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<br />04-27-20,00 <br /> <br />STATE OF FLORIDA <br />DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY <br />DIVISION OF WORKERS' COMPENSATION <br /> <br />CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION <br />FROM FLORIDA WORKERS' COMPENSATION LAW <br /> <br />This certifies that the individual IIsttad below has elected to be exempt from Florida Workers' <br />Compensation Law. <br /> <br />EFFECTIVE DATE <br /> <br />EXPIRATION DATE <br />EXEMPTED INDIVIDUAL NAME <br /> <br />S.S. <br /> <br />BUSINESS NAME <br /> <br />03/10/2000 <br />03/10/2002 <br />ALEXANDER <br />594-64-3031 <br /> <br />TIMOTHY <br /> <br />B <br /> <br />ALEXANDER BROTHERS FENCING INC <br /> <br />FEIN <br />BUSINESS ADDRESS <br /> <br />593589534 <br /> <br />24928 JOINER CT <br />LUTZ <br /> <br />FL 33549 <br /> <br />NOTE: Pursuant to. Chapter 44O.10(1t,{g),2 F.S., . sole proprietor, partner, or an offlc_ of. <br />corporation who elects ,.-xemption from the Florida Workers' Compensation Law may not recover <br />benefits or compensation under Chapter 440. <br /> <br />PLEASE' CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> <br />STATE OF FLORIDA <br />OEPARTMENT OF LABOR AND EMPLOYMENT SECURITY <br />DIVISION OF WORKERS' COMPENSATION <br /> <br />CONSTRUCTION INDUSTRY CERTIFICATE OF EXEMPTION <br />FROM FLORIDA WORKERS' COMPENSATION LAW <br />EFFECTIVE DATE 03'10/2000 <br />EXPIRATION OATE 03'10/2002 <br />EXEMPTED PERSON LAST NAME ALEXANDER <br />FIRST NAME nMOntY B <br />SOCIAL SECURITY NUMBER 594 64-3031 <br />BUSINESS NAME ALEXANDER BR01lfERS FENCING INt <br /> <br />FEDERAL IDENTIFICATION NUMBER 593689534 <br />BUSINESS ADDRESS 24928 101_ CT <br /> <br /> <br />NOTE: Pursuant to chapter 440.10(1).(91.2. F.S.. a sole <br />proprietor. pa-tner. or officer of a corporlltion who <br />elec:u exem!ltion from the Florida Workers' Compenslltion <br />Law may not recover benefits or compensation under <br />Chapter 440. <br /> <br />H <br />E <br />R <br />E <br /> <br />CUT HERE <br /> <br />* Carry bottom portion on the job, keep upper ponion for your recorda. <br />