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  5. PROVIDENCE ENGRAVING LLC

PROVIDENCE ENGRAVING LLC

Company Details

Entity Name: PROVIDENCE ENGRAVING LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 04 Mar 2013 (12 years ago)
Last Event: LC AMENDMENT AND NAME CHANGE
Event Date Filed: 18 Jul 2013 (12 years ago)
Document Number: L13000033671
FEI/EIN Number 46-2169217
Address: 11 E. Orange St., Tarpon Springs, FL, 34689, US
Mail Address: 11 E. Orange St., Tarpon Springs, FL, 34689, US
ZIP code: 34689
County: Pinellas
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FORUS 401(K) 2023 462169217 2024-10-02 PROVIDENCE ENGRAVING, LLC 39
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC.
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2024-10-02
Name of individual signing JUSTIN RAMIREZ
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2022 462169217 2023-10-02 PROVIDENCE ENGRAVING, LLC 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC.
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2023-10-02
Name of individual signing ALEXANDER JACOBSEN
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2021 462169217 2022-09-22 PROVIDENCE ENGRAVING, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-11-01
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC.
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2022-09-22
Name of individual signing ALEXANDER JACOBSEN
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2020 462169217 2021-09-26 PROVIDENCE ENGRAVING, LLC 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-09-02
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 461803145
Plan administrator’s name FORUSALL, INC.
Plan administrator’s address 809 LAUREL ST., #1328, SAN CARLOS, CA, 94070
Administrator’s telephone number 8444012253

Signature of
Role Plan administrator
Date 2021-09-26
Name of individual signing CINDY BLOCH
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2019 462169217 2020-09-13 PROVIDENCE ENGRAVING, LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-09-02
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2020-09-13
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2018 462169217 2019-07-14 PROVIDENCE ENGRAVING, LLC 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-09-02
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2019-07-14
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2017 462169217 2018-06-24 PROVIDENCE ENGRAVING, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-09-02
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2018-06-24
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature
FORUS 401(K) 2016 462169217 2017-09-14 PROVIDENCE ENGRAVING, LLC 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-09-02
Business code 561900
Sponsor’s telephone number 8137489553
Plan sponsor’s address 2444 MERCHANT AVENUE, SUITE 103, ODESSA, FL, 33556

Plan administrator’s name and address
Administrator’s EIN 464315488
Plan administrator’s name 3(16) FIDUCIARY SOLUTIONS, INC.
Plan administrator’s address 878 W AIRPORT ROAD, MENASHA, WI, 54952
Administrator’s telephone number 9205605698

Signature of
Role Plan administrator
Date 2017-09-14
Name of individual signing CHRISTOPHER DIERINGER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GERBASE JAY GALEN Agent 11 E. Orange St., Tarpon Springs, FL, 34689

Managing Member

Name Role Address
GERBASE JAY GALEN Managing Member 11 E. Orange St., Tarpon Springs, FL, 34689
ISBELL-GERBASE LESLEY MAE Managing Member 11 E. Orange St., Tarpon Springs, FL, 34689

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2017-02-01 11 E. Orange St., Tarpon Springs, FL 34689 No data
CHANGE OF MAILING ADDRESS 2017-02-01 11 E. Orange St., Tarpon Springs, FL 34689 No data
REGISTERED AGENT ADDRESS CHANGED 2017-02-01 11 E. Orange St., Tarpon Springs, FL 34689 No data
LC AMENDMENT AND NAME CHANGE 2013-07-18 PROVIDENCE ENGRAVING LLC No data

Documents

Name Date
ANNUAL REPORT 2025-01-20
ANNUAL REPORT 2024-01-17
ANNUAL REPORT 2023-01-26
ANNUAL REPORT 2022-01-24
ANNUAL REPORT 2021-01-11
ANNUAL REPORT 2020-01-15
ANNUAL REPORT 2019-02-18
ANNUAL REPORT 2018-03-01
ANNUAL REPORT 2017-02-01
ANNUAL REPORT 2016-01-25

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5801087304 2020-04-30 0455 PPP 11 E ORANGE ST,, TARPON SPRINGS, FL, 34689
Loan Status Date 2021-01-13
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 106810
Loan Approval Amount (current) 106810
Undisbursed Amount 0
Franchise Name -
Lender Location ID 2408
Servicing Lender Name Regions Bank
Servicing Lender Address 1900 Fifth Avenue North, BIRMINGHAM, AL, 35203
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description Existing or more than 2 years old
Project Address TARPON SPRINGS, PINELLAS, FL, 34689-0001
Project Congressional District FL-13
Number of Employees 13
NAICS code 326199
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Limited Liability Company(LLC)
Originating Lender ID 2408
Originating Lender Name Regions Bank
Originating Lender Address BIRMINGHAM, AL
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 107409.89
Forgiveness Paid Date 2020-11-27

U.S. Small Business Administration Profile

Status User ID Name of Firm Trade Name UEI Address
Active P2443947 PROVIDENCE ENGRAVING LLC PROVIDENCE ENGRAVING LLC JNLSGAH42V74 11 E ORANGE ST, TARPON SPRINGS, FL, 34689-
Capabilities Statement Link -
Phone Number 813-748-9553
Fax Number -
E-mail Address jay@providenceengraving.com
WWW Page www.providenceengraving.com
E-Commerce Website https://www.providenceengraving.com
Contact Person JAY GERBASE
County Code (3 digit) 103
Congressional District 13
Metropolitan Statistical Area 8280
CAGE Code 8J9B1
Year Established 2013
Accepts Government Credit Card Yes
Legal Structure LLC
Ownership and Self-Certifications Service-Disabled Veteran, Veteran
Business Development Servicing Office SOUTH FLORIDA DISTRICT OFFICE (SBA office code 0455)
Capabilities Narrative (none given)
Special Equipment/Materials (none given)
Business Type Percentages Manufacturing (98 %) Service (2 %)
Keywords name tags, name badges, dog tags, cat tags, pet name tags, desk plates, wall plate, nameplate, signs, ada sign, office signs, employee awards, employee of the month, plaques, recognition, wire tag, electrical tag, identification tag, engraved tag
Quality Assurance Standards (none given)
Electronic Data Interchange capable -

Current Principals
Name Jay G Gerbase
Role PRESIDENT / MANAGING MEMBER
Name Lesley Isbell-Gerbase
Role MANAGING MEMBER

SBA Federal Certifications
HUBZone Certified No
Women Owned Certified No
Women Owned Pending No
Economically Disadvantaged Women Owned Certified No
Economically Disadvantaged Women Owned Pending No
Veteran-Owned Small Business Certified No
Veteran-Owned Small Business Joint Venture No
Service-Disabled Veteran-Owned Small Business Certified No
Service-Disabled Veteran-Owned Small Business Joint Venture No

Bonding Levels
Description Construction Bonding Level (per contract)
Level $0
Description Construction Bonding Level (aggregate)
Level $0
Description Service Bonding Level (per contract)
Level $0
Description Service Bonding Level (aggregate)
Level $0

NAICS Codes with Size Determinations by NAICS
Primary Yes
Code 323111
NAICS Code's Description Commercial Printing (except Screen and Books)
Small Yes
Code 326199
NAICS Code's Description All Other Plastics Product Manufacturing
Small Yes
Code 332999
NAICS Code's Description All Other Miscellaneous Fabricated Metal Product Manufacturing
Small Yes
Code 541430
NAICS Code's Description Graphic Design Services
Small Yes

Export Profile (Trade Mission Online)
Exporter No
Export Business Activities (none given)
Exporting to (none given)
Desired Export Business Relationships (none given)
Description of Export Objective(s) (none given)

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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