1650 MARITIME OAK DR - TERMITE 1171
HomeTeam
PEST DEFENSE'
New Construction Subterranean Termite Treatment
This report is submitted for information purposes to the builder on(new)construction cases where treatment for prevention of
subterranean termite infestation is required by the Florida Building Code,Section 104.2.6.
All contracts for services are between the Pest Control Operator and builder, unless stated otherwise.
Section 1: Hometeam Pest Defense
Company Address:6694 Columbia Park Drive City:Jacksonville State:FL
Zip:2440909 Company Phone No.:904-730-2522 Business License No.: 1640370000
Section 2: Builder Information
Company Name:Toll Brothers Inc
Phone No.:
Section 3: Property Information
Building Permit No.:
Location of Structure(s)Treated:1650 Maritime Oak Drive,Atlantic
Type of Construction: 129 Slab ❑Basement ❑Crawl ❑Other
Approximate Depth of Footing: Outside: Inside: Type Fill:
Section 4: Treatment Information
Date(s)of Treatment(s):12/29/17 EPA Registration No.:64405-1-AA
Brand Name of Product(s)Used:Bora-Care
Final Mix Solution:23 Treatment Area Sq.Ft.:5508
Linear Ft.227 Linear Ft.of Masonry Voids:
Total Gallons of Termiticide Applied: 5
Service Agreement Available? ®Yes ❑No This building has received a complete treatment for the
Liquid treatment: ❑Yes ®No prevention of subterranean termites.Treatment is in
Liquid Final exterior treatment: ❑Yes ®No accordance with the rules and laws established by the
Borate treatment: ®Yes ❑No Florida Department of Agricultural and onsumer
Bait in lieu of Pretreat: ❑Yes ®No Services. Initial
Note:Some State laws require service agreements to be issued. This form does not preempt State law.
Attachments(List)
Comments
Name of Applicator(s):HARRY CRUZ (/ Certification No.: JE252234
Authorized Signature 3?-/544 /� /�!l Date 12/29/17
RH-NT9/05
(RI) THIS AGREEMENT PROVIDES FOR
RETREATMENT OF A STRUCTURE
H o m eTe a rn AND THE REPAIR OF DAMAGES
'EST OErEaSE CAUSED BY WOOD DESTROYING
ORGANISMS WITHIN THE LIMITS
STATED IN THIS AGREEMENT.
Account No.:2 7 6 016 5
SUBTERRANEAN TERMITE REPAIR AGREEMENT
Section I.GENERAL INFORMATION.
Name: Toll Brothers/Lot 127 ABCC Billing Address: 1650 Maritime Oak Drive
Service Address: 1650 Maritime Oak Drive City: Atlantic Beach
City: Atlantic Beach State: FL Zip Code: 32233
State: FL Zip Code: 32233 Home Phone: 904-000-0000
Work Phone:
Section II.INSPECTION FINDINGS.
The condition of the readily accessible areas of the structure(s)located at the Service Address on the date of the inspection only is listed below:
a. ®No Visible evidence of previous or current subterranean termite infestation was observed.
b. U Visible evidence of a subterranean termite infestation was observed as follows:
0 Live subterranean termites(description and location indicated on the attached graph)
0 Termite parts,exit holes or shelter tubes(description and location indicated on the attached graph)
0 Damage from subterranean termites was noted in the following area(s):
Any damage noted above should be considered only as evidence of current or previous infestation of subterranean termites.If any of the boxes in subsection
b.above are checked,some degree of damage,including hidden damage,may be present.The inspector's training and experience do not qualify the
inspector in damage evaluation or any other building construction technology and/or repair.Any visible evidence observed above appears:
❑Active; Cl Inactive; 0 Activity cannot be determined without further investigation.Reason:
In many cases,based upon visible signs of infestation by subterranean termites,it is not possible to ascertain whether an infestation is active or inactive
without benefit of subsequent inspections and evaluations over a period of time.
LI It appears that the structure(s)or a portion of the structure(s)may have been previously treated.Evidence of previous treatment:
Section III.OBSTRUCTIONS AND INACCESSIBLE AREAS.
The following areas of the structure(s)inspected were obstructed or inaccessible(see Section VII.I under General Terms and Conditions):
0 Basement U Exterior U Crawl Space 0 Porch 0 Main Level U Addition 0 Attic 0 Garage 0 Other
Comments:
Section IV.ADDITIONAL COMMENTS.
Section V.TYPE OF TREATMENT.
❑Post Construction Corrective Treatment (See reverse side for a description of the Company's obligation to retreat
and to repair damage caused by subterranean termites.)
0 Post Construction Preventative Treatment
Location of Treatment Sticker.
® Pre-Construction Treatment
0 Other:
Treatment is provided against the attack of subterranean termites(Reticulitermes spp.,Heterotermes spp.and Coptotermes spp.(Formosan)),but does not protect
against any other pests,plant,animal or organism other than subterranean termites.During the term of this Agreement,HomeTeam Pest Defense,Inc.(the"Company")
will re-inspect the treated structure(s)annually or at more frequent intervals as the Company deems necessary upon Customer's request,subject to the General Terms
and Conditions on the reverse side.Customer agrees to make the treated structure(s)available for re-inspection.The Company will retreat the treated structure(s)only
upon(a)visual evidence of a live termite infestation or(b)disturbance of the soil surrounding the treated structure(s).The Company has not inspected or treated the
structure(s)for health-related molds or fungi.By law,the Company is not qualified,authorized or licensed to inspect for health-related molds or fungi.
Actual Treatment Date: 12/29/2017 PAYMENT METHOD:
Initial Treatment Date: 12/29/2017
Down Payment: 0.00 ❑Cash 0 Check 0 Credit Card
Balance Due: ; 0.00
Annual Renewal: $ 475 00 If paying by credit card or recurring debit from your bank account,please
complete the attached Authorization for Pre-Arranged Payments.
This Agreement contains certain limitations,conditions and exclusions on the Company's obligations.Please read the entire Agreement before signing.
In consideration for the Company performing the services specified above and subject to the terms and conditions of this Agreement,Customer agrees to make the
payments indicated above.Customer acknowledges receipt of a signed copy of this Agreement.This Agreement is not binding on the Company until signed by an
authorized manager or executive officer of the Company.
CUSTOMER: HOMETEAM PEST DEFENSE,INC.
Signature: Signature: 5'4(5'449(.Lq, i
Printed Name: Printed Name: ernear4 MARK
Email: Effective Date: 12/29/2017
RIGHT TO CANCEL:YOU,THE CUSTOMER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS
DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT.
O HomeTeam Pest Defense,Inc.2012 2/12-(53314 5YR)
PDF processed with CutePDF evaluation edition www.CutePDF.com
New Construction Subterranean Termite OMB Approval No.2502-0525
Service Record (exp.05/30/2018)
This form is completed by the licensed Pest Control Company
Public reporting burden for this collection of information is estimated to average 15 minutes per response,including the time for reviewing
instructions,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.
This information is required to obtain benefits.HUD may not collect this information,and you are not required to complete this form,unless it displays
a currently valid OMB control number.
Section 24 CFR 200.926d(b)(3)requires that the sites for HUD insured structures must be free of termite hazards.This information collection requires
the builder to certify that an authorized Pest Control company performed all required treatment for termites,and that the builder guarantees the
treated area against infestation for one year.Builders,pest control companies,mortgage lenders,homebuyers,and HUD as a record of treatment for
specific homes will use the information collected.The information is not considered confidential,therefore no assurance of confidentiality is provided.
This report is submitted for informational purposes to the builder on proposed(new)construction cases when treatment for prevention of subterranean
termite infestation is specified by the builder, architect,or required by the lender,architect,FHA,or VA.
All contracts for services are between the Pest Control company and builder,unless stated otherwise.
Section 1:General Information(Pest Control Company Information)
Company Name HomeTeam Pest Defense,Inc.
Company Address 6694 Columbia Park Drive City Jacksonville State FL Zip 32258-2409
Company Business License No. 1640370000 Company Phone No. 904-730-2522
FHANA Case No.(if any) -
Section 2:Builder Information
Company Name Toll Brothers Inc Phone No. 904-217-0739
Section 3:Property Information
Location of Structure(s)Treated(Street Address or Legal Description,City,State and Zip) 1650 Maritime Oak Drive,Atlantic Beach,
FL,32233
Section 4:Treatment Information
Date(s)of Service(s) 12/29/17
Type of Construction(More than one box may be checked) ®Slab i-.Basement F.Crawl r,Other
Check all that apply:
A.Soil Applied Liquid Termiticide
Brand Name of EPA Registration No.
Termiticide:
Approx.Dilution(%): Approx.Total Gallons Mix Applied: Treatment completed on exterior:®Yes IT No
® B.Wood Applied Liquid Termiticide
Brand Name of Bora-Care EPA Registration 64405-1-AA
Termiticide: No.
Approx.Dilution(%): 23 Approx.Total Gallons Mix Applied: 5
7 C.Bait system Installed
Name of System: EPA Registration Number of Stations
No. installed
7 D.Physical Barrier System Installed
Name of System: Attach installation information(required)
Service Agreement Available? ®Yes L.No
Note:Some state laws require service agreements to be issued.This form does not preempt state law.
Attachments(List)
Comments
Name of Applicator(s) HARRY CRUZ Certification No.(if required by State law) JE252234
The applicator has used a product in accordance with the product label and state requirements. All materials and methods used comply with state
and federal regulations.
4 I
Authorized Signature '' ` Date 12/29/17
Warning:HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.(18 U.S.C.1001,1010.1012;31 U.S.C.3729,3802)
form HUD-NPMA-99-B(08/2008)