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<br /> <br />06"19-2007 <br /> <br />~ <br />AlEX SINK STATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVices <br />DIVISION OF WORKERS' COMPENSATION <br />* * CBlJIflCATE OF aa:r.- m BE EXM'T FROM R.OIIIDA WDRlBIS' co.ENSATION LAW * * <br /> <br />CONSTRUCTION INDUSTRY EXEMPTION <br /> <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> <br />EFFECTIVE DATE: 06/19/2007 <br /> <br />PERSON: SCHLlamNG <br />FEIN: 204010658 <br />BUSINESS NAME AN) ADDRESS: <br />PICTURE PERFEct EXTERIORS & lUtE LLC <br />777 S "USER IJR #800 <br />WEST PAUl IIOf FL 33401 <br /> <br />EXPIRATION DATE: 06/18/2009 <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- CERTIFIED RODFI.. aJN1'UCTDR <br /> <br />WAYNE <br /> <br />A <br /> <br />IMPoRTAIlT: ....... Ie ~r 448 . 85(14), f.5., u...k. of a ~ ... elects -.,do '- lIIls dIIpI... lIy flllll a cldifiClllll at.lectfaa .... tills <br />seetin .IY lOt reca_ buellts Dr c..,..u.. .... lIIis cllepler. ....... .. CIIIpter 448.85(121. f.S.. ter1if1cales of elaeli.. ID lie uapl... IJIPly Hly wllllla tII. <br />SCDpe eI tJIe llHi_ .r lnlIa lillad .. tIItt ....ce of eIecIIo ID lIa .lUIIIPL ....... ID a..a., 448.05(13), f.S.. llellces eI .llICIin ID II. .1l8IIpt HI certificates eI <br />.Iectl.. ID II. ...... ..II lie _jed ID rencetin If, III ny Ii1n eher ... 111111 eI tile IIllIlce Dr ... '-a at ... C8I1ItICllle. ... penn ..u .. tII. aadce Dr <br />cenlflcat. aD In,., _ IIIe r...._ .. litis sectiH I., 1_. eI a cenifiClllll. n. ~ ...." r..eIla . certlflcat. at ..y u_ ler lalllII1I eI ... plIrHlI <br />~ .. ... CMlfflcat. ID ... ... RlpIIrelDeIIts .. tills seelillL <br /> <br />DWC-252 CERTIFICATE OF aeCTION TO BE EXEMPT REVISED 09-06 <br /> <br />QUESTIONS? (850) 413-16( <br /> <br />"--~'--- .... -.- '-._._'~---~-----------.---- ...--......., <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETAAN FOR FUTURE REFERENCE <br /> <br />STATE OF FI.ORIM <br />OEPMTMENToFFWANClALSERVICES e <br />DMSION OFWORKERS' COMPENSATION <br />aJN5TRUCTICIlI IreusTRY <br />CEKTFlCATE OF EL.ECTION TO lie EXEMPT FROM FLORIDA .'. <br />WORI<ERS" COMPENSATION LAW <br />EFFECTIVE 08/18/2007 EXPIRATlCIlI DATE: 08/18/2008 <br />PERSON: WAYNE A SOLlatTING <br />FEIN: 204010858 <br />BUSINESS NAME AlII) ADDRESS: <br />PICTURE PERFECT EXTERIORS a. MORE UC <br />777 S FlAGER OJ! .800 <br />WEST PALM SCH, Fl 33401 <br /> <br />SCOPE OF BUSINESS OR TRADE: <br />1- CERTIFIED ROOFIIIG CClIITRACTOR <br /> <br />IMPORTANT <br /> <br />~ PurSUIRt to ChIpter 4411;05(14), F.$.. III officer of 8 corporation who <br />L elects exemption from 1I1is chapter by filing 8 certifiCllte of election <br />under 1I1is sec:tionmay not recover benefits or clllllJlel$ltion l.I1der this <br />D cluJpter. <br /> <br />H PurSlllllt to Chlpter 440.05(12), F.$., Certificates of election fa be <br />E exempt... /lPP1y only within the scope of the business or trade listed on <br />the IllItice of election to be exempt. <br />R <br />E PID'SVIllt faChlpter 440.05(13), F.$., Notices of election fa be exempt <br />IIId certific:8tes of electian fa be exempt shall be subject fa revocation <br />if, at ..., time after the filing of the notice or 1he iSSUlllCe of 1I1e <br />certifiCllte, 1I1e person IIItlIlld on 1I1e notice or certifiCllte no longer meets <br />the requirements of 1I1is section for iSSl8lCe of a certificate. The <br />.depa1ment SbIII revoke a certificate at ..., time for failure of 1I1e <br />person IIIII1ed on the certifiCllte to meet 1I1e requirements of 1I1is <br />section. <br /> <br />QUESTIONS? (850) 413-1609 <br /> <br />CUT tERE <br /> <br />* Carry bottom portion on the job, keep upper portion for YOW' records. <br /> <br />lJWC-252 'CERTIFICATE OF aeCTION TO BE EXEMPT REVISED 09-06 <br />