Addendum 03/28/1990
ADDENDUM TO AGREEMENT
(Jackson Square)
THIS ADDENDUM TO AGREEMENT is made and entered into this
28th day of March, 1990, between the COUNTY OF MONROE and ACE
BUILDING MAINTENANCE in order to amend that certain agreement
between the parties dated April 4, 1989, as follows:
1. In accordance with Paragraph 5 of aforementioned
agreement, the County hereby exercises its option to renew said
Agreement and Paragraph 5 is also therefor amended to read as
follows:
"5.) The party of the first part shall have the option to
renew this agreement after the second year, which terminates on
April 3, 1991, for two (2) additional one-year periods. The
contract amount agreed to herein will be adjusted annually in
accordance with the Official U.S. Government Consumer Price Index
(CPI) and applied annually during the term of this agreement.
Increases in the contract amount during each option year period
shall be extended into the succeeding years."
2. Payment by the County to Ace Building Maintenance for
the performance of said service remains at $2,475.00 per month,
in arrears.
3. In all other respects, the agreement between the parties
dated April 4, 1989, remains in full force and effect.
IN WITNESS WHEREOF, the parties have hereunto set their
hands and seal, the day and year first written above.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
~~
By: C/ V' fl.-'-
Mayor al.rman
(SEAL)
::~27.zfZfC;~
epu er
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ACE BUILDING MAINTENANCE~
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By: ~ ~
~^-i--<h W~ ~
~tness
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API'RDVED AS TO FORI>,' f~"
~lVD LEGAL S<<{/C/E!lJCV. . \'i
BY (Lee ~~Q_\,1J..J-O)i.. . )
Attorno 's Office j ',\ "
SWORN STATEMENT UNDER SECTION 287.133(3){a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.
1.
This sworn statement is submitted with Bid, Proposal or
Contract No. Jani torial Service
for Jackson Square, Key West
2.
This sworn statement is submitted by
Ace BuildinG Maintenance
(name of entity submitting sworns~tement)
whose business address is .pO t/LQ)!! ).'7~3
'<&ic uJE$"r r,---, 3j cJ1f ()
and (if applicable) its F deral Employer Identlflcatlon
Number (FEIN) is {If the
entity has no FEIN, include the Social Security Number
of the :f~)V}fL;~} raftgning thi s sworn statement:
My name is 3v JA &~t3lcJf & ~l.l 6~ ct-
(please ~in~ name~of lndlvidual signlng)
enti ty named above is (-lce /:.>1.1/ U~j 1\t41'.vfW~.
I understand that a "public entity crime" as defined in
Paragraph 287.133(1){g), Florida Statutes, means a
violation of any state or federal law by a person with
respect to and directly related to the transaction of
business with any public entity or with an agency or
poli tical subdi vi sion of any other state or with the
Uni ted States, including, but not limited to, any bid
or contract for goods or services to be provided to any
public entity or an agency or political subdivision of
any other state or of the United States and involving
antitrust, fraud, theft, bribery, collusion,
racketeering, conspiracy, or material misrepresentation.
3.
4.
5.
I understand that "convicted" or "conviction" as
defined in Paragraph 287.133 (1) (b), Florida Statutes,
means a finding of guilt or a conviction of a public
entity crime, with or without an adjudication of guilt,
in any federal or state trial court of record relating
to charges brought by indictment or information after
July 1, 1989, as a result of a jury verdict, nonjury
trial, or entry of a plea of guilty or nolo contendere.
6.
I understand that an "affiliate" as defined in
Paragraph 287.133(1)(a), Florida Statutes, means:
1. A predecessor or successor of a person convicted of
a public entity crime: or
2. An entity under the control of any natural person
who is active in the management of the enti ty and who
has been convicted of a public entity crime. The term
r,
"affiliate" includes those officers, directors,
executives, partners, shareholders, employees, members,
and agents who are active in the management of an
affiliate. The ownership by one person of shares
consti tuting a controlling interest in another person,
or a pooling of equipment or income among persons when
not for fair market value under an arm's length
agreement, shall be a prima facie case that one person
controls another person. A person who knowingly enters
into a joint venture with a person who has been
convicted of a public entity crime in Florida during
the preceding 36 months shall be considered an
affiliate.
7.
I understand that a "person" as defined in Paragraph
287.133(1)(e), Florida Statutes means natural person
or entity organized under the laws of any state or of
the United States with the legal power to enter into a
binding contract and which bids or applies to bid on
contracts for the provision of goods or services let by
a public entity, or which otherwise transacts or
applies to transact business with a public entity. The
term "Person" includes those officers, directors,
executives, partners, shareholders, employees, members,
and agents who are active in management of an entity.
8. Based on information and belief, the statement which I
have marked below is true in relation to the entity
submitting this sworn statement. (please indicate
which statement applies.)
i4 Neither the entity submitting this sworn statement, nor
any officers, dlrectors, executives, partners, shareholders,
employees, members, or agents who are active in management of the
enti ty, nor any affi liate of the entity have been charged with
and convicted of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or
more of the officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in
management of the entity, or an affiliate of the entity has been
charged with and convicted of a public entity crime subsequent to
July I, 1989, AND (Please indicate which additional statement
applies.)
There has been a proceeding concerning the
conviction before a hearing officer of the State of
Florida, Division of Administrative Hearings. The
final order entered by the hearing officer did not
place the person or affiliate on the convicted vendor
list. (Please attach a copy of the final order.)
The person or
convicted vendor list.
affiliate was placed on the
There has been a subsequent
proceeding before a hearing officer of the State of
Florida, Division of Administrative Hearings. The
final order entered by the hearing officer determined
that it was in the public interest to remove the person
or affiliate from the convicted vendor list. (Please
attach a copy of the final order)
The person or affiliate has not been placed on
the convicted vendor list. (Please describe any action
taken by or pending with the Department of General
Services.)
~~ &,~
(signature) ,
Date: 3/;f/t(J
,
STATE OF
~LoQlDk}
Moll! ~ t;,
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
3'JOIJ . ~ ~btc..k...
I
(name of individual signing)
who,
after fi rst being sworn by
me,
affixed hisjher signature in'the space provided above on this
J~~
day of
M kfLGtJ
, 1990.
Noi!dP~~
My commi ssion expi res: Ifotary Public. StlteotFlorida at IJIrge
__ Qommission Expires Feb. 26, 1991
upllnte Agency
'ft.;
LICENSE YEAR
1989-l990
OCCUPATIONAL LICENSE
City of Key West, Florida
No. 50016139012
NO REFUNDS
THIS LICENSE MUST BE PROMINENTLY DISPLAYED
LICENSE PERIOD BEGINNING 1 0/01/89 THROUGH 09/30/90
PENALTY SCHEDULE
50.00
LICENSE FEE
55.00
OCTOBER
57.50 60.00
NOVEMBER DECEMBER
TOTAL UN
0067 2 02085628 REVE 01/18/90 12:24
GENERAL REVENUE FUND 50016139012
NAME: ACE BLDG MAINTENANCE CK 208
001 LICENSES 321-100 $ 62.50
JANITORIAL
BUSINESS
ADDRESS:
TYPE
LICENSE:
P.O. BOX 2763
6Q WINDOW WASHERS & FLOOR CLEANERS:
BUSINESS /
NAME: ( ACE BUILDING MAINTENANCE
\
OWNER: ACE BUILDING MAINTENANCE
ADDRESS: ~4.().J,.-ilAR&*S-~:g~- P .0. BOX 2768
CITY:,,- KEY WEST FL 33040
FINANCE DEPARTMENT
DIVISION OF REVENUE
#?- r:L
~.
~
COUNTY OCCUPATIONAL LICENSE 1 '89-1990
THIS L1C~~:ER:~IRESSEii'll8taA1J6; F\fmt TAX: .
471-00~1 0 . C~:~A1~ ,~5"/..
MUaSC&,O# caPLOYEES: S
c"l'ciFCUaa~ItT :118.1 Of'EJt.LOYEES'"KERE:'1~'''';' ~,." TRANSFER FEE""
22.00
5.50
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TOTAL DUE
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STATE CERTIFICATE NUMBER
~~. HaliR'. f..: IUII6tll'",'CfC
'0 .1'"' COLLECtOR 294-8403
P_o_ao&~1129
~E'-"cST.. fl. 33041+11.29
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PLEASE SEE BACK OF FORM
TIlE'A80"E'L~CE"SEE IS'HEREBY'
LlCiMSED.TOEII6A6E I. 'THE BUSI.ESS
PIlOfCS$lOIl OR.OCCUPA:JIOIt,OF :
..lAJU~ORIAL" SUVJCE '.
*~*PAID*HARRY F.KNIGHT*** 27.50
~:=~"--"ACCOU"T.U.8Ea' IS 20566
LOCATJ.Ga=aOillLE . UNIT "
',I
ACE BUIUI.". IIAlItTEN.NCE ,.
:&,ADY: .lUDY:O...ER "
"p 0.. BOX ,2763
','KEY ; ..e$~ ~ fL 33040
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il'\" "1' '1'" ,,.. 'Q'4I~~!1~Ii"." ",E(;E,E(;EIIF~..~riI~N ~DATEO BY RECEIPTING
w V f 01 7 Uo'QS~~~'l"'I:l'''!I'\:1;P!I.7' AND AMOUNT PAlO,
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THIS LICENSE MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
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The Porter.AIIen Company. Inc.
. ,
513 Southad St.
Kev West. Fl33041-1940
(305) 294-2542
AUGust 16, 1989
JLldy Eady
Ace Building Maintenance
P.O. Bo}: 2763
Key West, FL 33040
Re: Policy# D19993814/ADV PACKAGE
Effective September 30, 1989 TO September 30, 1990
Dea\'- M!:,. Eady:
Enclosed is the above policy. Your premium payment
for this policy period is $1.062.00.
Should you have an~ questions, please do not hesitate to con-
t ..:\ C t 0 Lll- 0 f fie e .
mJF/ss
Ei".IC 3. OS,UI-E'
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Fl33040
, POLlCY-ID
I 01 99 93 01
PRODUCER BILLE
CIGNA INSURANCE COMPANY'" ,-
aEC(ARATH:;.~S
NAMED INSURED
~UDY EADY DBA
PO BOX 2763
, KEY WEST
I
I
I
I
- SERVICE INDUSTRIES PACKAGE
ACE BUILDING MAINTENANCE
RENEWAL CERTIFICATE
CO./NSUR
CH,4J ~NCE CON'l
{JpO~ 1/fJ THIs fIiOL RACT -;-HI::
~;rrAC/~ OF A co./~~ 5ASt:D RATE
OF THE A'~"':!~To. V~;;-H i~ CLAUse
..;;)':;;1;...11"(1:0. ' nt: CO!'Vc:::~. 4..
, -';c'r:JT
THE'NAMED INSURED IS: INDIVIDUAL
BUSINESS DC INSURED: GENERAL SERVICES
POLICY PERIOD: FRCM 09/30/89 TO 09/30/90 12:01 A.M., STANDARD TIME
AT YOUR MAILING ADDRESS SHOWN ABOVE.
IMPORTANT NOTE: THE COMMERCIAL GENERAL lIABILITY SECTION OF THIS INSURANCe
APPLIES ON AN OCCURRENCE BASIS
P;~ E H I U M
PAY MEN T
CON D I T ION S
PAYMENT PLAN
:
PREPAID
TOTAL NET PREMIUM :
TCTAL PAYf';::}'jT:
$1. 062
$1,062
,-. :...,...:-~~. <:~ (~~.,~_.......~ -""',.-,
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PREMIU~S DUE ~ITH REPORTS OR RESULTING fROM AUDITS ARE NOT INCLUDED IN THE
ABOVE Pf:Ei-iIW1.
SU,\1"~APY
C F
C eVE RAG E S
THE FCLLC:ING CDVERAGEI$) ARE PROVIDED SUE~ECT Tn ALL OF THE TERMS AND
CONDITIGNS Dr THIS POLICY.
COMMERCIAL PROPERTY COVERAGE FORM
COM~ GENERAL LIABILITY COV. FORM
S C Ii E 0 U L E
fJ F
L 0 CAT ION S
Ki<- r~. .!t
(Cr.\T INUU]
r\ ;'r:XT P ~GE)
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:>EClAftA~Tf]NS - SERVICE INDUSTRIES PACKAGE POL"ICY" '..,'. < ...,'" . :..;:':'""",pltOPUCER, ,BILL
;C NAMED INSUR-ED. . "', '; :'i<-"~:";;~;..i: " :" ~:"',:,:".'.;,,,;(;.'f...i>i~if,...f:(;'i~:I1fi<:; ;. '~e,~f~f~,.i;':"":":/~ ,"
,JUDY EADY DBA ACE BUILDING MAINTENANCE .
'PO BOX 2703 I'
,--KEY WEST FL33040 '
, ~ (,,""~
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I LOCATIO;\
NUMBER
MARkETING OFFICE: MIAMI
DESCRIPTION OR ADDRESS
1-1
2401 HARRIS AVE
KEY WEST FLORIDA
PRO PER T Y
C 0 V ERA G E S
~
l 1 M ITS
o F
INS U RAN C E
COVERED
LOCATION
NUMBER A.REAL PROPERTY B.PERSONAL PROPERTY C.LOSS OF INCOME O.EXTRA EXPENSE
1-1
NOT COVERED
---
$5,200
NOT COVERED
$IJ,JOO
E. PERSONAL PROPERTY OFF YOUR PREMISES
::'JVERAGE LIMIT
$10,00.)
SPECIAL DEDUCTIBLE $250
LEVELS Lr PROPERTY PROTECTION
COVERfiJ LSCATION
"If r~B E?
COVERAGE
~EVEl OF PROTECTION
ALL
B,D
BASIC
COINSURANCE AGREEMENT
COVERED LOCATION
h..i,'<1 BER
COVERAGE
COINSURANCE PERCENTAGE
----
'.-1
B
80
PROPERTY uEDUCTIBLE
COVERF~ LOCATION
NU;.!B ER
AMOUNT
AL.....
$250
OPTION 1 - SUPPLEMENTARY VALUABLE PAPERS AND RECORDS
KI<-72 4
( em'iT I NU ED
,';EXT PAGE)
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". CIGNA INSURANCE COMPANY
. ';<" /' ~.~ .:;.,~,..~~~~
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DECLARATIONS - SERVICE INDUSTRIES PACKAGE
NAMED INSUR D '".'. ..~.."~"i:F.:.,::;,~..~'.,.{c;t.~~,'/
. "'UDY EADY GuA ACE BUILDING MAINTENANCE
PO BOX 2163
KEY WEST Fl33040
~ . .,",'h",,,'POUCY_ID
'r~~~ rOl 99: 93 81
" f"'. ':PRODUCER BIlU
".~<N,'~~~!~~;i?,'
i.'K
. MARkETING OFFICE: MIAMI
All lOCATIONS ARE COVERED UNDER EXTENSION 3 ONLY
OPTION 2 - SUPPLEMENTARY ACCOUNTS RECEIVABLE
------""-- ---------
--- --_. ----
ALL lOCATIONS ARE COVERED UNDER EXTENSION 5 ONLY
OPTION 3 - MONEY AND SECURITIES
ALL LOCATIONS ARE NOT COVERED
---
OPTION 4 - PERSONAL PROPERTY - CRIME
All LOCATIONS ARE NOT COVERED
ADD I T ION A L
PRO PER T Y, C 0 V ERA G E S
AUTOMATIC INCREASE fOR PERSONAL PROPERTY ENDORSEMENT
COV. LOC.
NUMBER
-----
All
l I A B 1 lIT Y
C 0 V ERA G c S
&
L I M ITS
o F
INS U RAN C -
-------
lIMITS Of
INSURANCE
COMMERCIAL GENERAL lIABILITY:
GENERAL AGGREGATE LIMIT (eTHER THAN PRODUCTSI
COMPLETED OPERATIONS)
PRODUCTS/COMPLETED OPERATIONS AGGREGATE lIMIT
PERSCNAl S ADVERTISING INJURY LIMIT
EACH OCCURRENCE LIMIT
FIRE DAMAGE LIMIT (ANY ONE FIRE)
MEDICAL EXPENSE LIMIT (ANY ONE PERSON)
$SOO,CDC
$5CO,cOO
$500,COO
$5JO,C00
$50,000
$5 , coo
KK-72j4
(CONTINUED eN NEXT PAGE)
.'.tS2
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C:~NA INSURANCE" COi4PANW;';%~,;
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~';.J".:",,~\,~;;,it~i SV t.,OI 99 93 81
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" .. oRODUCER BILU
:,~?>.'~,~n:;" '~",f .". '
, -
FL33O.ftO
MARKEtING.OFFICE: MIAMI
FOR 14 S
AND
ENDORSEMENTS
CC-2R57 SVP PORTFOLIO COVER
CC-3R09 SPECIAL CONDITIONS-GENERAL SERVICES
FA-2R62 COMMERCIAL PROPERTY COVERAGE fORM
FA-3R60 PERSONAL PROPERTY AUTOMATIC INFLATION
FA-3R83 LEVEL Of PROPERTY PROTECTION-BASIC
FA-3R85 COMMERCIAL PROPERTY CONDITIONS
FA-3R86 COMMERCIAL PROPERTY COVERAGE DEFINITIONS
CG-D220 FL CHANGES
CG-QODl COMM GENERAL LIABILITY CDV. fORM
CG-0041 AMENDMENT OF POLLUTION EXCLUSION
ll-0021 BROAD FGRM NUCLEAR ENERGY EXCL ENDT
FA3R99 WINDSTORM/HAIL DELETION ENDORSEMENT
KK1520 FLORIDA CHANGES
THIS DECLARATION, AND THE COVERAGE fORMSfSJ AND ENDORSEMENTS, IF ANY, LISTED
ABOVE AND INCLUDED, COMPLETES THIS POLICY.
W'm~ ...
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EXCLUDEi~~
COUNTERSIGNED AT:
DA T E :
.;1.'.'10 W. FREEMAN C:= ~_
KF.-72 )4
(CONTINUED ON NEXT PAGEl
PAGE
,
'-+
,--...., '"-. ......
DECLARATIONS ->
NAMEDINSUREb
~UpY EADY DBA ACE BUILDING MAINTENANCE
PO BOX 2763
KEY WE ST
~i Ui~A ~i~5UKAf~CE -CO-~~~#~>:~:--:~SSYVM"?[~<(~'}'~;POUCY-ID
- ,:', .;>...~---.:...;. '..-' .~ . - :.,,,,",,,-- ~:' 01 99 93 81
UPPLEMENTAl .- ".;."""'::-,,,. - ~ PRODUCER BILL
~:,...
FL33040
";.:-:&." ':;~tf'o.':.
.
MARKETING OFFICE: MIAMI
PREMIUM AD~USTMENTS RESULTING FROM AUDITS OR REPORTS (IF ANY) WILL BE
DEVELOPED FROM THE FOLLOWING
LIABILITY
AUDIT FREQUENCY: ANNUAL
THE CLASSIFICATION AND RATING USED IN THIS POLICY ARE PRESENTED BELOW
AS FOLLOWS:
FIRST LINE
CLASS CODE
CLASSIFICATION DESCRIPTION
SECOND AND SUBSEQUENT LINES
--------
LDCATION
COVERAGE
PREMIUM BASIS CODE
EXPOSURE
RATE
PREHIUF
WHEN USED AS A PREMIUM 8ASIS THE FOLLOWING CODE DEFINITIONS APPLY:
P-PAYROLL - PER $l,ODO OF PAYROLL
COMMERCIAL GENEPAL LIABILITY COVERAGE FORM
96816
J^NITORIAL SERVICES - INCLUDING PRODUCTS
ANDleR COMPLETED OPERATIONS
PF:EM-OP p 16400 63.421
PROD-INCLUDED
$1~04C
1
1
TOTAl ADVANCE PREMIUM (COMMERCIAL GENERAL LIABILITY INSURANCE)
$1,040
ALL PREMIUMS ABOVE ARE INCLUDED IN THE TOTAL NET PREMIUM SHOWN ON THE FIRST ?,~G:::
OF YOUR DEClARATIUN.
KK-72D4
(lAST P.'\GEJ
p .~~ r; E
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FLORIDA
APPLICATION FOR WORKERS COMPENSATION INSURANCE
This application mUlt be typed or printed and flied, In duplicate, with:
NCCI- ATLANTIC DIVISION · Post Olfice BOle ')098, Bo~a Raton, Florida 33431-0998 . (407) 997.4633
Important: Instructions lor completing this application can belound In the Florida Workers Compensallon Insurance Plan-Inlormallon and Procedures-
Handbook. This handbook Is evallable Irom NCCI - Order Processing. 750 Park 01 Commerce Drive, Bocs R*ton, Fl 33487,
PlelSe snswer all questions and requested Inlormetlon thoroughly, Omlaalons may result In delay 01 coverage,
The undersigned employer hereby applies lor workers compensallon Insurance In Florida and expressly represents Ihal such Insurance Is soughl In good lallh,
I. GENERAL INFORMATION
JUDY BOBICK, VBA ACE BUILVING 6 MAINTENA~CE
" NAME OF EMPLOYER
EFFECTIVE 12:01 A.M. (DATE)
03/16/90
000000000
1
F.E.t.N. REOUIREO BY LAW
SStI 263-94-1596
3,
MAILING A~ORESS
SAME
(SIre")
LORIVA 33040 (305) 296-6?06
:! FEDERAL EMPLOYER 10 NUMBER
2401 HAR~IS AVE, KEY WEST,
(Clly)
(State)
(Zip)
(Phone)
(
PnlNCIPALLO~TION OF BUSINESS (Slreel) (Clly) (County)
--~ . L
5 OTHER FLORIDA LOCATIONS (Slreet) (Cily) ICounty) (Slale) (Zip)
.& iT ;A~~li;oFFiCEAoORESS-"- -----islreel'--------T-(Cltyj- --.--.----. -I. ic~~,Yl) -------(Si~t;j'--- ---------iZi;;j
I- 7.0. iJ;G~L stATUS J{I'sole Prop,lelor n Parlnershlp n Corporallon n dther(eXp,aln,: _________________ ___ '_______
" 8,' Hes Ihore been a nllme chenge during Ihe pesl lhree years? n Yel ~ ~o, II yes, give p,evloul name and dale 0' change: ____. _ _.. _ _.. ____._ ._.. ,. .._...
Ill'
(SIale)
(Zip)
't'
_._- -_.~ ~.....-_._---. ..-..------.------
9, Are Ihore operations in slales other Ihan Florida? 1'1 Vel ~ No, II ylts, complete Ihelollowlng' (sell-I'lSured or uninsured. Indicate under Insu,ance Caff'e,,)
--~~~--~-
Location
Insurance Carrier
j
II. INSURANCE RECORD
" Has lhere been previous workers compensallon'insurance coverage In Florida? Illl Yes 0 No.
II no. complere: fJ New Busine88 0 Sell-Insured n Olher (explain):
II yes, Insurance Record-Three Previous Years: :' '
Policy Period:
From To
Premiums
317.00
~
10lnl Rudlh,d payroll lor each 01 Ihe above polley periods_ (00 Not Complele II New Business)
Policy Period:
From To
Payroll
E
:J ^,,, YC'IJ 'n debllo IIny broker, agent or Insurance company 'or any unpaid pr6mlums lor workers compensation coverage? 0 Yes Xl No,
"yes, coverage may be denied or canceled, Explain: _;...-.- ____________.______
III. INSURANCE COMPANIES WHO HAVE REFUSED INSURANCE
Ust b~low namlllnd represenlalive 0' lwo companies who havlt r!!fused coverage In Ihe past sixty days, The relJ'e~enlatlvll nllmed must be a lull-lime em"loYlle of Ihn Insurn"n,
company II npplicable, orlO 01 these companies should Ile Ihe one providing workers compensation Insurance 10 I'le applkllnl althe lime 01 application
f-_~iNA~:-~- IM~_~~~ 1= ~~~Ilmi ~;~'~.""-~--===1
--_.EEl ---- I FISHER =----,1
IV. CORPORATE OFFICERS, SOLE PROPRIETORS ORPARTNERS
I. isl bel".,. n,'m,~, 1111(', dull"s and approxlmale annual salary 01 ollicers. so'e proprlelors or partners,
Title
~
Dulles Approximale AnnUli Slllry
-- "--- -.--
,r~~~~~N~
1 It n corporahon, are any ollicers exempt? n Yes tJ No, II yes, al1ach a copy oflhe exemption 101m which has been lIIed wilh Ihe Deplrtment of labor and Entp/oymtnI See",
'r .' 1A'." . -.' tlty, execut...,.. . office,s 01 a corporation are nutornallcally covered under Ihe law. I' any ofllcers choose nollo be covered, Ihen an lIlCem pilon form his 10 be completed In duplIce'I, ~
~ " . Th4t payrollDt e. oIIIcets wfIIch Ire covered must be Included In Ihe premium clilculellons in Section VI of 1hI1appllcallon,
" ;. "Ii i pertneiihlp or ProPrielcnhlp, hIM lhe P8rtn8fl or proprlelora elected cove.? 0"'" JO No. If yes, Illach I copy of lbe election lDtm which hII been IIIed wIIh Oepertment
. 0( Labor Ilnd Employment Secutlly. I
. . ". Partners nrid sole ptUprielorl Ir. nol aulomeIlcally covered under the Law. If ~ de.. to be c:owred,lttey must complete an election of coverage lDtm In dupllc8le. Thepeyrol
. . for parlneri llr lloIe ~ Is nolto be Included In the premium caIcuIeIlons unIeu \hey have ~ to be covered under lhe policy.
3. HIS lhe corporallon oIlicer.. part!",lor sole proprlelors P8yrol been lnduded 1rI determining the estimated ennuII premium? r] Yes }(J No,
' IIlny 8ll8CUllve oIIIcers, partners or sole proprietors are to be covered under lhe;poIlcy, Ihen Ihls question should be answered yes.
4" I~ Ih~ premium IInanced? 0 ""s IlIl No. II yel, I"ach a signed copy oIlhe finance agreement.
V. AGENCY AND PRODUCER I '
Agency Nllnl" _If!E PORTER ALLEN COMPANY I
Addrpss 513 SOUTHARV STREET KE W
Producpr" wfiLlAilA FR
Name
Fed, Emp, 10 No.lSoc, Sec, No,
! ,
i
lOVER
I
I
I
1
,
I
3fr/t?{)
Dale
59-0407360
WCIPI,FU881
"'cu.o
1.'pH,
., .
. .
LICENSE YEAR
1989-l990
OCCUPATIONAL LICENSE
City of Key West, Florida
No. 50016139012
NO REFUNDS
THIS LICENSE MUST BE PROMINENTLY DISPLAYED
LICENSE PERIOD BEGINNING 1 0/01/8 9 THROUGH 0 9/3 0/90
PENAL TV SCHEDULE
50.00
LICENSE FEE
55.00
OCTOBER
57.50 60.00
NOVEMBER DECEMBER
TOTAL UN
00b7 2 02085628 REVE 01/18/90 12:24
GENERAL REVENUE FUND 50016139012
NAME: ACE BLDG MAINTENANCE CK 208
001 LICENSES 321-100 $ 62.50
JANITORIAL
BUSINESS
ADDRESS:
TYPE
LICENSE:
P.O. BOX 2763
6Q WINDOW WASHERS & FLOOR CLEANERS:
BUSINESS /
NAME: ( ACE BUILDING MAINTENANCE
~
OWNER: ACE BUILDING MAINTENANCE
ADDRESS: 2-4-O.J..-IlM&1-S-~ENQ.B.- P.O. BOX 2768
CITY:\.... KEY WEST FL 33040
FINANCE DEPARTMENT
DIVISION OF REVENUE
~)
~ CL
1~
COUNTY OCCUPATIONAL LICENSE t 989-1990
THIS L1C~~:E~~~IRES sei'i'llifaA1N; F'Rfct
471-00~10 '
MU.SEa UI caPLOYEES: S
c"TciVC"aa~IfT'.lI8a 0.' EItPLOYEES""IlERE:"''''
TAX
COST' AND -RO-1...
PENALTY
22. ,DO
5.50
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TRANSFER FEE'
TOTAL DUE
,'- '"
STATE CERTIFICATE NUMBER
=~_ HAaal _ f_: ICMI6..'I.:C'(
'0.. ,J" COLLECIOa 294-8403
P.O.dOX.1129
I'EJ.afESl:. 11. 33041+11.29
I,'
PLEASE SeE BACK OF FOAM
IaE'AaOVE'L~CE.SEE IS,HEREBY'
L~C&~ED.TO i.SAGE J. THE BUSI.ESS
PJlOfCSSIOII oa,OCCUPAJ'IOII,Of :
,.uJU.TO&lAL" SSVICE,
ACE BUILDIN&,RAINTENANCE
EADY: JUD,!" OWNE.R
"P 0 BOX' 2763
,KEY' WeST. . fL 33040
; ,
\
***PAID*HARRY F.KNIGHT***
:~=~"""ACCOU"I.U"8Ea IS 20566
LO':AT IGN=aOB.lLE UNIT'
27.50 CK
_. . T.H1S,.fQFI"'-BE:C~ISl\,<\ R,ECEIPT ONLY WHEN VALIDATED BY RECEIPTING
ij 1 i 18/9 ~q,iMlji;j\1\Ii~~~~~D~1'J. AND AMOUNT PAID,
'~''''~l'''~
THIS LICENSE MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
, ,
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