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<br /> <br />06-19-2007 <br /> <br />ALEX SINK STATE OF FLORIDA <br />CHIEFFlNANClALOFFICER DEPARTMENT OF FINANCIAL SERVices <br />DIVISION OF WORKERS' COMPENSATION <br />* * CERTIFICATE OF B.ECTION TO BE Exa.r FROM FLORIDA WORKBlS' COMPENSAnON LAW * * <br />CONSTRUCTION INDUSTRY EXEMPTION <br />This certifies that the individual listed below has ejected to be exempt from Florida Workers' Compensation law. <br /> <br />EFFECTIVE DATE: <br /> <br />06/19/2007 <br /> <br />EXPIRA nON DATE: 06/18/2009 <br /> <br />PERSON: SCtLICHTING <br />FEIN: 204010658 <br /> <br />BUSINESS NAME AND ADDRESS: <br />PICTURE PERFECT EXTERIORS a IIDRE LLC <br />777 S PLMER DR #800 <br />WEST PAUl 801 FL 33401 <br /> <br />WAYNE <br /> <br />A <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- CERTIFIED ROOFINB CDN'I'RM:TDR <br /> <br />IMPlIRTAIT: ......... CIllqDr 440 . 115C14J, F.S. .. .ffl__ ., . ClIfJItQIi88 .... el_ ........ .,.. IIIls dIaIIIer ., III... . eerlfficare ., electlu ..... IIIIs <br />seetin .., IIlIt ree..er be...lts Dr e.....IlSDIi.. "er IIIls cllapler. P_ Ie Cllapler 440.05(121. F.S.. Certlfielltes of elect... III be esHPL-. ......, DlI, wltlll. lIIe <br />scope If lIIe Hsi_ er .He Ii.... H ... IDllce at elecll.. ID .e eXllllPL ...... ID CIIIpter 440.05(131. F.5-. IIotlces If electl.. ID be e... .. eertlflceles .1 <br />eleClioa 10 .. .XlIIIpt _II .. _'ed 10 rev~H I', . .., tilee ...... ... '/1111 .. lite IOIlce er lIIe i_e .. III. CIfIlticete. ... P-' -.. H IIIe nIlee Dr <br />eenlflcete .0 I..,er .eelS III. relflllr_ ., IIIls sediell flll' i_e .. . certificet.. TIIe""",- sII.n re.oIl. e eerllficete III ..y U_ 'er f.ller. .. ... pers.. <br />...... H lite certfflelle ID .eet III. no...I....... ., lIIis sedloL <br /> <br />DWC-2S2 CERTIFICATE OF elECTION TO BE EXEMPT REVISED 09-06 <br /> <br />QUESTIONS? (850) 413-1&( <br /> <br />. -.-._.._-- ...- "-- .-.._. .__.____._____ ._,h... .__~___ _ <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETA.'N FOR FUTURE REFERENCE <br /> <br />STATE OF PLORIDA <br />DEPARTMENT oF FINANCW. SERVICES e <br />DIVISION OF WORKERS' COIlIF'ENSATION <br />CD'fS11IJCTION II'GJSTRY <br />CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA . -. <br />WORKERS' COMPENSATION LAW <br /> <br />EFFECTIVE: 08/19/2007 EXPIRATION DATE: 08/18/2008 <br /> <br />PERSON: WAYNE A SCHLIafTING <br /> <br />FEIN: 204010858 <br /> <br />BUSINESS NAME AND ADDRESS: <br />PICTURE PERFECT EXTERIORS 6 MORE LLC <br />777 S FlAGER DR .800 <br />WEST PALM eCH, Fl 3340 1 <br /> <br />F IM~ANT <br />o Pursuant to ChIpter 440;05(14). F.S.. .. officer of 8 corporation who <br />L elects exemption fram this chepter by filing a certifiCllte of election <br />under this section may not recover benefits or compensation under this <br />D chlpter. <br /> <br />H Purs1BIt to ChIpter 440.05(12). F.S.. Certificates of election to be <br />E exempt.... apply only within the scope of the business or 1rade listed on <br />the notice of election to be exempt <br />R <br />E Pursuw toCbapter 440.05(13). F.S.. Notices of electiDn to be exempt <br />IIld certificates of election to be exempt shall be subject to revocation <br />if. at any time after the filing of the notice or the iSSUllJCe of the <br />certifiCllte. the person lllmed an the notice or certifiCllte no longer meets <br />the requirements of this section far isSIBIce Df a certificate. The <br />.department Shall revalte a certificate at any time far failure of the <br />person named on the certifiCllte to meet the requirements of this <br />section. <br /> <br />SCOPE OF BUSINESS OR TRADE: <br />1- CERTIFIED ROOFIIG CONTRACTOR <br /> <br />QIESTIONS? (850) 413-1&09 <br /> <br />CUT tERE <br /> <br />* Carry bottom portion on the job, keep upper portion for VOW' records. <br /> <br />OWC-252 'CERTIFICATE OF ElECTION TO BE EXEMPT REVISED 09-06 <br />