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<br />~,,~ <br />ALEX SINK STATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br /> <br />* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * <br />CONSTRUCTION INDUSTRY EXEMPTION <br /> <br /> <br />11-19-2007 <br /> <br />This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> <br />EFFECTIVE DATE: 11/19/2007 <br /> <br />PERSON: CRANDALL <br />FEIN: 030547834 <br /> <br />BUSINESS NAME AND ADDRESS: <br />RICHARD CRANDALL ELECTRIC INC <br />39935 OTIS ALLEN <br />ZEPHYRHILLS FL 33540 <br /> <br />EXPIRATION DATE: 11/18/2009 <br /> <br />RICHARD <br /> <br />p <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- ELECTRICAL CONTRACTOR <br /> <br />IMPORTANT: Parsuant to Chapter 440 . 051141, F.S., an allicer 01 a corporation who elects exemption Irom this chapter by liliag a certillcate 01 election aader this <br />section may not recover benefits or compeasation under this cbapter. Porsuaot to Cbapler 440.051121, F.S., Certificates 01 election to be exempt... apply oaly wilhln the <br />scope 01 the business ar trade listed on the aollce 01 electloa to be exempl. Pursualt to Chapter 440.051131, F.S., Nollc.s 01 .I.ctioa to be ex..pt and certiflcat.s 01 <br />election to be exempt shall be subject to revocation if, at aey time ah.r the filiag af the notice or the isslllnce 01 the certificate, the person aamed aa the Dotice ar <br />certilicate ao longer meets tile requiremeats 01 tills section lor issuance of a certificate. The ..partm.at sball revoke a certificate at aay lime lor failore of the person <br />nam.d on tbe certificate to .e.t tbe reqairements of tIIis sectioa. <br /> <br />o.UESTIONS? (850) 413-150 <br /> <br />DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-05 <br /> <br />. <br /> <br />11-19-2007 <br /> <br />ALEX SINK STATE OF FLORIDA <br />CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br />DIVISION OF WORKERS' COMPENSATION <br />* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA 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: <br /> <br />11/19/2007 <br /> <br />EXPIRATION DATE: 11/18/2009 <br /> <br />PERSON: CRANDALL <br />FEIN: 030547834 <br /> <br />BUSINESS NAME AND ADDRESS: <br />RICHARD CRANDALL ELECTRIC INC <br />39935 OTIS ALLEN RO <br />ZEPHYRHILLS FL 33540 <br /> <br />STEPHEN <br /> <br />H <br /> <br />SCOPES OF BUSINESS OR TRADE: <br />1- REGISTERED ELECTRICAL CONTRACT <br /> <br />IMPORTANT: ParsOlal 10 Chapter 440 . 05(14), F.S., an ollicer 01 a corporatiol wbo eleclS exemption frnm tills chapter by liling a certilicate uf .I.ctioe ....r tIIis <br />section may not recover benelilS or compensation uad~rthiS cbapter. Pursuanl to Cbapler 440.05(12), F.S., Certilicates 01 .Iection to be exempL.. apply ouly wilbia tbe <br />scope of Ibe basiaess or tr"e listed on tile notice lif eleclioe lobe exempt. Pursuanl to Cbapler 440.05\131, F.S., Notices of election 10 be exempt an. certificales of <br />electioa to be exempl shall be sabjecl 10 revocation ii, at ,aay tillle afler tile 11IIIg 01 tile aotice or Ibe issuance 01 tile certificate, Ihe persoa aam.d oa Ibe aolice or <br />certificale DO longer meels Ibe reqoiremenls of Ihls seclion for Issa..ce 01 a certiflcale. The departmenl shall revoke a certificale II any lime for fallare of tile persoo <br />named on Ibe certificale to meet tile r.qoire.eats of tIIis section. - <br />QUESTIONS? (850) 413-150! <br /> <br />n\A.r_?I:? rCDTICU"'^'TC nc CI rrTlnr..l Tn ac CVC'.PT D~lIc:rn nQ-nc::: <br />