PROCLAMATION #PRO2012-10
IN HONOR OF NATIONAL POLICE WEEK
Whereas, the members of the law enforcement agency of the Dunnellon Police Department play an essential
role in safeguarding the rights and freedoms of the City of Dunnellon; and
Whereas, it is important that all citizens know and understand the duties, responsibilities, hazards, and
sacrifices of their law enforcement agency, and that members of our law enforcement agency recognize their
duty to serve the people by safeguarding life and property, by protecting them against violence and disorder,
and by protecting the innocent against deception and the weak against oppression; and
Whereas, the men and women of the law enforcement agency of the City of Dunnellon unceasingly provide a
vital public service.
NOW, THEREFORE, the Dunnellon City Council calls upon all citizens of Dunnellon and upon all
patriotic, civic and educational organizations to observe the week of May 13 through May 19, 2012, as Police
Week with appropriate ceremonies and observances in which all of our people may join in commemorating
law enforcement officers, past and present, who, by their faithful and loyal devotion to their responsibilities,
have rendered a dedicated service to their communities and, in so doing, have established for themselves an
enviable and enduring reputation for preserving the rights and security of all citizens.
I further call upon all citizens of the City of Dunnellon to observe Sunday, May 13, 2012, as Peace Officers'
Memorial Day in honor of those law enforcement officers who, through their courageous deeds, have made
the ultimate sacrifice in service to their community or have become disabled in the performance of duty, and
let us recognize and pay respect to the survivors of our fallen heroes.
PASSED and PROCLAIMED this 14th day of May 2012. DUNNELLON CITY COUNCIL __________________________________ FRED R. WARD, Mayor __________________________________ FREDERICK C. STARK, Vice-Mayor __________________________________ DENNIS D. EVANS, Councilman ATTEST: __________________________________ LYNNE B. MCANDREW, Councilwoman _______________________________ __________________________________ DAWN M. BOWNE, MMC PENELOPE L. FLEEGER, Councilwoman City Clerk
DUNNELLON POLICE DEPARTMENTCODE ENFORCEMENT DWISION
12014 SOUTH WILLIAMS STREETDUNNELLON, FL 34432
NOTICE OF VIOLATION
DATE: FEBRUARY 27, 2012 RE: CA5E#120362VIoL~rIoN ADDRESs:20413 W. MCKINNEY AVE., DUNNELLON, FLLEGAL DESCRIPTION:SEC 35 TwP 16 RGE 18, PLAT BK A PG 174DUNNEU..ON, E ½ OF LOT 1251, ID#3380-1251-02
OWNER: WILLIE JONES, JR.P0 BOX 641CHIEFLAND, FL 32644-0641
DEAR SIR/MADAM:
You ARE HEREBY NOTIFIED THAT ON FEBRUARY 27, 2012, THE FOLLOWING INiTIAL VIOLATION(S)WERE OBSERVED ON ThE ABOVE REFERENCED PROPERTY:
VIOLATION(S): NUISANCE STRUCTURES — DETERIORATED BUILDINGSCITY OF DuNNELLON ORDINANCE SECTION 99A, 99.5
CORRECTIVE ACTION REQUIRED: REPAIR OR REMOVE STRUCTURES
THE ABOVE CONDmON(S) MUST BE CORRECTED AND THE PROPERTY BROUGHT INTO COMPLIANCE BYAPRIL 30, 2012. FAILuRE TO COMPLY BY THE TIME SPECIFIED MAY RESULT IN A PUBLIC HEARINGBEFORE THE SPECIAL MAGISTRATE.
THE SPECIAL MAGISTRATE HAS THE POWER TO ISSUE ORDERS HAVING THE EFFECT OF LAW; TOORDER ABATEMENTS AND REPAIRS; TO ESTABLISH AND LEVY FINES UP TO $500 PER DAY. FINES ANDPENALTIES IMPOSED BY THE SPECIAL MAGISTRATE MAY BECOME LIENS WiTH THE CLERK OF COURT.
IF YOU TRANSFER OWNERSHIP OF THE AFOREMENTIONED PROPERTY PRIOR TO THE HEARING, YOUMUST DISCLOSE THE EXISTENCE OF THIS VIOLATION(S) TO THE TRANSFEREE AND PROVIDE NOTICE OFTHE TRANSFER TO THE ENFORCEMENT OFFICIAL AS REQUIRED BY FLORIDA STATUTE SECTION162.06.
SHOULD YOU REQUIRE FURTHER INFORMATION OR ASSISTANCE, PLEASE CONTACT THE CODEENFORCEMENT DIVISION AT (352) 465-8510.
RESPECTFULLY SUBM1TrED,
— I ~
_______~~~~
‘I
LARRY STR~US, CODE ENFORCEMENT OFFICER
Ordinance ORD2O1 1-03 Abatement of Dangerous BuildingsPage 4
b. After the sixtieth day, the case will first be referred to the CityCouncil for a preliminary review of the circumstances. The property owner will benoticed as to the date and time of the Council Hearing in the same manner asprovided in Paragraph 3. At the scheduled Council Meeting, the Staff will presentthe facts of the case and the property owner or his designee will be allowed tooffer testimony.
c. At the conclusion of this limited review, the Council will vote toeither send the matter back to Code Enforcement for further resolution or refersame to the Special Magistrate for hearing and possible approval of demolition orother corrective action at the expense of the property owner. This notice shallinform all recipients of the date, time and location where the Special Magistratewill consider the case.
(5) After the initial notice is given and while the 60-day period allowed forcorrective action is running, city staff will determine if the building in question hasany special historical or cultural significance:
a. Staff should consult knowledgeable citizens and other sources inthis determination.
b. Staff should also determine whether the city would benefit byacquiring the property or whether any other person or agency may be interestedin doing so in furtherance of community development efforts, or efforts to provideaffordable housing or other public benefits, if the city should obtain title to it vialien foreclosure or in some other manner as a result of the code enforcementactivities.
c. Staff shall keep notes of its investigations under this subsection, inorder to document that this procedure has been followed and to support theultimate determination made as to these questions.
d. All investigations should be completed by the end of the 60-daycurative period allowed in the initial notice.
(6) If the conditions which led to issuance of the initial notice have not beenresolved:
a. and no arrangements satisfactory to the building official or codeenforcement officer have been made to alleviate those conditions by the end ofthe sixty (60) days;
b. no appeal has been filed, or if an appeal was filed, if a final decisionhas been rendered supporting the determination of the building official; and
4th version- Monday, March 28, 2011
MCPA Search Results Page 1 of 3
Marion county Property AppraiserVith~ M~. Srniti~ CFA~ ASA
HOME SearchPrevious ParcelNext ParcelTRIM NoticeTRIM SupplementAddress Change Form
GO TO 2011 2010 PRC
20123380-1251-02
Property Information Nap It.! As of 4/30/2012
JONES WILLIE JR lazes / Assessments: r~1.S.T.U.P0 BOX 641 Nap: 21 PC:01CHIEFLAND FL 32644—0641 Nih Group: 3002 Acres: 0.15
Location: 20413 W MCKINNEY AV DUNNELLON
Values NOT Available
History of Assessed Values
Year Land Building Misc Impr Just Assessed Exemption Taxable2011 $4,850 $0 $0 $4,850 $4,850 $0 $4,8502010 $4,850 $0 $0 $4,850 $4,850 $0 $4,8502009 $6,063 $0 $0 $6,063 $6,063 $0 $6,063
Property Description
35 TWP 16 RGE 18FLAT BOOK A PAGE 174DUNNELLONE 1/2 OF LOT 1251
Land Data — Warning: Verify Zoning
Use Front Depth Zone C NotesUnits TypeRate Loc Shp Phy Class Value Just Value0100 50 135 R3A 50.00 FF 1.00 0.97 1.00
Neighborhood 8150 - DUNNELLON HISTORICALDISTRICT
Mkt: 1 70
http://2 16.255.243.13 5/DEFAULT.aspx?Key80 1 828&YR~20 12 4/30/2012
MCPA Search Results
Building 1 of 1
RESO1=L12D32R26U12L14U20.USTO2=R5D5L5U5 D5UOP03=D15R5U15L5 . U5L12D32R1UOPO4=D6R24U6L24.
Page 2 of 3
RESO1 12
5 5
SUOPO3S
Type ID Exterior Walls
RES 01 26 — SIDING—NO SHTGFiST 02 26 - SIDING—NO SHTG
Bsmt Grd Flr Total FlrFinish Area Area
0 1 552 552 SF0% 25 25SF
raverse
JSTO2S
20
15 15
32
14
12
2FiUOPO4 24
6 6
24
Building Characteristics
Structure Type 1F-SFR- 01 FAMILY RESID Year Built 1918
Effective Age 9 - 40-99 YRS Obsolescence: Functional 0.00 %
Condition 0 - 0 Obsolescence: Locational 0.00 %
Quality Grade 1 - POOR Architecture 0 - STANDARD SFR
Inspected on 7/15/2011 by 118 Base Perimeter 116
Nbr Yr Attic BsmtStories Built Finish Area
1.00 1918 N 0 %1.00 1918 N 0 1
http://216.255.243.135/DEFAULT.aspx?Key=801 828&YR2012 4/30/2012
MCPA Search Results Page 3 of 3
UOP 03 01 - NO EXTERIORUOP 04 01 - NO EXTERIOR
1.00 1918 N 0 % 0 %1.00 1918 N 0 % 0 %
Section: 1
Roof Type 10 GABLE
Roof Cover 16 GALVANIZEDMTL
Heat Typel 02 NO HEATMETHOD
Heat Type2 00
Foundation 3 PIER
A/C N
Floor Finish
Wall Finish
Heat Sourcel
Heat Source2
Fireplaces
28 SOFTWD ONWOOD
22 CUSTOM WDPANL
02 NO HEAT FUEL
00
0
Bedrooms 2 Kitchen Y
4FixBath 0 Dishwasher N
3FixBath 1 Disposal N
2FixBath 0 Compactor N
XFixture 2 Intercom N
Vacuum N
75144
75 SF144 SF
http://2 16.255.243.13 5/DEFAULT.aspx?Key801 828&YR20 12 4/30/2012
Property Tax Module - Tax Roll Property Summary Page 1 of 2
Tax Roll Property SummaryTHIS INFORMATION IS NOT A TITLE SEARCH
THE IN FORMATION IS NOT WARRANTED
New Search Back to Search Results Help
Account Number R3380-1251-02 Type REAL ESTA1
Address 2O413WMCKINNEYAVI DU Status
SeclTwnlRng 35 16 18 Subdivision 8150
Year Roll Account Number Status Date Paid Amount Paid Balance Due
1999 R 1999 R3380-1251-02 PAID 12/1999 141.11
2000 R 2000 R3380-1251-02 PAID 12/2000 157.19
2001 R 2001 R3380-1251-02 PAID 01/2002 77.32
2002 R 2002 R3380-1251-02 PAID 12/2002 81.51
2003 R 2003 R3380-1251-02 PAID 11/2003 77.99
2004 R 2004 R3380-1251-02 PAID 03/2005 78.16
2005 R 2005 R3380-1251-02 PAID 04/2006 77.94
2006 R 2006 R3380-1251-02 PAID 12/2006 70.00
2007 R 2007 R3380-1251-02 PAID 04/2008 108.30
2008 R 2008 R3380-1251-02 PAID 01 /2009 102.40
2009 R 2009 R3380-1251-02 PAID 05/2010 125.22
2010 R 2010 R3380-1251-02 PAID 01/2011 89.81
2011 R 2011 R3380-1251-02 PAID 02/2012 91.86
CURRENT ACCOUNT DETAILS
Account Number 2011 R3380-1251-02
Property Description Owner Information
SEC 35 TWP 16 RGE 18 PLAT BOOK A JONES WILLIE JRPAGE 174 DUNNELLON E 1/2 OF LOT P0 BOX 6411251 CHIEFLAND FL 32644-0641
Current Values and Exemptions Taxes and Fees Levied
ASSESSMENT 4,850 TAXESTAXABLE 4,850
FEB 29 2012 MAR 31 2012 APR 30 2012 PAST DUE ON
91.86 92.79 95.57 APR 1 2012
Post Date Receipt # Pint Type Status Disc Interest Tota:
https://www.mariontax.comlitm/PropertyDetails.aspx?Acctno=+++++++++++++++R33 80... 4/30/2012
Property Tax Module - Tax Roll Property Summary Page 2 of 2
102/07/2012 998 2011 2055049.0001 Pmt Posted $.93— $.00 $91.8’
Links of InterestLINK TO PROPERTY APPRAISER WEB
https://www.mariontax.comlitm!PropertyDetails.aspx?Acctno+++++++++++++++R3 380... 4/30/2012
DUNNELLON POLICE DEPARTMENTCODE ENFORCEMENT DWISION
12014 SOUTH WILLIAMS STREETDUNNELLON, FL 34432
NOTICE OF VIOLATION
RE: CASE#11-0674VIOLATION ADDRESS: 20689 W. MCKENNEY AVE., DUNNELLON, FLLEGAL DESCRIPTION: SEC 35 TWP 16 RGE 18, PLAT BK A PG 174,DUNNELLON LoT 1264, PARCEL ID#3380-1264-00
OWNER: EST OF ANNIE (AMIE) MILTONC/O CARL FRAZIER1060 NW 102~ ST.MIAMI, FL 33150
DEAR SIR/MADAM:
You ARE HEREBY NOTIFIED ThAT ON FEBRUARY 24, 2012, ThE FOLLOWING INiTIAL VIOLATION(S)WERE OBSERVED ON ThE ABOVE REFERENCED PROPERTY:
VIOLATION(S): PUBLIC NUI5AwcE STRUCTURE — DETERIORATED BUILDING (HOUSE)CiTY OF DUNNEIION ORDINANCE SEcrIoN 99A-2, 99-2 & 99-5
CORRECTIVE ACELON REQUIRED REPAIR OR REMOVE STRUCTURE
THE ABOVE CONDmON(S) MUST BE CORRECTED AND THE PROPERTY BROUGHT INTO COMPLIANCE BYAPRIL 30, 201.2. FAILURE TO COMPLY BY THE TIME SPECIFIED MAY RESULT IN A PUBLIC HEARINGBEFORE THE SPECIAL MAGISTRATE.
THE SPECIAL MAGISTRATE HAS THE POWER TO ISSUE ORDERS HAVING THE EFFECT OF LAW; TOORDER ABATEMENTS AND REPAIRS; TO ESTABLISH AND LEVY FINES UP TO $500 PER DAY. FINES ANDPENALTIES IMPOSED BY ThE SPECIAL MAGISTRATE MAY BECOME LIENS WITH ThE CLERK OF COURT.
IF YOU TRANSFER OWNERSHIP OF ThE AFOREMENTIONED PROPERTY PRIOR TO ThE HEARING, YOUMUST DISCLOSE THE EXISTENCE OF THIS VIOLATION(S) TO THE TRANSFEREE AND PROVIDE NOTICE OFTHE TRANSFER TO ThE ENFORCEMENT OFFICIAL AS REQUIRED BY FLORIDA STATUTE SECTION162.06.
SI-IOUW YOU REQUIRE RJRTHER INFORMATION OR ASSISTANCE, PLEASE CONTACT ThE CODEENFORCEMENT DIVISION AT (352) 465-8510.
RESPECTFULLY SUBMiTTED,
~;f:: ~LARRY US, CODE ENFORCEMENT OFFICER
DATE: FEBRUARY 24, 2012
Ordinance ORD2OI 1-03 Abatement of Dangerous BuildingsPage 4
b. After the sixtieth ~ the case will first be referred to the CityCouncil for a preliminary review of the circumstances. The property owner will benoticed as to the date and time of the Council Hearing in the same manner asprovided in Paragraph 3. At the scheduled Council Meeting, the Staff will presentthe facts of the case and the property owner or his designee will be allowed tooffer testimony.
c. At the conclusion of this limited review, the Council will vote toeither send the matter back to Code Enforcement for further resolution or refersame to the Special Magistrate for hearing and possible approval of demolition orother corrective action at the expense of the property owner. This notice shallinform all recipients of the date, time and location where the Special Magistratewill consider the case.
(5) After the initial notice is given and while the 60-day period allowed forcorrective action is running, city staff will determine if the building in question hasany special historical or cultural significance:
a. Staff should consult knowledgeable citizens and other sources inthis determination.
b. Staff should also determine whether the city would benefit byacquiring the property or whether any other person or agency may be interestedin doing so in furtherance of community development efforts, or efforts to provideaffordable housing or other public benefits, if the city should obtain title to it vialien foreclosure or in some other manner as a result of the code enforcementactivities.
c. Staff shall keep notes of its investigations under this subsection, inorder to document that this procedure has been followed and to support theultimate determination made as to these questions.
d. All investigations should be completed by the end of the 60-daycurative period allowed in the initial notice.
(6) If the conditions which led to issuance of the initial notice have not beenresolved:
a. and no arrangements satisfactory to the building official or codeenforcement officer have been made to alleviate those conditions by the end ofthe sixty (60) days;
b. no appeal has been filed, or if an appeal was filed, if a final decisionhas been rendered supporting the determination of the building official; and
4th version- Monday, March 28, 2011
MCPA Search Results Page 1 of 5
Marion county Proper~ AppraiserVith M~. Smith,, CFA~ AS4\
HONE SearchPrevious ParcelNext ParcelTRIM NoticeTRIM SupplementAddress Change Form
GO TO 2011 2010 PRC
20123380—1264—00Prime Key: ~?roertv Information Map It! As of 4/30/2012
MILTON ANNIE EST OF lazes / Assessments: M.S.T.U.C/O CARL FRAZIER Map: 21 PC:081060 NW 102ND ST Mill Group: 3002 Acres: 0.34MIAMI FL 33150
Location: 20689 W MCKINNEY AVE DUNNELLON
Values NOT Available
History of Assessed Values
Year Land Building Misc Impr Just Assessed Exemption Taxable2011 $10,573 $41, 513 $1,087 $53, 173 $53, 173 $0 $53, 1732010 $10,573 $45,333 $1, 087 $56, 993 $56, 993 $0 $56, 9932009 $13,216 $54,327 $1,086 $68,629 $68,629 $0 $68,629
Property Transfer History
Book/Page Date Instrument Code Q/U V/I PriceUNRE/INST 05/01 71 DTH CER 0 U I $1000463/0038 04/71 07 WARRANTY 9 UNVERIFIED U I $100
Property Description
SEC 35 TWP 16 RGE 18PLAT BOOK A PAGE 174DUNNELLONLOT 1264
Land Data — Warning: Verify Zoning
Use Front Depth Zone C Notes Units TypeRate Loc Shp Phy Class Value Just Value
http://2 16.255.243.13 5/DEFAULT.aspx?Key=802000&YR20 12 4/30/2012
MCPA Search Results Page 2 of 5
0100 109 135 R3A 109.00 FT 1.00 0.97 1.00
Neighborhood 8150 - DUNNELLON HISTORICALDISTRICT
Mkt: 1 70
T:ra verseBuilding 1 of 2
RESO1=L20D7L13U23R2U18R31D34.FSPO2=L20D7R20U7.U34L315T003=R31U5L31D5.
PTOO3 31
5 53131
18
34RESGI
23
20FSPO2 20
7 7
13
Building Characterist:ics
Structure Type 1F-SFR- 01 FAMILY RESID Year Built 1968
Effective Age 5 - 20-24 YRS Obsolescence: Functional 0.00 %
Condition 2 - 2 Obsolescence: Locational 0.00 %
Quality Grade 400 - FAIR Architecture 0 - STANDARD SFR
Inspected on 5/20/2008 by 209 Base Perimeter 148
http://2 16.255.243.13 5/DEFAULT.aspx?Key=802000&YR20 12 4/30/2012
MCPA Search Results Page 3 of 5
• Nbr Yr Attic Bsmt Bsmt Grd Fir Total FlrType ID Exterior Walls .Stories Built Finish Area Finish Area AreaRES 01 24 — CONC ELK—PAINT 1.00 1968 N 0 % 0 % 1,177 1,177 SFFSP 02 01 — NO EXTERIOR 1.00 1968 N 0 % 0 1 140 140 SFPTO 03 01 — NO EXTERIOR 1.00 1968 N 0 1 0 1 155 155 SF
Section: 1
Roof Type 10 GABLE Floor Finish 24 CARPET Bedrooms 2 Kitchen Y
Roof Cover 08 FBRGLASS SHNGL Wail Finish 16 DRYWALL-PAINT 4FixBath 0 Dishwasher N
Heat Typel 22 DUCTED FRA Heat Sourcel 10 ELECTRIC 3FixBath 2 Disposal N
Heat Type2 00 Heat Source2 00 2FixBath 0 Compactor N
Foundation 7 BLK PERIMETER Fireplaces 0 XFixture 2 Intercom N
A/C Y Vacuum N
Building 2 of 2Traverse
http://2 16.255.243.13 5/DEFAULT.aspx?Key=802000&YR20 12 4/30/2012
MCPA Search Results Page 4 of 5
RESO1=R22U36L22D36 . RiFSPO2=R2006L20U6.UCPO3=D6L13U24R12D18R1 . L1U36R1USPO4=R20U6L20D6.
01 10 - ASBESTOS SHNGL02 01 - NO EXTERIOR03 01 - NO EXTERIOR04 01 - NO EXTFRIOR
Nbr YrStories Built
1.00 19381.00 19381.00 19381.00 2004
Area Area792 792 SF120 120 SF294 294 SF120 120 SF
USPO4 20
6
20
6~
~S01 22
36 36
22
LICPO3 12
24
18
FSPO2 20
6
13 20
Building Characteristics
Structure Type 1F-SFR- 01 FAMILY RESID Year Built 1938
Effective Age 9 - 40-99 YRS Obsolescence: Functional 0.00 %
Condition 1 - 1 Obsolescence: Locational 0.00 %
Quality Grade 200 - LOW Architecture H -
Inspected on 5/20/2008 by 209 Base Perimeter 116
Type ID Exterior Walls
RESFS PUC P[iS P
AtticFinish
N
BsmtArea0%
Bsmt Grd Fir Total FlrFinish
0%~Th
L4
N 0% 0-~N 0% 0%
http://2 16.255.243.135~EFAULT.aspx?Key8O2O0O&YR2O 12 4/30/2012
MCPA Search Results Page 5 of 5
Section: 1
Roof Type 10 GABLE Floor Finish ~Q~OFTWD ON Bedrooms 2 Kitchen Y
16 GALVANIZED 12 PLYWDRoof Cover MTL Wall Finish PANELING 4FixBath0DishwasherN
Heat Typel 06 CONVECTION Heat Sourcel 08 OIL 3FixBath 1 Disposal N
Heat Type2 00 Heat Source2 00 2FixBath 0 Compactor N
Foundation 3 PIER Fireplaces 0 XFixture 2 Intercom N
A/C N Vacuum N
Miscellaneous Improvements
Type Nbr Units Type Life EYB Grade Length Width Depr Value159 PAV CONCRETE 1404.00 SF 20 1938 3 0.0 0.0250 WALLS MASONRY 60.00 SF 50 1938 3 15.0 4.0
Appraiser Notes
ANNIE MILTON IS ACTUALLY AMIE MILTON TYPO ON DEED BROTHERGEORGE LEE CAME IN TO VERIFY INFO & BRING FUNERAL ANNOUNCEMENT PER HX SSN~S OF DECEASED HUS MATCHESADD ON DIRT N/AINTERIOR INFORMATION ON BOTH HOMES ESTIMATED DPI
Planning and Building, County Permit Searchkk Fermit Search k~
Permit Number Amount Issued Completed Construction DescriptionDM03158 $8,960 7/1/1992 — RE—HAB (BLDG #1)
http://2 16.255.243.13 5~EFAULT.aspx?Key802000&YR2O12 4/30/2012
Property Tax Module - Tax Roll Property Summary
Tax Roll Property SummaryTHIS INFORMATION IS NOT A TITLE SEARCH
THE INFORMATION IS NOT WARRANTED
Page 1 of2
New Search Back to Search Results Helo
Account Number R3380-1264-0O Type REAL ESTATE REMINDER
Address 20689 W MCKINNEY AVE 1 DU Status
SeclTwnlRng 35 16 18 Subdivision 8150
Year Roll Account Number Status Date Paid Amount Paid Balance Due Pay Online
1999 R 1999 R3380-1264-O0 PAID 12/1999 191.23 Tax Bill
2000 R 2000 R3380-1264-0O PAID 12/2000 210.25 Tax Bill
2001 R 2001 R3380-1264-0O PAID 01/2002 232.87 Tax Bill
2002 R 2002 R3380-1264-0O PAID 03/2003 249.27 Tax Bill
2003 R 2003 R3380-1264-0O PAID 12/2003 961.52 Tax Bill
2004 R 2004 R3380-1264-00 PAID 11/2004 957.73 Tax Bill
2005 R 2005 R3380-1264-00 CER SOLD 06/2006 Tax Bill
2005 CER 2006-00007428-00 REDEEMED 08/2007 1,198.01 Certificate
2006 R 2006 R3380-1264-00 CER SOLD 06/2007 Tax Bill
2006 CER 2007-00007997-00 REDEEMED 08/2007 1,521.15 Certificate
2007 R 2007 R3380-1264-00 CER SOLD 06/2008 Tax Bill
2007 CER 2008-00010212-00 REDEEMED 06/2008 1,836.63 Certificate
2008 R 2008 R3380-1264-00 CER SOLD 06/2009 Tax Bill
2008 CER 2009-00014534-00 REDEEMED 10/2010 1,625.84 Certificate
2009 R 2009 R3380-1264-00 CER SOLD 06/2010 Tax Bill
2009 CER 2010-00015806-00 REDEEMED 10/2010 1,485.49 Certificate
2010 R 2010 R3380-1264-00 PAID 11/2010 1,033.81 Tax Bill
2011 R 2011 R3380-1264-00 UNPAID 1,047.80 Tax Bill
Add to cart
CURRENT ACCOUNT DETAILS
R3380-1264-00 Tax BillAccount Number 2011
Property Description Owner Information
SEC 35 TWP 16 RGE 18 PLAT BOOK A MILTON ANNIE EST OFPAGE 174 DUNNELLON LOT 1264 C/O CARL FRAZIER
1060 NW 102ND STMIAMI FL 33150
Current Values and Exemptions Taxes and Fees Levied
ASSESSMENT 53,173 TAXES 1,017.28TAXABLE 53,173 INT. 3.0000% 30.52
https://www.mariontax.comlitm!PropertyDetails.aspx?Acctno+++++++++++++++R3380... 4/30/2012
Property Tax Module - Tax Roll Property Summary Page 2 of 2
APR 30 2012
1,047.80
MAY 31 2012
1,053.85
ONLY CERTIFIED
ACCEPTED AFTER
FUNDS PAST DUE ON
APRIL 30 2012 APR 1 2012
Links of InterestLINK TO PROPERTY APPRAISER WEB
Post Date Receipt # Pmt Type Status Disc Interest Total
https://www.mariontax.comlitmlPropertyDetails.aspx?Acctno+++++++++++++++R3380... 4/30/2012
AC~RD
AGENCY
Brown & Brown of Florida, Inc.
P0 Box 491636
Leesburg FL 34749-1636
CONTACT Sandra Mitchell _____ —
PHONE —
~ (352)787—9922 X
~i~ss Sandy .Mitchell@bbleesburg. cornCODE: SUE CODE:
UNDERWRITER: UNDERWRITER OFFICE:POLICIES OR PROGRAM REQUESTED POLICY NUMBER
GL85 0845
INDICATE SECTIONS ATTACHED ELECTRONIC DATA PROCACCOUNTS RECEIVABLE! EQUIPMENT FLOATER
,......4 VALUABLE PAPERSBOILER & MACHINERY GARAGE AND DEALERS
BUSINESS AUTO GLASS AND SIGN
COMMERCIAL — INSTALLATION/BUILDERS RISKGENERAL LIABILITYCRIME/MISCELLANEOUS CRIME OPEN CARGO
DEALERS PROPERTY
DRIVER INFO SCHEDULE TRANSPORTATION!CV CAQ(Zfl
ACORD 125 (2007107)1NS125 (200707)
Page 1 of 3 © 1993-2007 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERC~AL INSURANCE APPLJCATION
APPLiCANT INFORMATION SECTIONCARRIER
Colony Ins Co
DATE (MMIDDIYYYY)
5/2/2012NAIC CODE
039993
A(tFNC.YnICTflMFPID: 00007938
TRUCKERS/MOTOR CARRIER
UMBRELLA
VEHICLE SCHEDULE
WORKERS COMPENSATION
YACHT
STATUS OF TRANSACTION PACKAGE POLICY INFORMATIONQUOTE ISSUE POLICY RENEW ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL LINES, OR FOR MONOLINE POLICIES.
BOUND (G~ve Date and/or Attach Copy): PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN AUDIT
CHANGE DATE TIME 3 AM DIRECT BILL _______________________________________
CANCEL 5/2/2012 12:01 PM 5/2/2012 5/2/2013 AGENCYBILL PACKAGEPOLICYPREMIUM:$ 0.00
APPLICANT INFORMATIONNAME (First Named Insured & Other Named Insureds) MAILING ADDRESS INCL ZIP+4 (of First Named Insured)
City of Dunnellon 20750 River Dr.
Dunnellon FL 34431
FEIN OR SOC SEC S PHONE (35>(of First Named Insured): )Q~xt(~~.__1 WEBSITEE-MAILADDRESS(ESI: mroberts@dunnellon . org I ADDRESS(ES(:
~ INDIVIDUAL CORPORATION SUBCHAPTER “5” LLC NO. OF MEMBERS DATE BUSCORPORATION AND MANAGERS CR BUREAU NAME: STARTEDfl~ NOT FOR~ PARTNERSHIP JOINT VENTURE PROFIT ORG . ID NUMBER:
INSPECTION CONTACT: ACCOUNTING RECORDS CONTACT:
PHONE E-MAIL PHONE E-MAIL(A/C, No. ExtI: ADDRESS: (NC, No, Exti: ADDRESS:
PREMISES INFORMATION ACORD 823 attached for additional premisesI YR S
LOC S BLD S STREET, CITY, COUNTY, STATE, ZIP+4 CITY LIMITS INTEREST ANNUAL REVENUESBUILT EMPLOYEES OCCUPIED
~ 20750 River Dr.
Dunnellon FL 34431 OUTSIDE H TENANT
1 Marion
~ INSIDE OWNER~ OUTSIDE TENANT I
~,
~ INSIDE OWNER~ OUTSIDE TENANT
~,
~ INSIDE OWNER
~ OUTSIDE,_~ TENANT
NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S)
Municipality
AGENCY CUSTOMER ID: 00007938GENERAL INFORMATIONEXPLAIN ALL ‘YES RESPONSES
15. IS THE APPLICANT A SUBSIDIARY OF ANOTHER ENTITY
lb. DOES THE APPLICANT HAVE ANY SUBSIDIARIES?
2. IS A FORMAL SAFETY PROGRAM IN OPERATION?
3. ANY EXPOSURE TO FLAMMABLES. EXPLOSIVES. CHEMICALS?
4. ANY CATASTROPHE EXPOSURE?
5. ANY OTHER INSURANCE WITH THIS COMPANY OR BEING SUBMITTED?
~
7. ANY PAST LOSSES OR CLAIMS RELATING TO SEXUAL ABUSE OR MOLESTATION ALLEGATIONS. DISCRIMINATION OR NEGLIGENT HIRING?
~8. DURING THE LAST FIVE YEARS (TEN IN RI), HAS ANY APPLICANT BEEN INDICTED FOR OR CONVICTED OF ANY DEGREE OF THE CRIME OF FRAUD, BRIBERY, ARSON OR ANY Ej~i
OTHER ARSON-RELATED CRIME IN CONNECTION WITH THIS OR ANY OTHER PROPERTY?(In RI, Ihis question must be answered by any applicant for property insurance, Failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to oneyear of imprisonment).
9.ANY UNCORRECTED FIRE CODE VIOLATIONS? - [~J
10. ANY BANKRUPTCIES, TAX OR CREDIT LIENS AGAINST THE APPLICANT IN THE PAST FIVE (5) YEARS? —
H. HAS BUSINESS BEEN PLACED INATRUST?IF “YES”, NAME OF TRUST: —
12. ANY FOREIGN OPERATIONS, FOREIGN PRODUCTS DISTRIBUTED IN USA, OR US PRODUCTS SOLD/DISTRIBUTED IN FOREIGN COUNTRIES?(If “YES”, attach ACORD 815 for Liability Eaposure and/or ACORD 816 for Property Exposure) L_.j
REMARKS/PROCESSING INSTRUCTIONS (Attach additional sheets if more space is required(
COPY OF THE NOTICE OF INFORMATION PRACTICES (PRIVACY) HAS BEEN GIVEN TO THE APPLICANT. (Not applicable in all states, consult your agent or broker for yoar stale’s requirements.)
NOTICE OF INSURANCE INFORMATION PRACTICES - PERSONAL INFORMATION ABOUT YOU, INCLUDING INFORMATION FROM A CREDIT REPORT, MAY BE COLLECTEDFROM PERSONS OTHER THAN YOU IN CONNECTION WITH THIS APPLICATION FOR INSURANCE AND SUBSEQUENT POLICY RENEWALS. SUCH INFORMATION ASWELL AS OTHER PERSONAL AND PRIVILEGED INFORMATION COLLECTED BY US OR OUR AGENTS MAY IN CERTAIN CIRCUMSTANCES BE DISCLOSED TO THIRDPARTIES WITHOUT YOUR AUTHORIZATION. YOU HAVE THE RIGHT TO REVIEW YOUR PERSONAL INFORMATION IN OUR FILES AND CAN REQUEST CORRECTION OFANY INACCURACIES. A MORE DETAILED DESCRIPTION OF YOUR RIGHTS AND OUR PRACTICES REGARDING SUCH INFORMATION IS AVAILABLE UPON REQUEST.
,CONTACT YOUR AGENT OR BROKER FOR INSTRUCTIONS ON HOW TO SUBMIT A REQUEST TO US.
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE ORSTATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANYFACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY: SUBSTANTIAL] CIVILPENALTIES. (Not applicable in CO, FL, HI, MA, NE, OH, OK, OR, or VT; in DC, LA, ME, TN, VA and WA, insurance benefits may also be denied)IN FLORIDA, ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATIONCONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.
THE UNDERSIGNED IS AN AUTHORIZED REPRESENTATIVE OF THE APPLICANT AND REPRESENTS THAT REASONABLE ENQUIRY HAS BEEN MADE TO OBTAIN THEANSWERS TO QUESTIONS ON THIS APPLICATION. HE/SHE REPRESENTS THAT THE ANSWERS ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF HIS/HERKNOWLEDGE.
PRODUCER’S SIGNATURE PRODUCER’S NAME (Please Print) NATIONAL PRODUCER NUMBER
APPLICANT’S SIGNATURE DATE
ACORD 125 (2007/07) Page 2 of 3INS125 (200707)
PRIOR CARRIER INFORMATION AGENCY CUSTOMER ID: 00007938
LINE CATEGORY
CARRIER
~ POLICY NUMBER
~ OCCURRENCE OCCURRENCE ~ ~~RRENcE ~ OCCURRENCE I OCCURRERCE
~ RETRO DATE
~ EFF-EXP DATE
N GENERAL AGGREGATE
c E PRODUCTS COM2 OPo R AGGREGATE
AL I PERSONAL & ADV INJM
E EACH OCCURRENCERL ~L:c I I FIRE DAMAGE
~‘ 5~L L S~ BODILY OCCURRENC~
I INJURY AGGREGATET~ —_______________________
“ PROPERTY OCCURRENCE
DAMAGE AGGREGATE~ -~-~________________________
j COMBINED SINGLE LIMIT
~ MODIFICATION FACTOR
~ TOTAL PREMIUM
CARRIER~~ POLICY NUMBER
A POLICY TYPEuLT I EFF-EXP DATE0ArM ~ COMBINED SINGLE LIMIT
B BODILY BA PERSON I
I T INJURY EAACCIDENT IEY
PROPERTY DAMAGE
MODIFICATION FACTOR
TOTAL PREMIUM
~ CARRIER
POL CY NUMBER
~ POLICY TYPE
~ EFF-EXP DATEELR I BUILDING AMT
~PROPAMT
~ MODIFICATION FACTOR I~ TOTAL PREMIUM
~ CARRIER
~ POLICY NUMBER
~ POLICY TYPE
~ EFF-EXP DATE
LIMIT
~ MODIFICATION FACTOR
~ TOTAL PREMIUM
LOSS HISTORYENTER ALL CLAIMS OR LOSSES (REGARDLESS OF FAULT AND WHETHER OR NOT INSURED) OR OCCURRENCES THAT MAY GIVE RISE TO CLAIMS CHK HERE SEE ATTACHEDFOR THE PRIOR 5 YEARS (3 YEARS IN KS & NY/ IF NONE LOSS SUMMARY
~ I CLAIM
OCCURRENCE LINE TYPE/DESCRIPTION OF OCCURRENCE OR CLAIM OF CLAIM AMOUNT RESERVED ~~TATUS
REMARKS NOTE: FIDELITY REQUIRES A FIVE YEAR LOSS HISTORY ATTACHMENTS
ij STATE SUPPLEMENT(S) (II applicable)
ACORD 125 (2007/07)INS125 (200707)
Page 3 of 3
Addition& Named ~nsureds
Other Named Insureds
Greenlight Dunnellon Communications Additional Named Insured
OFAPPINF (02/2007) COPYRIGHT 2007 AMS SERVICES INC
STATEMENT ACKNOWLEDGING THAT COVERAGE HAS
BEEN PLACED WITH A NON-ADMITTED CARRIER
Per Florida Statute, the insured is required to sign the following E&S disclosure:
The undersigned hereby agrees to place insurance coverage in the surplus lines market and understands
that superior coverage may be available in the admitted market and at a lesser cost. Persons insured by
surplus lines carriers are not protected by the Florida Insurance Guaranty Association with respect to any
right of recovery for the obligation of an insolvent unlicensed insurer.
City of Dunnellon
Named Insured
Signature of Insured’s Authorized Representative Date
Colony Ins Co
Name of Excess and Surplus Lines Carrier
General Liability
Type of Insurance
5/2/2012
Effective Date of Coverage
POLICYHOLDER DISCLOSURENOTICE OF TERRORISM INSU RANCE COVERAGE
You are hereby notified that under the Terrorism Risk Insurance Act, as amended, that you have a right to purchase insurancecoverage for losses resulting from acts of terrorism, as defined in Section 102(1) of the Act: The term “act of terrorism” meansany act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State and the Attorney General ofthe United States, to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, orinfrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain aircarriers or vessels or the premises of a United States mission: and to have been committed by an individual or individuals aspart of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of theUnited States Government bycoercion.
YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROMCERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHEREXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THEFORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 85% OF COVERED TERRORISM LOSSESEXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THECOVERAGE. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANYCHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT.
YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAPTHAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURER’S LIABILITY FOR LOSSES RESULTING FROMCERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BEREDUCED.
PLEASE ALSO BE AWARE THAT YOUR POLICY DOES NOT PROVIDE COVERAGE FOR ACTS OF TERRORISM THAT ARENOT CERTIFIED BY THE SECRETARY OF THE TREASURY.
Acceptance or Reiection of Terrorism insurance Coverage
You must accept or reject this insurance coverage for losses arising out of acts of terrorism, as defined in Section 102(1)of the Act, before the effective date of this policy, Your coverage cannot be bound unless our representative has receivedthis form signed by you on behalf of all insureds with all premiums due.
~ Coverage acceptance.I hereby elect to purchase coverage for certified acts of terrorism, as defined in Section 102(1) of the Act for aprospective annual premium of $847 . I understand that I will not have coverage for losses resultingfrom any non-certified acts of terrorism.
OR~ Coverage rejection.
I hereby decline to purchase coverage for certified acts of terrorism, as defined in Section 102(1) of the Act. Iunderstand that I will not have coverage for any losses arising from certified or non-certified acts of terrorism.
Colony Insurance CompanyPolicyholder/Applicant’s Signature Insurance Company
Must be person authorized to sign for all insureds.
___________________________________________________ GL850845
Print Name Policy Number
CITY OF DUNNELLON N/ADBA: GREENLIGHT DUNNELLON COMMUNICATIONS Submission Number
Named Insured 09031
___________________________________________________ Producer Number
Date ALL RISKS LTD. (FL)Producer Name
1551 SAWGRASS CORPORATE PKWY., SUITE 220Street Address
SUNRISE, FL 33323City, State, Zip
The producer shown above is the wholesale insurance broker your local insurance agent used to place yourinsurance coverage with us. Please discuss this Disclosure with your agent before signing.
TRIA2002Notice-0108 Page 1 of 1
Brown & Brown of Florida, Inc.PC Box 491636Leesburg, FL 34749-1636
City of Dunnellon20750 River Dr.Dunnellon, FL 34431
City of DunnellonCustQmer
7938
Date 05/02/2012
Customer Travis Childers, dCService Sandra Mitchell
Page lofi
Payment Information
Invoice $ummary 18,23433Payment AmountPayment for: lnvoice#1 66265GL850845
Customer: City of Dunnelloninvoice Effective Transaction Description Amount
Policy #GL850845 05/02/2012-05/02/2013
Colony Ins Co166265 05/02/2012 Renew policy General Liability - Renew policy 17,095.00
Florida Hurricane Cat Fun - Renew policy 1,139.33
Total
18,234.33
[~rown & Brown of Florida, Inc. (352)787-2431 1~atePC Box 491636Leesburg, FL 34749-1636 05/02/2012
©A~RD COMMERC~AL GENERAL UAB~LIITY SECT~ON
AGENCY APPLICANTC1ty of Out-mellon
](A/C,No(: (352)787—9922 ~ed
Brown & Brown of Florida, InC. nsure
P0 Box 491636 EFFECTIVEDATE EXPIRATIONDATE DIRECT BILL PAVMENTPLAN AUDIT
5/2/2012 5/2/2013 —~ AGENCY BILL
Leesburg FL 347491636 FORCOMPANY
CODE: SUB CODE: USEONLYAGENCY ~flQo793CUSTOMER ID:
COVERAGES LIMITS
~ COMMERCIAL GENERAL LIABILITY GENERALAGGREGATE $5,000,000 PREMIUMS
~ CLAIMS MADE L_J OCCURRENCE PRODUCTS & COMPLETED OPERATIONS AGGREGATE $5 , 000 , 000 PREMISES/OPERATIONS
OWNER’S&CONTRACTOR’S PROTECTIVE PERSONAL& ADVERTISING INJURY $5,000,000
EACH OCCURRENCE s5,000 ,000 PRODUCTS
DEDUCTIBLES DAMAGE TO RENTED PREMISES (each occurrence) $100 , 000~ PROPERTY DAMAGE $ — ] MEDICAL EXPENSE (Any one person) $5 , 000 OTHER
BODILY INJURY $ X CAM EMPLOYEE BENEFITS $
x Both RI & PD $2 .500 OCCURRENCE TOTAL
OTHER COVERAGES, RESTRICTIONS AND/OR ENDORSEMENTS (For hired/non-owned auto coverages attach the applicable stale Business Auto Section ACORD 137)
SCHEDULE OF HAZARDS
LOC HAZ CLASSIFICATION CLASS PREMIUM EXPOSURE TERR I RATE PREMIUMS S CODE BASIS PREM/OPS PRODUCTS PREM/OPS PRODUCTS
1 Contractors - Suc I~ contracted 91585 C Total if any
1 Contractors - Executive~ Supervisors 91580 P Payroll if any
Contractors —1 subcontracted work 91585 C Total 2,700,000
~Th-
~.__
RATING AND PREMIUM BASIS (P) PAYROLL- PER $1 .000/PAY (C> TOTAL COST - PER $1 .000/COST (U) UNIT - PER UNIT
(5) GROSS SALES - PER $1 .000/SALES (A) AREA - PER I .000/SO FT (M) ADMISSIONS - PER I 000/ADM (T( OTHER
CLAIMS MADE (Explain all “Yes’~ responses)EXPLAINALL “YES’ RESPONSES Y/N
1 PROPOSED RETROACTIVE DATE:
Z ENTRY DATE INTO UNINTERRUPTED CLA(MS MADE COVERAGE
3. HAS ANY PRODUCT, WORK, ACCIDENT. OR LOCATION BEEN EXCLUDED, UMNSURED OR SELF-INSURED FROM ANY PREVIOUS COVERAGE?
4. WAS TAIL COVERAGE PURCHASED UNDER ANY PREVIOUS POLICY?
EMPLOYEE BENEFITS LIABILITY
1± DEDUCTIBLE PER CLAIM: $ 3. NUMBER OF EMPLOYEES COVERED BY EMPLOYEE BENEFITS PLANS:[2. NUMBER OF EMPLOYEES: 4. RETROACTIVE DATE:
DATE (MM/DD)YYYY)
5/2/2 012
ACORD 126 (2007/05)INSI26 (200705)
Page 1 of 4 © ACORD CORPORATION 1993-2007. All rights reserved.The ACORD name and logo are registered marks of ACORD
CONTRACTORSEXPLAIN ALL ‘YES” RESPONSES (For past or present operations) YIN
1 DOES APPLICANT DRAW PLANS, DESIGNS, OR SPECIFICATIONS FOR OTHERS?
2. DO ANY OPERATIONS INCLUDE BLASTING OR UTILIZE OR STORE EXPLOSIVE MATERIAL?
3. DO ANY OPERATIONS INCLUDE EXCAVATION, TUNNELING, UNDERGROUND WORK OR EARTH MOVING?
4. DO YOUR SUBCONTRACTORS CARRY COVERAGES OR LIMITS LESS THAN YOURS?~
5. ARE SUBCONTRACTORS ALLOWED TO WORK WITHOUT PROVIDING YOU WITH A CERTIFICATE OF INSURANCE?
6. DOES APPLICANT LEASE EQUIPMENT TO OTHERS WITH OR WITHOUT OPERATORS?~J
DESCRIBE THE TYPE OF WORK SUBCONTRACTED $ PAID TO SUB- % OF WORK # FULL- II PARTLGONIRAGTP~S......~.~.J...SJ,ISPOJITBAGTED: TIME STAFF: TIME STAFF:
PRODUCTS/COMPLETED OPERATIONSPRODUCTS ANNUAL GROSS SALES II OF UNITS ~~tEi~r F INTENDED USE — PRINCIPAL COMPONENTS
EXPLAIN ALL “YES” RESPONSES IFor any pastor present product or operation) PLEASE ATTACH LITERATURE, BROCHURES, LABELS, WARNINGS, ETC. Y/N
1. DOES APPLICANT INSTALL, SERVICE OR DEMONSTRATE PRODUCTS? E
2. FOREIGN PRODUCTS SOLD, DISTRIBUTED, USED AS COMPONENTS? (If “YES”, attach ACORD 815) Li3. RESEARCH AND DEVELOPMENT CONDUCTED OR NEW PRODUCTS PLANNED? Li
4. GUARANTEES. WARRANTIES, HOLD HARMLESS AGREEMENTS? -_______________________________
5. PRODUCTS RELATED TO AIRCRAFT/SPACE INDUSTRY? -~_______________
6. PRODUCTS RECALLED. DISCONTINUED, CHANGED?
7. PRODUCTS OF OTHERS SOLD OR RE-PACKAGED UNDER APPLICANT LABEL?
8. PRODUCTS UNDER LABEL OF OTHERS? E1
9. VENDORS COVERAGE REQUIRED?
10. DOES ANY NAMED INSURED SELL TO OTHER NAMED INSUREDS?
ACORD 126 (2007/05)INS-I 26 (200705)
ATTACH TO ACORD 125
ACORD 45 attached for additional namesADDITIONAL INTEREST/CERTIFICATE RECIPIENTINTEREST RANK: I NAME AND ADDRESS REFERENCE C: CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER—
X~ ADDITIONALINSURED Progress Energy LOCATION: BUILDING:
~ LOSS PAYEE 3300 Exchange Place VEHICLE: BOAT:
MORTGAGEE SCHEDULED ITEM NUMBER:
,j LIENHOLDER OTHER
,_____~ EMPLOYEEAS LESSOR Lake Mary FL 32746
ITEM DESCRIPTION:
GENERAL INFORMATIONY/NEXPLAIN ALL YES’ RESPONSES (For all past or present operations)
1. ANY MEDICAL FACILITIES PROVIDED OR MEDICAL PROFESSIONALS EMPLOYED OR CONTRACTED?
2. ANY EXPOSURE TO RADIOACTIVE/NUCLEAR MATERIALS?
3. DO/HAVE PAST, PRESENT OR DISCONTINUED OPERATIONS INVOLVE(D) STORING, TREATING, DISCHARGING, APPLYING, DISPOSING. ORTRANSPORTING OF HAZARDOUS MATERIAL? (e.g. landfills, wastes, fuel tanks, etc)
4. ANY OPERATIONS SOLD, ACQUIRED, OR DISCONTINUED IN LAST FIVE (5) YEARS? —
5. MACHINERY OR EQUIPMENT LOANED OR RENTED TO OTHERS?
6. ANY WATERCRAFT, DOCKS, FLOATS OWNED, HIRED OR LEASED?
7. ANY PARKING FACILITIES OWNED/RENTED? — —
~ ISA FEE CHARGED FOR PARKING?
9. RECREATION FACILITIES PROVIDED?
10. IS THERE A SWIMMING POOL ON THE PREMISES?
11. SPORTING OR SOCIAL EVENTS SPONSORED?
12. ANY STRUCTURAL ALTERATIONS CONTEMPLATED?
13. ANY DEMOLITION EXPOSURE CONTEMPLATED?
14. HAS APPLICANT BEEN ACTIVE IN OR IS CURRENTLY ACTIVE IN JOINT VENTURES? —
15.DO YOU LEASE EMPLOYEES TO OR FROM OTHER EMPLOYERS?
16. IS THERE A LABOR INTERCHANGE WITH ANY OTHER BUSINESS OR SUBSIDIARIES?
ACORD 126 (2007/05)INSI26 (200705)
Page 3 of 4
GENERAL INFORMATION (continued)EXPLAIN ALL YES RESPONSES (For all past or present operations) YIN
17. ARE DAY CARE FACILITIES OPERATED OR CONTROLLED?
18. HAVE ANY CRIMES OCCURRED OR BEEN ATTEMPTED ON YOUR PREMISES WITHIN THE LAST THREE (3) YEARS?
19. IS THERE A FORMAL. WRITTEN SAFETY AND SECURITY POLICY IN EFFECT?
20. DOES THE BUSINESSES’ PROMOTIONAL LITERATURE MAKE ANY REPRESENTATIONS ABOUT THE SAFETY OR SECURITY OF THE PREMISES?
REMARKS
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE ORSTATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANYFACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH ISA CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY: SUBSTANTIAL] CIVILPENALTIES. (Not applicable in CO, FL, HI, MA, NE, OH, OK, OR or VT. In DC, LA, ME. TN, VA and WA insurance benefits may also be denied).IN FLORIDA, ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR ANAPPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.
ACORD 126 (2007/05)1NS126 (200705)
Page 4 of 4
ACORD~, ADD~TIIONAL ANTEREST 5n~012>
AGENCY ~ ExI); (352) 7872431 APPLICANT (First Namxd Insured) Ext);
(AJC,No): (352)787-9922 City of DunneilonBrown & Brown of Florida, Inc. 20750 River Dr.P0 Box 491636
Dunnellon FL 34431Leesburg FL 34749—1636 EFFECTIVE DATE EXPIRATION DATE COIPLAN
CODE: SUBCODE; 5/2/2012 5/2/2013 Colony Ins CoAGENCY CUSTOMER ID POLICY NUMBER; GL8 50845
00007938 ACCOUNTNUMBER;
INTEREST LRANK; NAME AND ADDRESS REFERENCES CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
X ADDITIONAL INSURED CXS Transportation Inc LOCATION: BUILDING:
LOSS PAYEE 500 Water Street VEHICLE: BOAT:
MORTGAGEE SCHEDULED ITEM NUMBER;
LIENHOLDER Jacksonville FL 32202 OTHER
EMPLOYEE AS LESSOR
ITEM DESCRIPTION:
INTEREST RANK: NAME AND ADDRESS REFERENCES: CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED LOCATION: BUILDING;
LOSS PAYEE VEHICLE: BOAT:
MORTGAGEE SCHEDULED ITEM NUMBER:
LIENHOLDER OTHER
EMPLOYEE AS LESSOR
ITEM DESCRIPTION:
INTEREST RANK: NAME AND ADDRESS j REFERENCES; j CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED LOCATION: BUILDING:
LOSS PAYEE VEHICLE: BOAT:
MORTGAGEE SCHEDULED ITEM NUMBER;
LIENHOLDER OTHER
EMPLOYEE AS LESSOR
ITEM DESCRIPTION;
INTEREST RANK: NAME AND ADDRESS REFERENCES; CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED LOCATION: I BUILDING:
LOSS PAYEE VEHICLE; j BOAT;
MORTGAGEE SCHEDULED ITEM NUMBER;
LIENHOLDER OTHER
EMPLOYEE AS LESSOR
ITEM DESCRIPTION;
INTEREST RANK: NAME AND ADDRESS L~~RENCE 5; CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED LOCATION: BUILDING;
LOSS PAYEE VEHICLE; BOAT;
MORTGAGEE SCHEDULED ITEM NUMBER;
LIENHOLDER OTHER
EMPLOYEE AS LESSOR
ITEM DESCRIPTION;
INTEREST J RANK; NAME AND ADDRESS [~EFERENCE 5; CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED LOCATION: BUILDING:
LOSS PAYEE VEHICLE: BOAT;
MORTGAGEE SCHEDULED ITEM NUMBER;
LIENHOLDER OTHER
EMPLOYEE AS LESSOR
— ITEM DESCRIPTION;INTEREST f RANK; NAME AND ADDRESS REFERENCES; j CERTIFICATE REQUIRED INTEREST IN ITEM NUMBER
ADDITIONAL INSURED LOCATION; BUILDING:
LOSS PAYEE VEHICLE; BOAT:
MORTGAGEE SCHEDULED ITEM NUMBER;
LIENHOLDER OTHER
EMPLOYEE AS LESSOR
ITEM DESCRIPTION;
ACORD 45 (2003/04)1NS045 (0304)a
©ACORD CORPORATION 1993
City of Dunnellon20750 River Drive
Dunnellon, Florida 34431(352) 465-8500
(352) 465-8505 faxwww.dunnellon.org
[email protected]@dunnellon.org
Memo
To: City ofDunnellon City Council
From: City of Dunnellon City Tree Board
Thru: Harold Home, Community Development
Date: May7,2012
Re: PZ1 112-034 Manko Co. Tree Removal Permit Applicaton
To the Honorable City Council,
Mr. James Hilgers of Manko Co. came before the Tree Board on April 26, 2012 to request removal of treesfrom their site. Said request was accompanied by a Tree Removal Plan, which is stored in the CommunityDevelopment Department. Mr. Hilgers is requesting the tree removal permit to facilitate the remediation of theproperty to return the property to a more natural state.
Upon a vote of 3-0, and the additional approval of Alternate Board Member Ron Senykoff, the Boardrecommends to the City Council that the Tree Removal Permit Application by approved with the followingconditions:
1) Manko Co. must install a buffer along U.S. 41 (N. Williams Street); and2) To ensure the buffering Manko Co. will plant trees as necessary and as reasonably determined
by the City of Dunnellon Tree Board; and3) The plantings must be properly maintained until full establishment of the trees.
Respectfully,
City ofDunnellon Tree Board
I
him Hilgers
CITY OF DUNNELLON
TREE REMOVAL PERMIT Tree City USA
1/10/12
Tree Information
Species / Diameter 4.5 ft. above ground To be reolaced with:
See attached- su-2 for speciesand count
Reason for removal:Remediation on land used for hard rock mining. Remove materialfrom trenches and fill in with material from berm on east side.
If Applicable:Contractor Name License ≠≠Phone: ( City Reg. #Address:Contractor Signature:
Tree Permits: Commercial and Residential
Application Checklist:a) Completed and signed applicationb) Tree Sketch — Use an existing property survey to show:
i) Location, species and diameter of the trees to be removedii) Location, species and size of replacement trees.
If no survey is available please use Site Plan Sketch below showing property boundaries, adjacent roads andlocation of house and driveway.
City Code exempts removal of dead or significantly damaged, trees removed for personal use, or treesendangering property, from a permit fee, however, a permit is still required AND an Administration Fee of $50.00is payable for securing ANY permit
FEE:
Applicant Information:
R33607-O01-06Parcel Number: —
Applicant Name:
Business Name: —
Business Address:
Mank6 Co., [nc.
PU Box 369. Dunnellon. FL 34430
Phone: 3524892563
Location Address: _______________
Contact Person if other than above:
CelIt
Permit Number: __________
Date:
Type: U Commercial Li Residential
Zip:
Email: [email protected]
Zip:
Phone:
PermitAdministration Fee 32?O/TOTAL
$ 75.00
$125.00
Waived QY _______
I Site Plan Sketch**Indicate North
See attached-area to NW will not be disturbed.
1 understand that this is an application for tree removal and that the application must be reviewed and approvedP!Q~ to any removal taking place. I also understand that if I do not plant appropriate replacement trees within 60days of removal I may be in violation of the City of Dunnellon’s minimum 16 trees per acre requirement and sublectto enforcement action.
NOTE: Failure to secure a permit will result in a $25.00 per inch DBH. However the fine for unauthorizedremoval of a champion or heritage tree shall be $100.00 per inch DBH, in addition to a requirement to pay thecurrent tree permit fee. When the size of a champion or heritage tree cannot be determined, the minimumpenalty shall be $3,600.00. If proof that removed tree is replaced, credits will be granted upon receipt of proofthat replacement is in excess of 16 trees per acre (per City of Dunnellon Ordinance 2007-04)
Date
FOR CITY USE ONLY
Approved Li Yes LI No ______________________________________ Date:Community Development Director
Reason for denial:
MANKO Co.1 \(ORPORAII~I)
DUNNELLON, FLORIDA 34430 POST OFFICE BOX 369 PHONE 489-2563
January 10, 2012
City of Dunnellon20750 River DriveDunnellon, FL 34431
Re: R33067-O01-06“Lowes Site” Tree Permit
Dear Sir:
We have a current Environmental Resource Permit issued by Southwest Florida WaterManagement District (Permit No. 44030506.000) for this site. Your office has informed methat, according to the City Attorney, we also need to get a Tree Permit for the remedial workwe are doing at that site.
Accordingly, attached is ourTree Removal Permit Application and a check for $125.00 for thePermit Fee. If you need any additional information, please contact me.
Sincerely,
Director of Operations
End.
Copy: Kevin Camp w/o Attachments