DocuSign Envelope ID: 260B962D-2E7F-4911-B570-DDCCB1021913 FLORIDA SOLAR ENERGY INDUSTRIES ASSOCIATION 2018-2020 TERM DIRECTOR NOMINATION BIOGRAPHICAL INFORMATION FORM The FlaSEIA Nominating Committee will be meeting in the future to establish the slate of directors for the 2018-2020 term. If you are interested in serving as a FlaSEIA director for the 2018-2020 term, please complete and submit this form, along with a current photo of yourself, to the FlaSEIA office for inclusion on the FlaSEIA 2018 Ballot no later than Monday, July 2. If additional space is required, please feel free to utilize a separate sheet of paper. Name: __________________________________________________________________________Justin Vandenbroeck Member Company: ________________________________________________________________Renergetica USA Corporation Mailing Address: ___________108 Commerce _______________________________________________________St | Suite 105 City, State, Zip: Lake___________________________________________________________________ Mary, Florida 32746 Phone: (____)_____________________________954 658-4531 FAX: (____)__________________________n/a E-mail Address:
[email protected]______________________________________________________ Please list your title with the member company and your responsibilities: _________________________________________________________________________________Vice President of Development. ___________________________________________As a commercial, industrial and utility-scale solar development______________________________________