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RESIDENTIAL EXTERIOR IMPROVEMENT GRANT AGREEMENT - NG-R-25-08RESIDENTIAL EXTERIOR IMPROVEMENT GRANT AGREEMENT NG -R-25-08 /� This Residential Exterior Improvement Grant Agreement (this "Agreement") is made as of Oa n3, tag (the "Effective Date"), by and between THE COMMUNITY REDEVELOPMENT AGENCY OF THE CITY OF CLEARWATER, FLORIDA, a public body corporate and politic of the State of Florida created purs}},i,�; nt,�t �to Part III, Chapter 163, Florida Statutes (the "Agency"), and Robert and Carolina Washingto% married couple (together, the "Applicant ")(collectively the Agency and the Applicant are the "Parties"). WITNESSETH: WHEREAS, the Agency was created to implement community redevelopment activities as provided in the Florida Community Redevelopment Act of 1969 (the "Act") codified at Chapter 163, Part III, Florida Statutes; and WHEREAS, on January 12, 2023, the Agency adopted the North Greenwood Community Redevelopment Area Plan (the "Plan"); and WHEREAS, in furtherance of the Plan, the Agency has established the Residential Exterior Improvement Grant Program (the "Program") to rehabilitate single-family homes, improve property conditions, aesthetics, reduce housing cost burden, and aid in the elimination of slum and blight in the North Greenwood Community Redevelopment Area (the "Redevelopment Area"); and WHEREAS, the Agency has approved a grant to the Applicant in an amount not to exceed $18,274.00 in financial assistance under the Program to provide exterior improvement assistance to the property located at 1754 Fulton Avenue, Clearwater, Florida 33755 (the "Property"). The grant is intended to replace AC, electrical upgrades, roof replacement, tree removal and install a new hot water heater at the Property (the "Project") as further detailed in the Applicant's grant application and plan specifications attached hereto as Exhibit "C" (the "Specifications"); and WHEREAS, the Agency finds that providing financial assistance for the exterior improvement of the Property is a permissible use of the Agency's funds; and WHEREAS, the Agency finds that the Project comports with and furthers the goals, objectives, and policies of the Plan. NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the Parties hereby agree as follows: I. GENERAL 1. Recitals. The foregoing recitals are true and correct and are incorporated in and form a part of this Agreement. 2. Purpose of Agreement. The purpose of this Agreement is to further the implementation of the Plan by the completion of the Project. 1 3. Legal Description. The legal description for the Property is attached hereto as Exhibit "A". II. APPLICANT WARRANTIES AND RESPONSIBILITIES 1. Development of the Project. The Applicant shall complete the Project in accordance with the Specifications and the grant application. The Applicant shall complete all Project work within one hundred and eighty (180) days from the date of application approval. Such completion shall be evidenced by receipt of a Finding of Project Completion from the Agency. A Finding of Project Completion shall be granted in accordance with the criteria contained in the Agency's Residential Exterior Improvement Grant Policy attached hereto as Exhibit "B" (the "Policy"). The date of application approval shall be the Effective Date. 2. Applicant's Project Contribution. As a condition of receiving reimbursement grant funding from the Agency, the Applicant shall provide one thousand eight hundred twenty-seven dollars and 40/100 cents ($1,827.40) in monetary contribution (the "Monetary Contribution") toward the Project. Evidence of expenditure of the Monetary Contribution towards the Project shall be submitted to the Agency's satisfaction before disbursement of the Agency's grant funding. Notwithstanding the foregoing, the Applicant may have the Monetary Contribution reduced if the Applicant completes certain community service acts in accordance with the Policy. The Applicant has agreed to complete thirteen (13) hours of community service ("Hours") reducing the Monetary Contribution to zero dollars and 00/100 cents ($0.00) (the "Reduced Contribution"). In the event the Applicant is unable to provide the number of Hours agreed to herein, the Reduced Contribution shall be calculated only by the number of Hours actually provided. The difference between the Monetary Contribution and the Reduced Contribution shall be added to the balance of the Applicant's available grant funds. For avoidance of doubt, the amount that can be added to the Applicant's available grant funds is the amount of money that is subtracted out of the Monetary Contribution for the completion of Hours to calculate the Reduced Contribution. Proof of completion of Hours shall be provided to the Agency before release of grant funds. 3. Warranties of the Applicant. The Applicant warrants that the following information is true and correct: a. The Applicant is the owner of the Property; b. A single-family home is located on the Property; c. The Property is located in the Redevelopment Area; d. The Property is the primary residence and legal homestead of the Applicant or meets an alternative qualification under the Policy; e. The Applicant is current on their property taxes for the Property or a payment plan has been approved by the Director; f. The Applicant is current on all mortgage payments, if applicable; 2 g. The Property has no outstanding code enforcement or building code violations or the Applicant has made the Agency aware of such violations and the Agency has agreed to allow the Project to move forward as the renovations will remediate any violations; and h. The Property has not received a grant from the Agency in the preceding thirty-six (36) months prior to the Effective Date. III. AGENCY RESPONSIBILITIES 1. Grant Funding. The Agency shall reimburse the Applicant for the Project's eligible costs up to a base amount of sixteen thousand four hundred forty-six dollars and 60/100 cents ($16,446.60). Depending upon the number of Hours completed or a waiver of the community service option pursuant to the Policy, the Applicant may receive up to an additional one thousand eight hundred twenty-seven dollars and 40/100 cents ($1,827.40) in grant funds for a total grant not to exceed eighteen thousand two hundred seventy-four dollars and 00/100 cents ($18,274.00) (the "Grant Funds"). The Grant Funds shall be payable within thirty (30) days of receipt of a fully completed reimbursement request after the issuance of a Finding of Project Completion by the Agency assuming the Applicant has also complied with Section II of this Agreement where applicable. 2. Upon agreement between the Agency and the Applicant, the Agency may provide the Grant Funds directly to any approved licensed contractor or vendor in lieu of providing the Grant Funds to the Applicant. Notwithstanding Paragraph 1 of this section, The Agency's director (the "Director") may allow earlier draw requests of the Grant Funds to approved licensed contractors or vendors in accordance with the Policy. However, the Grant Funds disbursed to a contractor or vendor shall not be disbursed more frequently than once every thirty (30) days. The Parties understand and agree that nothing in this Agreement creates any contractual relationship between the Agency and any contractor or vendor and the Agency shall not be liable for any monies owed to any contractor or vendor. The ability of the Agency to pay the contractor or vendor directly is only for the sake of convenience to the Applicant and the Applicant remains exclusively liable for any funds owed to the contractor or vendor. 3. If the Director determines that a reimbursement request does not meet the requirements of this Agreement or the Policy, then the Parties agree that the Agency shall not owe any monies to the Applicant for the requested reimbursement, the Applicant shall have no recourse against the Agency, and the Director's decision shall be final without any means of appeal. IV. APPLICANT DEFAULT 1. Failure to Timely Complete the Project. If the Applicant fails to obtain a Finding of Project Completion within one hundred eighty (180) days of the date of application approval, then the Parties agree that the Applicant shall be in default under this Agreement without notice or opportunity to cure the default. An extension to this timeframe may be granted by the Director for good cause if the Applicant submits a written request for such an extension before the expiration of the one hundred eighty (180) day period. 3 2. Other Events of Default. In addition to the foregoing event of default, the occurrence of any one or more of the following events after the Effective Date shall also constitute an event of default by the Applicant: a. The Applicant makes a general assignment for the benefit of its creditors, or admits in writing its inability to pay its debts as they become due or files a petition in bankruptcy, or is adjudicated a bankrupt or insolvent, or files a petition seeking any reorganization, arrangement, composition, readjustment, liquidation, dissolution or similar relief under any present or future statute, law or regulation or files an answer admitting, or fails reasonably to contest, the material allegations of a petition filed against it in any such proceeding, or seeks or consents to or acquiesce in the appointment of any trustee, receiver or liquidator of the Applicant or any material part of such entity's properties; b. Within sixty (60) days after the commencement of any proceeding by or against the Applicant seeking any reorganization, arrangement, composition, readjustment, liquidation, dissolution or similar relief under any present or future statute, law or regulation, such proceeding shall not have been dismissed or otherwise terminated, or if, within sixty (60) days after the appointment without the consent or acquiescence of the Applicant or any trustee, receiver or liquidator of any such entities or of any material part of any such entity's properties, such appointment shall not have been vacated; or c. A breach by the Applicant of any other term, condition, requirement, or warranty of this Agreement or the Policy. 3. Agency's Remedy Upon Certain Applicant Default. In the event of default and if the Applicant has failed to cure the default within the allotted time prescribed under Section IV, Paragraph 4 (if applicable), then the Parties agree that: a) this Agreement shall be null and void; b) that the Agency will have no further responsibility to the Applicant, including the responsibility to tender any remaining amounts of the Grant Funds to the Applicant; and c) that if the Agency has tendered any of the Grant Funds to the Applicant, the Agency shall be entitled to the return of all the Grant Funds plus default interest at a rate of ten percent (10%) starting from the date of default. The remedial provisions shall survive the termination of this Agreement. 4. Notice of Default and Opportunity to Cure. The Agency shall provide written notice of a default under Section IV, Paragraph 2 of this Agreement and provide the Applicant thirty (30) days from the date the notice is sent to cure such a default. This notice will be deemed received when sent by first class mail to the Applicant's notice address or when delivered to the Applicant if sent by a different means. V. MISCELLANEOUS 1. Notices. All notices, demands, requests for approvals, or other communications given by either party to another shall be in writing, and shall be sent to the office for each party indicated below and addressed as follows: 4 To the Applicant: Robert & Carolina Washington 1754 Fulton Ave. Clearwater, Florida 33755 To the Agency: Community Redevelopment Agency of the City of Clearwater P.O. Box 4748 Clearwater, Florida 33758 Attention: Executive Director with copies to: City of Clearwater P.O. Box 4748 Clearwater, Florida 33758 Attention: Clearwater City Attorney's Office 2. Unavoidable Delay. Any delay in performance of or inability to perform any obligation under this Agreement (other than an obligation to pay money) due to any event or condition described in this section as an event of "Unavoidable Delay" shall be excused in the manner provided in this section. 3. "Unavoidable Delay" means any of the following events or conditions or any combination thereof: acts of God, acts of the public enemy, riot, insurrection, war, pestilence, archaeological excavations required by law, unavailability of materials after timely ordering of same, building moratoria, epidemics, quarantine restrictions, freight embargoes, fire, lightning, hurricanes, earthquakes, tornadoes, floods, extremely abnormal and excessively inclement weather (as indicated by the records of the local weather bureau for a five year period preceding the Effective Date), strikes or labor disturbances, delays due to proceedings under Chapters 73 and 74, Florida Statutes, restoration in connection with any of the foregoing or any other cause beyond the reasonable control of the party performing the obligation in question, including, without limitation, such causes as may arise from the act of the other party to this Agreement, or acts of any governmental authority (except that acts of the Agency shall not constitute an Unavoidable Delay with respect to performance by the Agency). An application by any party hereto for an extension of time pursuant to this section must be in writing, must set forth in detail the reasons and causes of delay, and must be filed with the other party to this Agreement within thirty (30) days following the occurrence of the event or condition causing the Unavoidable Delay or thirty (30) days following the party becoming aware (or with the exercise of reasonable diligence should have become aware) of such occurrence. The party shall be entitled to an extension of time for an Unavoidable Delay only for the number of days of delay due solely to the occurrence of the event or condition causing such Unavoidable Delay and only to the extent that any such occurrence actually delays that party from proceeding with its rights, duties and obligations under this Agreement affected by such occurrence. In the event the party is the Applicant then the Director is authorized to grant an extension of time for an Unavoidable Delay for a period of up to six (6) months. 5 Any further requests for extensions of time from the Applicant under this section must be agreed to and approved by the Agency's Board of Trustees. 4. Indemnification. The Applicant agrees to assume all inherent risks of this Agreement and all liability therefore, and shall defend, indemnify, and hold harmless the Agency and the City of Clearwater, Florida, a Florida municipal corporation ("the City"), and the Agency's and the City's officers, agents, and employees from and against any and all claims of loss, liability and damages of whatever nature, to persons and property, including, without limiting the generality of the foregoing, death of any person and loss of the use of any property, except claims arising from the negligence of the Agency, the City, or the Agency's or the City's agents or employees. This includes, but is not limited to, matters arising out of or claimed to have been caused by or in any manner related to the Applicant's activities or those of any approved or unapproved invitee, contractor, subcontractor, or other person approved, authorized, or permitted by the Applicant whether or not based on negligence. Nothing herein shall be construed as consent by the Agency or the City to be sued by third parties, or as a waiver or modification of the provisions or limits of Section 768.28, Florida Statutes, or the Doctrine of Sovereign Immunity. 5. Assignability; Complete Agreement. This Agreement is non -assignable by either party and constitutes the entire Agreement between the Applicant and the Agency and all prior or contemporaneous oral and written agreements or representations of any nature with reference to the subject of this Agreement are canceled and superseded by the provisions of this Agreement. 6. Applicable Law and Construction. The laws of the State of Florida shall govern the validity, performance, and enforcement of this Agreement. This Agreement has been negotiated by the Agency and the Applicant, and the Agreement, including, without limitation, the exhibits, shall not be deemed to have been prepared by the Agency or the Applicant, but by all equally. 7. Severability. Should any section or part of this Agreement be rendered void, invalid, or unenforceable by any court of law, for any reason, such a determination shall not render void, invalid, or unenforceable any other section or part of this Agreement. 8. Amendments. This Agreement cannot be changed or revised except by written amendment signed by the Parties. 9. Jurisdiction and Venue. For purposes of any suit, action or other proceeding arising out of or relating to this Agreement, the Parties do acknowledge, consent, and agree that venue thereof is Pinellas County, Florida. Each party to this Agreement hereby submits to the jurisdiction of the State of Florida, Pinellas County and the courts thereof and to the jurisdiction of the United States District Court for the Middle District of Florida, for the purposes of any suit, action or other proceeding arising out of or relating to this Agreement and hereby agrees not to assert by 6 way of a motion as a defense or otherwise that such action is brought in an inconvenient forum or that the venue of such action is improper or that the subject matter thereof may not be enforced in or by such courts. If, at any time during the term of this Agreement, the Applicant is not a resident of the State of Florida or has no office, employee, agency, registered agent or general partner thereof available for service of process as a resident of the State of Florida, or if any permitted assignee thereof shall be a foreign corporation, partnership or other entity or shall have no officer, employee, agent, or general partner available for service of process in the State of Florida, the Applicant hereby designates the Secretary of State, State of Florida, its agent for the service of process in any court action between it and the Agency arising out of or relating to this Agreement and such service shall be made as provided by the laws of the State of Florida for service upon a nonresident; provided, however, that at the time of service on the Florida Secretary of State, a copy of such service shall be delivered to the Applicant at the address for notices as provided in Section V, Paragraph 1. 10. Termination. If not earlier terminated as provided in this Agreement, this Agreement shall expire and shall no longer be of any force and effect one hundred eighty (180) days from the anniversary of the date of application approval. IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed on the date and year first above written. 7 (CRA SIGNATURE PAGE) Approved as to form: Matthew J. Mytych, Esq. CRA Attorney Date: 1 0/1-Vls COMMUNITY REDEVELOPMENT AGENCY OF THE CITY OF CLEARWATER, FLORIDA, a public body corporate and politic of the State of Florida. By: 8 Jesus Nino CRA Executive Director Date: t/ Attest: r 2� Rosemarie Call City Clee��''ic� Date: +a1i'�k .�i 3 , '2101S 0�GvAR Wq TA4�>' z�qt.CORPORRr- S�z • 10o S SEAL = s0 • yam: (APPLICANT SIGNATURE PAGE) STATE OF FLORIDA ) COUNTY OF PINELLAS ) The foregoing instrument was acknowledged before notarization, this 24 day of 0 C -i -O6 cr personally known to me or ❑ who has/have produced STATE OF FLORIDA ) COUNTY OF PINELLAS ) The foregoing instrument was acknowledged before notarization, this $qday of 004 --oh er- personally known to me or ❑ who has/have produced (NO (' 41) •**** *Ve eF�� :4r 4i0• Icy COMMISSION EXPIRES 1240.2027 s, OF :,raj. 9 APPLICANT: By: Print name: ROAR Irlas��+on Title: Ownt r Date: /0/ f /.2O $ me by means �hysical presence or ❑ online , 2025 by REZerfVi1Gs��^� w'�io is/are a driver's license as identification. Notary Public, State of Florida Name of Notary: Wt 11i Gwi C, .%M f�e l I My Commission Expires: t2. -3e) -Z.0 Z7 My Commission No.: -1144732-iiit APPLICANT: By: C1.2„r.0. V:a�S1'un Print name: Cera 11 na. 110St; +o^ Title: O w't er Date: I \Zj$ c\'1,` me by means o'physical presence or ❑ online , 2025 by C.€ lmq Wa5411:0f0ho his/are a driver's license as identification. Notary Public, State o Florida N ry,! / Name of Notary: Wt [ lia wt C 1 •t.t,' b e. 11 My Commission Expires: !Z " 30 —2027 My Commission No.: 14 ft 473 21 S' EXHIBIT "A" LEGAL DESCRIPTION The South 35.72 feet lot of 4 and the north 21.42 feet of lots 5 in block "A" of a Vondale Subdivision, as recorded in Plat Book 7, page 40 of the Public Records of Pinellas County, Florida. 10 EXHIBIT "B" RESIDENTIAL EXTERIOR IMPROVEMENT GRANT PROGRAM POLICY 11 SECTION 9 — APPLICATION N 64- 9.6-- of 1) Applicant (Property Owner) Full Legal Name(s): rosER-r AND CAROLENq WikslywNGToN Mailing Address: tZS4 FUL-CON AVE City/State/Zip: CLEARWATER 1 FL 33155 Phone Number: E-mail Address: (` u I I w moil, 2) Subject Property Address commonly known as: t-/54 Fut,-t ON ANE CLEAANA FL 33155 Parcel Identification Number(s): 03-29— 15-01926 -001-0050 3) Project description, scope of work to be performed, sketch plans and specifications detailing the scope of work (provide attachment(s) if needed). (Applicant understands that depending on the project, certain city departments may require additional documentation, plans, etc. to properly review and approve the proposed project described in this application.) buthewGril- 3(k.,c,.11),,r3 ZUo� CkUl W C1/4.k-tc lu-e�✓ 'V\‘' 8 9 4) Financial and Other Disclosures Annual Household Income: $ a?1,000 (Income examples (not limited to the following): employment or self-employment income, Social Security, Pension, Disability, etc.) Household Size: # 2 Is the subject property current with property tax payments, mortgage payments (if applicable), fees, and in compliance with City codes and regulations? (must provide copies oroperty tax payment and mortgage payment statements) Yes ✓ No If no, please explain: Have you received a loan or grant assistance from a city -managed financial assistance program for a project at the subject property? Yes No ✓ 6u'r IN PitJCESS MANN& vit-ttk MEA i If yes, please specify the program(s), dates received, and the loan/grant amount(s) below or provide attachment(s). Program Name: Date Received: Amount Received $ Program Name: Date Received: Amount Received $ 5) Amount of Grant Requested under this program: $ 20,000.00 A e y. eques ' , direct p ent of . • pr. ved grant funds to - auth , ized c•ntr:ct•r? Ye If yes, please specify the contractor's name: Note: This option must be approved by the CRA Director. 9 At,chment A - Project Budget F rm (Attach contractor/vendor estimates/quotes for consistency verification of items listed below. Contractor/vendor estimates/quotes improvement item descriptions and cost will supersede if improvement item descriptions and cost are listed different below. If more project budget form lines are need, Applicant may duplicate budget template below on separate sheet. If new Project Budget Form is created, write "See Attached" in Line No. 1 below. For Applicant Use For staff use only Line Item No. 1 2 Improvement(s) Item Description (Including construction materials, labor, permitting, other fees, etc) [1t) J .s Ho-+i 3 4 5 6 7 8 J Improvements) Cost Amount Line Item Eligible for Grant Consideration Yes/No Cost Amount Eligible for Grant PitCotjOls6N - taorAkuiv $ 5,&AO--- $ c} $ (/ 0 b $ 1159- $ X00 9 $ 10 11 12 13 14 15 16 17 Total Improvement(s) Cost Amount Total Cost�yn Eligible for Considerati Vq- PLEASE NOTE: For multiple signers: This Application may be executed in one or more counterparts, each of which when executed and delivered, shall be an original, but all such counterparts shall constitute one and the same instrument. I ACKNOWLEDGE THAT I HAVE RECEIVED AND UNDERSTAND THE GRANT GUIDELINES HEREIN ABOVE STATED. IN ADDITION, BY EXECUTING THIS APPLICATION, I ACKNOWLEDGE THAT I AM LAWFULLY AUTHORIZED TO EXECUTE THIS APPLICATION AND THAT ALL INFORMATION AND STATEMENTS CONTAINED HEREIN AND ON ANY ATTACHEMENTS ARE TRUE, CORRECT, AND COMPLETE. Co.A 0-141• Applicant Signature Date CGraI no O sh►n 11 Printed Name STATE OF FLORIDA ) COUNTY OF PINELLAS ) The foregoing instrument was acknowledged before me by means * pI sisal -pr s r online notarization, this OS day of 'UL`1 , 202 . .uEnav is/are p anally owl me or * who has/have produced ..river's licen-- as identification. Notaty Public, State of Florida (NOTARIAL SEAL) My Commission Expires: toioi I o My Commission No.: 4.t{ cool t00 ,tylia C. Batas b Comm.: HH 601100 Mires. T, 2028 • Notary Pubdc • Stab of Ronda Name of Notary: TVLtA C•13AAt u -S Mail or hand deliver completed application form to: Community Redevelopment Agency City of Clearwater / 600 Cleveland Street, Suite 600 / Clearwater, FL 33755 For question call the Community Redevelopment Department at 727-562-4039 11 PLEASE NOTE: For multiple signers: This Application may be executed in one or more counterparts, each of which when executed and delivered, shall be an original, but all such counterparts shall constitute one and the same instrument. I ACKNOWLEDGE THAT I HAVE RECEIVED AND UNDERSTAND THE GRANT GUIDELINES HEREIN ABOVE STATED. IN ADDITION, BY EXECUTING THIS APPLICATION, I ACKNOWLEDGE THAT I AM LAWFULLY AUTHORIZED TO EXECUTE THIS APPLICATION AND THAT ALL INFORMATION AND STATEMENTS CONTAINED HEREIN AND ON ANY ATTACHEMENTS ARE TRUE, - RECT, AND COMPLETE. Applica Sigriat 7/x/'6as Date OAS L'�( 14,J Printed Name d STATE OF FLORIDA ) COUNTY OF PINELLAS ) The foregoing instrument was acknowledged before me by means * physical presence�NN online notarization, this OS day of 1ut-y , 2025 by ne6zrc ries 1�vri is/are p y nowrrt? me or * who has/have produced a cir:Paer's1TrJ9 as identification. Nota Public, Sta e of Florida (NOTARIAL SEAL) My Commission Expires: WI p'I IOUS My Commission No.:. i ti 001100 ArOrlik Julia C. Batts fr 151 Corm.: HH 601100 Wires: Oct 7, 2028 Notary Pubic - State of Raid& Name of Notary: JVUk C. SNIP& Mail or hand deliver completed application form to: Community Redevelopment Agency City of Clearwater / 600 Cleveland Street, Suite 600 / Clearwater, FL 33755 For question call the Community Redevelopment Department at 727-562-4039 11 10/2/25 Robert & Carolena Washington 1754 Fulton Ave. Clearwater, FL 33755 CITY OF CLEARWATER COMMUNITY REDEVELOPMENT AGENCY PosT OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748 600 CLEVELAND STREET, CLEARWATER, FLORIDA 33755 TELEPHONE (727) 562-4039 RE: NG CRA Grant Award Letter Notification (NG -C-25-08) Dear Robert & Carolena Washington , This letter is to inform you that the North Greenwood Community Redevelopment Agency (NGCRA) has approved your application for a Residential Exterior Improvement Grant for the project specified in the grant agreement attached hereto. The grant funding has been approved in an amount not to exceed $18,274.00, subject to the terms and conditions of the grant agreement, for your property located at 1754 Fulton Ave., Clearwater, Florida 33755. As a condition of receiving reimbursement grant funding from the Agency, the Applicant shall: • Provide $1,827.40 in monetary contribution toward the Project; or • Complete community service hours to reduce the Applicant's required monetary contribution as permitted under the grant policy. Applicant Next Steps: Complete the enclosed grant agreement and return to CRA staff. Grant agreement and proof of completion hours on the organization letterhead must be completed prior to reimbursement. If you have any questions regarding your NG CRA Grant award letter, please contact Vickie.shire(a,myclearwater.com. Sincerely, Jesus Nino CRA Executive Director, Community Redevelopment Agency Ryan Cotton, Councilmember Mike Mannino, Councilmember Bruce Rector, Mayor David Allbritton, Councilmember Lina Teixeira, Councilmember "Equal Employment and Affirmative Action Employer" Residential Exterior Improvement Grant Program Due Diligence Check Applicant: Z_Obir C 6 - W 04 hi 7 (j� N1 Property Address: 1-4;-4 (,fit Avc 3 Contact Number: G7 -S Case Number: . - — Requirement: 1 Entered into Grant Log 2 Applicant is the Property Owner 3 Located in CRA Boundary 4 Single -Family Residential Property 5 Primary Residence/Legal Homestead 6 Area Median Income/Applicant Match 7 Self -Employed, Tax Returns, Bank Statements 8 Income Verification SS - gTi a q-2. 9 Photographs 10 Quotes from Contractors 11 Requesting Direct Contractor Pay 12 Scope of Work Eligible for Grant Award 13 Volunteer Hours for Applicant's Match 14 Applicant is Requesting a Wavier 15 Property Tax are Current 16 Code Violations 17 W9 19 Vendor Request/PO 20 Create Grant Agreement 21 Completed Application w/ Project Budget Form 22 Additional Information 00 Total Project Cost Eligible for Grant Consideration Applicant's Match Amount Grant Amount Rec,ommended by Staff \IS 101 A -I CRA AD Approval.u�� t it/ Wei' CRA ED Approva Yesv<o_ Yeso_ YesiPQo_ Yeso_ Yesllo_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes_ No_ Yes No Yes_ No_ Yes_ No_ Yes_ No_ Comments: 3 M O (k V -I ourS Ye9/ No_ Ye( Date: \O Date: /G7/7/2 Z 5 - Approval Comments: Entire File Scanned in Sharepoint Yes_ No_ Date: Residential Exterior Improvement Grant Program Due Diligence Check Applicant: -O ER -T ANT> CodROL A WA£#}INUTD/4 Property Address: 1154 FULTot4 qVE CLEAMAt 1ER, Ft- 331SS Contact Number: IS 6g- 5 -'.'Case Number: tJ G —r1 -,1c' Requirement: 1 Entered into Grant Log 2 Applicant is the Property Owner 3 Located in CRA Boundary 4 Single -Family Residential Property 5 Primary Residence/Legal Homestead 6 Area Median Income/Applicant Match 7 Self -Employed, Tax Returns, Bank Statements 8 Income Verification A 00 9 Photographs 10 Quotes from Contractors 11 Requesting Direct Contractor Pay 12 Scope of Work Eligible for Grant Award 13 Volunteer Hours for Applicant's Match 14 Applicant is Requesting a Wavier 15 Property Tax are Current 16 Code Violations 17 W9 19 Vendor Request/PO 20 Create Grant Agreement 21 Completed Application w/ Project Budget Form 22 Additional Information Total Project Cost Eligible for Grant Consideration Applicant's Match Amount Grant Amount Recommended by Staff CRA AD Approva Yes ✓1\1o_ Yes ✓ 1o_ Yes 6/ Yes�O Yes ✓No Yes_ No_ Yes -'<o_ YesAlo Yes ✓ICro Yes No_ YesIo_ Yes,_ No_ Yes\_4_ Yes_ No_✓ Yes4o_ Yes_ No YesL/No_ Yes No Yes_ No_ Comments: 5k 4$.E ?owT wGai5 19141-01,11xat. ROOF VOLUNTEER a%t GuLA vA3Vi'-i?-)1-16/ L3, 3 CRA ED Approval;----� Yek4To Yes No Date: Date: Approval Comments: Entire File Scanned in Sharepoint Yes No Date: a Granada St Charles St Sedeeva St Sunset Point Rd Jotewild Dr N Sedeeva Cir Y OLD CLEARWATER BAY Oa 4 z ;• (; iALTI ry 4 rt any llanasooa Metto St nr 4a '� Fairmont St 05, z� sv r— Carlton St Russell St to Tangerine St 7C Engman St to • La Salle St Palm Bluff St ro Seminole St Eldndge Si HARB WAT R BLUFFS RFRONT z -n O any el093SO N z of Sandy In Mary L Rd Terrace Rd Fairmont St Parkwood St Woodbine St Springdale St Overlea St ik Maple St Nicholson St Eldridge St g. Plaza St COUNTRY o CLUB ESTATES Z co EW & r moi, PLAZA r a. Drew St Drew St cyti D Laura St NEG>Q�e, Grove St Grove SI 1E► (`Ios rwntcnr DOWNTOWN (s o d• O " 4 CA o a Sun t Spring Ln BRENTWOOD ESTATES z Otten St rc Gree m < Sand Linw Fairmont St m i• 0 Oi N n 0 Pirie Brook Dr LC N Hibiscus St tto St Waln Elmv cL m Map GLEN Forest Rd liavhnartiAkfldr�d� M r 7/8/25, 9:15 AM Mike Twitty, MM, CFA Pinellas County Property Appraiser Parcel Summary (as of 08 -Jul -2025) Parcel Number 03-29- 01-00 • Owner Name WASHINGTON, ROBERT J WASHI 0110 Single Family H NA Property Details I Pinellas County PropeL:,4ppraiser 1754 FULTON AVE CLEARWATER, FL 33755 • Mailing Address 1754 FULTON AVE CLEARWATER, FL 33755-1819 • Legal Description AVONDALE BLK A, S 35.72FT OF LOT 4 & N 21.42FT OF LOT 5 • Current Tax District CLEARWATER (CW). • Year Built 1949 Living SF Gross SF Living Units Buildings 672 876 1 1 Parcel Map 85429 Homestead Use % Status Property Exemptions & Classifications 2025 Yes 024 No 100% 0% No Property Exemptions or Classifications found. Please note that Ownership Exemptions (Homestead, Senior, Widow/Widower, Veterans, First Responder, etc... will not display here). Rus Parcel Info https://www.pcpao.gov/property-details?s=152903019260010050&xmin=-9216651.46755622&ymin=3246953.8816771107&xmax=-9216195.2340437... 1/3 7/8/25, 9:15 AM Last Recorded Deed Sales Comparison Property Details 1 Pinellas County Property' Appraiser Ce Evacuation Zone Flood Zone levation Tract .. ertificate Zoning Plat Bk/Pg 22710/1872 $202,800 261.01 Current FEMA Maps 2024 Final Values Year Just/Market Value Assessed Value/SOH Cap County Taxable Value Check for EC Zoning Map 7/40 School Taxable Value Municipal Taxable Value 2024 $171,623 $68,304 $68,304 $171,623 $68,304 Value History Year Homestead Exemption Just/Market Value Assessed Value/SOH County Taxable School Taxable Municipal Taxable Cap Value Value Value 2023 N $153,027 2022 N $149,098 2021 N $116,001 2020 N $73,306 2019 N $76,324 $62,095 $56,450 $51,318 $46,653 $42,412 $62,095 $56,450 $51,318 $46,653 $42,412 $153,027 $149,098 $116,001 $73,306 $76,324 $62,095 $56,450 $51,318 $46,653 $42,412 2024 Tax Information 1 Tax Bill 2024 Millage Rate Do not rely on current taxes as an estimate following a change in ownership. A significant change in taxable value may occur after a transfer due to a loss of exemptions, reset of the Save Our Homes or 10% Cap, and/or market conditions. Please use our Tax Estimator to estimate taxes under new ownership. Tax District View 2024 Tax Bill 18.9481 (CW) Sales History Sale Date Price Qualified / Unqualified Vacant / Improved Grantor Grantee Book/Page 09 -Feb -2024 $130,000 08 -May -1998 $24,300 05 -Jan -1998 $0 31 -Dec -1978 $9,500 U U Q CAMPBELL WILLIAM C WASHINGTON ROBERT J 22710/1872 KING BERTHA CAMPBELL, WILLIAM C 10089/1160 MURRY ROSA LEE KING, BERTHA 09954/0239 EST 04661/0581 2024 Land Informatioi Land Area: - 7,170 sf 1 __ 0.16 acres Frontage and/or View: Park/Cons/Pres Seawall: No Property Use Land Dimensions Unit Value Units Method Total Adjustments Adjusted Value Single Family 57x125 $2,150 57.00 FF 1.1445 $140,258 2024 Building 1 Structural Elements and Sub Area Information Structural Elements Sub Area Living Area SF Gross Area SF Foundat,on: Continuous Footing Poured Base (BAS): 672 672 Floor System: Slab On Grade Enclosed Porch (EPF): 0 140 Exterior Walls: Frame Siding Open Porch (OPF): 0 28 Unit Stones: 1 Utility Unfinished (UTU): 0 36 Living Units: 1 Total Area SF: 672 876 Roof Frame: Gable Or Hip Roof Cover: Shingle Composition Year Built: 1949 Building Type: Single Family Quality: Fair Floor Finish: Carpet/ Vinyl/Asphalt Interior Finish: Drywall/Plaster Heating: Central Duct Cooling: Cooling (Central) Fixtures: 3 Effective Age: 55 https://www.pcpao.gov/property-details?s=152903019260010050&xmin=-9216651.46755622&ymin=3246953.8816771107&xmax=-9216195.2340437... 2/3 7/8/25, 9:15 AM Description Property Details I Pinellas County Property Appraiser 2024 Extra Features 6 6 UTU 36 6 6 10 EPF 14 14 140 10 Value/Unit 4 20 3 20 8 BAS 672 25 24 4 OPF 28 4 Units Total Value as New Depreciated Value Year No Extra Features on Record. <s d Permit information is received from the County and Cities. This data may be incomplete and may exclude permits that do not result in field reviews (for example for water heater replacement permits). We are required to list all improvements, which may include unpermitted construction. Any questions regarding permits, or the status of non - permitted improvements, should be directed to the permitting jurisdiction in which the structure is located. Permit Number Description Issue Date Estimated Value BCP2025-050851 BCP2016-06001 BCP1997-020413 ROOF MISCELLANEOUS HEAT/AIR 06/17/2025 06/01/2016 03/19/1997 $6,337 $1,200 $2,475 https://www. pcpao.gov/property-deta ils?s=152903019260010050&xmin=-9216651.46755622&ymin=3246953.8816771107&xmax=-9216195.2340437... 3/3 7/8/25, 9:16 AM Pinellas - Payments & Service., Search > Account Summary Real Estate Account #R21623 Owner: Situs: Parcel details WASHINGTON, ROBERT J 1754 FULTON AVE Property Appraiser WASHINGTON, CAROLENA CLEARWATER uGet bills by email Amount Due Your account is paid in full. Th Your most recent payment was made o e is nothing dye a this time. 04/03/2025 for $1,952.6 Account History BILL AMOUNT DUE STATUS ACTION 2024 Annual Bill 0 $0 Paid $1,952.63 04/03/2025 Receipt #952-24-137933 a Print (PDF) 2023 Annual Bill 0 $0.0 Paid $1,66 11/29/2023 Receipt #1665-23-070573 s Print (PDF), 2022 Annual Bill 0 $0.00 Paid $1,647.15 03/21/2023 Receipt #1665-22-109172 s Print (PDF) 2021 Annual Bill 0 $0.00 Paid $1,393.91 11/30/2021 Receipt #1655-21-086178 2020 Annual Bill 0 $0.00 Paid $1,109.10 01/28/2021 Receipt #1655-20-111892 2019 Annual Bill '0 $0.00 Paid $1,103.62 03/27/2020 Receipt #755-19-136195 2018 Annual Bill 0 $0.00 Paid $912.93 11/30/2018 Receipt #755-18-098527 2017 0 3017 Annual Bill $0.00 Paid $847.18 06/26/2018 Receipt #907-18-000426 Certificate #1246 Redeemed 06/26/2018 Face $800.89, Rate 0.25% G3 Print (PDF) • Print (PDF) ▪ Print (PDF), • PritPDF1 • Print (PDF) Paid $847.18 2016 Annual Bill 0 $0.00 Paid $1,149.46 12/27/2016 Receipt #755-16-123185 Q Print (PDF) 2015 Annual Bill 0 $0.00 Paid $1,233.45 03/24/2016 Receipt #908-15-002944 Print PDF), 2014 Annual Bill 0 $0.00 Paid $1,153.73 03/25/2015 Receipt #755-14-132994 (g) Print (PDF) 2013 Annual Bill 0 $0.00 Paid $969.12 03/25/2014 Receipt #907-13-009556 GI Print (PQ) 2012 Annual Bill 0 $0.00 Paid $1,002.90 11/28/2012 Receipt #756-12-042440 0 Print (PDF) 2011 Annual Bill 0 $0.00 Paid $971.49 11/23/2011 Receipt #755-11-069159 0 Print (PDF) 2010 Annual Bill 0 $0.00 Paid $1,619.45 03/18/2011 Receipt #110-10-000392 G) Print (PDF) 2009 Annual Bill 0 $0.00 Paid $1,853.08 05/25/2010 Receipt #755-09-147044 Print (PDF) 2008 Annual Bill 0 $0.00 Paid $2,071.59 11/26/2008 Receipt #755-08-094767 Ig) Print (PDF) 2007 Annual Bill 0 $0.00 Paid $2,119.92 01/30/2008 Receipt #055-07-00157752 05 Print (PDF), 2006 Annual Bill 0 $0.00 Paid $1,681.92 11/22/2006 Receipt #012-06-00008882 CD Print (PDF), 2005 Annual Bill 0 $0.00 Paid $1,503.54 11/30/2005 Receipt #055-05-00128894 g) Edit(' 2004 Annual Bill 0 $0.00 Paid $1,113.55 11/15/2004 Receipt #055-04-00056011 CD Print PDF) 2003 Annual Bill 0 $0.00 Paid $733.56 11/21/2003 Receipt #055-03-00069243 0 Print (PDF) 2002 Annual Bill 0 $0.00 Paid $711.03 11/22/2002 Receipt #055-02-00058114 0 Print (PDF), 2001 Annual Bill 0 $0.00 Paid $731.73 11/30/2001 Receipt #055-01-00126155 fgl Print (PDF) 2000 Annual Bill 0 $0.00 Paid $527.56 11/30/2000 Receipt #055-00-00123151 ( Print (PDF) 1999 Annual Bill 0 $0.00 Paid $520.58 11/30/1999 Receipt #055-99-00103378 Print PDF) Total Amount Due $0.00 https://county-taxes.net/pinellas/property-tax/cGIuZWxsYXM6cmVhbF91c3RhdGU6cGFyZW5OczpiOTkzODU5YS 1 IMzY4LTExZWItOTRkMSOwMDUw... 1/1 $18.50 D DOC STAMP COLLECTION $910.00 KEN BURKE, CLERK OF COURT AND COMPTROLLER PINELLAS COL Y, FL BY DEPUTY CLERK: CLF2189 Prepared by and return to;. Gladys Young MV Real Title LLC dba Trust & Title 1715 N Howard Ave B Tampa, FL 33607 (813) 262-1962 File No 24-1050 Parcel Identification No 03-29-15-01926-001-0050 ]Spay Above This Lino For Recording Data] WARRANTY DEED (STATUTORY FORM — SECTION 689.02, F.S.) This indenture made the 9th day of February 2024 between William C. Campbell, and Gloria D. Cara r : and and t : :.. _ - - . . Florida, Grantors, to obert J. Washington, and Carolena Washington Husband and Wife, whose post office address is 1754 Fulton Ave. earwater , of the County of Pinellas, Florida, Grantees: Witnesseth, that said Grantors, for and in consideration of the sum of TEN DOLLARS (U.S.$10.00) and other good and valuable considerations to said Grantors in hand paid by said Grantees, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said Grantees, and Grantees' heirs and assigns forever, the following described land, situate, lying and being in Pinellas, Florida, to -wit: THE SOUTH 35.72 FEET OF LOT 4 AND THE NORTH 21.42 FEET OF LOT 5 IN BLOCK "A" OF AVONDALE SUBDIVISION, ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 7, PAGE 40, OF THE PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA, AND BEING FURTHER DESCRIBED AS FOLLOWS: BEGIN AT THE MOST EASTERLY POINT OF THE BOUNDARY LINE BETWEEN SAID LOTS 4 AND 5 FOR A POINT OF BEGINNING, AND FROM THE POINT OF BEGINNING THUS ESTABLISHED RUN SOUTHERLY ALONG THE EASTERLY BOUNDARY OF SAID LOT 5 A DISTANCE OF 21.42 FEET, THENCE WESTERLY PARALLEL TO THE BOUNDARY LINE BETWEEN SAID LOTS 4 AND 5 A DISTANCE OF 125.60 FEET TO THE WESTERLY BOUNDARY OF SAID LOT 5, THENCE NORTHERLY ALONG THE WESTERLY BOUNDARY OF SAID LOTS 4 AND 5, A DISTANCE OF 57.14 FEET, THENC-tE EASTERLY PARALLEL TO THE BOUNDARY LINE BETWEEN LOTS 4 AND 5 A DISTANCE OF 125.61 FEET TO THE EASTERLY BOUNDARY OF SAID LOT 4, THENCE SOUTHERLY ALONG THE EASTERLY BOUNDARY OF SAID LOT 4, A DISTANCE OF 35.72 FEET TO THE POINT OF BEGINNING. Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. Subject to taxes for 2023 and subsequent years, not yet due and payable; covenants, restrictions, easements, reservations and limitations of record, if any. TO HAVE AND TO HOLD the same in fee simple forever. And Grantors hereby covenant with the Grantees that the Grantors are lawfully seized of said land in fee simple, that Grantors have good right and lawful authority to sell and convey said land and that the Grantors hereby fully warrant the title to said land and will defend the same against the lawful claims of all persons whomsoever. Warranty Deed File No.: 24-1050 Page 1 of 2 In Witness Whereof, Grantors have hereunto set Grantors' hand and seal the day and year first above written. Signed, sealed and delivered in our presence: WIT PRINT NAVE: WITNESS PRINT NAME. STATE OF FLORIDA COUNTY OF HILLSBOROUGH rete I) WITWCTNES. 1 ADDRESS .kye(KO LK 1 nr2,c.g R, L_o c)ervfJ iz, r t-, Sc'N`FNt7L WITNESS 2 ADDRESS The foregoing instrument was acknowledged before me by means of Fe William C Campbell, and Gloria I) Campbell. Signature of Notary Public Print, Type/Stamp Name of Notaiy Personally Known: OR Produced Identification: Type of Identificati Produced: - L t i,oi1-` FITC No,: 24-1051) physical presence or ( ) online notarization this 9th day of Wan'aut}' Deed TYNECIAAI_SAY Notary Public - State of Florida Commission N HW 155484 . F'•' My Comm. Expires Aug 14, 2025 Page 2 01'2 William Campbell Family Trust 2095 East Bay Drive Largo, FL 33771 727-585-4276 Bill.campbell2@outlook.com May 28, 2025 City of Clearwater P.O. Box 4748 Clearwater, FL 33758 RE: Mortgage Payment Status for Robert and Carolena Washington Property Address: 1754 Fulton Avenue, Clearwater, FL 33755 To Whom It May Concern, This letter is to confirm that the mortgage account for the above -referenced property and borrower, Robert and Carolena Washington, is current as of the date of this letter. The mortgagee, William C. Campbell affirms that all required payments have been made in a timely manner and there are no delinquencies or arrears on the account. Should you require any further information or documentation, please do not hesitate to contact our office at 727-585-4276 or via email at bill.campbe112@outlook.com Sincerely, Si William C. Campbell Mortgagee Representative William Campbell Family Trust Mortgage# 2024042807 FreeTaxUSA=® Federal Tax Return Printed on 05/28/2025 12:34 PM EDT Important: Your taxes are not finished until all required steps are completed. USERNAME TAX DUE DUE DATE nescafe2 $422 April 15, 2025 Print and Sign Your Return p Print a copy of your tax return. p Sign and date the Form 1040 in the Sign Here section. • Both spouses must sign and date the tax return. Attach Documents O Federal copy of your W -2s. Pay the Amount You Owe o Pay the IRS the amount you owe. • Any payments made after April 15, 2025 may result in penalties. • You can pay by check, money order, credit card, debit card, or electronic payment. Mail Your Return p Keep these instructions along with a copy of your tax return for your records. p Mail your federal tax return to: If enclosing a payment (check or money order): Internal Revenue Service PO Box 1214 Charlotte, NC 28201-1214 If NOT enclosing a payment: Department of the Treasury Internal Revenue Service Austin, TX 73301-0002 LL ��O Department of the Treasury—Internal Revenue Service U.S. Individual Income Tax Return I ^ O �� 2 I OMB No. 1545-0074 IRS Use Only—Do not write or staple in this space. For the year Jan. 1 -Dec. 31, 2024, or other tax year beginning , 2024, ending , 20 See separate instructions. Your first name and middle initial CAROLENA V Last name WASHINGTON Your social security number If joint return, spouse's first name and middle initial ROBERT J Last name WASHINGTON JR Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. 1754 FULTON AVE Apt. no. Presidential Check here spouse if to go to this box below your tax Election if you, or filing jointly, fund. Checking will not change or refund. In You Campaign your I. want $3 a Spouse City, town, or post office. If you have a foreign address, also complete spaces below. CLEARWATER State FL ZIP code 33755 Foreign country name Foreign province/state/county Foreign postal code Filing Status Check only one box. Single ❑x Married filing jointly (even if only one had income) ❑ Married filing separately (MFS) 0 Qualifying surviving spouse (QSS) If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QSS box, enter the child's name if the qualifying person is a child but not your dependent: ❑ Head of household (HOH) ❑ If treating a nonresident alien or dual -status alien spouse as a U.S. resident for the entire tax year, check the box and enter their name (see instructions and attach statement if required): Digital Assets Standard Deduction At any time during 2024, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Someone can claim: ❑ You as a dependent ❑ Your spouse as a dependent ❑ Spouse itemizes on a separate return or you were a dual -status alien ❑ Yes ❑X No Age/Blindness You: ❑ Were born before January 2, 1960 ❑ Are blind Spouse: ❑ Was born before January 2, 1960 ❑ Is blind Dependents (see instructions): If more (1) First name than four dependents, see instructions and check ❑ here Last name (2) Social security number (3) Relationship to you (4) Check the box if qualifies for (see instructions): Child tax credit Credit for other dependents SO 111 Income Attach Form(s) W-2 here. Also attach Forms W -2G and 1099-R if tax was withheld. If you did not get a Form W-2, see instructions. • Attach Sch. B if required. • i • Standard Deduction for— • Single or Married filing separately, $14,600 • Married filing jointly or Qualifying surviving spouse, $29,200 • Head of household, $21,900 • If you checked any box under Standard Deduction, ` see instructions 1a b c d e f g h z 2a 3a 4a 5a 6a c 7 8 9 10 11 12 13 14 15 Total amount from Form(s) W-2, box 1 (see instructions) Household employee wages not reported on Form(s) W-2 Tip income not reported on line 1a (see instructions) Medicaid waiver payments not reported on Form(s) W-2 (see instructions) Taxable dependent care benefits from Form 2441, line 26 Employer-provided adoption benefits from Form 8839, line 29 Wages from Form 8919, line 6 Other earned income (see instructions) Nontaxable combat pay election (see instructions) Add lines 1 a through 1 h Tax-exempt interest . . 2a b Taxable interest Qualified dividends . . 3a b Ordinary dividends IRA distributions . . . 4a b Taxable amount Pensions and annuities . 5a b Taxable amount Social security benefits . . 6a 19,380 . b Taxable amount If you elect to use the lump -sum election method, check here (see instructions) 0 Capital gain or (loss). Attach Schedule D if required. If not required, check here ❑ Additional income from Schedule 1, line 10 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income Adjustments to income from Schedule 1, line 26 Subtract line 10 from line 9. This is your adjusted gross income Standard deduction or itemized deductions (from Schedule A) Qualified business income deduction from Form 8995 or Form 8995-A Add lines 12 and 13 Subtract line 14 from line 11. If zero or less, enter -0-. This is your taxable income la 165. 1b is 1d 1e 1f ig lh lz 165. 2b 18. 3b 4b 5b 6b 0. 7 8 9 10 11 12 0. 6,193 . 6,376. 438. 5,938. 29,200. 13 14 15 For Disclosure, CDA Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 113208 29,200. 0. Form 1040 (2024) Form 1040 (2024) CAROLENA V WAS NGTON & ROBERT J WASHINGTr. Tax and 16 Tax (see instructions). Check if any from Form(s): 1 9 8814 2 0 4972 3 u Credits 17 Amount from Schedule 2, line 3 18 Add lines 16 and 17 19 Child tax credit or credit for other dependents from Schedule 8812 20 Amount from Schedule 3, line 8 21 Add lines 19 and 20 22 Subtract line 21 from line 18. If zero or less, enter -0- 23 Other taxes, including self-employment tax, from Schedule 2, line 21 24 Add lines 22 and 23. This is your total tax Page 2 16 0. 17 0. 18 0. 19 20 21 22 0. 0. 0. 23 875. 24 875. Payments 25 Federal income tax withheld from: a Form(s) W-2 b Form(s) 1099 c Other forms (see instructions) d 25a 25b 25c Add lines 25a through 25c If you have a 26 2024 estimated tax payments and amount applied from 2023 return qualifying child, 27 Earned income credit (EIC) 27 attach Sch. EIC. 28 Additional child tax credit from Schedule 8812 29 American opportunity credit from Form 8863, line 8 30 Reserved for future use 31 Amount from Schedule 3, line 15 32 Add lines 27, 28, 29, and 31. These are your total other payments and refundable credits 33 Add lines 25d, 26, and 32. These are your total payments Refund 34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid 35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . . . ❑ Direct deposit? b Routing number I X I X I X I X I X I X I X I X I X I c Type: ❑ Checking ❑ Savings See instructions. d Account number I X I X I X I X I X I X I X I X I X I X I X I X I X I X I X X I X 36 Amount of line 34 you want applied to your 2025 estimated tax . . . 36 28 29 30 31 453. 25d 26 32 453. 33 453. 34 35a Amount 37 Subtract line 33 from line 24. This is the amount you owe. You Owe For details on how to pay, go to www.irs.gov/Payments or see instructions 38 Estimated tax penalty (see instructions) 138 Do you want to allow another person to discuss this return with the IRS? See instructions Third Party Designee 37 422. 0 Yes. Complete below. ❑X No Designee's Phone Personal identification name no. number (PIN) Sign Here Joint return? See instructions. Keep a copy for your records. Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your signature Date Your occupation If the IRS sent you an Identity Protection PIN, enter it here DISABLED (seeinst.) Spouse's signature. If a joint return, both must sign. Date Spouse's occupation SELF EMPLOYEED If the IRS sent your spouse an Identity Protection PIN, enter it here (see inst.) Paid Preparer Use Only Phone no. Preparer's name 727-687-2267 Email address Preparer's signature SELF—PREPARED Date PTIN Check if: ❑ Self-employed Firm's name Phone no. Firm's address Firm's EIN Go to www.irs.gov/Form1040 for instructions and the latest information. Form 1040 (2024) CDA SCHEDULE 1 (Form 1040) Department of the Treasury Internal Revenue Service Additional Income and Adjustments to Income Attach to Form 1040, 1040 -SR, or 1040 -NR. Go to www.irs.gov/Form1040 for instructions and the latest information. Name(s) shown on Form 1040, 1040 -SR, or 1040 -NR Your social security number CAROLENA V WASHINGTON & ROBERT J WASHINGTON For 2024, enter the amount reported to you on Form(s) 1099-K that was included in error or for personal items sold at a loss OMB No. 1545-0074 00024 Attachment Sequence No. 01 Note: The remaining amounts reported to you on Form(s) 1099-K should be reported elsewhere on your return depending on the nature of the transaction. See www.irs.gov/1099k. Part 1 Additional Income 1 Taxable refunds, credits, or offsets of state and local income taxes 2a Alimony received b Date of original divorce or separation agreement (see instructions): 3 Business income or (loss). Attach Schedule C 4 Other gains or (losses). Attach Form 4797 5 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 6 Farm income or (loss). Attach Schedule F Unemployment compensation 7 8 Other income: a Net operating loss b Gambling c Cancellation of debt d Foreign earned income exclusion from Form 2555 e Income from Form 8853 f Income from Form 8889 g Alaska Permanent Fund dividends h Jury duty pay i Prizes and awards j Activity not engaged in for profit income k Stock options 1 Income from the rental of personal property if you engaged in the rental for profit but were not in the business of renting such property m Olympic and Paralympic medals and USOC prize money (see instructions) n Section 951(a) inclusion (see instructions) o Section 951A(a) inclusion (see instructions) p Section 461(1) excess business loss adjustment q Taxable distributions from an ABLE account (see instructions) r Scholarship and fellowship grants not reported on Form W-2 s Nontaxable amount of Medicaid waiver payments included on Form 1040, line laorld t Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan u Wages earned while incarcerated ✓ Digital assets received as ordinary income not reported elsewhere. See instructions z Other income. List type and amount: 8a ( 1 2a 3 4 5 6 7 8b 8c 8d 8e 8f 8g 8h 8i 8j 8k 81 8m 8n 8o 8p 8q 8r 8s 8t 8u 8v 8z 9 Total other income. Add lines 8a through 8z 10 Combine lines 1 through 7 and 9. This is your additional income. Enter here and on Form 1040, 1040 -SR, or 1040 -NR, line 8 9 10 6,193. For Paperwork Reduction Act Notice, see your tax return instructions. CDA Cat. No. 71479F Schedule 1 (Form 1040) 2024 Schedule 1 (Form 1040) 2024 Part I1 11 Page 2 Adjustments to Income Educator expenses 12 Certain business expenses of reservists, performing artists, and fee -basis government officials. Attach Form 2106 13 Health savings account deduction. Attach Form 8889 14 Moving expenses for members of the Armed Forces. Attach Form 3903 15 Deductible part of self-employment tax. Attach Schedule SE 16 Self-employed SEP, SIMPLE, and qualified plans 17 Self-employed health insurance deduction 11 12 13 14 15 438 16 17 18 Penalty on early withdrawal of savings 18 19a Alimony paid 19a b Recipient's SSN c Date of original divorce or separation agreement (see instructions): 20 IRA deduction 20 21 Student loan interest deduction 22 Reserved for future use 23 Archer MSA deduction 24 Other adjustments: a Jury duty pay (see instructions) b Deductible expenses related to income reported on line 81 from the rental of personal property engaged in for profit c Nontaxable amount of the value of Olympic and Paralympic medals and USOC prize money reported on line 8m d Reforestation amortization and expenses e Repayment of supplemental unemployment benefits under the Trade Act of 1974 f Contributions to section 501(c)(18)(D) pension plans g Contributions by certain chaplains to section 403(b) plans h Attorney fees and court costs for actions involving certain unlawful discrimination claims (see instructions) i Attorney fees and court costs you paid in connection with an award from the IRS for information you provided that helped the IRS detect tax law violations j Housing deduction from Form 2555 k Excess deductions of section 67(e) expenses from Schedule K-1 (Form 1041) z Other adjustments. List type and amount: 24a 21 22 23 24b 24c 24d 24e 24f 24g 24h 24i 24j 24k 24z 25 Total other adjustments. Add lines 24a through 24z 26 Add lines 11 through 23 and 25. These are your adjustments to income. Enter here and on Form 1040, 1040 -SR, or 1040 -NR, line 10 25 26 438. Schedule 1 (Form 1040) 2024 CDA SCHEDULE 2 (Form 1040) Department of the Treasury Internal Revenue Service Additional Taxes Attach to Form 1040, 1040 -SR, or 1040 -NR. Go to www.irs.gov/Form1040 for instructions and the latest information. Name(s) shown on Form 1040, 1040 -SR, or 1040 -NR CAROLENA V WASHINGTON & ROBERT J WASHINGTON OMB No. 1545-0074 Part 1 Tax 20024 Attachment Sequence No. 02 Your social security number 1 Additions to tax: a Excess advance premium tax credit repayment. Attach Form 8962. . b Repayment of new clean vehicle credit(s) transferred to a registered dealer from Schedule A (Form 8936), Part II. Attach Form 8936 and Schedule A (Form 8936) c Repayment of previously owned clean vehicle credit(s) transferred to a registered dealer from Schedule A (Form 8936), Part IV. Attach Form 8936 and Schedule A (Form 8936) d Recapture of net EPE from Form 4255, line 2a, column (I) e Excessive payments (EP) from Form 4255. Check applicable box and enter amount. (i) ❑ Line 1 a, column (n) (ii) ❑ Line 1 c, column (n) (iii) 0 Line 1 d, column (n) (iv) 0 Line 2a, column (n) f 20% EP from Form 4255. Check applicable box and enter amount. See instructions. (i) 0 Line 1 a, column (o) (ii) 0 Line 1 c, column (o) (iii) 0 Line 1d, column (o) (iv) 0 Line 2a, column (o) . . y Other additions to tax (see instructions): z Add lines 1a through 1y 2 Alternative minimum tax. Attach Form 6251 is 1b is id 1e if 1y 3 Add lines 1z and 2. Enter here and on Form 1040, 1040 -SR, or 1040 -NR, line 17 Part 11 lz 2 3 Other Taxes 4 Self-employment tax. Attach Schedule SE 5 Social security and Medicare tax on unreported tip income. Attach Form 4137 6 Uncollected social security and Medicare tax on wages. Attach Form 8919 . 7 Total additional social security and Medicare tax. Add lines 5 and 6 4 875. 5 6 8 Additional tax on IRAs or other tax -favored accounts. Attach Form 5329 if required. If not required, check here 0 9 Household employment taxes. Attach Schedule H 10 Repayment of first-time homebuyer credit. Attach Form 5405 if required 11 Additional Medicare Tax. Attach Form 8959 12 Net investment income tax. Attach Form 8960 13 Uncollected social security and Medicare or RRTA tax on tips or group -term life insurance from Form W-2, box 12 14 Interest on tax due on installment income from the sale of certain residential lots and timeshares 15 Interest on the deferred tax on gain from certain installment sales with a sales price over $150,000 . 16 Recapture of low-income housing credit. Attach Form 8611 7 8 9 10 11 12 13 14 15 16 (continued on page 2) For Paperwork Reduction Act Notice, see your tax return instructions. CDA Cat. No. 71478U Schedule 2 (Form 1040) 2024 Schedule 2 (Form 1040) 2024 Part 11 Other Taxes (continued) Page 2 17 Other additional taxes: a Recapture of other credits. List type, form number, and amount: b Recapture of federal mortgage subsidy, if you sold your home see instructions c Additional tax on HSA distributions. Attach Form 8889 d Additional tax on an HSA because you didn't remain an eligible individual. Attach Form 8889 e Additional tax on Archer MSA distributions. Attach Form 8853 f Additional tax on Medicare Advantage MSA distributions. Attach Form 8853 g Recapture of a charitable contribution deduction related to a fractional interest in tangible personal property h Income you received from a nonqualified deferred compensation plan that fails to meet the requirements of section 409A i Compensation you received from a nonqualified deferred compensation plan described in section 457A j Section 72(m)(5) excess benefits tax k Golden parachute payments 1 Tax on accumulation distribution of trusts m Excise tax on insider stock compensation from an expatriated corporation n Look -back interest under section 167(g) or 460(b) from Form 8697 or 8866 o Tax on non -effectively connected income for any part of the year you were a nonresident alien from Form 1040 -NR p Any interest from Form 8621, line 16f, relating to distributions from, and dispositions of, stock of a section 1291 fund q Any interest from Form 8621, line 24 z Any other taxes. List type and amount: 18 Total additional taxes. Add lines 17a through 17z 19 Recapture of net EPE from Form 4255, line 1d, column (I) 20 Section 965 net tax liability installment from Form 965-A 21 Add lines 4, 7 through 16, 18, and 19. These are your total other taxes. Enter h or 1040 -SR, line 23, or Form 1040 -NR, line 23b 17a 17b 17c 17d 17e 17f 17g 17h 17i 17j 17k 171 17m 17n 170 17p 17q 17z 20 18 19 re and on Form 1040 21 875. Schedule 2 (Form 1040) 2024 CDA SCHEDULE C (Form 1040) Department of the Treasury Internal Revenue Service Profit or Loss From Business (Sole Proprietorship) Attach to Form 1040, 1040 -SR, 1040 -SS, 1040 -NR, or 1041; partnerships must generally file Form 1065. Go to www.irs.gov/Schedu/eC for instructions and the latest information. OMB No. 1545-0074 Name of proprietor ROBERT J WASHINGTON JR A Principal business or profession, including product or service (see instructions) C RJ E Business name. If no separate business name, leave blank. CONNECTION Business address (including suite or room no.) 833 2 2ND STREET SOUTH 00024 Attachment Sequence No. 09 Social security number (SSN) B Enter code from instructions D Employer ID number (EIN) (see instr.) 217 31317111016151 City, town or post office, state, and ZIP code ST PETERSBURG, FL 33712 F Accounting method: (1) ❑X Cash (2) ❑ Accrual (3) ❑ Other (specify) G Did you "materially participate" in the operation of this business during 2024? If "No," see instructions for limit on losses ❑X Yes ❑ No H If you started or acquired this business during 2024, check here 0 Did you make any payments in 2024 that would require you to file Form(s) 1099? See instructions ❑ Yes ❑X No J If "Yes," did you or will you file required Form(s) 1099? ❑ Yes ❑ No Part I Income 1 Gross receipts or sales. See instructions for line 1 and check the box if this income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked ❑ Returns and allowances Subtract line 2 from line 1 2 3 4 5 6 7 Cost of goods sold (from line 42) Gross profit. Subtract line 4 from line 3 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) Gross income. Add lines 5 and 6 1 7 20-0.; 2 3 4 5 7 200. 500. 6 700. 6 7 Part II Expenses. Enter expenses for business use of your home only on line 30. 6, 700 . 8 Advertising 9 Car and truck expenses (see instructions) . . . 8 18 Office expense (see instructions) . 19 Pension and profit-sharing plans . 20 Rent or lease (see instructions): 18 9 257 . 19 10 Commissions and fees . 10 a Vehicles, machinery, and equipment 20a 11 Contract labor (see instructions) 11 b Other business property . . . 20b 12 Depletion 12 21 Repairs and maintenance . . . 21 13 Depreciation and section 179 22 Supplies (not included in Part III) . 22 250 . expense deduction (not included in Part III) (see 23 Taxes and licenses 23 instructions) . . . . 13 24 Travel and meals: 14 Employee benefit programs a Travel 24a (other than on line 19) . 14 b Deductible meals (see instructions) 24b 15 Insurance (other than health) 15 25 Utilities 25 16 Interest (see instructions): 26 Wages (less employment credits) 26 a Mortgage (paid to banks, etc.) 16a 27a Other expenses (from line 48) . . 27a b Other 16b b Energy efficient commercial bldgs 17 Legal and professional services 17 deduction (attach Form 7205) . . 27b 28 Total expenses before expenses for business use of home. Add lines 8 through 27b 28 507 . 29 Tentative profit or (loss). Subtract line 28 from line 7 29 6, 193 . 30 Expenses for business use of your home. Do not report these expenses elsewhere. Attach Form 8829 unless using the simplified method. See instructions. Simplified method filers only: Enter the total square footage of (a) your home: and (b) the part of your home used for business: . Use the Simplified Method Worksheet in the instructions to figure the amount to enter on line 30 30 31 Net profit or (loss). Subtract line 30 from line 29. • If a profit, enter on both Schedule 1 (Form 1040), line 3, and on Schedule SE, line 2. (If you checked the box on line 1, see instructions.) Estates and trusts, enter on Form 1041, line 3. 31 6, 193 . • If a loss, you must go to line 32. 32 If you have a loss, check the box that describes your investment in this activity. See instructions. • If you checked 32a, enter the loss on both Schedule 1 (Form 1040), line 3, and on Schedule SE, line 2. (If you checked the box on line 1, see the line 31 instructions.) Estates and trusts, enter on Form 1041, line 3. • If you checked 32b, you must attach Form 6198. Your loss may be limited. i 32a ❑ All investment is at risk. 32b ❑ Some investment is not at risk. For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11334P CDA Schedule C (Form 1040) 2024 Schedule C (Form 1040) 2024 Cost of Goods Sold (see instructions) Page 2 33 Method(s) used to value closing inventory: a 0 Cost b ❑ Lower of cost or market c 0 Other (attach explanation) 34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If "Yes," attach explanation 0 Yes 35 Inventory at beginning of year. If different from last year's closing inventory, attach explanation . . 36 Purchases less cost of items withdrawn for personal use 37 Cost of labor. Do not include any amounts paid to yourself 38 Materials and supplies 39 Other costs 40 Add lines 35 through 39 41 Inventory at end of year 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on line 4 35 0 No 250. 36 37 38 250. 39 40 500. 41 42 500. Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9 and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562. 43 When did you place your vehicle in service for business purposes? (month/day/year) 06/21/24 44 Of the total number of miles you drove your vehicle during 2024, enter the number of miles you used your vehicle for: a Business 384 b Commuting (see instructions) 256 c Other 7360 45 Was your vehicle available for personal use during off-duty hours', ❑X Yes 0 No 46 Do you (or your spouse) have another vehicle available for personal use? ❑X Yes 0 No 47a Do you have evidence to support your deduction'? ❑X Yes 0 No b If "Yes," is the evidence written? ❑X Yes 0 No Part V Other Expenses. List below business expenses not included on lines 8-26, line 27b, or line 30. 48 Total other expenses. Enter here and on line 27a Schedule C (Form 1040) 2024 CDA SCHEDULE SE (Form 1040) Department of the Treasury Internal Revenue Service Self -Employment Tax Attach to Form 1040, 1040 -SR, 1040 -SS, or 1040 -NR. Go to www.irs.gov/ScheduleSE for instructions and the latest information. Name of person with self-employment income (as shown on Form 1040, 1040 -SR, 1040 -SS, or 1040 -NR) ROBERT J WASHINGTON JR Part I Self -Employment Tax OMB No. 1545-0074 00024 Attachment Sequence No. 17 Social security number of person with self-employment income Note: If your only income subject to self-employment tax is church employee income, see instructions for how to report your income and the definition of church employee income. A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had $400 or more of other net earnings from self-employment, check here and continue with Part I ❑ Skip lines 1 a and 1 b if you use the farm optional method in Part 11. See instructions. la Net farm profit or (loss) from Schedule F, line 34, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A la b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 4b, or listed on Schedule K-1 (Form 1065), box 20, code AQ Skip line 2 if you use the nonfarm optional method in Part ll. See instructions. 2 Net profit or (loss) from Schedule C, line 31; and Schedule K-1 (Form 1065), box 14, code A (other than farming). See instructions for other income to report or if you are a minister or member of a religious order 3 Combine lines 1 a, 1 b, and 2 4a If line 3 is more than zero, multiply line 3 by 92.35% (0.9235). Otherwise, enter amount from line 3 Note: If line 4a is less than $400 due to Conservation Reserve Program payments on line 1 b, see instructions. b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here c Combine lines 4a and 4b. If less than $400, stop; you don't owe self-employment tax. Exception: If less than $400 and you had church employee income, enter -0- and continue 5a Enter your church employee income from Form W-2. See instructions for definition of church employee income 5a b Multiply line 5a by 92.35% (0.9235). If less than $100, enter -0- 6 Add lines 4c and 5b 7 Maximum amount of combined wages and self-employment earnings subject to social security tax or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2024 8a Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2) and railroad retirement (tier 1) compensation. If $168,600 or more, skip lines 8b through 10, and go to line 11 8a b Unreported tips subject to social security tax from Form 4137, line 10 . . c Wages subject to social security tax from Form 8919, line 10 d Add lines 8a, 8b, and 8c 9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 10 Multiply the smaller of line 6 or line 9 by 12.4% (0 124) 11 Multiply line 6 by 2.9% (0 029) 12 Self-employment tax. Add lines 10 and 11. Enter here and on Schedule 2 (Form 1040), line 4, or Form 1040 -SS, Part I, line 3 13 Deduction for one-half of self-employment tax. Multiply line 12 by 50% (0.50). Enter here and on Schedule 1 (Form 1040), line 15 8b 8c 165. ib ( 2 3 4a 6,193. 6,193. 5,719. 4b 4c 5,719. 5b 6 5,719. 7 168,600. 13 8d 9 10 11 165. 168,435. 709. 166. 12 875. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11358Z CDA Schedule SE (Form 1040) 2024 Schedule SE (Form 1040) 2024 Part II Optional Methods To Figure Net Earnings (see instructions) Page 2 Farm Optional Method. You may use this method only if (a) your gross farm income' wasn't more than $10,380, or (b) your net farm profits2 were Tess than $7,493. 14 Maximum income for optional methods 15 Enter the smaller of: two-thirds (2/3) of gross farm income' (not less than zero) or $6,920. Also, include this amount on line 4b above 14 15 Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3 were Tess than $7,493 and also less than 72.189% of your gross nonfarm income,4 and (b) you had net earnings from self-employment of at least $400 in 2 of the prior 3 years. Caution: You may use this method no more than five times. 16 Subtract line 15 from line 14 17 Enter the smaller of: two-thirds (2/3) of gross nonfarm income4 (not Tess than zero) or the amount on line 16. Also, include this amount on line 4b above 1 From Sch. F, line 9; and Sch. K-1 (Form 1065), box 14, code B. 2 From Sch. F, line 34; and Sch. K-1 (Form 1065), box 14, code A—minus the amount 4 From Sch. C, line 7; and Sch. K-1 (Form 1065), box 14, code C. you would have entered on line 1 b had you not used the optional method. 16 17 3 From Sch. C, line 31; and Sch. K-1 (Form 1065), box 14, code A. Schedule SE (Form 1040) 2024 CDA Form 8962 Department of the Treasury Premium Tax Credit (PTC) Attach to Form 1040, 1040 -SR, or 1040 -NR. Internal Revenue Service Go to www.irs.gov/Form8962 for instructions and the latest information. S Seeqqueuenncece No. 73 Name shown on your retum Your social security number CAROLENA V WASHINGTON & ROBERT J WASHINGTON A. You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception. See instructions. If you qualify, check the box ❑ Annual and Monthly Contribution Amount OMB No. 1545-0074 20024 Part 1 1 Tax family size. Enter your tax family size. See instructions 2a Modified AGI. Enter your modified AGI. See instructions 2a 25,318. b Enter the total of your dependents' modified AGI. See instructions 3 Household income. Add the amounts on lines 2a and 2b. See instructions 4 Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3. See instructions. Check the appropriate box for the federal poverty table used. a ❑ Alaska b ❑ Hawaii c ❑X Other 48 states and DC 5 Household income as a percentage of federal poverty line (see instructions) 6 Reserved for future use 7 Applicable figure. Using your line 5 percentage, locate your "applicable figure" on the table in the instructions 8a Annual contribution amount. Multiply line 3 by 8b Monthly contribution amount. Divide line 8a line 7. Round to nearest whole dollar amount 8a1 by 12. Round to nearest whole dollar amount 2b Part 11 1 3 25,318. 4 5 19,720. 128% 7 8b Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit 9 Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage? See instructions. ❑ Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Altemative Calculation for Year of Marriage. ❑X No. Continue to line 10. 10 See the instructions to determine if you can use line 11 or must complete lines 12 through 23. ❑X Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12-23 and continue to line 24. ❑ No. Continue to lines 12-23. Compute your monthly PTC and continue to line 24. Annual Calculation (a) Annual enrollment Premiums. (Form(s) 1095-R Me 33IV) (b) Annual applicable SLCSP premium (Form(s)1Q95-A, line 33B) (c) Annual contribution amount (line 8a (d) Annual maximum premium assistance (suhtraot (c) from if (b); zero or less, enter -0-) (e) Annual PTC allowed (smaller of (a) or (ei� (f) Annual advance payment of PTC (Form(s) 1Q9Ei �4, line 33C) 11 Annual Totals 11,909. 11,909. 11,909. 11,909. 11,909. Monthlypremiums Calculation (e) enrollment (Form(s)premium 1095-A, lines 21-32, column A) )Month applicable SLCSPpremium (Form(s)1095-A, lines 21-32, column B) (c) MonthlyMonthly contribution amount (amount fram line Sb or alternative marriage monthly calculation) (d) Monthly maximum assistance (subtractc from (b); if zero or less, enter -0-) (e) Monthly PTC allowed (smaller of (a) or (d)) (I) Monthly advance payment of PTC (Form(S)' 1095-A, lines 21-32 ' column C) 12 January 13 February 14 March 15 April 16 May 17 June 18 July 19 August 20 September 21 October 22 November 23 December 24 Total PTC. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 24 11,909. 25 11,909. 26 Net PTC. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and on Schedule 3 (Form 1040), line 9. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24, leave this line blank and continue to line 27 26 Part 111 27 28 29 Excess advance PTC repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2 (Form 1040), line 1 a For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37784Z Repayment of Excess Advance Payment of the Premium Tax Credit Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here Repayment limitation (see instructions) CDA 27 28 29 Form 8962 (2024) NUDFLOR1 P.O..Box:8008 Lakeland, FL:33802-8008 (863) 588,3733 I Tolfriiel?, (856)91373733. ROBERT J WASHINGTON 1754 FULTON AVE QLEARWATER FL 33755A 819 Nat4P.afa.E.V...Wg14141:124.1... •Statement Ending 01/20/2025 Page id 2 •Contact Information O Direct Touch (858) 904-4896 (844) 868-2424.toll free Website midflorida.cOm En:101 hOlpdesk@miciflorida.pom Annual Meeting Tuesday, April 8, 2025.af5:30 pm MIDFLORIDA Hollingsworth Branch .11085. Fforkla.AVO,Lakeland,F1. 33803. Visit mirit1oritia.cniniannwairneetinR2025. •to !earn more aiaoutthis.:year'S hparid,candidats, View..our updatedaccount terrns -and tonditio0s and priva4.pOlicy at rniciflorida,cOmfacouritenanges2025. Summary of Accounts Account Type Fteedonn.Benking Account Number Ending Balance XXXXXXXX0303 $893.95 F.te:ealotia..Banicing -.X).1)(XXXXX0303 Account •S.UMMarY Date. Description 12/21/2024 BeginningiBalance 2 Credit(s) This period 5.bebit(S)-This Period .01/20/2825 Ending Balance: .Account Activity • Post. Date 'Description Amount •$5.96 $905.00 $17.01 •$893.95 Withdrawal D.OpOsit Balance 1241/2024 Beginning Balance: 12/21/2024 Point df Sale Withdrawal N&S OLEARWATER FLUS Point Of Sale Withdrawal WAL Wal-Mart Super 052288 4667 120112024 WAL-SAMS:CLEARWATER Point Of Sale Deposit ZBL', BRITTANY FIELDS Vise Direct 12/22/2024 AZUS 12128/2024 Point Of Bale-Withdrawal"N&S :CLEARWATER FLUS 12/31/2024 Monthly SeNice Chare 01/02/2025 Deposit NCUA. $5.00 :$0.45. $4.56 $4.00 :$5.00 •$900.00. $5.96 $0.96 $0.51 $5.51 4305 $896.95 Statement Ending 01/20/2025 Page 29f 2 Freedom Banking - XXXX.XXXX0303 (Continued) Account Activity (continued) Post Date Description Withdrawal Deposit Balance 01/20/2025 Paper Statement Feefor:!*r*-0303' 01/20/2025 'Ending Balance Overdraft and Returned -Item Fees $3.00' $893195 $893.95 Total for this period. Total year-to-date Total Overdraft Fees $0:00: .$0.00 Total Returned Item Fees $0,00 MIDFWRID ffl P.O. Box 8008 Lakeland, FL 33802-8008 (863) 688-3733 I Toll free (866) 913-3733 >006057 8600999 0001 93567 10Z ROBERT J WASHINGTON 1754 FULTON AVE CLEARWATER FL 33755-1819 111111ild4tilIlilillll1111lIrlIuihiinhIIiti111111liiitilriIiji Stater t Ending 03/20/2025 Page 1 of 4 Contact Information 0 Direct Touch Website • Email (863) 904-4896 (844) 888-2424 toll free midflorida.com helpdeskt midflorida.corn FAST, SECURE, �NTACTLES 11(n r,F_ �.��uur t)��it ct3rci cl � t14011 i u c! in t<�ntly kit n V hr:int�h! VL A Summary of Accounts Account Type Freedom Banking Account Number XXXXXXXX0303 Ending Balance $475.93 Freedom Banking - XXXXXXXX0303 Account Summary Date Description 02/21/2025 Beginning Balance 11 Credit(s) This Period 48 Debit(s) This Period 03/20/2025 Ending Balance Account Activity Post Date Description Amount $602.84 $1,309.33 $1,436.24 $475.93 Withdrawal Deposit Balance 02/21/2025 Beginning Balance 02/21/2025 Point Of Sale Withdrawal WAL WAL-MART #4667 002830 1815 N. HIGHLAND AVENUECLEARWATER 02/21/2025 Point Of Sale Withdrawal CHEVRON 0379997 CLEARWATER FLUS 0221/2025 Point Of Sale Withdrawal CHINA 1 CLEARWATER FLUS 02212025 Foreign Debit or ATM WD Fee Withdrawal DUNEDIN SHOPPES 1625 MAIN ST US DU 02/21/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 02/21/2025 Point Of Sale Deposit ZEL` REX C PAGGEOT Visa Direct $802.84 $84.63 $518.21 $20.00 $22.90 $2.00 $20.00 $114.33 $498.21 $475.31 $473.31 $453.31 $567.64 NCUA 06057 6600999 007617 015233 0001/0002 Statement Endin6 ,.,.10/2025 Page 2 of 4 Freedom Banking XXXXXXXX03O3 (continued) Account Activity (continued) Post Date Description Withdrawal Deposit Balance AZUS 02/22/2025 Point Of Sale Withdrawal TAMPA STYLE CUBANS LARGO FLUS 02/22/2025 Point Of Sale Withdrawal DOLLAR -GENERAL #9256 CLEARWATER FLUS 02/22/2025 Point Of Sale Withdrawal OUTBACK 1014 LARGO FLUS 02222025 Point Of Sale Withdrawal DOLLAR -GENERAL # DG 092CLEARWATER FLUS 02/22/2025 Point Of Sale Withdrawal DOLLAR -GENERAL #9564 DG 095646304 66TH ST PINELLAS PARKFLU 02/23/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 02/24/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 02/24/2025 Point Of Sale Withdrawal POPEYES 12619 CLEARWATER FLUS 02!24/2025 Point Of Sale Withdrawal 7 -ELEVEN 1898 N. Highland A US Clearwater FLUS 02!242025 Point Of Sale Withdrawal WM SUPERCENTER #4667 Wal-Mart Super Center CLEARWATER FLU 02252025 Point Of Sale Withdrawal NS CLEARWATER FLUS 02/25/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 0226/2025 Point Of Sale Withdrawal CIRCLE K 09800 ST PETERSBURGFLUS 02/26/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 02/26/2025 Deposit Transfer from 143131205 SAV 02!26!2025 Point Of Sale Withdrawal WM SUPERCENTER #4667 Wal-Mart Super Center CLEARWATER FLU 02/27!2025 Point Of Sale Withdrawal DOMINO'S 5026 561-826-0883 FLUS 02282025 Point Of Sale Withdrawal CONVENIENT FOOD PINELLAS PARKFLUS 02/28/2025 Point Of Sale Withdrawal WM SUPERCENTER #4667 Wal-Mart Super Center CLEARWATER FLU 03/01/2025 Point Of Sale Withdrawal MCDONALD'S F482 CLEARWATER FLUS 03/012025 Point Of Sale Withdrawal WAL-MART #4667 1803 N HIGHLAND AVE CLEARWATER FLUS 03!052025 Point Of Sale Withdrawal MCDONALD'S F11017 DUNEDIN FLUS 03108!2025 Point Of Sale Withdrawal NNT CIRCLE A FOOD S061321 1201 SUNSET POINT RD CLEARWATER 03!072025 Point Of Sale Withdrawal CONVENIENT FOOD PINELLAS PARKFLUS 03/08/2025 Point Of Sale Withdrawal WAL-MART #46671803 N HIGHLAND AVE CLEARWATER FLUS 03/09/2025 Point Of Sale Withdrawal WM SUPERCENTER #4667 Wal-Mart Super Center CLEARWATER FLU 03/10/2025 Deposit Transfer from 143131205 SAV 03/11t2025 Point Of Sale Withdrawal NNT CIRCLE A FOOD S482249 1201 SUNSET POINT RD CLEARWATER 03/11/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/1 12025 Point Of Sale Withdrawal POPEYES 12619 CLEARWATER FLUS 03/11/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/112025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/12/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/12/2026 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/122025 Deposit Transfer from 143131205 SAV $17.94 $549.70 $6.96 $542.74 $83.73 $459.01 $6.45 $452.56 $106.70 $345.86 $39.00 $306.86 $32.00 $274.86 $17.63 $257.23 $4.59 $252.64 $88.74 $22.00 $32.00 $28.19 $28.50 $100.00 $163.90 $141.90 $109.90 $81.71 $53.21 $153.21 $42.98 $110.23 $38.71 $71.52 $3.00 $68.52 $1.61 $66.91 $11.00 $55.91 $2.66 $53,25 $5.36 $47.90 $11.65 $36.25 $3.00 $33.25 $0.69 $32.56 $20.95 $11.61 $150.00 $161.61 $5.89 $155.72 $40.00 $115.72 $22.35 $40.00 $5.94 $30.00 $3.00 $145.00 $93.37 $53.37 $47.43 $17.43 $14.43 $159.43 Statement Ending .J/2025 Page 3 of 4 Freedom Banking - XXXXXXXX0303 (continued) Account Activity (continued) Post Date Description Withdrawal Deposit Balance 03/13/2025 Point Of Sale Withdrawal CONVENIENT FOOD PINELLAS PARKFLUS 03/13/2025 Deposit Transfer from 143131205 SAV 03/13/2025 Point Of Sale Withdrawal WENDYS #8960 MISSOURI AVE. CLEARWATER FLUS 03/13/2025 Point Of Sale Withdrawal CITY OF CLEARWATER EMV CLEARWATER FLFLUS 03/13/2025 Deposit Transfer from 143131205 SAV 03/13/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/13/2025 Deposit Transfer from 143131205 SAV 03/14/2025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/14/2025 Deposit,Transfer from 143131205 SAV 03/142025 Point Of Sale Withdrawal NS CLEARWATER FLUS 03/142025 Deposit Transfer from 143131205 SAV 03/14/2025 Deposit Transfer from 143131205 SAV 03/14/2025 Point Of Sale Withdrawal SO * CHOICE MED GROUP LLgosq.com FLUS 03/152025 Point Of Sale Withdrawal MCDONALD'S F27982 TAMPA FLUS 03/17/2025 Point Of Sale Withdrawal SO * CASABLANCA FUSION Clearwater FLUS 03/17/2025 Deposit 03/182025 Point Of Sale Withdrawal 7 -ELEVEN 21869 CLEARWATER PLUS 03/20/2025 Paper Statement Fee for * • * * 0303 03/20/2025 Ending Balance $25.50 $133.93 $25.00 $158.93 $25.33 $133.60 $127.71 $5,89 $50.00 $55.89 $30.00 $25.89 $30.00 $55.89 $27.00 $28.89 $150.00 $178.89 $35.00 $143.89 $25.00 $168.89 $20.00 $188.89 $45.24 $143.65 $21.07 $20.96 $24.28 $3.00 $500.00 $24.17 $3.21 $503.21 $478.93 $475.93 $475.93 06057 5600499 007616 015235 0002/000? Total for this period Total year-to-date Total Overdraft Fees $0.00 $0.00 Total Returned Item Fees $0.00 $0.00 06057 5600499 007616 015235 0002/000? Statement Ending ,,,2012025 Page 4 of 4 This page left intentionally blank C William Campbell Family Trust 2095 East Bay Drive Largo, FL 33771 727-585-4276 Bill.campbe112@outlook.com May 28, 2025 City of Clearwater P.O. Box 4748 Clearwater, FL 33758 RE: Mortgage Payment Status for Robert and Carolena Washington Property Address: 1754 Fulton Avenue, Clearwater, FL 33755 To Whom It May Concern, This letter is to confirm that the mortgage account for the above -referenced property and borrower, Robert and Carolena Washington, is current as of the date of this letter. The mortgagee, William C. Campbell affirms that all required payments have been made in a timely manner and there are no delinquencies or arrears on the account. Should you require any further information or documentation, please do not hesitate to contact our office at 727-585-4276 or via email at bill.campbe112@outlook.com Sincerely,Si 1\ William C. Campbell Mortgagee Representative William Campbell Family Trust Mortgage# 2024042807 Social Security Administration Benefit Verification Letter CAROLENA VANESMA WASHINGTON MI= 1764 RULTON AVE. CLEARWATER. FL 337554819 ate: December 4, 202 BNC#: EF: A, C3, DI You asked us for information from your record. The information that you requested is shown below. If you want anyone else to have this information, you may send them this: letter. Information About Current Social Security Benefits Beginning Decerober 2023, the f-ull monthly Social Security benefit before any deductions is $1,.615.80. We deduct $0,00 for medical insurance premiu The regular monthly Social Sedulity paythe (We mut round down to the whole dollar.) Social:Security:benefits for a given month a example, Social:Security benefits for March ar Your $0Cial. Security benefits are paid on or about the third of each Month. We found. that you became •clisablod under our rules on September 5, 2019. Inforniation About Past Social Security Benefits From December 2022 to. November 2023, the full monthly Social Security benefit before any deductions was $1,565..70. We deducted $0.00 for medical insurance preroluMs each month. The regular Monthly Social Security payinent Was $1,565.00. (We:mnst round down to the Whale dollar.) Type of Social:Security Benefit Information You are.entitled to monthly disability benefits. .See Next Page VOZIEZIFSGAMTZLWIA103 1,9t0AITH6AHRTOZO* FOLD & TEAR DFF STUB SOCIAL ^' '1TY 2340 DRL.. „ i REET CLEARWATER, FL 33765 How are we doing? Go to www.ssa.gov/feedback to tell us. Go paperless & get your COLA notice online at www.ssa.gov/myaccount Tells hpw_wggrea�doilw at www.ssa.gov/feedback/COLA SOCIAL SECURITY ADMINISTRATION PO Box 67610 Wilkes-Barre; PA 18767-7610 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE, $300 Securing today and tomorrow 00084-04543-5352 CAROLENA V WASHINGTON 1754 FULTON AVE CLEARWATER FL 33755-1819 11111111"11" 111111111 1111,111,11,10,1111,1111111,11 4111 N� j, -,if t.n 14. -'mac I -a '�.��r`► j1� a" ¢ - `' sem' j �N L` rte. s . s, ',mum.a szaa�3 $ 5 NIFS(and1N3WNU8OO'STh !3 '•-11 _ �,. 1,441 ` ;`�;;t ! 4- */j' t' )114-1,* r 111 iltr.irialrat IlFf ill*, -,-/424:4,. 4.641-111.4%*T1.-k"‘-24-vALV/§rg-.-_-itgilt. doe-41,1ift‘.7$4, _:.;4=_-tfitdi''„g'- ACJ'b'SS'OIO lV V Y3S 3H1 laOd3H '£ Ipalool aq lou oa •uolloe le6al ja4to Alit INOIlYWIJOdNI 1VNOSIi3d ao Isa»e ploAe oI luew.(ed aleipewwI puswap et' ,(ewpuenor( ueieOJy3 rtewi a41 'saaPAZdwwa titer.i. a0 AMOW W3Hl 3AIJ ION Oa 7 �� luewwano6 aq of 6ulpuelaxd WE Saawweo$ btiiit rr1 �$ It :Ueo snolaldsns a anlage+ nog( it 0 11:13111/ VN V OS Q . kY RT4,..w. ti F; ra. � �la +T, i[,R� � iL 'Fi'tJ�? %'$ %h`` � , ..... "id� I�Z �"�'7 i"t FK �r'y;d�� :yq li:t«lr; j+ I! / :.>.► $�t ! 1\4�_a rt /•r�%I%`.{ $ NOIlVWdOENI A11111133S IVI3OS 1NV.UOd1All � .� r w t' r istivd,%" ,�,r?Att; ,p,N Fp r i,.�d ' ` t - r it ��y ,s mit)/ as ' 11=t�1 rii:, ��\"F�` 'ii �i eh �. `l#it; Zm4 Ca� i \ ! - ij ' �i} `,f�� r��', .\�tjj / y1 • `�fi. '=jro �; "�. ,�r ^� �- � til t >� ., ,—..�.�t � '� �� k�� }"!j'�j�'as�,�3p� r�it_�� ' ��,jl�� • a'+, it�;��''�; //' Yi_/H�t�pti��" ��•�s��i�: ,�+� A �:� �� + �• � I ai 44 ALVA '• ' N- r 6VAAra`,#a is *, J� / .� g I 1 A ')'� A i1 it-� ' Ir; � Over ► FIRST-CLASS MAIL PRESORTED POSTAGE AND FEES PAID SOCIAL SECURITY ADMINISTRATION PERMIT NO.0-11 tr\41-tntaciPs /f to l,MAf1- �.V.IF4 _4}t^`�1%/t!1' M ®'. . $11.*(SbDb-l? WS 9ZSi•VSS J v' �, • LIFT TO OPEN alis An 2S'd31'8 010 .._,Notice of Cost -of -Living Adjustment (CO 41— Hello .Hello CAROLENA V WASHINGTON Your Social Security benefit will increase by 2.5% in January 2025 because of a rise in the cost of living. You can use this letter as proof of your benefit amount if you need to apply for food, rent, or energy assistance. You can also use it to apply for bank loans or for other business. Keep this letter with your important financial records or access this information online by signing into your my Social Security account. Your monthly benefit in 2025 before deductions Si, 656.0 Medicare Medical Insurance (Part B and Part C) If you did not have Medicare as of November 21, 2024, or if someone else pays your premium, we show $0.00. Medicare Prescription Drug Plan (Part D) We will notify you if the amount changes in 2025. If you did not elect withholding as of November 1, 2024, we show $0.00. U.S. federal tax withholding for non -citizens Voluntary federal tax withholding If you did not elect voluntary tax withholding as of November 21, 2024, we show $0.00. Your monthly benefit in 2025 after deductions This monthly amount may include deductions not listed above. For more information about your COLA and other benefits -related topics such as Medicare, Ticket to Work, Reporting Wages, Earnings Limits, Other Pensions, and more, go to www.ssa.gov/cola or scan the QR code. If you would like a paper copy of any of this information, please contact us. Need more help? 1. Visit www.ssa.gov for fast, simple, and secure online service. 2. Call us at 1-800-772-1213, weekdays from 8:00 am. to 7:00 pm. If you are deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter when you call. 3. You may also call your local office at 1-888-397-5325. SOCIAL SECURITY 2340 DREW STREET CLEARWATER, FL 33765 How are we doing? Go to www.ssa.gov/feedback to tell us. Go paperless & get your COLA notice online at www.ssa.gov/myaccount 1.20,1 S howNe ace do Ito at www.ssa.gov/feedback/COLA SOCIAL SECURITY ADMINISTRATION PO Box 67610 Wilkes-Barre, PA 18767-7610 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE. $300 Over ► FIRST-CLASS MAIL PRESORTED POSTAGE AND FEES PAID SOCIAL SECURITY ADMINISTRATION PERMIT NO.G-11 0 S.Clctt See -enact Ardseesait teesa �Zt SEC•0 ' USA 7:64., IIIIIII.<: nry5'CttA TTriz ; LIFE Actde .^''° `c "Cel Grating 30 years of Cultural its with the World?' 1751 Kings Highway 838 22nd Street South Clearwater, FL 33755 St. Petersburg, Fl 33712 (727) 216-3519 (727) 216-3903 Fax email: vmelendez@artz4life.org www.artz4life.orq Home of Dundu Dole Urban African Ballet, OST BT2U Girls Program, Young Gents, Explore The Arts Summer Camp, ACE After School Program SERVICE HOURS — VERIFICATION FORM Volunteer Community Service Educational Other Name of Participant: Robert and Carolena ashington Agency Contact and signature Referre DATE TIME IN 5pm TIME OUT 8pm HOURS 3 eF((PE WORK Clean Tables and Chairs and Bathrooms STAFF ip rE 7/7 7/8 5pm 8pm 3 Sweep and mop outdoor areas 7/9Oil 5pm 8pm 3 Clean Tables and Chairs and Bathrooms i 7/10 5pm 8pm 3 Clean Tables and Chairs and Bathrooms 7/11 5pm 8pm 3 Organize closets and cabinets 0el7/12 5pm 8pm 3 Organize Closets and cabinets 7/14 5pm 8pm 3 Organize cabinets and closets lk- 7/19 10am 2pm 4 Help with rental set up and clean up 4.000� 00.7/21 5pm 8pm 3 Organize cabinets and closets A I V i nis worker has completed the hours he/she has agreed to work for us. This worker has partially completed the hours he/she has agreed to work for us. I would be willing to have this individual work for me in the future. ARTZ 4 LIFE ACADEMY's Mission is to reinforce resilience to life's challenges by enhancing education, promoting diversity and developing life skills through cultural and preforming arts for youth, adults and families. I u .i RE: Letter of Intent to Volunteer CITY OF CLEARWATER COMMUNITY REDEVELOPMENT AGENCY POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748 600 CLEVELAND STREET, CLEARWATER, FLORIDA 33755 TELEPHONE (727) 562-4039 As part of the North Greenwood Community Redevelopment Agency (NGCRA) Residential Exterior Improvement Grant Program, you are making a commitment to complete volunteer hours in order to waive the financial match portion of the grant. This letter serves as a formal acknowledgment of your commitment to complete this volunteer requirement. Applicant Name: ROBERT "ASHlry(aTohl Organization: Az--t"Z 4 L.1FE ANAL ' V..I , lr`CC Address: fSt KirtLIS Hwy CLEA,aj - Et, FL 7' S Contact Person: VA 1 Hirlsonl Contact Number/Email: -1,D1 - - BS q / CIANSo,ic rr 4UFE.oaCa Brief Description of Role: Duc►tS 'iTTrkCkt O Total Volunteer Hours Required: Please Note: In the event the Applicant is unable to complete or provide the amount of hours agreed to in the application, the required contribution shall be reduced by the monetary value of the number of hours actually provided. Volunteer Commitment By signing, you confirm your intent to complete the required volunteer hours to fulfill the volunteer match for the North Greenwood Residential Improvement Grant. Upon completion, our organization may verify your service. Signature: Date: CRA Staff Signature: Date: Ryan Cotton, Councilmember Mike Mannino, Councilmember Bruce Rector, Mayor David Allbritton, Councilmember Lina Teixeira, Councilmember "Equal Employment and Affirmative Action Employer" litZ LIFE deaden.., I )c. "Cete6rating 30 years o f CutturatArts with the Wo . " 1751 Kings Highway 838 22nd Street South Clearwater, FL 33755 St. Petersburg, Fl 33712 (727) 216-3519 (727) 216-3903 Fax www.artz4life.org email: jaihinson@artz4life.org Home of Dundu Dole Urban African Ballet, OST BT2U Girls Program, Young Gents, Explore The Arts Summer Camp, ACE After School Program July 15, 2025 To Whom It May Concern, Re: Robert and Carolena Washington Community Service Hours This letter confirms that Robert and Carolena Washington have fulfilled 28 hours of Community Service at Artz 4 Life Academy. Attached, please find their notation of dates, times and duties that were performed. Please feel free to contact us if you have any questions, comments or concerns. S son utive Director ARTZ 4 LIFE ACADEMY's Mission is to reinforce resilience to life's challenges by enhancing education, promoting diversity and developing life skills through cultural and preforming arts for youth, adults and families. Shire, Vickie From: Mulder, Rebecca Sent: Wednesday, August 27, 2025 8:40 AM To: Shire, Vickie Subject: RE: Code Violations Attachments: DSCF0466.JPG; DSCF0469.JPG; DSCF0465.JPG; DSCF0478.JPG; DSCF0476.JPG; DSCF0477.J PG Vicki, The below information was shared by the inspector in the area. Looks like there are some exterior surface issues. Photos attached. First three photos are of Fulton and the last three are of Spring Dale. • 1312 Spring Dale Clearwater 33755 EXTERIOR SURFACE ISSUES • 1754 Fu n Ave. Clea = er 33755 ERIOR SURFACE ISSUES _TARPON ROOF Yards are in order, didn't see any ABVs Let me know if you need anything else. Thanks, From: Shire, Vickie <Vickie.Shire@MyClearwater.com> Sent: Friday, August 22, 2025 5:00 PM To: Kozak, Ted <Ted.Kozak@myclearwater.com>; Kurleman, Scott <Scott.Kurleman@myClearwater.com>; Mulder, Rebecca <Rebecca.Mulder@MyClearwater.com>; Root, Dana <Dana.Root@myClearwater.com>; Garriott, Kevin <Kevin.Garriott@myClearwater.com> Subject: Code Violations Can you please let me know if the following properties have any code violations by: August 26th • 1312 Spring Dale Clearwater 33755 • 1754 Fulton Ave. Clearwater 33755 Thank you Vickie Shire, FRA -RP CRA Manager: Programs Community Redevelopment Agency Clearwater City Hall 600 Cleveland Street, Suite 600 Clearwater, FL 33755 727-444-7127 1 E 1754 Fulton Ave X eGongle Street View Shire, Vickie From: Sent: To: Subject: Attachments: Vicki, Mulder, Rebecca Wednesday, August 27, 2025 8:40 AM Shire, Vickie RE: Code Violations DSCF0466.JPG; DSCF0469.JPG; DSCF0465.JPG; DSCF0478.JPG; DSCF0476.JPG; DSCF0477.J PG The below information was shared by the inspector in the area. Looks like there are some exterior surface issues. Photos attached. First three photos are of Fulton and the last three are of Spring Dale. • 1312 Spring Dale Clearwater 33755 EXTERIOR SURFACE ISSUES • 1754 Fulton Ave. Clearwater 33755 TE ORSU° FADE ISSUES TARP ON ROOF Yards are in order, didn't see anyABVs Let me know if you need anything else. Thanks, r� per -i- tr-ex-))-- Ir. G,old!'ts s 1 SSS .s lc2:3-Iar From: Shire, Vickie <Vickie.Shire@MyClearwater.com> Sent: Friday, August 22, 2025 5:00 PM To: Kozak, Ted <Ted.Kozak@myclearwater.com>; Kurleman, Scott <Scott.Kurleman@myClearwater.com>; Mulder, Rebecca <Rebecca.Mulder@MyClearwater.com>; Root, Dana <Dana.Root@myClearwater.com>; Garriott, Kevin <Kevin.Garriott@myClearwater.com> Subject: Code Violations Can you please let me know if the following properties have any code violations by: August 26th • 1312 Spring Dale Clearwater 33755 • 1754 Fulton Ave. Clearwater 33755 Thank you Vickie Shire, FRA -RP CRA Manager: Programs Community Redevelopment Agency Clearwater City Hall 600 Cleveland Street, Suite 600 Clearwater, FL 33755 727-444-7127 1 TO Robert Jackson Air Walls & Heating LIC.#CAC1823339 Dwight Walls 34921 US HWY N. Suite 320 Palm Harbor, 34684 727-678-3353 airwallsheating@gmail.com 1754 Fulton Avenue, Clearwater, FI 0 1 (727) 434-0072 ESTIMATE EST0036 DATE 07/11/2025 TOTAL USD $5,680.0 0 DESCRIPTION RATE QTY AMOUNT 2 ton system replacement Removal of old equipment for junk Electrical Drainage Copper connections Duct fab 5kw heater Heatshield Mechanical fasteners Tape & mastic 1yr labor warranty 10yr parts warranty TOTAL $5,680.00 1 $5,680.00 USD $5,680.00 THE OFFICIAL SITE OF THE FLORIDA DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION d ONLINE SERVICES Apply for a License Verify a Licensee View Food & Lodging Inspections C e artrne nt of Business & Professional Regulation File a Complaint Continuing Education Course Search View Application Status Find Exam Information Unlicensed Activity Search AB&T Delinquent Invoice & Activity List Search HOME CONTACT US MY ACCOUNT LICENSEE SEARCH OPTIONS 10:22:50 AM 8/27/2025 Data Contained In Search Results Is Current As Of 08/27/2025 10:21 AM. Search Results - 3 Records Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Certified Air Conditioning Contractor Address*: Name AIR WALLS & HEATING LLC License Location Main Address*: Construction Business Information AIR WALLS & HEATING LLC Name Type DBA License Number/ Rank CAC 1823339 Cert Air Status/Expires Current, Active 08/31/2026 34921 US HWY 19 N STE 320 PALM HARBOR, FL 34684 1455 WINDMOOR DRIVE DUNEDIN, FL 34698 Primary Business Info Current Main Address*: 34921 US HWY 19 N STE 320 PALM HARBOR, FL 34684 Construction AIR WALLS & Financial HEATING LLC DBA Officer Address*: FRO15980 Fin Officer Current License Location 34921 US HWY 19 N STE 320 PALM HARBOR, FL 34684 Main Address*: 1718 LINWOOD CIR CLEARWATER, FL 33755 Back New Search * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. 2601 Blair Stone Road, Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright ©2023 Department of Business and Professional Regulation - State of Florida. Privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must NC2812 - 2 -part • NC3812 - 3 -part i adams ne /(oz i/? s clec x/e4-( /.23f Loo(sick. 2L . (ea, a. , Y 3376.4( Ek /3DG.) 3.35 Vet) /1.2 pktic_.rCdA_ carbonless invoice INVOICE NO. DATECE 7.24 r •.. CUSTOMER ((/ ) ORDER NUMBER Invoice SOLD /da bN/" SHIP T0: 17541 Fa /A g8.- UNIT . r_i,r./2 J&n- L -I/ 3,-325-5 "SALESPERSON SFMPPED VIA TERMS F.O.B. CITY ORDERED OTY SNIPPED DESCRIPTION UNIT Elliganallie , e/74`/l, c vUi /0 -� o? f 't Jo tom /e/e1-3-h) Dtl / 3 ?be -01' Ocz l / Go,VA G c6 7 ..6,6e4/1.,-1-5 z,L ietac eI ell -cures 7 a w /'1 J112.-/ I awa. l i e -71-44al et-) (iL. 5- 71. UZ eosf 1q 61 00 11-12 ad/ nm. NC28121NC3812 THE OFFICIAL SITE OF THE FLORIDA DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION d ONLINE SERVICES Apply for a License Verify a Licensee View Food & Lodging Inspections File a Complaint Continuing Education Course Search artnient of Business & fofessionj Regulation View Application Status Find Exam Information Unlicensed Activity Search AB&T Delinquent Invoice & Activity List Search HOME CONTACT US MY ACCOUNT LICENSEE SEARCH OPTIONS 10:28:59 AM 8/27/2025 Data Contained In Search Results Is Current As Of 08/27/2025 10:28 AM. Search Results - 3 Records Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Cosmetology Salon Address*: Name J&TMC CULLOUGH'S SALON License Location Main Address*: Registered Electrical Contractor MCCULLOUGH'S ELECTRICAL CONCEPTS INC Name Type License Number/ Status/Expires Rank CE0061468 Primary Cosmo Salon Current, Active 11/30/2026 1675 WEST SILVER SPRINGS BLVD OCALA, FL 34475 1741 NW 42ND PLACE OCALA, FL 34475 ER13012335 Current, Active DBA Reg 08/31/2026 Electrical Main Address*: 1239 BROOKSIDE DR CLEARWATER, FL 33764 Electrical Business Information MCCULLOUGH'S ELECTRICAL CONCEPTS INC Primary Business Info Current 08/31/2002 Main Address*: 1536 CLARK STREET CLEARWATER, FL 33755 Back New Search * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. 2601 Blair Stone Road, Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer. Copyright ©2023 Department of Business and Professional Regulation - State of Florida. Privacy Statement Under Florida law, email addresses are public records. If you do not want your email address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emails provided may be used for official communication with the licensee. Better Business Bureau -.- s BBB® BUSINESS PROFILE Electrician McCullough's Electrical Concepts, Inc 0 This business is NOT BBB Accredited. Find BBB Accredited Businesses in Electrician. 4 Share ABOUT REVIEWS COMPLAINTS Complaints This business has 0 complaints a If you've experienced an issue Submit a CompiaL t McCullough's Electrical Concepts, Inc is NOT a BBB Accredited Business. To become accredited, a business must agree to BBB Standards for Trust and pass BBB's vetting process. II Why choose a BBB Accredited Business? We use cookies to give users the best content and online experience. By clicking "Accept All Cookies", you agree to allow us to use all cookies. Visit our Privacy_Eaky to learn more. Contract a iMM113 Systems, MC. ordable RoofingY CONTRACT AMOUNT - DEPOSIT MOUNT DATE yba, N Ttep ta . fine A. BALANCE AMOUNT ___- - ___ DA COMPLETION Ta. 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Search Results - 6 Records Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Certified Roofing Contractor Name Name Type License Number/ Status/Expires Rank AFFORDABLE LIFETIME METAL CCC1326987 Null and Void, ROOFING DBA Cert Roofing 08/31/2008 SYSTEMS INC Main Address*: 420 W LINGLEVILLE RD STEPHENVILLE, TX 76401-2210 Construction AFFORDABLE Business LIFETIME METAL Primary Current ROOFING Business Info Information SYSTEMS INC Main Address*: 420 LINGLEVILLE RD STEPHENVILLE, FL 76401 Certified General Contractor AFFORDABLE ROOFING SYSTEMS INC DBA CGC1517188 Current, Active Cert General 08/31/2026 License Location Address*: 9511 N TRASK ST TAMPA, FL 33624 Main Address*: 1903 VANDERVORT RD LUTZ, FL 33549 Certified Roofing Contractor AFFORDABLE ROOFING SYSTEMS INC DBA CCC1326722 Current, Active Cert Roofing 08/31/2026 License Location Address*: 9511 N TRASK ST STE A TAMPA, FL 33624 Main Address*: 1903 VANDERVORT RD LUTZ, FL 33549 Certified Roofing Contractor AFFORDABLE ROOFING SYSTEMS, INC. DBA CCC1335294 Current, Active Cert Roofing 08/31/2026 License Location Address*: 9511 N TRASK ST STE A TAMPA, FL 33624 Main Address*: 4706 W EL PRADO BLVD TAMPA, FL 33629 Construction Business Information AFFORDABLE ROOFING SYSTEMS, INC. Primary Current Business Info eAkts_CITY OJiNG,,,c1.,E ARWATER ,.. P!. DEPARmi 4s Posr OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748 MUNICIPAL. SERVICES BIJH.DING, 100 SOCTH MYRTLE. AVENUE, CLEARWATER, FLORIDA 33756 TELEPHONE (727) 562-4567 CASE SUMMARY Case No. BCP2025-050851 Address 1754 FULTON AVE Project Name Robert Washington Case Description Online Permit - Remove/replace roof shingles U NDER300K,1949 Active Case Status Fee Description Fee Amount Fee Paid Fee Bal Invoice Feeltem for Permit Fee per Structure $83.75 $83.75 $0.00 Invoice Feeltem for FL Fee - Building Code Admin and Inspector's Board $2.00 $2.00 $0.00 Invoice Feeltem for FL Fee - Building Commission $2.00 $2.00 $0.00 Invoice Feeltem for Plans Examination - Residential $23.00 $23.00 $0.00 Balance Due 0.00 Conditions Status Category ***Please circle or highlight which product number you are using down to the decimal for FL10124 and upload.*** Met Product Approval - Roofing Please upload the recorded NOC (Notice of Commencement) before issuance of permit. Met Recorded NOC Active Inspections/Workflow Active Permit Scheduled Status Disp Done By 6/17/2025 6/17/2025 Completed lnspections/Workflow Digital Plan Review Scheduled Status 5/23/2025 5/23/2025 Printed on: 7/1/2025 Disp Awaiting Plans Done By PlanRoom 1 of 7 ACA InfoSummary "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" Digital Plan Review Scheduled Status Disp Done By 5/23/2025 5/23/2025 Outstanding Issues Root Please see conditions report. Digital Plan Review Scheduled Status Disp Done By 5/23/2025 5/23/2025 Plans Received PlanRoom Review package submitted by: PUBLICUSER7891 Digital Plan Review Scheduled Status Disp Done By 5/23/2025 5/23/2025 Plans Received PlanRoom 2025-05-23 08:52**REVIEW PACKAGE SUBMITTED BY CUSTOMER!! Application Submittal Scheduled Status Disp Done By 5/23/2025 5/23/2025 Need Addtl Info Root Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 13:50 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 13:53 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 Walk Through Review Root Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 13:52 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 Outstanding Issues Root Please see conditions report. Printed on: 7/1/2025 2 of 7 ACA InfoSummary "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 11:53 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 11:53 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 11:53 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 11:53 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 NOTE PlanRoom 2025-05-27 12:01 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 Plans Received PlanRoom Review package submitted by: PUBLICUSER7891 Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 Plans Received PlanRoom 2025-05-27 12:04**REVIEW PACKAGE SUBMITTED BY CUSTOMER!! Application Submittal Scheduled Status Disp Done By 5/27/2025 5/23/2025 Need Addtl Info Root Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 Plans Received PlanRoom Review package submitted by: PUBLICUSER7891 Printed on: 7/1/2025 3 of 7 ACA InfoSummary "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" Digital Plan Review Scheduled Status Disp Done By 5/27/2025 5/23/2025 Plans Received PlanRoom 2025-05-27 13:56**REVIEW PACKAGE SUBMITTED BY CUSTOMER!! Application Submittal Scheduled Status Disp Done By 5/27/2025 5/23/2025 Online Submittal Root Processed Place review in Online Reviews task list Building Review Scheduled Status Disp Done By 6/3/2025 5/28/2025 Revision Needed Bryce Digital Plan Review Scheduled Status Disp Done By 6/3/2025 5/23/2025 Waiting for Revisions Bryce Digital Plan Review Scheduled Status Disp Done By 6/5/2025 5/23/2025 NOTE PlanRoom NOC Uploaded Digital Plan Review Scheduled Status Disp Done By 6/5/2025 5/23/2025 Task Processed Root Digital Plan Review Scheduled Status Disp Done By 6/10/2025 5/23/2025 NOTE PlanRoom 2025-06-10 11:04 **NEW DOC UPLOADED BY CUSTOMER!! Building Review Scheduled Status Disp Done By 6/17/2025 6/18/2025 Approve Bryce Building Review Scheduled Status Disp Done By 6/17/2025 6/18/2025 Revision Needed Bryce Permit Verification Scheduled Status Disp Done By 6/17/2025 6/17/2025 Issue Sever Digital Plan Review Scheduled Status Disp Done By Printed on: 7/1/2025 4 of 7 ACA InfoSummary "EQUAL EMPLOYMENT AND .AFFIRMATIVE ACTION EMPLOYER" 6/17/2025 5/2312u25 Walk Through - Revisions Mayberry Only Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 Walk Through - Revisions Mayberry Only Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 NOTE PlanRoom 2025-06-17 14:15 **NEW DOC UPLOADED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 NOTE Bryce Review Approved Online Customer Request Scheduled Status Disp Done By 6/17/2025 5/23/2025 Not Applicable Plan Room Printset Uploaded - Updated by script DUA;BUILDING!-!-!-.js Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 Plans Received PlanRoom Review package submitted by: PUBLICUSER7891 Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 Plans Received PlanRoom 2025-06-17 11:40**REVIEW PACKAGE SUBMITTED BY CUSTOMER!! Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 Waiting for Revisions Bryce Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 Plans Received PlanRoom Review package submitted by: PUBLICUSER7891 Digital Plan Review Scheduled Status Disp Done By 6/17/2025 5/23/2025 Plans Received PlanRoom 2025-06-17 14:18**REVIEW PACKAGE SUBMITTED BY CUSTOMER!! Digital Plan Review Printed on: 7/1/2025 5 of 7 ACA InfoSummary "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" Scheduled Status 6/17/2025 5/23/2025 Disp Done By Permit Issued Sever Plan Room Issues: BUILDING - NON -SUBSTANTIAL IMPROVEMENT FORMS Issue created by Robert Bryce on 6/3/2025 10:23:05 AM bob.bryce@myclearwater.com - 727-444-8737 The subject property is a Non -Compliant structure located within a Special Flood Hazard Zone (AE) with an assigned BFE of 12.1' and a Design Flood Elevation of 14.1' NAVD. Please provide a fully completed Non Substantial Improvement package. This documentation is required for our records (Community Rating System/ National Flood Insurance Program). City ordinance 9189 Chapter 51.204. Set to ACCEPTED on 6/17/2025 1:46:39 PM SUBMIT THE NON -SUBSTANTIAL IMPROVEMENT PACKAGE: https://www.myclearwater.com/files/sharedassets/public/v/1 /planning-amp- development/documents/non-substantial_ damage_ imp_1_9.pdf If an architect or engineer is not part of the project, no need to fill out the Architect/Engineer Affidavit. The rest of the package is still required. Sec. 51.204. - Substantial improvement and substantial damage determinations. For applications for building permits to improve buildings and structures, including alterations, movement, enlargement, replacement, repair, change of occupancy, additions, rehabilitations, renovations, substantial improvements, repairs of substantial damage, and any other improvement of or work on such buildings and structures, the floodplain administrator, in coordination with the building official, shall: 1. Estimate the market value, or require the applicant to obtain an appraisal of the market value prepared by a qualified independent appraiser, of the building or structure before the start of construction of the proposed work; in the case of repair, the market value of the building or structure shall be the market value before the damage occurred and before any repairs are made; https://library.municode.com/fl/clearwater/codes/community_ development_ code? node Id=PTIIBUDERE CH51FLDAPR ARTIAD David Torres on 6/10/2025 11:10:04 AM - ANSWERED The Non Substantial Improvement forms have been uploaded. Printed on: 7/1/2025 6 of 7 ACA InfoSummary "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" BUILDING - STRUCTURE'S VALUE Set to ACCEPTED on 6/17/2025 3:00:20 PM Issue created by Robert Bryce on 6/3/2025 10:23:25 AM bob.bryce@myclearwater.com - 727-444-8737 SUBMIT THE VALUE OF THE STRUCTURE ONLY: The subject property is a structure located within a Special Flood Hazard Zone unless an elevation certificate is provided showing compliance with flood elevation requirements. If the property value and spending limit as determined by the Pinellas County Property Appraiser is used, locate this value by going to the PCPA web site (https://www.pcpao.gov ) and search for the address. Using the Tools menu located at the top right corner, select "FEMA/WLM Letter and using the values under the "Federal Emergency Management (FEMA) 50% Rule" heading. Provide a copy of this letter with your FEMA package. The value from the Property Appraiser cannot be used if there are two or more structures on the property. In this case, an appraisal for the entire structure must be provided. If an appraisal is submitted, it must be a recent Cost Approach Appraisal, Actual Cash Value (not a market, sales approach or one for insurance purposes). Note the use of the appraisal is to establish the 50% threshold for FEMA. Name the City of Clearwater as a user of the appraisal. Another option is to submit an elevation certificate that shows compliance with the city's floodplain ordinance. David Torres on 6/10/2025 11:09:20 AM - ANSWERED The structure's value is 56,853 Robert Bryce on 6/17/2025 1:47:30 PM - NOTACCEPTED Upload the supporting document for the value of the structure. David Torres on 6/17/2025 2:17:21 PM - ANSWERED Uploaded FEMA 50% Letter -Structure Value Plan Room Conditions: No Plan Room Conditions. Plan Room Notes: No Plan Room Notes. PEOPLE Name Phone/Fax Role: Applicant Beth Brokaw 10113 Queens Park Dr Tampa, FL 33647 PHONE: 8139975590 FAX: Contractor DAVID TORRES 9511 N TRASK STE A TAMPA, FL 33624 PHONE: 813-542-8462 FAX: OWNER WILLIAM C CAMPBELL 1077 WEATHERSFIELD DR 34698-6434, DUNEDIN FL PHONE: FAX: PRIMARY OWNER ROBERT J WASHINGTON 1754 FULTON AVE 33755-1819, CLEARWATER FL PHONE: FAX: Printed on: 7/1/2025 7 of 7 "EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" ACA InfoSummary Better Business Bureau® BBB, BUSINESS PROFILE Roofing Contractors Affordable Roofing Systems, Inc. BBB Accredited Business A+ Rated by BBB Share ABOUT GET A QUOTE REVIEWS COMPLAINTS Complaints Customer Complaints Summary 2 total complaints in the last 3 years. 0 complaints closed in the last 12 months. If you've experienced an issue The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. L Initial Complaint Date: 02/14/2024 Type: ti Service or Repair Issues We use cookies to give users the best content and online experience. By clicking "Accept All Cookies", you agree to allow us to use all cookies. Visit our Privacy Policy to learn more. BILL TO Robert Washington 1754 Fulton Avenue #1754 Clearwater, FL 33755 USA JOB ADDRESS Robert Washington 1754 Fulton Avenue #1754 Clearwater, FL 33755 USA Delta Mechanical 6056 E. Baseline Rd. #155 Mesa, AZ, 85206 866-898-0007 License#: CFC1425917 ESTIMATE 243962307 ESTIMATE DATE Aug 27, 2025 ESTIMATE DETAILS Job: wh install : wh install utility room SERVICE DESCRIPTION QTY PRICE TOTAL New Install New Install Water Heater Water Heat Delivery of water heater 1692 Isolation of water system Inspect stand or location of unit Drain existing water heater Remove and dispose of existing water heater Install new water heater Replace supply lines Install sediment trap if necessary Connect T&P line (hard piped and soldered) Test T&P Fill and test unit Pick up work area Any misc. fittings and materials for install Review install with customer 1001301802 1001301802-38 ELEC SHORT 6 4500W (RHEEM) XE38S06ST45U1 RHEEM XE38S06ST45U1 Materials MATERIAL DESCRIPTION 1.00 $800.00 $800.00 1.00 $489.00 $489.00 QUANTITY YOUR PRICE Estimate #243962307 YOUR TOTAL Page 1 of 2 3000P City of Clearwater PT 115P Processing Fee 55 BV Ball Valve 60 Drip Pan 74 Expansion Tank CUSTOMER AUTHORIZATION 1.00 $105.00 $105.00 1.00 $85.00 $85.00 1.00 $100.00 $100.00 1.00 $50.00 $50.00 1.00 $125.00 $125.00 POTENTIAL SAVINGS SUB -TOTAL TOTAL EST. FINANCING $0.00 $1,754.00 $1,754.00 $21.05 I authorize Delta Mechanical to perform the work as quoted. Unforeseen site conditions may occur. Additional charges will be discussed prior to work being performed. • Scope of Work: Any work outside the plumbing trade will not be estimated or performed unless explicitly stated in this written estimate. • Code Compliance: The work does not include any materials or labor required to meet code compliance beyond two feet from the water heater connection or beyond the drywall, whichever occurs first. • Exclusions: This estimate does not cover additional or replacement parts for the water heater, such as Watts 210 valves, pumps, or similar items, unless specifically listed in this estimate. • Vent, Water, and Drain Lines: If the necessary vents, water lines, or drain lines for the heater are not in place, a change order will be required to install these according to code. The scope of work does not include modifications to walls, ceilings, or roofs for code compliance. • Unforeseen Issues: If any existing conditions or unforeseen issues prevent proper installation or operation of the water heater, or if permits are not approved due to the current plumbing system, a change order will be required to address the problem. • Testing: No testing has been performed on the water heater or any associated components, including pumps, filters, boosters, or conditioners, or any equipment connected to the water heater. Sign here Date Estimate #243962307 Page 2 of 2 THE OFFICIAL SITE OF THE FL PROFESSIO dbl RIDA DEPARTMENT OF BUSINESS & AL REGULATION rDeoartment of Business & f rofessi[xkal Regulation ONLINE SERVICES Apply for a License Verify a Licensee View Food & Lodging Inspections File a Complaint Continuing Education Course Search View Application Status Find Exam Information Unlicensed Activity Search AB&T Delinquent Invoice & Activity List Search HOME CONTACT US MY ACCOUNT LICENSEE SEARCH OPTIONS 5:19:24 PM 9/15/2025 Data Contained In Search Results Is Current As Of 09/15/2025 05:17 PM. Search Results - 2 Records Please see our glossary of terms for an explanation of the license status shown in these search results. For additional information, including any complaints or discipline, click on the name. License Type Certified Plumbing Contractor Address*: Certified Plumbing Contractor Address*: Name BOBEV, DIMITRE I License Location Main Address*: Mailing Address*: F •RIDA DELT ECHANICA INC License Location Main Address*: Mailing Address*: Name Type Prima License Number/ Rank CFC1425917 Plumbing Status/Expires Current, Active 08/31/2026 6146 BAYSIDE DRIVE NEW PORT RICHEY, FL 34652 6146 BAYS IDE DRIVE NEW PORT RICHEY, FL 34652 414 S ORLEANS AVE TAMPA, FL 33606 DBA FC142591 Cert Ing Current, Active 08/31/2026 6146 BAYSIDE DRIVE NEW PORT RICHEY, FL 34652 6146 BAYS IDE DRIVE NEW PORT RICHEY, FL 34652 414 S ORLEANS AVE TAMPA, FL 33606 : vv Scary;': * denotes Main Address - This address is the Primary Address on file. Mailing Address - This is the address where the mail associated with a particular license will be sent (if different from the Main or License Location addresses). License Location Address - This is the address where the place of business is physically located. Better Business Bureau® BBB BUSINESS PROFILE Plumber Florida Delta Mechanical Inc Share This business is NOT BBB Accredited. Find BBB Accredited Businesses in Plumber. ABOUT REVIEWS COMPLAINTS Complaints Customer Complaints Summary 1 complaint in the last 3 years. 0 complaints closed in the last 12 months. If you've experienced an issue The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. Initial Complaint Date: 04/04/2023 Type: ) Service or Repair Issues Status: % Answered We use cookies to give users the best content and online experience. By clicking "Accept All Cookies", you agree to allow us to use all cookies. Visit our Privacy Policy to learn more. J & S OUTDOOR MAINTENANCE LLC 1221 Turner Street Suite 202 Clearwater, FL 33756 United States contact@jsoutdoormaintenance.com I (727) 226-0192 Invoice #001141 Thanks for the opportunity Customer Robert Washington rjw1128@gmail.com (727) 858-5725 1754 FULTON AVE CLEARWATER, FL 33755 Items Invoice Details PDF created September 25, 2025 $3,400.00 Service date October 6, 2025 Tree Removal/Trimming Will remove two large trees in backyard. Will lift /trim three trees located in backyard. Will remove two bushes from front right side against structure. Subtotal Total Due Pay online Quantity 1 Payment Due September 25, 2025 $3,400.00 To pay your invoice go to https://squareup.com/u/f768nWUN Or open the camera on your mobile device and place the QR code in the camera's view. Price $3,400.00 Invoice #001141 Issue date Sep 25, 2025 Amount $3,400.00 $3,400.00 $3,400.00 Page 1 of 1 EXHIBIT "C" GRANT APPLICATION AND PLAN SPECIFICATIONS 12 RESIDENTIAL EXTERIOR IMPROVEMENT GRANT PROGRAM APPLICATION FORM City of Clearwater Community Redevelopment Agency North Greenwood Community Redevelopment Area TABLE OF CONTENTS SECTION 1 — PROGRAM GOAL 1 SECTION 2 — PURPOSE AND INTENT 1 2 4 5 6 7 7 8 11 SECTION 3 — AVAILABLE ASSISTANCE AND PROGRAM ELIGIBILITY SECTION 4 — ELIGIBLE RESIDENTIAL IMPROVEMENTS SECTION 5 — PROGRAM REQUIREMENTS AND APPLICATION PROCESS SECTION 6 — DISBURSEMENT POLICY AND PROCEDURE SECTION 7 — GRANT EXPIRATION SECTION 8 — COMPLIANCE WITH THE CITY OF CLEARWATER ETHICS CODE SECTION 9 — APPLICATION SECTION 10 — ELIGIBLE CRA AREA MAP Residential Exterior Improvement Grant Program Approved by the CRA Trustees July 15, 2024 Case Number: RESIDENTIAL EXTERIOR IMPROVEMENT GRANT PROGRAM The Program provides a matching grant of up to $20,000. SECTION 1 — PROGRAM GOAL The City of Clearwater (City) Community Redevelopment Agency (CRA) Residential Exterior Improvement Grant Program (Program) is designed to increase access to redevelopment funding for residential improvements to homesteaded single-family homes in the North Greenwood Community Redevelopment Area (NGCRA). The purpose of the Program is to rehabilitate single family homes, improve property conditions, aesthetics, reduce housing cost burden, and aid in the elimination of slum and blight. The focus of this Program is directed to the exterior improvement of residential properties to enhance neighborhood aesthetics and pride. SECTION 2 — PURPOSE AND INTENT The purpose of the Program is to support the implementation of the adopted Community Redevelopment Area Plan (Plan) for the North Greenwood Community Redevelopment Area in accordance with the Florida Community Redevelopment Act of 1969. Sections 163.330, et seq., Florida Statutes, by: 1) Carrying out plans for a program of voluntary or compulsory repair and rehabilitation of buildings or other improvements in accordance with the community redevelopment plan (Sections 163.370(2)(c)(5), Florida Statutes). 2) Reducing the percent of households that are housing cost burdened (Plan Section 3.2, Goals and Objectives, Goal 4 Housing Affordability, Objectives, page 94). 3) Prioritizing keeping existing residents in their homes through funding for addressing property maintenance and building code issues and reducing visual blight (Plan Section 3.3, Redevelopment Policies, Housing, page 95). 4) Developing grant programs to improve the exterior and interior of blighted properties (Plan Section 4.5, Plan Implementation, Table 15, Goal 1 Policy Implementation: Public Safety, page 134). 5) Developing programs to encourage neighborhood pride in yard and home appearance (Plan Section 4.5, Plan Implementation, Table 15, Goal 1 Policy Implementation: Public Safety, page 136). 6) Providing emergency assistance funds for low-income residents for life safety home repairs and renovations to accommodate physical disabilities (Plan Section 4.5, Plan Implementation, Table 15, Goal 4 Policy Implementation: Housing Affordability, page 140). 7) Creating a grant program to reduce blight through the repair and preservation of historic homes (Plan Section 4.5, Plan Implementation, Table 15, Goal 4 Policy Implementation: Housing Affordability, page 142). 8) Creating value for the citizens of Clearwater and improving the North Greenwood CRA by (themes stressed throughout the Plan): a) Promoting a resident and neighborhood friendly atmosphere; 1 b) Promoting economic development and neighborhood revitalization; c) Incentivizing property owners to enhance and sustain the values of their property; d) Creating a more inviting and visually appealing atmosphere; and e) Instilling a greater sense of place and civic identity. It is not the intent of the CRA to engage in any rehabilitation activity that requires vacating property or displacing any residents from property. Moreover, this Program does not assist in temporary relocation cost or the development of new construction projects. Rather, it is to rehabilitate existing single-family structures. SECTION 3 — AVAILABLE ASSISTANCE AND PROGRAM ELIGIBILITY The Program provides a matching grant, as specified below, of up to $20,000 to assist applicants with exterior home repairs. Program assistance is based on a sliding scale and adjusted for family size and income limits, which are subject to change from time to time. Applicants with Household incomes that exceed 120% Area Median Income do not qualify for this Program. Applicant will match the grant amount by the percentages listed below (must provide proof of matching funds prior to project work commencing): Area Median Income (AMI) % Applicant Contribution/Match 0-30% 5%* 31% — 50% 10%* 51% — 80% 15%** 81% — 120% 20%** 121% — plus Not eligible for grant. *Match may be waived at the rate of one hour of community service per $150 of approved grant amount and will be added back into the total grant amount not to exceed $20,000. **Up to 50% of Applicant's match may be waived at the rate of one hour of community service per $150 of approved grant amount and will be added back into the total grant amount not to exceed $20,000. (Community Service must be performed by Applicant, or anyone over 18 years of age legally residing in the home, within the NGCRA boundary and through a tax- exempt not-for-profit organization recognized by the CRA or City of Clearwater. Community service must be performed without pay or compensation from the not-for- profit organization, and service must be performed in full hour increments rounding up to the nearest whole hour. Scope of community service must be pre -approved, by the CRA Director, prior to commencement. In addition, said community service must be performed prior to release of grant funds.) The CRA Director may waive, or reduce, on a case-by-case basis, the community service provision for certain individuals with disabilities, including age related disabilities, or other verifiable hardships, that prevent the Applicant, and anyone over 18 years of age legally residing in the home, from performing community service. In the event the waiver is granted, then the Applicant Contribution/Match will be set to zero percent. The grant is a reimbursement grant, unless otherwise approved by the CRA Director to pay an approved licensed contractor directly, no more than one payment within a 30 -day period. The CRA Director may require in all grant applications that licensed contractors 2 be paid directly, eliminating the need for homeowners to pay contractors, and then requesting reimbursement from the CRA. The chart below is data provided by the Florida Housing Finance Corporation (FHFC) which is based upon figures provided by the United States Department of Housing and Urban Development (HUD) and are subject to change. Updated charts by FHFC will supersede any income limit chart provided within this document. When updates are made available by FHFC, the chart below will be updated. County (Metro) Percentage Category Income Limit by Number of Persons in Household 1 2 3 4 5 6 7 8 Pinellas County 30% 21,950 25.050 28,200 32.150 37,650 43.150 48,650 34,150 (Tampa•StPeter5burg• 50% 36,500 41,700 46,950 52,150 56,350 60.500 64,700 68,550 Clearwater MSA BO% 58,450 66.800 75,150 83.450 90,150 963597 103,500 110.200 Median_ 98.400 120% 87,600 100,080 112,680 125,160 135,240 145,200 155,280 165,240 140% 102.200 116.760 131,460 146,020 157,780 169.400 181.160 192.7.1 Eligibility Criteria To be eligible for the Program, the project/property must meet all the following qualifications: • Applicant must be the owner of the subject property. * • The subject property must be a single-family home. • Property must be located within the North Greenwood Community Redevelopment Area. • The single-family home must be the primary residence and legal homestead of the Applicant. In addition, the following may qualify for the Program. • Owners of property that have applied to Pinellas County for homestead exemption consideration may be eligible for this Program. • Applicants that reside at the property, control said property other than through outright ownership, and are authorized to approve the repairs and other work that are the subject of this program, may provide alternative documents to substantiate that they have such control and authority regarding the property. This documentation may include probate court documents, wills, heirship affidavit, letters of administration, or other legal documentation. After review of the documents, the residing applicant(s) may qualify for the Program, provided the applicant(s) wishing to apply for the Program reside at the property as their primary residence. If such control or authority is disputed by another party or parties, the application may be denied until such time as the Applicant resolves such disputes. • Must demonstrate property taxes are current or a satisfactory payment plan is approved by the CRA Director. • Must be current on mortgage payments (if applicable). • Must be in good standing with the city (no outstanding code enforcement or building code violations). This requirement may be waived by the CRA Director if the work proposed under this application will remediate the code violations. • If combined with a Home Rehabilitation Loan from the Economic Development and Housing Department, other requirements may vary. *The owner of the Property (Owner) shall be the Applicant. Owner means a holder of any legal or equitable estate in the premises, whether alone or jointly with others and 3 whether in possession or not shall include all individuals, associations, partnerships, corporations, limited liability companies and others who have interest in a structure and any who are in possession or control thereof as agent of the owner, as executor, administrator, trustee, or guardian of the estate of the owner. No Owner shall receive more than $20,000 in total CRA grant value across all CRA grant programs within a 36 - month rolling year. For the purposes of this application, the total CRA grant value that an Owner has received over such period shall be the combined value, in the 36 month period immediately preceding the submission of an application for this program, of: (1) the amount of CRA grant funds that the applicant has received; (2) the amount of CRA grant funds that any holder of legal title in the subject property other than the applicant has received; and (3) if a business entity holds legal title in the subject property, the total amount of CRA grant funds received by any directors, members, partners, shareholders, any others with an ownership interest in such entity, and any others able to exert managerial control over or direct the affairs of said entity. Previous Participation — Each property may not receive a grant any more than every thirty-six months. The following are ineligible for Program assistance: • Work or improvements that are completed prior to an application being approved. • Any unpermitted work or improvements performed on the property that required a permit and inspections. • Any work or improvements on the property that fail required inspections. • Multi -family properties. • Properties that do not qualify for homestead exemption. • New construction or improvements on vacant land. Proiect Implementation Projects are to be coordinated, managed, and implemented by the Applicant with close interaction with Community Redevelopment Agency Department staff and the appropriate City departments. Applicant is responsible for obtaining/arranging any permits required by the city. SECTION 4 — ELIGIBLE RESIDENTIAL IMPROVEMENTS One or more of the following improvements maybe eligible for Program assistance: 1) Exterior repairs (walls, foundation, piers, siding, etc.); 2) Exterior painting; 3) Exterior windows and doors; 4) Roof repairs or replacement, including facia board, soffits, and gutters; 5) Window or door awnings and shutters (including hurricane shutters; replacement or repair); 6) Exterior weatherization improvements; 7) The installation, repair, or renovation of porches; 8) The installation of decorative lighting; 9) Decorative fencing; 10) Driveway, pedestrian walkways/pathways, and sidewalk improvements; 11) American with Disabilities Act (ADA) accessibility improvements; 4 12) The installation of landscaping and irrigation systems, not to exceed twenty percent (20%) of the total grant amount; 13) Tree trimming or removal (requires city approval, and city may require a licensed arborist to confirm tree removal is necessary); 14) Heating, ventilation, and air conditioning (HVAC) systems; 15) Certain interior repairs: a. Interior deterioration/damage directly resulting from an exterior defect or damage, may qualify for grant funding to repair said deterioration/damage. Such interior repairs may include, but are not limited to, load bearing walls, drywall, insulation, and wood repair. However, grant funds must first be used for improvements or repairs to fully remedy the external defect or damage that resulted in such interior deterioration/damage prior to any use of grant funds on interior repairs. b. Interior deterioration/damage that is verified by the city as a life safety issue to home inhabitants. c. ADA accessibility improvements. 16) Home fumigation (including tenting if necessary) for termites; and 17) Other improvements may be submitted for consideration but must demonstrate that the improvement meets the intent of this grant program. The following improvements are not eligible for Program assistance: 1) Repairs to unsafe or substandard structures that cannot be made safe for habitation with Program funds. 2) Room additions, garage conversions, repairs to structures separate from the living units (detached garage, shed, etc.), furnishings, and pools. 3) Repairs covered by insurance. 4) Non -permanent improvements. 5) Enclosing a front porch. 6) Installation of window or door security bars. 7) General interior home improvements and repairs. SECTION 5 — PROGRAM REQUIREMENTS AND APPLICATION PROCESS Program Requirements • All statements and representations made in the application must be correct in all material respects when made. Any applicant requesting grant funding from this program will have their income verified by City staff and must supply the items listed below, and, if requested, any other income or employment documents that are not listed below: • If applicable, self-employed year to date profit and loss statements. • All pages of last two year's tax returns, with all schedules and W-2s/1099(s). • Most recent and consecutive last two months of bank statements (with bank name and account number) (ALL PAGES, even if blank) for all household members with accounts. • If combined with a Home Rehabilitation Loan from the Economic Development and Housing Department, additional information may be required. Applicants that do not wish to have their income verified will automatically be disqualified from Program participation. 5 • • Color digital photographs of the existing structure exterior, showing all sides of the building, must be provided with application. • An estimated detailed budget must be provided on the attached project budget form (Attachment A). • Work required to be performed by licensed contractors. Applicant must provide, as attachments, three quotes from contractors and copies of their licenses. Quotes to include complete description of materials to be used). o If work is performed by non -licensed workers, then only materials purchased will be eligible for grant funds, unless the work performed was required to be performed by a licensed individual per City codes. • Portions of the project costs not funded by the requested grant must be provided by Owner funding. Owner funding may consist of bank loans, lines of credit, a Home Rehabilitation Loan from the city's Economic Development and Housing Department, and owned assets (Owner Equity), etc. • Owner must demonstrate their source of the Owner Funding and their ability to meet the financial obligations of the Program prior to Program approval. • Proceeds from other City -managed financial assistance programs may be used as Owner Equity to satisfy the Owner Funding requirements of this Program and may be used to assist with funding of remaining portion of larger improvement project. Grant funds cannot be used as Owner Equity to satisfy the Owner Funding requirements of other City -managed financial assistance programs. Grant Application Process • Submittal of an application does not guarantee a grant award. • Grant preference will be given to Applicants at or below 80% AMI, applicants 65 years of age and above, and the disabled. • Completed applications that meet all the Program requirements will be reviewed by the CRA Director. • The CRA Director will approve or deny applications based on the criteria set forth in this document. • Incomplete applications will not be considered submitted until all required documentation has been submitted to Community Redevelopment Agency Department staff. • All construction/design contracts will be between the Applicant and the contractor/design professional. SECTION 6 — DISBURSEMENT POLICY AND PROCEDURE Grant funds will, unless otherwise approved by the CRA Director to allow initial project deposits or other necessary draws, up to fifty percent of the grant amount, to be paid directly to a City/CRA approved licensed contractor, be disbursed upon a "Finding of Project Completion" by CRA Director. A "Finding of Project Completion" will be granted when the following criteria are met: 1) Applicant must demonstrate their ability to meet the financial match/obligations of the Program and any required community service has been completed by qualifying applicants. 6 2) Requests for disbursement of project costs will be viewed as a single, completed package, unless prior disbursement of funds arrangements have been made to pay licensed contractors directly (no more than one payment within a 30 -day period). Costs not included in the approved application budget will not be considered for disbursement. 3) Required documentation for disbursement of project costs must include: a. Copies of cancelled checks, certified checks or money orders of project costs, or credit card statements of project cost; b. Detailed invoices and paid receipts signed, dated, and marked "paid in full;" c. Name, address, telephone number of design professional(s), general contractor, etc.; and d. Photos of the project (before and after photos). 4) The Applicant must have obtained all necessary/required permits (e.g. zoning and building), passed all required inspections, and prior to final disbursement of funds received (if relevant) notice, in the form of a Certificate of Occupancy or Certificate of Completion for the project demonstrating the legal occupancy of the project area. Any work performed without a permit that required a permit will not be eligible for grant funding. 5) The CRA disburses funds to grant recipients within 30 days of fully completed reimbursement request. SECTION 7 — GRANT EXPIRATION Applicants must receive a "Finding of Project Completion" within 180 calendar days from the date of application approval. After the said 180 days, the grant will expire. An extension for the grant funds may be granted by the CRA Director for a good cause. It is the responsibility of the Applicant to request, in writing, from the CRA Director an extension of the grant approval before the expiration date. SECTION 8 — COMPLIANCE WITH THE CITY OF CLEARWATER ETHICS CODE The applicant will comply with all applicable City rules and regulations including the City's Ethics Codes. Moreover, each applicant to the Program acknowledges and understands that the City's Ethics Code prohibit City employees from receiving any benefit, direct or indirect, from any contract or obligation entered with the City. 7 SECTION 9 — APPLICATION 1) Applicant (Property Owner) Full Legal Name(s): Mailing Address: City/State/Zip: Phone Number: E-mail Address: 2) Subject Property Address commonly known as: Parcel Identification Number(s): 3) Project description, scope of work to be performed, sketch plans and specifications detailing the scope of work (provide attachment(s) if needed). (Applicant understands that depending on the project, certain city departments may require additional documentation, plans, etc. to properly review and approve the proposed project described in this application.) 8 9 4) Financial and Other Disclosures Annual Household Income: $ (Income examples (not limited to the following): employment or self-employment income, Social Security, Pension, Disability, etc.) Household Size: # Is the subject property current with property tax payments, mortgage payments (if applicable), fees, and in compliance with City codes and regulations? (must provide copies of property tax payment and mortgage payment statements) Yes No If no, please explain: Have you received a loan or grant assistance from a city -managed financial assistance program for a project at the subject property? Yes No If yes, please specify the program(s), dates received, and the loan/grant amount(s) below or provide attachment(s). Program Name: Date Received: Amount Received $ Program Name: Date Received: Amount Received $ 5) Amount of Grant Requested under this program: $ Are you requesting direct payment of approved grant funds to an authorized contractor? Yes No If yes, please specify the contractor's name: Note: This option must be approved by the CRA Director. 9 Attachment A - Project Budget Form (Attach contractor/vendor estimates/quotes for consistency verification of items listed below. Contractor/vendor estimates/quotes improvement item descriptions and cost will supersede if improvement item descriptions and cost are listed different below. If more project budget form lines are need, Applicant may duplicate budget template below on separate sheet. If new Project Budget Form is created, write "See Attached" in Line No. 1 below. For Applicant Use For staff use only Line Item No. Improvement(s) Item Description (Including construction materials, labor, permitting, other fees, etc.) Improvement(s) Cost Amount Line Item Eligible for Grant Consideration Yes/No Cost Amount Eligible for Grant 1 $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ 10 $ $ 11 $ $ 12 $ $ 13 $ $ 14 $ $ 15 $ $ 16 $ $ 17 $ $ Total Improvement(s) Cost Amount $ Total Cost Amount Eligible for Grant Consideration $ Line No. For Staff Use Only 1 Total Cost Amount Eligible for Grant Consideration (from "Attachment A" above and/or from attached contractor estimates/quotes. $ 2 Amount of Grant Requested under this program (Section 9, question 5 of Application). $ 3 Enter the amount with the lower monetary value from either Line No. 1 or Line No. 2. $ 4 Enter required Applicant Contribution/Match (either 5%, 10%, 15%, or 20% contribution/match, see Section 3 of Grant Program). $ 5 Subtract Line No. 4 from Line No. 3 and enter amount. $ 6 Enter value of eligible community service hours for contribution/match waiver, if applicable. (See Section 3 of Grant Program for value of service hours). Number of service hours approved by CRA Director: . $ 7 Add Line No. 6 to amount in Line No. 5 and enter amount. $ 8 Enter amount from Line No. 7. This is eligible grant award amount to enter in approval letter: $ 10 PLEASE NOTE: For multiple signers: This Application may be executed in one or more counterparts, each of which when executed and delivered, shall be an original, but all such counterparts shall constitute one and the same instrument. I ACKNOWLEDGE THAT I HAVE RECEIVED AND UNDERSTAND THE GRANT GUIDELINES HEREIN ABOVE STATED. IN ADDITION, BY EXECUTING THIS APPLICATION, I ACKNOWLEDGE THAT I AM LAWFULLY AUTHORIZED TO EXECUTE THIS APPLICATION AND THAT ALL INFORMATION AND STATEMENTS CONTAINED HEREIN AND ON ANY ATTACHEMENTS ARE TRUE, CORRECT, AND COMPLETE. Applicant Signature Printed Name Date STATE OF FLORIDA ) COUNTY OF PINELLAS ) The foregoing instrument was acknowledged before me by means * physical presence or * online notarization, this day of , 2025 by , who * is/are personally known to me or * who has/have produced a driver's license as identification. Notary Public, State of Florida (NOTARIAL SEAL) My Commission Expires: My Commission No.: Name of Notary: Mail or hand deliver completed application form to: Community Redevelopment Agency City of Clearwater / 600 Cleveland Street, Suite 600 / Clearwater, FL 33755 For question call the Community Redevelopment Department at 727-562-4039 11 SECTION 10 — ELIGIBLE CRA AREA MAP NORTH GREENWOOD COMMUNITY REDEVELOPMENT AREA oai .np.ee bY o,....,...r Nam 61.1..6........E 6eaifa61ee TeeMMop 6Eaae1 NEE YpAU lam aeonemem, PL(M)1111471111, flee g27026-4796 mar ploCemerseesteelen 375E North Greenwood CRA Boundary Area not in Clearwater Jurisdiction Map Gen By: KF Reviewed By: ES Aerial Flown 2029 Date: 10120/2023 Page: 1 of 1 s Scale: N.T S. E aPPPP 1poll, CWaPPL.A.PewCRy a1 C►aw.PPW,50,...e fi.[goM4 TcPwelew-Oepoeve tell6teRhealworMd aPel Qtwrb.a CRAVYnriWid wvk ri CRA ape 12