HomeMy WebLinkAboutCHANGE OF SUB CONTRACTOR - AGREEMENTra
��� _ PLANNING & DEVELOPMENT SERVICES
" . - BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECUNI90
FORT PIERCE, FL 34982
�p (772) 462-1553 FAX 462-1578 MAR 0 6
ST, Lucie County, Permitung
qQ, CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE'SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out)., A recorded copy must be submitted prior to
com encing any work. There is a $50.00 fee for the Change of Contractor.
ZCHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2 - b - aou) Permit Number: 1 1 16 azall
Site Address: 511,111R OAK
lqG d C40A f{ I .UC.. State License C/1C, 1 � 1 W9 SLC License 301 I V
Original GC, subcontractor or owner/builder
BUROY,5 A1L 4L State License r/161$200Q SLC License 3126A
New GC, subcontractor
Reason for Cancellation 01650koa pAEV1045 ampor
The undersigned does hereby agree to indemnify and hold harniless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot ekanccelle/ if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINTNAME D-V t lY L-401mcr
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this Thy following i enI ackn ed ed before a thud
_day of .20 Eby //J da of ✓ 2p�(�fb /ilriia
who is personally known to me who is personally known to
or who has produced as ID. �meor wh uc,-,-uurr11 as ID.
�7�AAiI
Signature of Notary Date Signature of Note
,Y•0 a
KAREN S. NIELSEN
State of Florida -Notary Public
Revised 04/15/16 •E Commission N GG 207464
My Commission Expires
"%°iin°� June 12, 202E
PERMIT # 1 Q to — O9_a ISSUE DATE ==1
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Company Name/Individual
the HVAG
(Type of Trade)
For the project located at
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
=County,
have agreed to be
Sub -contractor for Q W RE5 I OZAnl u lLL
(Primary Contractor)
31 g1WER. OAP,
Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CONTRACTOR SIGNATURE (Qualifier)
NVI O 1Ain 111 r✓
PRINT NAME
COUNTY CERTIFICATION UMBER ss
State of Florida, County o IL
The forego- instrument was signed before me this day of
,2,,by, Utn LOIAI18C F .
who is personally known _or has produced a F1 _ 1) L_
Print Name of Not
"pr ep o
KAREN S. NIELSEN
C, t:';State of Florida -Notary Public
Commission 0 GG 207484
My commissionExpires
o` June 12, 0
Revised 11/162016
'y W'A
SUB -CONTRACTOR SIGNAT Qualifier)
--(1 (WAAI 0. 4A)rroti FA -
PRINT NAME
311611 COUNTY CERTIFICATION i' 1 MBER
State of Florida, County o14-i IE A�
The foregoing instrument was signed before me this-kL day of
202b by' lA A 1C 191ri tJ
who is personally known _or has produced a_
Print Name of NotaryPubli KAREN S. NIELSEN
State of Florida -(Votary Public
=it = Commission #1 GG 207484
pa`o My Commissio2nUExpires
"i„Si �"`�� June 12
PLANNING & DEVELOPMENT SER
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
V RECEIVED
APR 2 9 niq
ST. Lucie County, Permitting
,ONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
XX CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
", CANCELLATION OF PERMIT— The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2/19/19
Site Address: 7731 Silver Oak Or, Port St Lucie, FI 34952
FTL Electric
Original GC, subcontractor or owner/builder
Blosser Electric
New GC, subcontractor
Permit Number 9`D948
License SLC License
License EC13001570 SLC License 20618
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled ij,%york has'Wifperformed.
SIGNATURE OF OWNER (or owner/bu iIder)
PRINT
Slate of Florida. County of St. Lucie County
The following instrument was acknowledged before me this
_day of . 20_, by
who is personally known to me
or who has produced as ID.
2/19/19
Signature of Notary Date
Revised 04/15/16
GC, as
PRINT NAM
State or Florida. County of St. Lucic County
xhis,falloWin 'nsuum n was ack v[edged before me this
day r.'--0ja by
has prgfiugtd as ID.
Date
JOANTHAYER
20*aoe�
''
comausslottrlic262a9r'
NlyrEOf
Expires December 9, 2022
rtOPo�
It�aen.aewgtxmnistntoae
known
PERMIT # ISSUE DATE 11
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Blosser Electric
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
the Electrical Sub -contractor for TC Custom Homes
(Type of Trade)
For the project located at
(Primary Contractor)
7731 Silver Oak Dr.
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of
1V
;'t q � 1
COUNTY CERTIFICATION
NUMBER
State of Florida, County oP=nLd1.C�Gl/@.L�i
SUB -CONTRACTOR SIGNATURE (Qualifier)
ken+ L7A O SStr
PRINT NAME
go(O,Iss
COUNTY CERTIFICATION NUMBER
State of Florida, County of te- +�
The foregoing instrument was signed before me this day of ./� �{�The
`foregoing instrument was signed before me this I� day of
20 ,by rn� m0tWEOrWfr ,201Ot,by Ken+tNosstr
who is pets ally known _or has produced a who is personally known Vor has produced a
as identification.
STAMP
Signature of Nora u
Je��Print Name of Notary Publi
Revised 11/16/2016 ;•u+...... a• $t: AWREyS.HUMPHREY
ۥ; + M1 COMMISSION#GG300817
+ e'. EXPIR
yES
�:
,_Mardt6,2023
`•;:;dd]i3e• BWMXW Tluu .,_ PuDGe UMaNAI'lam
as identification.
4r1` mil/
Signature of Notary Public
GV4 2 Zo„ (,hc(
Print N me of Notary Public
Y' GUYR BOUCHER
MY COMMISSION # GG091810
' 4p, EXPIRES April 09, 2021
STAMP
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
SCANNED
BY
St. Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNIT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit. / ] 9)
O - O
Date: 1 n '— 9 — ) O 19 Permit Number:
Site Address: 1131 S rly & f — Off- e—
�'70V P 0 �U E i'o>,l S-r (LV rT o)J State License SLC License
Original GC, subcontractor or owner/builder
��'w • L ST hL,AITTA(, State License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
=ontrac�r/� ont�tor or cancellationpermit. A permit c�nnoV
ncelled if work has been performed.
® 4_
SIGNATURE OF OWNER (or owner/builder) SIGH N�IURE ERAL CONTRACTOR (or
/new
/GC, as applicable)
PRINT NAME B6 : T I/L P PRINT NAME
Stt Fldnda, my ziuteRM11 Al State of Florida, County of St. Lucie County
The following instrument was ac o[4[��Iedged before me this a ollowing i�rJ�3u,;ryy,m@@nt was ac vledg�ofp mp th q �e
day of 20�1 by d day ofSJ l'.T , 20ix by J 4 )16 1N a'' a 0 �.
Ua o is personally (mown to me —who is personally known to
or o has produced y�TgspD. CAe oVQy has produced ,✓� as Ip.�
Signature of Notaty Date
•t�s+oil AUDREY B. HUMPHREY 17
m MY COMMISSION # GG 300617
t
EXPIRES: March 6, 2023 �$
�•>`,dri;°'•`' Bonded Thor NoLscr¢;nic Undervriters
Signature of Notary
AUDREY B. HUMPI
MY COMMISSION Il GI
EXPIRES: March 6,
Bonded Thru Notary PuNic I
F;4
OCT 19 2019
ftmitting Department
St. Lucie County, FL
PERMIT #
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
SCANNED
BUILDING PERMIT BY
SUB -CONTRACTOR AGREEMENT St. Lucie County
FTL Electric have agreed to be
(Company Nameilndividual \ame)
the electrical Sub -contractor for Group One Construction and Develol
(Type of Trade) m....,.,.., ram.......,...,__.
For the project located at Silver Oak
(Project Street Address or Property Tax ID m)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code
filing of a Change
Mike Miranda
PRINTNAME
COUNTY CERTIFICATION N ER
State of Florida, County of
���
s signede foregoing insrume before me thiC oftzo�by
wh known_or has produced a
of St. Lucie County will be advised pursuant to the
a 3v6-3
COUNTY CERTIFICATIONNUMBER-
state of Florida, County of✓�-C�1'L ��
The foregoing i�trumeot s signed before me thla�l Lyn'
'�Ix7 .zo by` ' iJ•Uy&'wok
who is personalty known or has produmd a
as identific`atio1n,., as identification.
STAMPSignure ofNotary Public ->SiguaU
Nryi
ohlc
uS woau
Pnnt Nami of Notary Pnbile Print Name of Notary Public
CRYSTAL DAWN MOORE eYpi, s SYIYViL06'RiA.RDOID
MY COMMISSION p GG066606 _ j4 v' thy CO?AMSSbN'FF93';
EXPIRES January 26.2021 7 f71PIRES: fehn>ary �'
Revised 11/162016 - J�"�•• • • .. "�'w,"�,'„Y•,•= 3oamdTAr+No3aYPwG:noeuvags i
STAhfP
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Treasure Coast Roofing
(Company Name/Individual Name)
the Roofing Sub -contractor for
(Type of Trade) �o �-y i T\ I.
For the project located at
SCANNED
BY
St.-Lucie.County-- -
have agreed to be
Group One Construction and Development Inc.
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Re Ion Division of St. Lucie County will be advised pursuant to the
filing of a Change of Suycontr r notice.
4
IGN (Quali er) SUB -CONTRACT GNA E (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER'
State of Florida, County of C..\e
The.foregoing instrume I was ' ed b or me t I day of
z h/v 1 � I
who is personally known/v or has produced a
(`as identification
\�\r�\
`,,'~ `''CnQ STAMP
Signature of Notary Public
C(L-V�r�` Mod(,Q_
Print Name of Notary Public
MYWW AR®SMTNdfK=2 1
COUNTY CERTIFICATION NUMBER
State of Florida, County ofy�lC�.
The foregoing instrument was signed before me this I day of
—, 20AL by h�b., TW2:S4
who is personally known,,�aor has produced a
as identification.
Revised 11/162016 CRYSTAL DAWN MOORE
`? MY COMMISSION # GGO6660;
EXPIRES January
26. 2021
�¢Y 12.2p
o.a
#FF122434
STAMP
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERISIIT
SUB -CONTRACTOR AGREEMENT
SCANNED
By
St. Lucie County
B&N Plumbing/ Bradley Beddome have agreed to be
(Company NameAndividual Name)
the Plumbing Sub -contractor for Group One Construction And Devel®
(Type of Trade) (Primary Contractor)
For the project located at TBD Silver Oak Drive, Port St. Lucie
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Cade Rea on Division of St. Lucie County will he advised pursuant to the
filing of a Change of con for notice. j� Q
CO, R NATURE lirwl SUS-CO\CiL\CTORS . ATURE (Qoalllicr)
Mike Miranda Bradley Beddome
PRINT NAME PRINT NAME
State of Florida,
I1 , , 20-�.VbF I Li�
persoustly knoua �or has 'Prod Iuced a
u idmlifcfado\a,�\\
CJ� =-1 \"�✓ C� O STAMP
Sign2tare,of Notary Public
Print Name ofNomry Public
CRYSTAL DAWN MOORE
MY COMMISSION # GG066605
Revised 11116rA16 w EXPIRES January 26, 2021
COUNTY CERTIFICATION NUMBER
State of Florida, County af�Uc/\I
7777���\onzatug ins um ugued before me !4i-day of
1�, 20 bI
who is personally Imown for bus produced a
as identification. {� ,f(�
A p t \ 1 t 015112 STAMP
Sigoatuma NatoryPublic
CkASkek\ MCYJ(`Q__
Print Nanic orNotary Public
4;: CRYSTAL DAWN MOORE
MY COMMISSION # GG066605
' ,ql�� EXPIRES January 26. 2021
PERMIT# ISSUE DATE
AC Buddy, Inc.
(Comp Tam
the
(Type ofTra e)
For the project located at
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor f r
� i M r
-oject Street Address or Property Tax ID #)
SCANNED
BY
St. Lucie C-ounty —
to be
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
COUNTY CERTIFICATIO�'��
State of Florida, County of o k%
TlIe foregoing instrument was signed before me miDa day of
20L , by
who is personally. known _or has produced a
as identification.
LDS 1S ttJ�l \ IQ STAMP
SigOatare tNotary Public
Ct "4A Mo cs-&-
Print Name of Notary Public
�•• �, CRYSTAL pgyyN MOORE
MY COMMISSION # GG066605
Re}ised l tl76rz076 ''• ,$, EXPIRES January 28, 2021
SUB -CONTRACTOR SIGNATURE (Qualifier)
Wanda Gahn
PRINT NAME
30113
COUNTY CERTIFICATION NUMBER
State of Florida, County ofM�%
Th 0rgGiingg iinnsstrru'men1t wwns signed before me f day of
20.L by
who is personalty known_or has produced a
as identification.
VU_ 8( z \ f M 'caa STAMP
Signature Public
b kooc-p-
Print Nome bfNotary Public
W,-4CRYSTAL DAWN MOORE
.:
MY COMMISSION # G . 5
EXPIRES January 26, 2021 2027
PERMIT# ISSUE DATE
PLANNING At DEVELOPMENT SERVICES
"- - Building & Code Compliance Division
SCANNED
BUILDING PERMIT BY
SUR- ONTRACTOR AGREEMENT St. Lucie County
AC Buddy, Inc. have agreed to be
(Company Name(Individual Name)
the HVAC/Mechanical Sub -contractor for Group One Construction & Development
(Type of Trade) (Primary Contractor)
For the project located at 5144 Cherry Palm Way
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation
filing of a Change of
COL'NPY CERTIFICA R
State of Florida, County
CIO instru assigned beforem�s �ay of
Ca�20 y
who persona yknown_or has produced
as identification.
L-M s i-Q3 \ ocu -Q STAMP
Signatures Notary Public
LAcS� c%,\ rn C7J ,(\Q
Print Name of Notary Public
of St. Lucie County will be advised pursuant to the
CRYSTAL DAWN MOORE
v�• be
MY COMMISSION # GG066605
EXPIRES January 26, 2021
Revised 11116t2016
SOB -CONTRACTOR SIGNATURE (Qualifier)
Wanda Galin
PRCrr NAME
30113
COUNTY CERTIFICATION BEf`R - /J
State of Florida, County o M
The foregoing instrume�¢tt��,as signed before me this day of
// o Z �t1Y
whowho' p\�•own or has produced a
as identification.
STAMP
Signature of Notary Public
CC,L�s-W moo(
Print Name of Notary Public
:CRYSTAL DAWN MOORE
MY COMMISSION # GG066605
EXPIRES January 26. 2021
•
PERMIT #
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
SCANNED
BY
St. Lucie Counts-__
FTL Electric have agreed to be
(Company Name/Individual Name)
the electrical Sub -contractor for Group One Construction and Develor
(Type of Trade)
(Primary Contractor)
For the project located at 5144 Cherry Palm Way, Port St. Lucie
(Project Street Address or Properly Tax 1D #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice%
Mike Miranda
PRINT NAME
State of Florida, County of
has produced a
as identification.
C(
J ma" STAMP
Notary Pool,,
S kek\ ccar'_'z'_
Print Name of Notary Public
;y+i4: CRYSTAL DAWN MOORE
MY COMMISSION # GG066605
ii,. FvelpFo t?rrtary?R °97t
Revised I I/162016 •.
COUNTY CERTIFICATION NLTNIBER
State of Florida, County of _5LLx1e ; r•L-
The foregoing instrument wassi ned before me this `/ day of
ao�y k Y1 I T Un'4g '401
who is personally known for has produced a
as identification.
S: lure of No, tary�PuElie STAMP
Print Name of Notary Public
a
A1Y C.^MJASS:Oid,4fFXS??4
g EXPIRES: February 22, 20M
^' eaitlud Tfa NClyry Pubs UnaDnm".:" 1.
.
PERMIT # I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
SCANNED
BY
St. Lucie Countv
(Company NameAndmdual Name) B&N Plumbing have agreed to be
the - oifd tubing Sub -contractor for GrOUP One Construction and Develol
(Type of de)
(Primary Contractor)
For the project located at 5144 Cher
(Project Street Address or Property
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor /tice.
Mike Miranda
PRINT NAME
COUNTY CERTIFICATI U5 ER '
State of Florida, County o —0 (�
hef ing instrume7p't�was ' 1`.before is d of
2 rn 3.
who is pe nally know-.++����_��1" or has produced a
as identification.
C A'. 'a) Mow STAMP
Signature of Notary Public
S l Ct 1M CfJ(�2
Print Name of Notary Public
CRYSTAL DAWN MOORE
MY COMMISSION # GG066605
'?}•„,�... EXPIRES January 26, 2021
Revised 11/162016
44
SUB -CONTRACTOR SIGNATURE (Qualifier)
Bradley R Beddome
PRINT NAME
COUNTY CERTIFICATI N NU11
State of Flortda,Couoryo (�Ij—�-t/I�
;rbe fo oing instrunt was s of r e this ay f
20 by
person
who is peon By known _or has produced a
assiid{enndi6tlNon. (�(�
` Sk3 ` STAMP
Signature o Notary Public
Moom-
Print Name of Notary Public
v"'"•• CRYSTAL DAWN MOORE
' MY COMMISSION # GG066605
'?�a•,1•,+ EXPIRES January 26. 2021
EE7
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
SCANNED
BY
St Lucie County
Treasure Coast Roofing have agreed to be
(Company Name/Individual Name)
the Roofing Sub -contractor for Group One Construction and Development Inc.
(Type of Trade) 1�1 ' t C tractor)
For the project located at
�3 � k N -(Project tree Address or Prope4 Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of
COUNTY CERTIFICAT ER +
State of Florida, County o 7 1tc
he ford\Soing ios[rum was si e m ay
20 ;7wh is person IIy lmow•a a�// or has produced a
as identiBca6on.
�Jtt� m� STAMP
Signatur of Notary Public
C.c4sk0.1 mcmc�
Print Name of Notary Public
CRYSTAL DAWN MO
MY COMMISSION# GG066605
�?;t iEXPIRESJanUary 26, 2021
Revised 11/162016 ` •"
/ 3 rj
SUB -CONTRACT GNA E (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of Iyr L"Ac�
The foregoing instrument was signed before me this i day of
�G� • 20_1J, by ? • be' I ,e•`•7C�
who is personally Imowa.2gorh produced a
as identification. //Tl
PIV413 .
O�V N.
r:FF122434