PROCLAMATION #PRO2012-10 IN HONOR OF NATIONAL POLICE …

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

fdaniel

Text Box

Item #2

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

fdaniel

Text Box

Item #4

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


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


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

fdaniel

Text Box

Item #5

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


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


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




Quality Grade 400 - FAIR Architecture 0 - STANDARD SFR




• 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



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




Quality Grade 200 - LOW Architecture H -


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


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









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


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

fdaniel

Text Box

Item #6

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:


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;


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;


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;


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:


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

fdaniel

Text Box

Item #7

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

Documents

PROCLAMATION #PRO2012-10 IN HONOR OF NATIONAL POLICE …