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JIMMY PATRONIS <br /> CHIEF FINANICAL OFFICER STATE 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: 3/4/2019 EXPIRATION DATE: 3/3/2021 <br /> PERSON: DAVID CARR EMAIL: CARRCONSTRUCTORS AOL.COM <br /> FEIN: 203645197 <br /> BUSINESS NAME AND ADDRESS: <br /> CARR CONTRACTING SERVICES INC <br /> I <br /> 39334 NORDEL LANE <br /> ZEPHYRHILLS, FL 33542 <br /> SCOPE OF BUSINESS OR TRADE: <br /> I <br /> Contractor-Project Manager, <br /> Construction Executive, <br /> Construction Manager or <br /> Construction Superintendent <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 /> 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 certificate,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 />