRATION DATE: NOVEMBER 36.261 Always verily Ikenses.Nin. at MyFi.ritlatkensec.m 0�\ 0 Do not alter this Eoament in arr, form. �4 This is Vom license. It is oni I for anyone other than the licensee to ose this em..'St. Florida A jff CERTIFICATE OF LIABILITY INSURANCE DATEIMM/2021 �� 09/28/2021 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 this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER RSC Insurance Brokerage, Inc. 135OAvenue of the Americas 18U FIOr New York NY 10019 CONTACT Irene Weiss NAME: PHONE Es"'— NoM : AIC No E fweissQkraotergroup.com ADDRESS: INSURER(S) AFFORDING COVERAGE MAID# INSURERA: American Casualty Cc of Reading PA 20427 INSURED INSURER B.: Continental Casualty Company 20443 SkyeTec Engineering Services LLC INSURER C: Continental Casualty Company 20443 9570 Regency Sq. Blvd., Suite 405 INSURER D: INSURERS: Jacksonville FL 32225 INSURER F UUVERAGFU CERTIFICATE NUMBER UL216927.275 octnstnid MnaalgcC. 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 RESPECTTO 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. PIER LTR TYPE OF INSURANCE INSO WVD POUCYNUMBER POLICY EFF MM/DO/YYYY POLICY EXP MMIDD/YYYY LIMIT$ X COMMERCIALGENERALLJABILITY CLAIMS -MADE 7x OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGETORE T PREMISES Es oocurrence 1,000,000 MED EXP (Any We Perean) $ 10,000 A 7014945225 07/15/2021 07/15/2022 PERSONAL SAOV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMITAPPLIES PER: POLICY ❑ JECTPRO- LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILELNBILRY ANYAU0 COMBINED SINGLELIMIT Ea accident S 1,000,000 X BODILY INJURY (Per person) s 1,000,000 A OWNED SCHEDULED AUTOSONLY AUTO$ 7015100566 07/15/2021 07/15/2022 BODILY INJURY Per aodaent) 8 1,000,000 HIRED NON -OWNED AUTOSONLY AUTOS ONLY X PROPERTY DAMAGE Par acddent S 1,000,000 $ X UMBRELLA LIAR X CCCUR EACH OCCURRENCE 8 5,000,000 B EXCESS UAB I CLAIMS -MADE 7014998278 07/15/2021 07/15/2022 AGGREGATE $ 5,000,000 DEO X RETENTION $ 101000 $ WORKERS COMPENSATION ANOEMPLOYERS'UABIUMY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in MIN) Ryes, descrbe under MIA I PER OTH- STATE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EAEMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I I C Professional Liability MCH591947545 03116/2021 03716/2022 Each Claim Aggregate $2,000,000 $3,000,000 DESCRIPTION OF OPERATIONS I LOCATION$/ VEHICLES (ACORD 101,Additional Remarks Schedule, may be attached if more space Is required) This certificate is issued as evidence of insurance coverage only. 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. Building Division 2300 Virginia Ave AUTHORIZED REPRESENTATIVE Albany FL 34982�G'�/�_1 / ACORD 25 (2016103) ©1988.2015 ACORD The ACORD name and logo are registered marks of ACORD reserved ACORN® CERTIFICATE OF LIABILITY INSURANCE `---� DAT 12127//27/2021 Y) 021 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh & McLennan (CLW) 101 N Starcrest Dr Clearwater FL 33765 CONTACT Certificates Department PHONE FAx 727-447-6481 c o:727-449-1267 E-MAIL ADDRESS: Cicerts bouchardinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: Clear Spring ri0 Property & Casualty Co. 15563 INSURED SKYETENGIN Skyetec Engineering Services LLC 9570 Regency Square Blvd Suite 405 INSURERS: INSURERC: Jacksonville FL 32225 INSURER D: INSURER E : INSURER F: CWtHAGts CERTIFICATE NUMBER: 77An1A3RF. ccwcrnM NUMBER 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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 TYPEOFINSURANCE ADDL INSO SUER MID POLICYNUMBER POLICY. EFF MM/DD POLICY EXP MWDD LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE $ PREMISES Ea - ante S MED EXP (Any one person) S PERSONAL &ADV INJURY $ GEN'L AGGREGATE LI MIT. APPLIES PER: POLICY ❑ JECT PRO- ❑LOC GENERAL AGGREGATE $ PRODUCTS -COMPIOP AGO $ $ OTHER: AUTOMOBILE LMBIUTY COMBINED SINGLE LIMIT Eaaccider S BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON.WNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS.MAOE DEC) RETENTION$ $ I I A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED9 ❑ NIA Y CSWC00587501 12/23/2021 12/23/2022 X PER OTR- STATUTE ER L. EACH ACCIOE ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under EL DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks schedule, may Its attached if mare space is required) When required by written contract, waiver of subrogation applies in favor of Certificate Holder with respect to Worker's Compensation, subject to the terms, conditions and exclusions of the policy. City of Port St. Lucie 121 SW Port St. Lucie Blvd Port St. Lucie FL 34984 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ACORD 25 (2016/03) ©1988.2015 The ACORD name and logo are registered marks of ACORD All rights reserved-