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Home My WebLink AboutPlan ReviewNotice of Building Official of Use of Private Provider Project Name: Creekside Lot # 100, 9212 Potomac Dr: Fort Pierce, Florida Parcel Tax -ID: 2327-502-0108=000-8 Services to be provided: Plan Review: X Inspections X Note: If the notice applies to either private review or private inspection. services, the. Building Official may require, at his or her discretion, the private provider be used for both services pursuant to Section 553.791(2) Florida Statute. I, D.-R. Horton: Inc. as.the fee owner, affirm 'l. have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm:. Universal Engineering Sciences Private Provider: John Carl..Peterson . Address: 607 NW COMMODITY.COVE, PORT. ST:.LUCIE FL-3.4986 Telephone: (772) 924-3575 Fax: (772) 924-3580 Email Address (optional): gfaschedulinq(-universalengineering.com . Florida License Registration or Certificate #:BU1721 .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, by s. 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 with1he applicable code, 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 required minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. - By executing this form, -1 acknowledge that I have made in 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. If I make any changes to the listed private providers orthe services to be provided bythose 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 serviices.provided. by the private provider is limited to building code compliance and does not include review for .fire code, land use, environmental or other codes. The following attachments are provide as required: 1. Qualification statements and/or resumes of the private provider and all duly authorized representatives. 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 minimum of 5 years subsequent to the performance of building code inspection services. Individual (signature) Print Name: Address: Telephone No.: Please use appropriate notary block. STATE OF Florida COUNTY OF Brevard Individual Before me, this day of , 20__, personally appeared who executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein expressed. Corporation DR Horton Inc Print Corporati ame By: (signature) Print Name: Brian W. Davidson its: Assistant Secretary Address: 1430 Culver Dr NE, Palm Bay, FL 32907 Partnership Print Partnership Name By: (signature) Print Name: Its: Address: Telephone Telephone No. 321-733-7972 No.: Corporation Before me, this day of February , 2022 , personally appeared Brian W. Davidson of DR Horton Inc a corporation, on behalf of the state corporation, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed. Partnership Before me, this day of , 20_, personally appeared partner/agent on behalf of a partnership, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed. Personally known V ; or Produced identification Type of identification produced Signature of Notary Print Name Notary Public: NOTARY STAMP BELOW My commission expires: a'r4' ?+s DINAPARRINO MY COMMISSION it GO 935643 =;, a 'EXPIRES: February 27, 2024 2 of 2 Banded ihru Notary Public Underwriters .[BUNIVERSAL® ENGINEERING SCIENCES DR Horton-Creekside Cali Lot 100 9212 Potomac Dr. Fort Pierce; FL - Private Provider . Plan Compliance Affidavit California Model-9700 Potomac Drive,, Private Provider.Firm: .Universal Engineering Sciences Private Provider: John Carl Peterson Address:....... 607 NW Commodity. Coye; Port St.. Lucie, Florida 34986 Phone: 772-924-3575 Fax:..' 7727924-3580 . Email: ipeterson(&,,universalen; ineering.com I hereby certify .that :to the'best. of my knowledge and belief ahe plans'submitted were. reviewed' for and are -in compliance with the Florida Building Code and all .local amendments to the Florida Building .Code by the following affiant, who is duly authorized to perform plans review pursuant to Section 553.791, Florida Statute and holds the appropriate license or certificate: Name: John' Carl Peterson. Revised Plan Sheets: C 1, . GN, Al, A2D; El, P l ,- D 1, -D2, WA1, WA2, WA3, WA4;.WA6, S1, SLIA, S1.12,.91:2A, S2, S2-jA, S2.2A,.S3, S11A, S3.1B, S3.1C, SN1, .PAL . PA2, -PA3, Manufacturers truss layout Page 1; Truss Engineering, Energy .Calculations, Ml Florida License/Registration/Certification #(s) and description:. John Carl Peterson RPX 243 l Digitally signed by John Car 1John Carl Peterson Date:2022.02.18 -Peterson--.-- 07:43:26-05'00' Signature of Reviewer: SWORN AND SUBSCRIBED bef me by John Carl Peterson, BU 17.21 being personally known to me or having produced as identification and Who being fully sworn and, cautioned, state .that the foregoing is true and. correct to the best of his/her knowledge or belief. S r hm,hn�ni v rai . Signature of Notary Print Name Notary Public: NOTARY STAMP BELOW My commission expires: 0,�.N4.,..,!/�''.,; 0. 66 914118 • EVIRES Sept 17, 2023,. p ACORl7� �� CERTIFICATE OF LIABILITY INSURANCE DATE (IAA11DD YYYYI 2)912022 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(les) 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). Beecher Carlson Insurance Services a Brown & Brown company COWPRODUCER r,E c Lynda Volpe PHONE FAX 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 rueL ADDRESS; L nda.vol a bbrown,com MSURER(SJ AFFORDING COVERAGE NAICC INSURER A: Everest National Insurance CompanyGompany 10120 % m v.bbinsuranco.eom INSURED GFA International, Inc., DBA Universal Engineering Sciences 3532 Mamie Blvd INSURERS: Everest Premier Insurance Company 16045 INSURERC: Star5tone Specialty Insurance Company 44776 IHSURERD: AXIS Surplus Insurance Company 26620 INSURERE: Evanston Insurance Company 35378 Orlando FL 32 311 INSURERF: Landmark American Insurance Company 33138 COVERAGES CERTIFICATE NUMBER: 66673825 REVISION 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. ILTR TYPE OF INSURANCE ADD SUB POLICY NUMBER rPrOJVoICY EFF r1gNVD0NYYYOLICY Pir L.r1ARs A rl COURAERCIALGENERALLIABILITY CLAIIAS•AIADE ❑G OCCUR Blanket Contractual Liability p D RMSOL00058-221 111r2022 1/112023 EACHOCCURRENCE $9 000000 Eecu ocNTED M noel S 100 400 ❑ MED EXP (Any oneperson) $10 000 PERSONAL K ADV INJURY $1 004 000 GOCL AGGREGATE L11611T APPLIES PER: POLICY � JET LOC. OTHER: GENERAL AGGREGATE $2.000,000 - cohlPloP A0G $ 2 400 000 Employee Benefits $1,000 000 A AUT011OBILELIA®rUTY p ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED RON-O'NNED AUTOS ONLY AUTOS ONLY Cl H RM5CA40056.221 111r2022 11112023 00h181NEDSINGLE LIMrr (Ea nddam) BODILY INJURY (Per person) 53000000 $ BODILY INJURY (Per scddenl) $ PROPERTYDAMAGE S S F 7 UMBRELIALIAD N EXCESS LIAR OCCUR CLAIMS -MADE I] D LHAW6870 11//2022 11112023 EACHOCCURRENCE $2,000000 AGGREGATE S 2 000D00 DE❑ I I RETENTIONS $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFCANYPAERMEMB REXCLIJDED7 OPRIETOWPARTN__ GUTIVE ® (IAandalory In NH) If yes, tleWbe under DESCRIPTION OF OPERATIONS below NIA p RM5WC00084-221 (AOS) RMSWC00085.221 (FL NJ ME) 11112022 111/2422 11112023 11112423 13 PYA UTE ERH* E.l.EACH ACCIDENT 31,O00,400 E.L. DISEASE- EA EWPLOYE $ E.L. DISEASE- POLICY LUAIT 1 $1,000 000 E C. D Professional Liability Excess General Uab. ($4M xs of $1 M) Excess Auto Liability $2M xs of S3M MKLV7PL0005114 77102C221ALI P-001-000769170-01 2 I12022 11112022 1/1/2022 211/2023 111/2023 1/1/2023 Per Claim $5,000,000 Aggregate $5,000,000 Limit S4,000,000 Limit S2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltbnal Romarks Schodlila, may bo attached It mom spaco Is rctlulroM Creekside Lot 100, 9212 Potomac Dr. Ft. Pierce, FL 34945 St. Lucie County Building Department 2300 Virginia Avenue Port St. Lucie FL 34982 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORUSO REPREUNTATIVE a "e, eavisme-`Trral:lrcwce SeYeefrea, Jt m Beecher Carlson Insurance Services, LLC 81988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 6GG13925 I FES 22-23 GFA Imternational, Imc., I L.rnda Volpe 1 2/9/2022 9:41341 AM (85T) I Page 1 of 1 This certiticate cancels and supersedes ALL previously issued certificates. UNIVERSAL „ Geoteehnica,VEngine6ririg .. . Construction Materials Testing &Inspection ENGINEERING SCIENCES Building -Code Compliance .Occupational Health &Safety. .. .. • .. E'nviro.nmental • Grounded in Excellence Buildi.ng.EnVelope., ' Alternative Service A'g.reement Project: DR Horton-Creekside = 9212 Potomac Drive,, Fort Pierce, FL 34945-Lot'100 Private Provider Firm: Universal Engineering Sciences.. Private Provider Name: John Carl Peterson,. 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 wh_o will be .providing services for this project: Name:. :. License/Certificate—'No.:.' License/Certificate Type:: Matthew Chaney ' : BN 17342 Inspector-= Building.. Don Determali. ' BN 4688 Inspector = Building (1 and 219mily), Plumbing Josean Duprey ' PE 92178 Inspector-- Building. -Carl Peterson BN'5555. Inspector —"'MEP,, Building. William McColman BN 7752. Inspector = Building Donald: Green BN 7301: . Inspector -Electrical Juan-C. Hernandez .. PE 586.38 Inspector:- Mechanical Pau I -Desentz' .. BN.7601. Inspector" Building-.. . Richard Jefferson BN.1164 Inspector— Building, Electric, Mechanical;' Plumbing Clyde Thfteinn 'BN.4046.-.Inspector ":Buildin, Mechanical; Plumbin : Raymond mond Geridron BN 4955 Inspector = Building 1 and 2 family), -Electrical 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. John Carl Digitally signed by John Carl .Peterson Representative Name: Peterson -0soo ozz.oz.o9 tz:ao:a4 . Signature State of Florida, County of Palm Beach, Sworn to. (or affirmed) and subscribed before me this day of .. 202% by who is personally known to me. Printed name of Notary Signature of.No Notary Public Stamp: ENTES := .Commission0 GSIFU G 2621 3 Expires September 25, 2022 UrAW Thu Tmy Fain inskm wo n5.7019 4Qonrs. N 4- n, CITY OF PORT SAINT LUCIE BUSINESS TAX RECEIPT PLEASE POST IN CONSPICIOUS PLACE OR KEEP ON PERSON Term : 10/01 /2021 — 09/30/2022 2021 -2022 Business Address: 607 NW COMMODITY COVE Business Name: UNIVERSAL ENGINEERING SCIENCES Mailing Address: 607 NW COMMODITY COVE PORT ST LUCIE, FL 34986 Category: Category 3 PROFESSIONAL Additional Data: ENGINEERING FIRM BTR#: 127198 Date Made: 09/01 /2021 Business Tax Authority $134.00 Total Tax Paid: $134.00 THIS IS A RECEIPT FOR TAX PAID AND IS NOT REGULATORY IN NATURE This receipt does not warrant that the receipt holder is competent to perform in the business, but that the holder has paid the required tax and provided the necessary documentation (if required) for this business. Valid only when all state and local regulated trade licenses/competency cards are valid for the current fiscal year as required by law. A Universal Engineering Sciences Company YEARS OF EXPERIENCE 5 EDUCATION BS IN CIVIL ENGINEERING, FLORIDA ATLANTIC UNIVERSITY (2016) LICENSES & CERTIFICATIONS FLORIDA STANDARD BUILDING INSPECTOR, BN7342 MATTHEW CHANEY Inspector SUMMARY OF QUALIFICATIONS Enthusiastic Structural/Geotechnical Engineering professional with a positive attitude and a strong focus on quality and service, whois capable of achieving goals in both individual and collaborative settings with excellent attention to detail, verbal, and written communication skills. SELECT PROJECT EXPERIENCE 5000 N. Ocean (North Palm Beach, Florida) Inspector This project consisted of the new construction of a 20-story condominium. Mr. Chaney was responsible for performing Threshold Inspections such as, but not limited to reinforced masonry, post tension, concrete placement monitoring, red iron, and all other interior nonstructural inspections. Alta Delray — Delray Beach, Florida Inspector This project consisted of the new construction seven 4-story apartment buildings. Mr. Chaney was responsible for performing Threshold Inspections such as, but not limited to reinforced masonry, post tension, concrete placement monitoring, wood frame, precast concrete and all other interior nonstructural inspections. The Waterclub — (North Palm Beach, Florida) Inspector This project consisted of the new construction of two, 23-story condominiums. Mr. Chaney was responsible for performing Threshold Inspections such as, but not limited to reinforced masonry, post tension, concrete placement monitoring, red iron, and all other interior nonstructural inspections. Watercrest — (Parkland, Florida) Inspector This project consisted of the new construction of 458 one and two-story single family homes. Mr. Chaney was responsible for performing Special Inspections, including reinforcement of slab on grade, unit masonry, roof and wall sheathing, and truss engineering. PGCC — (Parkland, Florida) Inspector This project consisted of the construction of.386 one and two-story single family homes. Mr. Chaney was responsible for performing Special Inspections, including reinforcement of slab on grade, unit masonry, roof and wall sheathing, and truss engineering. 3550 S. Ocean — (South Palm Beach, Florida) Inspector This project consisted of the new construction of a 5-story condominium. Mr. Chaney was responsible for performing Threshold Inspections such as, but not limited to: reinforced masonry, post tension, concrete placement monitoring, red iron, and all other interior nonstructural inspections. Ron DeSantis, Governor Julie I. Brown, Se STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGU BUILDING CODE TH E STAN DAR PROVIS10t N RS & I NSPECTOI UNDER THE JUTES 0 EXPIRATION DATE: NOVEMBER 30; 2023 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. 0 This is your license. It is unlawful for anyone other than the licensee to use this d. GFA INTERNATIONAL, INC. 607 Northwest Commodity Cove Port St. Lucie, Florida 34986 Phone: (772) 489-9989 Fax: (772) 489-2989 TeamGFA.com DON DETERMAN Building Inspector/Plans Examiner Mr. Determan has over thirty-seven (37) years of experience in the building inspections and plan review industry. Mr. Determan has a comprehensive understanding and knowledge of the most recent technical building codes and has ample experience performing field inspections on many high-rise threshold buildings, as well as various municipal and special inspection projects. Select Project Experience TOWN OF JUPITER BLD001-2013/DG PLAN REVIEW, INSPECTION SERVICES AND PERMIT TECHNICIANS . JUPITER, FL • Mr. Determan provides the Town of Jupiter with Plans Review, Inspection Services and Permitting services on an as -needed basis for projects within the Town of Jupiter. CITY OF SEBASTIAN PLAN REVIEW & INSPECTIONS . SEBASTIAN, FL • Mr. Determan provides the City of Sebastian with Plan Review and Inspection Services on an as -needed bases for projects within the City of Sebastian. CLARITY POINTE a STUART, FL This project consists of the new construction of a one-story memory care facility located in Stuart, Florida with a footprint of approximately 55,000-square feet. Mr. Determan is performing special inspection services for precast concrete units, engineered unit masonry, connections, metal systems building, truss erections, weld inspections, and bolt inspections. AZURE CONDOMINIUMS a PALM BEACH GARDENS, FL • This project consists of the new construction of two, 5-story residential structures totaling approximately 575,000-square feet. Mr. Determan is performing threshold inspection services for reinforcing steel placements, shoring and re -shoring inspection verification, concrete and grout placement monitoring, pre and post fill cell grouting, structural steel, welds, connections, and exterior window and door attachments. ST. LUCIE COUNTY TAX COLLECTOR OFFICE a TRADITION, FL • This project consists of the new construction of a 1-story, 22,000-square foot building to house a new St. Lucie County Tax Collector office in the Tradition area of St. Lucie County, Florida. Mr. Determan is performing special inspections on engineered unit masonry, connections, weld inspections, bolt inspections, and curtain walls. Education A.A., BUSINESS, SACRED HEART EARLY, IOWA Professional Registrations STANDARD INSPECTOR, BN4688 BUILDING INSPECTOR, BN4688 1 & 2 FAMILY DWELLING, BN4688 PLUMBING INSPECTOR, BN4688 STANDARD PLANS EXAMINER, PX2466 BUILDING PLANS EXAMINER, PX2466 SEMINOLE COUNTY RFP-603520-19rrLR Term Contract For Licensed Plans Examiners And Inspection Services 26 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects, to yacht brokers, from boxers to barbeque restaurants, and they keep Florida,s economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department,s initiatives. Our mission at the Department is. License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! Ron DeSantis, Governor , STATE OF FLORIDA DEPARTMENT doIFj1pr OF BUSINESS REGULATION AND PROFESSIONAL BN4688 ISSUED,10/29/2021 STANDARD INSPECTOR DETERMAN, DON L Signature LICENSED UNDER CHAPTER 468, FLORIDA STATUTES EXPIRATION DATE. NOVEMBER 30, 2023 STATE OF FLORIDA Julie I. Brown, Secretary DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR LICENSE NUMBER: BN4688 EXPIRATION DATE, NOVEMBER 30, 2023 THE STANDARD INSPECTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES DETERMAN, DON L 2401 CANOE CREEK LN FT PIERCE FL 34981 ISSUED. 10/29/2021 Always verify licenses online at MyFloridaUcense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. JOSEAN A. DUPREY, E.I. Inspection Department Manager / Inspector / Plans Examiner SUMMARY OF QUALIFICATIONS Mr. Duprey is the Inspections Department Manager for the Port St. Lucie, Florida branch of GFA International, Inc. Mr. Duprey has over ten years of experience in the construction industry with extensive knowledge and engineering skills in construction materials testing and special and threshold inspections. He is also experienced with performing building plans review. EXPERIENCE GFA International, Inc. 2019 - Present Inspection Department Manager Mr. Duprey is the current Inspections Department Manager for the Port St. Lucie branch of GFA International. His responsibilities include managing daily inspections department operations, performing inspections and plans review as needed, managing client relations, supervising the inspections staff, and performing project management for inspections and plans review contracts. Town of Jupiter Plan Review, Inspection Services & Permit Technicians Continuing Contract - Jupiter, FL Contract Manager Mr. Duprey is serving as the contract manager for GFA's continuing contract with the Town ofJupiterto provide professional building inspections, plan review services and Permit Technicians for all town wide construction projects. Mr. Duprey is responsible for coordinating with the town to provide staff as needed and overseeing GFA's assigned staff members. City of Palm Bay Inspections and Plans Review Services Continuing Contract - Palm Bay, FL Contract Manager Mr. Duprey is serving as the contract manager for GFA's continuing contract with the City of Palm Bay to provide professional building inspections, plan review services for all city-wide construction projects. Mr. Duprey is responsible for coordinating with the City to provide staff as needed and overseeing GFA's assigned staff members. City of West Palm Beach 2018 - 2019 Building Code Plans Examiner Mr. Duprey was responsible for performing building plans review services for projects within the City of West Palm Beach. ECS Limited 2017 - 2018 Construction Material Staff Project Manager Mr. Duprey was responsible for overseeing all construction materials staff who were performing soil densities, concrete testing, fireproof testing, stucco testing, special and threshold inspections, facilities and building envelope services, geotechnical services, and environmental services. GFA International. Inc. www.TeamGFA.com `E-9NATI0"4' YEARS OF EXPERIENCE 10 YEARS WITH THE FIRM EDUCATION B.S., CIVIL ENGINEERING/PROJECT MANAGEMENT, UNIVERSITY OF PUERTO RICO — MAYAGUEZ, 2009 LICENSES & CERTIFICATIONS • FLORIDA ENGINEERING INTERN #1100022345 • STANDARD BUILDING INSPECTOR, BN7330 • STANDARD BUILDING PLANS EXAMINER, PX4208 ttr Ir FBPE FLORIDA BOARD OF PROFESSIONAL ENGINEERS STATE OF FLORIDA BOARD • •ON L ENGINEERS t �♦ THE PROFESSIOe - u ,I- ED UNDER THE • '� 1 ^ ..ft nY 1 60 DUPR a { Ix y DRES ♦ S ]M EXPIRATION DATE: Always verify licenses online at MyFloridal-icense.com A'- 1!�1�! . • 1 �•K' IL • _ • • • •form. 1 •.ice This is your license. It is unlawful for anyone other than the licensee to use this document. JOHN CA,RL PETERSON Building Official / Inspector/ Plan Examiner SUMMARY OF QUALIFICATIONS Mr. Peterson has over thirteen years of experience as a Building Official, Code Administrator, and Building Inspector. He has served as the building official for Saint Lucie Village, the Village of Indiantown, and has served as a Building Code Administrator for the St. Lucie County Board of County Commissioners and as a Building Inspector for Okeechobee County. EXPERIENCE GFA International, Inc. 2019 - Present Inspector Mr. Peterson currently serves as a Building Official for GFA International, Inc. Currently, he is overseeing the Village of Indiantown as building official under GFA's continuing contract. Village of Indiantown Annual Contract for Uniform Building Code Inspection Services — Indiantown, FL Building Official/ Inspector/ Plan Examiner Under GFA's continuing contract with the Village of Indiantown to provide Uniform Building Code Inspection Services for village -wide construction projects, Mr. Peterson serves as the Building Official, provides multi -discipline code compliance inspections, and multi -discipline plan review services on various projects on an as -needed basis. St. Lucie County Board of County Commissioners 2012 — 2019 Building Code Administrator Certifications Building Inspector, Mechanical Inspector, 1&2 Family Inspector, Costal Inspector, Building Plans Examiner, Mechanical Plans Examiner, 1&2 Family Plans Examiner, Building Code Administrator, Certified Flood Plain Manager Okeechobee County, Florida 2008 — 2012 Building Inspector Certifications Building Inspector, Mechanical Inspector, 1&2 Family Inspector, Costal Inspector, Building Plans Examiner, Mechanical Plans Examiner, 1&2 Family Plans Examiner, Building Code Administrator, Contractor Licensing YEARS OF EXPERIENCE 13 YEARS WITH THE FIRM <1 EDUCATION HIGH SCHOOL DIPLOMA LICENSES & CERTIFICATIONS • BUILDING CODE ADMINISTRATOR, BU1721 • STANDARD BUILDING INSPECTOR, BN5555 • 1 & 2 FAMILY DWELLING INSPECTOR, BN5555 • MECHANICAL INSPECTOR, BN5555 • COASTAL CONSTRUCTION INSPECTOR, BN5555 • STANDARD BUILDING PLANS EXAMINER, PX2764 • MECHANICAL PLANS EXAMINER, PX2764 • STANDARD 1 & 2 FAMILY DWELLING PLANS, SFP243 • CERTIFIED FLOOD PLAIN MANAGER, US-16-09103 Ron DeSantis, Governor Julie 1. Brown, Secretary SATE OF FLORIDA DEPARTMENT OF BUSINESS'AND PROFESSIONAL REGULATION BUILDING CObt p% NIStRATOiS t;INSPECTOR LICENSE NUMBER: ONS555 EXRiRA'�ON DATE: NOVEMBER 30, 2023 THE STANDARD INSPECTOR HEREIN !S CERTIFpED_UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES PETERSON, JOHN CARL 2300 VIRGINIA AVE FORT PIERCE FL 34982 ' :a'. Always verify licenses online at MyFioridaUcense.com ISSUED: 09/07/2021 Do not alter this document In any form. This is your license. it is unlawful for anyone other than the licensee to use this document Ron DeSan*% Governor Julie I. Brown. Secretary ` STATE OF FLORIDA DEPARTMENT OF BUSINESS'ANP PROFES,SiONIALL REGULATION BUILDING CO AbM1h�156tt1�T®RS &� BNSPECTOR LICENSE NUMBER: RPX243 17MRATION DATE, NOVEMBER 30, 2023 THE STANDARD RESIDENTIAL PLANS EXAMINER HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES PETERSON, JOHN CARL 4404 ARECA PALM DRIVE FORT PIERCE FL 34982 ISSUED:09/07/2021 Always at This is your license. It Is unlawful for anyone _other than 1t 16 licensee to use this document Ron DeSantis, Governor Julie I. Brown, Secretary . .SY1�TvE Q�_fLORID/A DEPARTMENT 00 BUSINESS AND PROFE55IONlAL REGULATION BUILDING CO®E. Ap�B0gS�681AT®RS LICENSE NUMBER: PX2764 EXPaRATION DATE: NOVEMBER 30, 2023 THE STANDARD PLANS EXAMINER HEREIN( IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES PETERSON, JOHN CARL 4404 ARECA PALM DRIVE FORT PIERCE FL 34982 POOR. ISSUED.09/07/2021 Always verify licenses online at MyFloridaUcense.com Do not alter this document in any form. William McColrnan Inspector William has 35 years of experience in inspections and construction management. His areas of expertise include High Velocity Hurricane Zone construction in Dade, Broward, and Palm Beach Counties; estimating; and coordinating trades, materials, quality control, and completion of projects in a timely manner. He is a licensed Florida General Contractor, Home Inspector, and All Lines Adjuster. William's activities within the industry include serving as an active member on the Board of Directors of the National Association of Home Builders Non -Union Apprenticeship program. He was also appointed by the Broward County School Board's Vocational Technical and Adult Education Director to the Advisory Committee for the Southeast Florida Builders Apprenticeship program; served on the Broward County Apprenticeship Craft Committee; and served on the Board of Rules and Appeals and Planning and Zoning Board in the Township of Ocean Ridge, Palm Beach County for five years. PROJECT EXPERIENCE Track Development Homes Various locations, Florida William has provided services for companies such as Oriole Homes, Cadillac Fairview, Lennar Homes, Heffler Homes, and GL Homes. Spec Home Construction Ocean Ridge, West Palm Beach, and Boca Raton, Florida William has worked from design to finish on $1 M+ homes. Also conducted remodeling work on historic homes and for general remodels from $50K to $50KOK. Commercial Project History Various Locations, Florida William has completed six Marriott and Fairfield Inn Hotels in Broward and Palm Beach counties; schools including The Benjamin Upper School in Palm Beach County; and office buildings for companies such as Weitz Construction and Presidential Construction. City of Ft. Lauderdale, Prospect Avenue Water Plant Ft Lauderdale, Florida William completed the major renovation and addition for water plant on Prospect Avenue. Ron DeSantis, Governor STATE OF FLORIDA Julie I. Brown, Secretary i +F DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADM NI:STRA -ORS & INSPECTOR THE STANDARWNSPECT011 HEREI:N�15 CERTIFIED UNDER THE :3 PROVISIONS�OF_'CHAPTER 4'68;,FLORlDA35TATUTES BLDGsREST M., - - � _. - -•ice.. . ' LICENSENUMBER: B147752 EXPIRATION DATE: NOVEMBER 30, 2023 Always verify licenses online at MyFloridaLicense.com Do -not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. LOCATIONS A Universal Engineering Sciences Company Geotechnlcal Engineering I Construction Materiels Testing and Inspections Building Code Compliance I Environmental, Health & Safety I Facilities Consulting DONALD GREEN Building Inspector SUMMARY OF QUALIFICATIONS Atlanta, GA Hagerstown. MD Pensacola. FL Buford, GA Irvine, CA Port St Lucie, FL Chantilly, VA Jacksonville. FL Reno, HV Charlotte, NC Kennesaw, GA Rockledge, FL Clewiston, FL Las Vegas. NV Sarasota, FL Daytona, FL Miami, FL St. Petersburg, FL Delray Beach, FL Ocala, FL Tampa, FL Douglasvllle, GA Orlando. FL Tifton, GA Fort Myers, FL Palm Coast, FL West Palm Beach, FL Fort Pierce, FL Panama City, FL Galnesvhle, FL Pelham, AL Donald Green is a Building Inspector for GFA's Port St. Lucie branch who specializes in Electrical Inspections. Mr. Green brings over forty-five years of experience in the construction industry. He has vast experience providing services on projects from custom homes to high rise apartment buildings, marinas, and boatyards. SELECT PROJECT EXPERIENCE City of West Palm Beach Building Permit Inspections and Plan Review — West Palm Beach, FL Electrical Inspector As part of a continuing contract, GFA provides the City of West Palm Beach with licensed inspectors and plans examiners on an as -needed basis to provide supplemental services for various projects located within the City of West Palm Beach. Mr. Green has provided slab inspections on a 30-story high rise multi -use building as well as final fire alarm inspections for the City. Village of Indiantown Annual Contract for Uniform Building Code Inspection Services — Indiantown, FL Electrical Inspector As part of a continuing contract, GFA provides the Village of Indiantown with Building Official, Building Inspections, Plan Review, and Permitting services on an as -needed basis to provide supplemental services for various projects located within the Village of Indiantown. Mr. Green has provided various electrical inspections for projects located within the Village. Palm Beach County Continuing Contract for Building Inspection, Plan Review, and Permit Technician Services — Palm Beach County, FL Electrical Inspector As part of a continuing contract, GFA provides Palm Beach County with Building Inspectors, Plans Examiners, and Permit Technicians on an as -needed basis to provide supplemental services for various projects located within Palm Beach County. Mr. Green has provided Electrical Inspections for various projects under this contract. This includes slabs, TUG meter, electrical rough, LV rough, electrical power on and final, generator installations, pool bonds, and final pool alarms. YEARS OF EXPERIENCE 45 YEARS WITH THE FIRM <1 EDUCATION HIGH SCHOOL DIPLOMA LICENSES & CERTIFICATIONS • FLORIDA ELECTRICAL INSPECTOR, BN7301 • FLORIDA ELECTRICAL CONTRACTOR, EC13007447 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfforidalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! a STATE OF FLORIDA DEPARTMENT dbkxpr OF BUSINESS REGULATION AND PROFESSIONAL BN7301 ISSUED:09/28/2021 STANDARD INSPECTOR GREEN, DONALD BARRY i SignatWe LICENSED UNDER CHAPTER 468, FLORIDA STATUTES EXPIRATION DATE: NOVEMBER 30, 2023 Ron DeSantis, Governor Julie I. Brown, Secretary STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR LICENSE NUMBER: BN7301 EXPIRATION DATE: NOVEMBER 30, 2023 THE STANDARD INSPECTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES GREEN, DONALD BARRY 1305 WEST 1 ST STREET FORT PIERCE FL 34982 0 ISSUED: 09/28/2021 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. GFA INTERNATIONAL, INC. 607 Northwest Commodity Cove Port St. Lucie, Florida 34986 Phone: (772) 489-9989 Fax: (772) 489-2989 TeamGFA.com '�RNA710�P� JUAN HERNANDEZ, P.E. Professional Registrations Mechanical Inspector • STATE OF FLORIDA Mr. Hernandez is a State of Florida registered professional PROFESSIONAL ENGINEER engineer who specializes in Mechanical Engineering. He has #52659 over twenty years of experience with Mechanical Engineering. Mr. Hernandez currently performs Mechanical Inspections for GFA International, Inc. Select Project Experience TOWN OFJUPITER BLD001-2013/DG PLAN REVIEW, INSPECTION SERVICES AND PERMIT TECHNICIANS • JUPITER, FL • Mr. Hernandez is responsible for providing the Town of Jupiter with Plan Review and Building Inspection services on an as -needed basis for various projects within the Town of Jupiter. CITY OF FORT PIERCE PLANS REVIEW AND INSPECTIONS o FT. PIERCE, FL Mr. Hernandez is responsible for providing plan reviewer and building inspections services to the City of Fort Pierce on an as needed basis for various projects within the City of Fort Pierce. VILLAGE OF INDIANTOWN o INDIANTOWN, FL • Mr. Hernandez is responsible for providing plan reviewer and building inspections services to the Village of Indiantown on an as needed basis for various projects within the Village of Indiantown. OCEANSIDE RESORT • INDIANTOWN, FL • This project consisted of renovations to two existing four-story buildings and a new, two-story addition totaling approximately 198,886-square feet. GFA provided Private Provider Inspections services for building, gas, electrical, plumbing, and mechanical disciplines for the renovation areas and new construction. GFA International, Inc. www.TeamGFA.com June 26, 2019 39 Ron Mantis, Governor STATE OF FLORIDA BOARD OF PROFESSIONAL ENGINEERS EXPIRATION DATE: FEBRUARY 28, 2023 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. FBPE FLORIDA BOARD OF PROFESSIONAL ENGINEERS STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! STATE OF FLORIDA DEPARTMENT dblar OF BUSINESS AND PROFESSIONAL REGULATION BN7601 ISSUED: 09/09/2021 STANDARD INSPECTOR DESENTZ, PAUL CHRISTOPHER gnatur LICENSED UNDER CHAPTER 468 RIDA STATUTES EXPIRATION DATE: NOVEMB 0.2023 Ron DeSantis, Governor Julie I. Brown, Secretary STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS & INSPECTOR LICENSE NUMBER: BN7601 EXPIRATION DATE: NOVEMBER 30, 2023 THE STANDARD INSPECTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES DESENTZ, PAUL CHRISTOPHER r 0 1673 SW HAMPSHIRE LN PORT ST LUCIE FL 34953 Y Y ISSUED: 09/09/2021 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. GFA INTERNATIONAL, INC. 607 Northwest Commodity Cove Port St. Lucie, Florida 34986 Phone: (772) 489-9989 Fax: (772) 489-2989 TeamGFA.com RICHARD JEFFERSON Building Inspector/Plans Examiner Mr. Jefferson has over thirty-eight (38) years of experience in the building inspections and plan review industry. He has served as a building inspector, plans examiner, and building official for many building departments throughout the state of Florida and has a comprehensive understanding and knowledge of the most recent technical building codes and has ample experience performing field inspections, plans review, and building code administrative services on many high rise threshold buildings, as well as municipal and special inspection projects. Select Project Experience CITY OF FORT PIERCE PLAN REVIEW AND INSPECTION SERVICES • FT. PIERCE, FL Education B.S., ELECTRICAL ENGINEERING, UNIVERSITY OF TEXAS Professional Registrations • STANDARD INSPECTOR, BN1164 • BUILDING INSPECTOR, BN1164 • COMMERCIAL ELECTRIC, BN1164 • MECHANICAL INSPECTOR, BN1164 • PLUMBING INSPECTOR, BN1164 • RESIDENTIAL ELECTRIC, BN1164 • ELECTRIC PLANS EXAMINER, PX513 • BUILDING CODE ADMINISTATOR, BU1368 • Mr. Jefferson is responsible for providing the City of Fort Pierce with Plan Review and • MODULAR 1 & 2 BUILDING CODE Inspection services on an as -needed basis for various projects located within the City of Fort ADMINISTRATOR, BU 1368 Pierce. CITY OF SEBASTIAN PLAN REVIEW & INSPECTIONS • SEBASTIAN, FL • Mr. Jefferson is responsible for providing the City of Sebastian with Plan Review and Inspection services on an as -needed basis for various projects within the City of Sebastian. CITY OF ALTAMONTE SPRINGS BUILDING INSPECTIONS AND PLAN REVIEW SERVICES ALTAMONTE SPRINGS, FL • Mr. Jefferson is responsible for providing the City of Altamonte Springs with Plan Review and Inspection services on an as -needed basis for various projects within the City of Altamonte Springs. JOHNS ISLAND CLUBHOUSE o INDIAN RIVER SHORES, FL • This project consisted of the renovation and addition to the existing Johns Island Clubhouse located in Indian River Shores, Florida. Mr. Jefferson performed private provider and threshold inspections for building, electrical, mechanical, plumbing, and gas components. INDIAN RIVER MEDICAL CENTER CANCER CENTER a VERO BEACH, FL • This project consisted of the new construction of a two-story expansion to the existing cancer center located at Indian River Medical Center in Vero Beach, Florida. The footprint area is approximately 14,000-square feet with a second story of about 10,000-square feet. Mr. Jefferson performed special inspections for concrete work, reinforcing steel, fabricated structural steel, welding, anchor bolts, high strength bolting, structural masonry, expansion type anchors, adhesive type anchor bolts, and compacted fill. GFA International, Inc. www.TeamGFA.com June 26, 2019 25 Wr 'r.y r�•'� ri Rwn Moth, Govotor STATE OF FLORIDA Me I.8r-um, SekU y FPO lei Aft DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION THE ST & INSPECTOR UNDER THE UUTES EXPIMION DATE: NOVEMBER 30, 2023 Always verity licenses online at MyFlopidatacensetom Do not alter this document in any form. This is your license, it is unlawful for anyone other than the licensee to use this d(Koment 0 ■ a1 Clyde L. Thirbenny, BN, PX Inspector Clyde serves as a licensed inspector for GFA/UES' Port St. Lucie branch,with more than a decade of industry experience. He offers a wealth of knowledge to the team with qualifications encompassing building inspections and plans examination (including zoning). His expertise ranges from residential inspections to municipal efforts. He is well -versed in code compliance with FBC, state, local, ADA and city codeson new and existing structures. PROJECT EXPERIENCE GFA International, Inc. - Inspector/Plans Examiner 2021-present Port St. Lucie, FL Mr. Thirbenny currently serves as the Port St. Lucie location of GFA/UES. Currently, he performs building inspections and plans reviews as needed. Municipal Support: Code Compliance Stuart, FL GFA/UES currently holds a contract with the City of Stuart to provide municipal support. As an assigned inspector, Mr. Thirbenny performs inspections across various locations. Sovana Stuart Senior Housing: Threshold Inspections Stuart, FL GFA/UES is engaged as a threshold inspection consultant for the Sovana Stuart Senior Housing community. Mr. Thirbenny performs inspections as needed for this opportunity. Building Inspections/Evaluations - Maltz Jupiter Theatre Jupiter, FL GFA/UES' Port St. Lucie branch is engaged as a building inspection consultant for the Maltz Theatre in Jupiter, Florida. Mr. Thirbenny performs inspections as needed for this opportunity. Threshold Inspections - Florida Power & Light PGA Office Complex Palm Beach Gardens, FL GFA/UES' Port St. Lucie branch performed threshold inspections for Florida Power & Light's Office Complex in Palm Beach Gardens, Florida. Mr. Thirbenny served as inspector for this opportunity. Ron DeSantis, Governor STATE OF FLORIDA Julie 1. Brown, Secretary EPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE THESTANDARD � a 1061— EXPIRATION DA & INSPECTOR FIED UNDER THE VATUTES 30; 2023 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! a STATEOP*LORI,DA DEPARTMENT dblar REGUAT ON AND PROFESSIONAL F'BPX1847 ISSUED: 0.8/31/2021 STAN DARD.PLANS,EXAMI NER THIRBENNY;'GL L , 'Siggature�:" pF LICENSED UNDER CHAPTER 468; FLORIDA STATUTES EXPIRATION DATE: NOVEMBER,30; 2023 Ron DeSantis, Governor Julie I. Brown, Secretary STATE OF FLORIDA DEPARTMENT.OF BUSINESS AND PROFESSIONAL REGULATION BUILDING CODE ADMINISTRATORS:& INSPECTOR LICENSE NUMBER: PX1847 -- Y EX .IRATION,DATE: NOVEMBER 30, 2023 THE STANDARD PLANS EXAMINER "EREIN-IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 468, FLORIDA STATUTES THIRBENNY, CLYDE 5388 EADIE PL WEST PALM BEACH FL 33407 ISSUED: 08/31/2021 Always verify licenses online at MyFloridaLicense.com Do not.alter this. document it any form. This is vour license. It is unlawful for anvone other than the licensee to use this document. Raymond Oscar Gendron Inspector/Plans Examiner PROJECT EXPERIENCE Senior inspector/Plans Examiner Aspen, Colorado Senior inspector/Plans Examiner Hobe Sound, Florida inspector/Plans Examiner Stuart, Florida Inspector/Plans Examiner for the Martin County Building Department. Ron DeSantis, Gc err- , Julie I. Brown, Secretary dbp� .11TATE OF FLORIDA 44.1'.�O;t-ENI:bb AND PROFESSIONAL REGULATION F DM, T A ''kNIIS RATTORS &INSPECTOR TH.' W- `.11'13.ECT-ORe.',H,E,REIN--_[S.CER.T- IFIED UNDER THE CHAPTER 468.FLORI'DASTATUTES ELEC,;RLDGII' RESI^ CCI r -MONU-- 55, CR0 -P.0:B0X— 593 ."')�Ks6 -:UND A -3347-5, 1-CIENSE' NUMBER: SN4955 DATE: NOVEMBER 30,2023 il 'i('enses online at MyFloridaLicense.com .:d' alter this document in any form. This is yo..jr :T -:' i'.0 for anyone other than the licensee to use this document. JIM