Ne ; cof Fi j ice,’ REPRESENTING ay ALEX SINK ° CHIEF FINANCIAL OFFICER, STATE OF FLORIDA 000569 IN THE MATTER OF: JAX ENTERPRISES, INC. Case Number: 91615-07-WC / FINAL ORDER THIS PROCEEDING came on for final agency action and Alex Sink, Chief Financial Officer of the State of Florida, or her designee, having considered the record in this case, including the Stop-Work Order and Order of Penalty Assessment, Amended Stop-Work Order, and Amended Order of Penalty Assessment served in Division of Workers’ Compensation Case No. 07-157-D1, and being otherwise fully advised in the premises, hereby finds that: 1. On July 5, 2007, the Department of Financial Services, Division of Workers’ Compensation (hereinafter “Department”) issued a Stop-Work Order and Order of Penalty Assessment in Division of Workers’ Compensation Case No. 07-157-D1 to JAX ENTERPRISES, INC. The Stop-Work Order and Order of Penalty Assessment included a Notice of Rights wherein JAX ENTERPRISES, INC. was advised that any request for an administrative proceeding to challenge or contest the Stop-Work Order and Order of Penalty Assessment must be filed within twenty-one (21) days of receipt of the Stop-Work Order and Order of Penalty Assessment in accordance with Sections 120.569 and 120.57, Florida Statutes. 2. On July 5, 2007, the Stop-Work Order and Order of Penalty Assessment was served by personal service on JAX ENTERPRISES, INC. A copy of the Stop-Work Order and Order of Penalty Assessment is attached hereto as “Exhibit A” and incorporated herein by reference. 3. On July 5, 2007, the Department issued an Amended Stop-Work Order in Case No. 07-157-D1 to JAX ENTERPRISES, INC. The Amended Stop-Work Order included a Notice of Rights wherein JAX ENTERPRISES, INC. was advised that any request for an administrative ptoceeding to challenge or contest the Amended Stop-Work Order must be filed within twenty-one (21) days of receipt of the Amended Stop-Work Order in accordance with Sections 120.569 and 120.57, Florida Statutes. 4. On July 5, 2007, the Amended Stop-Work Order was served by personal service on JAX ENTERPRISES, INC. A copy of the Amended Stop-Work Order is attached hereto as “Exhibit B” and incorporated herein by reference. 5. On August 2, 2007, the Department issued an Amended Order of Penalty Assessment in Case No. 07-157-D1 to JAX ENTERPRISES, INC. The Amended Order of Penalty Assessment assessed a total penalty of $652,928.27 against JAX ENTERPRISES, INC. The Amended Order of Penalty Assessment included a Notice of Rights wherein JAX ENTERPRISES, INC. was advised that any request for an administrative proceeding to challenge or contest the Amended Order of Penalty Assessment must be filed within twenty-one (21) days of receipt of the Amended Order of Penalty Assessment in accordance with Sections 120.569 and 120.57, Florida Statutes. 6. On August 4, 2007, the Amended Order of Penalty Assessment was served by certified mail on JAX ENTERPRISES, INC. A copy of the Amended Order of Penalty Assessment is attached hereto as “Exhibit C” and incorporated herein by reference. 7. On August 23, 2007, JAX ENTERPRISES, INC. filed a petition for an administrative hearing with the Department. The Department forwarded the petition to the Division of Administrative Hearings on September 20, 2007, where it was assigned Division of Administrative Hearings Case No. 07-4379. 8. On November 30, 2007, JAX ENTERPRISES, INC. entered into a Settlement Agreement with the Department and subsequently filed a Notice of Voluntary Dismissal With Prejudice with the Division of Administrative Hearings, withdrawing the untitled petition and request for hearing. A copy of the Settlement Agreement is attached hereto as “Exhibit D” and incorporated herein by reference. 9. On December 12, 2007, the Hearing Officer issued an Order Closing File. The Order Closing File relinquished jurisdiction to the Department. A copy of the Order Closing File is attached hereto as “Exhibit E” and incorporated herein by reference. FINDINGS OF FACT 10. The factual allegations contained in the Amended Stop-Work Order issued on July 5, 2007, and the Amended Order of Penalty Assessment issued on August 2, 2007, which are fully incorporated herein by reference, are hereby adopted as the Department’s Findings of Fact in this case. CONCLUSIONS OF LAW 11. Based upon the Findings of Fact adopted herein, the Department concludes that JAX ENTERPRISES, INC. violated the specific statutes and rules alleged in the Amended Stop- Work Order and the Amended Order of Penalty Assessment and hereby adopts the violation(s) charged in the Amended Stop-Work Order and the Amended Order of Penalty Assessment as the Conclusions of Law in this case. PENALTY IMPOSED 12. The dismissal of the petition for hearing submitted in reference to the Amended Stop-Work Order and the Amended Order of Penalty Assessment, taken to gether with the Findings of Fact and Conclusions of Law adopted herein, constitute grounds for the Chief Financial Officer to impose the penalty and order the cessation of business operations as set forth herein. IT IS THEREFORE ORDERED that: a. JAX ENTERPRISES, INC. shall immediately pay the total penalty of $652,928.27 in full to the Department of Financial Services for deposit into the Workers' Compensation Administration Trust Fund; b. JAX ENTERPRISES, INC. shall immediately cease all business operations in the State of Florida until such time as the Department issues an order releasing the Amended Stop- Work Order. The Department shall not issue an Order releasing the Amended Stop-Work Order until JAX ENTERPRISES, INC. has come into compliance with the coverage requirements of Chapter 440, Florida Statutes, and has paid the total penalty of $652,928.27 to the Department. DONE and ORDERED this _@__ day of Leypueel 200. JAMES R. canny f= CHIEF OF STAFF NOTICE OF RIGHTS Any party to these proceedings adversely affected by this Order is entitled to seek review of this Order pursuant to Section 120.68, Florida Statutes, and Rule 9.110, Florida Rules of Appellate Procedure. Review proceedings must be instituted by filing a Notice of Appeal with the General Counsel, acting as the agency clerk, at 612 Larson Building, Tallahassee, Florida 32399-0333, and a copy of the same and filing fee with the appropriate District Court of Appeal within thirty (30) days of rendition of this Order. COPIES FURNISHED TO: SHAWN A. ARNOLD, ESQ. THE ARNOLD LAW FIRM 6279 DUPONT STATION COURT JACKSONVILLE, FLORIDA 32217 ALLAN DIMARIA FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF COMPLIANCE 921 N. DAVIS STREET SUITE B250 JACKSONVILLE, FLORIDA 32209 STATE OF FLORIDA, DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION STOP-WORK ORDER No.: 07-157-D1 ISSUANCE DATE: 7/5/2007 EMPLOYER NAME: JOHN COLLINS, DBA, JAX ENTERPRISES, INC., a Dissolved Florida Corporation and JAX ENTERPRISES, INC. FEIN: 593673737 EMPLOYER ADDRESS: 7042 WILEY ROAD CITY: JACKSONVILLE STATE: FL WORKSITE POSTING ADDRESS: 4990 PHILIPS HIGHWAY CITY: JACKSONVILLE STATE: FL -_ZIP; 32216 INDUSTRY OF EMPLOYER: [fl] Construction (C] Non-construction oO Agriculture STOP-WORK ORDER Pursuant to section 440.107, F.S., the above-referenced Employer is hereby ORDERED TO CEASE ALL BUSINESS OPERATIONS FOR ALL WORKSITES IN THE STATE based on the following violation(s): (1 Failure to secure the payment of workers’ compensation in violation of sections 440.10(1), 440.38(1), and 440.107(2) F.S., by: — ‘ A failing to obtain coverage that meets the requirements of chapter 440, F. S., and the Insurance Code; ZIP: 32210 materially understating or concealing payroll; materially misrepresenting or concealing employee duties so as to avoid proper classification for premium calculations; % ( materially misrepresenting or concealing information pertinent to the computation and application of an experience rating modification factor. Failure to produce required business records within 5 business days in violation of section 440.107(7)(a), F.S. Failure to produce required documents within 3 business days in violation of section 440,05(11), F.S. THIS STOP-WORK ORDER MAY BE AMENDED TO INCLUDE ADDITIONAL VIOLATIONS AND SHALL REMAIN IN EFFECT UNTIL THE DIVISION ISSUES AN ORDER RELEASING THE STOP-WORK ORDER FOR ALL WORKSITES. _IF THE EMPLOYER CONDUCTS ANY BUSINESS OPERATIONS IN VIOLATION OF THIS STOP-WORK ORDER, A PENALTY OF $1,000.00 PER DAY FOR EACH DAY OF VIOLATION SHALL BE ASSESSED. ORDER OF PENALTY ASSESSMENT: A penalty against the Employer is hereby ORDERED in an amount: x) Equal to 1.5 times the amount the employer would have paid in premium when applying approved manual rates to the employer's payroll during periods for which it failed to secure the payment of workers’ compensation required by this chapter within the preceding 3-year period, or $1,000, whichever is greater. Section 440.107(7)(d), F.S. (Up to $5,000 for each employee who the Employer misclassified as an independent contractor. Sections 440.10(1)(f) and 440.107(7)(f), F. S. The ‘penalty may be amended until a Final Order or an Order of Conditional Release from Stop-Work Order is issued. Pursuant to section 440.107(11), F.S., the Department may initiate lien proceedings to collect any penalty due that has not been paid. In addition, the Department may refer any unpaid penalty that is due to a collection agency for the initiation of proceedings to collect the unpaid penalty. CERTIFICATE OF SERVICE Pursuant to section 440.107(4), F.S., ALLEN DIMARIA WG INVESTIGATOR ' pant name and te of ser served a true copy of this Stop-Work Order: [By posting at the Worksite: Date:__Z~5~47, Time:_w#“FAege-; Server: fleas LA ocee [Spy hand delivery: Date: _7-S=a@7_; Time: 220 fac; Server: fillsaa Aare oO By certified mail: Date: ; Time: ; Article: Janay 352008 — Exhibit "A" NOTICE OF RIGHTS You, the Employer, have a right under sections 120.569 and 120.57, F.S., to initiate proceedings by filing a written petition for hearing. : If you dispute a material fact contained in this Amended Order of Penalty Assessment, you are entitled to a hearing urider section 120.57(1), F.S., at which you may be represented by counsel, present evidence and argument on the issue(s), examine witnesses, submit a proposed recommended order, and file exceptions to the recommended order of the : administrative law judge. If you do not dispute a material fact contained in this Amended Order of Penalty Assessment, you are entitled to a hearing under section 120.57(2), F.S., at which you may be represented by counsel, present documentary evidence, and present a written statement in opposition to this Amended Order of Penalty Assessment. A petition for a hearing under section 120.57, F.S. must conform to rules 28-106.201(2) and 28-106.301(2), Florida Administrative Code. The petition shall contain a) the name and address of each agency affected and each agency's file or identification number, if known; b) the name, address, and telephone number of the petitioner; the name, address, and telephone number of the petitioner's representative, if any, and an explanation of how the petitioner's substantial interests will be affected by the agency determination; c) a statement of when and how the petitioner received notice of the agency decision; d) if you dispute a material fact, a statement of all disputed issues of material fact (if there are none, then the petition must so indicate), and if you do not dispute a material fact, a concise statement of ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; e) a concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; f) a statement of the specific rules or statutes the petitioner contends require a reversal or modification of the agency's proposed action; and g) a statement of the relief sought by the petition with respect to the agency's proposed action. 5 You must file a petition for hearing so that it is received by the Division at the address identified below, within twenty-one (21) days of receipt of this Amended Order.of Penalty Assessment. FAILURE TO FILE A PETITION FOR HEARING WITHIN THE TWENTY-ONE (21) DAYS OF RECEIPT OF THIS AMENDED ORDER OF PENALTY ASSESSMENT CONSTITUTES A WAIVER OF YOUR RIGHT TO REQUEST A HEARING. Mediation under section 120.573, F.S., is not available. ISSUING AGENCY NAME AND ADDRESS Division of Workers' Compensation, Bureau of Compliance: 921 N Davis St Ste 250 Jacksonville FL 32209 a , Telephone: (904) 798-5870 Attn: Robert Lambert, Supervsior January 3, 2006 STATE C -...ORIDA, DEPARTMENT OF FINANCIAL —~—VICES utVISION OF WORKERS’ COMPENSATION FEIN COLLINS, OBA, JAX ENTERPRISES, INC., a Dissoived Florida Corporation and JAX ENTERPRISES, INC. ORDER No.: 3 07-157-D1-A 593673737 ISSUANCE DATE: Ne . 7-37-2007 EMPLOYER ADDRESS: 7042 Wiley Road : [GITy; Jacksorvile___ STATE: 2210 WORKSITE POSTING ADDRESS: 4990 Philips Highway CITY: Jacksonville STATE: FL ZIP: 32216 INDUSTRY OF EMPLOYER: [Construction []Non-construction [J Agriculture AMENDED STOP-WORK ORDER The Stop-Work Order issued to the above-referenced employer on 7/5/2007 is hereby amended as follows: 1. The following violations are added based upon Business records received iw Failure to secure the payment of workers’ compensation in violation of sections 440.10(1), 440.107(2), 440.38(1) F.S., y: \ failing to obtain coverage that meets the requirements of Chapter 440, F.S., and the Insurance Code; materially understating or concealing payroll; materially misrepresenting or concealing employee duties so as to avoid proper classification for premium calculations; . . , . oO materially misrepresenting or concealing information pertinent to the computation and application of an experience rating modification factor. : Failure to produce required business records within 5 business days in violation of section 440.107(7)(a), F.S. Conducting business operations in violation of a Stop-Work Order as proscribed in section 440.107(7)(c), F.S. 2. The Stop-Work Order issued to __on is amended to add the legal name of the employer, which is The Stop-Work Order issued on is hereby incorporated by reference. — The Stop-Work Order and this Amended Stop-Work order shall remain in effect until the Division issues an order releasing the Stop-Work Order and Amended Stop-Work Order. Pursuant to section 440.107(11), F.S, the Department may initiate lien proceedings to collect any penalty due that has not been paid. In addition, the Department may refer any unpaid’ penalty that is due to a collection agency for the initiation of proceedings to collect the unpaid penalty. CERTIFICATE OF SERVICE Pursuant to section 440.107(4), F.S., ALLEN DIMARIA WC INVESTIGATOR (print name and ive of servel served a true copy of this Amended Stop-Work Order: Oo By posting at the Worksite: Date: ; Time: ile ; Server: ; [i] By hand delivery: Date: 7/5/2007 : Time: __ Leen. | Server: Allen DiMaria (1 By certified mail: Date: : Time: ; Article: January 3, 2006 Exhibit up — [EMPLOYER NAME: / AMENDED STOP-WORK sf ‘NOTICE OF RIGHTS You, the Employer, have a right under sections 120.569 and 120.57, F.S., to initiate proceedings by filing a written petition for hearing. If you dispute a material fact contained in this Amended Order of Penalty Assessment, you are entitled to a hearing under section 120.57(1), F.S., at which you may be represented by counsel, present evidence and argument on the issue(s), examine witnessés, submit a proposed recommended order, and file exceptions to the recommended order of the administrative law judge. If you do not dispute a material fact contained in this Amended Order of Penalty Assessment, you are entitled to a hearing under section 120.57(2), F.S., at.which you may be represented by counsel, present documentary evidence, and present a written statement in opposition to this Amended Order of Penalty Assessment. A petition for a hearing under section 120.57, F.S. must conform to rules 28-106:201(2) and 28-1 06.301 (2), Florida Administrative Code. The petition shall contain a) the name and address of each agency affected and each agency's file or identification number, if known; b) the name, address, and telephone number of the petitioner; the name, address, and telephone number of the petitioner's representative, if any, and an explanation of how the petitioner's substantial interests will be affected by the agency determination; c) a statement of when and how the petitioner received notice of the agency decision; d) if you dispute a material fact, a statement of all disputed issues of material fact (if there are none, then the petition must so indicate), and if you do not dispute a material fact, a concise statement of ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; e) a concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; f) a statement of the specific rules or statutes the petitioner contends require a reversal or modification of the agency's proposed action; and g) a statement of the relief sought by the petition with respect to the agency's proposed action. You must file a petition for hearing so that it is received by the Division at the address identified below, within twenty-one (21) days of receipt of this Amended Order of Penalty ‘Assessment. FAILURE TO FILE A PETITION FOR HEARING WITHIN THE TWENTY-ONE (21) DAYS OF RECEIPT OF THIS AMENDED ORDER OF PENALTY ASSESSMENT CONSTITUTES A WAIVER OF YOUR RIGHT TO REQUEST A HEARING. , Mediation under section 120.573, F.S., is not available. ISSUING AGENCY NAME AND ADDRESS Division of Workers' Compensation, Bureau of Compliance: 921 N Davis St Ste 8250 Jacksonville FL $2209 ee Attn; Robert Lambert, Supervsior . , Telephone: (904) 798-5870 January 3, 2006 STATE OF »-LORIDA, DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION , EMPLOYER NAME: STOP-WORK ORDER No.: JAX ENTERPRISES, INC. 07-157-DI-A FEIN: 593673737 ISSUANCE DATE: 8/2/2007 EMPLOYER ADDRESS: 7042 WILEY ROAD CITY: JACKSONVILLE STATE: FL ZIP: 322107 AMENDED ORDER OF PENALTY ASSESSMENT The Division of Workers' Compensation issued a Stop-Work Order in this case on 7/5/2007 . The Stop-Work Order included an Order of Penalty Assessment that identified the penalties assessable under sections 440.10 and 440.107, - F.S. The Division hereby amends the Order of Penalty Assessment based on the following penaities: [f] Failure to secure the payment of workers’ compensation within the meaning of section 440.107(2), F.S., by: failing to obtain coverage that meets the requirements of Chapter 440, F.S., and the Insurance Code; materially understating or concealing payroll; . LJ materially misrepresenting or concealing employee duties so as to avoid proper classification for premium calculations; CO materially misrepresenting or concealing information pertinent to the computation and application of an experience rating modification factor. For such violation(s) the Employer is assessed a penalty of $ 652,028.27 (section 440.107(7)(d), F.S.) as detailed in the attached PENALTY WORKSHEET, which is incorporated herein by reference; (1 Conducting business operations in violation of the Stop-Work Order as detailed in the attached PENALTY WORKSHEET, which is incorporated herein by reference, for which the Employer is assessed a penalty of $ (section 440.107(7)(c), F.S.);. C1 Misrepresenting the status of the employee(s} as an independent contractor(s), as detailed on the attached PENALTY WORKSHEET, which is incorporated-herein by reference, for which the Employer is assessed a penalty of $ (section 440.10(1)(f), F.S.,). It is hereby ORDERED that the Employer is assessed a TOTAL PENALTY of $ 652,928.27 The penalties assessed herein supersede any penalties previously assessed in this case. The Employer shail pay the TOTAL PENALTY by money order or cashier's check, made payable to the DFS-Workers’ Compensation ~ Administration Trust Fund. . The Stop-Work Order issued in this case shall remain in effect until either (a) The Division issues an order releasing the Stop-Work Order upon finding that the employer has come into compliance with the coverage requirements of the workers’ compensation law and pays the total penalty in full, or (b) The Division issues an Order of Conditional Release From Stop-Work Order pursuant to the employer coming into compliance with the coverage requirements of the workers’ compensation law and entering into a Payment Agreement Schedule For Periodic Payment of Penalty. Pursuant to section 440.107(11), F.S, the Department may initiate lien proceedings to collect any penalty due that has not been paid. In addition, the Department may refer any unpaid penaity that is due to a collection agency for the initiation of proceedings to collect the unpaid penalty. CERTIFICATE OF SERVICE Pursuant to section 440.107(4), F.S., : Tprnt name anid tie ‘or server) — — —— To served a true copy of this Amended Order of Penalty Assessment: : (1 By hand delivery: Date: ; Time: ; Server: [ml By certified mail: Date: ; Time: ; Article: zose so sw oCeos FLOP 9 eR January 3, 2006 — Exhibit "C" 2.7 | - NOTICE OF RIGHTS You, the Employer, have a right under sections 420.569 and 120.57, F.S., to initiate proceedings by filing a written petition for hearing. If you dispute a material fact contained in this Amended Order of Penalty Assessment, you are entitled to a hearing under section 120.57(1), F.S., at which you may be represented by counsel, present evidence and argument on the issue(s), examine witnesses, submit a proposed recommended order, and file exceptions to the recommended order of the administrative law judge. If you do not dispute a material fact contained in this Amended Order of Penalty Assessment, you are entitled to a hearing under section 120.57(2), F.S., at which you may be represented by counsel, present documentary evidence, and present a written statement in opposition to this Amended Order of Penalty Assessment. A petition for a hearing under section 120.57, F.S. must conform to rules 28-106.201(2) and 28-106.301 (2), Florida Administrative Code. The petition shall contain a) the name and address of each.agency affected and each agency's file or identification number, if known; b) the name, address, and telephone number of the petitioner; the name, address, and | telephone number of the petitioner's representative, if any, and an explanation of how the petitioner's substantial interests will be affected by the agency determination; c) a statement of when and how the petitioner received notice of the agency decision; d) if you dispute a material fact, a statement of all disputed issues of material fact (if there are none, then the petition must so indicate), and if you do not dispute a material fact, a concise statement of ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; e) a concise statement of the ultimate facts alleged, including the specific facts the petitioner contends warrant reversal or modification of the agency's proposed action; f) a statement of the specific rules or statutes the petitioner contends require a reversal or modification of the agency's proposed action; and g) a statement of the relief sought by the petition with respect to the agency's proposed action. \ You must file a petition for hearing so that it is received by the Division at the address identified below, within twenty-one (21) days of receipt of this Amended Order-of Penalty Assessment. FAILURE TO FILE A PETITION FOR HEARING WITHIN THE TWENTY-ONE (21) DAYS.OF\RECEIPT OF THIS AMENDED ORDER OF PENALTY ASSESSMENT CONSTITUTES A WAIVER OF YOUR RIGHT TO REQUEST A HEARING. Mediation under section 120.573, F.S., is not available. ISSUING AGENCY NAME AND ADDRESS Division of Workers' Compensation, Bureau of Compliance: 921 N Davis St Ste 8250 Jacksonville FL 32209 on A Attn: Robert Lambert, Supervsior , Telephone: (904) 798-5870 January 3, 2006 ee EEE (1)(p) OL OPS “0001$ J0 (6) UUINIOD JepuN AyeuUsd $0 1EIE2ID) eee GL Jo sojory Aroynyeys Aq paydainw wnyweid 5, “(M2201 Ob») ‘9° Aq perdninu's'4 (2)Z1 OP's Ul pauyep se eGem Apjsem ebesene apyneyeys auy 6q 0} peyndust ag 1eys jjorAed ‘youked srefojdwa 8yj culLUszep 0} JUsWEdaq OU} ejgqeUe Oo} JUBIOIYINS Sploday SseUISNq apiaoid 0} payey sey seAojdwie ayy gy 9002/ Lee Faraeaem e e | sooz/tevet | soozresvo Le NOSLWM ASG | 2002/10/90 [/ Z002re1/¥0 | - Stava ASTOWa La-ZS1Z20 “ON 8SBD OMG “ONI ‘SASIMdYALNA XVF -AINVN SSANISNG . yooysyiona Ayeusg soueydwioy jo neoing ‘uoeEsuadUIOD ,SIaxAO/A JO UOISIAIG : Sdd]A18g [e;OUeULY Jo yUSLUEd|G ‘eEplO]y Jo a]e4S 730 | e6eq . 200Z/€/8 Ld-ZSLZ0 =*ON 9S8D DMG 240z abeg 740 2 aed (XP)Z61 OFS “0001S J0 (6) uUNJoD JepuN AyeUEd Jo 18}2215) yyy g'1 Jo 1079e3 KioNjeys Aq paydyn WNW yy ‘(OMDZOL-OvP) ‘S°4 Aa paydyinwrs’4 (z)ZLOpp's ul pauyep se eBem Apaam aGesene apynayels 843 9q 0} pandut aq [eys yorAed ‘yoshed siaXojdie ay) suiuueyap 0] jusWedag ay} djqeuUs 0} JUSININS sp10da1 ssaursng epiaoid 0} payey sey sahojdie aus fT x “ONI ‘SASIYdHaLNA XVP = =SINWN ssanisna yooysyiogy Ayeusg Ng ‘UOHESUSdWIO|D ,SIdxYIOM JO UOISIAIG , ; S8DdJA19g |B/UeUI JO JUsUTedaq ‘EplIOj4 JO a}e}S eoueyduioes jo neal LOOZIEIB Pad ite ant.uf Financial Services of Workers’ Compensation ¥¢ Compliance "B" Suite 250 avis Street vile, FL. 32209 John Collins EI : 08/03/2007 if z Mailed From 32209 US POSTAG Jax Enterprises 7042 Wiley Road ce Jacksonville FL 32210 ENDER: COMPLETE THIS SECTION i; @ Complete items 1, 2, and 3. Also compiete | {1 item 4 if Restricted Delivery is\desired. \ @ Print your name and address on the reverse so that we can return the card to:you. lm Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Shy COlVlIns JAX EnTEnpRises (He _ 7092n anlty A | faekseyt tle FL fee FLZZIO 3 2— 1 2. Article Number i 7N0b 2150 0005 526d 4Obe COMPLETE THIS SECTION ON DELIVERY . Received by (Printed Name) Chn ¢ oltidl —) D. Is delivery address different from tte If YES, enter delivery address below: 3, Service Type fied Mail (2) Express Mail C1 Registered (O Return Receipt for Merchandise C1 Insured Mail Oc.0.D. xyes 4. Restricted Delivery? (Extra Fée) ten ene ae! penne natin dosnt te (Transfer from service label) PS Form 3811, February 2004 - we nee ae 4Obe2 Return Recei (Endorsement Aecire, Restricted Deliver (Endorsement Aoairenh PLAGE STICKER AT TOP OF ENVELOPE TO THE RIGHT 7006 2150 o005 san4 City, State, ZB. 4 _ Domestic Return Receipt U.S. Postal Service. CERTIFIED MAIL... (Domestic Mail Only; ie ae seg COL Re. 102595-02-M-1540 + * RECEIPT No Insurance Coverage Pro’ vided) $2.65 LAR $2.15 70062150000552694062 (Green Card) ale Lege 8M. eessssseceeee Return Rept (6 r tified -abel #: “‘uctamar Pactanc “er STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS: JAX ENTERPRISES, INC. Petitioner, vs. DOAH CASE NO. 07-4379 DFS CASE NO. 07-157-D1-A DEPARTMENT OF FINANCIAL SERVICES, DIVISION OF WORKERS’ COMPENSATION, Respondent. SETTLEMENT AGREEMENT This Agreement is made and entered into by and between the Florida Department of Financial Services, Division of Workers’ Compensation (“Department”) and Jax Enterprises, Inc. WHEREAS, the Florida Department of Financial Services, Division of Workers’ Compensation, pursuant to Chapter 440, Florida Statutes, has certain duties and responsibilities with respect to administering Florida’s Workers’ Compensation Law, including enforcing the requirement that employers secure the payment of compensation for their employees under Chapter 440, Florida Statutes; and WHEREAS, Jax Enterprises, Inc. is an employer for purposes of Chapter 440, Florida Statutes, that was on July 5, 2007 issued an Amended Stop-Work Order by the Department for Exhibit "D" -_ failure to secure the payment of compensation for its employees, pursuant to section 440.107(7), Florida Statutes; and WHEREAS, the Department issued to Jax Enterprises, Inc. an Amended Order of Penalty Assessment on August 2, 2007 assessing a penalty in the amount of $652,928.27; and WHEREAS, Jax Enterprises, Inc. filed its petition challenging the Amended Stop-Work Order and Amended Order of Penalty Assessment pursuant to section 120.57(1), Florida Statutes, and the challenge is currently pending at the Division of Administrative Hearings in Case No. 07-4379, scheduled to be heard on December 5, 2007; and WHEREAS, the above parties desire to forego an administrative proceeding regarding the agency action taken by the Department in this matter; NOW THEREFORE, and without conceding the correctness of any position taken by any party to this proceeding, the parties agree to the following: lL. The Amended Stop-Work Order and Amended Order of Penalty Assessment issued to Jax Enterprises, Inc. in Department Case No. 07-157-D1-A remain in full force and effect. | 2.‘ Jax Enterprises, Inc. shall within 3 days of the date of final execution of this settlement agreement by the parties file with the Division of Administrative Hearings in Case No. 07-4379 its notice of voluntarily withdrawal and dismissal, with prejudice, of its petition to challenge the Amended Stop-Work Order and Amended Order of Penalty Assessment in Department Case No. 07-157-D1-A. 3. Subsequent to issuance of an order closing file in Division of Administrative Hearings Case No. 07-4379, the Department shall issue a Final Order in its Case No. 07-157-D1- A requiring immediate payment by Jax Enterprises, Inc. of the $652,928.27 penalty assessed against it and cessation of all business operations in the State of Florida until such time as the Department issues an order releasing the Amended Stop-Work Order upon finding that Jax Enterprises, Inc. has come into compliance with the coverage requirements of Chapter 440, Florida Statutes. 4. Each party hereto agrees that this Settlement Agreement is entered into voluntarily and with full authority of the parties, with the advice of counsel, and with the intent to settle this litigation without the expense of an administrative trial. 5. Each party hereto agrees that it shall bear its own costs and attomeys fees in this matter. Dated this 36" _day of November, 2007. FLORIDA DEPARTMENT OF FINANCIAL JAX ENTERPRISES, INC. SERVICES, DIVISION OF WORKERS’ COMPENSATION /) By: hlasl, HEL. lec By: So Name: ‘s&s Delew. Naive: John & collfns Title: aaiativat bares sel Cou, eel Title__@res themt STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS JAX ENTERPRISES, INC., Petitioner, vs. Case No. 07-4379 DEPARTMENT OF FINANCIAL SERVICES, DIVISION OF WORKERS' COMPENSATION, Respondent. ETO ORDER. CLOSING FILE This cause having come before the undersigned on . Petitioner's Notice of Voluntary Dismissal With Prejudice, and the undersigned being fully advised, it is, therefore, ORDERED that the file of the Division of Administrative Hearings in the above-captioned matter is hereby closed. Jurisdiction is hereby relinquished to the Department of Financial Services. DONE AND ORDERED this 12th day of December, 2007, in Tallahassee, Leon County, Florida. . . Glebe) st BARBARA J. STAROS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway . Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings ‘this 12th day of December, 2007. — Exhibit "E" COPIES FURNISHED: Douglas D. Dolan, Esquire Department of Financial Services Division of Legal Services 200 Bast Gaines Street Tallahassee, Florida 32399 Shawn A. Arnold, Esquire The Arnold Law Firm 6279 Dupont Station Court Jacksonville, Florida 32217 NSMUGM HOIS3S dHOI.S “Stel Hd €1 93020

Docket for Case No: 07-004379