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OIG No. 23-17 Investigation of Unauthorized Outside Employment by City Employee
Joseph M. Centorino, Inspector General TO: FROM: Honorable Mayor and Members of the City Commission Joseph Centorino, Inspector General DATE: RE: August 25, 2023 Investigation of Unauthorized Outside Employment and Exploitation of Official Position by a Public Works Employee in the City of Miami Beach OIG No. 23-17 EXECUTIVE SUMMARY This investigation was commenced following receipt by the Office of the Inspector General (OIG) of information from an anonymous source that a full-time City employee, Montrice McClain (Subject), a Control Room Supervisor in the Department of Public Works, was operating private businesses on City time and utilizing a city computer in that activity. The OIG found sufficient evidence of such activity that the matter was referred to the Miami-Dade Commission on Ethics and Public Trust (COE) for its evaluation. The OIG worked along with the COE to obtain further evidence that supported the allegations. Upon completion of the investigation, a complaint was filed against the Subject by the Ethics Commission Advocate for violations of Miami-Dade County Code Sections 2-11.1(k)(2) Prohibition on Outside Employment and 2-11.1 (g) Exploitation of Official Position. This resulted in a Final Order by the COE (attached to this report), which was not contested by the employee, finding that both violations had occurred, imposing a fine of $1500.00, and directing that a letter of instruction be issued to the Subject. During the investigation, but prior to final action by the COE, the Subject resigned from her City employment. INVESTIGATION The initial tip came in an email sent through the OIG website, which claimed that the Subject owned and operated two businesses while working for the City and had used her City-issued computer in connection with her private work. It also indicated that one of her businesses involved notary work. Records accessed through the State of Florida Department of State Division of Corporations showed two active companies directly related to the Subject: McClain Signature Services, LLC, which listed the Subject as the company's registered agent and sole manager; and Signature Dispatching, an active Florida fictitious name created and owned by McClain Signature Services, LLC. Records for an inactive company, Mogul Measures, LLC, listed the Subject as one of the company's managers. Page 1 of 1 State records also showed that the Subject had received a Notary Public license from the State of Florida while employed by the City. The Subject's personnel file with the City was obtained, which showed that the Subject had been hired on April 10, 2018, as a Control Room Operator in the Public Works Department. As a Control Room Operator, the Subject's duties included monitoring Water and Sewer Control Boards, answering citizen complaints, performing water meter turn-on and shut-off requests, monitoring and investigating alarms in the Water and Sewer system, and identifying electrical and mechanical problems in the system. During 2021, the Subject was promoted to Control Room Supervisor. The Subject's personnel file did not show any request for approval of outside employment. A check by OIG with the Human Resources Department, which maintains such records, confirmed that no approved request for outside employment was on file. Additionally, the City Clerk's Office was contacted to determine whether the Subject had ever filed an annual statement of income from outside employment, as required under the County Ethics Code. No such statement was on file . The OIG conducted a search of emails and scanned documents on the Subject's City computer, which revealed that the subject had used the computer to conduct work on her private businesses and also to work for another private business, Allstar Transportation Services, LLC., owned by a boyfriend of the Subject. All information obtained by the OIG was forwarded for review to the COE investigator, who also interviewed Public Works Director Joe Gomez and the Subject herself. After being confronted with the evidence, the Subject acknowledged that she had engaged in unauthorized private employment with her own businesses as well as that of her boyfriend, and that she also failed to timely file accurate annual Outside Employment statements with the City. The Subject initially denied to the COE investigator that she had utilized her City computer to conduct the work. However, when confronted with the documents obtained by the OIG from her computer, the Subject acknowledged having done so, but claimed that she had done so only after her daily work assignments were completed. On April 25, 2023, just prior to the COE Advocate's submission of a Probable Cause Memorandum to the full Ethics Commission in June, the Subject resigned from her employment with the City of Miami Beach. The detailed COE Probable Cause Memorandum with Exhibits is also attached to this report. COE COMPLAINT AND FINAL ACTION Based on the evidence compiled in the investigation. The COE advocate issued a three-count complaint to the Ethics Commission, citing violations of the following Miami-Dade County Code provisions applicable to municipal employees: Prohibition on Outside Employment -Section 2-11. 1 (k)(2) Counts I and II of the Complaint were filed under this section for the Subject's failure to file, by July 1 of 2021 and 2022, the required annual reports indicating the source of her outside employment, the nature of the work being done pursuant to the same, and any amount or types of money or other consideration that she received from said employment for those years. Page 2 of 3 Exploitation of Official Position-Section 2-11. 1 (g) Count 111 of the Complaint was filed under this section for the Subject's utilization of City of Miami Beach resources, namely, a City of Miami Beach issued laptop computer in furtherance of her outside employment activities unrelated to City of Miami Beach official business, securing privileges or exemptions for herself and/or others. On July 10, 2023, the Subject waived her right to a probable cause hearing before the Commission and stipulated that the allegations in the Complaint were supported by probable cause. At a Commission hearing held on July 20, 2023, to consider the Complaint before it, the Subject did not contest any of the allegations. In its Final Order issued on August 2, 2023, the Commission ordered her to pay a total fine of $1,500.00 (five hundred dollars for Count I and one thousand dollars for Count Ill), ordered her to accept a Letter of Instruction, and dismissed Count II of the Complaint. This investigation is now closed. espectfully submitted: cc: Alina Hudak, City Manager Eric Carpenter, Deputy City Manager Joe Gomez, Public Works Director Marla Alpizar, Human Resources Director OFF ICE OF THE INSPECTOR GENERAL, City of Miami Beach 1130 Washington Avenue, 6th Floor, Miami Beach, FL 33139 Tel: 305.673.7020 •Hotline: 786.897.1111 Emai l: CityofMiamiBeachOIG@miamibeachfl.gov Website: www.mbinspectorgeneral.com Page 3 of 3 DocuSign Envelope ID: 6B52F404-8B70-4FD2-909C-DE78DFECF6F3 MIAMI-DADE COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST IN RE: C 23-22-06 MONTRICE NICHOLE MCCLAIN RESPONDENT ___________________/ PUBLIC REPORT AND FINAL ORDER The Advocate ofthe Miami-Dade County Commission on Ethics and Public Trust filed a Complaint in this matter against Montrice Nichole McClain (hereinafter, "Respondent"), for violating the Miami-Dade County Conflict of Interest and Code of Ethics Ordinance Section 2-11.1 (k)(2), entitled "Prohibition on outside employment," and Section 2-11.1 (g), entitled "Exploitation ofOfficial Position. " The Respondent was employed full-time with the City of Miami Beach Department of Public Works as Control Room Supervisor. Investigation showed that in 2019, while employed by the City of Miami Beach, the Respondent established and was listed as a manager of a for-profit Florida Limited Liability corporation named Mogul Measures, LLC. The Respondent advised in her sworn statement to this agency that she initially intended to use the company to conduct a clothing business. Mogul Measures, LLC. was administratively dissolved by the State ofFlorida Department ofState Division of Corporations on September 24, 2021. Investigation also showed that in 2020, the Respondent established and was listed as a manager and registered agent of for-profit Florida Limited Liability corporation named McClain Signature Services, LLC. The Respondent provided notary services through McClain Signature Services, LLC. In 2021, McClain Signature Services, LLC., registered a fictitious name, Signature Dispatching. The Respondent used Signature Dispatching to conduct a truck load dispatching business. The Respondent in her sworn statement stated that she only operated her truck load dispatching business for approximately four (4) months in early 2021. She explained however that after she stopped operations of Signature Dispatching, she continued to perform truck load dispatching and administrative duties for AllStar C 23-22-06 In re: Montrice Nichole McClain Final Order DocuSign Envelope ID: 6B52F404-8B70-4FD2-909C-DE78DFECF6F3 Transportation Services, LLC., which is owned by her significant other, Emmanuel Sims. She indicated that she "helped" Sims, by signing off on invoices and managing Allstar Transportation Services, LLC's, administrative duties while Sims was on the road. As the Respondent was engaged in outside employment while she was employed full-time by the City of Miami Beach, she was required to file Outside Employment Statements indicating the source ofher outside employment, the nature ofthe work being done, and the amount and types of money or other consideration she received from her outside employment. See Miami-Dade County Ethics Code§ 2-11.l(k)(2); RQO 17-03; RQO 16-01. However, upon review ofthe Respondent's City ofMiami Beach personnel file and by the Respondent's own admission, the Respondent did not request approval to conduct her outside employment and did not file any Outside Employment Statements even though, she was an officer for and/or actively engaged with four (4) companies. Specifically, on or about July 2, 2021, the Respondent had not filed the required annual sworn report for 2020 that was due on July 1, 2021; and, on or about July 2, 2022, the Respondent had not filed the required annual sworn report for 2021 that was due on July 1, 2022. Investigation further showed that the Respondent used her position with the City of Miami Beach, and the access said position provided to a City of Miami Beach computer and computer related equipment, to support her outside employment activities. Documents obtained from the Respondent's City ofMiami Beach work computer showed that the Respondent used City resources to work on branding and marketing for McClain Signature Services, LLC., and Allstar Transportation Services, LLC.; transmitted documents via email that she notarized or planned to notarize for a fee; processed and electronically signed transportation load confirmation contracts for Allstar Transportation Services, LLC.; applied for McClain Signature Services to be a White Label Broker for Tradeline Supply Company; and assisted Sims with the completion of his personal Florida and Federal CDL registration obligations. Consequently, the Respondent violated Section (g) of the Ethics Code, by utilizing her assigned City of Miami Beach computer and equipment in furtherance of her outside employment activities, securing a special benefit for both herself and her significant other, Emmanuel Sims. The Respondent stipulated to Probable Cause. On July 20, 2023, the Miami-Dade County Commission on Ethics and Public Trust, by a unanimous vote, accepted the Respondent's Stipulation to Probable Cause regarding the facts underlying the Complaint and ratified the Settlement Agreement. Pursuant to the Settlement Agreement, the Commission accepted the Respondent's decision Not to Contest C 23-22-06 In re: Montrice Nichole McClain Final Order DocuSign Envelope ID: 6B52F404-8B70-4FD2-909C-DE78DFECF6F3 the allegations in the Complaint, ordered the Respondent to pay a total fine of $1,500.00 (five hundred dollars for Count I and one thousand dollars for Count III), ordered the Respondent to accept a Letter of Instruction, and dismissed Count II of the Complaint. Wherefore it is: ORDERED AND ADJUDGED that Complaint 23-22-06 against Respondent Montrice Nichole McClain is hereby concluded. DONE AND ORDERED by the Miami-Dade County Commission on Ethics & Public Trust in public session on this 20th day of July 2023. MIAMI-DADE COUNTY COMMISSION ON ETHICS & PUBLIC TRUST Judith Bernier Chair 8/2/2023Signed on:_______ C 23-22-06 In re: Montrice Nichole McClain Final Order PROBABLE CAUSE MEMORANDUM To: Miami-Dade County Commission on Ethics and Public Trust From: Radia Turay, Advocate Etta Akoni, Staff Attorney Re: C 23-22-06 (In re: Montrice Nichole McClain) Date: June 2023 I. Recommendation: There is Probable Cause to believe that Montrice Nichole McClain, (hereinafter "Respondent"), violated two (2) sections of the Miami-Dade County Conflict of Interest and Code of Ethics Ordinance (hereinafter "Ethics Code"), specifically, Section 2-11.1 (g), entitled "Exploitation of Official Position, " and Section 2-11.1 (k)(2) entitled "Prohibition on Outside Employment." 1 II. Background and Investigation: On August 20, 2022, the City of Miami Beach, Florida (hereinafter "City") Office of the Inspector General (hereinafter "OIG") received an anonymous complaint that the Respondent had engaged in outside employment without permission. The anonymous complaint also stated that Respondent owned two businesses and was using City resources to conduct outside employment. The OIG refe1Ted the allegation to the Miami Dade Commission on Ethics and Public Trust (hereinafter "COE") for its independent evaluation of the matters referenced therein that fall within the jurisdiction of the COE. The COE reviewed and investigated this allegation. The Respondent is employed full-time by the City of Miami Beach Department of Public Works as a Control Room Supervisor. A search of public records via the State of Florida Department of State Division of Corporations website showed that the Respondent is listed as an officer or registered agent for three (3) currently active companies: 1 Probable Cause exists where there are reasonably trustworthy facts and circumstances for the Miami-Dade County Commission on Ethics and Public Trust ("COE") to conclude that the Respondent violated any County or municipal law or provision over which the COE has jurisdiction. See Miami-Dade Commission on Ethics and Public Trust Rules of Procedure 4. l 2(b ). Page 1 of 9 1. Mogul Measures, LLC. -Mogul Measures, LLC. was created on November 18, 2019, and was administratively dissolved by the State of Florida Department of State Division of Corporations on September 24, 2021. See Sunbiz.org Profile, Articles of Incorporation, and Annual Corporate Filings for 2020 for Mogul Measures, LLC., attached hereto as "Exhibit A." The Respondent is listed as one of the company's managers. Id. 11. McClain Signature Services, LLC. -McClain Signature Services, LLC., is an active Florida limited liability corporation created on November 16, 2020. See Sunbiz.org Profile, Articles oflncorporation, and Annual Corporate Filings for years 2021, 2022, and 2023 for McClain Signature Services, LLC., attached hereto as "Exhibit B." The Respondent is listed as the company's registered agent and sole manager. Id. 111. Signature Dispatching -Signature Dispatching is an active Florida fictitious name created and owned by McClain Signature Services, LLC. See Sunbiz.org Profile and Fictitious Name Filings dated December 5, 2021, attached hereto as "Exhibit C." Signature Dispatching is an active :fictitious name until 2026. Id. The COE investigation of public records related to the Respondent also revealed that on October 7, 2019, the Respondent was awarded a Notary Public license by the State of Florida. See State of Florida, Department of State, Division of Corporations, Notary Section records for Montrice Nichole McClain, attached hereto as "Exhibit D." Upon the request of the COE, the City OIG conducted a search ofthe Respondent's City assigned computer and scanner. This agency reviewed the information and documentation produced from this search. The search revealed that the Respondent used her City assigned computer to conduct work for her personal businesses and to work for an um-elated non-City entity, Allstar Transportation Services, LLC. (hereinafter "Allstar"). A search for Allstar on the State of Florida Department of State Division of Corporation website revealed that Emanuel 0. Sims (hereinafter "Sims") is the only authorized person or manager listed for Allstar. See Sunbiz.org Profile, Articles of Incorporation, and Annual Corporate Filings for years 2022, attached for Allstar, attached hereto as "Exhibit E." The Respondent's computer contained several Load Confirmation Contracts issued to Allstar, including some that list the Respondent as either the contact person and/or a manager with her personal contact number, dated in the later two (2) quarters of 2022, as well as regulatory administrative documents for Allstar. See Load Confamation Contracts and Administrative Documents, attached hereto as "Exhibit F." The Respondent's City computer also contained an illustration of Allstar' s company logo, and a flyer for Allstar that both Sims' and the Respondent's contact phone numbers listed. See Allstar's Logos and Flyers, attached hereto as "Exhibit G." A copy of Sims' Florida driver's license; an executed United States Depaiiment of Transportation Medical Examination Rep01i form for commercial drivers, dated October 27, 2022; Sim's 2023 Unified Carrier Registration confamation, dated October 13, 2022; Sim's Florida CDL Medical Page 2 of 9 Self Certification Submission confirmation, dated October 28, 2022; Sim's September 2022 mortgage loan statement; and Allstar Transpmiation Services, LLC's Progressive Insurance Company Ce1iificate of Insurance form were also found on her computer. See Sim's Personal Documents, attached hereto as, "Exhibit H." The search of the Respondent's City computer also had illustrations of the McClain Signature Services Viliual Assistant Service logo. See McClain Signature Services logos, attached hereto as "Exhibit I." Her computer fmiher had scanned documents that had either been notarized by the Respondent or appear to be waiting to be notarized as her signature line was printed on the form, such as an email from the Respondent's personal email address to her work email address containing a pre-completed U.S. Passpmi application to be notarized. See Notarization Documents, attached hereto as "Exhibit J." Lastly, an application by McClain Signature Services to be a White Label Broker for Tradeline Supply Company, dated November 21, 2022, was found on the Respondent's computer. See Tradeline Supply Application, attached hereto as, "Exhibit K." A review ofthe Respondent's City of Miami Beach personnel file showed that the Respondent did not submit a request, nor had she received prior written authority from the City to engage in outside employment. The Respondent had also never filed any Annual Income Disclosure Statements with the City Clerk. After reviewing the above-mentioned information and documentation, the following interviews were conducted in fmiherance of this COE investigation. A. Interview ofJoe L. Gomez Director ofthe Department ofPublic Works for the City o(Miami Beach Joe Gomez, the Director of the Department of Public Works for the City of Miami Beach (hereinafter referred to as "Gomez") and Respondent's supervisor, was interviewed by COE investigators. Gomez described the Respondent's responsibilities as a Control Room Supervisor for Public Works as, including but not specifically limited to, managing the control room; monitoring the City of Miami Beach's water, wastewater, and stormwater indicators; responding to emergencies and alarms; and providing support and serving as a liaison between control room operators. The COE obtained a copy of the job description for a City of Miami Beach Department of Public Works Control Room Supervisor position. See Control Room Supervisor Position Description, attached hereto as "Exhibit L." The Control Room Supervisor Position Description does not reference any duties related to being a Notary Public. Id. Gomez stated that their department has employees that are tasked with the responsibilities of being a Notary Public for the depaiiment. For those designated by the City to be a department Notary Public, the fees and costs associated with being a Notary Public are paid for by the City of Miami Beach. According to Gomez, the City maintains employees with said credentials in the event a regulatory agency requests an affidavit from their office that would require notary services. Gomez stated that he has never seen a document notarized by the Respondent in the eighteen (18) months he has worked for the City. Gomez described the Respondent as an exceptional and reliable employee, always going above and beyond to perform her duties as supervisor. Page 3 of 9 B. Interview o(Montrice Nichole McClain (Respondent) The Respondent provided a sworn and recorded statement to this agency. The Respondent confirmed that she has been employed with City of Miami Beach, Florida Department of Public Works since 2018. For the last two (2) years, she has held the position of Control Room Supervisor. According to the Respondent, her responsibilities as Control Room Supervisor include, but are not limited to, managing the control room, ensuring 24/7 coverage in the control room, and overseeing the operation of the water supply and distribution system. The Respondent was questioned regarding her role and involvement with Mogul Measures, LLC., McClain Signature Services, LLC., Signature Dispatching, and Allstar Transpo1iation Services, LLC. A summary of the Respondent's responses to the inquiry into each of these companies is listed below. i. Mogul Measures, LLC. The Respondent advised that Mogul Measures, LLC., is a clothing design company that was never operational. She stated Mogul Measures, LLC., was created on November 18, 2019, and was administratively dissolved by the State of Florida Depaiiment of State Division of Corporations on September 24, 2021. See Exhibit A. The Respondent explained that whenever she got an idea for a business, she would register the name to have it readily available, but since the business did not launch, she did not profit from it. ii. McClain Signature Services, LLC. The Respondent advised that in 2019 she became a notary public. She stated that she established McClain Signature Services in 2020 to provide notary services. The Respondent acknowledged that there is a website for McClain Signature Services, LLC., but indicated that the company is not currently offering any services as she is focusing on rebranding the business in order to gain a bigger following and learn more about marketing. Before taking a break from the business, the Respondent claimed that she barely had clients, and would do mobile Notary Public work from referrals. The Respondent recounted three clients for the business: a customer in Miami who was referred to her by her cousin, Janieka Smith, in 2020; her cousin, Janieka Smith, in 2022; and a different cousin, Audrey Bent. She stated that she charged her customers twenty (20) dollars for her notary services. The Respondent denied notarizing any documents at her City employment unless she was asked to do so by her employer. When asked if being a notary public was paii ofher responsibilities for the City, the Respondent claimed that she is rarely asked to do so but that City management was aware that she is a Notary Public and have asked her to notarize documents once or twice before. When asked if the City has ever paid for her notaiy supplies, the Respondent confirmed the City paid for a stamp that she keeps at work locked in her locker along with her ledger to keep track of the documents she's notarized. The Respondent added that her personal stamp looks different than the one she has at work. The COE was provided a copy of an email between the Respondent and Tiffany Bain, an Office Assistant for the Operations Division of the Department of Public Works for the City of Miami Beach, dated October 27, 2021, wherein Ms. Bain confirms the purchase of notary supplies for Ms. McClain. See Notary Supply Purchase Email, attached hereto as, "Exhibit M." The Respondent initially denied using any City resources, specifically her City assigned a Page 4 of 9 computer, to complete work umelated to her City position for McClain Signature Services. However, her response changed when presented with a series of documents found on her City assigned computer including copies of notarized documents, pictures of her company logo for McClain Signature Services, an application by McClain Signature Services to be a White Label Broker for Tradeline Supply Company, and other personal documents. See Exhibits I, J, and K. The Respondent then admitted that she would conduct McClain Signature Services business on her City assigned computer while at work, but only once her daily work assignments were completed. 111. Signature Dispatching According to the Respondent, Signature Dispatching was created by the Respondent as a fictious name of McClain Signature Services, LLC. The Respondent stated that Signature Dispatching is currently inactive2. The Respondent stated that she registered the fictitious name in order to add a truck load dispatching business to her company. Signature Dispatching focused on finding and scheduling freight loads for truckers who are on the road and unable to complete the necessary paperwork for the loads. In exchange the Respondent was compensated with a percentage of her client's compensation for the load. However, the Respondent stated that she only did this type of work for approximately four (4) months in early 2021. The Respondent alleged that she stopped providing this service after the market truck load rates dropped so low that it made her services unaffordable for her clients. She stated that while she conducted this business, she worked with two truck companies, Allstar and Exclusive Prime, LLC (she was unable to recall the later entity's full name). She was unclear on how much she made per month doing dispatch work for Allstar but estimated it at approximately $3500USD for a five-month period. Altogether, the Respondent believed she made approximately $1 0,000USD in 2021 from Signature Dispatching. According to the Respondent, all her work for Signature Dispatching was conducted from her home office using her own computer.3 iv. Allstar Transportation Services Regarding Allstar, the Respondent explained that she was not and is not an employee of Allstar. She stated that she worked for her own company, Signature Dispatching, providing truck load dispatching service to carriers like Allstar. However, the Respondent admitted that she is in a personal romantic relationship with Emmanuel Sims, the owner of Allstar. She fu1iher explained that after she stopped operations for Signature Dispatching, she continued to help her "boyfriend," Sims, by signing off on invoices and managing Allstar administrative duties while Sims was on the road. See Exhibits F, G, and H. After she was confronted with all the documents found on her computer, the Respondent admitted that she used her City assigned computer to do this work for Sims. However, she reiterated that she only conducted work for Allstar after she had completed her City assigned responsibilities. Moreover, the Respondent stated that she was not compensated for her work as dispatcher for Allstar in 2022. 2 Signature Dispatching was confinned as "Active" until 2026 on the State of Florida Department of State Division of Corporations website. 3 The Respondent's computer however contained several Load Confirmation Contracts issued to Allstar Transportation Service, including some that list the Respondent as either the contract person or/a manager with her personal contact number, dated in the latter two (2) qua1ters of 2022, as well as regulatory administrative documents for Allstar. See "Exhibit F." Page 5 of 9 Lastly, the Respondent was advised that City resources may not be used to conduct work for her outside employment, even if she has completed her City work. The Respondent stated that she was not aware that her activities were considered outside employment. As such she indicated that she had not previously requested pe1mission to engage in outside employment and did not file any Annual Outside Employment Disclosures. The Respondent was informed that she would have to request permission to engage in any employment endeavor outside of the City of Miami Beach, and she needed to complete the financial disclosure statement f01ms for each year her businesses were active while employed with the City of Miami Beach, even if no income was earned. One week after this interview, this agency received an email from the Respondent stating that she filed Outside Employment Approval Request and Statement for 2018, 2019, 2020, and 2021. See McClain Outside Employment Approval Request and Statement, attached hereto as, "Exhibit N." A review of the Outside Employment Statement filed by the Respondent on February 15, 2022, for 2020 only lists McClain Signature Services, excluding Mogul Measures LLC. Id. A review of the Outside Employment Statement filed by the Respondent on February 15, 2023, for 2021 also only lists McClain Signature Services, excluding Mogul Measures LLC and Signature Dispatching. Id. Allstar Transp01iation Services is not refe1Ted on any of the Outside Employment Statement nor the City of Miami Beach Request for Approval for Outside Employment filed by the Respondent.4 Id. III. Applicable Law Miami-Dade County Ethics Code, Section 2-11.l(k), entitled, "Prohibition on outside employment," states in pe1iinent paii: All full-time County and municipal employees engaged in any outside employment for any person, firm, corporation or entity other than Miami-Dade County, or the respective municipality, or any of their agencies or instrnmentalities, shall file, under oath, an annual report indicating the source of the outside employment, the nature of the work being done pursuant to same and any amount or types ofmoney or other consideration received by the employee from said outside employment. Said County employee's rep01is shall be filed with the supervisor of elections no later than 12:00 noon on July 1st of each year, including the July 1st following the last year that person held such employment. Miami-Dade County Ethics Code§ 2-11.l(k)(2). Miami-Dade County Ethics Code, Section 2-11.1 (g), Exploitation of official position prohibited, States: 4 The Respondent has since resigned from her position at the City of Miami Beach. Page 6 of9 No person included in the te1ms defined in Subsection (b) (1) through (6) and (b) (13) shall use or attempt to use his or her official position to secure privileges or exemptions for himself or herself or others except as may be specifically permitted by other ordinances and resolutions previously ordained or adopted or hereafter to be ordained or adopted by the Board of County Commissioners." See Miami-Dade County Ethics Code§ 2-11.l(g). IV. Analysis Section 2-11.1 (a) of the Ethics Code provides that the Ethics Code sets minimum standards of ethical conduct and its provisions are applicable to all municipal governments within Miami-Dade County, including the City of Miami Beach. The Respondent in this case is a Control Room Supervisor for the Department ofPublic Works for the City ofMiami Beach, Florida. As a Control Room Supervisor, she is a covered party pursuant to Section 2-11.1 (b)(6) ofthe Ethics Code which applies to all other personnel employed by the County or municipal governments within Miami Dade County. Prohibition on Outside Employment -Miami-Dade County Ethics Code, Section 2-11.1 (lf)(2) Outside employment is considered any non-municipal employment or business relationship in which the municipal employee provides a personal service to the non-municipal entity that is compensated or customarily compensated. RQO 17-03 (citing RQO 16-01). Municipal employees are considered to be engaging in outside employment when they are running a business whether incorporated or not and regardless of whether it is generating any income, including running an internet-based business. RQO 16-01. Pursuant to Miami Dade Code Section 2-11, a municipal employee may accept outside employment provided that it is not contrary, detrimental, or adverse to the interests of the municipality; that the employee does not use municipal time, materials, or resources to perform the outside employment; and that the employee first obtains written approval from the head ofthe department, where the employee is assigned, before engaging in any outside employment. See COE Outside employment Guidelines dated May 29. 2019; Administrative Order 7-1; and County Procedure 403. Permission for outside employment must be requested annually, even in cases where the type of outside employment has not changed. 5 Additionally, pursuant to Section 2-11.1 (k)(2) ofthe Ethics Code, full-time municipal employees who engage in any outside employment during the preceding year for any person, firm, corporation, or entity other than their government employment must file a statement that discloses the source of the outside employment, the nature of the work being done pursuant to same and any amount or types of money or other consideration received by the employee for that outside employment. See Miami-Dade Code §2-11.l(k)(2); RQO 17-03 and RQO 16-01. The disclosure of the money or compensation received from outside employment is filed on an Outside 5 Miami-Dade Code 2-11, Administrative order 7-1, and Procedure 401, are not within the jurisdiction of the Ethics Commission, as they are not contained in the Ethics Code and/or any other ethics ordinance that this Commission enforces. Page 7 of 9 Employment Statement. Full-time City of Miami Beach, Florida employees must file the Outside Employment Statement with the City Clerk by July 1st of each year. Here, the Respondent, by her own admission, owns and operated three businesses between 2020 and 2022: Mogul Measures, LLC., which is a Florida limited liability corporation established in 2019, that was intended to be a clothing design company; McClain Signature Services, LLC., an active Florida limited liability corporation established in 2020 to facilitate the Respondent's Notary Public business; and Signature Dispatching, a fictitious name of McClain Signature Services, LLC., created in 2021 to expand her business to include a truck load dispatching service. See Exhibits A, B, and C. The Respondent also admitted to working for Allstar Transportation Services in 2021 and 2022 as a dispatcher and completed administrative tasks for its owner, Emmanuel Sims. In 2020 and 2021, the Respondent was employed full-time by the City of Miami Beach Department of Public Works as a Control Room Supervisor. As the Respondent was engaged in outside employment while she was employed full-time by the City of Miami Beach, she was required to file Outside Employment Statements indicating the source ofher outside employment, the nature of the work being done, and the amount and types of money or other consideration she received from her outside employment. See Miami-Dade County Ethics Code § 2-l 1.l(k)(2); RQO 17-03; RQO 16-01. However, upon review of the Respondent's City of Miami Beach personnel file and by the Respondent's own admission, the Respondent did not request approval to conduct her outside employment and did not file an Outside Employment Statement even though, at the time, she was an officer for and/or actively engaged with four (4) companies. Therefore, the Respondent violated Section (k)(2) ofthe Ethics Code, by failing to file an Outside Employment Statement by July 1, 2021 and July 1, 2022, to disclose the source of her outside employment, the nature of the work being done pursuant to same, and any amount or types of money or other consideration received by the employee for that outside employment during the tax years 2020 and 2021 respectively. Additionally, the Outside Employment Statements for years 2020 and 2021 that the Respondent filed after her interview with this agency, continue to violate Section (k)(2) of the Ethics Code as they do not fully disclose the source of her outside employment, the nature of the work being done pursuant to same, and any amount or types of money or other consideration received by the employee for that outside employment. Specifically, the subsequently filed Outside Employment Statements for 2020 and 2021 are inaccurate as they exclude Mogul Measures LLC for year 2020; and exclude Mogul Measures, LLC., Signature Dispatching, and Allstar Transpo1iation Services for year 2021. See Exhibit N. Exploitation ofOfficial Position Prohibited -Miami-Dade County Ethics Code, Section 2-11.1 (g) Section (g) of the County Ethics Code prohibits municipal employees from using their official positions to secure a special benefit for themselves or others. See Miami-Dade County Code at Sec. 2-11.1 (g). In this case, the Respondent exploited her official position by utilizing her City of Miami Beach laptop and office equipment, provided to her as tools for her position as a Control Room Supervisor, to work for her own companies and Allstar Transportation Services, owned by Emmanuel Sims. Page 8 of 9 As evidenced by her own admission and the documents obtained from the Respondent's City of Miami Beach work computer, the used City resources to work on branding and marketing for McClain Signature Services, LLC., and Allstar Transp01iation Services, LLC.; transmitted documents via email that she notarized or planned to notarize for a fee; processed and electronically signed transp01iation load confirmation contracts for Allstar Transportation Services, LLC.; applied for McClain Signature Services to be a White Label Broker for Tradeline Supply Company; and assisted Sims with the completion ofhis personal Florida and Federal CDL registration obligations. See Exhibit F, G, H, I, J and K. Therefore, the Respondent violated Section (g) of the Ethics Code, by utilizing her assigned City of Miami Beach computer and equipment in furtherance of her outside employment endeavors, securing a special benefit for both herself and her "boyfriend," Emmanuel Sims. V. Conclusion Accordingly, based on the investigation conducted, interviews, and supp01iing documentation, Probable Cause exists to conclude that Respondent, Montrice Nichole McClain, violated Section 2-11.1 (k)(2), "Prohibition on Outside Employment," and Section 2-11.1 (g), "Exploitation of Official Position," of the Ethics Code. Page 9 of 9 EXHIBIT A L19000285946Electronic Articles of Organization FILED 8:00 AMFor November 18, 2019 Florida Limited Liability Company Sec. Of State mdsellers Article I The name of the Limited Liability Company is: MOGUL MEASURES LLC Article II The street address of the principal office of the Limited Liability Company is: 17353 NW 7 AVENUE APT. 108 MIAMI GARDENS, FL. US 33169 The mailing address of the Limited Liability Company is: 17353 NW 7 AVENUE APT. 108 MIAMI GARDENS, FL. US 33169 Article III Other provisions, if any: OPERATING WITHIN THE BOUNDARIES OF ANY AND ALL LEGAL BUSINESS. Article IV The name and Florida street address of the registered agent is: MYSHELLA L HALL 17353 NW 7 A VENUE APT. 108 MIAMI GARDENS, FL. 33169 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relating to the proper and complete perfonnance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: MYSHELLA HALL Article V The name and address of person( s) authorized to manage LLC: Title: MGR MYSHELLA L HALL L19000285946 FILED 8:00 AM November 18, 2019 Sec. Of State mdsellers 17353 NW 7TH A VE APT. 108 MIAMI GARDENS, FL. 33169 US Title: MGR MONTRICE N MCCLAIN 1811 NW 69 STREET MIAMI, FL. 33147 US Title: MGR JANELLE GIBSON 17353 NW 7TH AVE APT. 108 MIAMI GARDENS, FL. 33169 US Title: MGR CYNDI M GREEN 11101 NW 37TH ST SUNRISE, FL. 33351 US Article VI The effective date for this Limited Liability Company shall be: 11/16/2019 Signature of member or an authorized representative Electronic Signature: MONTRICE MCCLAIN I am the member or authorized representative submitting these Articles of Organization and affinn that the facts stated herein are true. I am aware that false inf01mation submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the reqmrementto file an annual report between January 1st and May 1st in the calendar year following f01mation of the LLC and every year thereafter to maintain "active" status. 2020 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L 19000285946 Entity Name: MOGUL MEASURES LLC Current Principal Place of Business: 17353 NW 7 AVENUE APT.108 MIAMI GARDENS, FL 33169 Current Mailing Address: 17353 NW 7 AVENUE APT.108 MIAMI GARDENS, FL 33169 US FEI Number: 84-4235678 Name and Address of Current Registered Agent: HALL, MYSHELLA L 17353 NW 7 AVENUE APT.108 MIAMI GARDENS, FL 33169 US FILED Apr 29, 2020 Secretary of State 5455169853CC Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail: Title MGR Title MGR Name HALL, MYSHELLA L Name MCCLAIN, MONTRICE N Address 17353 NW 7TH AVE APT. 108 Address 1811 NW 69 STREET City-State-Zip: MIAMI GARDENS FL 33169 City-State-Zip: MIAMI FL 33147 Title MGR Title MGR Name GIBSON, JANELLE Name GREEN, CYNDI M Address 17353 NW 7TH AVE APT. 108 Address 11101 NW 37TH ST City-State-Zip: MIAMI GARDENS FL 33169 City-State-Zip: SUNRISE FL 33351 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: MYSHELLA HALL REGISTERED AGENT 04/29/2020 Electronic Signature of Signing Authorized Person(s) Detail Date 8/24/22, 9:50 AM Detail by Officer/Registered Agent Name D1v1s101, OF CORPORATIOMS ,, .J Del]artment of State I Division of Cor[lorations / Search Records / Search bY. Officer/Registered Agent Name / Detail by Officer/Registered Agent Name Florida Limited Liability Company MOGULMEASURESLLC Filing Information Document Number L19000285946 FEI/EIN Number 84-4235678 Date Filed 11/18/2019 Effective Date 11/16/2019 State FL Status INACTIVE Last Event ADMIN DISSOLUTION FOR ANNUAL REPORT Event Date Filed 09/24/2021 Event Effective Date NONE PrinciP-al Address 17353 NW 7 AVENUE APT. 108 MIAMI GARDENS, FL 33169 Mailing Address 17353 NW 7 AVENUE APT. 108 MIAMI GARDENS, FL 33169 Registered Agent Name & Address HALL, MYSHELLA L 17353 NW 7 AVENUE APT. 108 MIAMI GARDENS, FL 33169 Authorized Person{~) Detail Name & Address Title MGR HALL, MYSHELLA L 17353 NW 7TH AVE APT. 108 MIAMI GARDENS, FL 33169 Title MGR https://search.sunbiz.org/lnquiry/CorporationSearch/SearchResultDetail?inquirytype=OfficerRegisteredAgentName&directionType=lnitial&searchNam... 1/2 8/24/22, 9:50 AM Detail by Officer/Registered Agent Name MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 Title MGR GIBSON, JANELLE 17353 NW 7TH AVE APT. 108 MIAMI GARDENS, FL 33169 Title MGR GREEN, CYNDI M 11101 NW 37TH ST SUNRISE, FL 33351 Annual Reriorts Report Year Filed Date 2020 04/29/2020 Document Images 04/29/2020 --ANNUAL REPORT View image in PDF format 11/18/2019 --Florida Limited LiabilitY. View image in PDF_ format ___J https:/ /search .sunbiz.org/lnquiry/CorporationSearch/SearchResultDetail?inquirytype=OfficerRegisteredAgentName&direction Type= lnitial&searchNam... 2/2 EXHIBITB Electronic Articles of Organization L20000361443 FILED 8:00 AMFor November 16, 2020 Florida Limited Liability Company Sec. Of State tscott Article I The name of the Limited Liability Company is: MCCLAIN SIGNATURE SERVICES LLC Article II The street address of the principal office of the Limited Liability Company is: 1811 NW 69 STREET MIAMI, FL. US 33147 The mailing address of the Limited Liability Company is: 1811 NW 69 STREET MIAMI, FL. US 33147 Article III The name and Florida street address of the registered agent is: MONTRICE N MCCLAIN 1811 NW 69 STREET MIAMI, FL. 33147 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I fiuiher agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations ofmy position as registered agent Registered Agent Signature: MONTRICE MCCLAIN Article IV L20000361443 FILED 8:00 AMThe name and address of person(s) authorized to manage LLC: November 16, 2020 Sec. Of State Title: MGR tscottMONTRICE N MCCLAIN 1811 NW 69 STREET MIAMI, FL. 33147 US Article V The effective date for this Limited Liability Company shall be: 11/14/2020 Signature of member or an authorized representative Electronic Signature: MONTRICE MCCLAIN I am the member or authorized representative submitting these Articles of Organization and affinn that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual rep011 between January 1st ana May 1st in the calendar year following formation ofthe LLC and every year thereafter to maintain "active" status. 2021 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L20000361443 Entity Name: MCCLAIN SIGNATURE SERVICES LLC Current Principal Place of Business: 1811 NW 69 STREET MIAMI, FL 33147 Current Mailing Address: 1811 NW 69 STREET MIAMI, FL 33147 US FEI Number: 85-4098313 Name and Address of Current Registered Agent: MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 US FILED Apr 25, 2021 Secretary of State 717 4270545CC Certificate of Status Desired: Yes The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGR Name MCCLAIN, MONTRICE N Address 1811 NW 69 STREET City-State-Zip: MIAMI FL 33147 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: MONTRICE MCCLAIN OWNER 04/25/2021 Electronic Signature of Signing Authorized Person(s) Detail Date 2022 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L20000361443 Entity Name: MCCLAIN SIGNATURE SERVICES LLC Current Principal Place of Business: 1811 NW 69 STREET MIAMI, FL 33147 Current Mailing Address: 1811 NW 69 STREET MIAMI, FL 33147 US FEI Number: 85-4098313 Name and Address of Current Registered Agent: MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 US FILED Apr 30, 2022 Secretary of State 0483356075CC Certificate of Status Desired: No The above named entity submits this statement for the purpose ofchanging its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGR Name MCCLAIN, MONTRICE N Address 1811 NW 69 STREET City-State-Zip: MIAMI FL 33147 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager ofthe limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: MONTRICE MCCLAIN OWNER 04/30/2022 Electronic Signature of Signing Authorized Person(s) Detail Date 2023 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED DOCUMENT# L20000361443 Jan 17, 2023 Secretary of State Entity Name: MCCLAIN SIGNATURE SERVICES LLC 8721949567CC Current Principal Place of Business: 1317 EDGEWATER DR SUITE #1119 ORLANDO, FL 32804 Current Mailing Address: 1317 EDGEWATER DR SUITE #1119 ORLANDO, FL 32804 US FEI Number: 85-4098313 Certificate of Status Desired: Yes Name and Address of Current Registered Agent: MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: DateElectronic Signature of Registered Agent Authorized Person(s) Detail: Title MGR Name MCCLAIN, MONTRICE N Address 1811 NW 69 STREET City-State-Zip: MIAMI FL 33147 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager of the limited liability company or the receiver or tmstee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: MONTRICE MCCLAIN MANAGER 01/17/2023 Electronic Signature of Signing Authorized Person(s) Detail Date DIVISION OF CORPORATIONS .J DeRartment of State / Division of CorRorations I Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company MCCLAIN SIGNATURE SERVICES LLC Filing Information Document Number L20000361443 FEI/EIN Number 85-4098313 Date Filed 11/16/2020 Effective Date 11/14/2020 State FL Status ACTIVE Princii:ial Address 1317 Edgewater Dr Suite #1119 Orlando, FL 32804 Changed: 01/17/2023 Mailing Address 1317 Edgewater Dr Suite #1119 Orlando, FL 32804 Changed: 01/17/2023 Registered Agent Name & Address MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 Authorized Person(§.) Detail Name & Address Title MGR MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 Annual Rei:iorts Report Year Filed Date 2021 04/25/2021 2022 04/30/2022 2023 01/17/2023 Document Images 01/17/2023 --ANNUAL REPORT 04/30/2022 •• ANNUAL REPORT 04/25/2021 --ANNUAL REPORT View image in PDF format View image in PDF format View image in PDF format 11/16/2020 •· Florida Limited LiabilitY. View image in PDF format DIVISION OF CORPORATIONS Dei,artment of State I Division of Comorations / Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company MCCLAIN SIGNATURE SERVICES LLC Filing Information Document Number L20000361443 FEI/EIN Number 85-4098313 Date Filed 11/16/2020 Effective Date 11/14/2020 State FL Status ACTIVE PrinciP-al Address 1317 Edgewater Dr Suite #1119 Orlando, FL 32804 Changed: 01/17/2023 Mailing Address 1317 Edgewater Dr Suite #1119 Orlando, FL 32804 Changed: 01/17/2023 Registered Agent Name & Address MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 Authorized Person(~) Detail Name & Address Title MGR MCCLAIN, MONTRICE N 1811 NW 69 STREET MIAMI, FL 33147 Annual ReP-orts Report Year Filed Date 2021 04/25/2021 2022 04/30/2022 2023 01/17/2023 Document Images 01/17/2023 --ANNUAL REPORT View image in PDF format 04/30/2022 --ANNUAL REPORT View image in PDF format 04/25/2021 --ANNUAL REPORT View image in PDF format 11/16/2020 --Florida Limited LiabilitY. EXHIBIT C APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G21000160923 Fictitious Name to be Registered: SIGNATURE DISPATCHING Mailing Address of Business: 1811 NW 69TH ST MIAMI, FL 33147 Florida County of Principal Place of Business: MULTIPLE FILED Dec 05, 2021 FEI Number: Secretary of State Owner(s) of Fictitious Name: MCCLAIN SIGNATURE SERVICES LLC 1811 NW 69TH ST MIAMI, FL 33147 US Florida Document Number: L20000361443 FEI Number: 85-4098313 I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath and I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s. 817.155, Florida Statutes. MONTRICE MCCLAIN 12/05/2021 Electronic Signature(s) Date Certificate of Status Requested (X) Certified Copy Requested ( ) DIVISION OF CORPORATIONS r I J Previous on List Next on List Return to List Fictitious Name Search No Filing History ISubmit j Fictitious Name Detail Fictitious Name SIGNATURE DISPATCHING Filing Information Registration Number G21000160923 Status ACTIVE Filed Date 12/05/2021 Expiration Date 12/31/2026 Current Owners County MULTIPLE Total Pages 1 Events Filed NONE FEI/EIN Number NONE Mailing Address 1811 NW 69TH ST MIAMI, FL 33147 Owner Information MCCLAIN SIGNATURE SERVICES LLC 1811 NW 69TH ST MIAMI, FL 33147 FEI/EIN Number: 85-4098313 Document Number: L20000361443 Document Images . . . JIView image in PDF format 12/05/2021 --Fictitious Name F1lIng '------''------- Previous on List Next on List Return to List Fictitious Name Search No Filing History ISubmit j EXHIBITD Florida DeRartment of State> Division of CorRorations Notaries Home Commission Detail Notary ID: 1591840 Last Name: MCCLAIN First Name: MONTRICE Middle Name: Birth Date: 3/12/XX Transaction Type: NEW Certificate: GG 919651 Status: ACT Issue Date: 10/07/19 Expire Date: 10/06/23 Bonding Agency: Florida Notary Online, LLC Mailing Address: MIAMI, FL 33147 [Der2artment of State][Nota[Y. Public Access SY.stem][Email Us] Florida Department of State Division of Corporations P.O. Box 6327 Tallahassee, FL. 32314 Phone(850) 245-6975 1t·'~i'"f'.·jj'(SJK'~J.,1fi-.~:f .. •·••• ..:I.L.<;:~.-.: ::'{ !l!;/enfil.w_:r.temJL '.: 1,~.,-,,::,,,,;1,1:''~,1;,, "',,,;' .••,. ,,.,.,,, ~,. .,,,.,,.1,''",'·,, -"~,_, s ,' "J'CC•''."' 1:0~''.il!i-~~-: I~~!~> .- -- ! • "' I' 'i'tm11.(iarrd~moi:; 1ih:e...State of!rill01il/Ela, a,:'· . '1• ', '. 1 1ii'» ;,'t'1 ~ \11..,/ )i ;,~i.f !'~, ""1p·/ ,,/ 1f/-,,.: '1,1\,,,1; l •' sJ ", >-\• '"'111" ~• /,1 ,\Jl\\1; 1{'1), J~ I 1 111r0m\:@.~t0JD'.e11rf/4~\~'©.a ~·w011rffl·J:)ct,0'o,e'.l;,\~~(~{)2,iB1·.(ana~,m•:t11e,1 1 1 1 1 1 1 1 , ~ 1itcl 111 ,~ 1 •,vL·f1)i:~1.t 1~\: • \,'l_/2 ' ',,. r;11 1<,,c;'.),-,11//11" ri1,J1 1l! b~ 1/dl ,J,P1!'1 '" 1 .:.ll: me Re6p1e '9ftJ:1iie0$1:attf,0f Elcn'.!ie.a fo:,-~'a~e~'.!,ilit0lf~i.~G£,~e1&eFG1se''ifil:J.r£ s 0111 ", , °'' ~....-1-..,;;;.1,l 1:;",~~ ... , •• .1, ~1\ j\~1111i'Ji;Ptr,p/i».1~•'" ,~r/1'11 1"'.11:111,,' •iri e powers and resn.0msrBiil~ti"eS•ap':Wemia~ifuilg,{bn'.eref0ft~®::0:i·ltro receive'th1 1 1. : ,.,P \ J\' r,II ', '1'r.,1, 1il1,1•( ;11,1,/,Jih~:11: ill)i,1 11}, J? J ','11l!' 1., ' 11./1 ,,, 11 and erri0[00imenttreiere~if?-\iiiw'1a0efa1ir0}an:i~etwi~l:f'the Iaw•1 I,~ ', l-u•11'\'Jl;,i' 01~1,._,, __ /fr-;;1\1\,hi,r.c·;1ii,11rr1:,.~11r,1r-1\., I Tl ,J''~ my~ere~f\'~\tlt{:J:i~}-;e'tp1t.~ lS~'.'j] :~~dJJi~cl!.a'Ffa.c~use,t"'" 'h 0 ' ."I, : ;,..:': , , .. " · ..... ,,,•. ·.•·,,, , . . ,·;,1, r.;.l ,',.,l;A,/·,:,•,1,,(,h,iiflq,, :,• , 1\,1y .. ,',;•,,,1, ,,,',,. -•/·', ',,, .,, ' ;r, • ''""+' ·s-.. 'I'•·•"'C:t:\~'"'""C:i+!''li" .1:,..,!m•·"-t1,t .:t)l,·:....,, '. .,.'"Ell f•. ···..a:,..,..,."'"'" •. ea :01:1,,\i;l!1:e"s):).cai;e,t1.Ja •ia11:aS,$~~' •'·---- NOTARY PUBLIC COMMISSION APPLICATION Florida Department of State Notary Commissions and Certifications Section (850) 245-6975 PERSONAL INFORMATION Full Name: ________M_c,..C_l..,ai~n'--------Montrice Nichole (Last) (First) (Middle) Home Address: ------~'~8~ll~N\=W~6~9~S~tr~e~et'----------~M=i=am=i_____~F~l_____~M=i:-::an,...1=i-_D...,a_d_e______=3"'"'.3=14,...7:--- (Street) (City) (State) (County) (Zip) Place of Employment: -------------=C=i=ty~o~f=M=i=am=i=B~e=a=cl~1_____________ 0 Unemployed O Retired Business Address: _____,_l,._70,,_0"--"C"'o~n"-v""en.,,tceio"'n"---"C"'e"-nt,,ee..r-=D'-'-r'-'ivc.,e,_______~M.,i,,a"'m"-i-=B,.,e"'a"'cle..1_____.F...l_______M=i,,_am=i--=D'-'a"'d"'e'--------=3,,3_,_J"'3"--9__ (Street) (City) (State) (County) (Zip) Mail lo: IB] Home 0 Business O Other Address:-----------------------------------(Street/P.O. Box) (City) (State) (Zip) E-mail Address: tricemk@gmail.com Sex: 0 Male Race: 0 Asian (or write "NONE") [8) Female [81 Black or African American Home Phone: 305-988-6584 0 Native American or Alaska Native (or write "NONE") □ White Business Phone: None Extension: ______ 0 Other: _______(or write "NONE") Florida Driver License (or other State of Florida Issued ID): Dateofr (Month/DayN ear) Social Security Num· The disclosure of a Florida notary public applicant's social security number is expressly required by Fla. Stat. § 117.01(2) and is imperative for processing nota1y public commission applications. Please be advised that social security numbers are only used for processing tbe notaty application and are exempt from disclosure pursuant to Fla. Stat. §I 19.071(5)(a)5. 1. Are you a legal resident of Florida? [8] Yes D No (If No, you or~ nol eligible to apply fora Florida notary public commission. Legal residency must b-e maintained t11roughoul the appointment.) 2. Are you a United States citizen? ~ Yes D No (If No, you must submit nrecordedDeclnrnlionofDomicile. Obtain this document from yourcounly courthouse.) 3. Are you now or have you ever been commissioned a Notary Public in the State ofFlorida? 0 Yes [8J No (IfNo,you,mustcompl,tcn3 hourNotaiy,ducationcourscandsubmit a signed ccrtificotc ofcompletion. Fla. Stat. §668.50 (11 )(b).) IfYes: -~-'-,-~--,'-~-(Commission expiration date) (Commission number) (Name for which your commission Wlls issued) 4. Have you held any professional licenses or commissions (other than Nota,y Public) in Florida dming the past !0years? IB] Yes O No Ifyes, pl<ase list: Water Distribution Operator 3 Have any been revoked? D Yes 0 No (If Yes, you must submit nwritt~n statement about the nature ofthe action nnd ncopy of the finnl order from the regulating agency.) 5. Have yon been disciplined by a regulatory agency, including the Florida Bar, and including disciplinary action that is confidential? 0 Yes [81 No {IfYes, you must submit a written statement about the nature ofthe action and nny supporting dacumentation,such as a copy of the Final Order from the regulating agency.) 6. Have you been convicted of a felony, had an adjudication ofguilt withheld for a felony offense? 0 Yes [81 No (If Yes, you must submit a written statement of the nature ofthe offense{s), acopy ofthe court judgment nnds.entencing order. If convicted,you must submit a certificate ofRestomtion ofCivil Rights.) 7. Are you cun-ently on probation?0Yes ~No AFFIDAVIT OF CHARACTER STATE OF _______;F:..clocc.rc...:id""a______ -----=M=i=am=i~~=a=d=e_____ COUNTY I, L s Desir Jr am umelated to and have known Montrjce McClain (Print or Type Name of Affiant) (Name ofApplicant) for one year or more; and to the best of my knowledge and observation know him or her to be of good character. My address is -----------------"'-20,,,5,.,2,,e5__,N_,_W'-'-'3"'3_C=.,tM=,ia!em,,_,i...,G,.,a"'rd,,.,e"'n"'s...,F~L"-'M"-'-"ia""m"'i"'-D""a"'d"'e"'3"'3-"'05""6"-----------------(Street) (City) (State) (County) (Zip) UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AFFIDAVIT AND THAT THE FACTS STATED IN IT ARE TRUE. x ______________Home Pone: 786-256-1070 Work Phone: -----N~o=n=e____ (or write "NONE") (orwlite "NONE") (Signature of Affianl) A0900416 OATH OF OFFICE _____M_ia_m_i-D_a_d_e____ COUNTYSTATE OF FLORIDA I do solemnly swear (or affom) that I will support, protect, and defend the Constitution and Government of the United States and of the State of Florida; that I am duly qualified to hold office under the Constitution of the state; that I have read Chapter 117, Florida Statutes, and any amendments thereto, and !mow the duties, responsibilities, limitations, and powers of a nota1y public; and that I will well and faithfully perform the duties of Notary Public, State of Florida, on which I am now about to enter. So help me God.* UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND OATH, AND THAT THE FACTS STATED THEREIN ARE TRUE. I accept the Office ofNota1y Public, State of Florida. x _______________________ (Official Signature of Applicant) 09 I 25 (Date) I 2019 Montrice McClain (Print or Type Name -Name for which your commission will be issued) *Note: If you affitm, you may omit the words "So help me God." Fla. Stat. §92.52. MEMORANDUM AS A GENERAL MATTER, APPLICATIONS FOR ALL POSITIONS WITHIN STATE GOVERNMENT ARE PUBLIC RECORDS, WHICH MAY BE VIEWED BY ANYONE UPON REQUEST. HOWEVER, THERE ARE SOME EXEMPTIONS FROM THE PUBLIC RECORDS LAW FOR IDENTIFYING INFORMATION RELATING TO SOCIAL SECURITY NUMBERS, PAST AND PRESENT LAW ENFORCEMENT OFFICERS AND THEIR FAMILIES, VICTIMS OF CERTAIN CRIMES, ETC. IF YOU BELIEVE AN EXEMPTION FROM THE PUBLIC RECORDS LAW APPLIES TO YOUR FLORIDA NOTARY PUBLIC COMMISSION APPLICATION SUBMISSION, PLEASE CHECK THE FOLLOWING BOX: D Yes, I assert that identifying info1mation provided in this application ( other than my social security number, which I am aware is automatically exempt from public disclosure, pursuant to Fla. Stat. § 119.071(5)(a)5) should be excluded from inspection under Public Records Law. If Yes, please indicate what section of Florida Statutes provides this exemption in your patticular situation: IF YOU NEED ADDITIONAL GUIDANCE AS TO THE APPLICABILITY OF ANY PUBLIC RECORDS LAW EXEMPTION TO YOUR SITUATION, PLEASE CONTACT THE OFFICE OF THE ATTORNEY GENERAL: Office of the Attorney General The Capitol, PL-01 Tallahassee, FL 32399 (850) 245-0158 ### 2 A0900416 STATE OF FLORIDA BOND OF NOTARY PUBLIC Secretary of State Notaiy Commissions STATE OF FLORJDA KNOW ALL MEN BY THESE PRESENTS, That we, FOR OFFICE USE ONLY Approved by Department of State: Bond No. FNO7002534 ----------------~M~o~n=tr~ic=e~M~c~C~l=a~in~_______________ as Principal, and (Name of Applicant) RLI Insurance Company (309) 692-1000 (Imprint Name of Surety Company) (Telephone Number) as Surety Company, give bond payable to any individual who may be haimed as a result of a breach of duty by said applicant acting in his/her official capacity as Notary Public, in the amount of______________________ Seven Thousand Five Hundred and No/l00's Dollars ( $ 7,500.00 ) as assurance for the due discharge of the duties of his/her office ofNota1y Public and we do bind ourselves, and each of our heirs, executors and administrators, jointly and severally. Applicant was, on the date of issuance of commission, bonded as a Notary Public in and for the State of Florida, to hold office for the term of four years in accordance with the Constitution and Laws of this State. Now, therefore, if said applicant shall faithfully discharge the duties of the office of Notary Public, as prescribed by law, then this obligation shall be void, X Signed and sealed this _____2_5______ (Affix Surety Seal) (Signature of Applicant) day of _____S_e~p_te_m_b_e_r____~, ____2_0_1_9____ r/37 M.?J= Barton W. Davis Attorney in Fact RLI Insurance Company (Name of Surety Company) P.O. Box 3967 Peoria, IL 61612 (Address of Surety Company) Florida Notary Online, LLC (Name of Bouding Agency or Company) 59 Skyline Drive, Suite 1550 Lake Mary, FL 32746 (Address of Bonding Agency or Company) (Signature ofFlorida Licensed Agent) Pll7350 (Florida Licensed Agent Number) Daniel O'Donnell (Printed name of Florida Licensed Agent) Section 817.234(l)(b), F.S. "Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony in the third degree." This bond shall be for Seven Thousand Five Hundred and No/lO0's Dollars ($ 7,500.00). After execution by surety company, the bond must be submitted to the Department of State for approval and filing before issuance of the notary public commission. DS/DE 76 (3/04) N0900207-50,30 FOR OFFICE USE ONLY STATE OF FLORIDA BOND OF Approved by Department of State: NOTARY PUBLIC OR ONLINE NOTARY PUBLIC Secretary ofState Nota1y Commissions Form: DOC IN-7, R. lN-7.001, F.A.C, effective 01/2020 STATE OF FLORIDA KNOW ALL MEN BY THESE PRESENTS, That we; _________M,...o=nc:::t"'ri-=c,,,.e,,M-::ccc:--:-C::rl=a=in..-__________________ as Principal, and ame o eg1strant Merchants anding Company Mutual) 515-243-8171 (Imprint name of Surety Company) (Telephone Number) as Surety Company, give bondpayable to any individual who may be harmed as a result ofabreach ofduty by said applicant acting in his/her official capacity as a Notary Public OR Online Notary Public in the amount of Twenty Five Thousand Dollars ($25,000) as assurance for the due discharge ofthe duties of his/her office of Notary Public OR Online Notary Public andwe do bind ourselves, and each ofom heirs, executors and administrators,jointly and severally. Liability under this bond is limited to $7500 for acts pe1fo1med in the capacity of a Notaiy Public pursuant to section l 17.01 (7)(a), Florida Statutes. Applicant was, on the date of issuance ofNotary Public commission, bonded in and for the State of Florida as a Notary Public ofFlorida, to hold office for the term of four years inaccordance with the Constitution and Laws of this State. Now, therefore, ifsaid applicant shall faithfully discharge the duties of the office ofa Notary Public or Online Notary Public, as prescribed by law, then this obligation shall be void. By:__~~-~~~-----(S 1gnature ofReg1s trant) Signed and sealed the 13th day of__A_u~g~u_s_t_________20 20 Merchants Bonding Company (Mutual) (Name of Surety Company) 6700 Westown Parkway, West Des Moines, IA 50266-7754 (Address of Surety Company) Natlonal Notary Association (Name ofBonding Agency or Company) 9350 De Soto Avenue, PO Box 2402, Chatsworth, CA 91313-2402 By: ~Bon~o=~ (SignatureofFloridaLicensru Agent License #P155576 (Florida Licensed Agent Number) Mary Elizabeth Erba (Printed name ofFlorida Licensed Agent) Section 817.234(l)(b), F.S. "Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statelllcnt of claim or an applicMion containing any false, incomplete, or misleading information is guilty of a felony in the third degree." This bond shall be for Twenty-Five Thousand Dollars ($25,000). Aftct· execution by surety company, the bond must be submitted to theDepat·tment of Statefo1· approval and filing before issuance ofthe registration ofonlinc notary public. MERCHAN~ BONDING COMPANY'" MERCHANTS BONDING COMPANY (MUTUAL) P.O. Box 14498, DES MOINES, IA 50306-3498 PHONE: (800) 876-6827 FAX: (800) 833-1211 NOTARY PUBLIC ERRORS AND OMISSIONS POLICY FL5252674Policy No. Premium: $65.00 COVERAGE: MERCHANTS BONDING COMPANY (MUTUAL) ("the Company") will pay on behalf of MONTRICE MCCLAIN of MIAMI, FL ("the Insured"), all sums, subject to the Limit of Liability stated below, which the Insured shall become obligated to pay by reason of liability for breach of duty while acting as a duly commissioned and sworn Notary Public, claim for which Is made against the Insured by reason of any negligent act, error or omission, committed or alleged to have been committed by the Insured, arising out of the performance of notarial service for others in the lnsured's capacity as a duly commissioned and sworn Notary Public. The Company will also pay on behalf of the Insured, subject to the Limit of Liability stated below, costs and expenses incurred in investigating, defending or settling the lnsured's liability arising from any negligent act, error or omission, committed or alleged to have been committed by the Insured, arising out of the performance of notarial service for others in the lnsured's capacity as a duly commissioned and sworn Notary Public. POLICY PERIOD: This policy applies only to negligent acts, errors or omissions which occur during the policy period and then only if claim, suit or other action arising therefrom is commenced within the applicable statute of limitations pertaining to the Insured. The Policy Period commences on the Effective Date hereof and terminates upon the Expiration Date hereof. LIMIT OF LIABILITY: The liability of the Company shall not exceed in the aggregate for all claims, costs and expenses under this policy the amount of Twenty Five Thousand ( $25,000.00 ) Dollars. (NOT VALID IF FILLED IN FOR MORE THAN $100,000) THIS LIMIT OF LIABILITY INCLUDES COSTS AND EXPENSES INCURRED IN INVESTIGATING, DEFENDING OR SETTLING LIABILITY. ONCE THE LIMIT OF LIABILITY STATED ABOVE HAS BEEN PAID, WHETHER BY SETTLEMENT OF A CLAIM OR CLAIMS, OR BY PAYMENT OF COSTS AND EXPENSES, THE COMPANY IS RELIEVED OF ANY FURTHER DUTY TO DEFEND OR INDEMNIFY THE INSURED UNDER THIS POLICY. SETTLEMENT: The Company, in the lnsured's name and behalf, shall have the exclusive right to make any settlement of any claim, suit, or other action, as the Company deems expedient. CONDITIONS PRECEDENT: As a condition precedent to the right of indemnification or defense hereunder, the Insured shall mail or deliver to the Company within ten (10) days after notice or knowledge of a claim or possible claim against the Insured copies of any written notice thereof and a complete description of the facts and circumstances alleged to give rise to such claim. Bankruptcy or insolvency of the Insured shall not release the Company or its liability hereunder. EXCLUSIONS: Coverage under this policy as described in the COVERAGE section of the policy above does not apply to any acts of or allegations of (i) dishonest, fraudulent, criminal, libelous, slanderous or malicious act or omission of the Insured; (ii) willful or intentional disregard of the law; (iii) bodily injury to, or sickness, disease or death of any person, including but not limited to, emotional or mental distress and related conditions; (iv) injury to or destruction of any tangible property, including the loss of use thereof; (v) fines or penalties imposed by law on the Insured; or (vi) punitive, treble, exemplary or similarly categorized damages, including fines and penalties. NEO 0807 FL (2/15) CO-INSURANCE: If the Insured has other insurance against a loss covered by this policy, the Company shall not be liable under this policy for a greater proportion of such loss than the limit of liability stated in this policy bears to the limit of liability of all other insurance against such loss. SUBROGATION: In the event of any payment for any loss under this insurance, the Company shall be subrogated to all of the lnsured's rights of recovery thereafter against any person or organization and the Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights to the Company. The Insured shall do nothing after loss to prejudice such rights. CANCELLATION: This policy may be cancelled by the Insured by surrender hereof to the Company or any of its authorized agents or by mailing to the Company written notice stating when thereafter the cancellation shall be effective. If this policy has been in effect for less than 90 days, we may cancel this policy for nonpayment of premium by giving 10 days advance written notice, or we may cancel for any other reason by giving 60 days advance written notice. If this policy has been in effect for 90 days or more, we may cancel only for one or more of the following reasons: (a) nonpayment of premium; (b) material misrepresentation on the application; (c) failure to comply with underwriting requirements within 90 days of the policy's effective date; ( d) substantial change in the risk; or ( e) if the Company is canceling all insureds under such policies. If this policy is being cancelled for reason (a) above, we will provide written notice to the Insured at least 10 days before the effective date of cancellation. If this policy is being cancelled for reasons (b) through (e) above, we will provide written notice to the Insured at least 60 days before the effective date of cancellation. If this policy is not to be renewed we will provide at least 60 days advance written notice of nonrenewal. The specific reason(s) for cancellation or nonrenewal shall be stated on all notices. The mailing of notice as aforesaid shall be sufficient proof of notice. Delivery of such written notice either by the Insured or by the Company shall be equivalent to mailing. The time of surrender or the effective date and hour of cancellation stated in the notice shall become the end of the policy period. If the Insured cancels, the premium shall be fully earned. If the Company cancels, return premium shall be computed pro rata. EFFECTIVE DATE: 12:01 AM May 30, 2020 EXPIRATION DATE: 12:01 AM May 30, 2024 ...... • • ·s,\NG co··•.•c:,~ ,,....... ~,<). : •<Q ..·~\'-P Ofi)j',:?-1,,.•• Countersigned By: • ~ :' c;:, ~-. ::.t. •. MERCHANTS BONDING COMPANY (Mutual) (',,t-,? L/ f~{~ -o- 0 1~: ✓ 7¥--a ~ •• <.?,\ 1933 /':'I: ~~ /=.•~·•.. /AC:::: B __t__C_H_R_IS_T_IA-N-ST_U_RD_IV_A_N_T______ • • ~ ............·• ~.• y • • • • * • •. Lany Taylor, President ...... Amendments or Endorsements to this policy. ________ 2NEO 0807 FL (2/15) EXHIBITE 2022 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L21000441580 Entity Name: ALLSTAR TRANSPORTATION SERVICES LLC Current Principal Place of Business: 4946 ATWATER DRIVE NORTH PORT, FL 34288 Current Mailing Address: 4946 ATWATER DRIVE NORTH PORT, FL 34288 FEI Number: 87-3035090 Name and Address of Current Registered Agent: SIMS, EMANUEL 0 4946 ATWATER DRIVE NORTH PORT, FL 34288 US FILED Apr 30, 2022 Secretary of State 0563142905CC Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title MGR Name SIMS, EMANUEL 0 Address 4946 ATWATER DRIVE City-State-Zip: NORTH PORT FL 34288 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: EMANUEL O SIMS OWNER 04/30/2022 Electronic Signature of Signing Authorized Person(s) Detail Date L21000441580Electronic Articles of Organization FILED 8:00 AMFor October 08, 2021 Florida Limited Liability Company Sec. Of State jsdennis Article I The name of the Limited Liability Company is: ALLSTAR TRANSPORTATION SERVICES LLC Article II The street address of the principal office of the Limited Liability Company is: 4946 ATWATER DRIVE NORTH PORT, FL. US 34288 The mailing address of the Limited Liability Company is: 4946 ATWATER DRIVE NORTH PORT, FL. 34288 Article III The name and Florida street address of the registered agent is: EMANUEL O SIMS 4946 ATWATER DRIVE NORTH PORT, FL. 34288 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this ce1iificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I futiher agree to comply with the provisions of all statutes relating to the proper and complete perfonnance ofmy duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: EMANUEL SIMS Article IV The name and address of person(s) authorized to manage LLC: Title: MGR EMANUEL O SIMS L21000441580 FILED 8:00 AM October 08, 2021 Sec. Of State jsdennis 4946 ATWATER DRIVE NORTH PORT, FL. 34288 Article V TI1e effective date for this Limited Liability Company shall be: 10/08/2021 Signature of member or an authorized representative Electronic Signature: EMANUEL SIMS I am the member or authorized representative submitting these Articles of Organization and affinn that the facts stated herein are true. I am aware that false infmmation submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual repmi between Janua1y 1st and May 1st in the calendar year following fmmation of the LLC and eve1y year thereafter to maintain "active" status. DIVISION OF CORPORATIONS Denartment of State / Division of Cornorations / Search Records / Search by Enti!Y. Name / Detail by Entity Name Florida Limited Liability Company ALLSTAR TRANSPORTATION SERVICES LLC Filing Information Document Number L21000441580 FEI/EIN Number 87-3035090 Date Filed 10/08/2021 Effective Date 10/08/2021 State FL Status ACTIVE PrinciP-al Address 4946 ATWATER DRIVE NORTH PORT, FL 34288 Mailing Address 4946 ATWATER DRIVE NORTH PORT, FL 34288 Registered Agent Name & Address SIMS, EMANUEL 0 4946 ATWATER DRIVE NORTH PORT, FL 34288 Authorized Person(§) Detail Name & Address Title MGR SIMS, EMANUEL 0 4946 ATWATER DRIVE NORTH PORT, FL 34288 AnnualReP-orts Report Year Filed Date 2022 04/30/2022 Document Images 04/30/2022 --ANNUAL REPORT ......View ir11.3~:_in P~F_format ~_J 10/08/2021 --Florida Limited Liabilitv. 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VA 2260:l Phone Fax. (540)-5?5-1056 Phone2: ($4Q).535-105S To: ALLSTAR TRANSPORTATION EMANUAL SIMS MC#; 1325615 Please Refer To This# On Invoice: 556216 (239)-841-7355 FAX: ( }-- ~,;;;;il'H~,:iJJ~!«r;,: No Tarp S',6" Wid• Load= Permit requir•d FLAT: S750QO Net Pay: $750.00 Picl<•UO Faciliry f!JRr.,g Eiii!wJI. 1/i/;Q !, ~ f£s .W,u 00 ~ PANEL TRUSS (884)397,7021 M1025 - 3 Wide Rocf 2000 0S/3012022 9:00-4:00 •31 FARW2R RD Truss•• iOVVNVlLLE. SC ~~5S.Q BOL 2 Faci!l;x ~ l2lli !1fil! GATEWAY@ ROSSVILLE (J0-4)3-07•7166 08130!2022 7:30-3:30 FCFS z4;9 1-V,l'FY VAi.LEY ROAD ROSSVILLE. GA :lQH 1 BOL 1: ;ll.EAS; F,fFE=t i◊ ·•~fi.O NO~◊\; S!LdNG. :;-:o ~..OT s:~..: YOlsF. Ti:t..;C~TO t..OA:16;!,fO~ 1HIS ,s S!Gt-.EO A\:: =A,X:O 6..1.Ct.. i; A:.i.. ~~'\1£.=iS MUSi' CAL.:. \11.fl'iEN ..o~ans. E.V?TY CR s:c Fi"\€ WlU. EE IU?0$f0! 4.i CJ.ftRla~ ;\.G-Re.S i'C +3E?:t~Cti.M TAA\Sl=vf\T SE~Vt:ES FC.J:i E<;:m:ss :..001sm:s. 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ALLSTAR TRJ,JJ!:"ORTATIOI, arof:er Sig SCOH SMITHSERVICE LLC. 132cd 15 rm) View PDF controls https://miamibeach-my.sharepoint.com/personal/janisinger_miamibeachfl_gov/_layoutsl15/onedrive.aspx?ga=1&Id=%2Fpersonal%2Fjanisinger_mlam... 111 217/23, 9:43 AM For Stephanie -OneDrive I& Share QQ Copy link _± Download CD l<1 55 I 101 X Carrier Profile Sheet Carrier Name: Allstar Transportation services 11 c DATE 8/30/2022 Malling Address: :,1946 Atwater Qr City, State & Zip: North Port FL 34288 Physical Address: Same as Above City, state & Zip: same as Above contact Name: Emanuel Sims Phone: W9-841-W55 carrier email address: contac!@allstar-trans.com FaK:"_________ MC/I 1325615 Fed IDt# 87-3035090 Factoring: (YES)/ NO Factoring Company Information: ___,B;;;,o,.,b..,,ta~i._1,_P"'='O,-,B'=o'!fx=:z!:'4;;-1':i!o~s~3="'3..._________ Chicago, IL 60674-0633 ach®bobtail.com Fleet Information: Tractors__vans__Flats~ steps___Reefers__ Insurance Agent: Reliance Partners Phone1-sn.ses-1194 Fax:._______ MS Express Logistics, LLC 540 Barley Lane, Winchester, VA 22602 €gi View PDF controls 1:man 81.:UllSIIIHll/ 104~~llloil.<.:U!ll https://miamlbeach-my.sharepolnt.com/personal/janisinger_miamibeachfl_gov/_layouts/15/onedrive.aspx?s:ia=1&id=%2Foersonal%2Fiimisinmar mli>m 1/1 X 2/7/23, 11:39 AM For Stephanie -OneDrive 1£? Share Ce.:i Copy link ± Download (i) I<! 146 / 162 I> I (Jillt.! 11 14 :17 BILL OF LADING-SHORT FORM -NOT NEGOTIABLE Page 1 of 1 SHlPPROM Bill of Lading Nurnw: 1AE3794 ~t,\lJ?iCN Tfv\JLE:RS !.il'.1£S. lNC ~l(>) E AC,AA.10 OR JM.!P,\ fl :1IB1CJ SIUPTO earner Name: ALLSTAR lRANS!'ORTATIO!I SERVICE KNO OC!'A~ CIO S~ll f"..Jl!J II.ACS 45•0I/CiNf<JSII HO FOHT 1 AU~FR:JA F Fl :;.!'HG TIURI> PARTY FREJGIIT CHARG£S DIU. TO SCAC: Ate~ J,B. Ho11t ltat15flil•I, lnr. l'!o humba: P.O. f;,x682 lM<?'J, M 7214, Spedal Instruct/on,: fteight Charge Teritt, (1tv~1 rlwf91®' ilM priti¾\~ unJ"'-s wtkiid'trthttmroJt i'l~p;nd l'il_ Cd'.i!ct O Jrd i'llrtY 181 .J Ma<let bill M!ad·ng 1\i:h a~.l~ned underi'(!ng bil'.s of t,s:,~g. CUSTOMER OI\DE!t ffifORHAlIOM Poll~SlipCuslolD<!r Order No. Al!ditional 5hlpix,:, Information(01deom,) Bsi of L•d re) Nurrtn.c 1/\Fl794 4700 a V Ii S>!ll'lO ~7527\1 Grand Tomi i O 42C,i)O CIIIIJUER INFORMI\UOfl LTL()_n')' W H w,,,;h: HM (X) Commodity Damiption 5ta<k N•irc No. Cfass (w1redU-♦ ™1,!"f-'9 ~n:;j (a ;;ditG"~l fi<'f' « ,r.m»1 n t,,;n,'t'lj ll! ,!Jr,h; l'r'»t Lt,.1:1e,alm.W-4f;>f{~itl ~ t.-;;imaw uf.t tl.Y~l!\:ti li:f't at.mr1 f.tn ~-S«U3"1:(t)drt.--Vtb't.l£0 4700 TRAILER i$"t; tt:'~r.i!.i.Utt:ti1:mt,r\J'tJZ.~lit1t~r•a~rr-q.1rt11@:r.:U l;»J:fcUty,ri f!J.U'~ 1-'l:Z!.;rt't'dtt COD Amount:$=i~~r~=;:t·~~.1:; 'Tt,~:.-;_rtMo ~'i~V~e;ft~P'mfJ'll~f-G'd/ footzu015.'. tofieitJ Viepa;d J 0J:S.t...Ml!fth~lC-C1':pta~CJ Nol:J!: Uablltty llmttatlon for lo~ or IU!magc In Ullt Jhlpntcnl may be appllrable. See 49 USC § 14700(c){l)(A) and (B), Th~ t"""f;.er slull !10\ rr.,,<:e dr.:k°'.::-Y -;( lhi:, !l'~t11r1;nt Yt-\h1t•t i:;t1ym{/:';_ of ~h11~~ ,-mt; au ollo<>r lawliJ '""'· ShiJIP'Or Signature Shlpptr Slgnature/O~te Trllll<)r L1>,1ded: Q\ttli!r SlgB11ture/Plcl<!l1' Date .i.Y8'/sh;~pC4( fa'.iL/ ii i4 J Bydm,cr t)niD~,kii.:Jt;1u:.J1w tl•rh'I. fha1i it~~~ ~!'Tittu!'"'-.!dr-~<1;:l-s,1re l~,fi{)n,½4!«,!!':!,ft(l!tf.cftm'.t,'Jil('i.o!frl ft':}.~) 1/'~1}1 tl.m,ftt.d,;w-;i~, m.H~ ir;J U:n.l-!d ,1,.,, A"e pU;«v'l, rttat:JtJ3/lfr;<e~rrQN¥;f-W.t.'.t'r,4-H,H'hl!01 b u~t(U>'l'-i:w !rt t·H"t,-;rl.1:-.:i•t tri:n-d~:1 k th,,; ·.v.J\t,1~ ;u,s-M!~ ij[~fu, tat;i,a hha H.t l:l:ll tt1tu:~ tV "'>'ilotU'1F;;i,tJ.r:r,n,,;Jtt'i'<l{J l~~q..,/_,;b:x¼,{$ f~{;l:t?;l' ,!t,c✓.\ffLili:l) :u il-U° 'tdi:0;.J!~t;ik:Y.~ii!.m~Ur.':!11~ll'Q,);:dU!~", O...".f!C'tMf!C'.td lnterport Logistics, LLC 12050 NW 25 Sue~! rMC 016J81UF MJ&1~, FL 3318? lf<iled S!f,Jao Tlll :,:,,,;.477,1910, f(1< 305-477<1776 DELIVERY ORDER 6300 E Ao;imo Drive f,~nh'4 .. ~~, •P,'i#h f 1-!t~J C."'i~·-•• naNJ1~l!r INTGR-730773 Preonll'y G httos://miamibeach-mv.shareooint.com/oersonal/iani,::innAr mktmihA,ir-.hll nnv/ bvn111c/11;/nnanriuo O<>nv?... 0 ~1 ~J,<-OL'lCCnM____,., 'lC:<--1-•---- V EXHIBITM CARRIER RA TE CONFIRMATION MCL PO# 1467838 BROKER: Rick Gallagher DRY 9103320820 X 1308 teamgallagher@megacorplogistics.com Date: 11/15/22 10:21AM Load Information RATEPICKUP DATE: 11/17/2022 TIME: 08:00 DELIVERY DATE: 11/17/2022 TIME: 14:00 Amount Description Total TRAILER TYPE: Hotshot TRAILER SIZE: 40FT MILES: 199.71 WEIGHT: 8000 Load Products Name Construction Advances Type $650.00 Flat Issued $650.00 $650.00 Amount •Carrier Information Carrier: ALLSTAR TRANSPORTATION SERVICES LLC Driver 1: Emmanuel Driver 2: Dispatcher: Montrice • STOPS ID Type Sched Date & Time Notes 1 Pick 11/17/2022 08:00 ID Type Sched Date & Time Notes 1 Drop 11/17/2022 14:00 Phone: Fax: Driver Cell: 2398417355 Driver Cell: Phone: 3059886627 Email Shed, Address City, State, Zip JMH Marine (AccuDock), 1790 Pompano Beach, FL SW 13th Ct 33069-_ Shed, Address City, State, Zip Kennedy Space Center Merritt Island, FL (KSC) Badging Office, Stated 32899 Rd 405 PU# DEL# Products Products Special Instructions Please have 6 or more straps for this load *****DO NOT BREAK SEAL***** This rate confirmation is an agreement between MegaCorp Logistics and carrier hired to haul the stated Load at the indicated rate. This load is not to be dispatched or double brokered. All accessorial charges must have prior authorization. Carrier must notify broker 1 hour before detention begins to accrue. Detention is on a per load basis and the carrier must get the agreed amount in writing. Truck ordered not used (fONU) fees will not be paid unless the driver has been dispatched by a MegaCorp Account manager. Any additional charges must appear on a revised rate confirmation sheet. This load/rate confirmation is inclusive of all charges and supersedes any tariff and/or any schedule of rates of Carrier. Carrier's use of pro-stickers or any other shipping document showing rates shall be void. ***Carrier or its agent certifies that any TRU Equipment furnished will be in compliance with in-use requirements of California's TRU regulations. (has to do with air resources/regulations) TERMS AND CONDITIONS 1. This load/rate confirmation is incorporated by reference into the Broker/Carrier Agreement and any revisions between the parties. 2. Drivers assigned to deliver the freight must have sufficient hours of service to comply with applicable FMCSA hours of service regulations. 3. All drivers are required to check call everyday (including Sat. Sun. and Holidays) between 8:00 AM and 9:00 AM eastern time. 4. Seals should be noted and signed on BOLs. When load is sealed, the driver/carrier cannot break any seal, or there will be a claim charged to the carrier. Driver must have a minimum of 2 load locks to secure the load. After hours, drivers are required to inspect load before truck is legally sealed. Do NOT break seal. 5. Trucker Tools and/or Fourkites GPS Tracking is a requirement for all carriers. 6. Carrier/driver is responsible for loading properly. The load must be secured prior to leaving the facility. All issues should be noted on the BOLs. If BOLs state overages, shortages, or damages, do not leave the receiver without calling MegaCorp. Carrier will be responsible for any OS&Ds not reported. Contact MegaCorp immediately if any concerns. 7. In-order to satisfy the specifications of the shipper, consignee, or beneficial owner of the freight any information supplied by the broker verbally or in writing may include but is not limited to routes, pick-up and delivery times, dates, special freight handling requirements such as bracing and blocking, dimensions, and weight. 8. The carrier assumes full responsibility for the means and manner of loading with securing the freight and the conduct and performance of its driver. In the event a shipper denies carrier access to the loading process or observation of process the bill of lading shall be marked (SLC) shipper load and count. Only in this event the carrier shall not be liable for any cargo damage that resulted in improper loading by the shipper. 9. All drivers are subject to direction, control, and supervision of carrier/dispatcher and not the Broker. 10. Once a load is delivered in full, the carrier is responsible for immediately suppling the broker with the receiver signed BOLs. 11. As a matter of due diligence, if any vehicle being used by Carrier is not 100% wholly owned, upon request by Broker and prior to transporting any freight hereunder, Carrier will furnish a copy of the lease agreement or rental agreement between both parties, the last four digits of the truck's vehicle identification number, as well as proof of insurance for said truck. 12. By signing this load/rate confirmation agreement (and/or transporting the shipment, even if it is not signed), the rate price above shall be final. 13. All carriers hauling produce commodities must pulp product if shipper allows driver to do so. If any temperature differentials of plus (+) 2 degree or minus (-) 2 degrees, the driver must report the temperature immediately to a MegaCorp broker. (all reefer loads must have a downloadable trailer) FUEL INFORMATION 1. Advances are limited to 40% of the line haul rate, not to exceed $3000 and no more than $1000 per 24-hour period. 2. A fee of $25.00 for all fuel advances will be deducted from your invoice for each fuel advance. ACCOUNTING INFORMATION 1. A fee of $7.50 per pallet will be charged on loads that the carrier is responsible to supply pallets for exchange, and they do not. 2. If a lumper fee is added to the rate sheet it is only an estimate and is not IN ADDITION to the flat rate. 3. A restack will need prior approval from the broker and pictures provided immediately. If procedure is not followed, carrier may risk restack fee not being reimbursed. 4. All quick pay fees are subject to change at any time without prior notification. If you are quick pay options in your set-up packet and are currently set-up as a quick pay carrier, email your paperwork to quickpay@megacorplogistics.com or fax it to 859-538-3281. 5. To process a normal payment (30 days), the paperwork including your invoice, BOLs and any accessorial fees related to the load needs to be submitted within 2 weeks unless otherwise noted under Special Instructions. The BOLs must be legible and full pages. If an advance for unloading is issued and the receipt/receipts are not provided with your invoice and BOLs this will result in a short payment. Email your paperwork to ap@megacorplogistics.com in PDF format or fax it to 859.538.1673 6. If original BOLs are required, please mail paperwork to MegaCorp Logistics, PO Box 1050, Wrightsville Beach, NC 28480. Physical address for overnight delivery, 1011 Ashes Drive, Wilmington, NC 28401. 7. If you do not have access to email documents, they may be sent to Transflo. Transflo is available at most major truck stops. A convenience fee of $3.00 will be deducted from your final payment for each instance that Transflo is used within each load. Please use our code, "MGPG" to send documents using Transflo. 8. As a courtesy we have auto generated emails that will inform you if paperwork is missing and we also have a web portal that you can access to view your loads and the paperwork on file. You can upload to our web portal any missing paperwork. Close out date is 30 days. https://megaweblite.megacorplogistics.com/ Account/RequestCarrierAccess. ****Please sign and return by email or fax (859) 538-3347) a copy of this rate confirmation to MegaCorp Logistics, LLC indicating your agreement with these terms. If not returned by the time the freight is pickup, you agree to be bound by these terms. **IMMEDIATELY FAX A COPY OF THIS SIGNED CONFIRMATION TO (859) 538-3331** Rick Gallagher ~~ MCL REPRESENTATIVE SIGNATURE CARRIER REPRESENTATIVE SIGNATURE "Our goal at MegaCorp is to be your #1 Broker. We want you to have the best experience and we would like you to consider reloading with us. If you have any questions or concerns. please contact our Carrier Services Department at carrier.services@megacorplogistics.com or 910.332.0820 ext. 1234. EXHIBITK Permits Information Management System (PIMS) Online User Account Application Form A logon account is required to access PIMS online. The ARPS logon account will not worl< with PIMS. A PIMS customer# is required to access PIMS online. If you do not have a PIMS customer#, call the permit unit at (919) 814-3700 to get a customer#. Company Allstar Transportation Services LLC PIMS Customer# Address 4946 Atwater Drive Email Address contact@allstar-trans.com City North Port Phone# 305-988-6627 State Florida Zip Code 34288 Log on accounts are associated with exactly one company. If a person submits applications for more than one company, they must have a separate logon account for each company, and each logon account must have a unique email address. Sharing of account information may result in loss of online privileges. Submit the following information for each logon account. Please write legibly and ensure the email address is accurate, as all correspondence regarding the account will go to that email address. Applications will NOT be accepted in person or by phone, and will be processed on a first come, first served basis. If the email address is incorrect or not legible, NCDOT will be unable to respond to you. First Name* Last Name* MI Email Address* Emanuel Sims contact@allstar-trans.com * required information Return this completed form to the Oversize Overweight Permit Unit via USPS: 750 N Greenfield Parkway, Garner, NC 27529 or fax: 919.662.4320 Mailing Address: Telephone: (919) 814-3700 NC Department of Transportation Fax: (919) 662-4320 Oversize/ Overweight Permit Unit Website: 1561 Mail Service Center https://connect.ncdot.gov/business/trucking/pages/overpermits.aspx Raleigh, NC 27699-1561 STATE OF SOUTH CAROLINA SECRETARY OF STATE APPLICATION FOR A CERTIFICATE OF AUTHORITY BY A FOREIGN LIMITED LIABILITY COMPANY TO TRANSACT BUSINESS IN SOUTH CAROLINA The following Foreign Limited Liability Company applies for a Certificate of Authority to Transact Business in South Carolina in accordance with Section 33-44-1002 of the 1976 S.C. Code of Laws, as amended. 1. The name of the foreign limited liability company which complies with Section 33-44-1005 of the 1976 S.C. Code of Laws, as amended is: Allstar Transportation Services LLC 2. The name of the State or Country under whose law the company is organized is _F_l_o_ri_d_a_________ 3. The street address of the Limited Liability Company's principal office is 4946 Atwater Drive (Street Address) North Port, FL 34288 (City, State, Zip Code) 4. The address of the Limited Liability Company's current designated office in South Carolina is 3912 Hearns Dr (Street Address) Columbia SC 29223 (City, State, Zip Code) 5. The street address of the Limited Liability Company's initial agent for service of process in South Carolina is 3912 Hearns Dr (Street Address) Columbia South Carolina 29223 ~(C-ity~)-------------------------(2-ip_C_od_e_)_____ And the name of the Limited Liability Company's agent for service of process at the address is: Emanuel Sims (Signature of Agent) 6. D Check this box only if the duration of the company is for a specified term, and if so, the period specified Form Revised by South Carolina Secretary of State, August 2016 F0008 Name of Limited Liability Company 7. ~ Check this box if the company is manager-managed. If so, list the names and business addresses of each manager. (a) Emanuel Sims (Name) 4946 Atwater Dr (Address) North Port, FL 34288 (City, State, Zip Code) (b) Montrice McClain (Name) 4946 Atwater Dr (Address) North Port, FL 34288 (City, State, Zip Code) 8. D Check this box if one or more of the members of the foreign limited liability company are to be liable for the company's debt and obligation under a provision similar to Section 33-44-303(c) of the 1976 S.C. Code of Laws, as amended. Date: November 18, 2022 ~~ Signature Emanuel Sims Name Owner Capacity/Title Form Revised by South Carolina Secretary of State, August 2016 FOOOB FILING INSTRUCTIONS 1. This application must be accompanied by an original certificate of existence not more than 30 days old (or a record of similar import) authenticated by the Secretary of State or other official having custody of the Limited Liability Company records in the state or country under which It is organized. 2. Two copies of this form, the original and either a duplicate original or a conformed copy, must be filed. Include a self addressed stamped envelope to have a filed copy returned to you by mail. 3. If the space in this form is insufficient, please attach additional sheets containing a reference to the appropriate paragraph in this form. 4. If management of a limited liability company is vested in managers, a manager shall execute this form. If management of a limited liability company Is reserved to the members, a member shall execute this form. Specify whether a member or manager is executing this form. 5. This form must be accompanied by the filing fee of $110.00 payable to the Secretary of State. Return to: Secretary of State ATTN: Corporate Filings 1205 Pendleton Street, Suite 525 Columbia, SC 29201 Form Revised by South Carolina Secretary of State, August 2016 F0008 2/7/23, 9:49 AM For Stephanie -OneDrive lB Share ee:i Copy link ± Download CD I<l 118 / 162 I> I X EXIDBITL ll.\ TRIDJ:.NT ... Load Confirmation **• Trident Transport, LLC Page Chattanooga, TN 37402 505 Riverfront Pkwy Office 727-440-3580 Ext: 381 Office: 727-440-3237 Cell: 727-404-8854 Invoice# : 0429065 Carrier: ALLSTAR TRA!ISPORTATIOtl SERVI Contact: Monlrice McClain llORTH PORT FL 34288 Phone: 305-988-6627 Date: 1112812022 Fax: Order Order: 0429065 Commodity: Miles: 79.0 Weight: 10000.0 Temp: Trailer: Flatbed Hotshot (OAT) BOL: Reference: PU 1 Name: Pick up Dale: 11/2812022 0700 Address: 110 V'lesl Interlake Blvd 11f28l2022 0700 Contact: Johnnie LAKE PLACID FL 33852 Orvr LdjLJnld: No driver loading or unload Phone: 613-493-1923 S02 Name· Drop Dale: 11/28/2022 0800 Address: 1811 tlW 271h St 11/2812022 1100 Contact: CAPE CORAL FL 33993 Orvr LdiUnld: No driver loading or unload Phone: Payment Carrier Freight Pay: 5700.00 Instructions Pick up• 12 fool wide no tarps Please send POOs to accounting@lridenttransport.com immediately upon delivery Please refeIence your crder number in the email subject line. Agreement No Double Brokering allowed. Please send Invoices to accounting@tridenttransJ)ort.com No additional charges will be paid without prior approval. Accessorials must be reported at the time of shipment prior to deJ)arture. We require ex.elusive use of the trailer. NO CO-MINGLING ALLOWED unless otherwise specified on the rate confinnalion. BY SIGNING THIS DOCUMENT, YOU ARE AGREEING TO OUR TERMS. Please sign and fax. or email back to Chris Lauyans chris.lauyans@tridenttransport.com Load Accepted By: _E_m_,an_,u_•1_5_im_~________ Signature: Driver Name Em.;;nuel Sims Cell# 23~-I41-i355 Truck# ~---Trailer# ~ View PDF controls ""M•11~ 1~~1ha-,,-h.m" c:h,rnannint r:om/oersonal/lanisinqer miamibeachfl_gov/_layouts/15/onedrive.aspx?ga=1 &id=%2Fpersonal%2Fjanisinger_mlam... 1/1 2/7/23, 9:49 AM For Stephanie -OneDrive LB Share ~ Copy link ± Download CD I<l 118 / 162 I> I X EXHIBITL "' Load Confirmation '"lll TRICIENT Trident Transport, LLC Page Chattanooga, TN 37402 505 Riverfront Pkwy Office 727-440-3580 Ext: 381 Office: 727-440-3237 Cell: 727-404-8854 Invoice # : 0429065 Carrier: ALLSTAR TRAIISPORTATIOtl SERVI Contact: Monlrice McClain llORTH PORT FL 34288 Phone: 305-988-6627 Date: 1112812022 Fax: Order Order: 0429065 commodity: Miles: 79.0 Weight: 10000.0 Temp: Trailer: Flalbed Hotshot {OAT) BOL: Reference: PU 1 Name: Pick up Dale: 11/2812022 0700 Address: 110 'Nest Interlake Blvd 11/2812022 0700 Contact: Johnnie LAKE PLACID FL 33852 Orvr Ld/Unld: No driver loading or unload Phone: 813-493-1923 S02 Name· Drop Dale: 11/2812022 0800 Address: 1811 II\N271hSI 11/28/2022 1100 Contact: CAPE CORAL FL 33993 Or✓rLdiUnld: No driver loading or unload Phone: Payment Carrier Freight Pay: 5700.00 Instructions Pick up -12 foot wide no tarps Please send PODs to accounting@tridenttransport.com immediately upon delivery Please reference your crder number in the email subject line. Agreement No Double Brokering allowed. Please send Invoices to accounting@tridenttransport.com No additional charges will be paid without prior approval. Accessorials must be reported at the time of shipment prior to departure. We require exclusive use of the trailer. NO CO-MINGLING ALLOWED unless otherwise specified on the rate confirmation. BY SIGNING THIS DOCUMENT, YOU ARE AGREEING TO OUR TERMS. Please sign and fax or email back to Chris Lauyans chris.tauyans@tridenttransport.com Load Accepted By: _E_m_,,_nu_•I_S_irr_&________ Signature: Driver Name Ermnuel Sims Truck# ~---Trailer# lilll View PDF controls -,L, ,.____,.__ _., ~h~Mnntn, ,.,,......,fn<>r<:nMl/l"nis:lnoer miamibeachn qov/ layouts/15/onedrive.aspx?ga=1&ld=%2Fpersonal%2Fjanislnger_mlam... 1/1 SEND FREIGHT BILL TO: Brandon Johnson Trinity Logistics, Inc. Email brandon.johnson@trinitylogistics., P.O. BOX 1620 Phone (320) 227-7019 Seaford, DE 19973TRINITY Fax COMPANY@ carrierinvoices@trinitylogistics.com Trinity KS -GRANITE, SARTELL Fax (302) 883-8025 Office Rate Confirmation -Trinity Logistics, Inc. Reference #7357385 Shipment Details Shipment# 7357385 Shipment Miles 178.00 Straps yes Chains yes ::::ust Ref/PO# 69 Eq Type 40HS Shipment Mode Over The Road fodays Date 9/21/2022 16: 03 Eq ID Carrier Details ::::arrier ALLSTAR TRANSPORTATION SERVICES LLC Driver Name Emanuel I (239) 841-7355 OBA Dispatcher Emanuel MC Number 1325615 Phone (239) 841-7355 DOT# 3742861 Fax SCAC Carrier Ref Shipment Details Stop Type Pcs/Type/Wt Address Appt Date ApptTime PU/Delv # • CAV (CAVENDISH) ' 21505 SR 60 VERO1 Pickup 9/22/22 08:00 -15:00VERO BEACH, FL 32966 69 , (727) 420-3271 '1PY5075ETKK409873 Notes: 'Driver must have ramps and PPE on or their will be a rate reduction :Driver needs to tell us the unit# on bush hog EVG (EVERGLADES) ''SW 222 AVE 232 STREET2 !Delivery :9/22/22 '.os:oo -15:ooHOMESTEAD, FL 33031 i (239) 314-9810 Shipment Line Items Total Pcs/Type Total Weight Volume STCC Description NMFC Class ID 0 PIECES . 11000 lbs ; JD 5075E and bush hog Carrier Rate Agreement Item # Charge Description Unit Type Unit Quantity Unit Price Rate 1 ,TRK ORDERED/NOT USED 'Flat Rate 1 • $150.00 i $150,0( Total: $150.0( Shipment Notes L 1PY5075ETKK409873 )river must have ramps and PPE on or their will be a rate reduction )river needs to tell us the uniW on bush hog ALLSTAR TRANSPORTATION SERVICES LLC Signature~~ Date 9-21-22 Terms of Agreement l. Rate Confirmation should not be used as BOL 2. For all shipments going to or through the state of California, the following applies: In addition to being required to comply with all other =ederal, State and Provincial laws & regulations, Carrier is required to comply with the terms of the California Air Resources Board (CARB) rransport Refrigeration Unit (TRU) Airbone Toxic Control Measure (ATCM) and the CARB Heavy-duty Greenhouse Gas Regulation. Should Broker ncur penalties as a result of Carrier's non-compliance, Broker shall offset -with Carrier paying Broker an amount equal to the difference within :en (10) days. 3. GENERAL: Rate confirmation ("Agreement") is a contract. Agreement shall become part of the master contract Into which the above nentioned carrier ("Carrier") and Trinity Logistics, Inc. ("Trinity") have already entered ("Contract"). Agreement shall, in any and all cases, be ;ubject to terms and conditions of the Contract. Carrier agrees that it will review this Agreement immediately upon receipt in order to verify that :he Agreement lists the same rate(s) as the one(s) to which Carrier and Trinity agreed prior to time when Agreement was prepared. If Carrier foes not sign and return Agreement within twenty-four (24) hours, Carrier shall be deemed to have accepted the Agreement. By accepting this C\greement, Carrier acknowledges that this is a contract load and that tariff insurance exclusions do not apply. i, BROKERAGE: Carrier agrees that It will not broker the above load to another carrier or broker unless it receives written approval from Trinity :o do so. Trinity shall be released from its obligation to compensate Carrier should Carrier do otherwise. 5. SUBMITTING PAPERWORK: Paperwork may be sent to Trinity via the following methods: Email: carrierinvoices@trinitylogistics.com Fax: :302)883-8025 Transflo Express: see attached cover page for information on sending via Transflo Mail: P.O. Box 1620 Seaford DE 19973 5. ADVANCES: All advances are subject to a 4% of the advance amount fee, minimum charge of $10.00. The maximum advance amount Is P,000.00 USO, --·"··~"~r. r•---'-•" >ne~c "'r" "'i~hin twPntv-five (25) days of date on which all uncontested paperwork was received. For information on rRANSFLO Express® Cover Sheet T ISITY A 13UIUllS l.O<llStlCS COMPANY@ Thank you for choosing Trinity. Need a reload? Visit our available load board at www.trinityioqistics.com/carriers/access-ioad-board/. To obtain your login, contact (866)-TRINITY. lotes: If using Transflo, a $2.50 fee will be deducted from your final settlement. Scanned documents must be received within 24 hours of delivery. nstructions: 1. Visit a participating location, selected from the listed map of truck stops found on www.transfloexpress.com. 2. Perform the following check list before handing the fuel desk cashier your documents: c Clearly and legibly fill in the information at the bottom of this sheet labeled "Load Information". c Make sure all documents are face-up, with the writing on the top side. c Securely tape small receipts or documents to a regular sized sheet of paper. Materials are provided by the scanning clerk for your convenience. c Remove paperclips & staples from all documents. c Place this coversheet on top of your documents. You must use an original coversheet, no photocopies, to ensure proper transmission to Trinity's Accounting Department. 3. Once the scanning clerk has processed your documents, they will be returned to you with a confirmation receipt stapled to the front page. c Review this receipt to ensure the date and page count is correct. c Make sure all documents are face-up, with the writing on the top side. c Make sure Trinity's SCAC code, "TTFD", was used in order to confirm they were sent to the right company. 4. View the images on www.transfloexpress.com, click on "View Documents" in the top right corner.Enter the confirmation number from your receipt to view the scan as well as determine when the documents were delivered to Trinity. Images are kept online for 14 days, Load Information Load (Pro) Number: Pick Up Date: Pick Up City: 7357385 9/22/22 VERO BEACH Pick Up State: FL Delivery Date: Dest City: 9/22/22 HOMESTEAD Dest State: FL Carrier Name: ALLSTAR TRANSPORTATION SERVICES LLC 11111111111111111111111111111111 T T F D T T F D 2/7/23, 9:42 AM For Stephanie -OneDrive lB Share Q..) Copy link ,J, Download CD I<l 51 / 101 t> I X Allstar Transportation Services LLC. Em,tn:..Jel SHt,s 4946 Atwater Dr ,ve North Purl, rL 34l88 Bill To: Houfmg Plus, Inc 1525 University Dove Auburn, GA 3UU l 1 U.S.A INVOICE Invoice# 1015 Invoice Date Sep 16, 2022 Due Date Sep 19, 2022 20 ft of metal roofing supplies up to 6500 lbs. Notes It was great doing business with you! Terms & Conditions Payment due on pick up by check. 392 2.85 1117.20 Sub rota! 1117.20 Sales 1ax (0%) TOTI\L $1117.20 ~ View PDF controls •••• .L _____,_, --~1no•Mn<>l/i<.nl"1nmar miflmlbeachfl qov/ layouts/15/onedrive.aspx?ga=1&id=%2Fpersonai%2Fjanislnger_miam... 1/1 2/7/23, 9:42AM For Stephanie -OneDrive Le Share Ccb Copy link ± Download CD I<l so/ 101 t> I X Allstar Transportation Services LLC l:fll~il\'_leJ :_;m;:, 4946 A1water Dr i North Port, rL 34288 U.S.A Bill To: Roof111g Plus, Im. 1 :,2:, University Dr1ve Auburn, GA 3fJU 11 INVOICE lnvolcett Invoice Date Due Date 1015 Sep 19, 2022 20 ft up to b5UU lbs of building material Notes 392 2.85 Sub lotal Sales Tax {0%) TOlf\L Thank you for doing business with Aristar Transportation Services LLC Terms~, Conditions Payment due on pick up by Check. 1117.20 1117.20 $1117.20 ,,.. W-Afl•ilnvolce ~ View PDF controls ._,._ __ .,_,__,._ ___._ ~" ~hMannlnt ,..,..m/n,,r~nn,.I11,.ntsinaer miamlbeachfl qov/ layouts/15/onedrive.aspx?ga=1 &ld=%2Fpersonal%2Fjanlslnger_mlam .. , 1/1 2/7/23, 9:43 AM For Stephanie • OneDrive Le Share Ce:i Copy link l Download CD I<1 60 I 101 I> I X PO Box 569 Local: 205-379-0984 McDonough, GA 30253 FAX: 877-251-8541 RATE CONFIRMATION SHEET Bennett Order #: 7859130 BOL: 4387507 Please Call for Load Information: LISI FARR at 205-379-0984 or AL5 al 2053790984 Carrier: 8102847 ALLSTAR TRMISPORTATION SERv;cE Ph: 2398417355 Fax: 0 Driver. TBT Ph: TBT Comrno<lity: GENERATOR Equipment: F Pcs: 00001 1Nelght 2300 Length: 12.00 \o\/idtll: 3. 00 Heigh!: 5.00 B/H: Origin UUITEO RENTALS POWER & HVAC Load D.ete: QQi01l22 to 08/01122 Pcs: o 7390 PEPPER1.'ILL PARKWAY Load Time; 0800 lo 1600 Wt o NORTH CHARLESTON SC 2Q41S Appl?: N Ref#: ~stination UNITED RENTALS Delivery Date: Oll.102122 lo 09/02122 Pcs: o lOi SHJ..RON CT De·;.,.ery Tin,e,: 0800 to 0800 Wl:O POOLER GA 31222 Appl?: N Ref#: Special Instructions: PU# 4387507 PROPER PPE. NO PPE WILL RESULT Ill S400 FINE BOL REQUIRED UPON DEL OR FINE MAY OCCUR EMAIL AL5@8EHNETTIG.COM WITHIH 24HRS OF DEL INEXCUSABEL LATE DEL CAil RESULT IN $400 FINE A DAY NO COMI.\UNICATIOH CAN RESULT IN FINE UP TO $400 Carrier Pay: Linehaul 450.00 Total 450.00 Dtiv>r must c,11 BIL for disp1tch v,hen lo1ded and upon completion of lo,d for Relea;e#. \'/hen delr;ered. lax sign<d BOUPOD to: 800-688-2221 o, email p1p,r work to b~does@benneltig.com. Report any claims ot def.•ie,y probli,ms al thi, time tl1ey occur to: 205-379•091!4. Emergency Aft.r Hours Contact: 205-379-0984 Page1of2 Payrr.F-nt Rr:;uirements: Include !if;!nrd Bill of l2,;:Hng~ free snd d:a:1 or any not:ti:,ri, o~ ~J:s. dam:age, c,r de-1;.y at tte tirre of dElhsetyof tt: cargo. Include BIL Order and Release Numbers. BIL vJill not pay freig'h1 bills whfioL:1 our Ri::1=:..:=: Nl.!rrl::-=:r. Frei;;ht bi1lrr:1.i:1 show or>a,in. dstir,3.f,:,n, wmmodity, p>av_s, weight, amf tt".£: ,:t:i.,c,t~ rate. Mus1 pro1ii:'i: ra-c:e7;-ls to t,z-t-kup any aces:ssori3J t,?rar;;e!:. Any acoe:!i:sorial c.f'larff:S net specif.:ally 'fated tm this Rate Confirn--,:tion will nvt be paid \\t1hall1 prior BIL wrhten appro•,al ar.d t•nly upoi Bl L's su.:ce.ssfol r=imbursement from Bil's ci...s~om:r. Tt-,e Rate compensati:in amount reted abo•,·= includes ar,y rr,:-tor cerrierfueJ..rn\:a~:i surc.h~rge-adju.stiri!!nts, ·,1M:h 1hr: patties lu:.re:by ackn,:-wle.d,a:r: ari::: be:in; pass-cd through entire;, to tli-e p~.;on. e,orpora1ion -or e:rc!it-j tl-.at dire-:t1y bears 1he c:o,;t of fuel ft,r tt.e ;hipment transported under thr:: Loa,f Confirmation. Carr:e.r shall r,ot be-paid Ot::tention, Laya'l!er. Di::.:idhe;ad, Rrron::ignrnent c-r Tn.:c;;: Ca1'1:-J for Nc1 Used 1.mle~!i and LTitil BIL i5 pEid in full by the cust,:,nier. '-"--· "-'~-'hMnh m" ch<>ronnlnt rnmlnArRonal/ianisinaer miamibeachfl_gov/_layouts/15/onedrive.aspx?ga=1 &id=%2Fpersonal%2Fjanisinger _miam... 1/1 X 217/23, 10:03 AM For Stephanie -OneDrive LB Share C2:l Copy link ± Download CD I<l 135 / 162 I> I LANDSTAR LOAD CONFIRMATION FB #: 8150720 EFFECTIVE DATE: 1013112022 CARRIER: ;._:...S-i-R TR;..11;.;,:JRTAT:::1••-. SCRVtCE EQUIPMEtH: SD CARRIER#: .....5090 COMMODITY: GEMERATOR: SERIAL# DRIVER: 3012104856 DIMEtl SION: DRIVER CELL: WEIGHT: 7000 CONTACT: E,\IAl'IUEL High Risk: PIECES: PHONE: (239) 841-i355 TARP: LRGR -Wl-lP SIGM THIS DOCUtlENT PICK-UP DATE: NAME/ADORES S: OIRECTIOtl S: SPECIFIC IH STRUCTION S: DELIVERY DATE: tlAl,IE/AODRE S S: DIRECTIONS: SPECIFIC Ill STRUCTION S: ANY QUESTIONS OR CONCERNS ABOUT THIS LOAD PLEASE CALL AGENCY: (830) 208-2151 IMPORTMlT: Carrier call aaent ii your dispatch instructions below differ from bill of ladlnn! jl 1/112022 09 00 -11i1I2022 10:00 CONTACT: lcol.'CAST CIO CR111CAL EIJERGY 21 D l,1ATTHEW ST PHONE: (786/ 560-5Ql8 ,.~ETTER. GA. 30431t DRIVER MUST SEMO THE PiCTURE OF THE BOL ONCE LOA.DEO! DRIVER ~IUST SIGM SOL AS LANDSTAR ·• STRAPS ANO CHAINS REQUIRED •• SER•AL <I 3012104855 ·• REF# 3341880: GENERATOR 0.m.: 16Q' X 41' X 123", 7000.0 Ins 111212022 07 30 -111212022 08:00 1F1DEL,TY MANUFACTURING IQOO ME 25TH AVE JOe# 50648 0C.4LA. FL 34470 CONTACT: PHOIIE: RiCHARD EVMJS {~52/ 414-4700 DELIVER'( APPOJIH1,!ENT ATS A\~ EST OM \.VCONESDAY t 1102 .. REF J,; 3341280 ° PICTURE OR COPY OF POD MUST BE SENT TO JOHM:!i\WIIPAGENCY.CO,\I OR TEXT TO (575/ 914-2564 OIJCE DELIVERED' ADDITIOHAL TO I AL CARRIER PA'/5 All INCLUSIVE. Ill STRUCTION S: Crieck car; are re:qu,red avery morn·ng by 3arn CST. Failure to do so 1,11,!! result ·n a S250 fine. Ori',•ars nhJ3t call LANDSTAR upon ::irriv31 .:!nd departure of ~cch shippll1·tl point and must c31i upc,n srriv3· at ar:st1nat O"'I Tnis 1; 3n e:<c'us1•,e us.e c,f tquiom~'1t un1e::s oV·H:r.vise r,oteo. Only Corisigr,;a c:rn break a .H~al. Failure to c·o :o •.yill re-suit irl afine. LAfJOSTA.R must o~ not1fed of ariJ ove:rage:s, sho·tages. or damaged prooud .nvY1ed1ai:?'y upon del,ver1. Fai1u•e to oo so will result in 50% fine. LAMOSTAR n,05:t be n13Qe. 3Ware. of 3ny proble:ms dur,n,;; transit tl13l m3y result in a delay in oeli·,•ary.' m(s:;e:i oic~~ uo F3i;ure to do .so w1li result in a 50<;.~ fine. C!irri,::r ~hal; b.e I aQ!,:: to LAMOSTAR for ail economic lo;s, ·nclud.ng con:se-quential oan'\3ges t'13l 3re incurreo by Brok.a, or the Cu;to'l1H for any freight 'o;;, d3013QE: or a~:ay. Unload ng mu;l Oe-reported '11,thin 2 hr.;. Ori-,er n1ust call upo:i arri11al :!:l t,ie shipp~r 3/'i0 receiver 3\sc departure of the ;;h pper 3nd re::e1•,er :along with the pieces weight. BOL and POD nformation. Fa lure to do so \\fl r~sulti'"l 50% ff"le. POD must be enui1e:i er faxed within 24 rir:, fai u'e to cio so -.•;ii· re suit a 25% fir.e.. Total Carrier Pay: $600.00 GET PAID IN 2 DAYS! CALL t-866-321-PLUS (7587) TO LEARN HOW! LRGR-WNP Agency Cont3d: Jahn Carr,er Agency Phone: ATTENTION caITier certifies It is aware of the California Air Resources Board's Truck and Bus, Drayage and Greenhouse Gas Rules and that, 011 all loacls originating in, destined for or passing through California, Carrier will utilize only vehicles that are compliant with those Rules. Please see CARB Regulations, including the CARB Dray rules. https://www.arb.ca.gov PAGE 1 OF 2 LANDSTAR LOAD CONFIRMATION FB #: 8150720 Signatu..e Confirm Date: 1012' li2022 Conf,rm Date: Carrier Fax: CARRIER MUST SIGN LOAD CONFIRMATIOH AND FAX BACK TO AGENCY AT: 830-253,5771 THANK YOU FOR OOIIIG BUSINESS WITH LANDSTAR TO VIEW Al raker.corn "CALL OUR INTERA ~ View PDF controls JS ,, (800) 972-9490 l~IFORTANT BILLlf.lG IUSTRUCTIONSI ••• YOUR INVOICE, BILL OF LADING, PROOF OF DELII/ERY, AND THIS SIGNED LOAD httos://miamlbeach-my.sharepoint.com/personal/janisinger _miamibeachfl_gov/ _layouts/15/onedrive.aspx?ga= 1 &id=%2F personal%2Fjanisinger _miam... 1/1 2/7/23, 10:03 AM For Stephanie -OneDrive lB Share Ce) Copy link ± Download CD I<I 137/162 I> I X LANDSTAR LOAD CONFIRMATION FB #: 7025204 EFFECTIVE DATE: 10.-3112022 CARRIER: EQUlPMEIH: so CARRIER#: COMMODITY: GEMERATOR: SERIAL I' DRIVER: 3012104358 DIMEtlSION: DRIVER CELL: WEIGHT: 7000 CONTACT: C\f~ilJCl High Risk: PIECES: 1 PHONE: 123;i. S4t-7?55 TARP: LRGR -Wt-IP SIGN THIS OOCUUEflT ANY QUESTIONS OR CONCERNS ABOUT THIS LOAD PLEASE CALL AGEtlCY: (830) 208-2151 IMPORTANT: Carrier call agent if your dispatch Instructions below differ from bill of ladlnn! PICl<·UP DATE: 110131,2022 11 30 • 10131•2022 12:00 CONTACT: NAMEIAODRE S S: IF10EUTY ,\IANUFACTURll·/G 1101 SW 37TH AVE PHOflE: OCALA, FL 34474-2813 DIRECTIONS: DRIVER l,IUST SEND THE PICTURE OF THE SOL ONCE LOADED! SPECIFIC DrtlVER 1,IUST CHECK iM ANOS IGM SOL AS LAl·IOSTAR " STRAPS ANO CHA1r-Is REQUIRED •• JOB F INSTRUCTIONS: 51023 I/ETTER GA •• SERIAL,; 3012104853 " REF 1' 3342128: GENERA.TOR Di'11s 169'' X 41'' X 123'. 7000.0 lbs DELIVERY DATE: 11/1/2022 08 30 • 11/112022 09:00 CONTACT: 1.-\ISAEL NAME/ADDRESS: 1CO1.lCAST CIO CRITICAL ENERG'r' 210 1.-\ATTHEW ST PHONE: (786) 553-5918 MUST DEL!I/ER 11,1 AT Q 00 /,V METTER. GA 2043P DIRECTIONS: SPECIFIC STRICT DELil/ERY MID GRA.NE ;.,PFOINTMEMT AT Q Mi ON TUESDAY I 111 REFF 3342133 " P·CTUrtE Ill STRUCTION S. OR COPY OF POD l,IUST BE SENT ,o JOHl·l@WNPAGEllCY.COT,I OR TEXT TO (575) 914-2564 ONCE D:=LI\/ER"D! ADDITIONAL TO,AL CARRIER PAYS ALL INCLUSIVE. INSTRUCTIONS: Cneck C3f:: are reqLned every morn ng by 83ri1 CS"T. Farlure to do sow ii rasult n a S250 fine. Dri'.'ar: must c.a:!I U..NDSTAR upon 3rriv3 1 and departure of eact, shipping point and musical: u.oon 3rriva1 31 oestin3ton Tru:s an e:,:c 1u::fr1e use of frquiomerd unless ot'lerNise noteo. Only Consigr:ee ca,i break:; :e:al. Fsrlure to oo ;;o •,•,•ii!1S rnsult in 2 fme LANDSTAR must oe notifed of :my o•:erage:i. sho~t3ges. or darriag9d product 1mmed1ata:y uoon dal, 11erJ. ra1ru"e to oo so 1hill ms ult in 50%; fine. LANDSTAR mu;t be m.Bde 3,•,•,•are of any problem; dur,ng transit th3t may rnsult in 3 d~laJ 1n ciehvery/ missed oic\.:: uo F31 u~e to de .:::o wi!: result in 3 50%: fine, Carrier shal: be l·3olt: to LAMOSTAR fo~ all economic lo.=.s, includ,ng consequ-:ntial oamag2:s t11at 3re incurreo by Broker or the Customer for any freight 1055, d3m3ge or de·ay. Unload ng muat be reported within 2 hrs. or;•,·er mu::st ca!I L:J:0'1 .:1m•,al at ti-le, shipper 3'10 receiver :f•ao dt:parturc of the sh:pper 3rid rece1•1er along ·Nith the pieces. weight. SOL and POD .nformalian. Fa lure to do so wi't r-:sult i11 50½ f,ne. POD rnust be em3iled or faxed within 24 hrE, f3i'u'"e to oo so '.',•ll• result a 25c,~ fire. Total Carrier Pay: S600.00 GET PAID IN 2 DAYS! CALL I·866-321-PLUS (7587) TO LEARN HOW! LandEt3r Agent: LRGR-WNP Carr,er A.gency Contact: John Carr,er ATTENTION Carrier certifies it is aware of the California Air Resources Board's Truck and Bus, Drayage and Greenhouse Gas Rules and that, 011 all loads originating in, destined for or passing through California, Carrier will utilize only vehicles that are compliant with those Rules. Please see CARB Regulations, including the CARB Dray rules. https:llwww.arl.J,ca.gov P1\GE 1 OF 2 LANDSTAR LOAD CONFIRMATION Agency Phone: (~30) 2Cll-2151 Signature FB #: 7025204 ~•- ----~Vl_'n._'1-_l\t~•-·tl_ ~ ",~;,a~·0. -·_'lr_,,v__~x Confi'"m Date: 10,'31 .12022 Confrm Date-: t0l3H2022 Carrier Fa>:: CARRIER MUST! Q : 830-263-5771 ~ View PDF controls TO VIEW Al roker.oom "CALL OUR INTERACTIVE VOICE RESPONSE SYSTEM TO REPORT LOAD STATUS" (800) S72-94S0 https://miamlbeach-my.sharepoint.com/personal/janisinger _miamibeachfl_gov/ _layouts/15/onedrive.aspx?ga= 1 &id=%2Fpersonal%2Fjanislnger _mlam... 1/1 X 2/7/23, 9:46 AM For Stephanie -OneDrive ~ Share Ce:> Copy link :±'. Download 0 I<l 101 / 162 t> I Carrier Confirmation for Load 1AE3794 Total Rate:S550.0 J.B. Hunt Transport, Inc ('J.B. Hunt"), as a licensed Property Broker, hereby arranges for Allslar Transportation Services LLC to transport this load as a licensed Motor Carrier. Alls tar Transportation Services LLC must call K1le Morgan for infomiaUon and ask forload#IAE3794. J.B. Hunt Contact Load Details l{yleMorgan 237 Miles kyl!! d mc,rgan@jbhur-t.cc'n S44242:i:oDS3 pl-'-0nte Equipmentfa.x Trai'."1!.r. Carrier Contact 32FL.l\T8ED Allslar Transportation Servic,,s LLC Ha=m~t. No Atte~iiorr,· Al Star Trar,:portation S:-e:r.oice:.s LLC • Temp-areture: Contrc,l',ed. No e-m3H: contact@al:.rtar-trans.«:•m 239-341-7355 phc-ne Requirements Carrier Services J.B. Hunt offers many carrier services Iha! include: QuickPay, cash advance, direct scanning, and discounts with many reputable vendors. CaU your J.B. Hunt representative or visit wvm.jbhunt com to le.im mo,e about our ca1rier programs. Comments All appointments must be met. If driver is late, the,• will either be refuse<! or worked in 1•Alh no detention paid On lime service is critical on this load! 1. PRELOADED TRAILER IS :LIVE 22' HOTSHOT I,,· LOADING A TRAJLER ON A TRAILER If Sl1ipper and Receiver addresses on the Bill of Lading do not match the lender, your J.B. Hunt represenlali•,e must be notified! 'CaD 800-UNLOAOI (800-865-6231) to be issue<! a Com~hek number for all Load and Unload ser~ices. • Please have a blank Comchek with you prior lo arrival. 'J.B. Hunt will pay au Load and Unload events directl,• lo the Load or Unload service. • Oo not pay out of pocket as you will not be reimbursed for Load or Unload costs. • Send a copy of the lumper receipt with BOL upon load complefion. 1111111111111111 Shipper:f Pickup CHAMPION TRAILERS SALES, INC. 21l22-1t-1408:00-2022-t 1-14 15:/JO i8300 E AOP..t/JO OR, TM.IPA.Flcrida 33i!Hl 813-626·8116 phc-ne Driver must ask for and receive Cnntmndit-_,.: 7RA!LER 0 PIECES (Estin1at<?:l 1Neight~.'.?:JD.O lbs) Driving Directions B, View PDF controls https://miamlbeach-my.sharepoint.com/personal/janislnger _miamibeachll_gov/ _layouts/15/onedrive.aspx?ga= 1 &id=%2Fpersonal%2Fjanisinger _miam... 1/1 X For Stephanie -OneDrive 2/7/23, 9:48 AM I<l 116 / 162 t>Il8 Share Ce:> Copy link ± Download CD ,;; J ~j (¼: ~ View PDF controls LU--· 11-•--1hnn~h m" ch<>rt>nnint r.nm/oersonal/ianislnqer miamibeachfl_gov/ _layouts/15/onedrive.aspx?ga==1 &ld==%2Fpersonal%2Fjanlsinger _mlam... 1/1 X 2/7/23, 11:39AM For Stephanie -OneDrlve iB Share CeJ Copy link 1 Download CD I<l 146 / 162 t> I Pale 11 14 n llILL OF LADING -SHORT FORM -NOT NEGOTIABLE Page 1 of l SIIIP FROM c•tAUPIC?I TRAILERS S,\Ll:.S, 1,1lC rt1011F-on~2&&116 6JOJ E AOMIO Df1 11'AH'A rL 'J'.lot!J SlllP TO ,KIIO OCEA~ CiO SUtl TERIHl~LS 4610M-GltHOSltll0 FORT IAtJnFAU/1.' F H J-))1t,i TIITRD PARlY FREIGHT CHARGES DILL TO 1.ll tlunt 11a,1Spo1t, Inc. JU Hul'\t load Numb~: 1At:.379l P.O. 80< C01 LOWt'!ll, A,Q.. /l /4~ spedol In1\ruttlons: DIii or Lading Numb•r: 1AE3794 canlor flame: ALLSTAR TMNSPORTATIOU SERVICE SCACt A1CE freight Charge Term, (tr-c9M thl1Q$1.tN rttp;aid un1e1s 1J1J1~!:d O'Jtuw1'c)1 !'repaid 0 Ccl'cct O :lrd l',rty 0 'J M3Ste< lliU or bd,r,g \\itl1 ,u,dled underl)•lrcg bii; of la<:ing, CUSTOMER ORDER IIIFORMATlOfl i ~ of Packag;:s i, \\'eiqht Pallet/Slip Additional Shipper lnfom1al1onCustomer Order tlo, i, (rndc one} 0 [4700 0 Y N SHll'IU ~15219 y ,, Grand Total 1•120')0 CARRIER lllFORMATlOtl Uandllng Unit_ l'.11: Only_ <:/'I IYI" IV H \Vl'<;ht IIM (X) Commodity Ooscrlptlon frrm:dl,H 1x1,l1l9 tftt'1tlu l,,\'.J,,;-,.ilt.;i--,a .(llflli:Jl h •.l'difl}I• HU<',hJ 1n.;JU(ilt-~\1,1rnd;1,~!Ut11rl at,.HM,tt \11\! ti.i,!()"ltt~·n ,acth c.dr.irf u.·11. ~ ~'<tl:tl O(t) ii tWC tun HJ:> Stack IIMfC No, Uass ricccs 4100 TRAILER 1Wt;,tt"t ,.~ \i.~t:4d:11tM\'J\1t, ~l\'\"'fl ."it 1rq.11oot.a r.Ut 111"!1'1!.llYln M th}lt~ :.;ttN « coo Amount:$ l.:"'.l ui t-:iu~cft"•! fJl'.l..""Ct)':i: J;loM -'fl,:,;,;,:tJtr O::<b oivl\J-,(.ftt~ fl (\-:.'.1f) h!()ffitGll/ !f.;{t,j h1 thesll\:p!f ~t-!r£(hl::t~dl\;) ~c• Fi:-c tc,01s.: ro\lf{t Ll 11,e:pc:;id U Olstoncr chc-<k a<ceptablC! U tlote: Uablllly lln11tal1011 for loJ! or damage In !his shlpmont may be appllcable, see 49 use§ 14706(c)(l)(A) and (D}. R>;t1.',l.\l, 1u:1,1t.l '1Jm:orJv1I) \)d(mlhtJ 11IH tl' <.cttlr.t;b tt1,ll,11'Rbx<t t1Jlft'1 The c-J'TICr shi!ll not rrJ(c dr.kVcf)' cf thi'i s"i1;11•1:nl y11\hJul p,1yml·a~ of t..h3rtj~,; .-md 1..1~" h ,,ifi:H)~r'obr.',1'1 .. 0irit U1~>11'n.i,,1rlt'1H1J1l.-,, i;ihlt'/,it"'fill'~ ,;.·.l<l, ,11 otc-0, 1,w1d foes,d;,.<Jft.l,o.>1;,,hl ·~·,~ U,1th~Nl1<1ll 1>,UU.J11t! ltt 11.1 ldJi,I .ln! d,;! j1M,{l.; tu t•i-~'1Wt1, en 11,:uN:,.l•d h1 H 1·\1J\1tM• \"..H, Jnj ftD-•1-4 1tjt1hlbH Shipper Signature ((:!':,...-· • J Shipper Slgnaturo/Oalo ' Troller Loaded: Fr~lght Counted: :.Jlly sh:ppc, :,{8'/!hlpr,,r(Yiv 111!.J 11 U Oy dri<t< :J Gy driwr/p,'llk•ls ~till to lv·,!~11' lh~il ';:ltierti~ t.h:.ttl'-e d::cm r,y:-dr:ttrlth J1e pw.1i1 t\lnfr..J, w:li-JoJ, tiu·\~, 011d l!t-:.W, Jr,j tt"e U By d1i'.~1/plec<, h(T':(l!I un!(tY ,(~t·mn~t,t,:-n tuW.ll\]l.,lh~ "·' lceU,• ,r;ul...:u,\<I th•1101, carrier stgn•lure/Plckup Date [in LO.,ft q.j_!,./(l/11,;) Jll/zL (A"Tiff !!ltl:t~k&,d /ff!! p-: t~~},t:7-3 fl nl re,, l"t\l t-i"k(~-( !'I'll'.' ,,.tlr~ 0/:'1'1' :)".H'( , .... ,~·op ~·fa·n,,t,;n \"l,flfl\..t., #1fi1\1!ifd'1fc, t•••:th.-\tlo{ ()Jl UIHl~-c'l'i tM1)'.flW'Q.k'.ib'.1l u t1J1n~tl. (OC:.m+tt.Jf\'.j) )l ttu W.tH.J!. I\\.\JL''tJ' d!i-ti\c,1,d;,t.J9t?U no:.~\t,qt>:dt•,-:o, (HI\:t1Hlltt.td, lnterport Logistics, LLC 12050 NW 25 Stri:ol rMc 016]811JF. f,lhunl, rL ~]18l lh•ilt>f sI11h,s Tlll :,:io,477-191O, Fux 305477-6776 DELIVERY ORDER o,i. neNJ1L1:1 INrGR-730773 fhi~i~:l Fy Nov/07/22 G Fkiup l ttt.1!111 8 View PDF controls CHAMPION TRAI\.ER SAlE "Fli.3tilJVi:)i."S't'!' Nov/07/2022 6300 E Acl~rno Drive Y--••"'-et •Pi.;an I l-:1_..J C,t-1-... -· • _._ -•-nnlnt Mm/no,cnn:,1/iAnisinaer miamibeachfl_gov/_layouts/15/onedrive.aspx?ga=1 &id=%2Fpersonal%2Fjanislnger _mlam... 1/1 X 2/7/23, 11:45AM For Stephanie -OneDrive tB Share Q:, Copy link :J: Download CD I<l 146/162 t> I P'.r.telliJ, 111~1•J ;,J111,odlLll) t,\,dcrmr-:d 111~, 1r <st11'J,h H11l ~,If;. bw-• r1;tnJ The c1nk:r shell nat n-..iYc tlcl.r~cry of lili!->h1:o'f!fll wilh:Hl r~1y1r11~111, of lhll\Jw• ,Wttlt..J"'-, 11 \o.1fl191.,,.-,kr!',tf1>'(Aft11 ~wl '111p!'',1f f(1H-.J 1l1-,cd1,11t,li--l,, I' .. If"•• d;..l.lft.f,t:••·· --,s h,.l,i. IJ,H h;,ty l~t<\ nt11J,-J,o.: t,, 11,, t;'.,s1i,t .111; 1l \' ,.,,,,vi, 1,, all othNhwful fre~. '{"''/) t"o1! l1if\!«,"l f~•Jf".1,,\'J1 fo IJ l"(i1~Jti\J ""JI" J1df,•."1•r;l 11?1h!~'1ll Shipper Signature l_).,;;V ' Shipper ~lgnaturo/Dalc fr9lghl Counted: C..uler Signature/Pickup Date~i~•;,~~~~ed: :,J'S-/ ,hipper {:i}w>ltA ~0f!.,-f.o: i;) /il/lLLI Oydrivt:t W0-/ driwrt,Mlk:t~ ~-,hi to (trit;falh• .Ce.ilk,,.,,.,!Ull;;,,,,, C4i,¼J .!{ln::,dedjti rtrtv; (,,;~\,~, ~ni ~s,,t"~l fft'{Y.1!1 tltnf..:d, PJ~lx-JW, ml h:1, ,.mJ lJtdsJ.M,i i"t-e J 8'( drirn/~◄ ec<S ~K/'I(~. (t1•~1 ll'!'tr'.nrt"f-r"l}"tlJ 'f'jJ fl\';' ~•f,1:Jtul1 'l in pq~t tinll,fY', f,;t t·,-i1p-:-1,1-:n 1un-Jn1 Ir,, lh!' v1,1,.,,...1 .. .,...»tJrfl:•djl."< (ol1l-•th,"II>! lXlJ tt11Uj<C'l'I >l'Tlldi!11r71tn,,, dtJ-~1101 tc,<~•.(,(.t 9.lt.Jlu!. u c11l1J\•rl UL1.t.Wlltb1 )1 IM -w-ditl:. f\\.V,-ftfd!stn:c-j ;,~.-.~h !U..C\\!dlt,qc,;du,!1.), t:lfl'\,"t1nrtnd, lnterport Logistics, LLC 12050 UW 2!, St1c-0l fMC 018'.38Hlr, t.ll.1.i11i, fl :l.'.\tn? llrit,'il StalM Tr.I ~-•177, 1010, fnt 305 477-0776 DELIVERY ORDER O:i\.:I fle~J11lt1 Nov/07/2022 INTGR-730773 ----------lr~·r~~:;';~77:1 .. ··---· ----------~;!~tdPJ ___ -rtiJh!IVr.r1,;n O:tt1ri;1,r, Nov/01/22 BG r\d11pli:at.1;r1 P%tt l1 l~,i,Jrne and ,\01-'t~t} CHAMPION TRAILER SALES Sun Tcrrnlnols 6300 E Adamo Drive Tampa, FL 33169. Unit,id Sl~lns 46 IO Mclnlosch Rd Hollywood, Fl 33310. Te'.zf>~~n~ 8 I 36268116 Doreen Moran r.i,,,n"' 9 54-524-8600 S-~1ry~r \ti~-:-~, ~nd ~.d1·vt1j Ci;r,rigr1◊1 it1JIT'4 ::in:t M;h::t'i) CHAMPION TRAILER SALES Sun Tuiml11ub 6300 E Adamo Drlvo Tampa, FL 33169. United Slalos 4610 Mclntosch Rd Hollywoc<l, Fl. 33310. I.IARKS MIi) IJI/Mf\FRS QTY DE~GRIPf\CJ!I VOL 1NEIGHT v~19trr I VIN# 46UFUl821 P 1266987 Diamond c; rnoc/el LPX Gemenl Gray WldU1 102" I lolghl 44'' Tolol longth 286 112" Booking //10934522 Final Desllnallon: Aruba ! rlECES VD... WE!G,llf 1NEJC-lff '1 0.00 Vlb i).00 Kg TOTAL ► l r).00 Lb I n:11•1rn111GcNm1m f.)/ /<,' /li ( 71 ansp.Hk< I 1u, 1 S'// 111cr, / IC J\GFHT ?l:'"JTF 1,1 e ,.Y{:tJ /.HE $'1]Nll'IU ,0;-~_ DOCUMENTS AND FREIGHT {!J17,~IJ1! (/( ·,~;,,<1_ ,/ -·----------~ THE GOODS IIEREIN DESCRlllED ARE ACCEPTED IN APPARENT l Y GOOD ORDER AND CONDITION RECEIVED BY (PLEASE PRINT) / ,rvo 11 u. I 1 ·) l!Y),; 11· /1/ 12 DATE TIME: 8 View PDF controls hH~~· 11"'1~"'1ha<>r-h.mv ssh,irnnoint.comloersonal/lanislnger _miamlbeachfl_gov/_layouts/15/onedrive .aspx?ga=1 &ld=%2Fpersonal%2Fjanislnger _miam... 1/1 X 2/7/23, 11:35AM For Stephanie -OneDrive le Share C7b Copy link ± Download CD I<l 119 / 162 l>I The Roots Logistics LLC Ill 1111111111111111111111111 Page5920 Nall Ave #400 0017882Mission, KS 66202 913-372-6300 (913) 224-1480 Load Confirmation 0017882 Carrier: Allslar Transportation Servi Contact: Emannuel North Port FL 342888310 Phone: (239) 841-7355 Date: 11/1612022 Fax: Order Order: 0017882 Commodity: Reels of Wire Miles: 153.0 Weight: 6000.0 Temp: Trailer: Flatbed Holshol (DAT) BOL: Reference: PU 1 Name: Graybar Date: 11/16/2022 0800 Address: 8520 Eagle Palm Dr 1111612022 1000 RIVERVIEW FL 3357B Contact shpg/rcvg Phone: (813) 739-4100 Driver Load: No driver loading or unload SO2 Name: Walmart Supercenter Dale: 11/1612022 1001 Address: 1675 NW SI. Lucie W Blvd 11/16120221430 PORT ST LUCIE FL 34986 Conlact: Phone: Dri'ler Load: No driver loading or unload Payment Carrier Freight Pay: 5383.00 Fuel Surcharge Pay 117.00 Stopoff Pay 50.00 Detention Shipper 01 100.00 Total Carrier Pay: 5650.00 Please send your POD and Invoice to bil/ing@therootslogistics.com. For quick pay, please send your invoice ro quickpay@rherootslogisrics.com Carrier Instructions and Requirements: This farm must be completed and returned before driver can be loaded. Graybar - 6 Pieces@ approximately 6,000 lbs of reels of wire, legal load, must slrap to secure 'Nalmart Supercenler -walmart slore ereclric charging vehicle station Joe 0eAngelo Atlention· 913-372-4428 t@ View PDF controls https:/ /mlamibeach-my.sharepoint.com/personal/Janising er_ miamlbeachfl_gov/ _layouts/15/onedrive.aspx?ga=1 &ld=%2Fpersonal%2Fjanislnger _miam... 1/1 2/7/23, 11:47 AM For Stephanie -OneDrive 18 Share ~ Copy link l Download CD I<l 152 / 162 I> I X P.lga 1 of l STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 2141706 2022-0001 OVERSIZE/ OVERWEIGHT TRIP PERMIT PERMIT NUMBER-2141706 -2022-0001 EFFECTIVE DATES 11/17/2022-11/27/2022 INVOICE: EMANUEL SIMS PERMIT FEE: $5.00 PERMITTEE: ALLSTAR TRANSPORTATION SERVICES LLC TRANS. FEE: $5.00 4946AlWATER DR TOTAL FEE: $10.00 NORTH PORT, FL 34288 8310 FAX: -- FROM: POMPANO BEACH TO: KENNEDY ROUTE: See other side for route details_ VEHICLE CONFIGURATION HEIGHT: 13 FT 6 IN LENGTH: 80 FT 0 Ill WIDTH: 12 FT 0 IN GVW: LEGAL LOAD ID: H673338 CONFIGURATION: TRUCK TRACTOR SEMITRAILER HAULING: CONSTRUCTIOll MATERIALS PERMIT RESTRICTIONS/ MOVEMENT CONDITIONS TRAVCL $CUTI I or flORIDA Cffi'; VCtlJCLCS UP TO 10 rT\'1JDC TRAVi:l. IS PCRI/.ITTCO 11211oun ocron.c sorm1sc TO 1r2' I IOUR /inCR SUUSCT, 1\LL Of,,YS. VCIIICLCS. GRCATCR. TlfJ\tJ 10 rT 'NIDC TMVCL l!j PCR\IITTLO rnou 9PM SAM MO!lDJ\Y· fRID/\YOH!..\' ID(CLUOltlG llOUO/,YSI. VCIIICLCS O'JLR. 10 fCCT WIDC AHO U? TO 14 rrtT\11lDC RCOVIA.C 1 OUJ\l lriCO ($CORT. VCtllCl[$ oven t~ rcCT \"lDC R[OUIAC l L/tW tHronccu;::rrr rscorn. TR,\VCL HOR.Ti! or noruoA Cl1\', TR.,\Vi:l l:i PCRJ.IJTTCO fROM Vi IIOUR nrront SUHR!5C TO h IIOUR Anrn SUU:1CT. N.l OA't'S. IIOUDA\' TRN/Ct. 5!tALL oc lr1 N.:ccrtol...~1cc \'1\TII fAC 1! 20. MOVLMClff 15 HUT /d.LO'NCO ron VLl!iO... CS OVCR 12' WiDC OA; n5· LO~m, rnoM 7AlJ, 8At., b. ~F\I (t'U WCCKO,\i'S, O~lAfI'( STATC M/\UJTAlrltD ilO.'\DW,W {INCLUDL'tG ltlTCrtST/\TCS]IHTOC rou.ownw cowmcs. OADC. OROWARfJ. P1\L\l ilCACII, g~~i.\i~x~ri,1~\~~g~~?~~~'~!.~~t\:~[\~Eo'b?~~t'~il\~~)Jf tc1lJ}:~1iEf. ~i*~~~\ffl1~~~~~h0sg1k~1~b"if&~:zJfc~Ol l OVa'ltJG cmrs 2 WAIVlHlG UGI rrs Wfh~;f:Jci0&b;lf.!ifi~?i~\itdf,'i~ii'11~ff8~['[W(r{lf&f~~}Pftiv, 01\cKGRoUHD 1,nr ntouinco o~, n,r rnortr s. ncM\ or rue vr111cLr. REMARKS: MOVE!.IEIITSIIALL DE IN CO!.IF1.1Al!CEWffil fL011101\ STATU1ES 316.00. 310.1701\ND CII/\PTER 106. fLORIDl\/ulMIUJSTRATIVE CODE. PC!lMITVALID ON STATE lllGIIV/1\Y ffi'ST(UONLY. TIIIS Pt:n,nT IS VALID roR 0/lt,TRIP OIILY. tlO l,IOYCMCllT IS PmMITIE0\'11101 VISIDlllTY IS LESS TlWI OllE ~J%~.tlti~~6Ji:1'.'¥,riPWn..?#Jl/:1if~~~&m:Lt}~~r{),~1'W6;+~~fu'.K.Pc'i~~?cf~~~f~~1~ill'rW~II'M'~MorJ= LOADS PRIOR TO Aff'{ fl,O\JD.1£1/T NlD IS RESPotlSIDLE roR ODT,IJIIJ!IG AlJTIIORITY fOR TMVC\. Oil LOCAL ROADWAYS mo DRIOOES. THC PCRI.IITTCC IS RESPO!ISIOLC AflD LIADLC ran ALL OVER D\UEIISlotlAL CltA!WICES. ACCIDDITS. Ot-J.IAGES. NID,'OR lllJURIES. RESTRlCTCD TIIG OR 00,000 lD REGISTERCD GW/ IS REOUIRED roo OVC!lWCKll IT LOADS. PCMIITTCO VEIIICU:S CNIHOT OYPASS NN OPCII WElGII ST/ITlOll. '" TlllS PERMIT MAY OCVOIOEO AT NIYTill.t If NlYOf TlltTER'-1S OR CONDITIONS l~\VE DEEN l\tTEREO OR\'lOLATEO ••• IITTPS:JNNNl.rDOT.GOWMNl/TCIWICCIOWOOPCRMITS.SIITTf ISSUED BY: PAS DATE: 11/16/2022 TIME: 4:43 FM Pog:,2of3STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 2141708-20220001 OVERSIZE/ OVERWEIGHT TRIP PERMIT PERMIT NUMBER· 2141706 -2022-0001 EFFECTIVE DATES 11/17l2022-11/27/2022 VEHICLE ROUTING FROM: POMPANO BEACH TO:KENNEDY ROUTE: START AT mo SW 13TH CT. POMPANO BEACH, FLORIDA, 3306Q, GOEASTON! Q. TURNRtGHTC ~ View PDF controls BEARRIGHTC.n,,.,~1 1v111v1 \\._u,~unL.tn._,,,, TURN RIGHT ON S POWERLINE RD fSR-8461. '-"·-__ ,,_,__,,..._M,... ~" ~h~•0 nninf MmlnArsnm11/ianlsinaer miamibeachfl_gov/_layouts/15/onedrive.aspx?ga=1 &id=%2Fpersonal%2Fjanislnger_miam... 1/1 2/7/23, 11:48AM For Stephanie -OneDrive ~ Share Qi Copy link ± Download CD 152 / 162 I> I X Pagi,2or3STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 214170<,:10220001 OVERSIZE/ OVERWEIGHT TRIP PERMIT PERMIT NUMBER-2141706 -2022-0001 EFFECTIVE DATES 11/17/2022-11/27/2022 VEHICLE ROUTING FROM: POMPANO BEACH TO:KENNEDY ROUTE: START AT 1790 SW 13TH CT. POMPANO BEACH. FLORIDA, 3306~. GO EAST ON SW 13TH CT TOWARD SW 12TH AVE. TURN RIGHT ON SW 12TH AVE (S /.J,JDREW3 AVE), BEAR RIGHT ON SW 15TH ST \W MCNAB RD). TURN RIGHT ON S POWER LINE RO (SR-!J45), AT FORK KEEP RIGHT ON S POWERLINE RD (SR-845). TURN LEFT OU\\' ATLANTIC BLVD (SR·B14), TURN RIGHT ON ATLANTIC BLVD EXT (NW 31ST AVE), TAKE RA!,1P TO FLORIDA'S TFKE (RONALD REAGAN TFKE}. AT FORK KEEP RIGHT, TAKE RAMP ON THE RIGHT TO OKEECHOBEE RD (SR-70), TURN RIGHT ON OKEECHOBEE RD (SR•70). TAKE RAMP ON THE RIGHT TO 1-Q5, AT FORK KEEP LEFT. TAKE RAMP Oil THE RIGHT TO SR,524, TURN RIGHT ON SR-524. TURN LEFT ONE INDUSTRY RD, TAKE RAMF ON THE RIGHT AND GO ON SR-528 (SEE LINE EXFY), TAKE RAMP ON THE RIGHT TO 49, ARR~/E ATWAYFOINT, ON THE RIGHT, DEPART WAYPOINT. CONTINUE EAST ON 49, TURN LEFT Oil N COURTENAY FKWi (SR-3), CONTINUE ON KEl-lNEOY PKWY S, TU ml LEFT 011 SPACE COMMERCE WAY, TURN RIGHT ON NASA FKW{ W, ARR11/E ATWAYPOINT. ON THE RIGHT, DEPART WAYPOIIIT, CONTINUE EAST ON NASA PKWY W, MAKE U•TURN AND GO eACK OU IIASA PKWf W. ARRIVE AT WAYFOINT, ON THE LEFT, DEPART WAYPOIIIT, CONTINUE WEST ON NASA P'r.Wf W, MAKE U•TURll AT SPACE COMMERCE \VAY AND GO EACK ON UASA F'IJJW W, TURN RIGHT, ARRIVE AT WAYPOINT, ON THE RIGHT, OEPARTWAYPOINT, CONW,UE SOUTH, FINISH AT KENNEDY, ON THE RIGHT MOVCMElff SIIAU. DE 111 COMPi.WICEWiTII flOHIOA STATIITCS 316.0i!, 316.170AflD CIIAPTCR 11-26, 11.0RJOAADMINISTRATIVC COOL PCflMIT VALID Oil STATC lllGlfVIAY sYSTCM OIILY. TIIIS PERMIT IS VALID roR OIIC TRIP OHtY. llO IJOVCMENT IS Pcru.nnr:o Wl!Ol VlSIOILITY IS LCSS TIWI OIIE rJrJ.fA~i~fib~~i:1:.'~\lPWru.?JWl:l\f'rl!:~~nmtt~~~tr~J\?i1~~{ ~WcWuill/bi=cmi~~~i'~WYMgl5'?h.t"li°JtMh,J-OCA!.LOADS PHIOR TO Alf'( IAO\IO!Cllf MIO IS RCSPONS!OU: roR OOTNHll{G AUTHORITY roR TRAVEL OIi LOCAi. ROADWAYS MID ll!UQG[S. TIIE PERIMTTTC IS RESPOl!SIOLC AflD UAllLC FOO ALL OVEROU.l(IISIOl!Al CLENWICES, ACC!O[lfTS, D>J.IAGCS, AIID.'OR lflJURIES. RESTRICTED TAG OR 00,000 L!l RCG!STCRrD GV.V IS ntOUIRrD roR OVERWCIGIIT LOADS. PCfll.llTICO \ICIIICLES CAlr.mT DYPASS Alf'( OPCII V/ElGll STATION. ... nus P£RMIT M,\Y DC VOIDED AT MIY TIII.E tr AIIY OF TIIE TERAIS OR COllDITIOIIS IV.VE DEEN I\LTCRCD OR VIOLATCD ... lffTPSJNNNr.f00T.G0V,'MAf?ITTtV\NCCtOWOOPCRM!TS.Stlnl ISSUED BY: PAS DATE: 11/16!2022 TIME: 4: ◄ 3 PM STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION OVERSIZE/ OVERWEIGHT TRIP PERMIT P.i~3or3 2141706-2022-0001 PERMIT NUMBER· 2141706 -2022-0001 ROUTE MAP EFFECTIVE DATES 11/17/2022-11127/2022 [El View PDF controls ""~~· 11~ 1-mlhnMh mH ~h~eonnlnl rnmlnAr<:nn:,l/i:,nl<1innAr mlamibeachfl aov/ lavouts/15/onedrive.aspx?ga=1&id=%2Fpersonal%2Fjanislnger_mlam .. ' 1/1 X 2/7/23, 11:48AM For Stephanie -OneDrive 18 Share Ce:i Copy link ± Download CD l<l 152 / 162 I> I MOVEMOff SIIALl DC Ill COMPlWICC VIITII fLORIDASTATIJTCS316.00, 316.170,INDCIIAPTCR 14 26. f\.Ol!ID/\ADMIIUSTllATIVE CODE. PrnMITVAUD ON STATC IHGIIVIAY sYST[M ONLY. TlllS PCAAIIT IS VALID fOR ONE TRIP OHLY. llO MOVWENT IS PCAAIITTCD l'lllOl VISIDILITY IS LCSS TIWI ONE ~J~~f;.lf's¼cgili'rif~·c1l.1j1riP/!lfofr\!Jl/A{iii~1nlbs&Wf/fv~J1fli~~ ~5i?ifilf1.:'b~~R:f~~~~Cli\'i¼'IBi-~Ef~iI'At"ii°JJM~rJ-0 C/\l. LOADS PRIOR TO /\10' MOVO.lEIIT ANO IS l!ESPONSIDLC roR ODTNIIUIG N.ITIIORITY roR TMVCL Oil LOCAL ROADWAYS AND DRIOGCS. T!I[ P[RI/.ITT[CIS RCSPOIISIDLEAllD LIADLC roR /\Ll OVER·DIMEIISIOIIAL CLCARAIICCS, ACC!O(IITS, OMIAGES, AIID/OR IIIJURICS. RCSTlllCTCD TAG OR 00,000 LB REGISTERCD GV.V IS RCOUIRW ron OVCRWCIGIITLOADS. PCAAIITTCD VEIIICLCS C/\lUIOT DYPASS AIN OPCN V/[IGII STATION. ... TIIIS PCll~IIT itAY DC VOIDED AT AllY TIM[ Ir AllY or TIIE TCAAIS OR CONDITIO!IS IV.VE DCCU AlTERCD OR VIOLATCD "' IITTPScJN,\Wl.fDOT.GOV,M"11Clt:11MlCS'O','/OOPCRJllTS.SIITM ISSUED BY: PAS DATE: 11/16/2022 TIME: 4:43 PM Pogo 3 of 3 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 21417062(122-0C<ll OVERSIZE/ OVERWEIGHT TRIP PERMIT PERMIT NUMBER -2141706 -2022-0001 EFFECTIVE DATES 11/17/2022-11/27/2022 ROUTE MAP / MOVEMENT SHALL OE IH CO!.IPLIAIICC v,rn1 rLORJO/\ ST/\nJTES 31H8, 316.170 AND CHAPTER 14 26. rLO!UOAAOMIUISTMTM: CODE. PERMIT VALID Oil STATC lllGJIWAY SYSTEM DtlLY. llllS PCAAIIT IS VALID fOR OllE TRIP OillV. IJO MOVEMCNTIS PCll\llnt:DWllrn VISIOILITYIS LESS TIIAH Oil[TIIOUS/\llD (1000) rC£T. TIIC ROUTE Oil me fACC Of TIIIS PCll\llT IIAS ltOT DECH RC'lltWCD llOR VALIDATED roo IIEIGIIT, LCUGTI I, \"1DTI I, tlOR LOCAL ROAf/.VAVS AND DRIOGES. TUC PClllJITTEC IS RESPOllSIOLE ron VERlrYlllG TIIAT ADEQUATE CLE.l.!WICE CXJSTS Oil ROUTC roR All ovrnstzco LOADS PRIOR TONN 11.0'IEMEIIT /\llD IS RESPOllS!DLE roR OBTAJll!IIG N.ITIIORITY roR TRAVCL OU LOCAL ROADWAYS AllO ORIOGES. TIIE PCRI/.ITT[CWci'f:m1s:~~.¢\1f~~~11.rn1~oirrr£~f#r8tm.ilt~:i\~EllWi\0t't~i!Xi1~t¥t~~xts'~~i~~cW~~\IT'il~Jl1i%1f0 TAGOROO,OOOLO ... THIS PEAAIIT MAY OE VOIDCO AT AIIY TIME Ir AIO' or TIIC TERMS OR COllDITIOIIS l!AVE 0£0l /\llERtD OR VIOLATCO ... IITTPS.IN,WW.rDOT.GOV,tWllTCllANCS'O'.VOOPCRMITS.SIIThl .... ISSUED BY: PAS __ ·-----··--·-------· DATE:_11/1612022 ______________ TIME: 4:43PM G:@ View PDF controls hu~~· 11 m 1nmlhMr-h.m" <>h01rAnnint r.nminArsonal/lanlsinaer miamibeachn_gov/_layouts/15/onedrive.aspx?ga=1 &ld=%2Fpersonal%2Fjanisinger _mlam... 1/1 Rate & Load Confirmation Carrier Pay: Line Haul: $500.00, TOTAL: $500.00 USO Accepted By: Emanuel Sims Date: November 15, 2022 Signature:-~----~~~-·--- Driver Name: Emanuel Sims Cell #: 239-841-7355 Truck #: 1 Trailer#: 1~------''------ Carrier ALLSTAR TRANSPORTATION SERVICES LLC Shipper 1 Aggreko Miami 3601 NW 123rd St Miami, FL, 33167 Consignee 1 1 Tropicana Field Saint Petersburg, FL, 33705 Dispatch Notes: QUICK PAY 5% charge available. [l Dispatcher: Rolando D LOAD# 30166 Phone#: 800-209-1143 Ship Date: 2022-11-15 Fax#: Today's Date: 2022-11-15 Email: W/O: invoices@perpetual.llc Phone# Fax# Equipment Agreed Amount Load Status 239-84i -7355 Hot Shot $500.00 USO Open Date: Type: Quantity: Weight: 2022-11-15 lbs Purchase Order#: Major Intersection: Shipping Hours: Appointment: Description: No See bol Date: Type: Quantity: Weight: 2022-11-15 lbs Purchase Order#: Major Intersection: Receiving Hours: Appointment: Description: No See bol EXHIBITG 2/7/23, 9:40 AM For Stephanie -OneDrive l8 Share C7b Copy link ,~ Download CD I<1 24 / 101 t> I X htlps://miamibeach-my.sharepoint.com/personal/janisinAer miamibeachfl 1/2AOVI layouts/15/oned rive.aspx?ga= 1 &id=%2Fpersonal%2Fjanisinger _miam... X 2/7/23, 9:40 AM For Stephanie -OneDrive lf::i> Share Ce.l Copy link ± Download CD 1<1 25/101 t>I EXHIBITH _____ ___ 217/23, 11 :30 AM For Stephanie -OneDrive 1B Share Ce:i Copy link .J., Download CD I<I 52 / 101 f>I X PROGREIIIVE' COJ/.l/ERC/ltl Policy number: ?rc:,g:;;:i,e ':.,p-e:s r.; C-:rq:,s"i1 11~C l·hrntfr l0'.9E /.,,,,,,: ;.::, :o:: =-a;~ I :if : Certificate of Insurance C<rtrtlGltt _lb_klet E.\.pr~J: Logi.::c:: LLC 5.!0 S; !'f'f Ln \\iirtf°EJ:-:tr, '/~ 216)2 tuuu:d ~.!'1~;fr;r:.;p:,rtati:Jfl ~;rli:~: LL( 4?46 .~:\\•~.TEP OP. PO SO, 11227 NOF:TY PCRT, :.__ 3LJ08 c~..•.:0_t.t..100Gl. n: 374·)2 1r:i co:1...rnentcertr-a:; thct :ru1..1rarxt: po1ici-:; 1d~r:rf):d b'1!0N na,te be~., 1;:,,~Qd c:i,, :<J: df:;1gnat;d ir:.;urar ~0th~ ir1ursd rarrfc' abo:~ fer th; ~ericc(i) ind~~amd Th,:.; C!:!r.if11:at'l GG;u;d fer 1r'lforr.iati0e., purpcs;.; only. !t confer; r.o rigbt :.;pen tr~ c,r.:,f,:a:;; c,cld;r ;;nc dee, nctcran;e. alt,r. rnocif/. o-e..:mnd th; cc,;"rag,; affcrds!d by :'-G po\;cl:; liimc bslo.•,. n~ cCNQra;eJ affcfCi;d br th; pcH:ie'.i hs:ed l:410,\1 cm rnbf-ct to 1:l t:"ca IHffG. g,:du;rcm. !irnitaticru ;rdor.i4rr..;nb 2~0 conriiticm o~ t'"~:;e pcki;; Ucbiky ca,'Qrii£P-m:;,/ ra: app:') to al ~chaciuled \·~r~:·es. Pole,. E,.pi•aton ),t. ,.~ 3. 2023 •u~~~c~ ~o~-e;,ag.~(s} lllll!S 8:•:f'-t 1n,ur1,'Prop;rt1 [E;ra g: ~ 1.000 ooei·c.:-mc'ir~,; S·f,;~ L1rr1~ P;;r;c:r~i.i'1i,lf>; t1r0:;cti:n 5rn .06.J ,i,,i!O :>id:· ~~;:y~.j·1·~1Ji·c Cir.•1 Motor Truck Cargo coverage part D1mription of LocationNQhicles/SpQcial ltGms Scl1edul~_d autos only 2:121 P,t.M 2500 7 172.000 (')l'fipr~i'"tr~f1·i i2.500 Cfo C·ili:bn i2.500 C,o 2122 7rail ':"r;;~1,' Cornpr;ri::r~~:~ l 2.500 C,,1 Co·ti;iJr1 E500 C,a Please be advised that the certificate holder will not be notified in the event of a mid-term cancellation. 1/1" -_L --• _.__ ,_, ,_Mnnnnl//nn1~1nno, mbmlhA<irhfl ~ View PDF controls nnv/ IRVnllls/15/onedrive.asox?cia=1 &id=%2Fpersonal%2Fjanisinger_miam.'. --·-· r.: X 2/7 /23, 11 :33 AM For Stephanie -OneDrive lB Share Ccb Copy link J, Download CD I<l 88 / 101 t> I ·' '-· ·•-1• 1-~-,-1,;,,a <>c,w?n,.=1R.irl=%2Foersonal%2Fianisinger_miam... 1/2 X 217/23, 9:46 AM For Stephanie -OneDrive L6> Share CeJ Copy link i Download CD l<l 100 / 162 l>I 2023 UCR Registration is VALID! Confirmation# 000-0;l45'-30&1 Registered 011: 10/131~0;211:llEST Generated: 101131202211:11 EST Yeal.'; 2023 Date Bracket UCRFee Conv.Fee Tollll 1011312022 Tier 1 [1 veh,J S41.00 S1.22 ~42;22 Br~cket: 0 to 2 vehicles (1 vehlcle(s)] USDOTff: 374~861 dlllSSific~tions: Matq~ QaiJier Legal Name: ALI;STAR 'IRANSPORTATION SERVICESLLC Base State: US_GA 4946 ATI•,,TATER DR Prlndpal: !xORTH PORT, FL 34288 us Payor: ALLSTAR TRANSPORTATION.SERVICES LLC *** Expires: 12l31:/2023 *** ~ View PDF controls hltos://mlamlbeach-mv.sharenolnt.com/oersonal/lanlslnnP.r ml,m1lhRAnhfl nnv/ IAVnlll~l1!l/nnArlrlvn AQnV?n":=1R.lrl:0/,.?J:noronnalO/.')l:lanlalnnor ,nla,n ~ M X 2/7/23, 11:34 AM For Stephanie -OneDrive 1B Share C"eJ Copy link ± Download (i) I<! 100 / 162 l>I 2023 UCR Registi·ation is VALID! Confhmation # 000-03.15-3061 Registered on: 10l1.3l2022 ll:11 EST Generated: 1011312022 11:11 EST Year: 2023 Date Bracket UCR Fee Conv. Fee TotalPaid: 1011312022 Tier 1 [1 veh.] S41.00 S1.22 S42.22 Bracl<et: 0 co 2 vehicles [1 vehicle(s)] USDOT #: 3742861 Olassifications: Motor Carner Legal Name: ALLSTAR TRANSPORTATION SERVICES LLC Base State: US_GA 4946 ATWATER DR Pl'lncipal: !\ORTH PORT, FL 34288 us Payol': ALLSTAR TRANSPORTATION SERVICES LLC *** Expires: 12!3112023 ,:.,,.*' ~ View PDF controls hllps://mlamlbeach-my,sha repolnt.com/personal/lanlslnQer mlamlbeachO aov/ lavouts/16/onedrive.asox?aa=1 &ld=%2Foersona l%2Flanlslnaar rnlam... 1/1 -------------- ---- Form MCSA-~875 0MB No.: 2126-0006 Expiration Date: 03/31/2025 - Public Burden Statement AFederal agency may not conduct or sponsor, and aperson Is not required to respond to, nor shall aperson be subject to a penalty for failure to comply with a collection of Information subject to the requirements of the Paperwork Reduction Act unless that collection of lnformallon displays acurrent valid 0MB Control Number.The 0MB Control Number for this Information collection Is 2126--0006, Public reporting for this collection of Information Is estimated to be approximately 25 minutes per response, Including the time for reviewing Instructions, gathering the data needed, and completing and reviewing the collection of Information. Allm responses to this collection ofinformatlon are mandatory. Send comments regarding this burden estimate or any other aspect of this collection ofinformatlon, Including suggestions for reducing this burden to: ~ ._In_fo_rm_a_t1_on_c_o_H_•c_t1_on_c_Ie_a_ra_nc_e_o_ffi_c_e,_,F_•d_e_ra_lM_ot_or_c_a_rrl_e_rs_af_e_tY_A_dm_ln_lst_ra_t1_on_,_M_C-_R_RA_,_12_o_o_N_e1_•iJ_e_rs,..;ey_A_v_en_u_e,_s_E,_W_as_h_ln_gt_o_n,_D_.c_.2_0_s9_o_.--------------------! U.S. Department ofTransportation Medical Examination Report FormFederal Motor Carrier Safety Administration (for Commercial Driver Medical Certification) MEDICAL RECORD # (or sticker) SECTION 1. Driver Information (to be filled out by the driver) Last Name: Sims First Name: _E_1_n_a_m_1e_l______ Middle Initial: _2_ Date of Birth: _______ Age:~ Street Address: 4946 Atwater Drive City: North Port State/Province: FL Zip Code: 34288 Driver's License Number: ________________ Issuing State/Province: Florida Phone: (239) 841-7355 E-Mail (optional): contact@allstar-trans.com CLP/COL Applicant/Holder*: @ Yes Q No Driver ID Verified By**: _________________ Has your USDOT/FMCSA medical certificate ever been denied or issued for less than 2 years? 0 Yes 0 No O Not Sure 'CLP/COL Applicant/Holder: See lnslructlons for definitions. "Driver ID Verified By: Record what type of photo ID was used to verify the identity oflhe driver, e.g., COL, driver's license, passport. Have you ever had surgery? lf"yes;'please list and explain below, l had surge1y on my years old. Are you currently taking medications (prescription, over-the-counter, herbal remedies, diet supplements)? If "yes;' please describe below. 0 Yes O No O Not Sure 0 Yes 0 No O Not Sure (Attach additional sheets ifnecessary) '*This document contains sensitive information and is for official use only. Improper handling of this information could negatively affect individuals. Handle and secure this information appropriately to prevent inadvertent disclosure by keeping the documents under the control of authorized persons. Properly dispose of this document when no longer required to be maintained by regulatory requirements.•• Page 1 ------------- Form MCSA-~875 0MB No.: 2126-0006 Expiration Date: 03/31/2025 Not Do you have or have you ever had: Yes No s...-! 1. Head/brain Injuries or illnesses (e.g., concussion) 2. Seizures/epilepsy 3. Eye problems (except glasses or contacts) 4. Ear and/or hearing problems 5. Heart disease, heart attack, bypass, or other heart problems 6. Pacemaker, stents, implantable devices, or other heart procedures 7. High blood pressure 8. High cholesterol 9. Chronic (long-term) cough, shortness of breath, or other breathing problems 10. Lung disease (e.g., asthma) 11. Kidney problems, kidney stones, or pain/problems with urination 12. Stomach, liver, or digestive problems 13. Diabetes or blood sugar problems Insulin used 14. Anxiety, depression, nervousness, other mental health problems 15. Fainting or passing out Not Yes No Sure 16. Dizziness, headaches, numbness, tingling, or memory 1 1 loss 17. Unexplained weight loss 18. Stroke, mini-stroke (TIA), paralysis, or weakness 19. Missing or limited use of arm, hand, finger, leg, foot, toe 20. Neck or back problems 21. Bone, muscle, joint, or nerve problems 22. Blood clots or bleeding problems 23. Cancer 24. Chronic (long-term) infection or other chronic diseases 25. Sleep disorders, pauses in breathing while asleep, daytime sleepiness, loud snoring 26. Have you ever had a sleep test (e.g., sleep apnea)7 27. Have you ever spent a night in the hospital? 28. Have you ever had a broken bone7 29. Have you ever used or do you now use tobacco? 30. Do you currently drink alcohol? 31. Have you used an illegal substance within the past two years? 32. Have you ever failed a drug test or been dependent on an illegal substance? Other health condition(s) not described above: Did you answer "yes" to any of questions 1-32? If so, please comment further on those health conditions below: (Attach additional sheets ifnecessary) I certify that the above information is accurate and complete. I understand that inaccurate, false or missing information may invalidate the examination and my Medical Examiner's Certificate, that submission of fraudulent or intentionally false information is a violation of 49 CFR 390.35, and that submission of fraudulent or intentionally f~se inform,tion ~ay subject me to civil or criminal penalties under 49 CFR 390.37 and 49 CFR 386 Appendices A and B. Driver's Signature: ~~ Date: 10/27/2022 SECTION 2, Examination Report (to be filled out by the medical examiner) Review and discuss pertinent driver answers and any available medical records. Comment on the driver's responses to the "health history" questions that may affect the driver's safe operation ofa commercial motorvehicle (CMV). (Attach additional sheets ifnecessary) Page 2 ---- Form MCSA-5,875 0MB No.: 2126-0006 Expiration Date: 03/31/2025 Blood Pressure Systolic Diastolic Urinalysis Sp.Gr. Protein Blood Sugar The presence of a certain condition may not necessarily disqualify a driver, particularly if the condition is controlled adequately, is not likely to worsen, or is readily amenable to treatment. Even if a condition does not disqualify a driver, the Medical Examiner may consider deferring the driver temporarily. Also, the driver should be advised to take the necessary steps to correct the condition as soon as possible, particularly if neglecting the condition could result in a more serious illness that might affect driving. Check the body systems for abnormalities. Received documentation from ophthalmologist or optometrist? 0 0 Pulse Rate: Pulse rhythm regular: 0 Yes O No Height:_ feet _inches Weight: __pounds Sitting Second reading (optional) Urinalysis is required. Numerical readings must be recorded. Other testing if indicated Protein, blood, or sugar in the urine may be an indication for further testing to rule out any underlying medical problem. Vision Hearing Standard is at least 20/40 acuity (Snellen) in each eye with or without correction. Standard: Must first perceive whispered voice at not less than 5feet OR average At least 70°field ofvision in horizontal meridian measured in each eye. The use of hearing loss ofless than or equal to 40 dB, in better ear (with or without hearing aid). corrective lenses should be noted on the Medical Examiner's Certificate. Acuity Uncorrected Corrected Horizontal Field ofVision Check if hearing aid used for test: D Right Ear D Left Ear D Neither Whisper Test Results Right Ear Left EarRight Eye: 20/__ 20/__ Right Eye: __ degrees Record distance (in feet) from driver at which a forced Left Eye: 20/__ 20/__ Left Eye: __ degrees whispered voice can first be heard Both Eyes: 20/__ 20/__ ORYes No Audiometric Test ResultsApplicant can recognize and distinguish among traffic control O 0 signals and devices showing red, green, and amber colors Right Ear; Left Ear: Monocular vision O 0 500 Hz 1000 Hz 2000 Hz 500 Hz 1000 Hz 2000 Hz Referred to ophthalmologist or optometrist? 0 0 Body System Normal Abnormal Body System Normal Abnormal 1. General 0 0 8.Abdomen 0 0 2. Skin 0 0 9. Genito-urinary system including hernias 0 0 3. Eyes 0 0 10. Back/spine 0 0 4. Ears 0 0 11. Extremities/joints 0 0 5. Mouth/throat 0 0 12. Neurological system including reflexes 0 0 6. Cardiovascular 0 0 13. Gait 0 0 7. Lungs/chest 0 0 14. Vascular system 0 0 Discuss any abnormal answers in detail in the space below and indicate whether it would affect the driver's ability to operate a CMV. Enter applicable item number before each comment. (Attach additional sheets ifnecessary) Page 3 -------------------- Form MCSA-5875 0MB No.: 2126-0006 Expiration Date: 03/31/2025 Last Name: _S_i1_n_s__________ First Name: Emanuel Exam Date:--------DOB: ---------------- Please complete only one of the following (Federal or State) Medical Examiner Determination sections: Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49): 0 Does not meet standards (specify reason): 0 Meets standards in 49 CFR 391.41; qualifies for 2-year certificate 0 Meets standards, but periodic monitoring required (specify reason): Driver qualified for: 0 3 months O 6 months O 1 year O other (specify): __________ D Wearing corrective lenses D Wearing hearing aid D Accompanied by a waiver/exemption (specify type): D Accompanied by a Skill Performance Evaluation (SPE) Certificate D Qualified by operation of 49 CFR 391.64 (Federal) D Driving within an exempt intracity zone (see 49 CFR 391.62) (Federal) 0 Determination pending (specify reason): ------------------------------------- □ Return to medical exam office for follow-up on (must be 45 days or less): __________ D Medical Examination Report amended (specify reason): _______________________________ (ifamended) Medical Examiner's Signature: ____________ Date: __________ 0 Incomplete examination (specify reason): ------------------------------------ 1 If the driver meets the standards outlined in 49 CFR 391.41, then complete a Medical Examiner's Certificate as stated in 49 CFR 391.43(hl, as appropriate, I have performed this evaluation for certification. I have personally reviewed all available records and recorded information pertaining to this evaluation, and attest that, to the best of my knowledge, I believe it to be true and correct. Medical Examiner's Signature: Medical Examiner's Name (please print or type): ______________________ Medical Examiner's Address: ________________ City: ________ State: ---"E]=v=· Zip Code: ____ Medical Examiner's Telephone Number: _____________ Date Certificate Signed: _______________ Medical Examiner's State License, Certificate, or Registration Number: ___________________ Issuing State: _ __.,,El=...,-=· D MD D DO D Physician Assistant D Chiropractor D Advanced Practice Nurse D Other Practitioner (specify): National Registry Number: _____________ Medical Examiner's Certificate Expiration Date: ,..________, Page4 Form MCSA-5875 0MB No.: 2126-0006 Expiration Date: 03/31/2025 Use this section for examinations performed in accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) with any applicable State variances (which will only be valid for Intrastate operations): 0 Does not meet standards in 49 CFR 391.41 with any applicable State variances (specify reason): ___________________ 0 Meets standards in 49 CFR 391.41 with any applicable State variances 0 Meets standards, but periodic monitoring required (specify reason): _____________________________ Driver qualified for: 0 3 months O 6 months O 1 year O other (specify): ___________ D Wearing corrective lenses D Wearing hearing aid D Accompanied by a waiver/exemption (specify type): ___________ D Accompanied by a Skill Performance Evaluation (SPE) Certificate O Grandfathered from State requirements (State) If the driver meets the standards outlined in 49 CFR 391.41, with applicable State variances, then complete a Medical Examiner's Certificate, as appropriate. I have performed this evaluation for certification. I have personally reviewed all available records and recorded information pertaining to this evaluation, and attest that, to the best of my knowledge, I believe it to be true and correct. Medical Examiner's Signature: Medical Examiner's Name (please print or type): Medical Examiner's Address: City:---------State:-~~=-~= Zip Code: _____ Medical Examiner's Telephone Number: ______________ Date Certificate Signed: ________________ Medical Examiner's State License, Certificate, or Registration Number: ____________________ Issuing State: --~E]="'.=' D MD D DO D Physician Assistant D Chiropractor O Advanced Practice Nurse D Other Practitioner (specify): National Registry Number: ______________ Medical Examiner's Certificate Expiration Date: ,________.., Page 5 MORTGAGE LOAN STATEMENT Ifthe COVID-19 Pandemic has impacted your abilityto make your mortgage payment, visit our COVID-19 Resource Center at mrcooper.corn/forbearance. There's a fast and easy online application ifyou decide this prog1·run is right for you. Want to make payments even easier? Pay on line at www.mrcooper.com, onthe go with the Mr. Cooper app, or by setting up AutoPay. No matter how you pay, we'll never charge a trru1s action fee. Please note the overnight payment address has changed. Please see the hack ofthe statementfor the updated address. Be the first to receive discount alerts, offers and new products hy signing ttp for Mr. Cooper's text alerts. Simply, text JOIN to COOPER (266737) TRANSACTION ACTIVITY (08/10/2022 to 09/13/2022) (Seepage2formoretrnnsactions) DATE DESCRIPTION TOTAL PRINCIPAL INTEREST ESCROW OTHER 09/12/2022 BORR PAID Ml DISBURSED $106.96 $106.96 09/10/2022 NSF Charges Payment $25.00 $25.00 09/10/2022 Payment 1,341.70 363.95 $597.83 379.92 08/12/2022 Payment 11,341.70 1362.93 $598.85 1379.92 Mr, Cooper is a brand name for Nationstar Mortgage LLC. Nationstar Mortgage LLC is doing business as Nationstar Mortgage LLC d/b/a Mr. Cooper. Mr. Cooper is a registered service mark of Nationstar Mortgage l.LC. All rights reserved. If you are a successor in interest (received the property from a relative through death, devise, or divorce, and you are not a borrov1er on the loan) that has not assumed, or otherwise become obligated on the debt, this communication is for informational purposes only and is not an attempt to collect a debt from you personally. mr. CHAIIGING THE FACE OF HOME LOAllS EMANUEL O SIMS 4946 ATWATER DR NORTH PORT, FL 34288 PRINCIPAL $364.98 ESCROW TAXES l, INSURANCE $493.18 EXPLANATION OF AMOUNT DUE REGULAR MONTHLY PAYMENT TOTAL FEES & CHARGES OVERDUE PAYMENT(S) PARTIAL PAYMENT (UNAPPLIED) TOTAL AMOUNT DUE TRIAL/WORl<OUT PAYMENT AMOUNT HERE'S SOME HELPFUL INFORMATION RETURN SERVICE ONLY PLEASE DO MOT SEND MAIL TO THIS ADDRESS PO Box 818060 5801 Postal Road Cleveland, OH 44181 INTEREST $596.80 $1,454.96 $0.00 $0.00 $0.00 $1,454.96$0,00 STATEMENT DATE 09/13/2022 LOAN NUMBER PROPERTY ADDRESS 4946ATWATERDR NORTH PORT, FL 34288 after10/17/2022, a$48.09 late fee will be chw·ged. QUESTIONS? WE'RE HERE TO HELP. CUSTOMER SERVICE: 888-480-2432 Mon-Thu 7a.m. to 8p.m. (CT) Fri 7a.m. to 7 p.m. (CT) Sat 8a.m. to 12 p.m. (CT) www.mrcooper.com ACCOUNT OVERVIEW INTEREST BEARING PRINCIPAL BALANCE $212,196.60 NON-INTEREST BEARING PRINCIPAL BALANCE'" $4,910.25 ~ 1 ~TheNoa~Jnterest Bem·ingPrincipal Balance includes all tlefen·ed ll))Wllnts related to a mortgage assistance JJl'D{Ji"aJll. 111ePti11cipa/Bala11ce does not repl'esent tltepayojfa»w1111t ofyo11r account and is not to be usedfo>· payojJpuJ'poses. PAST PAYMENTS BREAKDOWN CATEGORY PRINCIPAL INTEREST ESCROW (TAXES & IIISURAIKE) OPTIONAL INSURANCE FEES & CHARGES LENDER PAID EXPENSES PARTIAL PAYMENT (UNAPPLIED) TOTAL PAYMENT DUE DATE 10/01/2022 AMOUNT DUE $1, 6 Ifpaymentis1-eceivedon or PAID SINCE PAID YEAR 08/10/2022 TO DATE $726.88 $1,797.49 $1,196.68 $3,011.41 $759.84 $1,903.72 $0.00 $0.00 $25.00 $25,00 $0.00 $0.00 $0.00 $0.00 $2,708.40 $6,737.62 INTEREST RATE 3.375% ESCROW BALANCE $438.96 DETACII_IIERE AND RETURN WITH YOUR PAYMENT. PLEASE ALLOW A ~IINIMLIM OF 7 TO 10 DAYS FOR POSTAL DELIVERY. _______________ _ IMPORTANT PAYMENT INFORMATION • It is important to use the remittance stub and envelope provided since both contain computer encoding that will help ensure prompt and accurate posting of payments. Always include your loan number 011 your check or money order. However, should you not receive your statement, DO NOT DELAY PAYMENT. Simply write your loan number on your check or money order and mail to the payment address as provided in the Co11tactlnfol'lllatio11 section below. • Do not se11d cash or c01Tespondence as this could delay processing. Correspondence should be sent to tho address provided in the Co11taot I11formation section below. •Please be advised that ifyour account is delinquentorifthere are fees and charges due, your account may not be paic\ ahead nor may principal reduction payments be applied. When Mr. Cooper receives a remittance that is in excess of a payment amount, that excess is applied to your account in accordance with a predetermined sequence, 1) Principal and Interest due; 2) Applicable Escrow amounts; 3) Fees and other charges assessed to your account. Once this sec1uence has been satisfied, you may give specific instructions as to how you would like excess amouuts to be applied to your account by noting your preference on the face ofyourremittanco stub. •A11y lump sum received that is not accompanied by a payoff quote will be applied acc01·di11g to our standard payment application rules. '!'his will not result in satisfaction and reconveyance/release unless amount tendered satisfies all amounts due and owing on the account. •A Schedule ofFee for Select Services may he found on our website at www.nn·cooper.com. SERVICEMEMBERS CIVIL RELIEF ACT '!'he Servicemembers Civil Relief Act (SORA) may offer protection or relief to members of the military who have been called to active duty. If you are a member of the military who has been called to active duty or received a Permanent Change ofStation orde1· and you have not already made us aware, please fonvard a copy of your 01·ders to us at: Mr. Coope1·, Attn: Military Families, P.O. Box 619098, Dallas, TX 75261-97,H, fax 855-856-0427 or e!lluil MilitaryFamilies@mrcoopm·.com. Be sure to include your loan number with the copy of the ol'ders. Please visit our website atwww.nu·coopei·.co!ll for complete details regarding Legal Ri1;hts and Protections Under the SORA. LATE CHARGES AND OVERDRAFT FEES Payments received and posted after a grace period will be assessed a late cha1·ge. '!'he late charge rate and 11umbe1· of grace days are shown on yom· Note. Please allow adequate time for postal delays as the receipt a11d posting date will govern the assessment of u late charge. Partial payments cannot he applied. If a payment is credited to your account and subsequently dishonot·ed by your bank, Mr. Cooper will reverse that payment and assess your loan account an insufficient funds fee ofup to $50.00, as permitted hy applicable law. ('!'his foe may vary by state.) HOMEOWNER COUNSELING NOTICE If your loan is delinquent, you are entitled to receive homeownership counseling from an agency approved by the United States Department of Housing and Urban Development (HUD). A list of the HUD-approved, nonprofit homeownership counseling agencies may be downloaded from the Internet at: https,//apps.hud.gov/offices/hsg/sth/hcc/hes.cfm or by calling the HUD toll free nun1bor 1-800-569- 4287 (toll free TDD number 1·800·877·8339)to obtain a list ofapprovednonprofit agencies servingyour residential area. NEW YORK STATE RESIDENTS Forthose customerswho reside in the stateofNewYork, abonowermayfile complaints ah out the Servicer with the New York State Department ofFinancialServices or may obtain further information by calling the Department's Consumer Help Unit at 1·800-342-3736 or by visiting the Departme11t's website at www.dfs.ny.gov. Mi·. Coope,· is registered with the New York Superintendent ofFinancial Services. PAYMENT OPTIONS AUTO PAY Allows you to have your payment automatically debited, each month, from the checking or savings account of your choice. Mr. Cooper docs not charge a fee to activate this service. Call 888-480-2432 for 11101·0 information or visit our website at www.1mcooper.com. ONLINE PAYMENT Allows you to sign in to yolll' account anytime to make a payment. There is no charge for this se,·vice. Sign in to www.mrcoopor.com. AUTOMATED PHONE PAYMENT Is a pay-by-phone servicepl'Ovided through our automated phone system. '!'here is no charge for this service. Call 888·480-2432. AGENT AS SI ST ED PAYMENT Is a pay by phone service provided by a customer service agent. Call 888-480-2432 and speak with an agent. There is 110 charge fo1· this service. PAY BY MAIL Detach the coupon provided with this statement and mail it withyour check or money order in the envelope provided. Please write your loan mnnber on your payment and allow adequate time for postal delays as the receipt and posting elate willgover11 the assessment oflate charges, Send payment via express 01· overnight mail to Mr. Coopcr,Attn: Payment Processing· 650783, 3000 Kellway Drive, Suite 120, Canollton, 'l'X 75006. WI RE Allows you to send payoff/reinstatement funds via wire transfer. Visit our website www.mrcooper.com or refer to your payoffstatement for wiring instructions. MON EYGRAM EXPRESSPAYMENT Ensures same-day delivery ofyour payment to Mr. Cooper. Visit your local MoneyGramAgent. Calll-800-926·9'100 to locate the one nearestyou. Complete the Express Payment form, providing your name and Mr.Cooper loan number. 'l'hcMoneyGram Receive Code is '"1678"\AIIExp1·essPayment trnnsactions require cash. 11ie agent will charge a fee for this service. WESTERN UN ION OUICKCOLLECP Ensures same-day delivery of your payment to Mr. Cooper. Visit your local ·western Union Agent. Call 1-800·325·6000 to locate the one nearest you. Complete the QuickCollect form with your name and Mr. Cooper loan mnnber, indicating: Pay to: Mr, Cooper Code City: MRCOOPER State: TX All QuickCollect transactions require cash. Western Union will charge a fee forthis service. NOTICE TO CUSTOMERS MAKING PAYMENTS BY CHECI( Authorization to Convert Your Cheek: Ifyou send us a check to make your payment, ymir check may be converted into an electronic fund transfer. An electronic fund trnnsfer is the process in which your financial institution transfers funds electronically fromyom· account to our account. By sendingyour completed signed check to us, you authorize us to copy your check and use the information from your check to make an electroniefunds transfer from your account for the same amount as the check. Ifthe electronic fund tTansfercannot be processed for technical reasons, you authorize us to process the copy ofyour check. Insufficient Funds: '!'he electronic ftmd transfer from your account will usually occur within 24 hours ofour receipt ofyonr check. Ifthe electronic fund transfer cannotbe completed becanse of insufficient funds, you may be assessed an NSF fee in connection with the attempted transaction. Transaction Information: '!'he electronic fund transfer from your account will be on the account statement yol1 receive from your financial institution. You will not receive your original check back from your financial institution. For securityreasons, your original check will he destroyed, hut we will keep a secured copy of the check for record keeping purposes. Your Rights: You should contact your financial institution immediately ifyou believe that the electronic fund transfer reported on your statement was not properly autho1·izecl or is otherwise inconect. Consumers have p1·otections under the Electronic Fund 'l'rnnsferActfor any unauthorized or incorrect electronic fund trnnsfe,·. CONTACT INFORMATION CUSTOMER SERVICE: 888•480·2432, Monday through Thursday 7 a.m. to 8 p.m. (C'I'), Friday'/ a.m. to'/ p.m. (01'), and Saturday 8 a.m. to 12 p.m. (CT) [Calls maybe monitored and/or recorded for quality assurance purposes]. 24-HOUR AUTOMATED ACCOUNT INFORMATION: Sign in to www.mrcooper.oom OR call 888·480-2432. MAILING ADD RESS ES: For Mr. Cooperare listed below. Please carefully select the address suited to your needs nnd remember, sending payments to any address other than the one specifically identified for J)ayments will l'esult in delays and may result in additional fees being assessed to your account. PAYMENTS: NOTICE OF ERROR/ OVERNIGHT DELIVERY INSURANCE RENEWALS/ TAX NOTICES/ BANKRUPTCY NOTICES/ INFORMATION CORRESPONDENCE: BILLS: BILLS: PAYMENTS: REQUEST/OWR': PO Box 60516 PO Box 619098 Lake Vista 4 PO Box 7729 PO Box 9225 PO Box 619094 City of Industry, CA Dallas, TX 75261-9741 800 State Highway 121 Bypass Springfield, OH 45501-7729 Coppell, TX 75019 Dallas, TX 75261·9741 91716-0516 Lewisville, TX 75067 Fax (800) 687·4729 Fax (817) 826·1861 *PURSUANT TO RESPA, A "QUALIFIED WRITTEN REQUEST" (QWR) REGARDING THE SERVICING OF YOUR LOAN, A NOTICE ASSERTING THAT AN ERROR OCCURRED WITH RESPECT TO YOUR LOAN OR A NOTICE REQUESTING INFORMATION WITH RESPECT 'l'O YOUR LOAN MUST BE SEN'l' TO THIS ADDRESS: Mr. Cooper PO Box 619098, Dallas, 'l'X 75261-9741, Attn, Customer Relations Oftlcer. A "qualified written request" must comply with the requirements of RESPA, as follows: Qualifiecl written 1·equest; defined. A qualified written request means a written correspondence (other than notice 011 a payment coupon or other payment medium supplied by the servicer) that includes, or otherwise enables the servicer to identify, the name and account of the borrower, and includes a statementof the reasons that thebonowerbelieves the accountis in error, ifapplicable, or thatprovides sufficient detail to the scrvicerrcgardingin formation EQU.lLIIQ\lSJIIGrelatingto the servicing of the loan sought by the borrower.A QWR, notice oferror or request for information is not timely ifit is delivered to a sm·vicer more than 1-year OPPOATllNlf'l' after either the date oftransferofservicing 01·the date that the mortgage loan is discharged, whichever date is applicable. Mr. Cooper, its affilintes, successors or its assigns or their officers> dil'ectors, agents, or employees, are neithe1• liable nor respousihle for, 01·n1n.ke any repl'esentntion regarding the products or services offered 011 any enclosed inserts. MORTGAGE LOAN STATEMENT STATEMENT DATE PAYMENT DUE DATE mr. 09/13/2022 10/01/2022RETURN SERVICE OMLY PLEASE DO NOT SEND MAIL TO THIS ADDRESS LOAN NUMBERPO Box 818060 AMOUNT DUE S801 Postal Road CHMlGIMG THE FACE OF HOME LOAtlS Cleveland, OH 44181 $1,454uPROPERTY ADDRESS 4946ATWATERDR Jfpayment is received on or NORTH PORT, FL 34288 aftei· 10/17/2022, a $48,09 late fee will be charged. QUESTIONS? WE'RE HERE TO HELP. CUSTOMER SERVICE: 888-480-2432 Mon-Thu 7a.rn. to 8p.m. (CT) Fri 7 a.m. to 7 p.rn. (CT) Sat 8 a.m. to 12 p.m. (CT) www.mrcooper.com TRANSACTION ACTIVITY (08/10/2022 TO 09/13/2022) (Seepage2formoretrnnsactions) DATE DESCRIPTION TOTAL PRINCIPAL INTEREST ESCROW OTHER 08/10/2022 BORR PAID Ml DISBURSED $106.96 $106.96 08/07/2022 Reversal-Payment $1,341.70 $362.93 $598.85 $379.92 08/07/2022 Insufficient Funds Fee $25.00 $25.00 ' ' ' ~----,:-~ , .. ,.,.,.,,.,_-. .,;,.;hla mr. Make life More Affordable Call 855-781-7996 Reservation ID: Life Getting Expensive? r uity Emanuel, We know life is more expensive these days. Here's the good news: You can turn your hard-earned equity into cash to help cover unexpected expenses or pay for exciting new projects. According to our records, you can cash-out up to $70,123.00*. Call 855-781-7996 today to learn more and get started. Sincerely, Your Home Loan Team at Mr. Cooper You've Earned It. Access Your Equity Today 855-781..7996 Reservation ID: We Text. You Save. Text JOIN to COOPER (266737) ,\ rr.sgs/mo. ,"-li:ss'.lg.e ;,nd d1t-1 rates. m,w jpp:--,, Tenns ::i11d con(ft!ons .it http:ttirw.<c/TCMC Hours of Operation: Mon-Thur 7 am to 9 pm CT / Friday 7 am to 7 pm CT / Saturday 8 am to 5 pm CT 'Available cash or cash-out amount is an estimate of the equity you may be able to withdraw. It is based on the highest estimated current value of your property minus the estimated • current amount owed. Closing r.osts may affect amount of cash-in-hand. For rnost conventional and FHA loan products. it assumes you can v1ithdraw up to 80% of the equity. For VA loans. it assumes you can withdraw up to 90% of the equity. If you clo not occupy the prope1ty. it assumes you can withdraw between 70-75% of the equity, depending on the nurnber • • ·' ·-'------"'°'' "" ,,,, r,vmor', affiliatp Xome' bv application of various mathematical formulas/techniques using available local EXHIBIT I • -•' ,,..~....._,....._ ~----~10/'"JC/,.,nic-innar miam 1/1 2/7/23, 11:34 AM For Stephanie -OneDrive lB Share Ce.:i Copy link ± Download CD I<l 93 I 101 I> I X EXIDBITB • ~-'· ·---~~"~~~1.R.;,1=•1,. 2/7/23, 11 :34 AM For Stephanie -OneDrive lB Share ¼b Copy link '1-Download CD I<l 92 / 101 t>I X EXRIBITC ?FnP.rsonal%2Fianisinger_miam... 1/2 X 1131/23, 3:41 PM For Stephanie -OneDrive 1.6' Share Ce, Copy link :!, Download 0 l<l 83 / 162 EXHIBITD hltps:1/miamibeach-my.sharepoint.comlpersonal/janisinger _miamibeachfl_govl_layouts/15/onedrive.aspx?ga=1 &id=%2Fpersonal%2Fjanisinger _miam... 1 /2 EXHIBIT J December 14, 2021 Agreement between: Ms. Lakeise Martin 1280 NW 128TH Street North Miami, FL 33167 & Mr. David James 227 W 2srn Street West Palm Beach, FL 33404 Re: Case# 2021-66046 / 2019 Dodge Caravan/ VIN Damages occurred to a 2019 Red Dodge Caravan, which took place in North Miami, FL, on Sunday, December 12, 2021, costs $1,500.00 to repair per an estimate by Napletons Collision Center, 3626 Northlake Blvd B, Palm Beach Gardens, FL 33403 on Monday, December 13, 2021 at 8:47AM. Payment has been made in full on Tuesday, December 14, 2021, in person, to the owner of the 2019 Red Dodge Caravan, Mr. David James, by way of two money orders: a $1,000.00 Money Order and a $500 Money Order, which will satisfy all repair costs to the 2019 Red Dodge Caravan. Notary Seal: Ms. Lakeise Martin MONTRICE MCCLAIN Notary Public, Slate 61 Florida Commi$$i0n No, 00910051 CommiMian ~10/0iit2023 Notarized By: Mr. David James December 14, 2021 Agreement between: Ms. Lakeise Martin 1280 NW 128TH Street North Miami, FL 33167 & Mr. David James 227 W 25TH Street West Palm Beach, FL 33404 Re: Case# 2021-66046 / 2019 Dodge Caravan/ VIN Damages occurred to a 2019 Red Dodge Caravan, which took place in North Miami, FL, on Sunday, December 12, 2021, costs $1,500.00 to repair per an estimate by Napletons Collision Center, 3626 Northlake Blvd B, Palm Beach Gardens, FL 33403 on Monday, December 13, 2021 at 8:47AM. Payment has been made in full on Tuesday, December 14, 2021, in person, to the owner of the 2019 Red Dodge Caravan, Mr. David James, by way of two money orders: a $1,000.00 Money Order and a $500 Money Order, which will satisfy all repair costs to the 2019 Red Dodge Caravan. Notary Seal: Ms. Lakeise Martin MONTRICE MCCLAIN Notary PubHc. Slate ol Florida Commi~ No. GG911l1161 ~~10/06/2023 Notarized By: Mr. David James Ve a Saraf, Stephanie From: Montrice Sent: Thursday, November 11, 2021 12:28 PM To: McClain, Montrice Attachments: Ta_niyah Passport Consent Form.pdf; attachment.txt [ THIS MESSAGE COMES FROM AN EXTERNAL EMAIL -USE CAUTION WHEN REPLYING AND OPENING LINKS OR ATTACHMENTS] 1 0MB CONTROL NO. 1405-0129 U.S. Department of State EXPIRES: 12-31-2023 Estimated Burden: 20 minutesSTATEMENT OF CONSENT: ISSUANCE OF A U.S. PASSPORT TO A CHILD Please Print Legibly Using Black Ink Only. Ifyou make an error, complete a new form. Do not correct. USE OF THIS FORM This form is used when one or both legal parents and/or legal guardians cannot apply in person with the child for that child's passport. The legal parent/legal guardian who cannot apply with the child can give consent using this form or a written statement that includes all of the information on this form. This form or the written statement must be notarized. If the required consent is not submitted, the child may not be eligible for a U.S. passport. . For children under the age of 16: Both legal parents/legal guardians must apply for the passport with the child or the legal parent/legal guardian that cannot apply with the child must complete and notarize this form to be submitted with the application. • For children 16 or 17 years old: The Department may request the consent of one legal parent/legal guardian to the issuance of a passport to an applicant who is 16 or 17 years of age. In many cases, the passport authorizing officer may be able to ascertain parental awareness of the application by virtue of the parent's presence when the minor submits the application or a signed note from the parent or proof the parent is paying the application fees. However, the passport authorizing officer retains discretion to request the legal parent's/legal guardian's notarized statement of consent to issuance (e.g., on Form DS-3053). IMPORTANT • If #3 on page two is not completed, consent will be valid for both passport book and card . . Statements of consent expire 90 days after the date of notarization . . You must submit a photocopy of the front and back of the identification you presented to the notary . . You must sign the statement of consent in front of a notary . • The date of the notary's signature must be the same as the date of your signature . • This form can also be used to authorize a third party to apply for a child's passport on behalf of the legal parents/legal guardians who cannot apply in person. INSTITUTIONS/ENTITIES GRANTED GUARDIANSHIP You must submit all of the following with this form: 1. A certified court order granting guardianship to the institution/entity. Photocopies are not acceptable. 2. A signed statement from the Institution/entity on letterhead authorizing a specific person to apply for a passport for the child on the child's behalf. The statement must include the child's name and the name of the individual(s) authorized to apply for the passport. 3. A photocopy of employee identification documents proving the person applying for the child's passport works at the .institution/entity. - Please ensure that none of the above documents has any conditions placed on the period of validity of the passport or where the child may travel. If there are conditions in the statement, a new statement of consent is required. WARNING False statements made knowingly and willfully on passport applications, including affidavits or other supporting documents submitted therewith, may be punishable by fine and/or imprisonment under U.S. law, including the provisions of 18 U.S.C. 1001, 18 U.S.C. 1542, and/or 18 U.S.C. 1621. FOR INFORMATION AND QUESTIONS For passport and travel information, please visit travel.state.gov. In addition, contact the National Passport Information Center (NPIC) toll-free at 1-877-487-2778 (TDD/TTY 1-888-87 4-7793) or by email at NPIC@state.gov. For information on International Parental Child Abduction, please visit travel.state.gov/childabduction or contact the Office of Children's Issues by telephone at 1-888-407-4747 or bv email at PreventAbduction1@.state.Qov. PRIVACY ACT STATEMENT AUTHORITIES: We are authorized to collect this information by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 26 U.S.C. 6039E; Executive Order 11295 (August 5, 1966); and 22 C.F.R. parts 50 and 51. PURPOSE: The primary purpose for soliciting the information is to establish two-parent consent for applicants under the age of 16 or one-parent consent, when requested by the Department, for applicants age 16 or 17, consistent with Public Law 106-113, Section 236. ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities, and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non- citizen nationals abroad. More information on the Routine Uses for the system can be found in System of Records Notices State-26, Passport Records, and State-05, Overseas Citizen Services Records and Other Overseas Records. DISCLOSURE: Failure to provide the information requested on this form may result in the refusal or denial of a U.S. passport application. PAPERWORK REDUCTION ACT STATEMENT Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time required for searching existing data sources, gathering the necessary data, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid 0MB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Program Management and Operational Suooort, Attn: Forms Officer, 44132 Mercure Cir, PO Box 1199, Sterlinq, Virqinia 20166-1199. Page 1 of 2 DS-3053 12-2020 0MB CONTROL NO. 1405-0129 U.S. Department of State EXPIRES: 12-31-2023 Estimated Burden: 20 minutesSTATEMENT OF CONSENT: ISSUANCE OF A U.S. PASSPORT TO A CHILD Please Print Legibly Using Black Ink Only. Ifyou make an error, complete a new form. Do not correct. 1. CHILD'S NAME (As it appears on form DS-11, Ap /ication for a U.S. Passport) Last Sanders First Ta'niyah Middle Akira 2. CHILD'S DATE OF BIRTH (mmldd/yyyy) 3. THIS CONSENT IS VALID FOR A: D Passport Book and Card Ii] Book Only D Card Only 4a. IS CHILD UNDER 16 YEARS OLD? 4b. IF YES, PRINT NAME OF ADULT APPLYING WITH CHILD ~Yes □ No Taurus Sanders 5. STATEMENT OF CONSENT To be completed by the legal parenVlegal guardian who cannot apply with the child. The legal parent/legal guardian who cannot apply with the child must complete the information below. This statement expires 90 days after the date of notarization. 1, Audrey Bent , give my consent to the issuance of a United States passport to the minor child Print Name of Legal ParenVLegal Guardian (who cannot apply in person with the child) named on this application. My consent is unconditional with regards to passport validity and travel. FL Street Address Apt# City State Zip Code OATH: I declare under penalty of perjury that all statements made in this supporting document are true and correct. Signature of Legal Parental/Legal Guardian (who cannot apply in person with the child) Date (mmldd/yyyy) IMPORTANT: You must submit a clear photocopy of the front and back of the identification you presented to the notary. The date ou si n the form must be the same date that the nota si ns the form. 6. FOR COMPLETION BY NOT ARY On the date specified above and below, the affiant listed above, who is not related to me, personally appeared before me and is ..· known to me to be the person whose name is subscribed to and acknowledged that he/she executed the same for the uses and = purposes therein contained. I have properly verified the identity of the affiant by personally viewing the below notated identification document and matching photocopy. Location Commission Expires Identification Presented by Legal ParenVLegal Guardian: (who cannot apply in person with the child) Legal ParenVLegal Guardian ID Number: Issue Date (mmldd/yyyy): Signature of Notary Print Name (Notary Public) City, State Date (mmlddlyyyy) NOTARY SEAL 0 Driver's License O Passport D Military ID D Other (specify) Place of Issue: Expiration Date (mm/dd/yyyy): Date of Notarization: Page 2 of2DS-3053 12-2020 EXHIBITK X 2/7/23, 9:46 AM For Stephanie -OneDrlve 1B Share ~ Copy link 1 Download CD I<l 99 I 162 t> I WHITE LABEL BROKER APPLICATION 2534 Stato Street. Suite H3 I San Diego, Ci\ !11101 www.TrndelincSupply.com I 88B ·84 4-8010 EXHIBITE COMPANY INFORMATION ,Company Name: IDate,: ,McClain Signature Seivices LLC f November 21, 2022 'Company Address: ,City: --------:stale: 'Zip Code: 1811 NW 69 street :Miami 1 !FL 33147 , Webslte(s): W\W1.mcclainss.co1n Phone: Email Address For Broker Account: 3059886627 book@mcciainss.com Entity type (sole proprietor, LLC. corporation. limited partnership. etc.): LLC PRIMARY. CONTACT ..INF-ORMATION Full Name: Montrice McClain Position / Titlo: Owner Cell Phone: Work Phono: Email Address: 3059886627 book@mcctainss.com BuslnC!ss Address (if different than company address): City: istate: ;zip Code: SECONDARY CONTACT INFORMATION 'Full Name: Position/ Title: 'Cell Phone: Work Phone: Email Address: Business Address (if difforent than company addrc,ss): City: State: i Zip Cede: ::;:::;;:::~ l cf 2 1/1 WHITE LABEL BROKER APPLICATION 2534 Slate Street. Suite •133 I San Diego, CA 92101 wv,w.TradelineSupply.com I 888-844-8910 REQUIRED DOCUMENTATION ;1. Business Documentation(, Q. (A) Busintm lictmse I@ View PDF controls (B) Fictitious business na ... ~, ~~~ (C) ArticlQS of omanization (for a LLC) '•· -'--'h~Mhfl Nmd b"n' ,tc:11 nlnnAdrive.asox?oa==1 &id==%2Fpersonal%2Fjanisinger_miam...--'-'---- EXHIBITL Close this window Control Room Supervisor -Public Works Class Code: 4018 / Grade u15 Bargaining Unit: Unclassified CITY OF MIAMI BEACH Established Date: Jun 1, 2021 Revision Date: Aug 20, 2021 NATURE OF WORK: The Control Room Supervisor oversees the activities of a tlu·ee-shift, seven-day-a-week Control Room Center and a 24-hour City of Miami Beach hotline. Control room fonctions include: monitoring the City of Miami Beach's water, wastewater, storm water, streets and streetlighting systems; responding to emergencies and alarms; dispatching field staff for utilities; controlling the water systems pumping, storage, and pressures; and providing after-hours support and dispatch for several non-utility City of Miami Beach departments. ILLUSTRATIVE EXAMPLES OF ESSENTIAL DUTIES: " Oversee the operation of the water supply and distribution system using the Supervisory Control and Data Acquisition (SCAD A) system, which includes real time monitoring, historical data gathering, alarming, and generating a variety of reports for management • Oversee the operation of the call and dispatch center to ensure customer service goals are maintained. • Create, monitor, and follow up on the progress of all City asset related service requests and as instructed by management • Evaluate control room activities and provide recommendations for improvements and mo difications to existing methods and processes • Request and define upgrades to the functionality and programming of the SCAD A system. • project, schedule, manage, and track day-to- day system water usage to meet the yearly water usage goals; • ensure work conforms to local, state, and federal governmental regulations, and other app licable rules and requirements. Prepare and complete Control Room Policies and Processes • Monitor the CCTV security system for PW Facilities • Serve as a primary point of contact or liaison between Control Room Operators, management, emergency management and other internal and external City stakeholders • i\tlaintain a safe operating environment with full regard to Health & Safety responsibilities • Performs related work as required • Maintain employee daily vehicle key logbook • Maintains and produces accurate report of Submersible Sewer Station Hourly Readings and Variable Frequency Drive (VFDs) on a daily/ weekly/ monthly basis and provides it to Management for Management's submittal of Elapsed Time Filings to the Department of Environmental Resources Management (DERM) • Maintains and produces accurate rep01i to Management for Management's submittal of Fats, Oils, and Grease (FOG) report to DERM MINIMUM REQUIREMENTS: • At least one (1) year supervisory experience in a control room or dispatch center work environment; or at least two (2) years of control room operation experience • A valid High School Diploma or GED • At least a "Class 3" level Florida Department of Environmental Protection license in water distribution, or a Level C sewer/wastewater system collection, stormwater management certification " At least a Level III Certificate in Utilities Maintenance Preferred: • A Class 11 B11 Water Distribution Operator Certificate from the Florida Water and Pollution Control Operator's Association is preferred but not required. KNOWLEDGE, SKILLS AND ABILITIES: • Knowledge of city government, organization and operations • Excellent written and oral communication skills, including an exceptional ability to convey complex information to a variety of audiences " Ability to communicate with staff, management, and City stakeholders effectively and professionally " Ability to establish and maintain effective working relationships with other employees, city officials and the general public • Ability to handle multiple projects efficiently • Ability to instruct others regarding the performance of hydraulic calculations, proper water system operations, and the handling of emergency calls. • Ability to prepare performance appraisals and provides clear communication regarding performance expectations to subordinate staff. • Considerable knowledge of the principles of operation of a SCAD A system including the creation of graphics and generation of reports • Considerable knowledge of the general water supply and distribution practices and procedures; the normal pressure, flows, and levels for the City's water supply, stormwater and wastewater systems computer system report generation, data collection, and conversion; • Considerable knowledge of Microsoft Office Suite • Knowledge or use of general office equipment (fax machine, copiers, telephone communication equipment) • Ability to understand and follow written and verbal instructions • Ability to supervise, assign, evaluate, and train subordinate staff • Have general knowledge of pump stations trouble shooting, maintenance, and repairs • Create and enforce all Service Request in relation to City assets as instructed by management • Assist with maintaining Standard Operating Procedures (SOPs) and making sure they are up to date and enforced at all times • Ability to communicate via WebEOC during emergency events • Ability to establish and maintain effective working relationships with elected officials, coworkers, the press the general public and members of diverse cultural and linguistic backgrounds regardless of race, religion, age, sex, disability, political affiliation, gender identity or sexual orientation. • Ability to serve the public and fellow employees with honesty and integrity in full accord with the letter and spirit of all City ethics and conflicts of interest policies. Strong understanding of ethical behavior is required. • Ability to maintain regular and punctual attendance. • Ability to report to work as directed during an emergency as an essential employee of the City of Miami Beach • Performs related work as required PHYSICAL REQUIREMENTS: • Must have the use of sensory skills in order to effectively communicate and interact with other employees and the public through the use of the telephone, electronic mail and personal contact • Physical capability to effectively use and operate various items of office related equipment, such as, but not limited to, word processor, calculator, copier, and fax machine • Continuous walking, moving, climbing, carrying, bending, kneeling, crawling, reaching, handling, sitt ing, standing, pushing, and pulling • Ability to lift heavy objects • Work in the field is required SUPERVISION RECEIVED: • Specific assignments are received fi:om Infrastructure Director and Water and Sewer Superintendent, and or their designee. • Work is performed with some supervision from Superintendent, Division Director, allowing latitude for independent judgment in the selection of work methods and procedures SUPERVISION EXERCISED: " Plans, organizes, evaluates, and supervises the work of skilled, semi-skilled, and unskilled pers01mel involved in performing a variety of functions for or on behalf of the Control Room EXHIBITM EXHIBITH Vega Saraf, Stephanie /v\l From: Bain, Tiffany <TiffanyBain@miamibeachfl.gov> Sent: Wednesday, October 27, 2021 3:05 PM To: McClain, Montrice Subject: RE: Notary Supplies Hi Montrice -It says the cart is empty when I click the link. Are you able to print it whenever you get back in? TIFFANY K. BAIN, Office Associate V PUBLIC WORKS DEPARTMENT-OPERATIONS 451 Dade Blvd Miami Beach, FL 33139 Phone: 305-673-7000 ext. 22563 Email: tiffanybain@miarnibeachfl.gov Website: www.miamibeachfl.gov Public Works Department Mission We are a multi-disciplined department comprised of Operations, Engineering, Sanitation, and Greenspace Management divisions. Together, these divisions ensure the technologically advanced design, maintenance, functionality, delivery, and cleanliness of the City's water services and resources, roadways and greenways. We place the utmost importance in valuing our employees and ensuring all are trained to be the most reliable, knowledgeable, environmentally-conscientious and solutions-oriented professionals who provide for the City's stakeholder needs and concerns in an efficient and socially-responsible manner to foster a better, safer, and healthier community for all to live, work, and play. Public Works Department Vision To be the most proactive, innovative, and dependable network of highly knowledgeable professionals who are skilled in providing stakeholders optimal service and solutions to our community's most pressing infrastructure and environmental needs. From: McClain, Montrice <MontriceMcClain@miamibeachfl.gov> Sent: Wednesday, October 27, 20212:52 PM To: Bain, Tiffany <TiffanyBain@miamibeachfl.gov> Subject: Notary Supplies Rect ul0-t' 'torHi Tiff: Please see the cart below. \\\OW'.J j~\\o https:/ /www.notarieseguipment.com/cart / l<indest Regards, MIAIVU ~®Jr.c~ Control Room Supervisor Licensed Water Distribution System Operator #0026371 1 EXHIBITN DocuSign Envelope ID: 85EDF964-0AF3-4BAF-984C-5F439CB707F5 CITY OF MIAMI BEACH REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT TO BE COMPLETED BY EMPLOYEE -City of Miami Beach employees may accept outside employment as long as the employment is not contrary, detrimental or adverse to the interests of the City, and as long as no City time, equipment or material Is used. This form must be completed and approved prior to beginning any outside employment. Requests for approval of outside employment must be made on a yearly basis (even if for the same outside employment that had been previously approved). City employees engaging in outside employment must also file an "Outside Employment Statement" form with the Office of the City Clerk by July 151 of each year, in accordance with Section 2-11.1 (k)(2) of the Miami-Dade County Code. INFORMATION REGARDING CITY OF MIAMI BEACH EMPLOYEE EMPLOYEE'S NAME: LAST NAME, FIRST NAME, MIDDLE NAME: EMPLOYEE ID NUMBER: McClain, Montrice Nichole 22967 JOB TITLE: HOME TELEPHONE NUMBER: Control Room Supervisor 3059886627 DEPARTMENT/DIVISION: Public Works Operations WORK TELEPHONE NUMBER: 3056737625 SUPERVISOR'S NAME: CELLULAR TELEPHONE NUMBER: Randy Boodoo 7865751440 NORMAL WORK DAYS AND TIMES: Monday -Friday Manual Schedule INFORMATION REGARDING OUTSIDE EMPLOYMENT NAME OF BUSINESS, ORGANIZATION OR INOlVIDUAL HIRING CMB EMPLOYEE: McClain Signature Services LLC ADDRESS OF OUTSIDE EMPLOYER· 1811 NW 69 Street TELEPHONE NUMBER: 3059886627 JOB TITLE THAT CMB EMPLOYEE WILL HOLD: Owner NAME OF OUTSIDE EMPLOYMENT SUPERVISOR: None NORMAL WORK DAYS AND TIMES: Manual Schedule DESCRIPTION OF DUTIES: dently.N, tarv Services as well as trucking load booking sei"\lices. Please note that Notary credentials were obtained and maintained indepeh WHAT DUTIES MIGHT BE A CONFLICT OF INTEREST WITH YOUR CMB POSlTION? There are no duties that are a conflict of interest with my CMB position. WILL YOUR PROPOSED OUTSIDE EMPLOYER RELEASE YOU IF AND WHEN YOU ARE CALLED FOR EMERGENCY SERVICE BY THE CITY? 1-iYES ONO ~·-~~--~~•«·-----~~---,--=---------~ -----· -· / This form has 2 pages -be sure to complete both pages. Employee signature required on page 2. DocuSign Envelope ID: 85EDF964-0AF3-4BAF-984C-5F439CB707F5 CITY OF MIAMI BEACH REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT· CONTINUED PAGE 2 of2 By signing below, I certify that all of the information given on page one (1) of this document is true, accurate, and complete to the best of my knowledge. I understand that all information is subject to investigation and that falsification, omission, or misrepresentation is sufficient cause for disciplinary action, up to and including termination. I also understand that I am responsible for informing my supeivisor in writing if any information about my outside employment changes, especially if there arises any possible conflict of interest. Failure to do so may lead to disciplinary action, including termination of employment with the City of Miami Beach. This request for approval of outside employment will be made on a yearly basis. E\IPL0YEE 10 NUVBER; Montrice McClain 22967 DME 8/24/2022 TO BE COMPLETED BY EMPLOYEE'S SUPERVISOR, DIVISION DIRECTOR, DEPARTMENT DIRECTOR AND ASSISTANT CITY MANAGER PLEASE CIRCLE ONE SUPERVISOR SIGNATURE &DATENAME OF SUPERVISOR Randy Boodoo APPROVED DISAPPROVED NAME OF DIVISION DIRECTOR PLEASE CIRCLE ONE DIVISION DIRECTOR SIGNATURE & :>ATE Lys Desir Jr. APPROVED DISAPPROVED SIGNATURE &DATE 8/30/2022 8/31/2022 ER SIGNATURE & DAH: 8/31/2022 NAME OF DEPARTMENT DIRECTOR Jose Gomez HUMAN RESOURCES DIRECTOR Marla Alpizar PLEASE CIRCLE ONE· 3:08 P EDT APPROVED DISAPPROVED PLEASE CIRCLE ONE: 9:44 A EDT APPROVED DISAPPROVED IPLEASE CIRCLE ONE ASSISTANT CITY MANAGER Lester Sola 8:43 A EDTAPPROVED DISAPPROVED If you have any questions regarding outside employment, please contact the Human Resources Department at 305,673.7524. M \$CMBIHU\h'I.RESOIOUTSIDE EMPLOYMENT Rv1sed 05162018.doc~ MIAM~ OUTSIDE EMPLOYMENT STATEMENT >Jl:!378 A.LIO ::th.<..:;,, ~;Ji::HO ,-'.~::}J/11?;_ For Full-time County and Municipal Employees H0\138 ltAJVll!\l ::iO kUC) Full-time County (including Public Health Trust) and municipal employees engaging In outside employment must file an~~~&aPdf~cl~~?e report by July 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami-Dade County Code. 03/\13838 Disclosure for Tax Year Ending Last Name 2021 McClain Mailing Address -Street Number, Street Name, or P.O. Box 1811 NW 69 Street City, State, Zip Miami, FL 33147 First Name Montrice Middle Name/Initial N RECEIVED FEB 16 2023 \ A, If your home address is exemptfrom public records pursuantto Florida Statutes §119.07, please see note on the fcill\fwil@:p~ atl\tc©:®J<<bllm;: Filing as an Employee (check one) D County D Public Health Trust E] Municipal City of Miami Beach (Municipality) Department Public Works Division Operations Position or Title Control Room Supervisor Employee ID Number 22967 Work telephone (305) 673-7625 Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other compensation you received for each source of outside employment. If no income or compensation was received from a particular outside employment, enter zero (0) for that organization in the section below. If continued on a separate sheet, check here. 0 Name and Address Nature of the Total Amount of Money or of the Source of Outside Income Work Performed Compensation Received McClain Signature Services LLC Notary and Administrative Services ~ 500.00 I hereby swear (or affirm) that the information above is atrue and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: D Hardcopy D Electronic Copy Date signed OFFICE USE ONLY Accepted: YI N Deficiency:__________ Processed Date/Initials:_____ Scanned Date/Initials: ______ 138_01-22 COE2010 OUTSIDE EMPLOYMENT STATEMENT For Full-time County and Municipal Employees FiECE!VED Full-time County (including Public Health Trust) and municipal employees engaging in outside employment must file an afntr~ di!cfost~J~eport by July 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami-Dade County Code. cny OF MIAMI BEACH Disclosure for Tax Year Ending 2020 Last Name McClain First Name Montrice LMrtltlh!=Na'li'ldlll'iltia!I I Y CLEAi< N Malling Address -Street Number, Street Name, or P.O. Box 1811 NW 69 Street City, State, Zip Miami, FL 33147 If your home address is exempt from public records pursuantto Florida Statutes §119.07, please see note on the following page and check here. D Filing as an Employee (check one) D County D Public Health Trust 0 Municipal City of Miami Beach (Municipality) Department Public Works Division Operations Position or Title Control Room Supervisor Employee ID Number 22967 Work telephone (305) 673-7625 Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other compensation you received for each source of outside employment. If no income or compensation was received from a particular outside employment, enter mm (0) for that organization in the section below. If continued on aseparate sheet, check here. D Name and Address of the Source of Outside Income Nature of the Work Periormed Total Amount of Money or Compensation Received MlC\aih Stqno.tu.rt g(IX\ltet~ l.fl {'lot11vy ~ Admtn1siro.1vt Suv. t 30. 00 I hereby swear (or affirm) that the information above is atrue and correct statement. Signature MPerson Disclosing RECEIVED BY ELECTIONS DEPARTMENT: □ Hardcopy D Electronic Copy Date signed OFFICE USE ONLY Accepted: Y / N Deficiency:__________ Processed Date/Initials:_____ Scanned Date/lnlllals: ______ 138_0H!2 COE 2018 HECE!Vt:UOUTSIDE EMPLOYMENT STATEMENT For Full-time County and Municipal Employees FEB 16 2023 Full-time County (including Public Health Trust) and municipal employees engaging in outside employment mustalfeafi€lfritMldM\tlbifiilrjliilt by July 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami-Dade County Code. OFFICF. oi: THE CITY Cl RK Disclosure for Tax Vear Ending 2019 Last Name McClain First Name Montrice Middle Name/Initial N Mailing Address -Street Number, Street Name, or P.O. Box 1811 NW 69 Street City, State, Zip Miami, FL 33147 If your home address is exemptfrom public records pursuant to Florida Statutes §119.07, please see note on the following page ancl check here. D Filing as an Employee (check one) D County D Public Health Trust 0 Municipal City of Miami Beach (Municipality) Department Public Works DiVision Operations Position or Title Control Room Supervisor Employee ID Number 22967 Work telephone (305) 673-7625 Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other compensation you received for each source of outside employment. If no income or compensation was received from a particular outside employment, enter~ (0) for that organization in the section below. If continued on a separate sheet, check here. D Name and Address of the Source of Outside Income Nature of the Work Perfonned Total Amount of Money or Compensation Received McClain Signature Services LLC Notary and Administrative Services Mo.oo Soo.si J Tu~q.s LL.C. C6'.tt.,n ng t o.oo I hereby swear (or affirm) that the information above Is atrue and correct statement (JJ//odJLvtL ~ Signature otPerson Disclosing RECEIVED BY ELECTIONS DEPARTMENT: □ Hardcopy D Electronic Copy Date signed OFFICE USE ONLY Accepted: y / N Deficiency:__________ Processed Date/Initials:______ Scanned Date/Initials: ______ 138_01·22 COE 2016 MIAMI OUTSIDE EMPLOYMENT STATEMENT j ~i• • For Full-time County and Municipal Employees FEB 16 2023 Full-time County (Including Public Health Trust) and municipal employees engaging in outside employment mus0ilifa'n(aan~all~l$¢.l,IJ@tglt;@Prt by July 1st of each year, in accordance with Section 2-11.1 (k)(2) of the Miami-Dade County Code. OFFlnr= nr-THP GITY CLERK Disclosure for Tax Vear Ending 2018 Last Name McClain First Name Montrice Middle Name/Initial N Mailing Address -Street Number, Street Name, or P.O. Box 1811 NW 69 Street City, State, Zip Miami, FL 33147 If your home address Is exempt from public records pursuant to Florida Statutes §119.07, please see note on the following page and check here. D Filing as an Employee {check one) D County D Public Health Trust El Municipal City of Miami Beach {Munioipalily) Department Public Works Division Operations Position or Title Control Room Supervisor Employee ID Number 22967 Work telephone (305) 673-7625 Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other compensation you received for each source of outside employment. If no income or compensation was received from a particular outside employment, enter zero (0) for that organization in the section below. If continued on a separate sheet1 check here. D Name and Address of the Source of Outside Income Nature of the Work Performed Total Amount of Money or Compensation Received tt 0,01)Sou.si t 1han~s LLC. Ca,-wri "~ I hereby swear (or affirm) that the information above is atrue and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: □ Hardcopy D Electronic Copy Signature of Person Disclosing Date signed OFFICE USE ONLY Accepted: Y / N Deficiency:,___________ Processed Date/Initials:_____ Scanned Date/Initials: _____ 138_01·22 COE 2016