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<br />. <br />..; '. <br /> <br /> <br />. ~ <br />.~ <br /> <br />02-01-2007 <br /> <br />ALEX SINK STATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />* * CERnFICATE OF B.ECTION TO BE EXEMPT FROM RORIOA WORkERS' COMPENSATION LAW * * <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: 03/02/2007 <br /> <br />PERSON: KENNEDY <br />FEIN: 592970767 <br /> <br />BUSINESS NAME AND ADDRESS: <br />GUARANTEE ELECTRIC INC <br />101145 FAWN DRIVE <br />NEW PORT RICHEY FL 34B54 <br /> <br />EXPIRATION DATE: 03/01/2009 <br />DAVID F <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- ELECTRICAL CONTRACTOR <br /> <br />IMPDRTANT: PurSUIR! 10 Cblpler 44D . D5(141, F.S., .n alfieer af I earp..llial .ba eleels exellpliaD froll lllis eNpler by fllllg I eeniffelle of eleellan II~er Ibis <br />slellll m.y Dol recover benefits ar eampHslliol uder Ibis eblpll'. P.rs.I.1 10 Chlpler 440.05(121, F.S., Clnllielles of electl.. 10 bo exlmpl... .pply only .lIbl. Ihe <br />seepe .f Iho blslness or Ir.~o Iisld on tae lalice of oleelion 10 bl eXllllpl. Plrsue.1 10 Chlpl., 44ll. 051 I 31, F.S., Noliees of Illctlal 10 bl eXlmpl II~ eeniliellls of <br />eleellon II bl Ixellpl sh.1I be sub jeel Ie revoeetio. if, II I.y lime eller Ibl filin, of ... .etlee or Iho IS_Ice 01 ... eenilieele, 11I1 perna ....d H Ibe .oliee or <br />eertllle.le no lo.ger IIIlels Ibe requlre.onls of Ihls soeliDII for IssuI.ee of I unllieete. TIll ~ep.n.111 shill rev.le I eenllielll II Iny lime for IIU.e 01 Ihe persal <br />nlmed an Ihl eenllie..e la meel Ihe rlquire..lnls af Ihis slelial. <br /> <br />DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br /> <br />QUESTIONS? (850) 413-1609 <br /> <br />PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> <br />STATE OF FLORIDA <br />DEPARTMENT OF FINANCIAL SERVICES <br />DMSfON OF WORKERS' COMPENSATION <br />CONSTRUCTION INJUSTRY <br />CERTfFlCATE OF ELECTION TO BE EXEMPT FROM FLORIDA <br />WORKERS' COMPENSATION LAW <br /> <br />EFFECTIVE: 03/02/2007 EXPIRATION DATE: <br />PERSON: DAVID F KENlIEDY <br />FEIN: 582870787 <br /> <br />BUSINESS NAME AND ADDRESS: <br />GUARANTEE ELECTRIC INC <br />10645 FAWN DRIVE <br />NEW PORT RICHEY. FL 34654 <br /> <br />.,. <br />. <br /> <br />03/01/2009 <br /> <br />SCOPE OF BUSINESS OR TRADE: <br />1 - ELECTRICAL CONTRACTOR <br /> <br />F IMPORTANT <br />o PursUlllt to Chlpter 440.05(14). F.S.. an officer of a corporation who <br />L elects exemption from this chapter by filing a certificate of election <br />under this section may not recover benefits or compensation under this <br />D chapter. <br /> <br />H P..-suant to Chapter 440..05(2). F.S.. Certificates of election to be <br />E exempt.. apply only within the scope of the business or trade listed on <br />the notice of election to be exempt <br />R <br />E Pursuant to Chlpter 440.05(13). F.S.. Notices of election to be exempt <br />and certificlites of election to be exempt shlIIl be subject to revocation <br />if. at any time after the filing ,f the notice or the issuance of the <br />certificate. the person l1IIned on the notice or certificate no longer meets <br />the requirements of this section for issuance of a certificate. The <br />deplrtment shall revoke a certificate at any time for failure of the <br />person named on the certificate to meet the requirements of this <br />section. <br /> <br />QUESTIONS? (850) 413 -1609 <br /> <br />CUT HERE <br /> <br />* Carry bottom portion on the job. keep upper portion for your records. <br /> <br />DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 <br />