11
ODen Letter to Contractors Performine:Services on Sadler Point Marina ProDertV: Welcome to Sadler Point Marina, Inc. We hope you will find our facility a convenient place to work. As our cost of doing business continues to increase, particularly insurance coverage, we need to clarify our requirements for those who work on our property. Before you commence your work you and/or your company must be pre-approved with our office. This requires the following conditions be met: 1. All Contractors must have on file with our office a copy of a current Marine Commercial Liability Insurance Policy with appropriate limits, listing Sadler Point Marina, Inc. as additional insured. We have included in this packet a brochure with information on how to obtain this coverage for your business. Please see attached letter from our insurance agent for more information. 2. All contractors need to provide us either proof of workers compensation coverage or proof that they are exempt from such coverage. Please see attached information from our WC carrier for more information. . 3. All contractors will pay Sadler Point a percentage of their charges for work they perform on Sadler Point Marina premises. The percentage is ten percent for contractors who buy all of their materials through our parts store and twenty percent for those who supply their own materials. These fees are independent of all haul-out, storage, and service charges that Sadler Point charges. 4. You will also find two agreements in this packet titled "Rules and Regulations" and "Environmental Policy". Please take the time to read, understand, sign and return them as this is required as part of your pre-approval process. We look forward to working with you once you have met the above obligations. Remember, Sadler Point has the right to exclude contractors from our property who do not meet our requirements or follow our rules. If you have any questions please feel free to contact me. Sincerely, Brooks Busey Proprietor Sadler Point Marina, Inc. 4669 Roosevelt Boulevard Jacksonville, Florida 32210 Phone: 384-1383

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Page 1: ODenLetter to Contractors Performine:Services on Sadler ......7. Sadler Point provides for cost-free waste disposal in nearly all circumstances. Please ask ifyou are not sure whatto

ODen Letter to Contractors Performine:Services on Sadler Point Marina ProDertV:

Welcome to Sadler Point Marina, Inc. We hope you will find our facility a convenientplace to work. As our cost of doing business continues to increase, particularly insurancecoverage, we need to clarify our requirements for those who work on our property. Beforeyou commence your work you and/or your company must be pre-approved with our office.This requires the following conditions be met:

1. All Contractors must have on file with our office a copy of a current Marine CommercialLiability Insurance Policy with appropriate limits, listing Sadler Point Marina, Inc. asadditional insured. We have included in this packet a brochure with information on howto obtain this coverage for your business. Please see attached letter from our insuranceagent for more information.

2. All contractors need to provide us either proof of workers compensation coverage orproof that they are exempt from such coverage. Please see attached information from ourWC carrier for more information. .

3. All contractors will pay Sadler Point a percentage of their charges for work they performon Sadler Point Marina premises. The percentage is ten percent for contractors who buyall of their materials through our parts store and twenty percent for those who supplytheir own materials. These fees are independent of all haul-out, storage, and servicecharges that Sadler Point charges.

4. You will also find two agreements in this packet titled "Rules and Regulations" and"Environmental Policy". Please take the time to read, understand, sign and return them asthis is required as part of your pre-approval process.

We look forward to working with you once you have met the above obligations. Remember,Sadler Point has the right to exclude contractors from our property who do not meet ourrequirements or follow our rules. If you have any questions please feel free to contact me.

Sincerely,

Brooks BuseyProprietorSadler Point Marina, Inc.

4669 Roosevelt Boulevard Jacksonville, Florida 32210 Phone: 384-1383

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Sadler Point Marina Environmental Policy

We believe that the St. Johns River and it's tributaries are one of our community's greatest natural resources,contribute significantly to our quality of life, and substantially benefit our businesses and local economy.

We recognize that we, as businesses and individuals, may have adverse impacts on our waterways andenvironment, and thus, we have an obligation to mitigate those impacts. In addition, we understand that we havea personal responsibility to operate our businesses and to make personal choices that will not knowingly harm.the St. Johns River or its tributaries.

Therefore, we have decided not to rely exclusively on government or others to address the problems impactingour waterways. Sadler Point Marina has committed to donate a percentage of sales to help protect and restorethe St. Johns River by supporting the efforts of St. Johns Riverkeeper.

We ask that all customers and contractors working on our property read, understand, and follow theseguidelines in order to support our efforts:

I. Anyone working on a vessel must report to our office the type and amount of paints used for all jobsdone while at SPM.

2. Hose spray nozzles are required on all hoses.

3. No spray painting outside of an enclosure.

4. All sanding requires use of a dustless vacuum sander or tenting of the vessel. You may not wetsand,scrub, pressure wash or otherwise abrade antifouling paint outside of our water reclamation area.

5. Work areas around the vessel must be kept clean at all times. Vessels will not be launched until yourarea is clean. Clean up charges will be assessed if we determine necessary. Please pay particularattention to dust and paint chips exposed to storm water runoff.

6. No discharge of bilge, tankage or hazardous waste is allowed except into approved containers ordrums. Owners and their agents are responsible for proper environmental waste disposal.

7. Sadler Point provides for cost-free waste disposal in nearly all circumstances. Please ask if you are notsure whatto do with something. This includes but is not limited to used oil and fuel, batteries, paints,thinners, solvents, flares, bilge switches, etc.

8. Weather conditions occasionally prohibit the safe use of some techniques and procedures. Please payattention to pending changes in weather.

9. The cleaning and scraping of hull bottoms including removing barnacles from running gear whilevessels are in the water is strictly prohibited.

10. In the event of an approaching named storm, owners and contractors must acquaint themselves withSPM's Hurricane Preparedness Plan, plan accordingly and assist SPM in assuring all steps are taken tominimize storm damage.

I have received, read and understand the above Environmental Policy and agree to adhere toit while using Sadler Point services and facilities.

Signature:

Printed Name:

Date:

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Sadler Point Marina Rules and Regulations

1. All contractors must be pre-approved and schedule work projects with our office prior toarrival.

2. All contractors must sign in and out when entering and exiting the yard.

3. Sadler Point Marina must have a signed Work Order and/or Storage Agreement for eachvessel at our docks or in our yard.

4. All subcontractors must have on file with our office a current Marine Commercial LiabiljtyInsurance Policy with an appropriate limit, listing Sadler Point Marina, Inc. as additional insured. Seeattached letter from our insurance carrier for more information.

5. All yard fees must be paid in full before any vessel leaves our property.

6. All contractors will pay Sadler Point a percentage of their charges for work theyperform on Sadler Point Marina premises. The percentage is ten percent for contractors whobuy all of their materials through our parts store and twenty percent for those who supplytheir own materials. These fees are independent of all haul-out, storage, and service chargesthat Sadler Point charges.

7. No alcoholic beverages permitted in the yard.

8. Vehicles may not drive from the parking lot into the yard without written permission.

9. Only SPM employees may relocate jack stands or blocking.

10. SPM is not responsible for any theft, loss or damages that occur while vessel is on thepremIses.

II. SPM is not responsible for vehicles that are damaged by equipment or conditions in the yard.

12. Please follow all other posted rules in the yard.

Sadler Point reserves the right to bar those owners, contractors and their agents from our propertywho do not follow these rules.

I have received, read and understood the above rules and regulations and agree to abide bythem while using Sadler Point services and facilities.

Signature:

Printed Name:

Date:

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Sadler Point Marina, Inc..Subcontractor Info and Contact Form

Please type or clearly print as much information as possible:

Business NamePrimary Contact NameWork NumberWork FaxEmail addressWebsite address

Mailing Address

Emergency contact info

Scope of services

Additional Information

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Beale Marine & Casualty, Inc.Post Office Box 5910Jacksonville, Florida 32247Ph: 904-399-0508 Fax: 904-399-8806Email: [email protected] .

WWW.beaJemarine.com

According to Sadler Point Marina's liability insurance carrier, any person orcompany providing services or doing business on the premises or on behalfof Sadler Point is required to provide a certificate of insurance showing thefollowing coverage as well as naming Sadler Point Marina, Inc. as anadditional insured:

Marine General Liability Coverage including but not limited to:COMPREHENSIVE GENERAL LIABILITYSHIP REPAIRER LEGAL LIABILITY LIMITPROTECTON AND INDEMNITY LIMITPRODUCTS AND COMPLETED OPERATIONS LIMITPERSONAL AND ADVERTISING LIMITFIRE DAMAGE LIABILITY LIMITMEDICAL EXPENSIVE LIMITANNUAL AGGREGATE, OTHER THAN PRODUCTS AND

COMPLETED OPERATIONLIMITED POLLUTION COVERAGE

$1,000,000$1,000,000$1,000,000$1,000,000$1,000,000$1,000,000$2,500$2,000,000

$25,000

Since 1986 Insuring:Yachts, Marina's, Ship Repairers, Marine Manufacturer's,Stevedores, Tug & Barge, Marine Contractor's, CharterBoat's, Head Boat's, Passenger Vessel's, Builder's Risk,Worker's Compensation, Cargo, Pollution, Etc.

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NOTICE OF ELECTION TO BE EXEMPTPlease thoroughly read the instructions before completing this application. Print legibly in each data entry field. Ifthis"application contains incomplete orinaccurate information or if~he handwriting is not legible, it may cause a delay in the issuance of your exemption.

THIS APPLICATION IS CONTINUED ON PAGE 2

owe 250, NOTICE OF ELECTION TO BE EXEMPT - REVISED 10/2006

SECTION 1:

Applicant Name (please print):,

Applicant's social security number or individual taxpayer ID: / / "

Applicant's E-mail address (optional):

SECTION 2: I am applying for exemption as a (You must check only one box in this section):

CONSTRUCTION INDUSTRY ($50 FEE REQUIRED)o Officer of a Corporation (Title): -OR- 0 Member of a Limited Liability Company (LLC)

NON-CONSTRUCTION INDUSTRY (NO FEE REQUIRED)o Officer of a Corporation (Title): )

The Divisionwill accept a moneyorder, a cashier's check, or an electronicpayment made payableto the DFS we AdministrationTrust Fund.An officer electinl! an exemption under Chapter 440, Florida Statutes is not entitled to benefits under this chapter.

SECTION 3. To be eligible for an exemption, the corporation of which you are an officer or the limited liability company of whichyou are a member must be registered with the Florida Division of Corporations. For applicants applying as an officer of acorporation, you must be listed as an officer of the Corporation with the Florida Division of Corporations. List the documentnumber (document number shown on your Annual Report) on file with the Florida Division of Corporations.

SECTION 4. This exemption application applies only to the person signing the application, the CorporationlLLC that is listedbelow, and the scope of business or trade listed:

Name of Corporation or LLC: FEIN:AS REGIS fERED WITH I HE FLORIDA DIVISION Of CORPORA I IONS

Business Name: Phone: ( )IF APPLICABLE - LIST FICTIOUS NAME; DOING BUSINESS AS (DBA); ALSO KNOW N AS NAME (AKA)

Business Mailing Address:INCLUDE APARTMENT OR SUITE NUMBER

City: State: Zip: County:

Scope of Business or Trade of Applicant: 1. 2. 3.

SECTION 5. List all certified or registered licenses issued pursuant to Chapter 489, F.S. held by the applicant, or the certified orregistered license numbers held by the qualifier for the corporation or LLC listed on this application of which the applicant is acorporate officer:

SECTION 6. Does the county or municipality in which your business is located require an occupational license for your business?DYes ONo . IF YES,A COPY OF A CURRENTOCCUPATIONALLICENSEMUSTBE ATTACHED.

SECTION 7. Are you affiliated with any corporation (including LLC) other than the corporation (including LLC) to which thisapplication applies? DYes 0 NoIF YES, PLEASE LIST THE NAME(s) AND FEIN(s) OF THE AFFILIATED CORPORATlON(s) OR LLC(s):NAME: FEIN:

SECTION 8. If your corporation or LLC is engaged in the construction industry, you must provide the required proof ofownership in the corporation or LLC.A. To be eligible for a construction industry exemption as an officer of a corporation, the applicant must be a shareholder,

owning at least 10% of the stock of the corporation. A COPY OF A STOCK CERTIFICATE EVIDENCING THEREQUIRED OWNERSHIP MUST BE ATTACHED.

B. To be eligible for a construction industry exemption as a member of a limited liability company, the applicant mustconfirm ownership of at least 10% of the company. THE REQUIRED OWNERSHIP MAYBE ESTABLISHED BYPRODUCTION OF DOCUMENTATION REFLECTING THE REQUIRED OWNERSHIP, OR BYSUBMITTING A STATEMENT ATTESTING TO THE REQUIRED OWNERSHIP.

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NOTICE OF ELECTION TO BE EXEMPT - Page 2

SECTION 9. FRAUD NOTICE

A. Any person who, knowingly and with intent to injure, defraud, or deceive the department or any employer oremployee, insurance company or any other persoQ, files a notice of election to be exempt containing any false ormisleadinginformation is guilty of a felonyof the third degree. .

B. Attestation of applicant -By signing below, I attest that I have read, understand and acknowledge the foregoingnotice.

SIGNATURE OF APPLICANT

SECTION 10. You must identify the workers' compensation insurance carrier that covers any non-exempt employees of yourbusiness. Carrier Name:

AFFIDAVIT OF APPLICANT: I hereby certify that the information contained herein is true and correct to the best of myknowledge and belief; that this election does not exceed exemption limits for corporate officers, including any affiliatedcorporations as provided in §440.02 Florida Statutes.

APPLICANT'S SIGNATURE

NOTARY STATE OF FLORIDA, COUNTY OF

DATE SIGNED

Sworn to and subscribed before me this_ day of

Personally Known_ OR Produced Identification_ Type ofIdentificationProduced

NOTARY SIGNATURE Mv Commission Expires

Please mail or submit your completed application, application fee, and anyrequired attachments to the district office nearest your place of business.

4415 Metro ParkwaySuite #300Ft. Myers FL 33916Telephone (239) 938-1840

610 E. Burgess RoadPensacola, FL 32504-6320Telephone(850)453-7804

3111 S. Dixie HighwaySuite #123West Palm Beach FL 33405Telephone (561) 837-5716

1718 Main Street, Suite 201Sarasota FL 34236Telephone (941) 329-1120

921 N. Davis StreetBuilding B, Suite #250Jacksonville, FL 32209Telephone (904) 798-5806

400 West Robinson StreetRoom #512, North TowerOrlando FL 32801

.Telephone (407) 835-4406 or(407) 245-0896

499 Northwest 70thAvenueSuite #116Plantation FL 33317Telephone (954) 321-2906

1313 N. Tampa StreetSuite #503Tampa FL 33602Telephone (813) 221-6506

DWC 250, NOTICE OF ELECTION TO BE EXEMPT -REVISED 10/2006

401 NW 2nd AvenueSuite #321, South TowerMiami FL 33128Telephone (305) 536-0306

1111 NE 25thAvenueSuite #403Ocala FL 34470Telephone (352) 401-5350

TALLAHASSEESUBMITTERS

Walk-in submissions:

2012 Capital Circle SESuite #102, Hartman Bldg.Tallahassee FL 32399-2161Telephone (850) 413-1609

Mail in submissions:200 East Gaines StreetTallahassee FL 32399-4228Telephone (850) 413-1609

, by

STATE USE ONLYEffective/Issue Date:

Expiration Date:

Control Number:

Postmark Date:

Received Date:

Payment Number:

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INSTRUCTIONS FOR COMPLETING NOTICE OF ELECTION TO BE EXEMPT

IMPORTANT INFORMATION:

Onlv corporate officers or members of a limited liability company (LLC) engaged in the construction industry are eligible for an exemption. Non-construction LLC members are NOT ELIGIBLE for an exemption.

Under the law, the Division has 30 days to review your application to determine if it meetS the eligibility requirements for the issuance of anexemption. The Division will either issue a Certificate of Election to be Exempt to you if your application is complete or notify you by mail thatyour application is incomplete and what information or documents are needed to complete the application. The Division reviews and processesexemption applications in the order they are received. Applicants filing this application to renew a current exemption should submit the applicationto the Division at least 45 days prior to the expiration date of their current exemption.

You can visit the Division's website at htto://www.fldfs.comlWC/and click on the Proof of Coverage icon on the right hand side of the page. Assoon as the Division issues your exemption, it will be reflected on the Proof of Coverage database and your certificate of exemption will be mailedthe day after it is issued. You should receive your Certificate of Election to be Exempt 7-10 days after the exemption has been issued.

If your corporation is dissolved or inactive, your Notice of Election to be Exempt will be DENIED. If the Notice of Election to be Exemptis denied, the applicant must submit a new Notice of Election to be Exempt and, if the applicant is engaged in the construction industry,another $50.00 fee is required.

An exemption is subject to revocation if the person named on the certificate no longer meets any of the requirements to be eligible for anexemption.

If you have any questions in regards to completing this application, please call the Division's Customer Service Center at (850) 413-1609 and pressoption #2.

SECTION]. Printyour name and social securitynumber,or individualtaxpayeridentificationnumber. Please list your e-mailaddress. Inadditionto mailing a future renewalapplicationto you, the Divisionwill also e-mailthe renewalapplicationto you.

SECTION 2. If you are applyingfor an exemptionas an officerof a corporationor member of a limitedliabilitycompanyengagedin theconstructionindustry,you must checkone ofthe boxes beneaththe heading"CONSTRUCTION INDUSTRY" ($50 FEE REQUIRED). TheDivision will accept a money order, a cashier's check or an electronic payment made payable to the DFS WC Administration Trust Fund.If you are applyingas an officerofa corporation,you must listyour corporatetitle (no abbreviationsplease).

If you are applying for exemption as an officer of a corporation not engaged in the construction industry, you must check the box next to "Officerof a Corporation" beneath the heading NON-CONSTRUCTION INDUSTRY (NO FEE REQUIRED), and list your corporate title (noabbreviations please).

SECTION 3. The registration number is the document number that was assigned to your corporation or limited liability company by theFlorida Division of Corporations when your corporation or limited liability company was established. This number can be found on your annualreport that you have filed with the Florida Division of Corporations. Your document number can also be found at the Florida Division ofCorporation's website, htto://www.sunbiz.orgf. Your corporation or limited liability company must be registered with the Florida Division ofCorporations. For applicants applying as an officer of a corporation, you must be listed as an officer of the Corporation with the Florida Divisionof Corporations.

SECTION 4. This section should be completed with information that is specific to your corporation, or to the limited liability company inwhich you are a member. Please include your complete corporate name, including Inc. or Corp., or the complete name ofthe limited liabilitycompany. The name of the corporation or limited liability company listed on the application must match the name of corporation or limitedliability company registered with the Florida Division of Corporations. If applicable, include your' fictitious name, doing business as (DBA) name,or also known as name (AKA) in the 'Business Name' field. In the mailing address area, list only one complete address, including suite orapartment number. The certificate of exemotion and future renewal aoolications will be mailed to the address listed in this section. A federalemployer identification number (FEIN) is required unless the application is for a single member limited liability company in which case themember's social security number will suffice for the limited liability company's FEIN. For information regarding FEIN, you may call the IRS at(800) 829-4933.

The certificate applies only to the corporation or limited liability company listed in this section. A new certificate must be obtained for each new oradditional corporation or limited liability company employing the applicant.

Scope of Trade or Business of Applicant refers to the trade or business activity that best describes your business. The issued certificate ofexemption will apply only within the scope of the business or trade listed.

SECTION 5. Certified or Registered licenses refer to any licenses that are issued by the Department of Business and ProfessionalRegulations (DBPR) as required by Chapter 489 F.S. Contractors are required to obtain a certified or registered license ITomDBPR. If you needadditional information about DBPR licensing requirements, please contact DBPR at (850) 487- 1395 or visit their website athtto://www.state.fl.us/dbor/. If a contractor licensed under Chapter 489 F.S. has applied to Department of Business and Professional Regulationsfor a change of business status, the applicant should list their current license number and specify that the change of status is "Pending."

Workers' Compensation Information Online - www.fldfs.com/wcDWC INSTRUCTIONS-NOTICEOF ELECTIONTO BE EXEMPT,REVISED10/2006

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SECTION 6. Each applicant, including an applicant outside the state of Florida, must submit a copy of an occupational license required bythe city or county in which the business is located or performing regular work. If the city or county does not require an occupational license, check"NO" for this section.

If the applicant is required to obtain a license issued pursuant to Chapter 489 F.S., the business name listed on the occupational license oroccupational license receipt must match the name of the corporation or limited liability company listed on the Notice of Election to be Exempt orthe application will be returned as incomplete.

If the applicant is not required to obtain a license issued pursuant to Chapter 489, F.S. the name of the corporation, limited liability company, orbusiness listed on the Notice of Election to be Exempt must match the business name listed on the occupational license or occupational licensereceipt, or the application will be returned as incomplete.

SECTION 7. If the corporation (including any limited liability company) of which you are an officer is affiliated with other corporations,(including limited liability companies), please list the name and FEIN of each such affiliated corporation (including limited liabilitY companies). Ifthere is more than one affiliated corporation (including limited liability companies), please attach a separate sheet identifYing the affiliatedcorporations (including limited liability companies).

If the corporation (including any limited liability company) of which you are an officer is not affiliated with any other corporation, (includinglimited liability companies), based upon the definition of "Affiliated Corporation" below, please indicate "Not Applicable."

For purposes of determining whether there are affiliated corporations of the corporation for which you are an officer, the following statutorydefinition applies: Affiliated corporations means and includes one or more corporations or entities, anyone of which is a corporation engaged inthe construction industry, under the same or substantially the same control of a group of business entities which are connected or associated so thatone entity controls or has the power to control each of the other business entities. The term "affiliated" includes, but is not limited to, the officers,directors, executives, shareholders active in management, employees, and agents of the affiliated corporation. The ownership by one entity or apooling of equipment or income among business entities shall be prima facie evidence that one business is affiliated with the other. No more

than three (3) officers of a corporation (including limited liability companies) or of any group of affiliated corporations (including limitedliability companies) may elect to be exempt.

SECTION 8. This section onlv applies to construction industry exemption applicants. Non-construction industry applicants do notneed to complete this section.

A. CORPORATION - The applicant for a construction industry exemption must attach copies of the stock certificate(s) evidencing at least 10%ownership in the corporation. There is no requirement for a corporate seal or for the certificate to be notarized. At a minimum, each stockcertificate must include:

. The name of the issuing corporation.·The state under which the corporation is organized.·The name of the person to whom the certificate is issued..An officer of the corporation must sign the certificate

·The percent of ownership that the issued shares represent (a stockregister can be provided in lieu of this requirement).· The number of shares issued by the corporation.

B. LIMITED LIABILITY COMPANY -The applicant for a construction industry exemption must produce documentation reflecting that theapplicant owns at least 10% the limited liability company, or submit a statement attesting that the applicant owns at least 10% of the limitedliability company.

SECTION 9. Each applicant must read the fraud notice and provide his or her signature in the appropriate area. The signature is anattestationthat the fraud noticewas read, understoodand acknowledged.

SECTION 10. List the name of the workers' compensation insurance carrier that covers your non-exempt employees. If you do not have non-exempt employees please indicate "not applicable."

If you are in the construction industry, workers' compensation coverage must be secured once you employ one or more employees. If you are inthe non-construction industry, workers' compensation coverage must be secured once you employ four or more employees.

NOTE: Corporate officers are counted as employees unless they have been issued a certificate of election to be exempt from the Divisionof Workers' Compensation.

Failure to secure workers' compensation coverage as defined in S. 440.107(2),F.S., shall result in the issuance of a stop-work order and anorder of penalty assessment.

AFFIDA VIT OF APPLICANT: An affidavit is a sworn statement in writing made under oath or on affirmation before an authorized officer.This section should be completed after careful review of the statement being attested to. The application should not be signed or dated until youare in the presence of a notary public.

NOTARY PUBLIC: The application must be notarized prior to submission. Any licensed notary public may notarize the application. Theyshould not be related to you. Most banks have a notary public available to notarize documents. There may be a charge for this service. Please beadvised that workers' compensation office personnel do not notarize applications for Notice of Election to be Exempt.

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(~ '-"

Vsilimmit"...the 'O(!of)le who ,

;.. kilo.., workers' comp@LOSS CONTROL SERVICES

November 30, 2007

Mr. S. Brooks Busey, PresidentSadler Point Marina, Inc.4669 Roosevelt BoulevardJacksonville, FL 32210

Date: 11/3012007

Policy#: FRF SIF 0520-28418

Location: Telephone

Contact: S. Brooks Busey

Dear Mr. Busey:

The Florida Retail Federation Self Insurers Fund, which is administered by Summit, providesyour company's workers' compensation insurance. As part of your coverage, you receiveloss control services that can help you identify potential hazards, address safety concerns,and potentially lower your workers' comp costs.

During our recent telepbone conversatio~"wereviewed y~ur,personnel practices, work activities,safety procedures, and employee injuries. As a result of this 'sUrVey,-Ioffer'the followingrecommendation:

RECOMMENDATION:

07-11-1

To exclude an independent contractor/subcontractor from your Workers' Compensationaudit he/she should be required to (before work begins):

Sign a written contractFurnish a signed affidavit stating that there are no employeeslhelpersFurnish a valid Certificate of General Liability InsuranceFurnish a copy of their occupational license (if county requires)Furnish a valid state approved exemption form (Construction Industry)-OR-Furnish a valid Certificate of Workers' Compensation Insurance

All contracts or certificates must be retained on ~e and should be reviewed periodicallyto verify current coverage.

South,.".s. Region

P.O. Box 80439 . Baton Rouge, LA 70898-0439(225) 926-3264 . 1-800-421-2944

Fax (225) 926-4102

Florid:lfCorporate Offi.e

P.O. Box 1087 . Lakeland,FL 33802-1087

(863) 665-6060 . 1-800-282-7648

Fax (863)665-3546www.summitholdings.com

Southeast Rej!ion

P.O. Box 600 . Gainesville, GA 30503-0600(678)450-5825 . 1-800-971-2667

Fax (770) 531-1349

Contents of this report are based upon conditions and practices observed and infonnation supplied by company personnel at the time of this visit. II is not purported 10 list aU hazards nor to indicale that other hazards do nol

exist. There is no guarantee of exemption fiom citalion by any legally constituted authority of any state or federal occupational safety and health standard, Recommendations made by Summit are advisory and are designed toassist the employer in the cstabUshment and majntenance of his own Joss-prevention activities. Summit assumes no responsibility for the control of these activities nor for the correction of the conditions pointed out within thebody of this report.

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Sadler Point Marina, Inc.FRF SIP 0520-28418Page 2

We encourage you to take advantage of our loss control resources--e.g., posters and safetyvideos-that are available to you. Additional information is also available on our companywebsite at www.summitholdings.com.

Thank you for the time and courtesy extended to me during our conversation. If you haveany questions or need assistance prior to our next visit, please feel free to contact me.

Sincerely,

Kevin Dobson, OHSTLoss Control Consultant

KD/ajb

ContenlS of this repon are based upon conditions and practices observed and infonnation supp1ied by company personnel at the time of this visit. It is not purported to list all hazards nor to indicate that other hazards do notexist. There is no guarantee of exemption from citation by any legally constituted authority of any state of-federal occupational safety and health stnndard. Recommendations made by Summit's Loss Control depanment are:

advisory and are designed to assist the employer in the establishment and maintenance of his own loss.prcvcntion activities. Summit assumes no responsibitity for Ihc control of these activities nor for the correclion of IIu:

conditions pointed out within the body of this report. (Summit includes Summit Consul~ng Inc.. and its affiliates.)