Permit Duna Vista Ct. R/W CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 05-00030020 Date 4/12/05
Property Address . . . . . . DUNA VISTA CT
Tenant nbr, name . . . . . . REPAIR UG ELEC PRIM 4 JEA
Application description . . . RIGHT OF WAY PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
---- -------------------- ------------------------
HENKELS & MCCOY INC .
1179 S . ELLIS RD
JACKSONVILLE FL 32205
(904) 783-6697
----------------------------------------------------------------------------
Permit . . . . . . UTILITIES PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 35 . 00 35 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 35 . 00 35 . 00 . 00 . 00
PERNffr IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
CODES.
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH
P LIC VDMMS DEPARTMENT
UB
1200 Sandpiper Lane
Atlantic Beach,Florida: 33 L I -n
(904)247-5834
(904)247-5843 Fax
www.coab.us
PLAN REVIEW COMMENTS
Permit Application # 05— a0020
Property Address: D)NJ-)12\ VtST44� Ll
Applicant:
Project: Flu,
7 Your application is approved as noted by the Public wom vuparunent.
,-Final application approval must come from the Building Department.
0 Your permit application has been reviewed by the Public Works Department
and the following items need attention:
7ZFJI�
OL ld��
&-0
Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions,please call(904)247-5834.
er,P.E.,Pub
Date
Signature
Contractor Notified Date dja;�d. q14
CITY OF ATLANTIC BEACH
PUBLIC WORKS DEPARTMENT
1200 Sandpiper Lane
Atlantic Beach,Florida 32233
(904)247-5834
-ell (904)247-5843 Fax
wwwcoab.us
PLAN REVIEW COMMENTS
Permit Application # 05— a0020
-T'.LZI.
Property Address: —IDL)
Applicant:
Project: o Lk(x 'Up r CPt- Pyl b—)(A Y�
Your application is approved as noted by the Public Works Department.
Final application approval must come from the Building Department.
u Your permit application has been reviewed by the Public Works Department
and the following items need attention:
Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane,
Atlantic Beach, FL 32233 in order that we can approve your application. If you have any
questions,please call (904)247-5834.
Carper,P.E.,Public Works Director
Date
Signature
Contractor Notified Date
AT!
j
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF MY ND EASEMENTS
-5800
Boo Seminole Road 904-247
-5445 Fax 904-247-5845
Atlantic Beach,Florida 32233
Date PERMIT�#
1 _Y,
ISSUED�,BY THit CrrV_,7-
Job Address 3CJ5
Permitee: EUD�a TelephoneAca, v6, 40(09 +
Permittee Address- k (a) - F m K �k, R
Requesting Permission t I Construct: I k S ��C-_Tvl (1AC , Py'k
oee-
Location: (Reference to Cross-Street) S(n2�
1 Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes N o ( ) Date: 'N'l
Bell South Telephone Company Yes No ( ) Date:
Ferrell Gas 'Yes o Date:
Comcast Yes (��No Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beacb,or Florida Department of Transportation Standards and be
performed under the supervi-. n of Coo rac )r's Project
'Llo t tc
Superintendent) located at k—+A 5 - li�j Ui"C.2 Telephone
4. All materials and equipment'shall be subject to inspection by the Dird6tor of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit
7. This permlittee shall commence actual construction in good faith with days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER
Signed: A44-6% Date- -19-40$'
Before me this iy he r,, D Notary Public State of Flodda
(_4 0'-) la
State Of Florida,has personally appe 0
a&5H4?2 � 4 � Sonya E Thomas
Notary Public at Large,StV4[l nicial.County of D al. AJ My Commission DD391019
My clomm'ss, 04
Of'Ve Expires 03/0412009
11 'on e 'r'�s
Personally Known�03 or —
4
Produced ldeni*iahln�_ ������
'Apr 04 05 03: 43p cit�j of Atlantic Beach Bu 904-247-5845 P. 1
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FLORIDA 32233-5445
Telephone: (904)247-5800
Fax: (904)247-5845
http://ci.atlantic-beach.fl.us
FAX
To: A�C'V_' Fax#:
From: Date: L4 L4-i as-
Pages: Re:
Urgent For Review Please Reply
N
Notes:
Apr 04 05 03:43p cittl of Atlantic Beach Bu 904-247-5845 P. 2
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
MAINTENANCE BOND Hartford,Connecticut 06183
BOND NO. 103869564
KNOW ALL MEN BY THESE PRESENTS:
That HENKELS&McCOY,INC.,985 Jolly Road,Blue Bell,PA 19422
as Principal,hereinafter called Contractor, and TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA,as
Surety,hereinafter called Surety, are held and firmly bound unto City of Atlantic Bea.ch
21 W. Church St. , Jacksonville, FL 32202
as Obliges, hereinafter called Owner, in the penal sum Of Ten Thousand and 00/100 ($10,000-00)
,for the payment whereof Contractor and Surety bind themselves,their heirs,executors, administrators, successors, and
assigns,jointly and severally, firmly by these
presents.
WHEREAS,Contractor has by written agreement, dated December 20, 2002
entered into a contract with Owner for Single Span UG Repairs - Miscellaneous Locations in
Atlantic Beach, FL
in accordance with the General Conditions, the Drawings and Specifications,which contract is by reference
incorporated herein, and made a part hereof, and is referred to as the Contract.
NOW,THEREFORE,the condition of this obligation is such that, if Contractor shall remedy any defects due to faulty
materials or workmanship which shall appear within a period of One (1) year(s) from the date of substantial
completion of the work provided for in the Contract,then this obligation to be void.; otherwise to remain in full fo.rce and
effect.
PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed defects with reasonable
promptness.
SIGNED and sealed this 23rd day of March, 2005
IN THE PRESENCE OF: HENKELS & McCOY, INC.
(Seal)
Principal
U0718-
title\/
M EW D.PIROLLC TREASUREF
AM TRAVELERS D SURETY COMPANY OF AMERICA
ASSIVANT SECRETARN E3y
RobeW orney-in-Fact
S-2326-1 (07-97)
Apr 04 05 03:43p cit%j of Atlantic Beach Bu 904-247-5845 P. 3
TRAVELERS CASUALTY AND SURETY COMANy oF ANMRICA
TRAVELERS CASUALTY AND SURETY COWANY
FARMWGTON CASUALTY COMTANY
Hartford,Connecticut 06183-9062
POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT
KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON�CASUALTY COMPANY,
corporations duly organized under the iaws or the State of Connecticut, and having their principal offices in the City of Hartford,
County of Hartford, State of Connecticut, (hereinafter the "Companies!) hath made, constituted and appointed, and do by these
presents make, constitute and appoint: Dorothy M. Zamorski,Robert D. Garis,Vicki L. Hippauf, of Lederach,Pennsylvania,
their true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred to sign,execute and acknowledge,at any
place within the United States, the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances,
contracts of inderanity, and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking and any and
all consents incident thereto and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the
duly authorized officers of the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are
hereby ratified and confirmed.
This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are
now in full force and effect:
VOTED: That the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any
Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact
and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe
to signwith the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in
the nature of a bond,recogni7Ance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such
appointee and revoke the power given him or her.
VOTED: That the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President
may delegate all or any part of the f6regoing authority to one or more officers or employees of this Comp.any,provided that each such delegation is
in writing and a copy thereof is filed in the office of the Secretary.
VOTED: That any bond, recogrtizance,'contract of indemnity, or writ-ing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any
Senior Vice President or any Vici President,any Second Vice President,the Treasurer,.any Assistant Treasurer,the Corporate Secretary or any
Assistant Secretary and duly attested a.nd*scaled with the Company's seal by a Secretary or Assistant Secretary,or(b)duly executed(under seal,if
required)by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or
by one or more Company officers pursuant to a written delegation of authority.
This Power of Attorney and Certificate of Authority is signed and sealed by facsimile(mechanical or printed)under and by
authority of the following Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY
COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY
COMPANY,which Resolution is now in full force and effect:
VOTED: That the signature of each of the following officers. President, any Executive Vice President, wiy Senior Vice President,any Vice
President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsintilc to any
power of attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attomeys-in-Fact for
purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such poNver of attorney
or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and
certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or
undertaking to w.hich it is attachecl.
RevLwd(0 1.03)Standard
Apr 04 05 03:44p Cittj of Atlantic Beach Bu 904-247-5845 p. 4
IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS
CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMTANY have caused this instrument to be
signed by their Senior Vice President and their corporate seals to be hereto affixed this I Sth day of March,2003.
STATE OF CONNECTICUT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
TRAVELERS CASUALTY AND SURETY COMPANY
)SS.Hartford FARMINGTON CASUALTY COMPANY
COUNTY OF HARTFORD
S U
A eovi�K-
0
KAMFORD.
"o CONN.
Com.
George W. Thompson ,
Senior Vice President
On this 18th day of March, 2003 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly
sworn,did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMTANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMIKGTON CASUALTY COMPANY, the
corporations described'in and which executed the above instrument; that he/she knows the seals of said corporations; that the seals
affixed to the said inStrument are such corporate seals;and that he/she executed the said instrument on behalf of the corpora tions by
authority of hMier office under the Standing Resolutions thereof
0 My commission expires June 30,2006 Notary Public- -
Marie C.Tetreault
CERTIFICATE
1, the undersigned, Vice President, Bond of TRAVELERS CASUALTY AND SURETY COMWANY OF AMERICA,
TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY,stock corporations of
the State of Connecticut, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority
remains in kult force and has not been revoked, and f�rthcrmorc, that the Standing Resolutions of(fie Boards of Directors, as set
forth in the Certificate of Authority, are now in force.
IN WITNESS WHEREOF,I have-hereunto set rny hand and affixed the seals of said Companies this 23rd day of
March 20 05
CINSUAC,
* .. By
r FO, KARTFORD, 1982 00
CONN. CON , A- 'Citrone
...... Vice A?sident, Bond
Rpr 04 05 03: 45p Cit�j of Atlantic Beach Bu 904-247-5845 P. 5
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
HARTFORD,CONNECTICUT 06183
FINANCIAL STATEMENT AS OF JUNE 30,2004
CAPITAL STOCK 6,000,000
UAR.)UTIES SURPLUS
CASH INVESTED CASH S 51,672,364 UNEARNED PREMIUMS $ 495,854,177
BONDS 1,900,711,942 LOSSES 496,611,406
STOCK 21.472,221 LOSS ADJUSTMENT EXPENSES 107,677,657.
OTHER INVESTED ASSETS COMMISSIONS 9,M'790
INVESTMENT INCOME DUE AND ACCRUED 20,688,590 TAXES,LICENSES AND FEES 7,779,413
PREMIUM BALANCES 148,202,446 OTHER EXPENSES 10,293,898
REINSURANCE RECOVERABLE 52,235.274 CURRENT FEDERAL AND FOREIGN INCOME TAXES 17,056,324
CURRENT FEDERAL INCOME TAX RF-COVERA13LE - PAYABLE FOR SECURITIES 58,488,883
NET DEFERRED TAX ASSET 3.4,303,735 PAYABLE TO PARENT,SUBSIDIARIES&AFFILIATES 875,951
RECEIVABLE FOR SECURITIES 1,356,735 OTHER ACCRUED EXPENSES AND LIABILITIES 63,261,427
RECEIVABLE FROM PARENT,SUBSIDIARIES AFFILIATES - TOTAL LIABILITIES $1, 67,752,921
OTHER ASSETS (48.890."0)
CAPITAL STOCK $ 6,000,000
PAID IN SURPLUS 303,297,402
OTHER SURPLUS 604,702.1"
TOTAL SURPLUS TO POLICYHOLDERS 913,999,546
TOTAL $2,181,762,467 TOTAL $2,181,752.467
1
STATE OF CONNECTICUT
COUNTY OF HARTFORD )SS.
CITY OF HARTFORD
LAWRENCE A.SIUTA,BEING DULY SWORN,SAYS THAT HE IS VICE PRESIDENT,BOND,OF THE TRAVELERS CASUALTY AND
SURETY COMPANY OF AMERICA,AND THAT TO THE SESTOF HIS KNOWLEDGE AND BELIEF,THE FOREGOING IS ATRUE AND
CORRECT STATEMENT OF THE FINANCIAL CONDITION OF SAID COMPANY AS OF THE 30TH DAY OF JUNE,2DO4.
SUBSCRIBED AND SWORN TO BEFORE ME THIS NOTARY-PUBLIC
23RD DAY OF AUGUST,2004
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