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03/28/1990 Agreement ADDENDUM TO AGREEMENT (1315 Whitehead Street) 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 $725.00 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 ::.~ . ayor a1rman, (SEAL) Attest: DANNY L. KOLHAGE, CLERK .'Tl \cj (-, BY:~' ~~f~ eput er . "" ,.' -) i'J 1,,-,0 --' , ~ .' c.:)") ACE BUILDING MAINTENANCE-".:>' :'J By: h BN (A'C'<\~ W~ Ujj~ ness API'ROVED AS roroRf.,' AND LEGAL. S.UFFf."'-'!r"..:r'~.', V' ~ \::\-~ I BY ,t\\'\~ L~~~ I Atti1Tnn1':; Of1:rr-' . ., 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 1315 Whitehead Street, Key West 2. This sworn statement is submitted by Ace Building Maintenance (name of entity submitting swo~ statement) whose business a dress is _ ..",D ~~ ~ 3. and (if applicabl ) Identification Number (FEIN) is (If the entity has no FEIN, include the Social Security Number of the iI)di){iduaJ..o/ signing this sworn statement: ~, ~-1-!i/ S /b My name is v""t ClI- !:>~uc.c... (please print name of entity named above is {268tdc individual signing) 4. 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, inc luding, 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. 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 entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employe~s, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting 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.l33(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.) )\ Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the enti ty, nor any affiliate 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 1, 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 Ii st. 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.) ~~ ~.fir~ () (signature) Date: 2> /1'/7(; , , STATE OF F-O(t,L VA Mo NIl.0t. COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, 3,,~ {- f>o 6r>iLck- who, after first being sworn by (name of individual signing) me, affixed hisjher signature in the space provided above on this I '7.Jh day of vY1~ , 19 10 . ~~- NOTA PUB C My commi ssion expires: Notary Public. State of Florida at U1rge My. Commission Expires Feb. 26, 1991 Laplante Agenq . The Porter.Allen Company,lnc. 513 Southard St, Key West, FL 33041-1940 (305) 294-2542 I~ugust 16~ 1989 Judy ECld\;, Ace Building Maintenance F' . 0, Bo:-: 27,~3 Key West, FL 33040 Re: Policy# D19993814/ADV PACKAGE Effective September 30~ 1989 TO September 30~ 1990 ,Dear- Ms:,. Ec:.~dy: Enclosed 1S the above policy. Your premium payment for this policy period is $1~062.00. ". Should you have any questions, please do not hesitate to con- tact .Dur officf? mJF/ss Eric 1 c. S,Ul--E' ~,.;C:.j-~ ,'; ..~:'.:f.~ ?rcp':;! r'..' ':n':! I~'-'::-l;aitv CO:-nDd~~1t;3 1- CIGNA INSURANCE COMPANY'" IDeCLARAT IONS - 'SERVICE INDUSTRIES- PACKAGE NAMED'INSURED ~'UOY EAOY DBA ACE BUILDING MAINTENANCE PO BOX 2763 KEY WEST Fl33040 I 1 ! MARK ~ 'POLlCY-ID SV I 01 99 93 81 ~ J PRODUCER BILLED RENEWAL CERTIFICATE g~~NSURANCE CO . (jPO~ IItI TNls ,JT.clACT -THe ATTA'C/:t, Oft;; co.IN~~~ BASED RATE OF THE A.sSU~~D' . To, 1I~''''H i~ C,LAUSE 1"0 c: I 1[: 0G'~v""~ . ~ , ~cNr THE'NAMED INSURED IS: INDIVIDUAL BUSINESS Of INSURED: GENERAL SERVICES POLICY PERIOO: FRCM 09/30/89 TO 09/30/90 12:01 A.M.. STANDARO TIME AT YOUR MAILING ADDRESS SHOWN ABOVE. IMPORTANT NOTE: THE COMMERCIAL GENERAL lIABILITY SECTION OF THIS INSURANCE APPLIES ON AN OCCURRENCE BASIS PRE H I U M PAY MEN T CON D I T ION S PAYMENT PLAN . . PREPAID TOTAL NET PREMIUM : TOTAL PAYVENT: $ 1. 062 $1. 062 "i:~ ./:: ,<~; ~i~ 're :~'~'J ..~~ ".f ~'.":" ''''!;'.I. , \~;; 1~;'; ," Ii ~ ~ ,~1(:. , ....~,.w . -':.I,;:. '-," ,"".I ... .-:... \"JI:" '-:.'1..,...... C'~ 'L~ ~ )'-~(~ PREMIUMS DUE wITH REPORTS OR RESULTING FROM AUDITS ARE NOT INCLUDED IN THE ABOVE PRBHUM. SU;\-tMAPY o F C 0 V ERA G E S THE FOLlDWING COVERAGE(S) ARE PROVIDED SUEJECT Tn ALL OF THE TERMS AND CONDITIONS OF THIS POLICY. COMMERCIAL PROPERTY COVERAGE fORM OOM~ GENERAL LIABILITY COV. fORM S C Ii E 0 U l E o F L 0 CAT ION S KK-72 'A -- --,.~--~ ______ - __""_ ___n_________ _ __~____.____________.____ __ ________. (CCNTINUED fN NEXT PAGE) l"J /\'~F DECLArtATIONS - , . NAMED INSURED JUDY EADY DBA PO BOX 2163 KEY WEST . ---------- :-co----p-l!Mr:--':'-:,--:s-:;-------:--~.'''''' 1.<;)" CIGNA INSURANCE M .'~~A'9''''''~''''< . ,w ""'. SYM.. *le;,.,.;., .r'POLlCy_m . . .' .,. q . .... ...A,~ .,.." SV r 01 99 93 81 ~ SERVICE INDUSTRIES PACKAGE POt'ICY' ,..' , '. .;,;.>.PRODUCER,BILLEI ~:~;;'~~;'->'7:'~~;><~~.",,,-, '~o.t,~~'f.- FL33040 ACE BUILDING MAINTENANCE MARKETING OFFICE: MIAMI LOCATION NUMBER DESCRIPTION OR ADDRESS 1-1 2401 HARRIS AVE KEY WEST FLORIDA PRO PER T Y ( 0 V ERA G E S & lIMITS o F INS U RAN ( E COVERED lOCATION NUM8ER A.REAL PROPERTY B.PERSONAl PROPERTY C.lOSS OF INCOME D.EXTRA EXPENSE - -------- ----- 1-1 NOT COVERED $5,200 NOT (OVERED $10,000 E. PERSONAL PROPERTY OFF YOUR PREMISES COVERAGE lIMIT $HhOOO SPECIAL DEDUCTIBLE $250 lEVELS OF PROPERTY PROTECTION COVERED LOCATION NUMBER COVERAGE lEVEL OF PROTECTION ALL B,D BASIC COINSURANCE AGREEMENT COVERED LOCATION NUMBER COVERAGE COINSURANCE PERCENTAGE 1-1 B 80 PROPERTY DEDUCTIBLE COVERED LOCATION NU M8 ER AMOUNT All $250 OPTION 1 - SUPPLEMENTARY VALUABLE PAPERS AND RECORDS KK-72J4 (CONTINUED ON NEXT PAGE) PAGE ') <- ~?JfS_S_~~~.~~_~_-:0''''1 '\-~E :'.:~~,~ '/E 3EE:: ,i .~~' IT c-~. -, ' . ;; ~) eM) \.I' J"'" '\ c: t= G'::" (~ " --------------- + ---------~----- ~ --------~- - -- - -------- ':;-:~~;~~~: .: Fl33040 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 I LIT Y C 0 V t RAG E S & L I M ITS o F INS U RAN C C COMMERCIAL GENERAL lIABILITY: LIMITS OF INSURANCE ----------------- GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTSI COMPLETED OPERATIONS) PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT PERSONAL & ADVERTISING INJURY LIMIT EACH OCCURRENCE LIMIT FIRE DAMAGE LIMIT (ANY ONE FIRE) MEDICAL EXPENSE LIMIT (ANY ONE PERSON) $500,00C $500,COO $500,COO $5JO,COO $50,000 $5 , COO KK-72J4 (CONTINUED eN NEXT PAGE) PAGE J}PH~S Qc_='-::~:__ ~<:,=!_.I\~€:'\lT ;";1\/[ ~~::\~ S~;"JT-O T \ .. ~ 2 -'"'; ;fJ.. D \-' -1\ '\~ T -~ :~; ~~ ~ G ~ ", / I DECLARATIONS NAMEO INSURED ~UQY EADY DBA PO BOX 2763 KEY WEST I ! [~--UCiGNA'. I~,SURANCJ: COM~:;::-'~:=~-~~.~:1;i" Dl ;~U~~D 81 4 SERVICE INDUSTRIES PACKAGE-POLICY H PRODUCER BILLED ACE BUILDING FL33G40 MARKETING OFFICE: MIAMI FOR M S AND END 0 R S E MEN T S 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-0220 FL CHANGES CG-OOOl COMM GENERAL LIABILITY COV. fORM CG-0041 AMENDMENT OF POLLUTION EXCLUSION IL-0021 BROAD FORM NUCLEAR ENERGY EXCL ENDT FA3R99 WINDSTORM/HAIL DELETION ENDORSEMENT KK1520 FLORIDA CHANGES THIS DECLARATI0Ny AND THE COVERAGE fORMS(S) AND ENDORSEMENTS, IF ANY, lISTED ABOVE AND INCLUDED, COMPLETES THIS POLICY. WI f~ fj ~ "W/~~, ~~ :-11,' ,], ~ Ii t3.;" ,',. ~.:' EXCLUDED~~ COUNTERSIGNED AT: DATE: ,),\'10 W. FREHIlAN CF _, I KK-72'J4 (CONTINUED uN NEXT PAGE) PAGE 4 "'C;pI c:" r:. :'.'- .....,..... r_~ "/It " ,t CIGNA IN I DtCLARATIONS -' UPPlEMENTAl NAMEO INSUREb ~UpY EADY DBA ACE BUILDING MAINTENANCE PO BOX 2763 KEY WEST Fl33040 " '-'"j)'. I ( POUCY-ID . 01 99 93 81 i. PRODUCER BILLE[ . MARKETING OFFICE: MIAMI PREMIUM AD~USTMENTS RESULTING FROM AUDITS OR REPORTS IIF 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 LOCATION COY ERAG E PREMIUM BASIS CODE EXPOSURE RATE PREHIUN WHEN USED AS A PREMIUM BASIS THE FOLLOWING CODE DEFINITIONS APPLY: P-PAYROLl - PER $1,000 OF PAYROLL COMMERCIAL GENERAL LIABILITY COVERAGE FORM 96816 JANITORIAL SERVICES - INCLUDING PRODUCTS AND/OR COMPLETED OPERATIONS PREM-OP P 16400 63.421 PROD-INCLUDED $1.040 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 P;~GF OF YOUR DECLARATION. KK-7204 (LAST P,"'GE) P~GE >;;; j ~QCl'::::: - ~ -." ~ ....~ --~"T"- '-r) n~f)\f 4 r C';: c FLORIDA APPLICATION FOR WORKERS COWIPENSATION INSURANCE This application mUlt be typed or printed end flied, In duplicate, with: NCCI- ATLANTIC DIVISION. Post Office Box 3098, Boca Raton, Florida 33431-0998 · (407) 997-4633 Important: Instructions for completing Ihls application can be found In Ihe Florida Workers Compensation Insurance Plan-Information and Procedures- Handbook, This handbook Is available from NCCI- Order Processing. 750 Park 01 Commerce Orlve, Boca Rllton, Fl33487. Please answer all questions and requested Information thoroughly, Omissions may result in delay 01 coverage The undersigned employer hereby applies lor workers compensation inSurance In Florida and expressly represents thai such insurance is sought in good faith, I. GENERAL INFORMATION JUDY BOBICK, VBA ACE BUILVING & MAINTENA~CE EFFECTIVE 12:01 A,M, (DATE) 03/16/90 1, NAME OF EMPLOYER o 00000000 i F.E.I.N. REQUIRED BY LAW , SS# 263-94-1596 3, MAILING A~.oRESS SAME (Street) , MONROE: COUNTY, (Clly)! (County) j, I fLOR!.VA 2 FEDERAL EMPLOYER 10 NUMBER 2401 HARRIS AVE, KEY WEST, 33040 13051 296-6206 tS:ate) (Zip) (Phone) PnlNCIPAL L0C4T10N OF BUSINESS NONE (Slreet) I ---L.-.-_______J (Cily) (Counly) (Cily) ( (County) (State) (Zip) 5 OTHE'1 FLORIDA LOCATIONS (Street) (Stale) (Zip) f.s:.. ..'.:..'. bf , (7, , 8, II" ~E ~ ItAYI'lOLl-OFFICE ADDRESS----'Street)-n -------,- (City) ----------- (CountYI - ---- --- -- (Stalel [~GAL stATUS )(J Sole Proprietor (] Partnership [) Corpo'atlon r1 dther (explain): _ -------------- ------- Hes there been a nllme change du,lng Ihe past three yea's? n Yes ~ ~o, II yes, give previous nllme and date 01 change: ------ (1,1') 9 Are Ihere operations in states other than Florida? "Yes ~ No, II y,?s. complete the (ollowing' (self-h,sured or uninsured. indica Ie under Insurance Carrier) Location Insurance Carrier -j - --- ----]- State --..--. --- -- -------- II. INSURANCE RECORD 1. Has there been p,evlous workers compensation'insurance coverage In Florida? Il!l If no, complete: (J New Business 0 Self-Insured n Other (explain): If yes, Insurance Record :Three Previous Years' Yes o No, ~------_. Stale .:J~~IVA - i , Policy Period: Insurance Company i Policy Number From To Premiums LIBERTY MUTUAL I~S. CO. WCT-351-415006-018 11/88 11/89 311.00 ,---- ------- ---- , --- 10\a1 "udl\~d pay'oll lor each 01 the above policy perir>ds. (Do Not Complete" New Business) Policy Period: From To Payroll - =-1 t~3 :J ^", yr>" in dehlto any broker, agent or Insurance company lor any unpaid pn~mlums lor workers compensation coverage? n Yes Xl No, II yes, covera(le may be denied or canceled, Explain: _____;---____ .---------------.--.---------- III. INSURANCE COMPANIES WHO HAVE REFUSED INSURANCE Ust below name and representative of two COmpanies who havll rE!'used coverage In Ihe past slxly days, The reprl!,enlalivlJ named must be a full-time eml'loyee of "m in""",,,,!, company II nl'plicable, 01U! of these companies should b,e the one providing workers compensation Insurance to I'll! applicant at the lime of application. ~--_--_h---N;~~;;~;-==-----n-.-I __ RAUNI121. __ ____________ VOUG FISHER__ IV. CORPORATE OFFICERS, SOLE PROPRIETORS O~.PARTNERS t ist belpw n,1m,', lille. dlJlir.s and approximate annual salary of officers, sole proprietors or partners, r~}~1=~~~NER '''~~- D"" --- __^:~~;'~;,..;--~ 1 " n corporation, are any o<<iCefS exempt? n Yes U No, It yes, attach a copy of the exemption form which has been filed with the Department of Labor and Employment Secu. f.' .'f.. .. ".' ".'IIY, EJreCUI._ officers ot a corporation are "utomatically covered under the Law, ". any olllcers choose nollo be coverad, then an exemption lorm has to be completed In duplicate, 1 ; "', !he payroll for a" officers whrch are covered must be Included In the premium c'lculatlons In Section Viol this apptication, . . "'2. III partnership or proprletOlllhlp. have the partners or proprietors elected coverag8? O'rtls JQ No. If yes, attach a copy of the election form which has been filed with Department it. o(labor IInd Employment Security. I ::~: . !>ertners nnd sole proprletOlllar. not automatically covered under the law. If th~ desire to be covered, thay must complete an election of coverage form In duplicate, The pAyroll - , ' lor partners or IIOle proprietors Is not to be Included In the premium calculations unless thay have chosen to be COIIllred under the policy, 3, Has the corporation ollicers, part!l8rs or sole proprietors payroll been Included Irl determining the estimated annual premium? [1 Yes )(1 No. , " any e.ecutive olflcers, plll1ners or sole proprietors are to be covered under thelpollcy, then this question should be Ilnswered yes, .,' I~ the premium financed? 0 Yes ll!I No, "yes, a"ach a signed copy of the finance agreement. , ' I I I f--~;NA -: _.-HI ____ Insurence Company _._--~- Ad(\'pss Fed, Emp, tD No,lSoc, Sec, No, 59-0401360 3)r7?() Date OVER WCIPI-FU661 NCI4'O 'o'prL) LICENSE YEAR 1989-1990 OCCUPATIONAL LICENSE City of Key West, Florida No. 50016139012 NO REFUNDS THIS LICENSE MUST BE PROMINENTLY DISPLAYED LICENSE PERIOD BEGINNING 10/01/8 9 THROUGH 0 9/3 0/9 0 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 GEHERAL 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:r ACE BUILDING MAINTENANCE '\ OWNER: ACE BUILDING MAINTENANCE ADDRESS: ~~]..-IiAR&l-S--A1J.EmJ&- P .0. BOX 2768 CITY:~ KEY WEST FL 33040 FINANCE DEPARTMENT DIVISION OF REVENUE ~. ~ (L ~ COUNTY OCCUPATIONAL L10ENSE 1989-199Q wallROE ~Q~~TA~~FFum~ THIS LICENSE EXPIRESSEr IDlIII:II, ,jU. '1YYU 471-00~10 . ' IIU88&&..&U: c.rLOIEES: S c.....~a)CUaa~ItT x_RiGf "EMPLOYEES'LItER.: ":;::::""'0;" TAX COST AND-R5"I,fI PENALTY 22.00 5.~ TRANSFER FEEt; " C.... iJl:t ~u; zC 37-5D ~~ ."l(l ;!!u; 0." :DC o~ )>- j~~ ')>m C!~ ....z m en ; . .;, - I ~ '; TOTAL DUE STATE CERTIFICATE NUMBER ~1:t.~.. MAlia, f.:X"~6"I,'CfC TD.. . 'I" · COU;.ECIoa 294-8403' P.O.80&..1129 1(1:, Wf.5'1. f1.33041~1t29 r-'~ ' PLEASE SEE BACK OF FORM Ift 'AaU"EiL~CEIISEE IS'IIEREBY .. LiCE_ED TOiJUiA6E lit THE BUSI.ESS P&O'CSSI011 OR, otCUPAJ:IO.1. Of : .,uIUIORlAI. SaVICE ACE aOIUING,RAIIITE..".CE .cADY:, ..uay'O....eR ,P 0 BOX .2763 ,XEY . veST. , fL 33040 \ ***PAID*HARRY F.KNIGHT*** ~~:="""AtCOU.T.U.BEa' IS 20566 LO';Al'lON.:8aILE UNIT' '/-'7. "'I)" ~,,' ,',' '1 r, ,r T.)'i1S"f~M-,I!fi'~~!\A ftEC.EIf'T QNLY :Nt!E;N VALIDATED BY RECEIPTING _ .., 1..1\ VIi Ol7UAQlIlI~ljqJqt~I!~ft:,D!1j,ANOAMOUNTPAID, ,.....:.. '~..........r.. THIS LICENSE MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS --:~ " ", " .. ~ .,. ,', ,.~-;~ ,:)> !~ _:~:t. :;~1 <~ ":'.-4 t ,~""f ,~.~;: ~ { ;:~/ '~!'~/' ;'_.~':.f. ~;:": ~.: ~ };~,~:: ~ T;~ .' "..t'." "