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r <br /> � �t�� � <br /> o� <br /> � �� � <br /> � - -- <br /> � � <br /> .�c���. <br /> JEFF ATWATER <br /> CHIEF FINANICAL OFFICER �TATE OF FLORIDA <br /> DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS'COMPENSATION <br /> **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW** <br /> CONSTRUCTION INDUSTRY EXEMPTION <br /> This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. <br /> EFFECTIVE DATE: 4/30/2016 EXPIRATION DATE: 4/30/2018 <br /> PERSON: GARCIA HUMBERTO <br /> FEIN: 205475354 <br /> BUSINESS NAME AND ADDRESS: <br /> AIR REPAIR HEATING AND COOLING INC <br /> 7803 SAINT LUKES RD. , <br /> LAND O LAKES FL 34638 I <br /> � <br /> SCOPE OF BUSIMESS OR TRADE: <br /> Heating,Ventilation,Air- <br /> �- Conditioning and Refrigeration <br /> ' Systems Installation,Service <br /> and Repair,Shop,Yard& <br /> Drivers <br /> IMPORTANT Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under <br /> ��i this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply <br /> � only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be <br /> exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certficate,the <br /> person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a <br /> certificate at any time for failure of the person named on the certificate to meet the requirements of this section. <br /> DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 <br /> � <br /> I <br />