RC-11-21-3070 Termite 10001 NE 1 AveNew Construction Subterranean Termite OMB Approval No. 2502-0525
(exp. 09/30/2022)
Service Record f�C l l -Z t - 3o-7d
This form is completed by the licensed Pest Control Company
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information its
required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control
number.
Section 24 CFR 200.926d(b)(3) requires that the sites for HUD insured st builder to certify that an authorized Pest Control company performed all required
treatment for termites, and that the builder guarantees the treated area against infestation for one year. Builders, pest control companies, mortgage lenders,
homebuyers, and HUD as a record of treatment for specific homes will use the information collected. The information is not considered confidential, therefore, no
assurance of confidentiality is provided.
This report is submitted for informational purposes to the builder on proposed (new) construction cases when treatment for prevention of subterranean termite
infestation is specified by the builder, architect, or required by the lender, architect, FHA, or VA.
All contracts for services are between the Pest Control company and builder, unless stated otherwise.
Section 1: General Information (Pest Control Company Information)
Company Name: Best Florida Pest Control
Company Address: 2507 nw 16th st road suite 334
City miami
State Florida
Company Business License No. JB280951 Company Phone No. 7863269667
FHA/VA Case No. (if any)
Section 2: Builder Information
Company Name Erik Beuckelaers
Phone No.
Zip 33125
Section 3: Property Information
Location of Structure (s) Treated (Street Address or Legal Description, City, State and Zip) 10001 Northeast 1st Avenue,Miami Shores,FL 33138
Section 4: Service Information
Date(s) of Service(s) 05/07/2022
Type of Construction (More than one box may be checked) ❑ Slab ❑✓ Basement ❑ Crawl ❑ Other
Check all that apply:
❑✓ A. Soil Applied Liquid Termiticide
Brand Name of Termiticide: Taurus 7.9 CS EPA Registration No. 63-8743
Approx. Dilution (%): 0. 125 Approx, Total Gallons Mix Applied: 20 Treatment completed on exterior:
❑ B. Wood Applied Liquid Termiticide
Brand Name of Termiticide: EPA Registration No.
Approx. Dilution (%): Approx. Total Gallons Mix Applied: _
❑ C. Bait system Installed
Name of System EPA Registration No.
❑ D. Physical Barrier System Installed
Name of System
❑ Yes 0 No
Number of Stations installed
Attach installation information (required)
Service Agreement Available? ❑ Yes 0 No
Note: Some state laws require service agreements to be issued. This form does not preempt state law.
Attachments (List)
Comments
Name of Applicator(s) Yorlando Duver er Certification No. (if required by State law) JB280951
The applicator has used a product in accordance with the product label and state requirements. All materials and methods used comply with state and federal
regulations.
Authorized Signature
Date 05/0712022
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010. 1012; 31 U.S.C. 3729,
3802)
form HUD-NPMA-99-B (08/2008)