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Home My WebLink AboutFolio 2024-2026 Permit - CR 7876 CR 7876 - 9/24/2024 AAA^ A CONTRACTORq(,I`z�l REGISTRATION 100 West Dania Beach Boulevard *Dania Beach, FL 33004 (954)924-6805*3651,3633 or 3652 Fax(954)922-2687 DANIA BEACH SEAR LM1'E Ii IOVE Iiq12 PLEASE PRINT LEGIBLY -*/1 Type of Contractor Certified Electrical contractor Company: Name 1 J w U jl t R'_(> `+ 4-1"-- Office Address 10226 Curry Ford rd City/State/Zip Orlando,Fl32825 Office Phone# 4074766212/407-448-5643 Qualifier: Name FREDERICK BRAUN Office Address 10226 Curry Ford rd City/State/Zip Orlando,Fl 32825 Home Phone# 407-448-5643 Owner: Name PAUL DONALDSON Office Address City/State/Zip SAME AS COMPANY Home Phone# PROVIDE PHOTOCOPIES OF THE FOLLOWING DOCUMENTS Qualifier's Driver's License 5850-243-55-091-6 State: orlando City Business Tax License City: County Business Tax License County: 1802-1240947 State License EC13012687 Certificate of Competency Certificates of Insurance must show the City of Dania Beach as the Certificate Holder General Liability Expiration Date: 06/22/2025 Workers Compensation Expiration Date: 12/31/2024 I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Qualifier's Signature Date The foregoing instrument was acknowledged before me this 4 day of AUGUST 20_24 By FRFnFRIc, RRAI 1N who is personally known to me or has produced as identification and did(or did not)take an oath My Commission Expires: "�r: CRYSTAL PENA MY ON$HH 418972 Contractor Registration Rev. EIS: mac; 09/26/2017 SIMMIIIIIIN , 0. 9 p z C fa, E ,..) . ID: 5 UJ U 0 . 0 1- a) , r.: 0 W 0 C: i—Lij co Z - 0 (t) < D D ! 1 --- , .4...0 E +V ra Z ta9 C) (L) , 0 Z 1-L-/ I— l'''',. ' •I- C4 t..) c — Li tf)- ' to) ......, r., 4 E 0 )._ .... r. -- .... C N -. , '1/4:j I co !, N 0 0 .Q- 4.. _ (/) .....' F-L -4 ,, 4,,, ,G. ce 0 ‘' saw LLIlifl':-, 4•r - -i cv >- (u 4;4 V) ' LLt ',Irj ' 0 .--...;,-,, -if Yi ...c C) W U-I -- ct-7' .uct, D.: Co 13.• ut) ' r%-=-- (..) - '' r... 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'.---.A ..t. • ;,,,,,,,%:k.marip. ,, *..:::',,:„..":,,- ..;‘,...tt.'cl,-',.•:,',..ii i 4 V6...-,.1. ib-1 'LL!,-- --;1,4•.'4) •••... .-Sal) •re.,•,-.4" n. t•. OtIL- '..• 'i •• ..C:1 Tax Collector Scott Randolph Local Business Tax Receipt Orange County, Florida 2023 EXPIRES 9/30/2024 2 CEERT ELECTRICAL CON $3X.00 1 EMP>GYEE i$ �^•12�3'= 'r" TOTe;.TAX $pt�CO BRAUN FREDEFR.IC;.�CCi PR.EVJCX,SLY FWD .Y��4'=00 TOTAL DUE SO ) P •M.D ENERGyY.LC BRAN FREC_TTICK C ;7226 CLRRY FORD RD CTC 107 PM2.*)' C ‘A`+Dig FL 3,,2525 2342 TRE'YMORE DR U ORLANC} ,32&25 EC1301 i? PAJ $ 3 2D -0512 z (1 4.111-T2?, Tax Collector Scott Randolph Local Business Tax Receipt Orange County, Florida 'x.n�-,_�=r��✓ ..' � `•• .,,�.�.�tax! r, a.�.�.;.5 ��._;f,= :�ra`<e !�a:r�rux X:..�;.;?*i;3,701;1,43 ;;41;7'x-�r.,-,1 tola,'r roc.'rr"=',= 4tfe i,krocgr,r34.1ri;trx2e . 173_.6w b rszrorrt portA ty it oddad+3citbot I 20223 EXPIRES 9130//2024 18O: -1 240947 1 W2 CER T EL EC I1#UCsi.L CON S22,20 1 EMP'OYES • TOTAL TAX S30,0 1 PREVIOUSLYPALI) 43Or.CC gs;~..;,JN:FF+,EDERICKCC 140.DTJE SO Cry 21,42 TIiEYfLRE Y Ft t:1.. CURRY FORD RD SIC 1-07 FlvfBs0 ciRTAI•1I=',+T:),: (;,2 a DRTA.t: '.)FE .r;n,2e, ECI3:12 2,7 S D C41. 2006- 20221! 7i212:T TF- rr?tonf.*'ti tv "o 1a r 3 a w='acrr'.r c.4.10 rah„rr r 1J a: n=.15-71rr1.:1 Tliye It 10[:.30471t;cry T Esc ..r%I ITV e,,k1/4 bt:At!t0A3 tr;PC1**;;. _*0* II t'6 a+ t 14147 Ch t y aLr:1416201 r- -.e s thci CeT,Tr.j OCt3xcoLCOm l ri octaxcc1 Ac R 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `" 06/26/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Amanda Katulich PGI of West Central Florida,LLC PHONE (NC,No,Ext): 941-242-9619 FAX No): 941-242-9621 L 608 15th St W ADDRESS: amanda@pgiofwestcentralflorida.com INSURER(S)AFFORDING COVERAGE NAIC N Bradenton FL 34205 INSURER A: Lloyds of London INSURED INSURER B: PJWD Energy LLC INSURER C: 333 N Orange Ave INSURER D: INSURER E: Orlando FL 32801 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH AUUL DUNK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDlYYYY) (MM/DD/Yl'YY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR UAMAME I O KEN I EU PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,000 A CSIXEL00553-00 06/22/2024 06/22/2025 PERSONAL 8ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 'F Ca LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMHINED SINGLE LIMI I $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED l'HUI'LHI Y DAMAGE AUTOS $ (Per accident) $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS UAB CLAIMS-MADE CSIEL01504-00 06/22/2024 06/22/2025 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION 0 — AND EMPLOYERS'LIABILITY Y!N STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Contractors Pollution Liability CSIXEL00553-00 06/22/2024 06/22/2025 Limit:$1,000,000/$2,000,000 A Professional Liability CSIXEL00553-00 06/22/2024 06/22/2025 Limit$1,000,000/$2,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) License EC13012687 CGC1534657 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Dania Beach THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 100 West Dania Beach ACCORDANCE WITH THE POLICY PROVISIONS. Boulevard Dania, FL 33004 AUTHORIZED REPRESENTATIVE ACORDI CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AccoREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/25/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Todd George Bouchard Insurance for WBS-TG PHONE 866 2 FAX PO Box 6090 (A/C.No,Ext): ( ) 93 3600 ext.623 (Arc,No): Clearwater,FL 33758-6090 A ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Zurich-American Insurance Company 16535 INSURED INSURER B: Workforce Business Services,Inc.Alt.Emp:PJWD Energy LLC 1401 Manatee Ave.West Ste 600 INSURER C: Bradenton,FL 34205-6708 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:23FL0791177708 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION $ PER AND EMPLOYERS'LIABILITY Y!N X STATUTE ERH A OFFICER/MEMBER ECUTIVE ER/M MBEREXCLU EXCLUDED? Y N/A WC 90-00-818-13 E.L.EACH ACCIDENT $ 1000000 (Mandatory in NH) 12/31/2023 12/31/2024 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below Paul Donaldson is not included in work comp E.L.DISEASE-POLICY LIMIT $ 1,000,000 coverage. Location Coverage Period: 12/31/2023 12/31/2024 Client# 055260 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Coverage is provided for PJWD Energy LLC only those co-employees 333 N Orange Ave,Unit 201 of,but not subcontractors Orlando,FL 32801 to: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Dania Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 100 West Dania Beach ACCORDANCE WITH THE POLICY PROVISIONS. Boulevard Dania,FL 33004 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) The ACORD name and Ioao are registered marks of ACORD ORD CORPORATION. All rights reserved. I/I l=lopa(ordi,Cdpsicbu tuuNDHDDroa9WIQ32IXLJZ2a3Wd/Xoqu?#I9$or8uu=4Eli./0/n/P.euz/uioa•alSoo2•Imia//sduq iii �.. a 44„ :.W., . AI Ir- ' " <>U.. SN 0Q 1< 0 III" eft C C. , � k ., fp t.., 0 c0 to _c, ,;, ; ", to c is '`* tt fi , - . a- • b'.. r , . fit.. _ I i I , gud'AIV£b'SP'I I Ir SO-0I-£Z0Z 10yS uaaiJS INVZ£:OI`bZ/ZI/Z • DIVISION OF CORPORATIONS .�^' 'i io i of . eut official State of Florida tuabs1u Department of State / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company PJWD ENERGY LLC Filing Information Document Number L20000338039 FEI/EIN Number 85-3659505 Date Filed 11/03/2020 Effective Date 11/03/2020 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 12/07/2023 Event Effective Date 04/13/2023 Principal Address 333 N ORANGE AVE ORLANDO, FL 32801 Changed: 12/07/2023 Mailing Address 333 N ORANGE AVE ORLANDO, FL 32801 Changed: 12/07/2023 Registered Agent Name&Address Foster's Accounting Services LLC 3270 SUNTREE BLVD STE 101D MELBOURNE, FL 32940 Name Changed: 04/13/2023 Authorized Person(s)Detail Name&Address Title MGR DONALDSON, PAUL 333 N ORANGE AVE ORLANDO, FL 32801 Annual Reports Report Year Filed Date 2022 04/13/2023 2023 04/13/2023 2024 04/15/2024 Document Imam 04/15/2024--ANNUAL REPORT View image in PDF format 12/07/2023--LC Amendment View image in PDF format 04/13/2023--REINSTATEMENT View image in PDF format 11/03/2020--Florida Limited Liability View image in PDF format Ro;iCa Departmem o,State.DiVi3iCP of Co a a`ors