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<br />FROM R&L CLEANING <br /> <br />FAX NO. 813-737-2080 <br /> <br />Mar. 04 2008 06:38PM P2 <br /> <br />-.-. ....-...-.. .....-...--..:-. <br /> <br />TOM GALLAGHER STATE OF FLORIDA <br />CHIEFFlNANCfALOFFICER DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />*.. CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW * * <br />CONSTRUCTION INDUSTRY EXEMPTION <br /> <br />. <br /> <br />01-03-2006 <br /> <br />This certifies that the individual listed below has elected to be exempt from <br />Florida Workers' Compensation Law. <br /> <br />- .,,~ .:~ <br />-:it~~!"~~ ~I <br />~~~~~ ~: i~ ~.a. ~~. <br />* * EXPIRATION DA TE: '2l22l2Dci~ ~ ~.~. !. $' ~. .=-..,;: t'- . <br />-.=-: =-:-: ~ ~ S : ~ i :..~~.-: 4:10 Jr - <br />~;~~~ ~.. ~ :: :"=-!'.~ -- <br />_ . RANDF . ~ = ~~.:~ .~~ _. <br />.......... -;"'" ;" .;':;. ~~~;:; ..lL~ -. - " <br />8tl16~ ~., ~ : ~~. 1_ .~ ~.... <br />":iiiW ... .... -..: "'';='''. ~ ~ ,;;... ~ <br />&:er - ~- .-..- <br />:.. ~&: ~- ~ING LLC <br />1> . 'BOX 2231 <br />SEFFNER FL 33583 <br /> <br />12/22/2005 <br /> <br />EFFECTIVE DATE: <br /> <br />PERSON: <br /> <br />FEIN: <br />......, <br />BUSJ.~$~~ <br />.,,;;, ~. A.'hnRESS:Jt <br />~ '~,"" ~ ~ ~~...z.. ,..- <br />'''''''''~I!' ..... oJ .",._ <br />~ ~t.T1)o- ,~.~I -" <br />I... <br /> <br />PHILLIPS <br /> <br />SCOPE OF BUSINESS 1- PRESSURE WASHING <br />OR TRADE; <br /> <br />IMPORTANT: Pursuant to Chapter 440 . OS(14}r F.S., an officer of a corporation who elects <br />exemption from this Ghapter by fifing a certificate of election under this section may not recover <br />benefits or compensation under this chapter. <br />. QUESTIONS? (850) 413-1609 <br />DWC-252 CERTIFICATE OF ~LECTlON TO BE EXEMPT REVISED 01-04 <br /> <br />" <br />