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Home My WebLink AboutCONTRACTOR INFORMATIONSt Lucie County ft 1. IV:, 11 i �� •,yam �. Jimmy, TRONISf�6�� CHIEF FII�IAANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICESGy DIVISION OF WORKERS' COMPENSATION 81 LtiCfOouy CER� I FICATE.OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * • CONSTI II UCTION INDUSTRY EXEMPTION This ce' fies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. I F-FFEC71VE DATE: 3/14/2018 ' EXPIRATION DATE: 3/18/2020 PERSOII: DOUGLAS DWIGHT JR FEIN- 824760494 _ BUSINE S NAME AND ADDRESS: QUAL MOBILE HOME SETUP OF LAKELAND LLC7$ l 4775 EL'ON CRESENT DR - , LAKEL D FL SCOPE F BUSINESS OR TRADE; Manufacturi 1. Modular or Prefatirtca Home Setup, mwkap, or 1 iawlewn At Building site 11 RECEIVED 3381 SEP 2 ® 318 ST. Lucie County, Permitting IMPORTANT: P AI rsuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exempdon from this chapter by firing a certificate of election under this secton may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06(12), F.S_, Certificates of election to be exempt_ apply only within the ° pe of the business ortmde listed on the notice at election to he exempt Pursuantto Chapter 440.05(13), F S., Notices of election to be exempt and cart cafes of election to be eocempt ahati be subject to revocation if, at any lime after the filing of the notice or the Issuance of the cerM[cate, the person named o the notice or certificate no longer meets the requirements of this section for Issuance of a certificate- The department shall revoke a Certificate at an (time for failure of the person named on me certificate to meet the fequlrements of this section. I I DFS-F2-DW ! 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 I �I I �I li !I II it !I 187U2I!Z7 13:34 Great Florida Arcadi 8634949280 >> 8638153352 P 1/3 STATE OF FLORIDA f SAF TY AND MOTOR VEHICLES A PERFORMANCE BOND Dlvt tore Or MOTORIST SERVICES FL IDA MOBILE HOME 1NSTALLIER 2900I ALACHEE PARKWAY _ R00, B-152, Mail Stop 066 11I�Y tiioTiDRVEitIC1.ES TAL 'IAHASSEE, FLORiDA 32399.0640 Bond No. 23242267 ,� �! e i R• a r �a erYTS�se�c r ALL MEN BY THESE Dwight Douglas dba Quality Mobile Home Set Up, LLC as principal and Iurety Company a surety company qualified to do business in the State of Florida, as a surety are held bound unto the duty appointed and qualified Director of the Division of Motorist Services of the State of Florida, it of Highway Safety and Motor Vehicles, and the successors in office of said DirectoFserithe_peil I sum of Five Dollars, for the payment whereof well and truly to be made, we do hereby jointly and verally�l�tr��i��l�es, our I representatives, successors and assigns, firmly by these presents. SEP e> 1 Sign ,tl and sealed this 9th day of November ZO]7 �' � -. j�:ue The condition of the above obligation is such that: ST• Lucie County, Per WHEREAS, the above named principal has made to the obligee hereunder application for a license, under Section 320. 249, Florida Statutes, to engage in the business of mobile home installation, and I ' WHEREAS, the above named principal is required as a condition precedent to this appointment as such installer to deliv r annually to the obligee hereto a good and sufficient surety bond for the license period conditioned upon proper per iance of mobile home installation and weather sealing duties - WHEREAS, such bond shall be in favor of any person who shall suffer any loss as a result of any violation of the conditions hereinabove contained. NOW "THEREFORE, if the above named principal shall properly perform all mobile home installation and weather sealbI �g duties undertaken, and such installer shall pay or cause to be paid to any person any loss or.damages which such person shall sustain as a result of any failure to comply with the conditions set forth herein, then this obligation shall be void, oche ; ise to remain in full force and effect. This bond becomes effective as of 1110912017 , in support of a license issued for the term ending 09/30/2018 , and may be continued by certificate each year in support of any license issued for any subsequent year. 1 1; I'i Provided, however, that the aggregate liability of the surety hereunder shall in no event, in any one. (])year, exceed the sum of the bond. Provided, further, the surety shall have the right to terminate its liability hereunder by serving written notice of its electipn so to do, by United States registered mail, upon the obligee, and thereupon the surety shall be discharged from any liabl6i' hereunder for any default of the principal, after the expiration of thirty (30) days from and after service of such notice. The premium anniversary date on this bond shall be the first day of October 2018 SICN�;IITURi; OF MORILF. HOME INSTALLER (PRINCIPAL) Dwigil i, Douglas dba Quality Mobile Home Set Up, LLC TYPE NAME OF MOBILE HOME INSTALLER W,steliV n Surety Company NAME II F SURFTY BOND COMPANY 101 S Reid St, Ste 300 Sioux Falls, SD 57103 AVDR =SS OF WRHIV BOND COMPANY �I CITY/E i1TF•J7.iP CODE. 605-3 04693 TELCPtONE HSM NUMDGR . R1402 (Rev. 01/11) I I J David Gonsalves TYPED NAME OF ATTORNEY-M-FACT (SURETY) anti Rxrhangp Inc.. a WhnlesWe .,;Iranr.0 A, geI3 COMPANY NAME OF SURETY AGENT 18-02- 13:35 Great 'FLor•ida Arcadi 8634949280 >>8638153352 P 2/3 RECEIVED SEP ®..918 ie County, Permitting Western SuretyCom an -- p � POWER OF ATTORNEY6'�� DW ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of Sout�lt Dec aandt� orized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, ware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, eland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, h Dakota, Tennessee, Texas, Utah, Vermont. Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United :s of America, does hereby make, constitute and appoint rid Gonsalves _ _ of Charlotte of North Carolina with limited authority, its true and lawful Attomey-in-Fact, will full power and 3rity hereby conferred to sign, execute, acknowledge and deliver for and on its behalf as Surety and as its act and deed, the ving bond: One Mobile Home Installer with bond number 23242267 Dwight Douglas dba Quality Mobile Home 'Set Up, LLC Principal in the penalty amount not to exceed: $5,000.00 western Surety Company further certifies that the following is a true antl exact copy of Section 7 of the by of Western Surety Company adopted and now in force, to -wit; Section 7. All bonds, policies, undertakings. Powers of Attorney, or other obligations of the corporation shall be executed in the corporals of the company by the President. Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the d of Directors may authorte. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint nays -in -fact or agents who shall have authority to issue bonds, policles,1or undertakings in the name of the Company. The corporate seal is ecessary for the validity of any bonds, policies, undertakings,.Powers of Attorney or other obligations of the corporation. The signature of any officer and the corporate seal may be printed by facsimile. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Vice President _ with the corporate seal affixed this 9th day of November 7 - Al EST WE T RN SU ETY COMPANY B A. Vlaior, Assistant Secretary y Paul T. BruOat, Vice President OF SOUTH DAKOTA Y OF MINNEWANA ss VO 2 On this 9th day of November 2017 ,before me a Notary Public�a�N` Of PR ,�`�� Paul T. Bruflat ry ,pers�fi�(I appeared and A. •yietor _ being by me duly sworn, acknowledged that they signed the above Power of Attorney as , Vice President dent Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the ntary act and deed of said Corporation. 't•�a�sb4hhhamhlb8�4o9htiti4Y�h + r J. MOHR a r f st:AL NOTARY PUBLIC i 1r�SOUT14 DAKOTA 3 L i My commission Expires June 23, 2021 Notary Public ralidate bond 'authenticity, go to n .corn > Owner/Obligee Services > Validate Band Coverage. 672-f-2als