Individual Information  | 
  
  
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    | Last Name  | 
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    | First Name  | 
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    | Middle Name  | 
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    | Suffix (Jr, III...)  | 
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    | Title  | 
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      Wyoming  | 
  
  
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    | County  | 
    (Select One) Alachua Baker Bay Bradford Brevard Broward Calhoun
      Charlotte Citrus Clay Collier Columbia De Soto Dixie Duval Escambia Flagler
      Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando
      Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette
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      Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk
      Putnam Saint Johns Saint Lucie Santa Rosa Sarasota Seminole Sumter Suwannee
      Taylor Union Volusia Wakulla Walton Washington * Out of Florida  | 
  
  
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    Ext.  | 
  
  
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    | Web Address  | 
    http://  | 
  
  
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    Business Information: (The following information is only
        required if different from your individual information.)  | 
  
  
    | Business/Firm Name  | 
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    | Email  | 
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    | Fax  | 
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    | Businnes Location Address  | 
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    | City  | 
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    | State  | 
    (Select One) Alabama Alaska Arizona Arkansas California Colorado Connecticut
      Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana
      Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota
      Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New
      Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Outside
      the United States Pennsylvania Rhode Island South Carolina South Dakota
      Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin
      Wyoming  | 
  
  
    | Zip  | 
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    | County  | 
    (Select One) Alachua Baker Bay Bradford Brevard Broward Calhoun
      Charlotte Citrus Clay Collier Columbia De Soto Dixie Duval Escambia Flagler
      Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando
      Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette
      Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe
      Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk
      Putnam Saint Johns Saint Lucie Santa Rosa Sarasota Seminole Sumter Suwannee
      Taylor Union Volusia Wakulla Walton Washington * Out of Florida  | 
  
  
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    Ext.  | 
  
  
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    Subject/Trade Area: (Select as many as apply)  | 
  
  
    
        
          | Accessibility  | 
          Administration  | 
          Building – Commercial  | 
         
        
          | Building – Residential  | 
          Building – Special Occupancy  | 
          Commercial Pool/Spa  | 
         
        
          | Electrical - Commercial  | 
          Electrical - Residential  | 
          Existing Building Code  | 
         
        
          | Fire  | 
          Fuel/Gas  | 
          Mechanical  | 
         
        
          | Other  | 
          Plumbing  | 
          Pollutant Storage System  | 
         
        
          | Residential Pool/Spa  | 
          Roofing  | 
         
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    Accreditor Qualifications: (Select one or more qualifications)  | 
  
  
    Any person with a minimum four year college or graduate degree
      within the field of study in which the Accreditor will be working.  
      Degree:  
      A person who is professionally licensed within the technical field with
      which they will be accrediting and have a minimum of five years experience
      in that field.  
      A substantially qualified authority within their field of relevant expertise.  | 
  
  
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    Supporting Documentation:  | 
  
  
    | Detailed Resume of the Accreditor Michael
        Rimoldi resume (2).pdf  | 
  
  
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    Evaluation Process Flowchart of Processes/Timelines:  | 
  
  
    Describe how you intend to evaluate courses to ensure 100%
      compliance with the most current edition of the Florida Building Code and
      its latest amendments?  
            Course
            evaluation.pdf  | 
  
  
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    Background Information:  | 
  
  
    | Is applicant approved as a provider by any board within DBPR
      to provide continuing education? 
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    | If yes, Board (Select One) Asbestos Board of Architecture
      and Interior Design Board of Landscape Architecture Board of Surveyors
      and Mappers Building Code Administrators and Inspectors Board Construction
      Industry Licensing Board Electrical Contractors Licensing Board  | 
  
    | DBPR Provider Number  | 
  
  
    | Has any license, registration or permit to practice any regulated
      profession, occupation, vocation or business been revoked, annulled, suspended,
      relinquished, surrendered, or withdrawn in Florida or in any other jusrisdiction,
      or is any such proceeding or investigation now pending? 
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    | If yes, please download and complete Form 0060-1 and then   | 
  
  
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    Certification Statements:  | 
  
  
    
        
          | I agree that payment for accreditation services will be rendered
            by the Training Provider requesting services directly to the Accreditor
            offline.  | 
         
        
          | I agree to comply with the Florida Building Commission requirement
            that this course update take no more than 30 days for courses up
            to 8 credit hours, and 45 days for courses in excess of 8 credit
            hours.  | 
         
        
          | I hereby certify that all statements made on this application are
            true and correct. I agree and understand that any misrepresentations
            of material facts will result in revocation of this approval.  | 
         
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