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1407 Stage Door IIPeter Piacenti 5013 Legacy Oaks Dr • Orlando, FL 32839 • Tel:(321) 287 -1402 EDUCATION THE UNIVERSITY OF FLORIDA, Gainesville, FL Bachelor of Science in Decision Information Sciences, May 2003 Bachelor of Arts in Economics with a Minor in Physics, May 2003 Overall GPA: 3.9/4.0 Core GPA: 4.0/4.0 GRE: Quantitative: 790/800 (93rd percentile), Analytical: 800/800 (97 percentile), Verbal: 700/800 (97' percentile) EXPERIENCE STAGE DOOR H, INC., Orlando, FL Operations Manager, February 2004 — Present • Exceeded each internal financial goal set each year • Managed many projects of different types successfully and efficiently GIVE HOPE FOUNDATION, Orlando, FL Founder and President, March 2005 — Present Founded this non -profit to help children and families battling cancer. • Achieved 501 (c) 3 status within the first few months • Managed 6 Charity Galas, which raised more than $250,000 in total • Implemented an internal program `The Give Hope Hero Program' in 2007, which is a wish granting program for children with cancer FLORIDA REAL ESTATE ENDEAVORS, Orlando, FL Owner and Operations Manager, 2006 — Present • Developed this business, which now has 10 renovated rental units operating SET ASSOCIATES, Arlington, VA SETA to DARPA, September, 2003 — February 2004 A SETA is a consultant to a project manager at DARPA, and DARPA stands for Defense Advanced Research Projects Agency. • Championed a project called Command Post of the Future (CPOF) with Captain Ryan Paterson, Project Manager for CPOF. • Successfully aided in the process of acquiring over 10 million dollars in funding, running CPOF through theoretical trials with experienced commanders, and helped push the concept closer to Tuition. THE MARINE CORPS WARFIGHTING LABORATORY, Quantico, VA Systems Analyst, June 2003 — August 2003 Conducted thorough analysis and update of the Warfighting Lab's knowledge management application • Improved the function of the application through the implementation of my own ideas • Was offered the position as a SETA at DARPA as a direct result of my performance in this postion SPECIALIZED SKILLS / PERSONAL Spanish: Fluent Italian: Conversational Speed Reading: Taught 3 courses of at least 7 students each to at least double their reading rate in 4 wks Scuba Diving: Open Water Certified and experienced, 2000- Present Basketball: City of Orlando Basketball Champions 2007, 2009, 2010 Racquetball: University of Florida Intramural Champion, 2003 TRAVIS PENDLETON 145 Springwood Trail Altamonte Springs, FL 407 - 578 -2918 2000 -Pres —Stage Door II, Inc. Director of Operations — Manage fiscal, physical and human resources to accomplish mission and objectives of company. Supervise multiple jobsites simultaneously. During my time at Stage Door II, 1 have supervised projects totaling upwards of $80 million. These projects have ranged from road construction and repair; restoration from utility breaks; stormwater upgrades or repairs; box culverts; and water /wastewater utility improvements. All work performed by Stage Door II is for municipalities in the Central Florida area that are open to public or then current residential areas. 1995 - 2000 — Various Healthcare facilities Administrator — Licensed administrator of long -term healthcare facilities throughout New Orleans, LA. I was responsible for as many as 300 employees and various Department Heads in the facility. Started off in 1995 in clerical position in accounting department and was rapidly promoted and trained to be Administrator. I was recognized as a specialist in turning around troubled facilities into successful facilities compliant with State regulations and profitable. 1992 -1995 — US Air Force Accountant — joined the USAF and was promoted in rank and responsibility throughout my tenure. In basic training I was assigned as "Dorm Chief which put me in charge of the entire group of trainees. Upon completion of technical training I was assigned to Hulbert Field Air Base, Special Operations Command where again I was promoted in rank ahead of other airmen and assigned positions which would normally go to people with much higher rank. I received numerous awards and letters of recognition from supervisors and even base commanders. Two different base commanders submitted letters of recommendation that I be admitted to the Air Force Academy for officer training. Peter V.Piacenti 1280 Wellington Terrace • Maitland F132751 • Tel:(321) 663 -4101 • petervpiacentigyahoo.com EDUCATION Brooklyn Technical H.S. Brooklyn N.Y. Majored in Aero Space Engineering Grad 1965 New York Institute of Technology, Old Westbury L.I., N.Y. Studied Aero Space Engineering 2 years EXPERIENCE Lizza & Sons Inc., Oyster Bay L.I., N.Y. Office Engineer, Deer Park Ave Improvements June 1967 — Oct 1968 • Responsible for monthly progress payments on 15 mi. long Federal Highway project. Assistant Superintendent, Hwy 17K, Newberg N.Y. 1 Oct 1968 — Sept 1970 • In charge of all dirt work, trucking, base preparation and paving 18 Mi. Long Federal Hwy • Soil sieve analysis and hardness tests to locate proper base material and negotiate purchase. Frank Mascali Construction Co, Flushing N.Y. Superintendent, Park Row Pedestrian Overpass Oct 1969 — Oct 1971 • Responsible for total construction of overpass connecting N.Y.City Police Headquarters to City Hall at the base of the Brooklyn Bridge. Lake Kathryn Estates Mobile Home Park, Casselberry Fl Construction Mgr., 1972 — 1973 • Supervise construction of mobile home park, swimming pools, clubhouse Miniature Golf Course and maintenance crews. Stage Door II Inc. Apopka Fl President & CEO, 1973 — Present • Stage Door II, Inc start up, from filing corporate papers, setting up bonding, insurance, acquiring equipment, labor force, bidding on jobs and completing jobs in a timely manner. Stage door II, Inc has grown over the last 38 years to a company that employs approx 50+ employees and performs $10,000,000.00 of work per year. The work consists of Underdrain, Storm Sewer, Sanitary Sewer, Water, Structural Concrete, Concrete Sidewalks, Asphalt Bikepaths, Curbing, Excavation, Base Work, Paving, Soddding and Landscaping. We basically perform any and all horizontal Construction for Municipalities and Private Clients. Spanish: Conversational Italian: Conversational Jai Alai: Won over 12 Jai Alai Tournaments, Several State Wide, and Played 4 years Professionally. SrA GE DOOR A INC. 3208 OVERLAND ROAD APOPKA, FL 32703 OFFICE (407) 578 -2918 FAX (407) 578 -2921 6/30/2011 Statement of Experience Stage Door I1, Inc. has, for 40 years now, been operating almost exclusively as a prime contractor. For many different central florida municipalities, we have performed over $100,000,000.00 in work as a prime contractor. We have included a spreadsheet with all of our recent and current contracts, but to point out three jobs that are similar to Oleander — for Orange County, we widened, repaved, installed drainage, and restored Chickasaw trail at Millinocket lane, which was around a $500,000.00 project. We also did a large restoration on a road in Barnett Park for Orange County. In this job, we did drainage, road base and paving, sidewalks, curb, and many other miscellaneous items. 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O O O 90� a o: (D �� a 0- cL CD a a) m T.� -+ w �� a c. m °� a) 'r m m '* CL a c o a o ° L CD Q a co CD a 3 CD CD 40 m N rn 0 0 0 0 0 0 � p 3 v v v v a 3 CL O CD CD CD W W f CD .�► O C. � 0 2 � C� - C 0 Cl) wn� @O DOF2 =r CD U) g CD 2 - (A v $ � m =L = M. , o g] ■ � - 0 £ o_ � � a' ��o0 c _ ■ c� ƒ00 Rt k § 0 7 2 g� @ c 2� ■nQ J@ ■:302 0) C � x § 5 _ n w d� § ƒ§ k� ^ 3 K a O k k 2 co ■ #0OD 0 Q #n #0L" 0 #0 -4 9 m #w@ o w _o� o o �0) o w o■_ - Z 4 03 o -4 N- 02) &=� 2 @o Co &� m ��D % oƒ m o O 0 o� o f co 9 O & n a a v■ m m° 0 2ra2 o2= q v © 2 n to §a o M. �< -4 w� mow$ K3 m m �\_ 0) Co w k w 0 -n ;/ S OD �� ��CD pox 0. 00 C CD 2 2 R E C) Im a A D k / O m °k w w & ;r OD E k -4 SD CD 2 w co I 40 40 n f 0 406 S k 2 k § CL CD in CD CD m ( p £ ■ k k k o D CL 2 E E « E E g CL � ORIGINAL SECTION 00410 BID FORM PART 1 GENERAL 1.01 Description The following Bid, for the Oleander Ave. Extension (IFB No. 10/11-14), is hereby made to City of Sanford hereafter called the Owner. This Bid is submitted by (1) (1) Name, address, and telephone number of Bidder 1.02 The Undersigned: A. Acknowledges receipt of: 1. Project Manual and Drawings identified within the Project Manual. 2. Addenda: Number _I Dated lO -It Number IZ2 Dated & -to -ll Number Dated & - Lo - Number Dated 4 " - ll Number Dated B. Has examined the site and all Bidding Documents and understands that in submitting his Bid, he waives all right to plead any misunderstanding regarding the same. C. Agrees: 1. To hold this Bid open for 90 calendar days after the bid opening date. 2. To accept the provisions of the Instructions to Bidders regarding disposition of Bid Security. 3. To enter into and execute a contract with the Owner, if awarded on the basis of this Bid, and to furnish a Performance Bond and a Labor and Material Payment Bond in accordance with the Instructions to Bidders. 4. To accomplish the work in accordance with the Contract Documents. 5. To begin work not later than 10 days after the issuance of a Notice to Proceed, unless otherwise provided, and substantially complete the work within 135 calendar days of the date of the Notice to Proceed. 00410 -1 Q �j �.1 �� � �'a' -�� -j1` c OLEANDER AVENUE EXTENSION (IFB 10/11 -14) NAME OF BIDDER REVISED PER ADDENDUM NO. 4 6/15/11 • • 6. To accept the provisions of the Agreement as to liquidated damages in the event of failure to complete the work on time. 1.03 Bid Schedule The Bidder hereby agrees to perform all work as required by the Contract Documents for the following Unit Prices. All work required to be performed by the Contract Documents is to be included within the following Pay Items, inclusive of furnishing all manpower, equipment, materials and performance of all operations relative to construction of the project. Work for which there is not a Pay Item will be considered incidental to the Contract and no additional compensation will be allowed. 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Z0 I I Z0 U U U (o v Q R H W i t I N l co J U Z LO b w o F- � r ti r- W W ( (0 C0 ( ((o ( ti 0 a0 0 0 coo 0 ` 0 0 0�0 0 a o �D LL m O Z- O=) Z Z X O W Q W w > W .d CL O O r O O 2 1� Q w w O m LL O w Q z 0 Q R/ E R R R R E R E/ w— 6 6»&» 6 6¥ d a m LO a 7$ k/\ q 7 2 3% m m� ��222 264 2q A 2 k R R 2 R R R 2 R R R R a a k// N N k CN % CY) - cli v 1-: mmmVl� VII amm mmm � % 0 2 111' $ % % � 0 $ L e < « m « m ± n « < < 2-j L L a w -i _ u w w � q k k k % R $ CL M / 2 § � \ U � / \ k 0 � � 2 § @ CU m o w R \ o a ƒ $ ¥ 2 12 2 f _/ R f 0 & / /%$, o f 2 2 0 a. R § f 0 � / k cu o ƒ \ B/ n w S' 2 3/ 0 LLJ m a» » 5 2 6 k_ a@ e q m o k 2 f k/ 3 Q k d/ m L : .2 = : L U) Q Z R 7 / / 7 \ \ \ \ \ 7 k / 0 ƒ{ . a© §/ 7--z 05 §§ j< §E <� 3E z> § LU � 0 0 � 2 � � q � Q � � § 2 0 § z • 1.07 Miscellaneous Requirements and Affirmations A. Proposals (Bids) must be on the Bid Form. • B. I have attached the required Bid Security to this Bid. C. I have attached the required Statement in connection with the Trench Safety Act. 1.08 RESPECTFULLY SUBMITTED, signed and sealed this �U.v1L 2� i i Contractor y (Signature) -� Date Printed Name and Title Business Address City V State Zip Code 409 5 - )Er4gt� - Ll yl S7C� / Telephone No. Facsimile No. ATTEST: By (Signature) U Date -- DCbv - /'a. h � pr cu,', O, n Printed Name and T tle END OF SECTION aG day of (CORPORATE SEAL) 00410 -7 � 4(oe t Color .. 'r OLEANDER AVENUE EXTENSION (IFB 10/11 -14) NAME OF BIDDER REVISED PER ADDENDUM NO. 4 6/15/11 05/20/2011 13:53 FAX 407 578 290 Stage Door II Inc SECTION 00420 BID BOND FORM • Q 0006/0007 KNOW ALL MEN BY THESE PRESENT, that we, the undersigned, (1) Stage Door II, Inc. as principal, and (2) The Ohio Casualty nsurance ompany as Surety, are hereby and firmly bound unto (3) City of Sanford , as Owner, in the penal SUM of (4) Five Percent of m- cunt Bid Dollars ($ 5 % ------ --- ) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors, and assigns. The condition of the above obligation is such that whereas the Principal has submitted to (3) City of Sanford a Certain Bid for (5) Oleander Avenue Extension IFB 10/11 -14 , attached hereto and hereby made a part hereof. f) Bidder 2) Surety 3) owner 4) Amount of Bond as Required In the instructions to Bidders 5) Name of Project as Shown in Invitation for Aids NOW, THEREFORE, A. If said Bidder shall be in rejected, or In the alternate, B. If said Bid shall be accepted and the Principal shall execute and deliver the Agreement (properly completed In accordance with the Bidding Documents), and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way Impaired or affected by any extension of the time within which the Owner may accept such Bid; and said Surety does hereby give waive notice of any such extension. 00420 -1 SPECUBMW3 05/20/2011 13:53 FAX 407 578 0 Stage Door II Inc • U 0007/0007 IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers. Signed and sealed this 9th day of June 2011 Stage Door II, Inc. EST: Principal By (Principal Officer) By (Signature of Offs er n 1�' S �i�l fifa� S.r ��, � � r � � �i ✓� -�� �R�4 t� ►.� Typed Name and Title Typed Name and Title END OF SECTION 00420 -2 SPECUUDS 806 3208 Overland Rd (CORPORATE SEAL) Address Apopka, FL 32703 City, State, Zip The Ohio Casualty Insurance Company ` Surety fi By: lilt 0 B Attorney -i Fact Jeanette Fiorvante, Witness Cindy L. Mirisola, Attorney -in -Fact Typed Name and Title Typed Name and Title 1021 Douglas Avenue (SEAL) Address Altamonte Springs, FL 32714 City, State, Zip (407)389 -3588 (407)389 -8488 Telephone No. Facsimile No, END OF SECTION 00420 -2 SPECUUDS 806 THIS POWER OF ATTORNEY IS NOT VALLESS IT IS PRINTED ON RED BACKGRO�. IFIED COPY OF POWER OF ATTORNEY THE OHIO CASUALTY INSURANCE COMPANY WEST AMERICAN INSURANCE COMPANY No. 43 -445 Know All Men by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN INSURANCE COMPANY, an Indiana Corporation, pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and By -Laws of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby nominate, constitute and appoint: Deidre R. Padgett, Barbara Aldinger, Gerald K, Sihle or Cindy L. Mirisola of Altamonte Spg, Florida its true and lawful agent (s) and attorney (s) -in -fact, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance TEN MILLION ($10,000,000:00) DOLLARS, excluding, however, any bond(s) or undertaking(s) guaranteeing the payment of notes and interest thereon And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield, Ohio, in their own proper persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s) -in -fact. In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of each Company this 10th day of May, 2010. J. Timothy D'Errico, Assistant Secretary STATE OF OHIO, COUNTY OF BUTLER On this 10th day of May, 2010 before the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and qualified, came J. Timothy D'Errico, Assistant Secretary of THE OHIO CASUALTY INSURANCE COMPANY and WEST AMERICAN INSURANCE COMPANY, to me personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn deposes and says that he is the officer of the Companies aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year first above written. Notary Public in and for County of Butler, State of Ohio My Commission expires August 5, 2012. This power of attorney is granted under and by authority of Article III, Section 9 of the Code of Regulations and By -Laws of The Ohio Casualty Insurance Company and West American Insurance Company, extracts from which read: Article III, Section 9. Appointment of Attomgys -in -Fact The Chairman of the Board, the President, any Vice - President, the Secretary or any Assistant Secretary of the corporation shall be and is hereby vested with full power and authority to appoint attorneys -in -fact for the purpose of signing the name of the corporation as surety to, and to execute, attach the seal of the corporation to, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or other instruments of suretyship and policies of insurance to be given in favor of any individual, firm, corporation, partnership, limited liability company or other entity, or the official representative thereof, or to any county or state, or any official board or boards of any county or state, or the United States of America or any agency thereof, or to any other political subdivision thereof This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21, 2004: RESOLVED, That the signature of any officer of the Company authorized under Article II1, Section 9 of its Code of Regulations and By -laws and the Company seal may be affixed by facsimile to any power of attorney or copy thereof issued on behalf of the Company to make, execute, seal and deliver for and on its behalf as surety any and all bonds, undertakings or other written obligations in the nature thereof, to prescribe their respective duties and the respective limits of their authority; and to revoke any such appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall, with respect to any bond, undertaking or other written obligations in the nature thereof to which it is attached, be valid and binding upon the Company with the same force and effect as though manually affixed. CERTIFICATE I, the undersigned Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby certify that the foregoing power of attorney, the referenced By -Laws of the Companies and the above resolution of their Boards of Directors are true and correct copies and are in full force and effect on this date. IN WITNESS WHEREOF, I have hereunto set my hand and the seals of the Companies this 9 day of J une 9 20 11 Assistant Secretary 05/20/2011 13:53 FAX 407 5781 Stage Door II Inc SECTION 00420 BID BOND FORM • 110006/0007 KNOW ALL MEN BY THESE PRESENT, that we, the undersigned, (1) Stage Door II, Inc. as Principal, and (2) The Ohio ty ce mpany as Surety, are hereby and firmly bound unto (3) C ity of Sanford , as Owner, In the penal sum of (4) Five Percent of ount Bid Dollars ($ So/ - -- ) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our helm, executors, administrators, successors, and assigns. The condition of the above obligation is such that whereas the Principal has submitted to (3) _ City of Sanford a certain Bid for (5) Oleander Avenue Extension EFB 10/11 -14 . attached hereto and hereby made a part hereof. 1) BkUW z) 3WW 3J owner 4) Amount ofDond as Raquh'ed in Mo MdrucUm to SW OM 8) Name of Project as Shown In InWagm for Bids NOW, THEREFORE, A. If said Bidder shall be in rejected, or In the aitemate, a. If said Bid shall be accepted and the Principal shall execute and deliver the Agreement (property completed in accordance with the Bidding Documents), and shall furnish a bond for his faithful perfo f said contract, and for the payment of all persons performing labor or fumishing erewitfi, and shall in all other respects perform the agree of said Bid, then this obligation shall be void, otherwise the same shalt ISma:n in force and effect; it being expressly understood and agreed that the liability of time Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and Its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid; and said Surety does hereby give waive notice of any such extension. 00420 -1 A � 05/20/2011 13:53 FAX 407 578 �1 Stage Door II Inc 440007/0007 IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers. Signed and sealed this 9th day of June 2011 Stage Door II, Inc. ATTEST: Principal By (Principal Officer) By (Signature of Officer) Typed Name and Title Typed Nam and True 3208 Overland Rd (CORPORATE SEAL) Address Apopka, FL 32703 City, State, Zip M Jeanette Fiorvante, Witness Typed Name and Title (SEAL) The Ohio Cas ualty Insurance Company Suret By: Attorney -in -Fact Cindy L. Mirisola, Attorney -in -Fact Typed Name and Title 1021 Douglas Avenue Address Altamonte Springs, FL 32714 City, State, Zip (407)389 - 3588 (407)389 - 8488 Telephone No. Facsimile No. END OF SECTION 00420 -2 THIS POWER OF ATTORNEY IS NOT VOR UNLESS IT IS PRINTED ON RED BACKGMND. RTIFIED COPY OF POWER OF ATTORNEY THE OHIO CASUALTY INSURANCE COMPANY WEST AMERICAN INSURANCE COMPANY No. 43-445 Know All Men by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN INSURANCE COMPANY, an Indiana Corporation, pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and By - Laws of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby nominate, constitute and appoint: Deidre R. Padgett, Barbara Aldinger, Gerald K. Sihle or Cindy L. Mirisoln of Altamonte Spg, Florida its true and lawful agent (s) and attorney (s)-m- fad, to make,: execute, seal and deliver for and on its behalf as surety. , ,000,000.46 ) and as - its act and deed any.apd all BONDS, UNDERTAKINGS, and RECOGNIZANCE$_ not exczeding in an y : s uigie instance .E:ION .($_10 DOI�Ia1R.S .. TEN -j11I) , exchrdntg, however, any bond(s) or undertaldng(s) guaranteeing thepttyment of iota's :anal interest thereoA .., . - <- And the execution of such bonds of undertald m pursuance of these presents, -shall be as binding upon said Compantes,.as frilly and amply, to all intents and as if = edged. he it - arl eic a officers - the Cor purposes,_ they •h8d ricer duty Cxe by t �cgted and ricicnowl gun y pontes at tbeu administrative offices in Fairfield, Ohio, 'in their awt4 properPersons. The authority granted hereunder sttpersedes myprevious suffiority heretofore granted the above : named attorneys }in fact In WITNESS WHEREOF, the undetstgiied officer of the soul The Ohio Casuaky Insurance Coin an - hereunto subscribed his name and affixed the:Gorporate Seal'of each -C 2 P arid -West Amencan ltisurance Company has ompan}! thxs30th day 'May, 2014 sw • SEAL 11 t t V J. Timothy D'Errico, Assistant Secretary 6 O CL a C m a o is m tv O d G m O m O C. m' O C O O a 6 O Z S STATE OF OHIO, COUNTY OF BUTLER d O On this 10th day of May, 2010 before the subscriber a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and C q q ualifl ed, came J. Timothy D . _ Errieo, Assistant Secretary of THE OHIO CASUALTY INSURANCE COMPANY. and WEST AMERICAN ca I INSURANCE COMPANY, to me personally known to be the individual and. officer described in, and who executed the preceding instrument, and, he ca a acknowledged the execution of the same, and being by me duly sworn deposes and says that he is the officer of the Companies aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies; and the said Corporate Seals and. his. signature as officer were v v m d duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN, TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year fast i i > a above written. L t! j _1% Q Q m N Notary Public in and for County of Butler, State of Ohio 0 0 C M My Commission expires August 5, 2012. G G This power of attorney is granted under and by authority of Article III, Section 9 of the Code of Regulations and By Laws of The Ohio Casualty a a L I Insurance Company and West American Insurance Company, extracts from which read: , ,e Bah . m e ereo , prescn err %O.a respective duties and the respec4 ve limits of then authority and_io revoke any sgch appouitttrent : = Such signatures and seal are hereby adopted by the � ,= an as o si and sieal and ` Comp. y signatures uhatl, with .moped to any bond, und or ng o ther_wntten, : obtigatons m thenatrue thereof to which it is attached, be valid and binding rigor the Company with die saiifo force and e$br i- _though inanetally affiied - CERTIFICATE L the undersigned Assistant Secretary o€-Tfte;Ohio Casualty Insurance Comp* *y arld West �4melican Ia$uianee Company da iieieby certify that the foregoing power of attorney, the rq&i �. e t� -Laws of thpritpanies and the - above re$oWou of their Boards: of •Diietrtors are true and correct copies and are in full force and effect this date. IN WITNESS W_ HEREOF, I have hereunto set my hand and the seals of the Companies this 9 day of - June 2011 ,/'Apt/< - 1r Assistant Secretary SECTION 00430 TRENCH SAFETY STATEMENT FORM Bidder acknowledges that included in the various items of the proposal contained on the Bid Form are costs for complying with the Florida Trench Safety Act (FS 553.60- 553.64). The Bidder further identifies the cost of compliance with the applicable trench safety standards for the project as follows (Bidder to attach additional sheets as necessary to identify all costs): The total cost shown herein is already included in the various items on the Bid Form and is not additional to the pricing shown on the Bid Form. Bidder, by signature below, assures that the contractor performing trench excavating will comply with the applicable Trench Safety Standards. Submitted, signed and sealed this ? _ day of -: f— , ZC 11 Bidder � ) Signature Printed Name and Title ATTEST: /�'� 9, Signature Date (SEAL) END OF SECTION SPECLIB052803 00430 -1 Trench Safety Measure ( Description) Units of Measure (I-F, SF, SY Unit Quantit Unit Cost Extended Cost A 4.-F / 1 8 IX B C D E F TOTAL The total cost shown herein is already included in the various items on the Bid Form and is not additional to the pricing shown on the Bid Form. Bidder, by signature below, assures that the contractor performing trench excavating will comply with the applicable Trench Safety Standards. Submitted, signed and sealed this ? _ day of -: f— , ZC 11 Bidder � ) Signature Printed Name and Title ATTEST: /�'� 9, Signature Date (SEAL) END OF SECTION SPECLIB052803 00430 -1 Disputes Disclosure Form 435 -1 Answer the following questions by answering "YES" or "NO ". If you answer "YES ", please explain in the space provided, please add a page(s) if additional space is needed. 1. Has your firm, or any of its officers, received a reprimand of any nature or been suspended by the Department of Professional Regulation or any other regulatory agency or professional association within the last five (5) years? No 2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years? No 3. Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business? No If yes, the explanation must state the nature of the request for equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or status of suit and the monetary amounts or extended contract time involved. I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of the project identified. Peter V.Piacenti, President Printed or Typed Name and Title FORM NO. DSPT 12.204 IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD Stage Door II, Inc. Firm Drug -Free Work Place 435 -2 The undersigned, in accordance with Florida Statute 287.087 hereby certifies that the company named below does: 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 proposed 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 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, by 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. Stage Door II, Inc. Firm Signature FORM NO. DFWP 14.204 Peter V. Piacenti, President Printed or Typed Name and Title Date IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD Florida Statutes On Public Entity Crimes 435 -3 THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted to The City of Sanford by Peter V. Piacenti on behalf of Stage Door II, Inc. whose business address is: 3208 Overland Road Apopka, FL 32703 and (if applicable) its Federal Employer Identification Number (FEIN) is 59- 1450081 (If the entity has no FEIN, include the Social Security Number of the individual signing this statement: 2. 1 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 political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. 1 understand the "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, non jury trial, or entry of a plea of guilt or nolo contendere. 4. 1 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, employees, 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 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. 5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any 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 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. 6. 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.) X Neither the entity submitting this sworn statement, nor any of its officers, director, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity were charged with and convicted of a public entity crime after 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 the management of the entity, or any affiliate of the entity was charged with and convicted of a public entity crime after July 1, 1989. IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD The entity submitting this sworn statement, or one of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity was charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. (signature) (date) State of Florid County of (✓ t�itiG,�. AF On this - -) 9 day of -- T" t0, 20 1((, before me, the undersigned Notary Public of the State of Florida, p sonally appeared - -e4f —c I t?,& Cam, l and (Name(s) of individuals who appeared before notary) whose name(s) is /are Subscribed to the within instrument, and he /she /they acknowledge that he /she /they executed it. WITNESS my hand 1, and official seal. NOTARY PU LIC, STATE OF FLORIDA NOTARY PUBLIC _ SEAL OF OFFICE: (Name of Notary Public: Print, Stamp, or Type as 4ommissioned.) ,•r •' DEBORAH JEAN LACEY `= MY COMMISSION # EED48206 A EXPIRES December 12, 2014 I � , �� (407) 398 -0153 FloridalloterySe ice.com _ ✓Personally known to me, or _ Produced identification: (Type of Identification Produced) _ DID take an oath, or DID NOT take an oath. FORM NO. PEC 15.204 00435 -4 IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD Certification of Non - Segregated Facilities 435 -5 By affixing his signature to this form, the Bidder certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The Bidder certifies further that he will not maintain or provide for his employees any segregated facilities at any location under his control where segregated facilities are maintained. The Bidder agrees that a breach of this certification will be a violation of the Equal Opportunity clause in any contract resulting from acceptance of this Bid. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage and dressing areas, parking lots, drinking fountains, recreation or entertainment area, transportation and housing facilities provided for employees which are segregated by explicit directive, or are in fact segregated on the basis of race, color, religious disability or national origin, because of habit, local custom, or otherwise. The Bidder agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certifications in his files. The nondiscriminatory guidelines as promulgated in Section 202, Executive Order 11246, and as amended by Executive Order 11375 and as amended, relative to Equal Opportunity for all persons and implementations of rules and regulations prescribed by the United States Secretary of Labor are incorporated herein. NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. Date: By: Peter V. Piacenti President Print Name Title Official Address: 3208 Overland Road Apopka, FL 32703 FORM NO. SFAC 16.204 IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD Conflict of Interest Statement 435 -6 1. Peter V. Piacenti of Stage Door II, Inc. deposes and states that Name of Affiant Name of Company 2. The above named entity is submitting an Expression of Interest for the City of Sanford project identified below. 3. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 4. The Affiant states that only one submittal for the above project is being submitted and that the above named entity has no financial interest in other entities submitting proposals for the same project. 5. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive pricing in connection with the entity's submittal for the above project. This statement restricts the discussion of pricing data until the completion of negotiations and execution of the Agreement for this project. 6. Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participating in contract lettings by any local, state, or federal agency. 7. Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 8. 1 certify that no member of the entity's ownership, management, or staff has a vested interest in any aspect of or Department of the City of Sanford. 9. 1 certify that no member of the entity's ownership or management is presently applying for an employee position or actively seeking an elected position with City of Sanford. 10. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Sanford in writing. Sign Peter V. Piacenti Typed or Printed Name of Affiant State of Florida, County of QC" (�- C On this Z� day of - !.t 11 C', 20 11, before me, the Florida, personally j � r( l a pp e � A and (Name(s) of individuals who appeared before notary) whose name(s) is /are Subscribed to the within instrument, and he /she /they acknowledge that he /she /they executed it. WITNESS my hand and official seal. NOTARY PUBLIC, STATE OF FLORIDW NOTARY PUBLIC SEAL OF OFFICE: (Name of Notary Public: Print, Stamp, or Type a Commissioned.) personally known to me, or DEBORAH JEAN LACEY Produced identification: MY COMMISSION # EE048208 (Type of Identification Produced) EXPIRES December 12 2014 _ DID take an oath, or (407)398 -0133 F1ondalloterySwvioe.c= DID NOT take an oath. FORM NO. CFI 18.204 President Title 412. g Date undersigned Notary Public of the State of IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD Non - collusion Affidavit of Offeror /Bidder 435 -7 The undersigned, by signing this document hereby certifies that the company named below hereby is or does: 1. States that the entity named below and the individual signing this document has submitted the attached bid or proposal: 2. He is fully informed respecting the preparation and contents of the attached proposal and of all pertinent circumstances respecting such proposal; 3. Said bid or proposal is genuine and is not a collusive or sham bid or proposal; 4. Neither the said bidder or proposer nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other bidder, proposer, firm or person to submit a collusive or sham bid or proposal in connection with the Contract for which the attached bid or proposal has been submitted or to refrain from bidding or proposing in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communications or conference with any other bidder, proposer, firm or person to fix the price or prices in the attached bid or proposal or of any other bidder of proposer, or to fix any overhead, profit or cost element of the bid or proposal price or the bid or proposal price of any other bidder or proposer, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City of Sanford or any person interested in the proposed Contract. 5. The price or prices quoted in the attached bid or proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the bidder or proposer or any of its agents, representatives, owners, employees, or parties in interest, including the individual signing this document. —eh e ll op Signature of Affiant Date Peter V. Piacenti President Typed or Printed Name of Affiant Title State of Florida, County of LlVl(�� On this day of LA-Ac- 20 It , before me, the undersigned Notary Public of the State of Florida, personally appeared and ( Name(s) of individuals who appeared before notary) whose name(s) is /are Subscribed to the within instrument, and he /she /they acknowledge that he /she /they executed it. WITNESS my hand and official seal. NOTARY PU LIC, STATE OF FL DA NOTARY PUBLIC S DEBORAH JEAN LACEY '= MY COMMISSION # E&048206 N dr" EXPIRES ` IRES December 12, 2014 (407) 398 -u 153 FlorideNota ryService.com (Name of Notary Public: Print, Stamp, or Type as Commissioned.) ✓Personally known to me, or _ Produced identification (Type of Identification Produced) _ DID take an oath, or DID NOT take an oath IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD FORM No. AC 5.908 THIS FORM MUST BE SUBMITTED WITH BID Unauthorized (Illegal) Alien Workers 435 -8 The CITY will not intentionally award publicly- funded contracts to any contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324a(e) Section 274A(e) of the Immigration and Nationally Act (INA). The CITY shall consider the employment by the CONTRACTOR of unauthorized aliens, a violation of Section 274A(e) of the INA. Such violation by the CONTRACTOR of the employment provisions contained in Section 274A(e) of the INA shall be grounds for immediate termination of this Agreement by the CITY. 1. By executing this certification, the CONTRACTOR certifies that Stage Door II, Inc. (name of company) does not and will not during the performance of any contract resulting from the solicitation identified below employ illegal alien workers or otherwise violate the provisions of the federal Immigration Reform and Control Act of 1986. 2. The Undersigned agrees to, upon request of the City, provide copies of Immigration Form I- 9 for each person associated with the above named company who has been or is present at the designated jobsite associated with any work or project resulting from this solicitation. CONTRACTOR: Stage Door II, Inc. Signature Printed Name: Peter V. Piacenti Title: President Date: GZZ 61 Affix Corporate Seal STATE OF )SS COUNTY OF The foregoing instrument was acknowledged before me this 2- day of I 46 20 it by �1 of S �-Ac r ��r - rr T ic on behalf of the fir /She is rsonally kno n to me or has produced identification. Print Name b f h Notary Public in and for the County and State Aforementioned My commission expires: DEBORAH JEAN LACEY A MY COMMISSION # E6048206 tm EXPIRES December 12, 2014 (407)398 -0753 FlondallotaryService.com Form No. IM 0506.209 firm), IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD Americans With Disabilities Act Affidavit 435 -9 By executing this Certification, the undersigned CONTRACTOR certifies that the information herein contained is true and correct and that none of the information supplied was for the purpose of defrauding the City of Sanford (CITY). the CONTRACTOR will not discriminate against any employee or applicant for employment because of physical or mental handicap in regard to any position for which the employee or applicant for employment is qualified. The CONTRACTOR agrees to comply with the rules, regulations and relevant orders issued pursuant to the Americans with Disabilities Act (AFA), 42 USC s. 12101 et seq. It is understood that in no event shall the CITY be held liable for the actions or omissions of the CONTRACTOR or any other party or parties to the Agreement for failure to comply with the ADA. The CONTRACTOR agrees to hold harmless and indemnify the CITY, its agents, officers or employees from any and all claims, demands, debts, liabilities or causes of action of every kind or character, whether in law or equity, resulting from the CONTRACTOR's acts or omissions in connection with the ADA. CONTRACTOR: Stage Door II Inc. Signature: -, ��� Printed Name: Peter V. Piacenti Title: President Date: Affix Corporate Seal STATE OF F to ZAP ,A ) )SS COUNTY OF Q,t° oW e ) The foregoing instrument was acknowledged before me this Z°t day of - -TIA.Ae , 20 l , by e( l�i of E firm), on behalf of the firm.(tLoYShe is pergonally kno 4h to me or has produced identification. Print Name DP60raLi :Te -,) Notary Public in and for the County and State Aforementioned My commission expires: Y'•'wt• DEBORAH JEAN LACEY • 1. t Py1Y COMMISSION # E6048206 "•?o. EXPIRES December 12, 2014 1 0 7 :398-ul 63 FforidallotaryService.com Form No. AWD 0512.209 Section 00425 -11 Code of Sanford, Florida IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD 435 -10 Affidavit: Security and Public Safety Requirements The CONTRACTOR shall be responsible for the accepted standards, appearance, conduct, and safety of its employees, subcontractors, agents, and any other person caused by the CONTRACTOR to have access to any facility under the authority of the City. 1. The CONTRACTOR under any agreement with the City, shall require all personnel under its cognizance, at all times when performing work in the context of that agreement to wear identification badges which, at a minimum, provides the name of the employee and the CONTRAACTOR. 2. The CONTRACTOR shall, when so required, provide to the CITY a list of employees working on the project which includes a list of employee work days, times and assignments for each employee within forty -eight (48) hours of the request for such information. This information, when requested by the CITY, shall be provided prior to the employees of the CONTRACTOR entering the CITY's premises. 3. The CONTRACTOR shall comply with Section 2 -67 of the Sanford City Code as it relates to security screenings of private contractors, subcontractors and employees of private contractors. The CONTRACTOR shall cause each person designated or found by the City to be functioning in a position and /or location critical to the security and /or public safety of the CITY to undergo the following inquiries and procedures conducted by the City of Sanford: a. Fingerprinting in accordance with the CITY's Procurement procedures, b. Submission of the fingerprints to the Florida Department of Law Enforcement for state criminal history evaluation, and C. Submission of the fingerprints to the Federal Bureau of Investigation for a national criminal history evaluation. Such confidential information shall be used by the CITY to determine a person's eligibility to function in such critical employment position(s) as described. Additionally, the CITY may request and the CONTRACTOR shall provide the name, address and social security number and licenses (driver's, commercial drivers license or CDL, or other operator's license) for employees of the CONTRACTOR that may work on the CITY's premises in positions found by the City to be critical to the security and /or public safety of the CITY by reason of access to any publicly owned or operated facility. The CONTRACTOR shall release such information upon approval of the employees. If an employee refuses to authorize the release of their address, social security number and /or licenses they shall not be allowed to work or contiwueAQ -work in such critical p9siMms. i Signature of Affiant Date Peter V. Piacenti President Stage Door II, Inc. Typed or Printed Name of Affiant Title Name of Company State of Florida, County of 01: ,V C On this 90 day of �i l,n� . , 20 I before me, the undersigned Notary Public of the State of Florida, personally appeared - Pe �f (`, P,VH A. and ( Name(s) of individuals who appeared before notary) whose name(s) is /are Subscribed to the within instrument, and he /she /they acknowledge that he /she /they executed it. WITNESS my hand and official seal. NOTARY Pff BLIC, STATE OF ORIDA NOTARY PUBLIC SEAL OF OFFICE: ,►" "•' DEBORAH JEAN LACEY ,� MY COMMISSION # E6048206 9y EXPIRES December 12, 2014 (407)398 -0753 FloridallotaryService.com (Name of Notary Public: Print, Stamp, or The as Commissioned.) Personally known to me, or _ Produced identification (Type of Identification Produced) DID take an oath, or DID NOT take an oath IFB- 10/11 -14 Oleander Avenue Extension THIS FORM MUST BE COMPLETED AND RETURNED TO THE CITY OF SANFORD