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<br />JU"!-23-'94 TI-U 12:07 ID:CITY CF ZEPKT'RHILLS TEL 1'-0:813 788 3293
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<br />1:1432 P02
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<br />~ITIOIfI or '.RMI'l AJ'I'IDAVIT
<br />A. ..!!ICl OJ' DID _~CTIOHS
<br />11II .... ....... OIt w. t .., be .Jtct to IdMd Dltrlc:t.laall tIblCl III III .. Ultrlctbt thu cnr
<br />ngIlltI_. fte.............. dIIpCIII1IdUtr tOt ClJltUIIICI .lth -, .,11_' .,... DItrlct1011.
<br />B. UHLICBNSBD COIft'RACTORS AND COMlULC'lOR RBSPOJIfSIBIL1T1BR .
<br />If till ~ ... Una I _trll;tDr II[ _tnc:ton to ....tIke -k, tMJ., III nplrl!ll1 to III lCMMa.. 1(lClO" Ill"
<br />llate _ lOI:d npIIUlIIU. If till cCJDtnl:tar 11 DOt liCllll8l1 u _11I1 br In, boll tilt 11IIIII' .. ~ ., be
<br />ctte4 I. I _.11": ,1011UCllIIId8t .tate lill. If tM ClID8r or iateDdec! COItrectoC m -.rttla . to tUt 1lc:.a1Qg
<br />regu1~ .,..11 lor tIMIlDtIIldII1lDR, t!IIJ an -Ilea to eaatact till cu, of ~11I1dl4bg~, (03)
<br />7118-61J1.
<br />FuEu..-n, If till... ... UnI I OOIltflCtor or eGIlUlCtoC., billa 14,111I1 to llad tile U11l:nctor(l) 11ga padJaGI of Ue
<br />'ea.u1Ctor .... of WI 1PP11catlm for wblell tber.lll be ruPlllltule. If p, .. tM car dill . ~ ClIIItnctor,
<br />rou an au~tlag tllIt JOIl, Clu.r tho Ue CllIIItRctar, In ':__11111 for tlllllU(k. 11 till CXlDtrIGtar ...... ... to dlPl
<br />18 c:GItnctDr Uat..., bI. WlAtllII tblt 11I18 DOt pnpU1J UCIIII8d 11141..t lIltlt1l1l1 to pmlttbg prltlJ1gu III the
<br />CUr of Ili*JrYIII.
<br />c. 'l'IWItlPORTATIOH IMPACT FIrES AND ~ILI"1'Y COHNICTION pass
<br />D. CO}f~'l'RVCTION LID LAW (CHAPTER 713, FLORIDA STA'l'UDS t AS AlllllDBD)
<br />I IlICtilJ I, tJIe ",UDIIIt, bml _ pr.14111 willa a COI1 of -,llIrldl'l r.tnctlOll 1.1. ,.. . .....,,'. PratlCtiOG
<br />Qal.,- papan4" till .lad.. ~ or IgrlCllltue UI1 ecm..r &fWn. If UlQPJlc:ut b _ ok tlIu *
<br />10000er-, J ~f, tIIIt I .... abt:PQt . CGU of th IIlon t.dW eoa..t UO prall.. ID .... ...Ii to 4IlI. it to to
<br />'0lIIIl" prior to lIC"ll1n~.
<br />
<br />
<br />B. COJrlRAC'1'OR~ '8 AFFIDAVIT
<br />I certifJ tIIit III till (It III W. IppUcatl. i. lCaInta ad tIlat d1 wrk ,111 lie .. 11 _-.. .It. 111
<br />eppl1C1blI _ npl.t.bIg ~tnct1C111, 1CIIIag, ... 1_ 4nIlDpIIat.
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<br />Ippliatl. 11 ..., .. to aIltdD I pUI1t tD do tmrk lid inltlll.tloq .. lIIcUmtll1. I ",tUf, lilt lID _ It
<br />lDItIJIIU. ... ~ ,rIOI' to "'.ce of . pen1t uc1 tllet d110rk ,111 III perforlll1 tI ... ..... of aU 1M
<br />tegulatlog CGDItrucUOG, Citr l104a, IlIII1Dg ngu!itJOIII, 11I411IIII 4Pe1~t ngdaU_ .Ia tM jarJItietICII. I tho
<br />cuUfJ tllat I ...tu4 tMt tJIe rep1aUCllII of utbIr pUllllita1 ,...ci. .., '11lr to tbI ia~ 110I'''' 11II1 tat it 11
<br />.., QIJOnIlblUq to i_tiff _t actiCIIII J -t teb to be ill COIIpl1lnce. 8udIltlldlllad_ bot In lOt llIdtIA to:
<br />t DeHfbI!llt of IIrlr:011111ltel M9\1laUon . CJprua ..,..., IIetlllllllwl d IDtI~I:I1IJ ...1U" LIllI,
<br />htIr/lllltwltlr ftllblllt
<br />t SoutMIt rlDr1da ..till' Dlltrlat . lilli, Cypnu 8IJIaeiI1a, IetlllH1ltW, UtlriDt IItIrcour..
<br />. . .....11, Daeb, IIflg11111 VltUI.,.
<br />t D i ....Ultati.. Benita Jqym-ntd IIMI ad . lIIll., vw-tIr 1r11_t, lIptla .....
<br />t . IlblltaI .~t ,
<br />J I Ir tIIIt. f f I .brl,llI to M .. In rllllld IOD8 III ar -.,etc.-, it b UIIdIntaoI tilt . ~ pl.
<br />.aar.1Dt a '~tbg tal.' uJI. IDlllitbl1lUcIt II pnpl1'll1" I proflldlllllllllllUU: regiatnlll . Me of
<br />Plori. prior to JUIlt iIIuIna. .
<br />
<br />I palt illUlllklllle DIIIIItrue4 to .. . Ii... to pl'OClld wi~ tIII__ IIIC1l1Ot II IlIthgrltl to de11l1, c:IICIl dt.r. or
<br />..t aU. ., Jl'G'bu. of tM tltJlalal1 aada, DOr aU IIIIIIIlCe of . ,..tt prmat tba 1u!WIg Dff1ch1 ,. tllenlfter
<br />nvmlDlr I mr.nct1... Df errGQ ... p..., CllGJt:nat:iCII, or 'lo11t10G1 of II)' CDII. Imr plDdt iIa4 .U __ 1III1i.
<br />lIllen tht .1 .tIlIrll'" br IUCb pmit iI ~ utUa 111 IIOGtM of iIIUIDcI, at if _ IlUarblcl If tile pean iI
<br />IIIPID&d ar ,...., fOr 8 JIII.IaI1lf iii utili aftlt 01 tHe tIJe 110I'. II ~CI!Il. 1M" Gar .... " u., III JII
<br />1111_ for t.M pall wltl f. d1erge of '15.00. 'tbI ulllqioa ..U lie ~tIl111lllrltllg to t!ll1UII4III Official. III
<br />1ppronc11D1(11dllll 11III&: he 1'" 4udllg .. Ib: ... PIl'I05, or the pnflCt IIU be ..1t8r1ll1 1Ib1N111111lt.
<br />__ to MIl: ... nu.- 10 ualII) . IOrICl or ~ III! IIIBILf II DI 'mill MCI POI ~. to YClUI
<br />. I' 10 . 'IMIII, caM' DB IlIIII-.at (II JllftCIIIf IIBftJI ..... ... alCl 01
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<br />Tbe foregoing 1118 t ... .cIU10111edged The foregolug ~1utraeat 11.. . -ow184984
<br />before.. tbia.:IL\-.. ~., " 19.3i by before lie tbi.'J~,;}.-'f-Lt, , 19.1.t...- bf
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<br />Dav~d k. c:O"'.I~S'~~ Ct:-.L l: S71:: 'f-'. '/I-IL /")C L.-
<br />vbo i. per....l~:r ~ to .e Qr -.bo. bill. "110 18 per.GasUy U10WD to H DE' wbQ ....
<br />!,rnrtl1~ J3~r:\~' L\ \lee.I \ H~fUe. ;.~;:~ ..or- .
<br />U idGt1:flcaticm 8Il. d - Jd .ot "" idlla.tificatlOll.8Ild do. d.14/d!d DOt
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<br />. l~) fH,r-fJ i . ,: t"L C, ~L,(k, ~-k'-t
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<br />(lfue , PriDted Ol" StflllJ)8d) (II.. 'I'ype4, PdDtedLW:~.~!~~ff-. .
<br />JfO'lARt MLIC ftO'lARY PUBLIC Nt. p""'lr ,~",;... cl I-I(,n(i:l.
<br />o.ar I ' c.~:. -', ~ l.'-' .~" " ,.. ,,".."fJ
<br />M Gc.rn'1l E.(l~.f"~ tiur::-\. o. .".::''''
<br />y .I~o. (::C~5'! i",i
<br />
<br />....rt..~'ri:",... DOREEN L. WOOD
<br />f:r'~~~ tt( COMMISSIGN , CC 191515 EXPIRES
<br />?...~.lf.: Aprll29. 1996
<br />'.~~"",W 80NIlED 1MIIJ TPm FAIN INSURANCE. INC.
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