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HomeMy WebLinkAboutTERMITE TREATMENT CERTIFICATEC Cf, 1l45 RECENED St Lucie County Inspections 2300 Virginia Avenue Ft Pierce, FL 34982 (722)462-2172 CERTIFICATE OF TERMITE TREATMENT CONSTRUCTION SOIL TREATMENT AUG 2 8 2019 %Permitting Department , St. Lucie County AP 9GC ��O C/O �dA jOj� [d d PERMIT # 110 3 - o ! / 3 JOB ADDRESS 5117 Palmetto Dr, Fort Pierce, FL 34982-7466 BUILDER Synergy Homes PEST CONTROL CONTRACTOR PEST CONTROL LICENSE # JF0001886 --WU UoUnhA a We, the undersigned, hereby certify that we have pretreated the above -described construction for subterranean termites in accordance with the standards of the National Pest Control Association. Square feet of area treated: 290 Percentage of solution:.50% Date of treatment: 08/21/19 ® Footing ® 1st Treatment ❑ Re -treat ❑ Slab ❑ 1st Treatment ❑ Re -treat ❑ Driveway ❑ 1st Treatment ❑ Re -treat ❑ Pools ❑ 1 st Treatment ❑ Re -treat ❑ Other ❑ 1st Treatment ❑ Re -treat Chemicals used: Sentricon Always Active HD Total gallons used: Time of treatment: AM FBC104.2.6 Certificate ofProteefive Treatment for prevention of termife& A weather resistantjobsite posting board shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed, providing a copy for the person the poermit is iisued to and another copy for the building permit files The Treatment Cer ficate shall provide the product used, identity of the applicator, time and date of the treatment, site location, area treated, chemical used, percent concentration and number ofgallons used, to establish a verifiable record ofprotective treatment. Ifthe soil chemical barrier method for termite prevention is used, final exterior treatment shall be completed prior to final building approval. St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on the electrical panel box cover, listing all the treatments and dates of applications. ® Perimeter for Final Inspection Signature of exterminator NOTE: There must be a completed form for each required treatment or re -treatment and this form must be on the job site to be picked up by the inspector at time of each inspection or the scheduled inspection will jail and a re -inspection fee charged THIS AGREEMENT PROVIDES FOR HATeam PEST DEFENSE' RETPEATMENT OF A STRUCTURE AND THE REPAIR OF DAMAGES CAUSED BY WOOD DESTROYING - ORGANISMS WITHIN THE LIMITS STATED IN THIS AGREEMENT. Amored No.: AGREEMENT FOR THE INSTALLATION AND MONITORING OF THE SENTRICONO COLONY ELIMINATION SYSTEM FOR NEW CONSTRUCHON Section I. GENERAL INFORMATION. Name: <V 6tF. � & Service Address: 5117 Palmetto Dr o;t.,. Fort Pierce State: FL Zip Code: 34982 Locetion orTraaboom Seclxr. Panel Ijrea Footage of Struchve(sb 290 Billing Address: City: State: Zip Code: Home Phone: Work Phone: Tmevn®t Type: O Carec s" o Devestave, Section H. SERVICE COMMITMENT. fmmeTemn Port Defaso, Inc. (the'Compmy�')will, invomplf ems with applicable federal, state and local laws,rulo mdregdatiom: A. Instal the Sentrivon tera ite bait stations (the "Stations") in the soil amend thoperimeter of tie structure(s) (ace attached graph) located at the Service Address above(the°Shuchua(s)') forme inatavaoah faaofSpaid by builder B. Mouitorthe Stations in accordance with the label directiaw for a period oflwelve(12)montlu immediately following inste➢etim ofthe Stations fixon atonal fee of S Zero C Total cast forthe fustyearofimmagame,wd Monitoring$Zero D. The Annual RenewriFceaftmemfirst year $300.00 E During the madlming period, add andn:mrve Remffi®mnmtelmil homthe Stations as appropriate; F During then mtoring pound. remebrnall Smtiers in aeviaable vondbion; Section III. CUSTOMER UNDERSTANDING OF PERFORMANCE OF SENTRICON SYSTEM. Crammer understands that, A The Senhicon System involves inuallefion and monitoring, colony elitrumman with Recruit termite bait and subsequent monitoring for commmus pmtecfian fmmnew oommo lomm B. Intervals of fiom a few weeks to mom than a year should he expected between: L Installation ofth Senbirm stations and sdnaat termite orivitym allmethe additicsofRecrdl tmante bait; and a AddifionofRmwtmoritabzit. C. Dming the marval(s)between imlalhom ofine Stations and ceurplete dimmtian ofe�dsting termite volumes, termite feeding within the Structures, possibly involving additional stmauml damage, may occur Additional services such as spot applications of vomermeasl temdticides are, available to combat tensile activity on alaealized, shoutterm(esu if desired, but menatmcded fund will not von ribme to teradte colony elimination D. The active ingredient in the Senirian System is an insect growth regulator (ReadQ mat prevas worker [enmtes from malting. (Molting is aifital to colony smvivaL) E. In tots that it conducted on Recruit DowAgreaSaaom LLC, the mamfachver of Recruit observed evidence ofvay low levels ofmmnmalim tmdaty only a very high levels ofmpo me. F. Treatment is provided against the attack of subterranean manatee (Reticmitavrs spp., Hetaotamo Epp. and Coptommes app. (Forstmann). This Agreement does not provide for the hmmhat of any other pis, pit animal or ugais n other than such tewtes. The Company has not impacted or honed the shuctoe(s) far health -related molds or fangs. By law, the Company is not qualified, amhorimd"licensed to inspect fuhmaltRralazed molds or furgL G. The Company makes an rainseentsta s regarding the exert location or number ofmy, existing termite colonies. Section IV. DOW AGROSCIENCES LLC OWNERSHIP OF SENTRICON SYSTEM COMPONENTS. Cmmucer also understands ttcrt A The Scanner System coal all of the components of the Sewn System ('Components') have been designed by Dow AgreSdam LLC. The Compounds are ad will remain the properly of Dow AgroSrierces LLC. Crrnersal as narighs withrespect m any ofine CorrPonas, omathm the rightm thairme as installed by the Company on the Custarets premises order this Agreement. B. On enpirmion or termination of this Agreamq the Comfy and Dow AgroSaam LLC mtheir respective representatives, are mdhorized by Cannoneer to retrieve lion Csmmeys premises the Sstiom and Aher Components fix appropriate disposition. In addition, if the Cempary. fa whatever reason, causes m represent or to be authorized to represent the Sentrian System, i. The Company will: a Sonotify Clsmmer, b. OIIa Cmtomrer the alternative ofeither using a diQerentfomh ofteroite protection or laminating this Agrcement c. Credit the Coalomer far servicexpaid for but actyetrredved, ifoppngriam; d. Refund To the Crammer an amamt equal to the fee pod for services not yet mmivd if Customer dean m dismnmme me relationship, or if the Company ®hot offs an effective alternative form of tewim pmtecdoq ad e. Retrieve," allow Dow AgroSciaees LLC" is representatives reasonable seems m the promises f"the retrieval ofine Components; and E Custaverwill: a Grant the Comlmry and Dow AgroSaaas LLC or their respective repramme vo reazombo arms to the premises fat the mhievol of the ConPoners; and b. Either agree with the Company, on the use ofan alternative form oftermte control or terminate this Agreemnt PAYMENTMETHOD. OCash ❑Check ❑Credit Cand Ifpsymg by credit and errac,mong debit fiemyourbodr aecoat please complete the amahed Aumorim5on far Pts-Avmmged Paynear s. This Agreement aonmins armor Ilmitetlons, vendtaam and exclusions on she Company's obligations. Please reed the atlre Agreemertbefore signing. the services specified above and subject to the teas and crmdifiom of this Agreement Crammer agrees to rake the edges receipt of a signed copy of this Agreement This Agmenent is Trot binding an the Company until signed by an Compay. HOMETEAM PEST DEFENSE, INC. Sipuhuc printed Name: Ken Colabella CO th 08/22/19 Worth. Date: UGUITTOCANCEL YOU, THE CUSTOMP,R, MAYCriNCEL NUS TRAASACHONATANY77ME PRIOR TO MUDMGHTOF THE 77IfRD BUSINESS DA YAFTER THEDA7E OF THIS TRANSACRON. SEE 7HEA TTICHED N077CE OFCAAMJ.A77ONFOR ANEEPLANA77ON OF7HISRIGHT. I THE REMOVAL OFnM BAIT OR BAITING SYSTEM MAY RESULT INA LACKOFTERMTTE PROTECTION CHown Reaui1ecB,m%lanerrgislvedtradanmtrafDvw ApnSamca LLC. ONamaram Pa IXfmRlnc.IOIJ (5I9USYfG3113 Benton V. CUSTOMER COMMfIhB 10 x TO CONDITIONS CONDUCIVE TO INFESTATIONS. The Cmimner agrm to he solely naporna fee maintaining the Treated premises free from my condition conducive to termite infestation ('Conditions Cmdiwivou see Wow for explarefion). The Csstramer ogeece to be solely responsible for identifying and conecting Conditions Conducive. The responsibility nob exclusively with the Camera, not with the Con any. Failure of the Company to alert Customer to my ofthe above conditions does not alter Costumers esspomibilily under this Section. In adddics, the epstorce of my Conditions Conducive that was cot timely concocted, including my Conditions Conducive existing but not visible a the time of the mossat rn of this Agreement, will Permit the Company, at its sole discretion, to temmcata the Ag,oment or to require Customer to pemlme any additional trrahrtent required as a result of the Condition Conducive. Crmmner agrees to My cooperate with the Company during the term of this Agreement, and agrees to maintain the mouse) baited free from such Conditions Conducive. Other specific items maybe noted below in 'Additional Cmmanamb' (Section XVI CONDITIONS CONDUCIVE: Conditions Conducive include, but sm cot limited to, mollusks, impmpr ventilation, faulty plumbing, and water leaks or incision in or=and the structure; ialmort structural pmbleme, including but not lunited to, woad to Emend contact, mummy, failures, and settlemem ofthe foundation, fears insulation, ahmm couwetion, expanded polystyrene m stymfomn nodded foundation systems, siding (including vinyl, wood and metal) if within 6 inches of the ground; imlch or otherpmtmfive ground awming; and frcunoi, hash, lumber, wood, mutely daubs, vines, and other protective ground covering if within 6 inches of contact with stmcton. mmificide being applied rg equipment msuppbe lion. attention or other m of Custome s, property, plants or ammals. Under m circumstances will the Compmmy, be responsible fen damage armed by the Company m the time the wad, as perfot>ffid, except these damage reaulting from gross negligence of the Company. Customer h responsible, m Catharses sole cepame, fen r ft bmhwg Clsstomees property (including lawn and landscape) after installation ofthe Station;. Section VBL REPAIR AND RETRLATAIENT OBLIGATION. Customer WBlab Subjecttodmgeneralternsandmrdi6mofthis Agw.eaeaifan infototionofsabtararcmm connotes access in the treated sbndae(s) during the temofthp Agreement, the Company will robot the meaofiatestalim at no additional clorage. In addition, subject to the general ter® mid conditions of this Agreement. the Company will repair, m its cast, new temnm damage to the heated struame(s} The Cmupanys total liability will not exceed in any one calendar year the lesser of () S200,000 or CA) the fah macho value of the heated shuctur*4 nor exceed E 1,000,000 in the legate over the teen ofthe Agreement, including extensions and menewwb. 1. Clutomer expressly waive my deem for ceoermn, compensatory, or carsa]uenbal dainages relating to the edstonce of S btemences temutes a Subtenaceaii temute damage, or for increased oats, lox ofteee, busineu interruption, dirtunahon ofvdue, or my damage due to the presence of Srbtemnran termites or Subterranean termite damage. The Cstomer acknowledges that the Company is pertaining a service and except for termite damage repairs set forth above and my damage to the strudme cased by the Company in the performance of its services, Customer waives my claim for property damage, and agrees that under no dnxvrssMroes shall Company be held liable foany ===greater than the mmuntpaid by the Custom to Company forthe termite service to be Performed. 2. Due to subterranean termite habits, termite acthdty may continue to be prevent In a dramas. far a peeled of Was following beahnent The Company Is not or carom Me Service Addtias, tooccur itter notification extent that the to located ®err about the Service will be emitted to select the eomactor who will mfoon the the deterrence the bid to be excessive, Customer agrees to Seem scams to the treated structures) to a cvnbmSo designated by the Company forme pmposo atobtarmrga seoand bid for the work In ems where them are multiple bids fen repair work Customer acknowledges that the Company manes the right to select the contractor to perfonntherepaim. 5. The Compay is not responsible for Me repair of either visible damage (noted on the attached inspection graph) or hidden damage coasting as of Me dam of this Agreement The Company does not guaimdce that the damage disclosed an the attached inspection gmph reFecoms all of the casting damage as of the date of this Agreement. The Company wIU not be respomMle for (Q any damage caused by termites to the treated struwre(s) or the comderda thereof arhing polar to or falloMng Me term of Mh Agnement or (2) any costs or expemm Incurred by Customer as a result of any such damage. Customer wahes a6 claim for damage to Me property or people that may result directly or hellroody from services pmNded by Me Company, with Me sale exception of claims for damages due to Me gross negligence ofthe Comparyand/orlts employee. Section DL PAYMENT. The Compmys obligation to perfomn ender this Agreement is coadifioned upon Cuttomers payment in full ofthe price ad forth in Section II above. Customers failure to pay each price in full will rase this Agreement to automatically and immediately temunato in its re irmy and the Company, will be disabmgM of ell liability. ALL amouma p.K Usury, will became the property of Me Company as tigmdated daoges heremder. Tha installed. fes is due and payable at the time ofthe initial service. The renewal fee is due and payable upoareoeipt ofinvoice. Invoices that eon cot paid within thirty (30) days ofthe invoice date will scene interest. the unpaid balance at a mte equal to thalessaof l.5%permenth (DIN, perymr)"the ma immorm, allowed by law. In the event thutlegal actions TERM. awing Me hand tern, upon aaa fen notice to Me oth e mowed amorally with the mutual consent of both Me end of the than camem hare, The Company move term of this Agraenrem will be for twelve (12) months and will be rem effacer (4) additional twelve (12) month pedods, following the ect to adjustment as provided in this sulaechm), unless atherparty unemt temm. This Ameement may be mmcneted by the Company m Section M. ARBITRATION. ANY CONTROVERSY OR CLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT OR ANY OTHER AGREEMENT BETWEEN THE PARTIES, INCLUDING BUT NOT LIMITED TO ANY TORT AND STATUTORY CLAIMS, AND ANY CLAIMS FOR PERSONAL INJURY OR PROPERTY DAMAGE, SHALL BE SETTLED BY BINDING ARBITRATION. UNLESS THE PARTIES AGREE OTHERWISE, THE ARBITRATION SHALL BE ADMINISIERED UNDER THE COMMERCIAL RULES OF THE AMERICAN ARBITRATION ASSOCIATION ("AAA-) OR, IF APPLICABLE, IT SHALL BE DETERMINED UNDER THE AAA PROCEDURES FOR CONSUMER -RELATED DISPUTES THE PARTIES EXPRESSLY AGREE THAT THE ARBITRATOR SHALL FOLLOW THE SUBSTANTIVE LAW, INCLUDING THE TERMS AND CONDITIONS OF THIS AGREEMENT, AND THAT ANY ARBITRATION PROCEEDING UNDERTQIS AGREEMENT WILL NOT BE CONSOLIDATED OR JOINED W ITH ANY AMON OR LEGAL PROCEEDING UNDER ANY OTHER AGREEMENT ORINVOLVING ANY OTHER PREMISES, AND WILL NOT PROCEED AS A CLASS ACTION, PRIVATE ATTORNEY GENERAL ACTION OR SIMILAR REPRESENTATIVE ACTION. EITHER PARTY HAS THE RIGHTTO REQUIRE A PANEL OF THREE (3) ARBITRATORS, AND THE REQUESTING PARTY SHALL BE RFSPONSEMLE FOR THE COST OF THE ADDITIONAL ARBITRATORS. EITHER PARTY MAY REQUEST AT ANY TIME PRIOR TO THE HEARING THATTHE AWARD BE ACCOMPANIED RYA REASONED OPINION. TREAWARD RENDERED BY THE ARBITRATOR(S) SHALL BE FINAL AND BINDING ON ALL PARTIES, EXCEPT THAT EITHER PARTY MAY WITHIN 30 DAYS OF THE ORIGINAL AWARD REQUEST AN ARBIfRAL APPEAL TO A THREE MEMBER APPEAL TRIBUNAL THE APPEALING PARTY SHALL BE RESPONSIBLE FOR ALL APPELLATE ARBITRATORS) FEES AND COSTS. THE APPEAL TRIBUNAL SHALL REVIEW ALL QUESTIONS OF LAW AND FACT UNDER A CLEARLY ERRONEOUS STANDARD. THE AWARD OF THE APPEAL TRIBUNAL SHALL BE FINAL AND BINDING. JUDGMENT MAY BE ENTERED ON THE AWARD IN ANY COURT HAVING JURISDICTION THEREOF. CUSTOMER AND COMPANY ACKNOWLEDGE AND AGREE THAT TIM ARBITRATION PROVISION IS MADE PURSUANT TO A TRANSACTION INVOLVING INTERSTATE COMMERCE AND SHALL BE GOVERNED BY THE FEDERAL ARBITRATION ACT. Strtion XIL CHEMICAL SENSITIVITY OR SPECIAL HEALTH CONDITIONS. If Cndma r believes that Customer or other ocoupants of the bested structure am or may (A) be sensitive to pesticidea/manitiddes or their odors or (B) have other health oonditiom that may be affected by peatiddes/termiticides or their odors, Copany recommends Berm you not have an intial or a subsequent service perfumed el your proviso until you leave moulted wind your fmnily physician At your aquas, Compmmy will Provide infommafion omen the chermcols to be, used M trotin& the premise. BY pemtittimg the treafmaemt, Qstama assumes the risk and waives anY and aU claims agaiot the Company in comectim wind suclr sensitivity or condition At yowrequcet, the Cmnpeny will pmvidainfamation about the chemicals to MILKY. Tbis Agmm is hansferAle to a new owner of the properly looted a Me Service Address providedt at Ma cow eweer of the nWlmion and moulming.greener. withthe Compuny. The Compmy seem® the right to ehage a baofer fee, ad sot the anmml renewal a ofthe Compannys obligations anderthu Agreaneot upon mysudm tmufer. Upon the closing ofthe sale ofthe pro" located at the Service will temvw=r. AGREEMENT AND SEVERABILIIY. This Agse®nat and the seethed &mph constitute the entire sgrmnamt between the parties. ants and mproma deco,. entering thh Agreermmt, psstomab notrelyig on myprmms , egmenent or summand. whether and or written, fully se, forth in this Agreement H my part ofthis Agreement is hdd to be invalid crwumbeemble fen say roaon, the revaiuing tams and ant wiD re PiR in full form end effa . The tome of Dee Arueennent sorted heron may not be, emended a alteea unless awrittm alemmRe h approved and signed by a Corporate OMeer of Company No other enployem m ag t of Conpmy have mdhodtyto anmd m alta my Provided, however, the as to Me paragraph an ARBITRATION, if tin sentence precluding Me mbibatar from conducting an arbitration representafivo or private attorney general action is found to be invalid on unenforceable Men the moody of the ARBITRATION paragraph deleted from this Agreement Scatter XV. ADDITIONAL COMMENTS. Smtdmn. Rams and Bmmbe rrcrrgi4vd osdmarks of Dow AgoSrimces MC (52986 SYR)3/H O NmncTem Pest l)cicn,a Inc. 20D Subterranean Termite Prot. -ion Builder's Guarantee OMB Approval 2-0525 (expp.. 0513s/3ono16) This form is completed by the builder. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information is required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. Section 24 CFR 200.926d(b)(3) requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires a licensed Pest Control company to provide the builder a record of speck treatment information in those cases when if any method other than use of pressure treated lumber is used for prevention of subterranean termite infestation. When applicable, form HUD-NPMA-99-B must accompany the farm HUD-NPMA-99-A. Builders, pest control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will use the information collected. The information is not considered confidential, therefore no assurance of confidentiality is provided. This form is submitted for proposed (new) construction cases when prevention of subterranean termite infestation is specified by the builder or required by the lender, the architect, FHA or VA. This form is to be completed by the builder. This guarantee is issued by the builder to the buyer. This guarantee is not to be considered as a waiver of, or in place of, any legal rights or remedies that the buyer may have against the builder. FHANA Case No.: Location of Structure(s) (Street Address, or Legal Description, City, State and Zip): 5117 Palmetto Dr Fort Pierce FL 34982-7466 Buyers Name QE?T -1 P00aA H d ZJ L+/,! ' I Pest Control Company Applied Treatment (See HUD-NPMA 99B for treatment information) The undersigned builder hereby certifies that a State licensed or otherwise authorized pest control company (where required by State law) was contracted to treat the property at the location referenced above to prevent subterranean termites. The builder further certifies that the contract with the pest control company required the treatment materials and methods used to be in cordornance with all applicable State and Federal requirements. All work required by the contract has been completed unless noted on HUD-NPMA 99B. Where not prohibited by applicable State requirements, the buyer, for an additional fee payable to the pest control company, may extend the protection against subterranean termites. Contact the pest control company listed on the attachment for further information. The builder hereby guarantees that, if subterranean termite infestation should occur within one year from the date of closing, the builder will ensure that a licensed or otherwise State authorized pest control company will treat as necessary to control infestations in the structure. This further treatment will be without cost to the buyer. If permitted by State law, the buyer may contract directly, at the buyer's expense, with a pest control company to inspect the property on a periodic basis and use EPA registered products to control any infestation. The builder will not be responsible for guaranteeing such contracted work. The builder further agrees to repair all damage by subterranean termites within the one-year builders womanly period. This guarantee does not apply to additions or alterations that are made by the buyer, which affects the original structure or treatment. Examples include, but are not limited to, landscape and mulch alterations, which disturb the treated area and create new subterranean termite hazards, or interfere with the control measures. If within the guarantee period the builder questions the validity of a claim by the buyer, the claim will be investigated by an unbiased expert mutually agreeable to the buyer and builder. The report of the expert will be accepted as the basis for disposition of the case. The non -prevailing party will pay the cost of any inspections made to investigate the claim. For further information, contact your State structural pest control regulatory agency. All service must be in compliance with the International Residential Code. of Service: ® Termite Bait System 11 Field Applied Wood Treatment ❑ Soil Treatment D Installed Physical Barrier System 2.0 Builder Installed Subterranean Termite Prevention using Pressure Treated Lumber The builder certifies that subterranean termite prevention was installed using pressure treated lumber only and certifies that use of the pressure treated lumber is in compliance with applicable building codes and HUD requirements including Mortgagee Letter 2001-04. Note: Using pressure treated sills as a sole method of termite prevention is NOT acceptable and violates the requirements of Mortgagee Letter 2001-04. Initial of Builder Date Attachments: Builders Company Name: Builders Signature: Phone No.: Consumer Maintenance Advisory regardingNinAgrated Pest Management for Prevention of Wood Destroying insects. Information regarding prevention of wood destroying insect infestation is helpful to any property owner interested in protecting the structure from Infestation. Any structure can be attacked by wood destroying Inseota.Periodic mainte nance should include measures to minimize possibilities of infestation in and around a structure. Factors which may lead to Infestation from wood destroying insects include foam insulation at foundation, earth -wood contact, faulty grade, firewood against structure, insufficient ventilation, moisture. wood debris in crawl space, wood mulch, tree branches touching structures, landscape timbers, and wood rot. Should these or other such conditions exist. corrective measure should be taken by the owner in order to reduce the chances of infestations by wood destroying insects, and the need for treatment. An original and one copy of this guarantee are to be prepared by the builder and sent to the lender. The lender provides one copy to the buyer at closing and includes a copy in the VA loan package or HUD insurance case binder. The builder sends one copy to the licensed pest control company which performed the treatment. Attached is a copy of the state authorized pest control companys New Construction Subterranean Termite Service Record, HUD-NPMA-99-B. Wanting: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001. 1010. 1012:31 U.S.C. 3729.3802) form HUD-NPMA-99-A (82008) New Construction Subtew__,. `an Termite OMB Approval No.2502-0525 (exp. 05/3012018) Service Record This form is completed by the licensed Pest Control Company Public reporting burden for this collection of information Is estimated to average 15 minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information is required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. Section 24 CFR 200.926d(b)(3) requires that the sites for HUD insured structures must be free of termite hazards. This information collection requires the builder to certify that an authorized Pest Control company performed all required treatment for termites, and that the builder guarantees the treated area against infestation for one year. Builders, pest control companies, mortgage lenders, homebuyers, and HUD as a record of treatment for specific homes will use the information collected The information is not considered confidential therefore no assurance of confidentiality is provided. This report is submitted for informational purposes to the builder on proposed (new) construction cases when treatment for prevention of subterranean termite infestation is specified by the builder, architect, or required by the lender, architect, FHA, or VA. All contracts for services are between the Pest Control company and builder, unless stated otherwise. Section 1: General Information (Pest Control Company Information) Company Name HomeTeam Pest Defense Inc. Company Address 4341 Fortune Place City West Melbourne State FL Zip 32904-1532 Company Business License No. JB168929 Company Phone No. 321-409-8489 FHANA Case No. (f any) Section 2: Builder Information Company Name Synergy Homes Phone No. 561-939-9885 Section 3: Property Information Location of Structure(s) Treated (Street Address or Legal Description, City, State and Zip) 5117 Palmetto Dr, Fort Pierce, FL, 34982-7466 Section 4: Treatment Information Date(s) of Services) 0821/19 Type of Construction (More than one box may be checked) ® Slab ❑ Basement ❑ Crawl ❑ Other Check all that apply: A Soil Applied Liquid Termiticide Brand Name of EPA Registration No. Termiticide: Approx. Dilution (%): Approx. Total Gallons Mix Applied: Treatment completed on exterior: ®Yes ❑ No B. Wood Applied Liquid Termiticide Brand Name of EPA Registration No. Termiticide: Approx. Dilution (°h): Approx. Total Gallons Mix Applied: ® C. Bait system Installed Name of System: SENTRICONAA EPA Registration 62719-608 Number of Stations 29 No. installed ❑ D. Physical Barrier System Installed Name of System: Attach installation information (required) Service Agreement Available? ®Yes ❑No Note: Some state laws require service agreements to be issued. This form does not preempt state law. Attachments (List) Comments Name of Applicator(s) Sebastian Quick Certification No. (if required by State law) JF132379 The applicator has used a product in accordance with the product label and state requirements. All materials and methods used comply with state and federal regulations. Authorized Signature Date 08/22/19 Waming: HUD will presecute ralse claims and statements. Conviction may result in criminal and/or civil penatlim (18 U.S.C. 1001, 1010. 1012; 31 U.S.C. 3729, 3802) form HUD-NPMA-99-B (0812008)