DBPR CILB 18 Change of Status One Qualified Business to Another Qualified Business

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1 21 1 of State of Florida Department of Business and Professional Regulation Construction Industry Licensing Board Application for Change of Status - One Qualified Business to Another Qualified Business Form # DBPR CILB 18 APPLICATION CHECKLIST – IMPORTANT all items on the checklist below with your – Submit application to ensure faster processing. APPLICATION REQUIREMENTS ALL License Applicants must submit:  Fees: $50. • Make check payable to the Florida Department of Business and Professional Regulation. • Credit re port containing a credit score (FICO derived) on applicant  from a nationally recognized credit reporting agency, which includes a public records statement that records have been checked at local, state, and federal levels. For a list of agencies, visit http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf . See Section 2(i) • of Instructions. If credit score is below 660 (FICO derived) applicant must submit • a bond or irrevocable letter of credit. Note - Fifty percent (50%) of the bond or letter of credit requirement may be met by completion of • hour a 14- financial responsibility course approved by the Board. yfloridalicense.com/dbpr/pro/cilb/documents/cilb_approved_financial_responsibility_courses.pdf http://www.m Credit report on business from a nationally recognized credit reporting agency, which includes a public  , state, and federal levels. For a list of agencies, visit records statement that records have been checked at local http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf .  Electronic fingerprints. See Section 1(c) of Instructions.  Supporting legal documentation, if necessary. See Section 2(j ) of Instructions.  Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable. Registered License Appli cants must also submit: current Submit a copy of your local competency card.  Note • You may also submit a letter from a local building official testifying that you have met local – competency standards and requirements for your specific trade, and you are waiting for state registration. See Section 1(a)(iii) of Instructions. • IF Applying with a Financially Responsible Officer you must ALSO submit:  Fees of $200 for Financially Responsible Officer application Credit report on  fro m a nationally recognized credit reporting agency, which financially responsible officer includes a public records statement that records have been checked at local, state, and federal levels. For a list of agencies, visit http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_credit_reporting_agencies.pdf .  Bond for Financially Responsible Officer . See Section 2(o ) of Instructions.  Proof of satisfaction of liens, judgments, and discharge of bankruptcy, if applicable. . See Section 1(c) of Instructions.  Electronic fingerprints for financially responsible officer Submit supporting legal documentation, if necessary. See Section 2(j  of Instructions. ) Please mail your completed application, documentation and required fee(s) to: Department of Business and Professional Regulation 2601 Blair Stone Road Tallahassee, FL 32399- 0783 DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 April Incorporated by Rule: 61- 35. 010

2 21 2 of State of Florida Department of Business and Professional Regulation Construction Industry Licensing Board ation for Change of Status Applic - One Qualified Business to Another Qualified Business Form # DBPR CIL B 18 If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regula tion, Customer Contact Center, at 850.487.1395 . of this application. For additional information see the Instructions at the end I Application Type Section – (Check only one.) APPLICATION TYPES - Certified License Qualified Business to One   Registered License - One Qualified Business to [06xx/3021] [06xx/3021] Another Qualified Business Another Qualified Business One Qualified Business to  One Qualified Business to cense- Registered Li  Certified License- with a Financially Another Qualified Business Another Qualified Business with a Financially Responsible Officer [06xx/3021; 0628/1030] Responsible Officer [06xx/3021; 0628/1030] NOTE: If applying with a Financially Responsible Officer, the Financially Responsible Officer must V X also complete Section XI I and Sections X I s – XV I . – Section II – Applicant Personal Information PERSONAL INFORMATION Social Security Number* License Number: FULL LEGAL NAME First Middle Last Name Title Suffix Birth Date (MM/DD/YYYY) Gender /  Male  Female / MAILING ADD RESS Street Address or P.O. Box State Zip Code (+4 optional) City County (if Florida address) Country CONTACT INFORMATION Primary E Mail Address Primary Phone Number - RESIDENCE ADDRESS (IF DIFFERENT THAN MAILING ADDRESS) Street Address City Sta te Zip Code (+4 optional) County (if Florida address) Country * The disclosure of your S ocial Security number is mandatory on all professional and occupational license applications, is solicited by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and licensees by a Title IV -D child support agency to assure co mpliance with child support obligations. It is also required by § 559.79(1), (i), to be Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C) used by the Department of Business and Prof essional Regulation to identify licensees for tax administration purposes. DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 April Incorporated by Rule: 61- 35. 010

3 21 3 of II Section Information – continued – Applicant Personal ADDITIONAL CONTACT INFORMATION (OPTIONAL) Alternate Phone Number Fax Number Mail Address - Alternate E CURRENT/ PRIOR LICE NSE INFORMATION hold or have previously held a business or professional license/registration in Florida or If you currently necessary) (attach additional copies o f this page as : below elsewhere, please list each one Date (To) Da te (From) State 1. License/Registration Type / / / / License Number Name Used Date (To) Date (From) 2. License/Registration Type State / / / / Name Used License Number Date (From) Date (To) State 3. License/Registration Type / / / / License Number Name Used PR IOR NAME INFORMATION are currently known by another name (example - maiden name, Have you used, been known as, or  Yes  No pseudonym, nickname) or alias other than the name signed to the application? names used below: If your answer is yes, state name or Last Name First Title Suffix Middle Last Name First Middle Title Suffix Title Last Name First Middle Suffix Section III – Information on Business No Longer Qualified BUSINESS NO LONGER QUALIFIED Business Name : L icense Number: Doing Business As (D/B/A): Federal Employer ID Number (FEID): DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 April Incorporated by Rule: 61- 35. 010

4 21 4 of – Business to be Qualified Information Section IV BUSINESS TO BE QUALIFIED Business Name : Federal Employer ID Number (FEID ): Doing Business As (D/B/A):  Sole Proprietor  LLC  Corporation  Partnership Business Type:  Other (please specify):  YES  NO Is this business already qualified? License Number (s) under which the business is qualified: If so, provide the License Number: Qualifier Name: Qualifier Name: License Number: Qualifier Name: License Number: Qualifier Name: License Number: Qualifier Name: License Number: MAILING ADDRESS Street Address or P.O. Box City State Zip Code County (if Florida address) Country BUSINESS CONTA CT INFORMATION (IF DIFFERENT THAN APPLICANT INFORMATION) Contact Name : Phone Number of Contact E - Mail Address of Contact BUSINESS L OCATION ADDRESS (IF DIFFERENT THAN MAILING ADDRESS) Street Address City State Zip Code (+4 optional) County (if Flori da address) Country Change of Status - One Qualified Business to Another Qualified Business 2019 April DBPR CILB 18 by Rule: 61- 35. 010 Incorporated

5 5 of 21 Section V – Primary Qualifier Information PRIMARY QUALIFIER Name of person legally appointed as the qualifier to act for the business organization in all matters ity to supervise all construction connected with its contracting business, and who has been given author work performed by the business (this must be the applicant or a licensed contractor): License Number (if applicable): Primary Qualifying Agent Name: on all business matters, including Does the primary qualifying agent also have final approval authority contracts, specifications, checks, drafts, or payments, regardless of the form of payment, made by the YES NO  entity?  NO, does the business you propose to qualify already have a Financially Responsible O fficer If appointed? YES:  __________________________________________ Name of Financially Responsible Officer: NO:  appoint a Financially Responsible Officer by completing Sections X –XII You Sections XIV – must and of this application. This will alleviate the licensed qualifier’s financial responsibility, but the qualifier XVI related matters. will still be responsible for all construction- Section V (Optional) I – Secondary Qualifier Information SECONDARY QUALIFIER Name of person legally appointed as a secondary qualifier and is responsible only for the supervision of fieldwork at sites where his or her license was used to obtain the building permit and any other work for ed contractor): which he or she accepts responsibility (this must be the applicant or a licens Secondary Qualifying Agent Name License Number (if applicable) A secondary qualifying agent is not responsible for the supervision of financial matters. Section VI I – Business Ownership BUSINESS OWNERSHIP List below the business owner s and the percentage of ownership for each. The total must equal Attach additional copies as necessary. 100%. Address Social Security #/ Name of Owner % of FEID ownership DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business April Incorporated by Rule: 61- 35. 010 2019

6 21 6 of I –Insurance Coverage Section VII INSURANCE Minimum amounts required for General Liability insurance: General and Building Contractors - $300,000 public liability; $50,000 property damage All other categories - $100,000 public liability; $25,000 property damage 1. Have you obtained public liability and property damage insurance in the amounts determined by rule of Yes  No the Construction Industry Licensing Board, as specified above?  2. Have you obtained workers’ compensation insurance or filed for an exemption with the Division of Workers’ Compensation, and if not, do you attest that you will obtain an exemption within 30 days after  Yes your license is issued? No  – Financial Responsibility & Stability Requirements Section IX FINANCIAL RESPONSIBILITY & STABILITY on 2(i of Instructions for information on completing this section. See Secti ) • CREDIT REPORT The applicant must submit a credit report containing a credit score (FICO derived) from a nationally recognized credit reporting agency, which includes a public records stat ement that records have been See Instructions checked at local, state, and federal levels. ( for more information). • FINANCIAL RESPONSIBILITY & STABILITY REQUIREMENTS and no Financial responsibility & stability can be demonstrated by a credit score of 660 or higher unsatisfied judgment 15.006, F lorida Administrative Code for details). s or liens. (See Rule 61G4- Does the submitted credit report show a credit score of 660 or higher?  Yes  No If no, the financial stability requirement may be met by provid ing a bond or irrevocable letter of credit from a bank authorized to do business in the State of Florida, of completion of an approved 14- hour financial responsibility course, in the with proof amount of: $10,000 for Division I applicants  $5,000 for Divi sion II applicants  hour financial responsibility course, in the of completion of an approved 14- without proof amount of: $20,000 for Division I applicants   $10,000 for Division II applicants Have you completed a financial responsibility course approved by the Construction Industry Licensing Board?  Yes  No If yes, please complete the fields below. : School Provider # School Name ourse Name of C : Date(s) A ttended: If you will be submitting a bond or an irrevoca ble letter of credit, see page 14 of t his application for further instructions. DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 Incorporated by Rule: 61- 35. 010 April

7 7 of 21 X – Background Questions Section BACKGROUND QUESTIONS Instructions: pplicant , Financially Responsible Officer (if applicable), and Authorized R epresentative(s) of The A questions the business must answer the background in this section. ized Representative(s) of the business are any of the following: Author • All officers and directors (if qualified business is a corporation or any other business entity with officers and directors) • All members and managers (if qualified business is a LLC) • All part ners (If qualified business is a partnership) • All members (if qualified business is a business entity other than those described above) NOTE : Accuracy of Authorized Representative(s) of the business may be checked on the Florida Division of Corporations we bsite www.su n biz.org . If YES to questions 1 or 2 I . , please complete section X If YES to questions 3 or 4 , please complete section X II. 1. Have you ever been convicted or found guilty of, or entered a plea of guilty or nolo contendere to, ? This question applies to any criminal violation of regardless of adjudication, a crime in any jurisdiction the laws of any municipality, county, state or nation, including felony, misdemeanor and traffic offenses (but not parking, speeding, inspection, or traffic signal violations), without regard to whether you were placed on probation, had adjudication withheld, were paroled, or pardoned. If you intend to answer “NO” because you believe those records have been expunged or sealed by court order pursuant to Section 943.058 5 or 943.059, Florida Statutes, or applicable law of another state, you are responsible for verifying the expungement or sealing prior to answering "NO." YOUR ANSWER TO THIS QUESTION BE CHECKED AGAINST LOCAL, STATE AND FEDERAL RECORDS. FAILURE TO ANS WER MAY THIS QUESTION ACCURATELY MAY RESULT IN THE DENIAL OR REVOCATION OF YOUR LICENSE. IF YOU DO NOT FULLY UNDERSTAND THIS QUESTION, CONSULT WITH AN ATTORNEY OR CONTACT THE DEPARTMENT. Are there any pending bankruptcies or unsatisfied judgments or lie ns against yourself, a business 2. you previously qualified, which were filed during your period of qualification, or the business you are applying to qualify? This question applies to any unpaid judgments or liens, including those for unpaid past - due bills b y creditors, construction and non - construction issues, and tax liens. . Have you ever had an application for registration, certification, or licensure in Florida or in any other 3 to deny such an application? jurisdiction denied, or is there now pending a proceeding or investigation any license, registration . Have you ever had , 4 or permit to practice any regulated profession, occupation, vocation, or business , revoked, annulled, suspended, relinquished, surrendered, or otherwise disciplined in Florida o r in any other jurisdiction, or is any such proceeding or investigation now pending? Incorporated DBPR CILB 18 - One Qualified Business to Another Qualified Business 2019 April Change of Status by Rule: 61- 35. 010

8 8 of 21 tinued – con – Background Questions Section X Question Number Person # 1 2 3 Indicate each response by checking “Yes” or “No” 4 Applicant – Print Name   Yes  Yes  Yes Yes 1    No No  No No Social Security #: Financially Responsible Officer – Print Name Yes Yes   Yes  Yes  2   No No  No No  Social Security #: Print Name Authorized Representative – Yes Yes   Yes  Yes  3  No No   No No  Social Security #: A uthorized Representative – Print Name  Yes Yes  Yes  Yes  4 No No  No No    Social Security #: – Authorized Representative Print Name Yes  Yes  Yes  Yes  5  No  No  No No  Social Security #: Authorized Representative Print Name –   Yes Yes  Yes  Yes 6  No  No  No  No Social Security #: Authorized Representative – Print Name  Yes  Yes  Yes  Yes 7  No  No  No  No Social Security #: Authorized Representative Print Name – Yes  Yes  Yes   Yes 8   No No  No  No Social Security #: Authorized Representative Print Name –  Yes  Yes Yes   Yes 9  No   No No No  Social Security #: – Print Name Authorized Representative Yes   Yes Yes   Yes 10 No   No  No No  Social Security #: If you answered “YES” to any question in questions 1 – 4 above, please refer to Sections 2(j -l) of , including requirements for Instructions for detailed instructions for providing complete explanations complete Section X . Please submitting supporting legal documents 1 and I for your response to questions offenses II for your response to questions 3 and 4. If you have mor e than three 2, and complete Section X I or m to document in Section X ary. as necess pages II, attach additional ore than two in Section X Incorporated DBPR CILB 18 - One Qualified Business to Another Qualified Business 2019 April Change of Status by Rule: 61- 35. 010

9 21 9 of I – Explanations for “Yes” answers to Questions 1 -2 – Attach additional copies as Section X necessary EXPLANATION This explanation relates to person # (check one): This explanation relates to question # (check one):  3  4  5  ____  1   1  2 2 Offense: County: State: Date of Offense (mm/dd/yyyy): Have all sanctions been satisfied? Penatly/ Disposition:  Yes  No Description: EXPLANATION This explanation relates to person # (check one): This explanation relates to question # (check one):  2   4  5  ____  1  1  2 3 Offense: County: State: Date of Offense (mm/dd/yyyy): Penatly/ Disposition: Have all sanctions been satisfied?  Yes  No Description: EXPLANATION This explanation relates to person # (check one): This explanation relates to question # (check one): 1  2  3  4  5  ____   1  2 Offense: Date of Offense (mm/dd/yyy County: State: y): Penatly/ Disposition: Have all sanctions been satisfied?  Yes  No Description: DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business April Incorporated by Rule: 61- 35. 010 2019

10 of 21 10 I – Explanations for “Yes” answers to Questions 3- Section XI 4 – Attach additional copies as necessary EXPLANATION This explanation relates to pers This explanation relates to question # (check one): on # (check one): 1  2  3  4  5    3  4 ____ State/Jurisdiction: Application Type/License Number: EXPLANATION This explanation relates to This explanation relates to question # (check one): person # (check one):  1  2  3  4  5  ____  3  4 State/Jurisdiction: Application Type/License Number: Change of Status - One Qualified Business to Another Qualified Business 2019 April DBPR CILB 18 by Rule: 61- 35. 010 Incorporated

11 of 21 11 XIII – Affirmation by Writte n Declaration Section BY WRITTEN DECLARATION AFFIRMATION I I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. understand that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts I understand that falsification of any material information on this application stated in it are true. may result in criminal penalty or adminis trative action, including a fine, suspension or revocation of the license. Date: Signature: Print Name: – Financially Responsible Officer Section XIV Note: Financially Responsible Officer must complete Background questions in Section s X-XII. PERSONAL I NFORMATION Social Security Number* FULL LEGAL NAME First Last Name Middle Title Suffix Birth Date (MM/DD/YYYY) Gender / /  Male  Female MAILING ADDRESS Business/Firm Name Street Address City State Zip Code (+4 optional) County (if Country Florida address) CONTACT INFORMATION Primary Phone Number Primary E - Mail Address PRIOR NAME INFORMATIO N are currently known by another name ( (example - maiden name, Have you used, been known as, or  Yes  No pseudonym, nickname) or alias other than the n ame signed to the application? If your answer is yes, state name or names used below: Middle First Title Suffix Last Name Last Name First Middle Title Suffix Title Last Name First Middle Suffix * The dis closure of your S ocial Security number is mandatory on all professional and occupational license applications, is solicited by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business & Professional Regulation pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and -D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1), licensees by a Title IV Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C) (i), to be used by the Department of Business & Professional Regulation to identify licensees for tax administration purposes . DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 April Incorporated by Rule: 61- 35. 010

12 Section XV – Financially Responsible Officer Bond Form 12 of 21 TE OF FLORIDA STA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION , Tallahassee, FL 32399-0783 2601 Blair Stone Road FINANCIALLY RESPONSIBLE OFFICER BOND STATE OF ___________________ COUNTY OF Bond #: $100,000.00 Bond Amount: Date: Type of Bond: Financially Responsible Officer Bond ________________________ Effective Florida Construction Industry Licensing Board Obligee: KNOW ALL PERSONS BY THESE PRESENTS, THAT ___________________________ _____________________________________________ (Financially Responsible Officer) _______________________ , a company fully of (Company Name) _____________________________________________ al, and authorized to do business in the State of Florida, as Princip (Bond Company) _________________________________________ ____ ____________ , a company fully authorized to do business in the State of Florida, as Surety , are held and firmly bound unto the Florida Construction Industry Licensing Board, as Obligee, in One Hundred Thousand Dollars ($100,000.00) for the payment of fines and costs pursuant to Rule 61G4- 15. 0021 , Penal Sum of Fl orida Administrative Code, well and to truly be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. The conditi on of this obligation is such that: WHEREAS appointed the Financially Responsible Officer of , Principal has been to conduct , a company authorized ______________________________________ (Company Name) _____________ business under Chapter 455, Florida Statutes, and , Principal is required to provide a $100,000 surety bond payable to the Florida Construction Industry Licensing WHEREAS Board for f 61G4- 15.0021, Fl orida Administrative Code; ines and costs pursuant to Rule NOW THEREFORE , if ______________________________________ (Company Name) _____________ , a company fully authorized to do business in the State of Florida, shall well and truly and faithfully make the payments to the State Treasur er of the State of Florida in his capacity as Treasurer of the Depar tment of Business and Professional Regulation as provided in and as required by any and al usiness and Professional R egulation, and shall faithfully and accurately l laws of the State of Florida B keep its books and records and make reports as in any and all of said laws provided and required, and shall conduct its conformity with said laws and rules of the Florida Department of Business and Professional Regulation, and shall well and truly ules provided, then this obligation to be null and void, keep and perform each and every requirement in and by said laws and r otherwise to remain in full force and effect. that the Obligee will retain an electronic record of this bond and power of IT IS FURTHER AGREED AND UNDERSTOOD attorney that will be utilized to make c laims against this bond pursuant to Section 668.50, Florida Statutes. The Princip al shall The Surety reserves the right to cancel this bond by sending a notice of cancellation retain the original bond for his records. of cancellation to the Executive Director of the Florida Construction Industry Licensing by certified mail 30 days in advance Board, 2601 Blair Stone Road , Tallahassee, Florida 32399. However, the Surety’s liability shall continue for any indebtedness day notice period. incurred or accrued during the period of this bond, including the 30- . SIGNED this _________ day of __________________________ , 20 ____ PRINCIPAL: ___________________________________ ______________________________________ Name, Title of Financially Responsible Officer Financially Responsible Officer Signature COMPANY: ______________________________________ ___________________________________ Authorized Company Officer Name, Title Signature Authorized Company Officer SURETY: _____________________________________ BY : _____________________________________ ______________________________________ -in -fact ame of Attorney Signature Attorney -in -fact Print N (Attach Power of Attorney) DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 April Incorporated by Rule: 61- 35. 010

13 13 of 21 on XV ially Responsible Officer Affirmation by Written Declaration Secti I – Financ BY WRITTEN DECLARATION AFFIRMATION I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I understand that my signature on this written dec laration has the same legal effect as an oath or affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that falsification of any material information on this applic ation may result in criminal penalty or administrative action, including a fine, suspension or revocation of the license. Signature: Date: Print Name: DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 201 9 April Incorporated by Rule: 61- 35. 010

14 14 of 21 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION see, FL 32399-0783 2601 Blair Stone Road , Tallahas LETTER OF CREDIT CONSTRUCTION LICENSE BOND/ IRREVOCABLE INSTRUCTIONS: 1. All applicants for active status construction licenses must demonstrate financial responsibility and stability. Rule provides the financial responsibility and stability requirements for obtaining a contractor license. 61G4-15.006, F.A.C. , a credit score of 660 (FICO derived) or higher Financial responsibility & stability can be demonstrated by providing 2. , unsatisfied judgments or liens. being without any and pplicant has a credit score less than 660 3. , the financial stability requirement shall be met by If the a (FICO derived) a bond or irrevocable letter of credit from a bank authorized to do business in the State of Florida. obtaining The applicant need only submit a c opy of the bond and power of attorney, or a copy of the irrevocable letter of credit, 4. with the application for licensure. The applicant shall retain the original bond and power of attorney for his records. The original letter of credit shall be retained by the bank issuing the letter. The Department of Business and Professional Regulation will retain an electronic record of the bond and power of 5. attorney, or letter of credit, that will be utilized to make claims against the bond or letter of credit. Section 668.50, Florida Statutes. 6. Fifty percent (50%) of the amount required by bond or irrevocable letter of credit may be satisfied by completion of a 14-hour financial responsibility course approved by the Construction Industry Licensing Board. Rule 61G4-15.00 6, courses, please visit: F.A.C. For a list of appr oved financial responsibility http://www.myfloridalicense.com/dbpr/pro/cilb/documents/cilb_approved_financial_responsibility_courses.pdf The amount of the license bond or 7. letter of credit is to be determined as follows: irrevocable o Applicants who HAVE NOT completed the 14-hour financial responsibility course must submit a bond or irrevocable letter of credit in the amount of:  (applicants applying for General Contractor, Building Contractor, $20,000 for Division I applicants or Residential Contractor License).  $10,000 for Division II applicants (applicants for types of contractor licenses not otherwise listed in Division I). Applicants who o HAVE hour financial responsibility course must submit a bond or completed the 14- letter of credit in the amount of: irrevocable $10,000 for Division I applicants (applicants applying for General Contractor, Building Contractor,  or Residential Contractor License).  $5,000 for Division II applicants (applicants for types of contractor licenses not otherwise listed in Division I). The license bond or 8. letter of credit, for fines and costs, is to be made payable to the Florida Construction irrevocable F.A.C. Industry Licensing Board. Rules 61G4-15.006 and 61G4-15.0021, 9. The licen se bond or irrevocable letter of credit must remain in effect until the applicant can demonstrate a credit to the Florida Construction Industry Licensing Board. score, FICO derived, of 660 or higher At its own request and regardless of the applicant’s credit score, a surety or bank may cancel the license bond or irrevocable letter of credit upon providing 30 days advance notice of cancelation to the Executive Director for the Construction Industry Licensing Board. However, the surety’s liability shall conti nue for any indebtedness incurred or accrued during the period of the license bond or irrevocable letter of credit If the license bond or irrevocable letter of credit is canceled prior to the applicant establishing a 660 credit score, the applicant must submit a new license bond or irrevocable letter of credit to the Florida Construction Industry Licensing Board. A cause of action for any indebtedness accrued during the period of the irrevocable letter of credit must be commenced within one year after the expiration date of the letter of credit or one year after the cause of action accrues, whichever occurs later. A cause of action accrues when the breach occurs, regardless of the aggrieved party’s lack of knowledge of the breach. Section 675.115, Florida Statutes. Collection of claims under the license bond or irrevocable letter of credit shall require: 10. A statement signed by a duly authorized official acting on behalf of the Florida Construction Industry o Licensing Board, referencing the bond number or ir revocable letter of credit number, and certifying that the amount of the draft is due and payable pursuant to a Final Order from the Florida Construction Industry Licensing Board. o A copy of the license bond or irrevocable letter of credit. 11. The bond or irrevocable letter of credit should be executed on the attached form. Some financial institutions will any alteration of the wording choose to retype these documents on their letterhead, which is acceptable. However, of the Construction License Bond or Irrevoc able Letter of Credit will result in a notice that the application is deficient. - One Qualified Business to Another Qualified Business 2019 April Incorporat ed by Rule: 61- 35. 010 DBPR CILB 18 Change of Status

15 15 of 21 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION , Tallahassee, FL 32399-0783 2601 Blair Stone Road CONSTRUCTION LICENSE BOND STATE OF __________________________ COUNTY OF Bond Amount: Bond #: $ Date: Type of Bond: ________________________ Effective Construction License Bond Florida Construction Industry Licensing Board Obligee: KNOW ALL PERSONS BY THESE PRESENTS, THAT ___________________________ (Applicant) _____________________________________________ _______________________ of (Company Name) _____________________________________________ , a company fully authorized to do business in the State of Florida, as Principal, and (Bond Co mpany) _____________________________________________ , a company fully authorized to do business ____________ in the State of Florida, as Surety , are held and firmly bound unto the Florida Construction Industry Licensing Board, as Obligee, in fines and _________ __________________________ ___ _____ ______ _ Dollars for the payment of (amount in words) Penal Sum of 15.006, Fl orida Administrative Code, well and to truly be made, we bind ourselves, our heirs, executors, costs pursuant to Rule 61G4- ccessors and assigns, jointly and severally, firmly by these presents. The condition of this obligation is such that: administrators, su WHEREAS , Principal has been granted a license to conduct business under Chapter 455, Florida Statutes and ; , shall well and (Company NOW THEREFORE _____________ ______________________________________ , if the Name) truly and faithfully make the payments to the State Treasurer of the State of Florida in his capacity as Treasurer of the Department of Business and Professional Regulation as provided in and as required by any and al l laws of the State of Florida Business and Professional R egulation, and shall faithfully and accurately keep its books and records and make reports as in any and all of said laws provided and required, and shall conduct its business in conformity with said laws and rules of the Florida Department of Business and Professional Regulation, and shall well and truly keep and perform each and every requirement in and by said laws and rules provided, then this obligation to be null and void, otherwise to remain in full force and effect. the Obligee will retain an electronic record of this bond and power of IT IS FURTHER AGREED AND UNDERSTOOD that Collection of claims attorney that will be utilized to make claims against this bond pursuant to Section 668.50, Florida Statutes. under this bond shall require a statement signed by a duly authorized official acting on behalf of the Florida Construction of the draft is due and payable pursuant Industry Licensing Board, referencing the bond number and certifying that the amount to a Final Order from the Construction Licensing Board; and a copy of this bond. The Principal shall retain the original bond. until the The Principal can demonstrat e a credit score of 660 (FICO derived) or must maintain a license bond in effect Principal to the Florida Construction Industry Licensing Board. The Surety reserves the right to cancel this bond by sending a higher notice of cancellation by certified mail 30 days in advance of cancellation to the Execut ive Director of the Florida Construction Industry Licensing Board, 2601 Blair Stone Road , Tallahassee, Florida 32399. However, the Surety’s liability shall continue for any indebtedness incurred or accrued during the period of this bond, including the 30-day notice period. . day of ____ , 20 _________ SIGNED this __________________________ PRINCIPAL: ___________________________________ ______________________________________ Print or Type Name of Applicant Applicant Signature ___________________________________ COMPANY: ______________________________________ Authorized Company Officer Name, Title Signature Authorized Company Officer SURETY: _____________________________________ ______________________________________ BY _____________________________________ : Print Name of Attorney -in -fact Signature Attorney -in -fact (Attach Power of Attorney) DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business April Incorporat ed by Rule: 61- 35. 010 2019

16 16 of 21 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATI ON 2601 Blair Stone Road , Tallahassee, FL 32399-0783 CONSTRUCTION LICENSE IRREVOCABLE LETTER OF CREDIT RE: Irrevocable Letter of Credit No. _____________ Beneficiary: Construction Industry Licensing Board 2601 Blair Stone Road Effective Date: ____________________________ Tallahassee, FL 32399-0783 Expiration Date: __________________________ Applicant: Company Name: Address: _______________________________ Lending Institution: ________________________________ Address: ________________________________ To the Florida Construction Industry Licensing Board: hereby authorize Beneficiary to draw on us, the aforementioned Lending Institution, for account of Applicant up to an We Dollars for the payment of fines and costs amount of _______________________________________________ aggregate pursuant to Rule 61G4- 15.006, Florida Administrative Code, available by your draft at sight on us accompanied by the following: 1. A statement signed by a duly authorized official acting on behalf of the Florida Construction Industry Licensing Board, referencing the Irrevocable Letter of Credit number and certifying that the amount of the draft is due and payable pursuant t o a Final Order from the Florida Construction Industry Lic ensing Board. 2. A copy of this Irrevocable Letter of Credit. The Beneficiary will retain an electronic record of this The Lending Institution shall retain the original irrevocable letter of credit. ake claims against this letter of credit pursuant to Section 668.50, Florida irrevocable letter of credit that will be utilized to m Statutes. The irrevocable letter of credit must remain in effect until the Applicant can demonstrate a credit score of 660 (FICO derived) or higher to the Lending Institution. Upo n proof of the required credit score, the Lending Institution may cancel the A cause of action for any indebtedness accrued during the period of the irrevocable letter of credit irrevocable letter of credit. must be commenced within one year after the expi ration date of the letter of credit or one year after the cause of action accrues, whichever occurs later. A cause of action accrues when the breach occurs, regardless of the aggrieved party’s lack of . knowledge of the breach. Section 675.115, Florida Statutes We hereby agree that all draft(s) drawn under and in compliance with the terms of this credit be duly honored, if drawn and presented to us. Nothing contained herein shall be construed to extend the gross liability of the Lending Institution to an amount greater than . the aforesaid $ This credit is subject to the Uniform Customs and Practice for Documentary Credits (1993), International Chamber of Commerce, Publication Number 500, and engages us in accordance with its terms. Sincerely, (Name, Title of Authorizing Officer) (Signature, Title of Authorizing Officer) (Date) ATTEST: (Name, Title) (Signature, Title) Incorporat DBPR CILB 18 Change of Status 2019 April - One Qualified Business to Another Qualified Business ed by Rule: 61- 35. 010

17 17 of 21 INSTRUCTIONS e in completing this application, please contact the Department of Business If you have any questions or need assistanc 850.487.1395 and Professional Regulation, Customer Contact Center, at . 1. General Requirements for Registration a. Definition of “Registered Contractor” – A contractor who has register i. ed with the department pursuant to fulfilling the competency requirements in the jurisdiction for which the registration is issued. ii. Registered contractors may contract only in such jurisdictions . Registered Contractor Applicants must meet local competency submit either iii. standard requirements and ir current local competency card the a letter from a local building official testifying that you a copy of , or have met local competency standards and requirements for your specific trade, and you are waiting for sta te registration. Definition of “Certified Contractor” – b. Any contractor who possesses a certificate of competency issued by the department and who shall be i. ompetency allowed to contract in any jurisdiction in the state without being required to fulfill the c requirements of that jurisdiction. c. All License Applicants: Must submit electronic fingerprints. i. Pursuant to Chapter 455, Florida Statutes, electronic fingerprinting is mandatory for all Construction (1) Initial License, Initial Business, Additional B usiness, Transfer (Change of Status), and Endorsement applications . Electronic fingerprinting allows applicants to have their fingerprints scanned and electronically submitted to the Florida Department of Law Enforcement and Feder al Bureau of Investigation. (2) Electronic Fingerprinting is located at various convenient sites throughout the state. See http://www.myfloridalicense.com/dbpr/servop/testing/documents/finger_faq.pdf for more information. 2. Application Instructions (by section) - Application Types a. Section I Certified License- One Qualified Business to Another Qualified Business i. (1) Select this application type if you qualify a business and want to change status to qua lifying another business, AND (2) Will only be operating or qualifying one business entity (as a sole proprietor or a qualifying agent) and meet the requirements outlined in 1(b) and (c) above. Complete sections I (3) -XIII. One Qualified Business to Another Qualified Business Registered License- ii. Select this application type if you qualify a business and want to change status to qualifying another (1) business, AND Will only be operating or qualifying one business entity (as a sole proprietor or a qualifying agent) and (2) meet the requirements outlined in 1(a) and (c) above. (3) -XIII. Complete sections I iii. One Qualified Business to Another Qualified Business with a Financially Responsible Certified License- Officer Select this application type if you qualify a business and want to change status to qualifying another (1) business, AND Will only be operating or qualifying one business entity (as a sole proprietor or a qualifying agent) and (2) meet the requirements outlined in 1(b) and (c) above, AND (3) You want to appoint a Financially Responsible Officer to be the final approval authority for all business matters. (4) Complete entire application. iv. Registered License- One Qualified Business to Another Qualified Business with a Financially Responsible Officer (1) lify a business and want to change status to qualifying another Select this application type if you qua business, AND (2) Will only be operating or qualifying one business entity (as a sole proprietor or a qualifying agent) and meet the requirements outlined in 1(a) and (c) above, AND (3) You want to appoint a Financially Responsible Officer to be the final approval authority for all business matters. (4) Complete entire application. b. Section II - Applicant Personal Information DBPR CILB 18 Change of Status 2019 April Incorporat ed by Rule: 61- 35. 010 - One Qualified Business to Another Qualified Business

18 18 of 21 Fill out each section completely. A social security number is required in order to apply for any individual i. license within the Department of Business and Professional Regulation. Provide the license number that you would like to change status from qualifying one business to ii. qualifying another business. In the Full Legal Name section provide your full legal name as it appears on your Social Security card. Do iii. not use any nicknames or initials. Please list any aliases or prior names in the prior name information section. iv. Provide your mailing address. This will be used for sending correspondence regarding your application and license. Contact information is often used to quickly resolve questions with applications by telephone call or email. v. If contact information is not provided, questions regarding applications will be mailed to the appl icant’s mailing address and may take longer to resolve. vi. i.e., not a P.O. Box. If the mailing Applicants are required to provide at least one physical address – address is not also your physical address, please provide a physical address. Additional contact information is optional and will be used when the applicant cannot be reached using vii. their primary contact information. Applicants must provide information on current or prior licenses held in Florida or any other state, territory, viii. nited States or in any foreign national jurisdiction. or jurisdiction of the U ix. Applicants must provide information on any prior names or aliases used by applicant. If the name on supporting documentation does not match the applicant’s legal name, the alias used in the supporting documentation must be provided in this section. Failure to do so will result in a deficient application. c. Section III - Information on Business No Longer Qualified Complete this section entirely. i. Provide the name of the business that will no longer be qualif ied as it is registered with the Florida ii. Division of Corporations. Provide the license number under which you currently qualify the business you are applying to change iii. status. iv. The “Doing Business As” (D/B/A) name of the business that will no longer be qual ified must be provided as it is registered with the Florida Division of Corporations, if the business uses a fictitious name to conduct business. v. Applicants must provide the Federal Employer Identification Number (FEID) for the business that will no longer be qualified. d. Section I V- Business to be Qualified Information i. Complete this section entirely. Provide the name of the business to be qualified as it is registered with the Florida Division of ii. Corporations. ovided as it is registered with the Florida Division of The “Doing Business As” (D/B/A) name must be pr iii. Corporations, if the business uses a fictitious name to conduct business. iv. Applicants must provide the Federal Employer Identification Number (FEID) for the business to be qualified. v. Select the box that indicates the type of business ownership for the business to be qualified. vi. Applicants must state whether the business to be qualified is already qualified by another contractor. If so, provide the qualifying contractor’s name and license number in the s paces provided. vii. Applicants must provide the business mailing address of the business to be qualified. Business contact information is often used to quickly resolve questions with applications by telephone call viii. ized representative of the business other than the primary or email. Please provide the name of an author qualifier. This could be an officer, a partner, etc. If the business is a Sole Proprietorship, you may leave the contact information field blank. (1) If contact information is not provided, questions regarding applications will be mailed to the applicant’s mailing address and may take longer to resolve. Provide the business location address of the business to be qualified. If this address is the same as the ix. mailing address you may leave this information blank. e. Section V - Primary Qualifier Information i. primary qualifier . All construction businesses must have a ii. If this application is for a new qualified business, the applicant must be the primary qualifier. iii. If this application is for a business that is alr eady qualified by another primary qualifier, the applicant may apply to be an additional primary qualifier or a secondary qualifier. (1) If you will be an additional primary qualifier, complete this section by inserting your name as the “Primary Qualifying Agent.” You will not provide a license number since it has not been issued. DBPR CILB 18 Change of Status - One Qualified Business to Another Qualified Business 2019 April Incorporat ed by Rule: 61- 35. 010

19 19 of 21 If you will be a secondary qualifier, complete this section by inserting the name and license number of (2) the “Primary Qualifying Agent”; and complete Section IV. All primary qualifiers iv. must have final approval authority on all business matters, including contracts, specifications, checks, drafts, or payments, regardless of the form of payment, made by the business organization. (1) If the primary qualifier does not have final approval authority, the business entity must have a Financially Responsible Officer. Failure to have an appointed Financially Responsible Officer results in the Primary Qualifier being financially responsible for all business matters of the business entity. If the bus iness entity has already appointed a Financially Responsible Officer, provide the name (a) of that individual. (b) If the business entity has not appointed a Financially Responsible Officer and will appoint -XII someone to be the Financially Responsible Officer with th is application, complete Sections X -XVI of the application. and Sections XIV f. VI- Secondary Qualifier Information Section i. Complete this section entirely, if the applicant will be a secondary qualifier. II- Business Ownership g. Section V Complete this secti on entirely. i. List the name, address, Social Security number, and percentage of ownership for all persons who have ii. an ownership interest in the business to be qualified. If an owner of the business is a company, please list the Federal Employer Identificati on Number (1) (FEID) of the owning company. iii. The percentage of ownership for all owners together must equal 100%. II- Insurance Coverage h. Section VI Complete this section entirely. i. ii. Applicants must have adequate Workers’ Compensation and Liability Insurance as specificied by the Construction Industry Licensing Board. Amounts for general liability insurance are specified in the application. Amounts for workers’ (1) compensation insurance are outlined in Chapter 440, Florida Statutes . (2) Section 489.115(5)(a), Florida Statutes , and Rule 61G4- 15.003, F.A.C. for more information. See iii. To verify the accuracy of the signed affidavit, the Board will, from time to ti me, conduct random sample audits of licensees by zip code area in which the total number of certificates and registrations selected for audit will be in a sufficient amount to insure the validity of the audit. Section IX - Financial Responsibility & Stability Requirements i. Complete this section entirely. i. Applicant must meet financial responsibility and stability requirements by submitting a credit report with a ii. FICO derived credit score. Financial responsibility – this requirement is met if the submitted credit report shows no outstanding (1) unsatisfied judgments or liens against the applicant. Applicant must submit proof of satisfaction of liens, judgments, and discharge of bankruptcy (a) if these are shown on the credit report. – this requirement is met if the submitted credit report shows a FICO derived credit (2) Financial Stability score of 660 or higher If the applicant has a FICO derived credit score less than 660, he or she must maintain a bond or (a) n the application. (See the irrevocable letter of credit from a bank in the amounts specified i instructions for the construction license bond/irrevocable letter of credit form at the end of this application). (b) Fifty percent of the financial stability bond or the letter of credit requirement may be met by completion of a 14- hour financial responsibility course approved by the Board. See Financial Responsibility and Financial Stability, Grounds for Denial Rule 61G4 -15.006, F.A.C. for more information. You only need to complete the 14- hour financial responsibility cours e if you have a credit score less (3) 660 (FICO) than and wish to meet fifty percent of the financial stability bond or the letter of credit requirement. (4) If you have completed the 14- hour financial responsibility course for a 50% reduction in the amount required for the construction bond/irrevocable letter of credit, please provide the school name, the school provider number, the name of the course, and the dates attended. j. - Background Questions Section X i. The applicant and the authorized representative(s), as specified in the section, must submit answers to each of the background questions. DBPR CILB 18 Change of Status 2019 April Incorporat ed by Rule: 61- 35. 010 - One Qualified Business to Another Qualified Business

20 20 of 21 For each “Yes” answer the person must provide an explanation in Section XI or XII, as applicable. ii. The number of “Yes” boxes checked must equal the number of explanation boxes completed. iii. If you answered “YES” to any question, please provide full explanations as required below. iv. If you have more than three offenses to doc , attach additional ument in Section XI or more than two in Section XII copies as necessary. v. If you are assigning a Financially Responsible Officer, the Financially Responsible Officer must -XII. also complete Sections X nd Questions 1 and 2 k. Section XI - Explanations for Backgrou i. For this section, provide as much detail as possible. ii. Each explanation can only relate to one person and one question. Question 1: iii. (1) [ make additional copies as If you answer “yes” to this question, you must complete Section XI ] of the application please provide the full details of the criminal charges including dates, necessary outcomes, sentences, and/or conditions imposed; the dates, name and location of the court and/or you answer NO to this question jurisdiction in which any proceedings were held or are pending. If because you believe that previous incidents have been dismissed, no action taken, nolle prossed, or expunged, you may be asked to supply documentation as proof of the disposition. Question 2: iv. If you answer “yes” to this ques [ make additional copies as (1) tion, you must complete Section XI necessary ] of the application and you must also supply documentation proving the bankruptcy has the been discharged or the judgment or lien has been satisfied, or if not, stating the current status of bankruptcy, judgment or lien. Section XII - Explanations for Background Questions 3 and 4 l. For this section, provide as much detail as possible. i. Each explanation can only relate to one person and one question. ii. iii. Question 3: If you answer “yes” to this q (1) [ make additional copies as uestion, you must complete Section XII necessary ] of the application and supply copies of documentation explaining the denial or pending action. (2) Provide the full details explaining the denial or pending administrative action incl uding the nature of any charges, dates, outcomes, sentences, and/or conditions imposed; the dates, name and location of the court and/or jurisdiction in which any proceedings were held or are pending; and the designation and/or license number for any actions against a license or licensure application. iv. Question 4: If you answer “yes” to this question, you must complete Section XII make additional copies as [ (1) (if applicable) showing the disciplinary necessary ] of the application and supply copies of the order(s) or documentation showing the status of the pending action. ainst the license action taken ag Provide the full details of any administrative action (2) including the nature of any charges, dates, outcomes, sentences, and/or conditions imposed; the dates, name and location of the court and/or jurisdiction in which any proceedings were held or are pending; and the designation and/or license number for any actions against a license or licensure application. v. Submit supporting legal documentation, if necessary, wit h this application. Section XIII- Affirmation by Written Declaration m. i. App licant must sign the affirmation by written declaration. n. Section XIV - Financially Responsible Officer Application i. The Financially Responsible Officer should complete this section. ii. The -XII. Financially Responsible Officer must also answer the background questions in sections X Fill out each section completely. A social security number is required in order to apply for any individual iii. sional Regulation. license within the Department of Business and Profes iv. In the Full Legal Name section provide your full legal name as it appears on your Social Security card. Do not use any nicknames or initials. Please list any aliases or prior names in the prior name information section. Provide your mailing address. This will be used for sending correspondence regarding your application v. and license. vi. Contact information is often used to quickly resolve questions with applications by telephone call or email. (1) If contact information is not provided, quest ions regarding applications will be mailed to the applicant’s mailing address and may take longer to resolve. vii. Applicants must provide information on any prior names or aliases used by applicant. If the name on supporting documentation does not match the applicant’s legal name, the alias used in the supporting documentation must be provided in this section. Failure to do so will result in a deficient application. DBPR CILB 18 Change of Status 2019 April Incorporat ed by Rule: 61- 35. 010 - One Qualified Business to Another Qualified Business

21 21 of 21 - Financially Responsible Officer Bond Form o. Section XV The bond application form should be compl eted by the bond company i. and signed by the Financially Responsible Officer, an authorized company officer, and the surety. ii. The Financially Responsible Officer is required to provide a $100,000 surety bond payable to the Florida Construction Industry Licens ing Board for fines and costs pursuant to Rules 61G4 -15.006 and 61G4- 15.0021, Florida Administrative Code. p. Section XVI - Financially Responsible Officer Affirmation by Written Declaration i. The Financially Responsible Officer must sign the affirmation by written declaration. DBPR CILB 18 Change of Status 2019 April Incorporat ed by Rule: 61- 35. 010 - One Qualified Business to Another Qualified Business

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