11/12/1997 •
LEASE AGREEMENT
THIS LEASE, entered into on the 12th day of November 1997, by and between the BOARD
OF COUNTY COMMISSIONERS, MONROE COUNTY, FLORIDA (Lessor) and ROBERT
CANGELOSI (Lessee), whose address is 114 Harry Harris Drive. Tavernier. Florida 33070.
1. This lease evidences the grants, covenants and agreements made between the parties
with reference to the following described premises:
Concession Stand
Located on a portion of Gov't Lots 3 & 4,
Section 27, Township 62S, Range 38E
Tavernier, Monroe County, Florida
2. The Lessor hereby grants to the Lessee the exclusive right and privilege of operating and
maintaining a full service concession stand at Harry Harris Park, Tavernier, Monroe County,
Florida, for a term of six (6) months, commencing January 1, 1998, and ending June 30, 1998
said concession stand to be located at the concrete building now situated upon said park and
known as the Harry Harris Park Concession Stand.
3. The Lessee may exercise an option to renew this lease for an additional two and a half
(2 1/2) years by giving Lessor written notice of their intention to exercise said option within
sixty (60) days previous to the expiration of the original six month term. This option clause is
voidable at the discretion of Lessor if Lessee violates any of the terms of this lease. ghatrthe 1 6g 71
Lessee, in consideration of the foregoing rights and privileges, does hereby covenan.�Ihe rg
rri
Lessor to pay a rental of $800.00 per month in the following m anner: g N
P Y p g c� c �' �- to
A. Upon execution of this lease and prior to the Lessor's delivery of the ises
Lessee, Lessee shall deliver to Lessor the sum of $1900.00, same representing firsteid Est G?
r _
month's rent and a damage deposit of $300.00. Lessor shall not be required to post.3onci
securing said advance rent or damage deposit.
B. The first month's rent shall be paid in advance on the first day of December
1997 and each and every month thereafter, rent being payable in advance during the term of this
lease. Lessee may assume occupancy as of January 1. 1998, assuming full compliance with all
terms of this lease, inclusive of insurance coverage effective as of said date. In addition to the
foregoing rental payments, the Lessee covenants and agrees with the Lessor to pay State taxes, if
any, and all other charges including but not limited to electric at said concession stand, which
shall be a result of the operation of the facilities granted under this lease. The Lessor reserves
the right to terminate this lease for non - payment of rent by the Lessee for a period of fifteen (15)
days or more, after written notice of said default.
•
4. In connection with the above demised properties, the Lessor covenants with the Lessee
that conditioned on Lessee's performance and observance of Lessee's covenants herein, Lessee
shall have quiet enjoyment and peaceable possession of the premises during the term of this
lease. In the event the county elects to maintain and/or improve its properties in the vicinity of
the leasehold herein, either by necessity, or by choice, such activity will not be considered as a
breach of any covenant of this lease.
5. Lessee further covenants and agrees as follows:
A. To keep open such concession stand not to exceed park hours, 7:30AM to sunset,
Monday - Sunday, including holidays, unless scheduled activities have been scheduled with the
Parks & Recreation Coordinator then said concession stand will remain open until 10:30PM.
B. All commodities must be sold at prices comparable with other like concessions
within the surrounding areas and shall not sell, offer or consume any beer, wine, or liquors in
accordance with Monroe County Code at said concession.
C. To furnish the necessary equipment, furnishings and fixtures needed to operate
the concession stand. All movable equipment and furnishings shall remain the property of
Lessee and may be removed from the premises by Lessee at the termination of this lease
agreement, with Lessor's consent. If Lessee fails to remove said movable equipment of
furnishings within five (5) days after termination of this lease, said items shall then become the
property of the Lessor.
D. Lessee shall maintain a County Occupational License during the period of this
lease.
E. Lessee agrees to keep the leased premises in a safe, clean, and well- maintained
order at no expense to the Lessor. This provision is to be monitored by the Director of Public
Facilities Maintenance or his representative.
F. Lessee agrees to operate his business in a business -like- manner.
6. It is agreed by the parties hereto that Lessee may elect to sub -lease or assign the lease
agreement only upon previous written consent of the Board of County Commissioners for
Monroe County. The terms of this agreement shall be binding on the heirs, executors,
administrators, sublessees and assigns of Lessee.
7. It is hereby covenanted, stipulated and agreed by and between the parties hereto that
there shall, during the said demised term, be no mechanic's liens upon the concession stand or
improvements thereto; in case of any attempt to place a mechanic's liens on premises, the Lessee
must pay off the same; and that if default in payment thereof shall continue for thirty (30) days
after written notice, said Lessor shall have the right and privilege, at its option, to pay off the
same or any portion of the same, and the amount so paid, including expenses, shall, at the option
of the said Lessor, be so much additional rent due from said Lessee at the next rent due after
such payment, with interest at the rate established by the Comptroller under Sec. 55.03, F.S., for
the year in which the payment became overdue. Nothing in this paragraph is to be read as a
waiver or authorization by the County of its constitutional and statutory immunity and right to
have its property free of such liens.
8. It is expressly covenanted between the parties hereto that the Lessee will not use, suffer
nor permit any person to use in any manner whatsoever the said demised property, nor any
portion thereof, for purposes calculated to injure the reputation of the premises or of the
neighboring property, nor for any purpose or use in violation of the laws of the United States, or
of the State of Florida, or of the ordinances of Monroe County, Florida, and that the Lessee will
keep and save the Lessor forever harmless from any penalty or damage or charges imposed for
any violation of any said laws, whether occasioned by neglect of Lessee, and that said Lessee
will indemnify and save and keep harmless the Lessor against and from any loss, cost, damage
and expense arising out of any accident or other occurrence, causing injury to any person or
property whomsoever or whatsoever, and due directly or indirectly to the use of the premises, or
any part thereof, by the Lessee.
9. It is further agreed that in no case shall the Lessor herein be liable, under any express or
implied covenants in this lease agreement, for any damages whatsoever to the Lessee beyond the
rent reserved by this lease agreement accruing, for the act, or breach of covenant, for which
damages may be sought to be recovered against said Lessor, and that in the event said Lessee
shall be ousted from the possession of said property by reason of any defect in the title of said
Lessor or said Lessor's authority to make this lease agreement, said Lessee shall not be required
to pay rent under this lease agreement while he is so deprived of the possession of said property,
and that said Lessor shall not incur any liability by such ouster.
10. It is further mutually covenanted and agreed between the parties hereto that no waiver of
a breach of any of the covenants of this lease agreement shall be construed to be a waiver of any
succeeding breach of the same covenant.
11. The Lessee hereby covenants and agrees that he, his agents, employees, or otherwise
shall observe and obey all lawful rules and regulations which may from time to time during the
term hereby by promulgated and enforced by the Lessor at said breach.
•
12. The Lessor reserves the right hereunder to enter upon the premises at any reasonable
time during normal park hours for the purpose of inspecting said premises, and the Lessee
hereby agrees to keep the premises at all times in a clean and sanitary condition, and not to
maintain or keep upon said premises any properties or equipment not used in connection with the
operation of said business, unless authorized by the Lessor to do so.
13. The Lessee agrees not to make any major alterations to the building located on said
premises, without first obtaining written consent of the Lessor to do so, which will not be
unreasonably withheld. Such alterations shall be based on plans approved by the Director of
Facilities Maintenance and shall be subject to all County Code provisions governing
construction.
14. Lessee agrees to fully indemnify and save and hold harmless by Lessor from and against
all claims and actions and all expenses incidental to the investigation and defense thereof; based
upon or arising out of damages or injuries to third persons or their property, caused by the
negligence of Lessee, its agents or employees, in the use or occupancy of the said leased
premises, and all activities connected therewith. The Lessee shall not be liable for any injury or
damage or loss occasioned by the negligence of Lessor, its agents or employees; and provided
further that Lessor shall give to Lessee prompt and reasonable notice of any such claims or
actions and Lessee shall have the right to investigate, compromise and defend the same.
15. Lessee agrees to carry and keep in force such insurance as outlined on the attached forms
indicated as INS 1 -4, attached hereto and incorporated as part of this lease agreement. The
Lessor shall be named an additional insured and will be furnished with a Certificate of evidence
of the insurance providing for no less than thirty (30) days notice in the event of material change
or cancellation. Lessee shall carry this insurance coverage with an insurance company
authorized to do business in the State of Florida and approved by Lessor.
16. All written notices pursuant to this lease shall be forwarded to the following address:
Lessor: Lessee:
Monroe County Public Works Robert Cangelosi
Facilities Maintenance Department 114 Harry Harris Drive
3583 So. Roosevelt Blvd. Tavernier, Florida 33070
Key West, Florida 33040
17. If any dispute concerning this lease should arise between Lessor and Lessee and which
results in litigation, the prevailing party shall be entitled to payment of its reasonable attorney's
fees and costs associated with said litigation from the losing party.
18. This lease shall be governed by the laws of the State of Florida. Venue for any disputes
arising under this agreement shall be in a court of competent jurisdiction in Monroe County,
Florida.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed as of
the day and year first above written
,rye yt. •
.;Z •�
BOARD OF COUNTY COMMISIONERS
0 ANNY L. KOLHAGE, CLERK OF MONROE COUNTY, FLORIDA
13 y: 0' - _. � , . At .. By:
Depu r lerk / / Mayor /Chairman
cl/ t[6:
Witness
A. Lit/
esse
III - al
Witness
APPROVED AS TO FO'
AND - AL SUFFICI
® ZANN A U ON
DA 77L5/9
1-21-1998 4:42PM FROM MONROE CTY FAC MAINT 306 295 3672 P.2
... ' ' ' ' f '.#1 - ' ' . - '.. :. ' . --.... : :... .: ' ' •• . DATE (mmiDo.1 Y'
Attillt10. .:CERTNICATKOrAN. :.- . : P '''• IN t;E - . : - .C.sg . sG . .
. :.. . . . . • )- .. •■,- . . .-r-a :. . ' • . . '''' .:::...*:: H -,. • :.! ........' .. ' .. .. • ' . • . ..' .: : ROO.ER22 . - ', 11/25/97
PRODUCER _ ..... • MIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Johnson s Insurance Agency
inIMPAII HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
13361 Overseas Highway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_
Marathon FL 33050 COMPANIES AFFORDING COVERAGE
PAM CURRY COMPANY
305-289-0213 A Nova Casualty Company
INSURED . COMPANY
B
COMPANY
ROBERT CANGELOSI C
114 Harry Harris Dr
COMPANY
TAVERNIER FL 33070 D
.Cirptkgr„,5:: ::: . , , : : : : • • •.:: : :. '.:,. ' : :..- '...:',.:...:••,- ;:....-.'.:;.:',,',.:', ::....:.'.. ' -: ... : ': • : '..'y :.:-. ':.• ....,:,:...,,,.......,'.:•:•:' : ' ...:-:-.......:.; ,: .::.:*: :-• ' - -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO The INSURED NAMED ABOVE FOR THE POUCY 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, WE 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.
co 1 1 POUCY EFFECTIVE POLICY ExPIRATION • ,
TYPE OF INSURANCE POLICY NumgER " UMITS
L.TR DATE MAL/DIVVY) DATE (111M/DD/YY)
CLENERAL LIABILITY i.-------- OENERAL AGGREGATE $ 300,000
.. .
A X COMMERCIAL GENERAL LIABUTY B i nder*Am71125546 12/01/97 12/01/98 PRODUCTS • COMP/OP AGG $ 300,000
CLAMS MADE m OCCUR PERSONAL & ADV INJURY $ 300,000
OwNErs a CONTRACTOR'S PRO'r EACH OCCURRENCE $ 300,000
FIRE DAMAGE (Any aft (n) $ 50 • 000
MED EXP (M,y one person) $ 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO .APD7 SY • 1 * .• ENT
t (
---1
ALL OWNED AUTOS ''
--i
$
• SCHEDULED AuTos RY -1 i • 1 . 111% BODILY INJURY
(Per penal)
r
H HIRED AUTOS
BODILY INJURY :
• al4 a
NON-OWNED AUTOS rIATE ( Pa acciderx)
.....
kkai 11 t$ rt N IA .4 VS .....--..- PROPERTY DAMAGE $
I
GARAGE IJABILITY AUTO ONLY. EA ACCIDENT $
. . ..
_ ANY AUTO OTHER THAN AUTO oNLy: :.• .
—I EACH ACCIDENT $ .
AGGREGATE $
---,
EXCESS LIABILITY EACH OCCURRENCE $
— 1 UMBRELLA FORM AGGREGATE • $
1 OTHER I HAN UMBRELLA FORM $ ,
WORKERS COMPENSATION AND 1 STATUTORY LIMITS
EMPLOYERS' LIABILITY
EACH ACCIDENT - - $
THE PROPRIETOR/ 1 I
PARTNERS/EXECUTIVE 1NCL D1$EASE • POLICY LIMIT $ 4F
OFFICERS ARE 1 EXCL DISEASE • EACH EMPLOYS $ - OTHER
DESCREPTIONOFOPERATIONSPLOCATIONS/VEHICLESSPECIAJAIBMS
LEASED CONCESSION STAND AT HARRY HARRIS PARK (OWNED BY
MONROE COUNTY)
CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED.
. .. ,
tailliCklit •. i :,.. :...:. ... . ..:4=A; 4 1MEXJAIi(*: .:',.: : :. .....:'''-:..::-,',:-. ::::%:::::':''.' !'''
MONRO-6 smOmo ANY OF THE ABOVE DESCRIBED mums BE CANCELLED BEFORE TIM
Monroe County Board of County . EXPIRATION DATE THEREOF, THE ISSuING COMPANY wILL ENDEAVOR TO MAIL
Commissioners 10 DAYS %MITTEN NOTICE TO THE CERITFicATE HOLDER NAMED TO TIE LEFT.
Risk Management
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIA.BILl'I'Y
5100 College Road
Key West FL 33040 01 ANY • 0 i ' • TIE COMPANY, ITS AGENTS OW ;PR + AT1VES.
AVTHO A. D RE :7‘. ENTATIVE '
1 '' PAM CURRY - lq \ • ). f I
- 1 C\ r Al . . . . . .
ACORD14-:S.: ..:. - - : • .• .. : : ....:'. . : .. : -.. . ... : : . •• : .... . . . . . ....:..:\.: .... . : : A , :.. - . . 7 . Ld : . ;... . ..- . A..
6 ■ ' mar
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season for filing this Application: DR -1
R. 03/97
A. This application is for (check all that apply): Page 1
B ' Sales Tax (collecting tax on sales of merchandise /services) — Fee is $5.00
0 Use Tax (only paying tax on items purchased tax -free which — No fee
are used in your business)
❑ Gross Receipts Tax (Telecommunications and Utilities) — No fee
❑ Documentary Stamp Tax — No fee
❑ Dry- cleaning Sales Tax on Gross Receipts — Fee is $30.00
B. This is for a (check one):
RrNew business
❑ Additional location f f
List current Sales and Use Tax Registration Number
❑ Change of:
❑ Ownership ❑ Legal Entity or ❑ County Location; as of (enter date: MM- DD -YY) f 1 1 1 1 1
List old Sales and Use Tax Registration Number 1 1
C. If this is a seasonal business, list your active business months. Opening month: Closing month:
Beginning of Month I A Day 1 5 Year 1
Business Activity: Enter the date this business location became or will become liable to collect and remit Florida sales and use tax. If you have been
in business for more than 30 days prior to registering, visit your nearest Department of Revenue Service Center immediately to
settle your tax liability. Do not use incorporation date unless that is the date your business became liable.
Report the date that a rental location became taxable as a result of the tenant occupying the unit.
Business Name: MR CAA trtGC LOSI'3 1TiAL►YiN —Lacs A. SNIAC.. Telephone # ("l°Ne_iirr - Prat-`' iv•
Enter business, trade, or fictitious (d/b /a) name. Area Code Number
Owner Name: MiR �o'1?jE RT S. CIt 4 Q Le 1 1
Daytime
Telephone DS
Telephone # 3 _ $5'Z _ Z3? C7
Enter individual, principal partner, or corporate name. Area Code Number
I1 `'1 Harry y Dr-) vE FAX# ___ ___ _
Business Location: CO KG @ SS 1. O t� STA tN Area Code Number
Physical address of business or real property. A Post Office Box is not acceptable.
1 6 . fl --A- ' 1 .S ?
ATIN:
• A L E'er.' R. cL 33c _
City State Zip Code
T`1Or1iZC7 ❑ R '-‘ Is business located within city limits?
County Yes No
Mailing Address: ? 0 - U DX 5' 1 S
Enter the address where you want us to mail your tax forms and correspondence.
If an agent or management company will be receiving the rent, place the agent's
or management company's address in this section.
r1R -" o8FRT S C.tR 4 C. €LinSl Agent's 30j_S5 5 1
ATTN: , Telephone # Area Code Number
— C'IA\I0..R l . PL- 33 67o_O.15 t - Ro t_ -
City State Zip Code County
If you have a Consolidated Sales Tax Number and want to Zink this business location, please complete the following:
(Does not apply to documentary stamp tax applicants)
1 8 0
Enter consolidated registration name on record with the Florida Department of Revenue. (Enter Consolidated Sales Tax Number)
If you want to obtain a new consolidated number contact the Department and request Form DR -1CON.
Federal Employer Identification Number (FEIN)
If you do not have an FEIN, is it 11 applied for ❑knot required?
For instructions on applying for a FEIN, call the IRS at 1- 800 - 829 -1040. When you receive your FEIN contact the Department.
If FEIN is not required or not yet received, enter your Social Security Number (SSN):
FOR DOR OFFICE USE ONLY
AN
10 QU SA SE --- SIC Kind Code Sales and Use Tax # Origin
1f in n s I 1 o f i' 5 h 9 0 L1` '/IJ1Io1&1 01 I) 131
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DR -1
Page 2
b anization - Check one box to enter the type of business. Listed are the definitions of business types:
.,rporation - A legal entity created by or under the authority of the laws of a state.
Partnership - Two or more persons or entities that have entered into a voluntary contract.
Trust - A legal entity created by a grantor for the benefit of designated beneficiaries under the laws of the state and the valid trust instrument.
Sole Proprietorship - An individual or individual and spouse.
Professional Association - Any group of professional people organized to practice their profession together.
Other - Any other type of business entity. Please write in (e.g., government, civic organization).
❑ Corporation ❑ Partnership ❑ Trust Sole Proprietorship ❑ Professional Association •
❑ Other (explain)
rporation or partnership, enter fiscal year ending date 1 1 1-1
NI/N1 D/D
Describe your major business activities (please be specific): Z1 CT A 1 l_ s A L € 5 fl C1 O T-t 'R.0 E
C-0U tr'1 t _s C o ,A c Vss L ova 5 A-i V ki fl ► Z - R, %S ?1; R. \-4. , 7 eRtA)t
TE: If applying for Documentary Stamp Tax ONLY -go to question 40 and continue.
What are the products you purchase for resale to your customers?
i ''
't
What are your estimated annual receipts from taxable sales and /or rentals?
(check one) ❑ $1,700 or less r] between $8,000 and $16,000
❑ $800,000 - up
111 between $1,700 and $8,000 ❑ between $16,000 and $800,000 Kr unable to estimate I
Do you sell merchandise? Yes E No ❑
Wholesale? Yes ❑ No E'
Retail? Yes No ❑
Do you rent living or sleeping accommodations for 6 months or less to individuals or businesses? Yes [ No ❑ ✓'
(This includes hotels, motels, time - shares, condominiums, apartments and trailer parks.)
Do you rent commercial real property to individuals or businesses? Yes ❑ No 0'
Do you charge admission or membership fees? Yes 1 I No {d'
Do you rent equipment or other tangible personal property to individuals or businesses? Yes ❑ No [Al'"
Do you provide any of the following services?
Pest control for nonresidential buildings Yes ❑ No Q'
Cleaning for nonresidential buildings Yes ❑ No ®'
Detective Yes ❑ No e•
Protection Yes ❑ No e.
Security alarm system monitoring Yes ❑ No R
Do you generate sales and remove receipts from vending machines? Yes J No
If yes, answer the questions in this block.
Food vending machines? Yes n No ❑
Beverage vending machines? Yes 1 1 No ❑
Vending machines for other products? - Yes ❑ No ❑
Do you sell food or beverages wholesale to vending machine operators? Yes LI No ❑
Are coin - operated amusement machines being operated at your business location? Yes ❑ No ❑
21a. Do you have a written agreement that requires someone else to obtain
Amusement Machines Certificates for all of the machines? Yes ❑ No ❑
Do you have a written agreement that specifies who is responsible for obtaining Amusement Machines Certificates? Yes ❑ No ❑
22a. Do you have a written agreement that requires you to obtain
Amusement Machines Certificates for any of the machines? Yes ❑ No ❑
Yon must complete an Application for Amusement Machines Certificate (Form DR -18) if:
• you answered NO to Question 21a al_id have amusement machines on your business location
OR
• you answered YES to Question 22a and lease amt, pmrnt marhtn '
• Y
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DR -1
,. Page 3
c tt tires or batteries or rent/lease motor vehicles to others? Yes ❑ No E
nr y, answer the questions in this block.
Do you make retail sales of new tires for motorized vehicles (either separately or as a part of a vehicle)? Yes ❑ No ❑
t5. Do you make retail sales of new, used, or remanufactured lead acid batteries sold separately
or as a component part of another product? Yes ❑ No ❑
'6. Are you in the business of renting or leasing motor vehicles which transport less than nine passengers
to individuals or businesses?
Yes No E
7. Do you own or operate a dry - cleaning plant in the State of Florida?
If yes, answer the questions in this block. Yes E No
'8. Do you use perchloroethylene in the dry - cleaning process?
If you use perchloroethylene, enclose an additional $30 for a dry - cleaning registration fee. Yes ❑ No ❑
'9. Do you produce or import perchloroethylene?
If yes, complete an Application for Florida License to Produce or Import Taxable Pollutants (Form DR -166). Yes ❑ No ❑
O. Do you sell any type of fuel or use diesel fuel?
If yes, answer the questions in this block. Yes E No
1. Do you or will you make retail sales of gasoline, diesel fuel, or aviation fuel at posted retail prices? Yes
❑ No ❑
If yes to # 31, do you expect the sales of diesel fuel (as measured in gallons) to exceed the sales of gasoline? Yes
If yes to # 31, does this business exist as a marina? ❑ No ❑
If yes to # 31, what is your seven (7) digit Florida Department of Environmental Protection Facility Yes ❑ No ❑
Registration Number for this location?
2 Do you use diesel fuel for non - highway purposes?
Yes ❑ No ❑
1
7 Are you a contractor who improves real property?
If yes, answer the questions in this block. Yes El No
Do you most frequently operate as a ❑ prime contractor ❑ sub contractor? List the type of construction you perform (building,
painting, electrical, etc.)
4. Do you operate under formal written contracts?
If yes, what type of contracts do ou o erate under? Yes n No ❑
Y P ❑ Lump Sum, ❑ Cost Plus, ❑ Fixed Fee, and
❑ Other, please explain
5. Do you purchase any materials or supplies from vendors located outside of Florida?
6. Does your company have a current occupational license in any Florida county? Yes ❑ No ❑
If yes, please list all the counties in which you are licensed and the corresponding license numbers Yes ❑ No ❑
7. Do you fabricate /manufacture any building components at a location other than contract sites?
— rac Yes No 111
i. Do you provide telecommunication services, electrical power or gas?
If yes, answer the questions in this block. Yes ❑ No
Do you sell:
a. Electrical power
b. Natural or manufactured gas Yes ❑ No ❑
c. Pay phone service Yes 11 No ❑
d. 2 -way cable television service Yes ❑ No ❑
e. Telex, telegram, teletype service Yes ❑ No ❑
f. Cellular or pagers service Yes [I] No (11
g. Long distance (inter- exchange service) Yes [1] No El
h. Shared tenant utility service Yes ❑ No [1]
i. Telephone service (local exchange) Yes El No Ell
j. Alternative access vendor service Yes 111 No ❑
k. Other telecommunication services (By -Pass provider, etc.) Yes El No El
Describe Yes E] No El
). 17 :,ou provide billing services to telecommunication service providers?
Yes No
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DR-1
Page4
, your business include sales finalized by written agreements which do not require recording by
the clerk of the court, but do require documentary stamps to be affixed? Yes ❑ No [
'ryes, answer the questions in this block.
.1. Is this application being completed to register your first location for sale of documentary stamps? Yes ❑ No ❑
If no, and this application is for additional locations, please list name and address of each additional location.
2. Do you anticipate five or more taxable transactions per month? Yes ❑ No ❑
3. Do you anticipate your average monthly tax remittance to be less than $80 a month? Yes ❑ No ❑
4. Owner, Partner, Officer Information List the primary owner or corporate officer first. Enter the name, social security number, home
address and telephone number of the owners, partners or corporate officers.
i
Name Social Security Number Home Address Telephone Number '',
'
RO1 S CANa LDS I
►t ;
I ��� s �;L 3o S - SS -ZSo I
- -
I VaR Gc
rIt .,ct- 33a")b _ _
5. Business Bank Information:
Business Bank Name Primary Business Account Number
Bank Street Address City State Zip Code
16. Is your business location rented? Yes No ❑
If you answered yes, provide the following information:
Landlord or Owner's Name: 1"1 D N r? O— CO O N 7 Y
Address:
City /State /Zip:
Telephone Number:
A s . 1icant Signature —This Application Cannot Be Processed If Not Signed by the Applicant
I certi , under .enalty of perjury, that the scat nts herein have been examined by me and are, to the best of my knowledge and belief, true,
co . ete a•. correct.
. /-4....„...._
/
':nature of the Busin s or Real Property wner, Partner, or Principal Corporate Officer Date Application Signed ■
�a .s CANgeLosl, o w 1 GoL�. Pao pfZl tTo? -
Print or Type the Name Signed Above Title of Si ignatory
Y
Please note that any person (including employees, corporate directors, corporate officers, etc.) who is required to collect, truthfully account for, and
pay any sales taxes and willfully fails to do so shall be personally liable for such taxes under the provisions of s. 213.29, Florida Statutes.
All information provided by the applicant is confidential as provided in Section 213.053, and is not subject to Florida Public Records Law (Section
119.07, Florida Statutes).
FOR DOR OFFICE USE ONLY
Documentary Stamp Tax ( 1 1 1 1 1 1 11 1 1 MO
QU
Gross Receipts Tax 1 1 1 11 1 1
SA
y
to request an Application for Refund DR-26). Lines 15 and 15
�rrtactit;a Department to � (form ). a () (b) should equal the sum of Line 16.
1 NE 9 PLUS ESTIMATED TAX DUE CURRENT MONTH — If you paid UNE 17 DISCRETIONARY SURTAX AMOUNTS COLLECTED —
5100,000 or more sales and use tax from July 1, 1995, to June 30, 1996 Enter the total amount of discretionary sales surtax collected in the
(Florida's fiscal year), you must make an estimated sales tax payment appropriate column. DO NOT include state sales tax on this line.
every month, starting with the December 1996 return due January 1,1997. ENTERPRISE ZONE NUMBER — If you are claiming an enterprise
If you do not meet this criteria, go to Line 10. Do not pay estimated tax if zone jobs credit, you must enter your Enterprise Zone number in the
Ibis is your final return. space provided. Applications for credits must first be certified by the
UNE 10 AMOUNT DUE — Enter result of Une 7 minus Une 8 plus Line 9. local Enterprise Zone Development Agency before submission to the
The amount entered on Une 10 cannot be negative. Department of Revenue. Applications must be received within four
UNE 11 LESS COLLECTION ALLOWANCE — If your return and months after the new employee is hired. A copy of the certification must
payment are filed on time, enter your collection allowance. I is 2.5% (.025) be mailed to Return Reconciliation, 5050 W. Tennessee St,
of the first $1,200 of tax due from Une 10, not to exceed $30. If your return Tallahassee, FL 32399 -0100. If you have been approved by your local
or payment is late, enter zero and proceed to Lines 12 and 13. Enterprise Zone Development Agency to claim a sales tax credit, you
UNE 12 PLUS PENALTY must complete Unes 18 - 20. Note: An Application for the Credit
Penalty for Late Filing — If your retum or payment is late, enter 10% of Against Sales Tax for Job Creation (form DR -15JZ) must be filed and
the amount due from Une 10 for each 30 days, or fraction thereof, that approved prior to claiming the credit.
your retum or payment is late. The maximum total penalty is 50% of the Une 18 ENTERPRISE ZONE JOBS CREDITS
amount due. The minimum penalty is $10 for monthly filers, and $5 for (a) For new employees who eam more than $1,500 per month and are
quarterly, semiannual and annual filers, for failure to timely file, even if a not participating in the Work and Gain Economic Self- Sufficiency
zero tax retum is dire. If you have received a Notice of Tax Action, DO (WAGES) Program, multiply the first $1,500 of their wages by 5% and
NOT enter that y
amount on your tax return: . ' � . ' , .. ;: enter this amount on Line 18(a). ,' .. , •
UNE 13 PLUS INTEREST If your return or payment is fate, interest .r `. (b) For new employees who earn more than $1,500 per month and are
at the rate of 12% per year is due on the amount reported on Line 10 :. participating in the WAGES Program, multiply the first $1,500 of their
To calculate your interest, use the prorated daily interest factor of wages by 15% and enter this amount on Une 18(b).
.000328767 (this is 12% interest per year divided by 365 days per (c) If 20% or more of your permanent full -time employees are residents
year). Estimate the number of days late by counting from the LATE of an enterprise zone, multiply eligible employee (new employees
AFTER date listed on the front of the retum until the return is earning not more than $1,500 per month) wages by 15% and enter this
postmarked by the U.S. Postal Service. If you have received a Notice of amount on Line 18(c).
Tax Action, DO NOT enter that amount on your tax retum. (d) If Tess than 20% of your permanent full -time employees are
UNE 14 AMOUNT DUE WITH RETURN — If filing on time, subtract residents of an enterprise zone, multiply eligible employee (new
Une 11 from Une 10. If filing late, add Unes 12 and 13 to Une 10. Enter employees earning not more than $1,500 per month) wages by 10%
this amount on Une 14. and enter this amount on Line 18(d).
FlUNG ELECTRONICALLY — If you transmitted your funds UNE 19 JOBS CREDITS/REFUNDS /LAWFUL DEDUCTIONS
electronically, please check the appropriate box in the bottom left corner (a) Total Jobs Credits: Add Lines 18(a), 18(b), 18(c) and 18(d) and
on the front of your DR -15 retum. enter the total on Une 19(a).
BACK OF RETURN (b) Other Refunds and Deductions: Enter the amount of other refunds
DISCRETIONARY SALES SURTAX - Complete Lines 15-17. This. and lawful deductions on Une 19(b). This includes tax refunded by you to
applies to dealers in a surtax county (even if you collected no surtax), and your customers because of canceled or rescinded sales; tax on
dealers who collected surtax for deliveries into a surtax county. Motor allowances for damaged merchandise; tax paid by you on purchases of
vehicle and mobile home dealers should collect the surtax rate of the goods intended for use or consumption but subsequently resold; and any
county where the vehido wifl be registered Any surtax collected must be s ti other deductions allowed by law. Sales tax DOR CREDIT MEMOS
included with'tax reported on lines A E m Column 4 of your DR-15: issued by the Department should be induded on Line 8, NOT Line 19(b).
return; Any surtax'collected must be remitted to the Department with yourr" :, UNE 20 TOTAL JOBS CREDITS AND OTHER REFUNDS AND ,
DR -15 . return. Only the first $5,030 out single; sale of tangible persona., DEDUCTIONS Add Lines 19(a) and 19(b) and enter on Line 20. Also
property (TPP) is subject to surtair;' The entire amount of rentals of real ;, enter this amount on Line 6 on front of return.
property or 'services is subject to tho,surtax Refer to Rule 12A. 15, , r, i' 4 T UNE 21 AGRICULTURAL EQUIPMENT Enter taxable amount of
FAC., for additional information. There lei* need to designate a county , sales/purchases of self - propelled or power -drawn agricultural
for the surtax you' remit: Updated discretionary sales surtax r are - equipment at the 3% rate. The tax collected or accrued, including surtax
available through Fax on Demand. Call 850 -922 -3676 from your fax• if applicable, must be included in the amount on Une A, Column 4.
machine to request Document Number 8075. UNE 22 COMMERCIAL TELECOMMUNICATIONS /ENERGY — Enter
1 IN y 15(a) EXEMPT AMOUNT OF ITEMS OVER $5,000 - For any taxable amount of sales /purchases of commercial telecommunication
single item of taxable tangible personal property sold for more than services and electric power or energy at the 7% state rate. The tax
$5,000, enter the amount in excess of $5,000r EXAMPLE: If a single collected or accrued, including surtax if applicable, must be included on
item is sold for $7,000, then $2,000 (the amount over $5,000) should be Une A, Column 4.
entered on Une 15(a). UNE 23 DIESEL — Enter on Line 23 the total taxable sales or
LINE 15(b) OTHER AMOUNTS IN COLUMN 3 NOT SUBJECT TO purchases of dyed diesel fuel used in self - propelled off-road equipment
SURTAX — Enter the amount of taxable sales/purchases included in (including all vessels) at the 6% rate. The tax due from these
Column 3 on the face of the return but not subject to the surtax. EDo not purchases, including surtax if applicable, must be included on Line A,
include amounts shown on Une 15(a).j The following are subject to sales Column 4.
tax but not to surtax: long distance telephone service; services delivered UNE 24 AMUSEMENT MACHINES
to a non -surtax county; and TPP delivered to a non -surtax county. (a) Enter the total number of amusement machines operated at your
UNE 18 TAXABLE SALES SUBJECT TO SURTAX — Enter the amount location(s). DO NOT INCLUDE VENDING MACHINES.
of taxable sales upon which discretionary surtaxes were collected. List (b) Enter the amount from Line A, Column 3, which represents
amounts in the appropriate column, based on the applicable surtax rate. amusement machine taxable sales.
NOTE: The sum of Column 3 on the face of the retum Tess the sum of
,a.
y � HE St�TF STATE OF FLORIDA R. °"9'
ri
=�' DEPARTMENT OF REVENUE
� A
TALLAHASSEE, FLORIDA 32399 -0100
C o o WE B
L. H. Fuchs DECEMBER 03, 1997
;xecutive Director
CANGRELOSI, ROBERT S.
MR. CANGELOSI'S ITALIAN ICES & SNACKS
P.O. BOX 515
TAVERNIER FL 33070 -0000
Received from MR. CANGELOSI'S ITALIAN ICES & SNACKS
the amount of for SALES AND USE TAX
SALES TAX RETURN for the period of 12/97.
Sales & Use Tax number :54040744
Received By :
)j.
FLORIDA DEPARTMENT OF REVENUE
Please detach bottom portion and return with your payment
0110 R. 01/97 SALE S AND USE TAX FLORIDA DEPARTMENT OF REVENUE
1. GROSS SALES 2 EXEMPT SALES 3. TAXABLE AMOUNT 4. TAX COLLECTEE -
a Salmi
B. Taxable Purchases SEE INSTRUCTIONS SEE INSTRUCTIONS 20
C. Servkes
21
D. Transient Rentals 22
E. Food/Beverage Vending -
5. Total amount of tax collected 23
Transient Rental Rate • 0 6 0 0 Surtax Rate • 010 0 24
8. Less Lawful Deductions (Line 20X _
Certificate No. SC FEI /SSN Period 25
'°�"e' � "' ^ ` � 7 Total tax duo .
y. gt140:7ay4- -064 5812 12/97 26
8.
9 Plus est. tax due current month 27
CANGRELOSI, ROBERT S. 28
MR. CANGELOSI'S ITALIAN ICES & SNACKS 'o' Amounldu. 29
11. Less collection allowance -
30
P.O. BOX 515 12. 31
TAVERNIER FL 33070 -0000 13. Plus interest HD
14. Amount due with retum
Be sure to sign and date the reverse side
•
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
,G ` s DA 1—
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the workplace and specifying,the actions that
will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining
a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs,
and the penalties that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are under bid a
copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the
commodities or contractual services that are under bid, the employee will abide by the terms of the
statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any
violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any
state, for a violation occurring in the workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation
program if such is available in the employee's community, or any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this
section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
.
Bidder ignature
F'g? Date
OMB - MCP #5
NON - COLLUSION AFFIDAVIT
I, Robert S. Cangelosi of the city
of Tavernier according to law on my oath, and under
penalty of perjury, depose and say that;
1) I am Robert S. Cangelosi , the bidder making the
Proposal for the project described as follows:
Concession Stand for Harry Harris Park •
2) The prices in this bid have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting competition, as
to any matter relating to such prices with any other bidder or with any competitor;
3) Unless otherwise required by law, the prices which have been quoted in this bid
have not been knowingly disclosed by the bidder and will not knowingly be disclosed by
the bidder prior to bid opening, directly or indirectly, to any other bidder or to any
competitor; and
4) No attempt has been made or will be made by the bidder to induce any other
person, partnership or corporation to submit, or not to submit, a bid for the purpose of
restricting competition;
5) The statements contained in this affidavit are true and correct, and made with
full knowledge that Monroe County relies upon the truth of the statements contained in
this affidavit in awarding contracts for said pr. r ct.
STATE OF FLORIDA
(S's nature of Birder) G�/'
COUNTY OF MJNROE // 4
< l DAT
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Robert S. Cangelosi who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
2nd day of Sept. ,19 97 .
r ! IA_ :1 • My commission expires:
NOTARY PUBLIC
ear, ASIA TRACY
OMB - MCP FORM #1 My CommisspnCC387111
* .. 'f * Expires Jun. 28, 1998
• > 4 Bonded by ANB
% am e 800- 852 -5878
SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990
MONROE COUNTY. FLORIDA
ETHICS CLAUSE
Robert S. Cangelosi warrants that he /it has not employed, retained
•
•
•
or otherwise had act on his /its behalf any former County officer or employee in violation of
Section 2 of Ordinance no. 10 -1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10 -1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to th • o er County officer or employee.
1
(si:natur:
Date: 7/07
STATE OF FLORIDA
COUNTY OF MONROE
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Robert S. Cangelosi who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this 2nd day of
Sept. ,19 97.
OR% ANASTASIA TRACY
- *A. ,. 1 ' My Commission CC387111
* * Expires Jun. 26, 1998
NOTARY PUBLIC ' Bonded by MB
%O 800- 852 -5878
My commission expires: June 26, 1998
OMB - MCP FORM #4 •