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<br />08-21-2003 <br /> <br />5T A TE OF FLORIDA <br />DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />CERTIFICA TE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW <br /> <br />CONSTRUCTION INDUSTRY EXEMPTION <br /> <br />This certifies that the individual listed below has elected to be exempt from <br />ROOda Workers' Compensation Law. <br /> <br />EFFECTIVE <br /> <br />05/12/2003 <br /> <br />PERSON <br />SSN <br />FEIN <br /> <br />ALEXANDER <br /> <br />EXPfRA TJON DATE <br /> <br />05/11/2005 <br /> <br />TIMOTHY <br /> <br />B <br /> <br />593589534 <br /> <br />594-64-3031 <br /> <br />BUSINESS <br /> <br />ALE~~~IDER BROTHERS FENCING INC <br />5238 4TH STREET <br />ZEPHYRHILLS FL 33542 <br /> <br />~fi~~r P~fS~~~rJgr~ti~~t;;h:~?ecisO~~eJ.g}ti~i ~ro~ th; ~~~&tw~;~;:~s' partner, or an <br />Compensation Law may not recover benefits or compensation under Chapter 440. <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> <br />j ~AlE FUlRIlA <br />i DEP OF RNANCAl. SiEHVEES <br />OF WORICERS' COIII'BISATIDN <br /> <br />I CONSTRucnoN NlUSTRv <br />I <br />1~~:=,fURlA <br /> <br />I EFfECT1VE: 05I1m813 <br />EXPRAl"K:W: iSi'W2HS <br />PERSON AlfXAIml 1IImlY <br />SSM: 594'"'*-3031 <br />FEIN: mmm <br /> <br />BUSNEss: AlfXAIIB ImIBi .. IE <br />5231 4111 STIR <br />2mmIIIlS R. mu <br /> <br /> <br />F <br />o <br />L <br />o <br /> <br />1IOTE: ?lmant;:o dIiIptw ~.latn.tgj.i. E.S.. <br />a seIe .~, ~,lI' atb at . ~ <br />... eiIcIs aIIIIIIliBI -.. iJIriAI w.ters' t-. ~ <br />Law IRf oot remer ~ iIf:GIIII__ _ Qapr.er <<0. <br /> <br />H <br />E <br />R <br />E <br /> <br />CUT HERE <br /> <br />* Carry bottom portion on the job, keep upper portion for your records. <br />