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Get DBPR Form HR-5023-060Verification Of Service Maintenance ...

DBPR Form HR-5023-060 Verification of Service Maintenance Contract Page of STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants Bureau of Elevator Safety 1940 North Monroe Street Tallahassee FL 32399-1013 Phone 850. 487. 1395 E-mail dhr. elevators dbpr*state. fl*us Internet www. MyFloridaLicense. com/dbpr/hr Please direct questions about this application to the Department of Business and Professional Regulation s Customer Contact Center at 850. 487. 1395. Information is also available online at www. MyFloridaLicense. com/dbpr/hr/. Section 1 Service Maintenance Company Information Registered Elevator Company REC Name REC License Number City County State 1st Building Building Name Zip Code Annual Verification Cancellation or Expiration Street Address Elevator 2nd Building Section 3 Authorized Signature Pursuant to Section 399. 061 1 Florida Statutes F*S* the undersigned verifies the existence of service maintenance contract s that comply with Section 399. 01 10 F*S* and Section 61C-5. 013 F*A. C. for the specified elevator s. Signature of Authorized Representative Date Signed Please attach additional pages as necessary. Indicate the number of pages at the top of each page. Submit the completed form to the Bureau of Elevator Safety at the e-mail or mailing address listed above. 487. 1395 E-mail dhr. elevators dbpr*state. fl*us Internet www. MyFloridaLicense. com/dbpr/hr Please direct questions about this application to the Department of Business and Professional Regulation s Customer Contact Center at 850. 487. 1395. Information is also available online at www. MyFloridaLicense. com/dbpr/hr/. Section 1 Service Maintenance Company Information Registered Elevator Company REC Name REC License Number City County State 1st Building Building Name Zip Code Annual Verification Cancellation or Expiration Street Address Elevator 2nd Building Section 3 Authorized Signature Pursuant to Section 399. 487. 1395. Information is also available online at www. MyFloridaLicense. com/dbpr/hr/. Section 1 Service Maintenance Company Information Registered Elevator Company REC Name REC License Number City County State 1st Building Building Name Zip Code Annual Verification Cancellation or Expiration Street Address Elevator 2nd Building Section 3 Authorized Signature Pursuant to Section 399. 061 1 Florida Statutes F*S* the undersigned verifies the existence of service maintenance contract s that comply with Section 399. 061 1 Florida Statutes F*S* the undersigned verifies the existence of service maintenance contract s that comply with Section 399. 01 10 F*S* and Section 61C-5. 013 F*A. C. for the specified elevator s. Signature of Authorized Representative Date Signed Please attach additional pages as necessary. 01 10 F*S* and Section 61C-5. 013 F*A. C. for the specified elevator s. Signature of Authorized Representative Date Signed Please attach additional pages as necessary. Indicate the number of pages at the top of each page. Submit the completed form to the Bureau of Elevator Safety at the e-mail or mailing address listed above.

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